Proposed Revision of Annual Information Return/Reports, 47533-47681 [2016-14893]
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Vol. 81
Thursday,
No. 140
July 21, 2016
Part III
Department of Labor
Employee Benefits Security Administration
29 CFR Parts 2520 and 2590
Department of Treasury
Internal Revenue Service
26 CFR Part 301
Pension Benefit Guaranty Corporation
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29 CFR Part 4065
Proposed Revision of Annual Information Return/Reports; Proposed Rules
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DEPARTMENT OF LABOR
Employee Benefits Security
Administration
29 CFR Parts 2520 and 2590
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 301
PENSION BENEFIT GUARANTY
CORPORATION
29 CFR Part 4065
RIN 1210–AB63
Proposed Revision of Annual
Information Return/Reports
Employee Benefits Security
Administration, Labor, Internal Revenue
Service, Treasury, Pension Benefit
Guaranty Corporation.
ACTION: Notice of proposed forms
revisions.
AGENCY:
This document contains
proposed changes to the Form 5500
Annual Return/Report forms, including
the Form 5500, Annual Return/Report of
Employee Benefit Plan (Form 5500
Annual Return/Report), and the Form
5500–SF, Short Form Annual Return/
Report of Small Employee Benefit Plan
(Form 5500–SF). The annual returns/
reports are filed for employee pension
and welfare benefit plans under the
Employee Retirement Income Security
Act of 1974 (ERISA) and the Internal
Revenue Code (Code). The proposed
revisions in this Notice reflect efforts of
the Department of Labor, the Internal
Revenue Service, and the Pension
Benefit Guaranty Corporation
(collectively Agencies) to improve
employee benefit plan reporting for
filers, the public, and the Agencies by
modernizing financial information filed
regarding plans; updating fee and
expense information on plan service
providers with a focus on harmonizing
annual reporting requirements with the
Department of Labor’s final disclosure
requirements enhancing mineability of
data filed on annual return/reports;
requiring reporting by all group health
plans covered by Title I of ERISA,
including adding a new Schedule J
(Group Health Plan Information); and
improving compliance under ERISA and
the Code through selected new
questions regarding plan operations,
service provider relationships, and
financial management of the plan. These
revisions, which are being proposed in
conjunction with a recompete of the
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SUMMARY:
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ERISA Filing and Acceptance System
(EFAST2) contract, if adopted, generally
would apply for plan years beginning on
or after January 1, 2019. EFAST2 is
expected to begin processing the Plan
Year 2019 Form 5500 Annual Return/
Report beginning January 1, 2020. The
proposed revisions would affect
employee pension and welfare benefit
plans, plan sponsors, administrators,
and service providers to plans subject to
annual reporting requirements under
ERISA and the Code.
DATES: Written comments must be
received by the Department of Labor on
or before October 4, 2016.
ADDRESSES: To facilitate the receipt and
processing of written comment letters
on the proposed regulation, EBSA
encourages interested persons to submit
their comments electronically. You may
submit comments, identified by RIN
1210–AB63, by any of the following
methods:
Federal eRulemaking Portal: https://
www.regulations.gov.
Follow instructions for submitting
comments.
Email: e-ORI@dol.gov. Include RIN
1210–AB63 in the subject line of the
message.
Mail: Office of Regulations and
Interpretations, Employee Benefits
Security Administration, Attn: RIN
1210–AB63; Annual Reporting and
Disclosure, Room N–5655, U.S.
Department of Labor, 200 Constitution
Avenue NW., Washington, DC 20210.
Hand Delivery/Courier: Office of
Regulations and Interpretations,
Employee Benefits Security
Administration, Attn: RIN 1210–AB63;
Annual Reporting and Disclosure, Room
N–5655, U.S. Department of Labor, 200
Constitution Avenue NW., Washington,
DC 20210.
Instructions: All comments received
must include the agency name and
Regulatory Identifier Number (RIN) for
this rulemaking (RIN 1210–AB63).
Persons submitting comments
electronically are encouraged not to
submit paper copies. All comments
received will be made available to the
public, posted without change to https://
www.regulations.gov and https://
www.dol.gov/ebsa, and made available
for public inspection at the Public
Disclosure Room, N–1513, Employee
Benefits Security Administration, U.S.
Department of Labor, 200 Constitution
Avenue NW., Washington, DC 20210,
including any personal information
provided.
FOR FURTHER INFORMATION CONTACT:
Mara S. Blumenthal, Employee Benefits
Security Administration (EBSA), U.S.
Department of Labor, (202) 693–8523,
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for questions relating to changes to the
Form 5500, Form 5500–SF, Schedules
A, C, D, G, and H, as well as the general
reporting requirements under Title I of
ERISA; Suzanne Bach, EBSA, U.S.
Department of Labor, 202–693–8440, for
questions relating to the collection of
group health plan information; Leslie
Larson, Internal Revenue Service (IRS),
at the IRS taxpayer assistance answering
service at 1–877–829–5500 (a toll-free
number), for questions relating to
Schedule R, Schedule E, as well as the
general reporting requirements under
Internal Revenue Code (Code); Steven
Klubock, IRS, at 1–877–829–5500, for
IRS questions relating to the Schedules
MB and SB; and Grace Kraemer or
Theresa Anderson, Pension Benefit
Guaranty Corporation (PBGC), (202)
326–4000 for questions relating to
Schedules MB and SB of the Form 5500,
and Lines 14 and 19 of Schedule R, as
well as questions relating to the general
reporting requirements under Title IV of
ERISA. For further information on an
item not mentioned above, contact Ms.
Blumenthal. The telephone numbers
referenced above are not toll-free
numbers, except as otherwise provided.
Customer service information:
Individuals interested in obtaining
information from the DOL concerning
Title I of ERISA may call the EBSA TollFree Hotline at 1–866–444–EBSA (3272)
or visit the DOL’s Web site
(www.dol.gov/ebsa).
SUPPLEMENTARY INFORMATION:
Sections 101 and 104 of Title I and
section 4065 of Title IV of the Employee
Retirement Income Security Act of 1974
(ERISA) and sections 6057(b), 6058(a),
and 6059(a) of the Internal Revenue
Code of 1986 (Code), and related
regulations, impose annual reporting
and filing obligations on pension and
welfare benefit plans, as well as on
certain other entities. Plan
administrators, employers, and others
generally satisfy these annual reporting
obligations by filing the Form 5500,
Annual Return/Report of Employee
Benefit Plan together with any required
schedules and attachments (Form 5500
Annual Return/Report), or Form 5500–
SF, Short Form Annual Return/Report
of Small Employee Benefit Plan (Form
5500–SF).1 Specifically, filing of the
1 Certain one-participant plans and foreign plans
that are not subject to the requirements of section
104(a) of ERISA are required to file Form 5500–EZ
with the IRS on paper, or voluntarily file
electronically using Form 5500–SF to satisfy certain
annual reporting and filing obligations imposed by
the Code. Beginning with the 2015 plan year,
however, some filers are required to file their
annual returns electronically using Form 5500–SF
instead of filing a paper Form 5500–EZ if the filer
is required to file at least 250 returns of any type
with the IRS. See Treasury Regulations section
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Form 5500 or, for eligible filers the
Form 5500–SF, with any required
schedules and attachments in
accordance with the instructions and
related regulations, constitutes
compliance under Title I of ERISA with
the applicable limited exemption,
alternative method of compliance, and
simplified reporting prescribed in 29
CFR 2520.103–1, et seq. Such filings
will also satisfy an applicable plan
administrator’s annual reporting
obligation under section 4065 of Title IV
of ERISA. Filing of a Form 5500 or Form
5500–SF, together with the required
attachments and schedules in
accordance with the instructions, by
plan administrators, employers, and
certain other entities also satisfies the
annual filing and reporting
requirements under Code sections
6057(b), 6058(a) and 6059(a).2
The Form 5500 Annual Return/Report
serves as the principal source of
information and data available to the
DOL, the IRS, and the PBGC
(collectively the Agencies) concerning
the operations, funding, and
investments of approximately 806,000
pension and welfare benefit plans.
These plans cover roughly 143 million
workers, retirees, and dependents of
private sector pension and welfare
plans 3 with estimated assets of $8.7
trillion.4 Accordingly, the Form 5500
Annual Return/Report is essential to
each Agency’s enforcement, research,
and policy formulation programs. They
are also an important source of
information and data for use by other
federal agencies, Congress, and the
private sector in assessing employee
benefit, tax, and economic trends and
policies. The Form 5500 Annual Return/
Report also serves as the primary means
by which the operations of plans can be
301.6058–2 for more information on mandatory
electronic filing of employee retirement benefit plan
returns.
2 Some filing requirements under these provisions
are not within the scope of this Notice. For
example, multiple employer welfare arrangements
and certain entities claiming exception are required
to file with the DOL the Form M–1 (Report for
Multiple Employer Welfare Arrangements (MEWAs)
and Certain Entities Claiming Exception (ECEs)).
3 Source: U.S. Department of Labor, EBSA
calculations using the March 2014 Current
Population Survey Annual Social and Economic
Supplement and the 2013 Medical Expenditure
Panel Survey.
4 EBSA projected ERISA covered pension,
welfare, and total assets based on the 2013 Form
5500 Annual Return/Report filings with the U.S.
Department of Labor (DOL), reported SIMPLE assets
from the Investment Company Institute (ICI) Report:
The U.S. Retirement Market, Second Quarter 2015,
and the Federal Reserve Statistical Release Z.1
Financial Accounts of the United States (Sept. 18,
2015).
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monitored by plan participants and
beneficiaries and by the general public.
Generally, the Agencies have
conducted a notice and comment
rulemaking initiative to implement
significant overhauls of the structure of
the forms and schedules coincident
with changes to the EFAST system. Past
revisions to the forms and schedules
have addressed changes to applicable
law, changes in employee benefit plans
and financial markets, and
corresponding shifts in agency priorities
and needs. The Agencies have also
made changes to reduce costs and make
filing and processing more efficient. In
interim years, the Agencies have made
other discrete changes as set forth
annually in the ‘‘Changes to Note’’
section in the instructions, some of
which have involved targeted
rulemaking activity to implement
reporting changes required by law.5 The
Agencies’ last major tri-agency revision
to the Form 5500 Annual Return/Report
was proposed in 2006, 71 FR 41615 (Jul.
21, 2006), and finalized in 2007,
effective for the 2009 form series. 72 FR
64731 (Nov. 16, 2007).
This forms revision proposal
generally is being coordinated with a
recompete of the contract for the ERISA
Filing Acceptance System II (EFAST2)—
the wholly electronic system operated
by a private-sector contractor for the
processing of Form 5500 Annual
Return/Report. The majority of
proposed forms revisions are currently
targeted for implementation in the Plan
Year 2019 Form 5500 Annual Return/
Report. Development of EFAST changes
pursuant to a new contract could begin
in spring 2018, with processing under
the new contract starting on January 1,
2020. However, this planned
implementation timeline may be
impacted if there are modifications to
the recompete contract acquisition plan.
As a result, some forms revisions may
be implemented in earlier or later form
years, including but not limited to the
IRS and PBGC changes for 2016 as
shown in the proposed data elements in
Appendix A. To the extent changes are
made separately from a more general
implementation of the proposed
revisions, the Agencies will seek
appropriate clearance under the
Paperwork Reduction Act of 1995 (PRA)
to implement the changes in connection
with any given year’s forms.
The Agencies expect that the EFAST2
recompete would continue to deliver a
e.g., Revisions to Annual Return/Report—
Multiple-Employer Plans, Interim Final Rule, 79 FR
66617 (Nov. 10, 2014); Filings Required of Multiple
Employer Welfare Arrangements and Certain Other
Related Entities, Final Rule, 78 FR 13781 (Mar. 1,
2013).
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user-friendly Web site, filing
applications and web services, and
contact center services similar to what
is currently being provided. The
existing EFAST2 web-based filing
search application is expected to be
enhanced and provided by EBSA. The
Agencies expect that EFAST2 would
continue to have the same or improved
functionality and web services and is
expected primarily to rely on existing
EFAST2 software, components and
logic. EFAST2 would continue to
include a user-friendly web portal that
provides registration, filing submission,
filing acceptance, filing data
dissemination, and help desk services.
As part of the comprehensive review
of how well the Form 5500 Annual
Return/Report serves to implement the
existing employee benefit plan filing
requirements under Titles I and IV of
ERISA and under the Code, the
Agencies have considered intervening
changes to the legal and regulatory
environment for employee benefit plans,
plan sponsors, plan service providers
and others since the last major revision
of the Form 5500 Annual Return/Report.
This includes implementation of the
Dodd-Frank Wall Street Reform and
Consumer Protection Act, Public Law
111–203, 124 Stat. 1376, (Jul. 21, 2010);
statutory changes to ERISA and the
Code relating to defined benefit pension
plans in the Moving Ahead for Progress
in the 21st Century Act (MAP 21) (Pub.
L. 112–141); the Cooperative and Small
Employer Charity Pension Flexibility
Act (CSEC Act) (Pub. L. 113–98); the
Highway and Transportation Funding
Act (HATFA) (Pub. L. 113–159); the
Multiemployer Pension Reform Act of
2014, Division O of the Consolidated
and Further Continuing Appropriations
Act, 2015, (Pub. L. 113–235) (MPRA),
and various regulatory actions adopted
by the Agencies since the last major
changes to the forms and instructions,
including the DOL’s final regulations at
29 CFR 2550.404a–5, 404c–5, and 408b–
2.
In addition, the enactment of the
Patient Protection and Affordable Care
Act (Affordable Care Act) 6 expanded
DOL’s already growing oversight
responsibilities with respect to the
provision of group health benefits to
workers in private sector employersponsored plans that provide group
health benefits (also referred to herein
as ‘‘group health plans’’). In that regard,
6 The Patient Protection and Affordable Care Act,
Public Law 111–148, was enacted on March 23,
2010, and the Health Care and Education
Reconciliation Act of 2010, Public Law 111–152,
was enacted on March 30, 2010. These statutes
generally are collectively known as the ‘‘Affordable
Care Act.’’
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the DOL has re-evaluated the existing
reporting scheme for group health plans,
which scheme was established well
before the enactment of the Health
Insurance Portability and
Accountability Act of 1996, Public Law
104–191, 110 Stat. 1936 (Aug. 21, 1996);
Title I of the Genetic Information
Nondiscrimination Act of 2008, Public
Law 110–233, 122 Stat. 881 (May 21,
2008); the Mental Health Parity Act of
1996, Public Law 104–204, 110 Stat.
2944 (Sept. 26, 1996) and the Mental
Health Parity and Addiction Equity Act
of 2008, Public Law 110–343, 122 Stat.
3881 (Oct. 3, 2008); the Newborns’ and
Mothers’ Health Protection Act of 1996,
Public Law 104–204, 110 Stat. 2935
(Sept. 26, 1996); the Women’s Health
and Cancer Rights Act of 1998, Public
Law 105–277, 112 Stat. 2681–436 (Oct.
21, 1998); and Michelle’s Law, Public
Law 110–381, 122 Stat. 4081 (Oct. 9,
2008), as well as the Affordable Care
Act.
After reviewing the existing reporting
scheme and the DOL’s experience with
oversight and enforcement, the DOL
determined that, in order for it to more
effectively fulfill its responsibilities
under the expanded requirements under
these laws, all plans that provide group
health benefits should be subject to
some level of annual reporting, with a
focus on compliance issues. As
described in more detail below, under
the proposal, those plans that provide
group health benefits that are already
required to file a Form 5500 Annual
Return/Report—generally all large plans
and small plans that are funded with a
trust or that are otherwise not eligible
for the annual reporting relief for
unfunded and insured plans—would
have to file group health plan
information on a new separate schedule
(Schedule J (Group Health Plan
Information)), as well as complete those
elements of the Form 5500 and
schedules that those plans are already
required to complete, as modified by
this proposal. Plans that provide group
health benefits that have fewer than 100
participants currently exempt from
filing an annual report under 29 CFR
2520.104–20 because they are either
completely ‘‘unfunded’’ or partially
insured and partially unfunded now
would be required to file a Form 5500
(except for those questions applicable
only to pension plans) and the new
Schedule J. Under the proposal, plans
that provide group health benefits that
have fewer than 100 participants that
currently are exempt from annual
reporting under 29 CFR 2520.104–20
because they are fully insured would be
required to file with answers to certain
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questions on the Form 5500 and the
Schedule J.
Certain information collection
requirements imposed under the Code,
but not required under ERISA, had to be
removed from the Form 5500 Annual
Return/Report when DOL implemented
its EFAST2 electronic filing requirement
beginning with the 2009 Form 5500
Annual Return/Report. The Code did
not permit the IRS to mandate electronic
filing of ‘‘IRS-only’’ components of the
Form 5500 Annual Return/Report with
respect to filers of fewer than 250
returns, and regulations did not
mandate such electronic filing with
respect to any filers. Specifically,
Schedules E, P, SSA, and T were not
included in the 2009 Form 5500 Annual
Return/Report. Some of those
information collection requirements can
now be added back to the Form 5500
Annual Return/Report. On September
29, 2014, the Treasury Department
issued final regulations under Code
sections 6058 and 6059 mandating
electronic filing of the Form 5500
Annual Return/Report (including
actuarial schedules) for certain filers.
T.D. 9695, 79 FR 58256 (Sept. 29, 2014).
In general, 26 CFR 301.6058–2 provides
that, in order to satisfy the filing
requirements of Code section 6058, a
Form 5500 Annual Return/Report must
be filed electronically if the filer is
required to file at least 250 returns of
any type during the calendar year that
includes the first day of the applicable
plan year. Similarly, 26 CFR 301.6059–
2 provides in general that, in order to
satisfy the filing requirements of Code
section 6059, actuarial reports filed with
a Form 5500 Annual Return/Report
must be filed electronically by filers
required to file at least 250 returns
during that calendar year. The
regulations are generally effective for
plan years beginning on or after January
1, 2015, but only for filings with a filing
deadline (not taking into account filing
extensions) after December 31, 2015.
Finally, the Agencies took into
account recommendations in reports
from the Government Accountability
Office (GAO), the DOL’s Office of
Inspector General (DOL–OIG), the
United States Treasury Inspector
General for Tax Administration
(TIGTA), and the ERISA Advisory
Council that have been issued since the
last major revision of the Form 5500
Annual Return/Report information
collection requirements in connection
with the 2009 return/report. See, e.g.,
U.S. Gov’t Accountability Office, GAO–
10–54, Private Pensions: Additional
Changes Could Improve Employee
Benefit Plan Financial Reporting (2009)
(available at www.gao.gov/assets/300/
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298052.pdf); U.S. Gov’t Accountability
Office, GAO–14–441, Private Pensions:
Targeted Revisions Could Improve
Usefulness of Form 5500 Information
(2014) (available at www.gao.gov/
products/GAO-14-441); 2013 ERISA
Advisory Council Report: Private Sector
Pension De-risking and Participant
Protections, Dep’t of Labor, (available at
www.dol.gov/ebsa/publications/
2013ACreport2.html); Dep’t of Labor
Office Of Inspector Gen., 05–14–003–12–
12, EBSA Could Improve Its Usage of
Form 5500 Data (2014) (available at
www.oig.dol.gov/public/reports/oa/
2014/05-14-003-12-121.pdf); U.S. Gov’t
Accountability Office, GAO–14–92,
Private Pensions: Clarity of Required
Reports and Disclosures Could Be
Improved (2013) (available at
www.gao.gov/assets/660/659211.pdf);
U.S. Gov’t Accountability Office, GAO–
14–92, Private Pensions: Clarity Of
Required Reports And Disclosures
Could Be Improved, Report to
Congressional Requesters (2013)
(available at www.gao.gov/assets/660/
659211.pdf); U.S. Dep’t of Labor Office
of Inspector Gen., 09–13–001–12–121,
Employee Benefits Security
Administration Needs to Provide
Additional Guidance And Oversight to
ERISA Plans Holding Hard-to-Value
Alternative Investments (2013)
(available at www.oig.dol.gov/public/
reports/oa/2013/09-13-001-12-121.pdf);
U.S. Gov’t Accountability Office, GAO–
12–665, Private Sector Pensions: Federal
Agencies Should Collect Data and
Coordinate Oversight of Multipleemployer Plans (2012) (available at
www.gao.gov/assets/650/648285.pdf);
U.S. Dep’t of Labor Office Of Inspector
Gen., 09–12–002–12–121, Changes Are
Still Needed In The ERISA Audit
Process To Increase Protections For
Employee Benefit Plan Participants
(2012) (available at www.oig.dol.gov/
public/reports/oa/2012/09-12-002-12121.pdf); U.S. Gov’t Accountability
Office, GAO–12–325, 401(K) Plans:
Increased Educational Outreach and
Broader Oversight May Help Reduce
Plan Fees (2012) (available at
www.gao.gov/products/GAO-12-325);
U.S. Gov’t Accountability Office, GAO–
08–692, Defined Benefit Plans:
Guidance Needed to Better Inform Plans
of the Challenges and Risks of Investing
in Hedge Funds and Private Equity
(2012) (available at www.gao.gov/
products/GAO-08-692); Treasury
Inspector Gen. for Tax Administration,
The Employee Plans Function Should
Continue Its Efforts to Obtain Needed
Retirement Plan Information (2011)
(available at www.treasury.gov/tigta/
auditreports/2011reports/
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201110108fr.pdf); 2011 ERISA Advisory
Council Report: Hedge Funds and
Private Equity Investments, Dep’t of
Labor, (available at www.dol.gov/ebsa/
publications/2011ACreport3.html); 2013
ERISA Advisory Council Report:
Locating Missing and Lost Participants,
Dep’t of Labor, (available at
www.dol.gov/ebsa/publications/
2013ACreport3.html#2); 2010 ERISA
Advisory Council Report: Employee
Benefit Plan Auditing and Financial
Reporting Models, Dep’t of Labor,
(available at www.dol.gov/ebsa/
publications/2010ACreport2.html); 2008
ERISA Advisory Council Report:
Working Group on Hard-to-Value Assets
and Target Date Funds, Dep’t of Labor,
(available at www.dol.gov/ebsa/
publications/2008ACreport1.html.)
The DOL also is publishing elsewhere
in today’s Federal Register a Notice of
Proposed Rulemaking with proposed
amendments to the annual reporting
regulations at Part 2520 of Chapter XXV
of Title 29 of the Code of Federal
Regulations to implement certain
proposed Form 5500 Annual Return/
Report changes under Title I of ERISA.
To avoid unnecessary duplication of
effort, public comments submitted in
response to this Notice of Proposed
Forms Revisions will be treated as
public comments on the Notice of
Proposed Rulemaking to the extent they
include information relevant to the
proposed regulatory amendments.
Although the Agencies’ historical
practice of undertaking major updates of
the Form 5500 Annual Return/Report
generally has coincided with the move
to and upgrades of the EFAST
processing system, the Agencies also
engage in an annual update process of
the forms, schedules, and instructions.
Some annual changes that are
anticipated to be implemented by the
IRS and the PBGC in connection with
the 2016 plan year forms are discussed
below. Those changes and other annual
updates have involved, or may in the
future involve, separate public notice
and comment processes, for example,
under the Paperwork Reduction Act
(PRA). The Agencies intend that any
annual update changes adopted during
the pendency of the changes proposed
in this Notice will be incorporated into
what is published as part of the Notice
of Final Forms Revisions as part of this
process.7
7 Minor changes not requiring notice and
comment rulemaking or system changes or changes
required by enactment of new laws may also be
made between the publication of the Notice of Final
Forms Revisions and the date when the revised
forms, schedules, and instructions are available for
e-filing through EFAST2.
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As with previous major forms
revisions cycles, the Agencies anticipate
actively engaging in outreach and
education regarding the forms revisions
well in advance of the plan year for
which the majority of the revisions
would be effective.
II. Appendices
A. Data Elements for Forms and
Schedules
Appendix A shows the questions/data
elements that are on each form and
schedule in the line-by-line sequence
the items would appear on that form
and schedule, as well as newly
‘‘structured’’ attachments, rather than
showing mock-ups of ‘‘final’’ forms,
schedules, and structured attachments.
The Agencies expect that the final forms
and schedules will have substantially
the same format as the existing forms
and schedules.8 The lists of data
elements for each individual form,
schedule, and ‘‘structured’’ attachment
to the Schedule H, show all of the
questions that would appear on that
form, schedule, or attachment—current
questions, renumbered questions,
revised questions, and new questions.
The data elements are numbered in the
sequence that the Agencies would
expect to use in the final version of the
forms and schedules. Next to the data
elements, the Agencies have, to the
extent feasible, indicated in brackets:
(1) ‘‘[Current]’’ if it is the same
question with the same line number on
both the proposal and the current form
or schedule; 9 ‘‘[Current (2016)]’’
indicates IRS changes and/or PBGC
changes that would first be made part of
the forms and schedules for the 2016
form year, respectively.
(2) ‘‘[Current Line X]’’ if the item is
already on the form or schedule, but is
renumbered in the proposal, to show
where the item appears on the current
form or schedule;
(3) ‘‘[Current with revisions]’’ to
indicate, with a short explanation, that
8 The Agencies intend to publish mock-ups of the
forms on the DOL’s Web site as part of the third
party software developer certification process and
in furtherance of public education efforts about the
changes to be implemented.
9 The Agencies used the 2015 forms, schedules,
and instructions as the ‘‘current’’ form version.
With respect to IRS-only changes, the changes for
2016 that appear in the notice published by the IRS
under the PRA, 81 FR 18687 (Mar. 31, 2016), are
used in the proposed data elements and
instructions and are so labeled, instead of showing
the changes in the information collection under the
Code that appear on the 2015 Form 5500 series,
which the IRS has directed filers not to answer. See
IRS Compliance Questions on the 2015 Form 5500
Series Returns (https://www.irs.gov/RetirementPlans/IRS-Compliance-Questions-on-the-2015Form-5500-Series-Returns).
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the item is already on the form or
schedule, but would be revised; and
(4) ‘‘[New]’’ if the item is a new
question or new to that form or
schedule.
Dates generally are shown in the data
element sheets (as well as the
instructions) as ‘‘20XX’’ for the Form
filing year; ‘‘20XX–1’’ for the prior year,
etc.
The Agencies believe this approach of
showing the intended changes to the
wording of the data elements, but not
providing a ‘‘mock up’’ of the forms and
schedules, will reduce costs associated
with publication of the proposed form
changes in the Federal Register and
provide greater flexibility for the related
EFAST2 development processes. The
Agencies also believe that this approach
(i.e., taking the questions out of the
disclosable form structure), gives a
better opportunity to review the format,
sequencing, and grouping of how the
information would be asked and entered
on each of the forms and schedules and
how it ultimately could potentially be
better presented for disclosure purposes.
The Agencies seek comments on
whether reordering or regrouping
questions on the Form 5500 and
schedules could enhance presentation
of the information for disclosure
purposes or minimize burden from a
data-gathering, data-entry,
recordkeeping, or other perspective, as
well as suggestions on the structure or
appearance of the forms as both on-line
and printed documents.
B. Proposed Instructions for Form 5500
Annual Return/Report
Appendix B to this document shows
the proposed instructions for the Form
5500 and its schedules. The proposed
instructions include possible additional
instructions and definitions for existing
line items, as well as instructions for
new items, and the proposed
instructions reflect the elimination of
current instructions for existing line
items or schedules that would be
deleted under the proposal. The
Agencies expect that the revised
instructions for the year in which the
majority of the proposed forms changes
are implemented, which will be
generally coincident with the
contracting and procurement process for
EFAST2, will also reflect changes in
intervening years, changes to law, and
any needed additional clarifications and
interpretations to the instructions for
existing and proposed line items, as
well as changes made in response to
comments on the proposal. For ease of
use by the different types of filers and
to eliminate the need for the footnotes
and exceptions in the current single
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‘‘Quick Reference Chart,’’ the Agencies
propose separate charts for the various
types of filers (pension plans, direct
filing entities (DFEs), group health
plans, and welfare plans other than
group health plans). These charts appear
at the end of Appendix B (Form 5500
Annual Return/Report Instructions).
The Agencies believe this proposed
change should help filers focus on the
specific requirements applicable to the
type of plan or entity for which the
Form 5500 Annual Return/Report is
being filed.
OMB Control Numbers, PRA Notice,
and up to date Business Codes are not
shown here, but will continue to be
included in both the Form 5500 Annual
Return/Report and Form 5500–SF
instructions published on the EFAST2
Web site for the form year(s) in which
the changes are implemented.
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C. Proposed Instructions for Form 5500–
SF
Appendix C to this document shows
the proposed instructions for the Form
5500–SF.
III. Request for Comments
The Agencies believe that the
modernization and restructuring of the
Form 5500 Annual Return/Report being
proposed in this Notice would support
the Agencies’ ability to implement
strong and effective enforcement
programs and better respond to
inquiries from plan participants and
beneficiaries, employers, other plan
sponsors, and the public regarding
employee benefit plans. Further, the
Agencies believe that the proposed
revisions would help them more
effectively develop and implement
regulations and other compliance
assistance guidance, and use data for
purposes of economic research, policy
formulation, and monitoring benefits
related developments and activities
among ERISA-covered employee benefit
plans.
The Agencies generally invite
comments and suggestions as to other
alternative solutions and whether and
how such alternatives would be more,
or less, beneficial compared to the
proposed changes to the forms,
schedules, and instructions.
Commenters are asked to take into
account the costs and burdens to plans,
participants and beneficiaries, plan
fiduciaries, plan service providers, and
other affected parties, in commenting on
the proposed annual reporting changes,
including any suggested alternatives.
The request for comments includes
areas on the existing forms, schedules,
and instructions that the Agencies have
not proposed changing, but which may
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benefit from further guidance, especially
with regard to how an existing provision
or instruction would apply for a
particular segment of the filing
population.
IV. Discussion of Proposed Changes
The proposed revisions in this Notice
reflect priorities of and efforts by the
DOL, IRS, and PBGC to improve
reporting for filers and the public, other
governmental users, as well as the
Agencies by: (1) Modernizing financial
information filed regarding plans; (2)
updating fee and expense information
on plan service providers, with a focus
on harmonizing annual reporting
requirements with the DOL’s final
disclosure requirements at 29 CFR
2550.408b–2; (3) enhancing mineability
of data filed on annual return/reports;
(4) requiring reporting by all group
health plans covered by Title I of
ERISA, including adding a new
Schedule J (Group Health Plan
Information); and (5) improving
compliance under ERISA and the Code
through selected new questions
regarding plan operations, service
provider relationships, and financial
management of the plan. The changes in
this proposal to the forms, schedules,
instructions, and DOL regulatory
exemptions and requirements are
intended to further these objectives.
A. Modernize Financial and Plan
Operations Information
An overriding objective of these
proposed forms revisions is to
modernize the Form 5500 Annual
Return/Report financial information
collection so that the presentation of
plan trust financial and balance sheet
information better reflects the
investment portfolios and asset
management practices of employee
benefit plans. The basic objective of
general purpose financial reporting is to
provide information about the reporting
entity for the Agencies’ enforcement,
research, and policy formulation
programs; to assist other federal
agencies, Congress, and the private
sector in assessing employee benefit,
tax, and economic trends and policies;
and to assist plan participants and
beneficiaries and the general public in
better monitoring the activities and
investments of employee benefit plans.
The financial statements contained in
the current Schedule H (Large Plan
Financial Information) and Schedule I
(Small Plan Financial Information) are
based on data elements that have
remained largely unchanged since the
Form 5500 Annual Return/Report was
established in 1975. Over the past four
decades, the U.S. private pension
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system has shifted from defined benefit
(DB) pension plans toward defined
contribution (DC) pension plans, often
participant-directed 401(k)-type DC
pension plans. The financing of
retirement benefits has changed
dramatically coincident with the shift
from DB to DC pension plans. In 1978,
when legislation was enacted
authorizing 401(k) plans that allow
employees to contribute to their own
retirement plan on a pre-tax basis,
participants contributed only 29 percent
of the contributions to DC pension plans
and only 11 percent of total
contributions to both DB and DC
pension plans. ‘‘In the years following
1978, employee contributions to DC
pension plans steadily rose to a peak of
approximately 60 percent in 1999,
where it has remained.’’ See Dep’t of
Labor, Private Pension Plan Bulletin
Abstract of 2012 Form 5500 Annual
Reports, at 1 (2015). Simultaneously, the
number of single-employer DB pension
plans has decreased from 92,000 in 1990
to just under 29,000 single-employer
pension plans in 2009. See U.S. Gov’t
Accountability Office, GAO–09–291,
Defined Benefit Pensions: Survey
Results of the Nation’s Largest Private
Defined Benefit Plan Sponsors
Highlights (2009) (available at https://
www.gao.gov/new.items/d09291.pdf).
The shift from DB pension plans to
DC pension plans has led to increased
responsibility for participants to manage
their own retirement savings, which
includes having to select among
investment options in their retirement
plans. See Private Pension Plan Bulletin
Abstract Of 2012 Form 5500 Annual
Reports, at 2 (Of the 516,000 section
401(k)-type plans in 2012, 87.8 percent
allowed participants to direct
investment of all of their assets, and 3.1
percent allowed participants to direct
investment of a portion of their assets.)
The need for more relevant and
comparable financial information is not
limited to 401(k) and other DC pension
plans; it also extends to DB pension
plans. Reports from GAO, the DOL–OIG,
the ERISA Advisory Council, and the
TIGTA also have focused on the need
for increased transparency and
accountability generally in connection
with employee benefit plan investments
in hard-to-value and alternative assets,
as well as assets held through pooled
investment vehicles.
1. Changes to Schedule H (Financial
Information)—Balance Sheet and
Income Statement
Section 103 of ERISA requires plans
to include in their annual report a
statement of assets and liabilities of the
plan, aggregated by categories and
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reported at current value. It also
requires plans to report a statement of
earnings (losses) and expenses.
Although the Form 5500 Annual
Return/Report has undergone major
revisions since its initial
implementation in 1975, there has been
little change to the basic balance sheet
and income statement information on
the Form 5500 Annual Return/Report
since the return/report was first
established. Under the proposal,
Schedule H, Parts I and II, would retain
the essential asset/liability and income/
expense structure of the current
reporting requirement. The Agencies are
proposing, however, to modify the asset
breakouts on the balance sheet
component of the Schedule H to enable
more accurate and detailed reporting on
the types of assets held by a plan,
including alternative investments, hardto-value assets, and investments through
collective investment vehicles. The
proposed changes take into account the
fact that many of these more
sophisticated and complex investments
do not fit neatly into any of the existing
reporting categories. As a result, filers
inconsistently report on the various
existing categories, and important
financial information is obscured by
consolidation of many diverse
investments into the catch-all ‘‘other’’
category on the balance sheet on the
Schedule H. The proposal would also
update the income/expense statement of
the Schedule H to get a better picture of
earnings and expenses associated with
plan investments and operations.
In addition to the Agencies’
assessment that Form 5500 Annual
Return/Report financial reporting would
benefit from improved transparency and
accountability, the proposal to change
the asset categories on the Schedule H
balance sheet is supported by recent
reports from both the GAO and the
DOL–OIG. The GAO has noted that the
plan asset categories on the Schedule H
are not representative of current plan
investments and provide little insight
into the investments themselves, the
level of associated risk, or the structures
of these investments. GAO–14–441,
Private Pensions: Targeted Revisions
Could Improve Usefulness of Form 5500
Information, at 11–12. The proposed
changes to the Schedule H also are
consistent with the DOL–OIG
recommendation that the Form 5500
Annual Return/Report be revised to
improve reporting of hard-to-value and
alternative investments. U.S. Dep’t of
Labor Office of Inspector Gen., 09–13–
001–12–121, Employee Benefits Security
Administration Needs to Provide
Additional Guidance And Oversight to
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ERISA Plans Holding Hard-To-Value
Alternative Investments, at 4, 19.
Accordingly, the Agencies are
proposing the following changes to the
Schedule H balance sheet and income
statement. Current Line 1a, ‘‘total
noninterest bearing cash,’’ would be
reported as a breakout element under
General Investments. This would also
result in Line 1b ‘‘Receivables’’ and Line
1c ‘‘General Investments’’ being
renumbered as Lines 1a and 1b
respectively. Participant loans would
continue to be reported as a separate
line item, but would be reported as a
breakout element under renumbered
Line 1a as a ‘‘receivable’’ rather than
under its current reporting classification
under the heading ‘‘General
Investments.’’ This change is responsive
to amendments made to ‘‘Generally
Accepted Accounting Principles’’
(GAAP) by the Financial Accounting
Standards Board (FASB), which
required participant loans to be
classified as notes receivable from
participants. See Financial Accounting
Standards Board, No. 2010–25, Plan
Accounting—Defined Contribution
Pension Plans (Topic 962) (2010). As
notes receivable, participant loans
would continue to be reported at their
unpaid principal balance plus any
accrued but unpaid interest.
Under proposed Line 1b (currently
Line 1c) ‘‘General Investments,’’ the
Agencies would add both new
categories and new breakouts within
existing categories. Cash and cash
equivalents would be the first category
under ‘‘General Investments.’’ As
indicated above, ‘‘noninterest bearing
cash (such as cash on hand or cash in
a non-interest bearing checking
account)’’ would no longer be separated
from ‘‘General Investments.’’ Instead it
would be a sub-breakout under ‘‘cash
and cash equivalents.’’ The category
would also have sub-breakouts for
interest bearing cash (assets that earn
interest in a financial institution
account such as interest bearing
checking accounts, passbook savings
accounts, or money market bank deposit
accounts). While the breakouts are new,
the information is already required to be
reported on current Line 1c(1).
The next category under ‘‘General
Investments,’’ would continue to be for
reporting ‘‘Debt Interests/Obligations.’’
The Form 5500 Annual Return/Report
currently provides little in the way of
detail or transparency about the range of
plan investments in bonds, loans, and
other debt instruments and obligations.
For example, a single line item for
‘‘other loans’’ on the Schedule H
currently covers, as indicated in the
Form 5500 Annual Return/Report
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47539
instructions, the value of loans for
construction, securities loans,
commercial and/or residential mortgage
loans that are not subject to Code
section 72(p), and other miscellaneous
loans. See, e.g., 2015, Schedule H, Form
5500 Annual Return/Report
Instructions.
The general debt heading, as
proposed, would keep the existing
breakout for corporate debt instruments.
Breakouts under that category, however,
would be investment grade debt and
high-yield debt, rather than ‘‘preferred’’
and ‘‘all other,’’ as on the current
Schedule H. This change is intended to
have the Schedule H financial
information for all reporting plans
regarding corporate debt instruments
correspond to the more detailed
financial information on Schedule R for
defined benefit pension plans that have
1,000 participants or more. In addition,
U.S. government securities would be
broken out from other government
securities. The instructions for the
current forms advise filers to report
such investments on the Schedule H
financial statements in ‘‘Other’’ debt
instruments. This proposal, however,
includes more investment categories on
the Schedule H to improve transparency
from the current ‘‘other’’ categories. For
example, there would be a breakout for
other loans (other than loans to
participants), exchange traded notes,
and asset backed securities (other than
real estate),10 and debt obligations
associated with real property would be
reported under the real property
category, rather than generally under
‘‘Other Debt Obligations.’’ Thus, with
respect to reporting such leveraged or
collateralized transactions on the
balance sheet portion of Schedule H,
filers would be advised in the
instructions to account for such
transactions in the appropriate asset
category in accordance with the
individual characteristics of the
investment.
The next category under ‘‘General
Investments’’ would continue to be
‘‘Corporate Stocks.’’ Under the corporate
securities category, filers would still
distinguish between ‘‘preferred’’ and
10 The SEC similarly is working towards more
transparency with regard to some of these assets.
See Securities and Exchange Commission, Assetbacked Securities Disclosure and Registration, 79
FR 57,184 (Sept. 24, 2014). FINRA has also
published an Investor Alert related on exchange
traded notes to increase investor awareness of the
associated risks. See Exchange-Traded Notes: Avoid
Unpleasant Surprises, FINRA, www.finra.org/
Investors/ProtectYourself/InvestorAlerts/
TradingSecurities/P131262. See also U.S. Gov’t
Accountability Office, GAO–12–324, Recent
Developments Highlight Challenged Of Hedge Fund
And Private Equity Investing (2012) (discussing
plan investment in distressed debt).
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‘‘common’’ stock for reporting direct
holdings of corporate securities. There
would be new breakouts, however, for
‘‘publicly traded’’ and ‘‘non-publicly
traded’’ securities under both the
‘‘preferred’’ and ‘‘common’’ stock
elements. This proposed change is
intended to present a more complete
picture of plan investments in hard-tovalue assets.
The existing reporting line items for
certain collective investment vehicles
that are treated as holding plan assets
under the DOL’s plan asset regulation at
29 CFR 2510.3–101 (i.e., bank common
or collective trusts (CCTs), insurance
company pooled separate accounts
(PSAs), entities meeting the conditions
of DOL regulation 29 CFR 2510.103–12
(103–12 IEs), and master trusts)
generally would be retained, but
grouped together for reporting under a
new category entitled ‘‘Eligible Pooled
Investment Funds (Other Than
Registered Investment Companies).’’ To
increase transparency and improve the
quality of data collected across various
components of the Form 5500 Annual
Return/Report, the proposal would
significantly reconfigure existing
reporting of assets held through the
various types of pooled investment
vehicles that have plan assets.
Under the proposal, a plan’s
investments in CCTs and PSAs would
be reported in the aggregate on single
line items for each vehicle type on the
Schedule H Line 1b balance sheet
information regardless of whether the
CCT or PSA files a Form 5500 Annual
Return/Report as a DFE. This is a
change from the current rule that has
filers break out the underlying assets in
the respective line items on the
Schedule H balance sheet under
‘‘general investments’’ if the CCT or
PSA has not filed a Form 5500 Annual
Return/Report and in the aggregate on
the CCT or PSA line if the Form 5500
Annual Return/Report has been filed.
Instead, as discussed in more detail
below, the Line 4i(1) Schedule of Assets
held for Investment of either the plan or
the CCT or PSA, depending on whether
the CCT or PSA has filed, would be
where the breakout of underlying assets
would be reported.
With respect to 103–12 IE reporting
on Schedule H, the proposal generally
continues the existing reporting
requirements. Specifically, similar to
the requirements for plans that invest in
CCTs and PSAs, a plan that invests in
an entity that files as a 103–12 IE would,
in identifying each individual 103–12 IE
on the Line 4i Schedules of Assets, have
to include the value of the plan’s
investment in each 103–12 IE.
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Reporting regarding investments in
master trusts by plans and reporting by
master trusts, as described in more
detail below, would be substantially
revised, including reporting on the
plan’s asset and liability statements on
Schedule H, Part I. Specifically, as they
did prior to 1999, plans would report
their total holdings in master trusts on
Schedule H, Line 1b, on an aggregate
basis, and the reporting concept of the
master trust investment account (MTIA)
would be eliminated. The participating
plans’ fractional interest in the various
holdings of the master trust (which
currently are reflected in the MTIA
Form 5500 Annual Return/Report) now
would be shown on the various plans’
Schedule H, Line 4i(1) Schedule of
Assets Held for Investment at End of
Year and Line 4i(2) Schedule of Assets
Disposed of During the Plan Year, as
well as on the filings by the master trust
itself.
The DOL views the proposed changes
to annual reporting regarding these
pooled investment vehicles as important
and necessary in light of the large
amount of plan assets (an estimated $1.1
trillion) held by CCTs, PSAs, master
trusts, and 103–12 IEs. See U.S. Gov’t
Accountability Office, GAO 12–121,
Limited Scope Audits Provide
Inadequate Protections To Retirement
Plan Participants, at 1 (2014).
As part of the focus on better
reflecting and understanding how plans
are investing, the Agencies also propose
to replace the single line existing
category entitled ‘‘Value of Interest in
Funds Held in Insurance General
Accounts (Unallocated Contracts)’’ by
adding breakouts of various types of
unallocated contracts. The proposal
would add to the existing general
category breakouts for deposit
administration, immediate participation
guarantees, guaranteed investment
contracts, and ‘‘other’’ unallocated
insurance contracts. These classes of
contracts parallel the existing Schedule
A reporting on insurance contracts with
unallocated funds. Comments are
specifically solicited on whether this
breakout is sufficient or whether the
value of investments in other or
additional classes of insurance
contracts, such as variable annuity
contracts,11 should be listed on the
Schedule H.
The Agencies are also proposing
changes to the existing category entitled,
‘‘Partnership/Joint Venture Interests.’’
To clarify the reporting of these general
partnership and joint venture
11 As discussed below, the proposal would add
new questions to Schedule A regarding variable
annuities.
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investments, new sub-categories are
being added to report the value of
interest in ‘‘limited partnerships,’’
‘‘venture capital operating companies
(VCOCs),’’ ‘‘private equity,’’ ‘‘hedge
funds,’’ and ‘‘other partnership/joint
venture interests.’’ The Agencies’
proposal was informed by the GAO’s
findings that there was a need for more
detail on plan investment in hedge
funds and private equity funds due to
substantial increases in the percentage
of plans investing in hedge funds and
private equity. U.S. Gov’t Accountability
Office, GAO–12–324, Recent
Developments Highlight Challenges
With Hedge Fund And Private Equity
Investing, at 19 (2012). In making this
recommendation, GAO acknowledged
that although there is no universally
accepted definition, the term ‘‘hedge
fund’’ is commonly used to describe
pooled investment vehicles that are
privately organized and administered by
professional managers who engage in
active trading of various types of
securities, commodity futures, options
contracts, and other investment
vehicles, including relatively illiquid
and hard-to-value investments.
Similarly, ‘‘private equity fund’’ is
commonly used to describe privately
managed pools of capital that invest in
companies that typically are not listed
on a stock exchange. See, e.g., 2011
ERISA Advisory Council Report: Hedge
Funds and Private Equity Investments
(noting that plan sponsors have
increased investment of defined benefit
pension plan assets in hedge funds and/
or private equity funds due to the need
to increase diversification, decrease
volatility, and enhance the plan’s
overall performance). The Agencies
specifically invite comments on
whether these definitions are adequate
for purposes of Form 5500 Annual
Return/Report financial reporting.
In addition, because investments in
the ‘‘Partnership/Joint venture interests’’
may or may not be holding plan assets
under the DOL’s plan asset regulation at
29 CFR 2510.3–101, the Agencies are
proposing an off-balance sheet item in
this category where filers would
indicate the total value of such
investments that are plan asset vehicles
and those that are not.
The real estate category on the
Schedule H balance sheet would be
expanded and include sub-categories to
include investments in particular types
of assets or pooled investment funds
designed to invest primarily in real
estate or real estate mortgages. In the
Agencies’ view, the current reporting
requirements do not accurately reveal
the extent and type of a plan’s real
estate and related holdings. The
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proposed new breakouts are: Developed
real property (other than employer real
property), undeveloped real property
(other than employer real property), real
estate investment trusts (REITs),
mortgage-backed securities (including
collateralized mortgage obligations
(CMOs)), real estate operating
companies (REOCs), and ‘‘Other’’ real
estate related investments. Adding these
breakouts is consistent with the
Agencies’ objective of improving
reporting on investments that constitute
alternative or hard-to-value assets. See
OECD/IOPS Good Practices on Pension
Funds’ Use of Alternative Investments
and Derivatives, OECD, (available at
https://www.oecd.org/finance/privatepensions/oecdiopsgoodpracticeson
pensionfundsuseofalternative
investmentsandderivatives.htm.)
Creating more specific categories also
should help address concerns about
inconsistencies in real property
reporting cited by the report, GAO
Targeted Revisions Could Improve
Usefulness Of Form 5500 Information,
at 10.
A significant new reporting category
is for investments in derivatives. The
sub-categories in the derivatives
category would be futures, forwards,
options, swaps, and ‘‘Other.’’ As in the
other general categories, filers would
enter a description for assets listed as
‘‘Other.’’ Obtaining more specific
information about the extent to which
plans are engaged in hedging or in the
listed types of derivative transactions
would help address concerns raised by
the GAO about limitations on usefulness
of data on investments in derivatives
under the current reporting structure.
See generally U.S. Gov’t Accountability
Office, GAO–08–692, Defined Benefit
Plans: Guidance Needed To Better
Inform Plans Of The Challenges And
Risks Of Investing In Hedge Funds And
Private Equity, at 25, 42–43 (expressing
specific concerns about the way in
which pension plans report investments
in derivatives and suggesting that plan
sponsors are currently reporting these
types of investments in various different
categories on the Schedule H, limiting
the usefulness of the data.)
The Agencies are also proposing a
new category for foreign investments
with breakouts to separately report
holdings of foreign equities and debt
interests. The Agencies propose that, for
this reporting purpose, foreign equities
would include American Depository
Receipts, U.S.-traded foreign stocks and
stocks traded on foreign markets.
Foreign debt would include both longterm and short-term foreign debt
investments, but would not include for
purposes of a Form 5500 Annual
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Return/Report such foreign securities
held through U.S. registered investment
funds or exchange traded funds, CCTs,
PSAs, 103–12 IEs, or master trusts.
There also would be subcategories for
foreign real estate, currency, and
‘‘Other,’’ with a description required for
anything reported in the ‘‘Other’’
category.
The Agencies also are proposing a
new asset category on the Schedule H,
‘‘Tangible Personal Property,’’ which
category currently appears on the
Schedule I, but not on the Schedule H.
Under the proposal, the Schedule H
would list on its face the main types of
assets as reportable in this category, i.e.
direct investments in tangible personal
property, with sub-categories for
collectibles, precious metals, and
‘‘Other.’’ There would also be a separate
breakout category for commodities,
which would be divided into ‘‘Precious
Metals’’ and ‘‘Other.’’ Moving this
category from the Schedule I to the
Schedule H for all filers required to
complete the Schedule H, including
former Schedule I filers, would add
transparency to these plan investment
holdings. To the extent plans have
direct investments in tangible personal
property and commodities (as opposed
to futures contracts or exchange traded
funds), they are likely to be reported
unhelpfully from a transparency
perspective as ‘‘Other’’ on the existing
Schedule H.
Finally, the Agencies propose making
reporting more transparent for assets
held through participant-directed
brokerage accounts. The proposal
generally follows the same breakout
requirements as the current rules. The
current rules provide that assets held
through participant-directed brokerage
accounts may be reported either: (1) As
individual investments in the applicable
asset and liability categories in Part I
and the income and expense categories
in Part II, or (2) by including on the
‘‘Other’’ lines (Line 1c(15) on the
balance sheet and 2c on the income
statement) the total aggregate value of
the assets and the total aggregate
investment income (loss) before
expenses, provided the assets are not
loans, partnership or joint venture
interests, real property, employer
securities, or investments, including
derivatives, that could result in a loss in
excess of the account balance of the
participant or beneficiary who directed
the transaction. Under the proposal,
filers would provide the total current
value of all assets held through
participant-directed brokerage accounts,
except there would be separate subtotals for brokerage account investments
in tangible personal property, loans,
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partnership or joint venture interests,
real property, employer securities, and
investments that could result in a loss
in excess of the account balance of the
participant or beneficiary who directed
the transaction. The current Form 5500
Annual Return/Report reporting rules
already require that these types of assets
be reported separately from other
participant-directed brokerage account
assets, similar to the reporting rules for
investments in CCTs and PSAs that do
not file their own Form 5500 Annual
Return/Report. On the proposed Line 4i
Schedules of Assets, assets held through
a participant-directed brokerage account
would be permitted to be reported in the
aggregate as a single asset held directly
by the plan. The broker would be
identified as the issuer/borrower/etc. In
the element requiring the filer to
indicate on what line the assets were
reported on Line 1b, the filer would
enter all the subcategories for types of
investments held through a participantdirected brokerage account.
The Agencies considered requiring
filers to break out all assets held through
a participant-directed brokerage account
on the Line 4i Schedules of Assets. The
Agencies also considered continuing to
require filers to break out those specific
assets that are currently required to be
broken out on Line 1c. For example, the
Agencies considered requiring a
breakout of information on whether
participants are investing in alternative
and hard-to-value assets through
participant-directed brokerage accounts.
The Agencies determined, on balance,
considering the benefits to the
information and the relative potential
burden, that having on the proposed
balance sheet (Line 1b) a general
breakout of asset types held through
participant-directed brokerage accounts
would be sufficient, and that details of
each individual asset so held would not
be required.
The proposal to continue to allow
filers to report assets held in
participant-directed brokerage accounts
in the aggregate is intended to be
responsive to comments on the DOL’s
Request for Information, Question 38, 79
FR 49469, 49473 (Aug. 14, 2014) (RFI),
which specifically asked whether
changes should be made to the Schedule
H to require more detail about
investments made through brokerage
windows. While some commenters on
the RFI thought it made sense for the
DOL to consider changes to the Form
5500 Annual Return/Report with
respect to brokerage windows, others
were concerned about the burden and
costs such changes would impose on
sponsors and participants and were
unclear about the relative benefit of
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more information. The Agencies do not
believe that there would be a substantial
additional burden imposed by requiring
aggregate participant-directed brokerage
account assets to be reported separately
instead of the current practice of
reporting such assets in the catch-all
‘‘Other’’ category. Similarly, the
Agencies believe that there would not
be a substantial burden change in the
proposed requirement to break out, on
the Line 4i Schedules of Assets, the
types of investments held in participantdirected brokerage accounts that are not
eligible for aggregated reporting under
current annual reporting rules.
One of the goals of the proposed
change is to get better information on
securities lending 12 practices and how
they impact plan finances and
operations. As indicated in the
Financial Stability Oversight Council’s
(FSOC) Annual Report for 2014
(available at https://www.treasury.gov/
initiatives/fsoc/Documents/
FSOC%202014%20Annual%20
Report.pdf), the global value of
securities loans was approximately $1.8
trillion in 2013. Pension plans are a
large segment of the entities engaged in
such transactions. Accordingly, the
Agencies believe that more precise
information is needed to understand
how these transactions impact plans
and how plans fit into the overall
markets. The Agencies explored adding
new breakout line items on the asset/
liability and income expense statements
to identify in more detail securities
lending transactions. It is the
understanding of the Agencies,
however, that filers are reporting
securities lending arrangements and
similar transactions on the financial
statements in various different ways,
depending on whether the plan is
borrowing or lending securities and the
structure of the arrangement or
transaction, including transactions such
as repurchase agreements and sell/buyback transactions where, technically,
the plan no longer owns the securities.
Accordingly, the Agencies believe that
the best way to get information on
securities financing transactions,
without creating particularized line
items that might not work for all types
of transactions, is to instruct filers to
report assets in the appropriate
categories on the Schedule H and then
identify the transactions in response to
the newly proposed compliance
12 The term ‘‘securities loans’’ generally refers to
the collateralized loan of a security from one party
to another. Such a loan can have a pre-specified
term, such as one business day, one week, or one
month, or it can be ‘‘open.’’ An open loan is
ongoing until one of the parties to the trade decides
to end it.
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questions. The new compliance
question would ask whether the plan
has investment acquisitions that are
leveraged, including assets subject to
collateralized lending activities (e.g.,
securities lending arrangements,
repurchase agreements (repos), etc.). If
‘‘Yes,’’ the plan would be required to
identify whether the plan engaged in
securities lending arrangements,
including repurchase agreements or
sell/buy-backs, or other transactions that
subjected plan assets to a mortgage, lien,
or other security interest, and to
describe the arrangement. The plan
would then have to report, as a total, the
amount of cash obligated in connection
with collateralized lending activities at
end of year, the value of securities
obligated in connection with
collateralized lending activities at end
of year, the value of other assets
obligated in connection with
collateralized lending activities at end
of year, and the approximate ratio of
collateralized/leveraged investments to
total plan assets at end of year. The
Agencies specifically request comments
on whether there could be effective
breakout line items on the balance sheet
that would more clearly show assets
that are subject to securities lending or
similar arrangements or whether there
are specific instructions that would be
helpful for filers to know where to
categorize the various components of
such transactions on both the balance
sheet and earnings statements on the
Schedule H.
Under the ‘‘Income and Expense’’
statement in Part II of the Schedule H,
the Agencies propose retaining the same
basic structure for reporting income as
on the current Schedule H, but with
additional breakout categories. Notably,
the ‘‘interest’’ income category includes
a new breakout for government
securities other than U.S. government
securities, and the unrealized
appreciation (depreciation) of assets
category would be broken out to report
separately partnership/joint venture
interests, commodities investments,
derivatives, employer securities, foreign
investments (other than those held
through U.S. registered investment
funds), and employer real property, in
addition to the existing breakouts for
real estate, CCTs, PSAs, MTIAs, 103–12
IEs, and registered investment
companies. These proposed changes are
intended to better support investment
monitoring by asset class and provide
more consistent data for research and
policy purposes.
The proposal would also add new
breakout categories to the
‘‘Administrative Expenses’’ category of
the Income and Expenses section of the
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balance sheet. The Agencies have
determined that to get a better picture of
plan expenses, particularly those related
to service providers, more detail in this
category is warranted. Accordingly, data
elements would be added for ‘‘Salaries
and allowances,’’ ‘‘Independent
Qualified Public Accountant (IQPA)
Audit fees,’’ ‘‘Recordkeeping and Other
Accounting Fees,’’ ‘‘Bank or Trust
Company Trustee/Custodial Fees’’
‘‘Actuarial fees’’ ‘‘Legal fees,’’
‘‘Valuation/appraisal fees,’’ and
‘‘Trustee fees/expenses (including
travel, seminars, meetings.’’ 13
The Agencies are also proposing to
change administrative expense reporting
to identify when participant accounts
are charged directly. The Agencies
believe that this information is
important to better understand how
compensation arrangements impact
participants, especially in defined
contribution pension plans. The
Agencies considered requiring filers to
break out direct expenses on a service
provider by service provider basis on
Schedule C to show how and when they
are charged to participant accounts
rather than at the plan level. To
minimize reporting burden under the
proposal, however, the information
would be reported only in the aggregate.
Therefore, instead of requesting this
information on the Schedule C, the
Agencies have proposed revising the
expense information on Schedule H.
Specifically, the ‘‘Total’’ administrative
expense line item on Schedule H would
now require that administrative
expenses charged directly against
participant accounts be separately
reported from those direct expenses
charged to other plan asset sources.
Filers would separate transaction-based
charges to individual participant
accounts and plan level expenses
apportioned among participant
accounts. With respect to the latter,
filers would indicate whether the
expenses were apportioned per capita,
pro rata by account balance, or ‘‘Other’’
apportionment method that they would
describe. This would give the Agencies
and other users of the Form 5500
Annual Return/Report data a better idea
of how and when participants are being
charged administrative expenses, which
is particularly important for defined
contribution pension plans.
13 Other than IQPA Audit Fees and Bank or Trust
Company Trustee/Custodial Fees, these questions
were on the Form 5500 prior to 1999. See 1998
Form 5500, Line 32(g).
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2. Proposed Changes to Schedule H,
Line 4i Schedules of Assets
As indicated above, the proposed
modernization of the financial reporting
required on the Schedule H would
include structural, data element, and
instruction changes to the Line 4i
Schedules of Assets. The current Line 4i
Schedules (‘‘Schedule of Assets Held for
Investment at End of Year’’ and
‘‘Schedule of Assets Acquired and
Disposed Within Year’’) are required
under section 103 of ERISA to be
included in the annual report, as
currently implemented in the DOL’s
regulations at 29 CFR 2520.103–11.14
These schedules are filed by plans
required to file the Schedule H and by
certain DFEs. The schedules are a
central element of the financial
disclosure structure of ERISA because
they are the only place in the Form 5500
Annual Return/Report where plans are
required to list individual plan
investments, identified by major
characteristics, such as issue, maturity
date, rate of interest, cost, and current
value. Accordingly, these schedules are
the only part of the Form 5500 Annual
Return/Report that can be used to
evaluate the year-to-year performance of
a plan’s individual investments. The
reported information, however, suffers
from several shortcomings.
Perhaps most fundamentally, this
information currently is not reported in
a data-capturable format. Thus, although
an image or picture of the attachments
that are currently filed as non-standard
attachments to filers’ electronic Form
5500 Annual Return/Report filings is
available through the EFAST2 public
disclosure function, it is not viewable as
part of the Schedule H, nor is the
information included in the data sets
that DOL prepares from the return/
report filing data and publishes on its
Web site (www.dol.gov/ebsa/foia/foia5500.html). Also, the Line 4i Schedules
of Assets are not always found in the
same place in each Form 5500 Annual
Return/Report filing. For example, the
Line 4i Schedules of Assets are often
incorporated in the larger audit report of
the plan’s IQPA that itself is filed as a
nonstandard attachment to the Form
5500 Annual Return/Report.15 The
schedules also do not require
14 To see the proposed changes to the DOL’s
regulations to implement these data element and
instruction revisions, please see the DOL’s Notice
of Proposed Rulemaking—Annual Reporting,
published elsewhere today in the Federal Register.
15 See EFAST2 FAQ 24a, (available at
www.dol.gov/ebsa/faqs/faq-EFAST2.html) (advising
filers of options in EFAST2 for filing the
accountant’s opinion and accompanying financial
statements, indicating that they do not need to be
‘‘tagged’’ separately for filing purposes.)
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standardized methods for identifying
and describing assets on the Line 4i
Schedules of Assets. Under the current
reporting rules, the same stock or
mutual fund may be identified with
various different names or by use of
different abbreviations. The creation of
more detailed and structured Line 4i
Schedules of Assets is a specific
recommendation of both the DOL–OIG
and the GAO. See DOL Inspector Gen.
EBSA Needs To Provide Additional
Guidance And Oversight To ERISA
Plans Holding Hard-To-Value
Alternative Investments, at 4–5; GAO
Private Pensions: Targeted Revisions
Could Improve Usefulness of Form 5500
Information, at 37.
The first proposed improvement
would require filers to complete
standardized Line 4i Schedules of
Assets in a data-capturable format. The
Agencies anticipate that EFAST2 would
have separate ‘‘structured’’ locations for
entering the data into the Form 5500
Annual Return/Report filing, using a
standardized format that would enable
incorporation of the Line 4i Schedules
of Assets information into the datasets
that EFAST and EBSA make available
from each year’s Form 5500 Annual
Return/Report and Form 5500–SF
filings and enable DOL to more readily
disclose the information, as required
under Title I of ERISA.
As under the current reporting
structure, there would continue to be
two separate schedules of assets.16 The
first would be the existing Schedule of
Assets Held for Investment at End of
Year. The second would modify the
existing ‘‘Schedule of Assets Acquired
and Disposed of Within Year’’ to a
‘‘Schedule of Assets Disposed of During
the Plan Year.’’ The objective of the
current Schedule of Assets Acquired
and Disposed of Within Year was to
ensure that the Form 5500 Annual
Return/Report (which generally
captures financial information at the
beginning and the end of the plan year)
captured information on assets that may
not have been held either at the
beginning of the year or end of year
because they were bought and sold
within the same year. That structure,
16 The current Line 4i question generally asks
whether the plan held assets for investment,
referring to both Schedules of Assets. Because all
filers, except filers for terminated plans, answer
‘‘Yes’’ to indicate that they have assets held at end
of year, answers to the current question do not
reveal whether the plan also had assets acquired
and disposed of during the plan year. The proposal
would separate the question into two parts: Line
4i(1) asking whether the plan held investments at
the end of the year; and Line 4i(2) asking whether
the plan disposed of assets during the plan year. If
the answer was ‘‘Yes’’ to either question, the
corresponding Schedule of Assets would need to be
attached.
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47543
however, suffers from a significant gap
in information about alternative
investments and hard-to-value assets
because neither of the current Schedules
of Assets provides information on the
sale of such assets if purchased in one
year and sold in the middle of a
subsequent year. The change in the
Schedule of Assets Disposed of During
the Plan Year to cover all investment
assets disposed of during the plan year
would close that gap, while continuing
to capture transactions that involve the
purchase and sale of investment assets
within the same plan year.
Both of the proposed Line 4i
Schedules of Assets would continue to
require filers to enter, as applicable, the
existing data elements (1) identifying
the issuer, borrower, lessor, or similar
party; (2) describing the investment and
identifying, as applicable, the issue,
maturity date, rate of interest, par, or
maturity value, including whether the
asset/investment is subject to surrender
charge; (3) reporting the cost of the
asset; and (4) reporting the current value
of the asset.
A new data element on the Line 4i(1)
Schedule of Assets Held for Investment
would require the filer to indicate
whether the plan or reporting DFE held
the investments directly, through a
master trust, CCT, PSA, or a 103–12 IE.
If the assets are held through a DFE, the
filer (whether a plan or an investing
DFE) would be required to list each DFE
as an investment and enter for each DFE
in which the filer was invested, the
name, employer identification number
(EIN), and plan number (PN) used by
the DFE on its own Form 5500. If a PSA
or CCT in which the reporting plan or
DFE invests has not filed a Form 5500
Annual Return/Report, the filer would
have to check a box to indicate that the
CCT or PSA has not filed a Form 5500
Annual Return/Report, and the
investing plan or DFE would have to
break out the underlying assets of the
CCT or PSA on its own Line 4i(1)
Schedule of Assets Held for Investment
at End of Year. This aspect of the
proposal is intended better to coordinate
the information currently reported by
plans and investing DFEs on Schedule
D and on the Line 4i(1) Schedule of
Assets Held for Investment at End of
Year.
The current instructions tell filers to
use an asterisk to identify investments
that involved a party-in-interest on the
Line 4i Schedule of Assets Held for
Investment at End of Year. Review of
Form 5500 Annual Return/Report data,
however, suggests that many filers may
not be aware of the requirement, which
is currently explained only in the
instructions for Schedule H of the Form
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5500 Annual Return/Report.
Identification of the involvement of a
party-in-interest, therefore, has been
inconsistent and incomplete. To address
the issue, the proposal would replace
the current requirement to include an
asterisk with a check box to indicate
whether the investment involved a
party-in-interest.
To indicate the type of asset generally,
filers generally would be required to
indicate on the Line 4i Schedule of
Assets the category under which the
value of the asset was included on the
Schedule H asset statement (proposed
Line 1b), or if held through a CCT or
PSA that has not filed, where the
individual assets would have been
included on Line 1b if not held through
the CCT or PSA.
The proposal would add to the Line
4i(1) Schedule of Assets Held for
Investment at End of Year a requirement
to report investment identifiers such as
CUSIP (Committee on Uniform
Securities Identification Procedures),
CIK (Central Index Key), and LEI (Legal
Entity Identifier), if applicable, for each
asset. Filers would also be expected to
provide any other uniform number
applicable to the entity or asset being
reported, such as the Financial
Instrument Global Identifier (FIGI),
which is now coming into more
common usage.17 The use of CUSIP in
particular has been recognized by the
GAO as a way to improve end-users’
ability to aggregate analyses of the
information contained on the Schedules
of Assets. GAO Private Pensions:
Targeted Revisions Could Improve
Usefulness Of Form 5500 Information,
at 17.
The Agencies recognize that some
identifiers, particularly the LEI, are not
yet widely used. The LEI is included in
the proposal in anticipation of increased
use by the time the rule becomes final.
The LEI is intended to identify legally
distinct entities that engage in a
financial transaction. It has support
from both industry and government
agencies who view having a universal
identifier of parties to financial
transactions, such as the LEI, as an
important response to the 2008 financial
crisis and the best way to track and
understand the true nature of risk
exposures across the financial system.
See, e.g., Statement on Legal Entity
Identification for Financial Contracts,
17 See U.S. Bank Adopts Bloomberg’s New
Industry-standard for Trustee Reporting,
Bloomberg, (available at https://
www.bloomberg.com/company/announcements/us-bank-adopts-bloombergs-new-industry-standardfor-trustee-reporting/) (reporting that U.S. Bank is
the first corporate trustee to adopt Bloomberg’s
transparent, open-source methodology.)
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75 FR 74146, 74147 (Nov. 30, 2010)
(noting that precise and accurate
identification of legal entities engaged
in financial transactions is important to
private markets and government
regulation); Executive Office of the
President of the United States, Nat’l
Science and Technology Council, Smart
Disclosure and Consumer Decisionmaking: Report of the Task Force on
Smart Disclosure, at 13 (2013) (noting
that the Administration is working to
promote a LEI system). The use of LEI
to identify pension plan transactions is
particularly important because pension
plan investments make up a large
percentage of all investment assets and,
as previously discussed, plans are
increasingly invested in alternative
investments that involve complicated
financial structures and transactions.
Under the proposal, filers would
continue to be required to set forth the
current value of each investment asset
listed on the Line 4i Schedules of
Assets. To improve reporting on hardto-value assets where the current value
is by definition not readily available,
filers would be required to check a box
for each individual investment listed to
indicate whether the asset is ‘‘hard-tovalue.’’ This requirement is meant to
supplement the current compliance
question on the Schedule H that asks
whether the plan held any investment
assets whose value was not readily
determinable on an established market
or set by a third party independent
appraisal. See, e.g., 2015 Form 5500
Annual Return/Report Instructions for
Schedule H. The aggregate compliance
question, by itself, does not provide
particularly useful information on hardto-value assets. An examination of Form
5500 Annual Return/Report filings
suggests substantial non-compliance or
inaccurate reporting in the ways plans
answer the question. See also DOL–OIG
EBSA Needs To Provide Additional
Guidance And Oversight To ERISA
Plans Holding Hard-To-Value
Alternative Investments, at 4–5, 18, and
19 (recognizing that the Form 5500
Annual Return/Report has a ‘‘limited
ability to capture information on hardto-value investments’’ and
recommending that EBSA ‘‘improve
Form 5500 [Annual Return/Report] data
collection, analysis, and targeting of
plans with hard-to-value investments.’’).
The Agencies believe that the
requirement for filers to indicate for
each specific investment asset whether
the asset is hard-to-value is in keeping
with the goals of obtaining better
information regarding plan assets.
The instructions would also include a
clearer definition of hard-to-value assets
for this purpose. Specifically, assets that
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are not listed on any national exchanges
or over-the-counter markets, or for
which quoted market prices are not
available from sources such as financial
publications, the exchanges, or the
National Association of Securities
Dealers Automated Quotations System
(NASDAQ), would be required to be
identified as hard-to-value assets on the
Line 4i Schedules of Assets. CCTs and
PSAs that are invested primarily in
hard-to-value assets must themselves be
identified as hard-to-value assets,
regardless of whether they are valued at
least annually. Similar to the existing
treatment in the instructions for
registered investment companies, CCTs,
and PSAs under the current rules, those
registered investment companies, CCTs,
and PSAs that are valued at least
annually and are invested primarily in
assets that are listed on any national
exchanges or over-the-counter markets,
or for which quoted market prices are
available from sources such as financial
publications, the exchanges, or the
NASDAQ, however, would not need to
be identified as hard-to-value assets on
the Line 4i Schedules of Assets.
A non-exhaustive list of examples of
assets that would be required to be
identified as hard-to-value on the
proposed Schedules of Assets includes:
Non-publicly traded securities, real
estate, private equity funds; hedge
funds; and real estate investment trusts
(REITs). The Agencies believe this
definition is generally consistent with
the FASB audit and accounting
requirements defining assets with a
readily determinable fair value. See,
e.g., FASB Accounting Standards
Codification TM (ASC) (Topic 820).
As discussed above, filers generally
would be permitted to aggregate
participant-directed brokerage account
reporting on the Line 4i Schedules of
Assets by indicating the value of all the
brokerage account investments as a
single entry (identifying the brokerage
account information). In the element
requiring filers to indicate the location
where the asset was aggregated for
purposes of balance sheet reporting on
Line 1b, the filer would have to indicate
all of the following applicable categories
of investments: Tangible personal
property, loans, partnership or joint
venture interests, real property,
employer securities, investments that
could result in a loss in excess of the
account balance of the participant or
beneficiary who directed the
transaction, and any asset that would be
categorized as ‘‘Other.’’
For the second of the Line 4i
Schedules of Assets, which would
correlate under the proposal to
Schedule H, Line 4i(2), as noted above,
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the Agencies propose to change
‘‘Schedule of Assets Acquired and
Disposed Within Year’’ to ‘‘Schedule of
Assets Disposed of During the Plan
Year.’’ Filers currently report some
information regarding the disposal of
hard-to-value assets and alternative
investments either on the Schedule H,
Line 4i Schedule of Assets if the assets
were both acquired and disposed of
during the plan year, or, if the value of
the transaction was five percent or more
of total plan assets, on the Schedule H,
Line 4j ‘‘Schedule of Reportable
Transactions.’’ The Agencies believe,
however, that requiring reporting of
hard-to-value assets and alternative
investments acquired in one year and
disposed of in another year, including
investments that fall under the five
percent limit of Line 4j,18 would
provide the Agencies with a more
complete report of the plan’s annual
investments. The limitations on what
assets need to be reported on the
Schedule of Assets Disposed of During
the Plan Year would remain unchanged
from the current exceptions from
reporting on the Schedules of Assets not
held at the end of the plan year. Thus,
the following would continue to be
excluded from the Line 4i(2) Schedule
of Assets Disposed of During the Plan
Year:
1. Debt obligations of the U.S. or any
U.S. agency.
2. Interests issued by a company
registered under the Investment
Company Act of 1940 (e.g., a mutual
fund).
3. Bank certificates of deposit with a
maturity of one year or less.
4. Commercial paper with a maturity
of 9 months or less if it is valued in the
highest rating category by at least two
nationally recognized statistical rating
services and is issued by a company
required to file reports with the
Securities and Exchange Commission
under section 13 of the Securities
Exchange Act of 1934.
5. Participations in a bank common or
collective trust (CCT).
6. Participations in an insurance
company pooled separate account
(PSA).
7. Securities purchased from a brokerdealer registered under the Securities
Exchange Act of 1934 and either: (1)
18 Title I of ERISA contemplates reporting
transactions involving three percent or more of plan
assets. ERISA section 103(b)(3)(H). By prior
rulemaking, the DOL has limited that reporting
requirement to transactions involving five percent
or more of plan assets. The Agencies continue to
believe that generally keeping the limit at
transactions involving five percent or more of plan
assets, with this change to the Line 4i schedules,
will provide sufficient information about significant
transactions during the plan year.
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Listed on a national securities exchange
and registered under section 6 of the
Securities Exchange Act of 1934 or (2)
quoted on NASDAQ.
Likewise, assets disposed of during
the plan year would continue to exclude
any investment that was not held by the
plan on the last day of the plan year if
that investment is reported in the
annual report for that plan year in any
of the following schedules:
1. The schedule of loans or fixed
income obligations in default required
by Schedule G, Part I;
2. The schedule of leases in default or
classified as uncollectible required by
Schedule G, Part II;
3. The schedule of nonexempt
transactions required by Schedule G,
Part III; or
4. The schedule of reportable
transactions required by Schedule H,
line 4j.
The new proposed Line 4i(2)
Schedule of Assets Disposed of Within
Year, generally would have the same
data elements as the current Schedule of
Assets Acquired and Disposed of Within
Year. To implement the change in the
schedule from ‘‘acquired and disposed
of during the plan year’’ to ‘‘disposed of
during the plan year,’’ however, filers
would have to indicate the acquisition
date. Basic parallel changes would be
made to the Line 4i(2) Schedule to keep
it generally consistent with the Line
4i(1) Schedule.
Under the proposal, the Line 4j
Schedule of Reportable (5%)
Transactions would remain essentially
unchanged. The current schedule of
reportable transactions requires the filer
to include information on the identity of
the party involved in the reportable
transaction or series of transactions.
Consistent with the Line 4i Schedules of
Assets, a checkbox is being added to
this schedule to indicate whether the
reportable transaction or series of
transactions involved a person known to
be a party-in-interest. Under the
proposal, the Line 4j Schedule of
Reportable (5%) Transactions would be
structured in a standard format for data
input and collection purposes; filers
would not be able to use a nonstandard
attachment.
3. Proposed Changes to DFE Reporting
As described in parts A.1 and A.2
above in the context of the new
Schedule H balance sheet information
and the updated schedules of assets,
respectively, the proposal includes
changes as to what information about
DFEs and their underlying investments
needs to be reported by both the plan
and the DFE. The proposal includes
correlative changes to the Schedule D
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47545
that are described below, including the
elimination of the requirement of plans
to complete Schedule D. The Agencies
considered a number of alternatives in
developing a proposal to address
problems and concerns with regard to
the consistency and quality of the
reporting of assets held through
collective investment vehicles,
including DFEs. The Agencies
considered whether both DFEs and
plans should be required, on their Line
4i Schedule of Assets, to show the
underlying investments of DFEs. The
Agencies also considered eliminating
filings for PSAs, CCTs, and 103–12 IEs
and simply requiring plans to report on
the Line 4i Schedules of Assets the
plan’s proportionate share of each of the
underlying assets held by each PSA,
CCT, or 103–12 IE in which the plan is
invested. The Agencies invite comments
on the most effective and efficient way
to address the inconsistent and limited
reporting of information invested
through DFEs. The Agencies are
particularly interested in information on
how investments in DFEs relate to
investment alternatives in participantdirected accounts and how much of the
underlying assets of DFEs consist of
hard-to-value and alternative
investments.
This revised reporting structure for
both the Schedule H and the Line 4i
Schedules of Assets for reporting
investments through pooled investment
vehicles is intended to enable the
Agencies, plan fiduciaries and service
providers, and other users of the data to
have a better and more complete picture
of the investments of plans. For nearly
44 percent of all assets held by large
pension plans, the public information
on plans’ investments on the Form 5500
Annual Return/Report is limited to the
class of the pooled investment
arrangements rather than the financial
class of the underlying investments
(including hard-to-value and alternative
investments). See Dep’t of Labor, 2010
Form 5500 Direct Filing Entity Bulletin:
Abstract of 2010 Form 5500 Annual
Reports (2013), at 6. The proposed
changes to reporting information about
assets held through DFEs on the Line 4i
Schedules of Assets, as well as the
proposed changes to the Schedule H
balance sheet information, is also
supported by the GAO’s
recommendation that the Agencies take
steps to reduce the difficulty associated
with matching a plan’s investments
with those reported in the DFE’s filing.
GAO Private Pensions: Targeted
Revisions Could Improve Usefulness of
Form 5500 Information, at 14–15.
The proposed filing requirements for
master trusts, CCTs and PSAs, 103–12
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IEs, group insurance arrangements
(GIAs), and the plans that invest
through these vehicles and the proposed
revisions to Schedule D reporting are
described more fully below.
a. DFE Reporting—Master Trusts
Some plans participate in certain
trusts, accounts, and other investment
arrangements that file the Form 5500
Annual Return/Report as a DFE. In
general, a master trust for Form 5500
Annual Return/Report filing purposes is
a trust maintained by a bank or similar
institution to hold the assets of more
than one plan sponsored by a single
employer or by a group of employers
under common control. Unlike CCTs
and PSAs, not every plan participating
in the master trust necessarily has a
proportionate share of all of the assets
of the master trust. To get information
about each plan’s holdings within the
master trust, the annual return/report
has historically asked for information
about so-called MTIAs. The Agencies
understand that the MTIA reporting
requirements are unique to the Form
5500 Annual Return/Report, do not
fully correspond to actual trust
accounting practices used for master
trusts, and may not be well understood
or consistently complied with by plans
that use master trusts for investment
and reinvestment of assets. Accordingly,
the proposal would eliminate MTIA
reporting and replace it with what is
intended to be a simpler approach.
Under the MTIA reporting concept,
each pool of assets held in a master trust
is treated as a separate MTIA if: (1) Each
plan that has an interest in the pool has
the same fractional interest in each of
the assets in the pool as its fractional
interest in the pool, and (2) each such
plan cannot dispose of its interest in any
asset in the pool without disposing of its
interest in the pool. Under this test, it
is possible for a single asset to be an
MTIA if ownership of the asset meets
the above test. Currently, a separate
Form 5500 Annual Return/Report must
be filed for each MTIA, among other
things, listing the underlying assets of
the MTIA on Schedule H and the
aggregate value of each investing plan’s
ownership interest in the MTIA on
Schedule D. The filing of each MTIA is
deemed to be part of the Form 5500
Annual Return/Report of the investing
plan, and the plan administrator is,
therefore, ultimately responsible for
MTIAs filing their Form 5500 Annual
Return/Report, even if the bank or other
third party is the person that files for the
MTIA.
According to GAO, MTIAs account for
roughly 20.4% of the total assets of large
defined contribution pension plans. See
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Private Pensions: Targeted Revisions
Could Improve Usefulness Of Form 5500
Information, at 14. Accuracy of filings
showing investments in master trusts
(regardless of reporting structure) is
therefore important to have a complete
picture of plan investments. To facilitate
consistent reporting, the Agencies now
propose to eliminate the concept of a
separate MTIA filing as part of the
changes to Schedules D and H and the
Line 4i Schedules of Assets. Prior to
1999, master trusts were required to file
the Form 5500 Annual Return/Report;
information about MTIAs was provided
in an attachment to the consolidated
master trust filing. See, e.g., 1998 Form
5500 Annual Return/Report and
Instructions. Under the proposal, master
trust filing would return to something
closer to the pre-1999 structure.
Specifically, a Form 5500 Annual
Return/Report would be required to be
filed for each master trust in which a
plan has an interest. The master trust,
like a MTIA under the current rules,
would be required to include as part of
its Form 5500 Annual Return/Report, a
Schedule D to list all participating
plans. The Schedule D listing of
participating plans would include the
requirement to report the total value of
each participating plan’s investment
assets in the master trust. Plans would
report their investments in master trusts
in detail on their Schedule H, Line 4i(1)
Schedule of Assets Held for Investment
at End of Year, including the name and
EIN of the master trust used on the
master trust’s Form 5500 Annual
Return/Report. Plans would also list the
aggregate value of their investment in
master trusts on the Schedule H balance
sheet.
The proposal also would change the
instructions to address what the
Agencies understand to be
inconsistency in the way master trust
expenses are reported. Specifically,
under the proposal, the master trust’s
report would include expenses that are
allocable equally to all plans investing
in the master trust. All other expenses
would have to be allocated to the
individual participating plans and
reported at the individual plan level.
Finally, the regulations and
instructions would provide that to be a
master trust for reporting purposes,
either the master trust must operate on
a calendar year or the master trust and
all of the plans invested in the master
trust must operate on the same fiscal
year. Where the master trust is on a
calendar year and a participating plan
on a fiscal year other than a calendar
year, similar to Schedule A reporting of
insurance contracts, the information
reported by the plan would be for the
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master trust year ending within the plan
year.
The combined changes for reporting
by both investing plans and master
trusts on both the Schedule H balance
sheet and the Line 4i Schedules are
intended better to effectuate the
purposes underlying the current
combination of MTIA, Schedule H
(including the Line 4i Schedules), and
Schedule D reporting. This should make
it easier to understand the finances of
the master trust as a whole, as well as
the finances of the plans investing
through a master trust. The Agencies
invite comments to provide alternative
suggestions on how to improve the
transparency and accuracy of reporting
plans’ proportionate ownership of
interests in assets held through a master
trust.
b. DFE Reporting—CCTs and PSAs
As with the existing rules, under the
proposal, a Form 5500 Annual Return/
Report may be, but is not required to be,
filed for a CCT or a PSA. The proposal
would change the filing requirements
with respect to CCTs and PSAs as
follows. As discussed above, regardless
of whether a CCT or PSA in which the
plan invests files a Form 5500 Annual
Return/Report as a DFE, the plan would
report the interests in the CCT or PSA
on the CCT or PSA line of the Schedule
H balance sheet (Part I, Line 1b),
although there would be breakouts
within those categories to give a general
idea of the types of assets held through
the CCT or PSA. The changes should
result in a clearer statement of total plan
assets invested through these collective
investment vehicles.
The current requirement to break out
the assets of non-filing CCTs or PSAs
would be retained, but the proposal
would shift the details of the underlying
investments to the newly structured
Line 4i(1) Schedule of Assets. Under the
proposed revisions, investing plans, on
their own Line 4i Schedules of Assets,
would be required to list each
underlying investment, identifying that
the investment was held through a nonfiling CCT or PSA, including the CCT’s
or PSA’s name and other identifying
information, as well as the information
on the underlying asset.19
19 As discussed above, if the CCT or PSA files a
Form 5500 Annual Return/Report, the holdings in
the CCT or PSA could be listed on the plan’s Line
4i(1) Schedule of Assets at the CCT/PSA level
(corresponding to the breakout categories on the
balance sheet statement). Thus, the PSA or CCT
filing of a Form 5500 Annual Return/Report,
including the Line 4i(1) Schedule of Assets Held for
Investment, would relieve each participating plan
from reporting detailed information regarding the
underlying investments.
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In this regard, the Agencies note that
under current DOL regulations CCTs
and PSAs are required to provide
information about the underlying assets
of the CCT or PSA to participating plans
and provide plans with relief from
reporting the underlying assets of the
CCT or PSA if the CCT or PSA files the
Form 5500 Annual Return/Report, but
that CCTs and PSAs are not required
themselves to file the Schedules of
Assets. The regulation would be
amended to provide that plans are
relieved from breaking out the
individual assets on the Schedule H,
Line 4i Schedules of Assets, if the CCT
or PSA instead files its own Form 5500,
including the Schedule H and the
Schedule of Assets Held for Investment.
Also, the regulation would indicate that
providing the information needed for a
plan to complete the Line 4i Schedules
of Assets constitutes compliance with
the requirement to transmit information
regarding the assets held by the CCT or
PSA. With this change, information
regarding the underlying investments of
CCTs and PSAs, which have been
provided only to plan fiduciaries, will
now be part of the annual return/report
data set; it will be filed either by the
participating plans or by the CCT or
PSA.
c. DFE Reporting—103–12 IE
The DOL’s regulation at 29 CFR
2520.103–12 provides that an entity in
which two or more unrelated plans
invest that is not a CCT, PSA, or master
trust, and which is deemed to hold plan
assets under the DOL’s regulations at 29
CFR 2510.3–101 that voluntarily
chooses to file a Form 5500 Annual
Return/Report for itself on behalf of its
investing plans, is treated as a ‘‘103–12
IE’’ filing entity for Form 5500 Annual
Return/Report reporting purposes.
Under the proposal, reporting for these
pooled investment vehicles generally
remains unchanged, except to the extent
that the data elements for the existing
forms and schedules have changed for
all filers. For a plan to be able to report
investments in such entities as a single
investment on the balance sheet portion
of Schedule H, as under the current
reporting rules, the entity in which the
plan invested would have to complete
its own Form 5500, together with a
Schedule H and Line 4i Schedules of
Assets, as well as Schedules A, C, D, G,
as revised in the proposal, and the
entity’s own IQPA report. Under the
proposal, similar to reporting assets
held through participant-directed
brokerage accounts, filers would have to
indicate all the Line 1b balance sheet
breakout categories for types of
underlying investment of each 103–12
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IE, but would not have to identify each
individual investment.
d. DFE Reporting—GIAs
The reporting requirements for GIAs
would generally remain unchanged,
except GIAs would be subject to the
same changes in reporting as
comparable welfare plans, including the
new requirements for welfare plans that
provide health benefits. As under the
current rules, welfare plans that are
fully insured, including group health
plans, would still have the exemption
from filing the Form 5500 Annual
Return/Report if they participate in a
GIA that has filed its Form 5500 Annual
Return/Report. GIAs would continue to
be required to file all the same forms,
schedules, and attachments as a large
group health plan funded with a trust.
GIAs that provide group health coverage
would be required to file a separate
Schedule J for each separate employer’s
participating plan.
e. DFE Reporting—Changes to Schedule
D
The Agencies propose to continue the
Schedule D requirement for DFEs in
which plans invest, but not for plans
participating in DFEs. DFEs would
continue to report identifying
information about the participating plan
and the dollar value of each investing
plan’s interests in the DFE as of the end
of the DFE reporting year. Participating
plans, because they would now be
reporting detailed information about
investments in DFEs on their Line 4i
Schedules of Assets, would no longer
have to complete the Schedule D.
4. Better Information on Plan
Terminations, Mergers, and
Consolidations
The Agencies propose revisions to
existing Schedule H and Form 5500–SF
questions on plan terminations,
mergers, and consolidations. First, the
Agencies propose expanding the
question that asks whether the plan has
adopted a resolution to terminate so that
it also asks for the effective date of the
plan termination, the year in which
assets were distributed to plan
participants and beneficiaries, and
whether the plan transferred assets or
liabilities to another plan.
Second, the proposal would add a
question asking filers to indicate
whether another plan transferred assets
or liabilities to the reporting plan (other
than pursuant to a direct rollover). If the
plan received a transfer of assets or
liabilities from another plan, the filer
would be asked to provide the date and
type of transfer (merger, consolidation,
spinoff, other). This new information is
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intended to provide better information
on transfers of participant benefit
obligations over the years.
Third, if the plan is a defined
contribution pension plan that
terminated and transferred plan assets
to a financial institution and established
accounts in the name of missing
participants, the filer would be asked to
provide the name and EIN of the
financial institution, the date the assets
were transferred to the institution, the
number of accounts established, and the
total amount transferred. Although the
question would not ask the filer to
identify individual affected participants
or beneficiaries, this requirement is
designed to help missing participants
locate information about their accounts,
in some cases years after the plan
termination when the plan or plan
sponsor may no longer exist or have
records of the accounts it established.
Asking for information about accounts
created for missing participants after
plan termination would also be
responsive to the ERISA Advisory
Council’s recommendations that the
DOL use the Form 5500 Annual Return/
Report to obtain more consistent
reporting on accounts that hold missing
participant plan assets. See 2013 ERISA
Advisory Council Report: Locating
Missing and Lost Participants, Dep’t of
Labor (available at www.dol.gov/ebsa/
publications/2013ACreport3.html#2).
In this 2013 report, the Advisory
Council noted that another issue with
‘‘lost’’ or ‘‘missing’’ participants for
ongoing plans as well as terminating
plans, especially 401(k) plans, is
‘‘uncashed’’ checks, particularly checks
sent to participants who have left
employment where the Code permits
the plan to ‘‘cash out’’ the participant.
Id. The report noted that a plan was not
necessarily able to tell whether
uncashed checks were sent to the wrong
address (a ‘‘lost’’ or ‘‘missing’’
participant issue) or whether a
participant received the check but had
not cashed it. To get better information
about the magnitude of the problem
with respect to defined contribution
pension plans and to make plan
fiduciaries aware that they should, at a
minimum, have procedures in place to
verify that a participant’s address is
good before a check is mailed and to
keep track of the number of uncashed
checks and the amount involved, the
proposal would also add to both the
Schedule H and the Form 5500–SF a
compliance question for defined
contribution pension plans asking
whether there were any uncashed
checks at the end of the plan year. If
there were any uncashed checks at the
end of the year, filers would be required
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to report how many uncashed checks
there were and the total dollar value of
the uncashed checks. Defined
contribution pension plan filers would
also be asked to describe briefly in an
open text field the procedures that they
followed to verify a participant’s
address and with respect to monitoring
the uncashed checks. The proposed
instructions provide that for Form 5500
Annual Return/Report reporting
purposes, an uncashed check is one that
is no longer negotiable or is subject to
limited payability.
In proposing to add a compliance
question instead of telling filers how to
account for the assets associated with
uncashed checks on the Schedule H, the
Agencies recognize that the ERISA
Advisory Council indicated that there
are questions regarding how the
underlying assets represented by
uncashed checks should be reported on
the Form 5500 Annual Return/Report.
Because of the variety of situations that
might result in uncashed checks and the
different ways uncashed checks might
be accounted for in an ongoing plan, the
Agencies have chosen to add a
compliance question, leaving flexibility
in the balance sheet reporting on
Schedule H and on the Form 5500–SF
and, where applicable, the IQPA report.
The ERISA Advisory Council and
some of the witnesses who testified
recommended that the DOL publish
guidance to advise plan fiduciaries how
to handle uncashed checks, among other
issues regarding missing or lost
participants and beneficiaries and how
to address the assets associated with
those participants or beneficiaries. In
making this recommendation, it was
recognized that there was a tension
between the mandatory distribution
requirements under the Code and
fiduciary responsibilities. In the absence
of further guidance with regard to how
to handle uncashed checks, the DOL
notes (as stated above) that plans should
at least have policies and procedures in
place to verify participant addresses, for
searching for missing participants and
for fiduciaries to keep track of or be
made aware of the number of uncashed
checks and the total value of such
checks that remained uncashed at the
end of the plan year. Depending on the
type of plan, the terms of the plan, and
the status of the plan sponsor, there may
be actions needed to satisfy fiduciary
obligations with regard to benefit
payments.
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5. Changes to Financial Reporting for
Small Plans
a. Changes to Form 5500–SF
In general, small plans that are
invested only in ‘‘eligible’’ plan assets
and otherwise meet the existing
requirements for eligibility to file the
Form 5500–SF would continue to be
able to file the Form 5500–SF.20 Welfare
plans with fewer than 100 participants
that do not provide group health
benefits and that are required to file an
annual return/report and that meet the
eligibility requirements for the Form
5500–SF will still be able to use the
Form 5500–SF to satisfy their filing
requirement. Welfare plans with fewer
than 100 participants that provide group
health benefits are not eligible to use the
Form 5500–SF.21 For Form 5500–SF
filers, there would be a modest
additional breakout on the balance sheet
information to give a basic picture of the
types of eligible assets in which Form
5500–SF eligible small plans are
invested. Specifically, filers would have
to categorize the plans’ investments into
one of the following categories: (1)
Cash/cash equivalents; (2) money
market funds; (3) publicly traded stock
(preferred/common); (4) publicly traded
bonds, including government securities;
(5) interests in registered investment
companies (mutual funds, unit
investment trusts, closed end funds); (6)
interests in PSAs; (7) interests in CCTs;
and (8) interests in insurance policies/
contracts other than PSAs, e.g. annuity
20 The Form 5500–SF was developed and adopted
for 2009 Form 5500 Annual Return/Report in part
to provide a simplified report required under the
Pension Protection Act of 2006. The DOL continues
to believe, as discussed when implementing the
2009 forms revisions, 72 FR 64731 (Nov. 16, 2007),
that the requirement in the PPA to provide
‘‘’simplified’’ reporting for plans with fewer than 25
participants is satisfied by making available the
simplified reporting in the 5500–SF only to those
plans invested in eligible assets—generally easy to
value assets. Section 1103(b) of the Pension
Protection Act of 2006, (PPA) 120 Stat. 780, 1057,
requires the Secretary of the Treasury/IRS and the
Secretary of Labor to provide for the filing of a
simplified annual return for any retirement plan
which covers fewer than 25 participants on the first
day of the plan year and which (1) meets the
minimum coverage requirements of section 410(b)
of the Internal Revenue Code without being
combined with any other plan of the business that
covers the employees of the business; (2) does not
cover a business that is a member of an affiliated
service group, a controlled group of corporations, or
a group of businesses under common control; and
(3) does not cover a business that uses the services
of leased employees (within the meaning of section
414(n) of the Code). The PPA provision does not
include specific requirements as to the form or
content of the simplified filing.
21 Currently welfare plans with fewer than 100
participants, including those that provide group
health benefits, that are not exempt from the
requirement to file an annual return/report (e.g.,
those that are funded with a trust) are permitted to
file the Form 5500–SF, if otherwise eligible.
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contracts. In contrast to the Schedule H
balance sheet financial breakout
categories, there would be no ‘‘Other’’
category for the balance sheet financials
on the Form 5500–SF. If a small plan
were to be invested in any assets other
than those in the eight listed categories,
it would not be eligible to file the Form
5500–SF.
As discussed in more detail below,
the proposal would eliminate the
current Form 5500 and Form 5500–SF
line items that require the filer to input
‘‘plan characteristics codes’’ onto the
form from a list in the instructions.
Instead, the filer would complete a
series of separate questions. In general,
those changes involve requesting
information about plan characteristics
as a series of ‘‘Yes’’/‘‘No’’ and check box
questions to make the forms easier to
complete, make the forms more
straightforward as a disclosure
document, and improve the quality of
the data. In addition, as with Form 5500
Schedule H filers, the proposal would
require that the Form 5500–SF filed for
a participant-directed individual
account plan must include an electronic
copy of the comparative chart of
designated investment alternatives
(DIAs) currently required to be provided
to participants of such plans under 29
CFR 2550.404a–5. The Agencies believe
that although this information would
not be filed in a data captured structure
and, thus, would not be as readily data
mineable, attaching the already required
404a–5 comparison chart would allow
participants and beneficiaries in
participant-directed individual account
plans to access the most recent and
prior year comparative charts through
the EFAST Form 5500 Annual Return/
Report public disclosure feature. It
would also enable the Agencies to
monitor more effectively compliance by
participant-directed individual account
plans with this important disclosure
requirement. It also would provide
important information regarding
investment features and investment fees
and expenses. We also understand that
private third parties would be able to
use the copies of the comparative charts
to develop more individualized tools to
help plan sponsors, plan fiduciaries,
and participants and beneficiaries
evaluate and compare their plans’
investment options. The Agencies
believe that a requirement that the plan
administrator of a participant-directed
individual account plan attach an
electronic copy of an existing document
should be less burdensome than adding
new questions that would require the
same data to be entered onto the form
or schedules to collect the information.
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The Agencies seek comment as to
whether there would be any real
additional burden, other than transition
costs to move to the new method, to
enter the data in a structured format
rather than attaching a copy of the
existing document.
b. Changes to Filing Exemptions and
Requirements for Small Plans Not
Eligible To File the Form 5500–SF
As discussed above, various oversight
and advisory bodies have identified a
significant need for better information
regarding employee benefit plan
investments, in particular regarding
plans invested in hard-to-value and
alternative investments. In that regard,
the Agencies are proposing a number of
changes for small plans that are not
Form 5500–SF eligible filers. First, the
Schedule I would be eliminated. Like
the Form 5500–SF, the Schedule I does
not require small plan filers to provide
detailed plan asset information. Since
small plan filers are the majority of
annual return/report filers overall
(taking into account both Form 5500–SF
and Form 5500 filers), this shortcoming
impairs the utility of the Form 5500
Annual Return/Report as a tool to obtain
a meaningful picture of small plan
investments in hard-to-value and other
assets. As the GAO has noted, the
limited financial information provided
on the Schedule I creates a challenge for
participants, beneficiaries, oversight
agencies, researchers, and other users of
the Form 5500 or Form 5500 data. GAO
Targeted Revisions Could Improve
Usefulness of Form 5500 Information, at
18. Accordingly, under the proposed
change, small plans that are not eligible
to file the Form 5500–SF and that
currently file the Schedule I would be
required to complete the Schedule H
and the applicable Line 4i Schedules of
assets. Small plans with simple
investment portfolios would not see a
significant increase in their annual
reporting burden. Although this would
result in additional reporting details for
those small plans with complex
portfolios that include hard-to-value or
alternative investments, the Agencies
believe that such small plans should
have more transparent financial
statements. In light of changes in the
financial environment and increasing
concern about investments in hard-tovalue assets and alternative
investments, the Agencies continue to
believe that requiring small plans
invested in such assets to report
separate financial information regarding
hard-to-value investments is important
for regulatory, enforcement, and
disclosure purposes. Although such
small plans would be required to
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complete the Schedule H instead of the
Schedule I, including the Line 4i(1) and
4i(2) Schedules of Assets, to minimize
increased burden, small plans that meet
the specified requirements, as they can
under the current rules, would continue
to be eligible for a waiver of the annual
examination and report of an
independent qualified public
accountant (IQPA) under 29 CFR
2520.104–46. As is currently the case,
under the proposal, all welfare plans
with fewer than 100 participants that
are required to file an annual return/
report are eligible for a waiver of the
annual examination and report of an
IQPA under 29 CFR 2520.104–46(b)(2).
The Agencies are also proposing to
change the rules for determining when
a plan is exempt from the requirement
to include an IQPA report with its filing.
In that regard, the Agencies are
proposing to add to the Form 5500 a
new question, for defined contribution
pension plans only, asking for the
number of participants with account
balances at the beginning of the plan
year. Defined contribution pension
plans would determine whether they
have to file as a large plan and whether
they have to attach an IQPA report
based on the number of participants
with account balances as of the
beginning of the plan year, as reported
on the face of the Form 5500 or Form
5500–SF. Currently, the IQPA
requirement is based on the total
number of participants (including those
eligible but not participating in a Code
section 401(k) or 403(b) plan) at the
beginning of the plan year. With the
changes in the reporting requirements
for small plans (for example, the
elimination of the Schedule I), this
would minimize burden, but would still
provide a picture of the types of
investments and fees of small plans
(plans with fewer than 100 participants
that have an account balance) without
requiring them to cover the cost of an
audit. For first plan year filings, the plan
would have to have fewer than 100
participants with account balances both
at the beginning of the plan year and the
end of the plan year.
The proposal would also require a
Schedule C to be filed by small pension
plans that are not eligible to file the
Form 5500–SF, small welfare plans that
provide group health benefits that are
not unfunded or insured (e.g., funded
using a trust), and other small welfare
plans that are not unfunded or insured
plans and are not eligible to file the
Form 5500–SF. Currently, only large
plans must file a Schedule C, thus
excluding a large portion of plans from
having to disclose service provider fees.
The Agencies recognize the burdens
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47549
small plans face in complying with
disclosure obligations, but requiring
certain small plans to file a Schedule C
would address some of the GAO’s
concerns that not all critical information
on indirect compensation is being
reported to the Agencies. See GAO
Targeted Revisions Could Improve
Usefulness of Form 5500 Information, at
25–26 (‘‘Given these various exceptions
to fee reporting requirements, Schedule
C may not provide participants, the
government, or the public with
information about a significant portion
of plan expenses and limits the ability
to identify fees that may be
questionable.’’). In addition, the rule
would better align financial information
reporting with recently adopted
disclosure rules to broaden the fees that
are reported by the affected plans. Id. at
50.
6. New Information on Employer
Matching Contributions, Employee
Participation Rates, and Plan Design for
Defined Contribution Pension Plans
The Agencies are proposing changes
that are intended to collect better
information on pension plan coverage
and performance as retirement savings
vehicles. The focus is on participantdirected defined contribution pension
plans, which are becoming the primary
source of retirement savings for many of
America’s workers. Specifically, the
proposal would add new questions to
the Form 5500, Form 5500–SF, and
Schedule R on participation,
contributions, and asset allocation by
age, and participant-level
diversification. The questions ask for
the number of participants making
catch-up contributions, investing in
default investment options, maximizing
the employer match, and deferring
compensation. Also, questions would be
added to the Form 5500 and Form
5500–SF to collect information on the
number of participants in defined
contribution pension plans with
account balances as of the beginning of
the plan year and on the number of
participants that terminated
employment during the plan year that
had their entire account balance
distributed. There are also new
questions about whether the plan uses
a default investment alternative for
participants who fail to direct assets in
their account and which type of
investment alternative is used.
7. Changes to Reporting on Schedule G
(Financial Transaction Schedules)
The proposal would reconfigure
Schedule G’s reporting to require more
uniform and detailed information on
loans, fixed income obligations, and
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leases in default, including swaps/
options and derivative transactions. By
creating specific data elements on the
existing Schedule G line items for plans
to identify specifically swaps and
options that would otherwise
generically have been reported as loans
or fixed income obligations in default or
uncollectible, the proposed Schedule G
is intended to provide a more complete
picture of issues of default,
uncollectibility, or conflict of interest
(nonexempt) transactions with respect
to plan investment in these types of
hard-to-value assets.
8. Re-introduction of Schedule E To
Improve Information on Employee Stock
Ownership Plans (ESOPs)
Prior to 2009, the Schedule E (ESOP
Annual Information) was an IRS
component of the Form 5500 Annual
Return/Report used to collect
information regarding ESOPs. As with
the other ‘‘IRS-only’’ schedules that are
part of the Form 5500 Annual Return/
Report, the Schedule E was removed
from the 2009 Form 5500 Annual
Return/Report when DOL mandated
electronic filing of the Form 5500
Annual Return/Report as part of
EFAST2 due to statutory limits on the
IRS’s authority to mandate electronic
filing of such information for filers of
fewer than 250 returns. A limited
number of the questions on the
Schedule E were moved to the Schedule
R beginning with the 2009 Form 5500
Annual Return/Report. The Schedule R
is not an ‘‘IRS-only’’ schedule nor were
the questions that were moved to the
Schedule R IRS-only. Accordingly,
filing of the current ESOP information
on the Schedule R was subject to DOL’s
electronic filing mandate under Title I
of ERISA.
The Agencies propose to bring back to
the Form 5500 Annual Return/Report a
revised version of the Schedule E,
which now generally would be required
reporting under both Title I of ERISA
and the Code and thus would be open
to public inspection. The new version
would include some of the questions on
the pre-2009 Schedule E, revisions to
other questions, and additional new
questions. The questions moved to the
Schedule R for the 2009 revisions would
be removed from the Schedule R and
instead be included on the new and
revised Schedule E. The Agencies
believe the use of a single schedule for
all ESOP questions would simplify the
filing of Form 5500 Annual Return/
Report for both ESOP and non-ESOP
filers. In addition, a single schedule for
ESOPs would also be a more effective
and efficient information collection tool
for the Agencies.
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The questions on the proposed
Schedule E are divided into sections
based on whether the ESOP stock was
acquired by a securities acquisition
loan, whether the stock is readily
tradable on an established securities
market (including stock acquired by
securities acquisition loans), whether
the ESOP has an outstanding securities
acquisition loan, and some
miscellaneous questions.
Part I of the proposed Schedule E
would apply only if the ESOP acquired
common or preferred stock with the
proceeds of a securities acquisition loan.
Several questions relate to the valuation
of the stock acquired by the ESOP and,
in particular, cases where a premium is
paid for a controlling interest in a
company where, in fact, a controlling
interest is not acquired. Questions
would also be included regarding the
release of common stock from a
suspense account and its allocation. For
example, a question would ask for the
method used when stock is released
from the suspense account (similar to
Line 5 of the 2008 Schedule E) in
accordance with Treasury regulations.
See 26 CFR 54.4975–7(b)(8). As with
Line 4 of the 2008 Schedule E, the
proposed Schedule E would also ask if
the ESOP holds preferred stock and
further ask for the method by which the
preferred stock is convertible into
common stock.
Part II of the proposed Schedule E
would ask questions related to
compliance issues when stock that is
not readily tradable on an established
securities market is acquired by an
ESOP. Specifically, with respect to each
acquisition of stock, the proposed
schedule would ask for information on
the relationship of the seller of the stock
to the plan or to the employer, and
whether the seller is a party-in-interest
or a disqualified person under the
prohibited transaction rules of Title I of
ERISA and the Code, respectively.
Further, the proposed schedule would
ask for the total consideration paid and
the date of the transaction. The
proposed schedule would also ask if the
stock was valued by an independent
appraiser and, if not, the identity of the
person who valued the stock. Lastly,
Part II would ask for the valuation
method(s) used to value the stock. Each
of these questions would assist the
Agencies in identifying possible issues
in the acquisition of stock, including
whether the stock was properly valued
and whether a prohibited transaction
may have occurred.
Part III of the proposed Schedule E
asks questions applicable to ESOPs with
outstanding securities acquisition loans.
Unlike the 2008 Schedule E which only
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asked whether the ESOP had a
securities acquisition loan, the proposed
Schedule E would ask for more
information regarding these loans. The
proposed schedule asks for basic
information regarding the amount and
date of the loan, as well as the interest
rate on the loan. In order to address
possible prohibited transactions and
situations where the ESOP may have
paid too much for the stock, the
proposed Schedule E also would ask for
the lender’s relationship to the plan and
the plan sponsor, whether the lender is
a disqualified person or a party-ininterest, and whether the loan was
guaranteed by a disqualified person or
a party-in-interest. Part III also would
ask questions regarding whether the
loan is in default and whether the loan
has been refinanced. A loan that is in
default raises issues as to whether the
plan sponsor is making substantial and
recurring payments to the ESOP and
whether the ESOP has been terminated,
in which case all of the ESOP shares
should be distributed.
Part IV of the proposed Schedule E
would include miscellaneous questions.
Specifically, to address compliance
concerns under Title I of ERISA, the
proposed schedule would ask whether
employee elective deferrals were used to
satisfy any securities acquisition loan.
With the exception of the elective
deferral question, which addresses a
DOL compliance issue and not an issue
under the Code, the Part IV questions
are carried over from the 2008 Schedule
E and continue to address significant
compliance issues under the Code,
including whether the amount of the
dividend is reasonable and whether the
requirements of 26 CFR 1.404(k)–3T are
satisfied. Specifically, the proposed
Schedule E would ask whether the
ESOP is maintained by an S corporation
and whether there are any disqualified
persons under Code section 409(p)(4)
(lines 1a and 1b of the 2008 Schedule
E), whether any unallocated securities
(or proceeds from unallocated
securities) were used to repay an
exempt loan (Line 6 of the 2008
Schedule E), and whether the plan
sponsor paid dividends deductible
under Code section 404(k) (Line 2b of
the 2008 Schedule E). This last question
is further broken down on the proposed
schedule to include information as to
the amount of the deduction, the
dividend rate, and whether the
dividends were used to reacquire stock
held by the ESOP.
As described above, several of the
questions on the proposed Schedule E
would be IRS-only questions. These
questions are subject to the electronic
filing rules imposed by Treasury
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regulations, but they are not subject to
the DOL electronic filing mandate. The
IRS-only questions would be identified
on the Schedule E itself or in the
Schedule E instructions. Accordingly,
although filers would be required to
answer most questions on the proposed
Schedule E electronically using
EFAST2, some filers who are not subject
to the IRS electronic filing requirements
and elect not to answer the questions
through EFAST2 would have the option
of answering the IRS-only questions on
the IRS’s Form 5500 SUP ‘‘Annual
Return of Employee Benefit Plan
Supplemental Information,’’ which is a
separate paper based IRS-only
information collection system
maintained by the IRS outside of the
EFAST2 system.
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B. Improve Fee and Service Provider
Transparency (Schedules C and H)
The Agencies continue to make efforts
to improve the reporting and disclosure
of service provider compensation. The
key focus of the proposed changes in
this regard is to harmonize Form 5500,
Schedule C, reporting of indirect
compensation with the disclosures
required under the DOL’s final
regulation under Title I of ERISA on
service provider compensation at 29
CFR 2550.408b–2. As discussed above
in the section on small plan reporting
changes, the proposal would also
expand Schedule C reporting to those
pension plans required to file the Form
5500, regardless of size.22 The current
Form 5500, Schedule C indirect
compensation reporting rules, including
the exception from reporting of ‘‘eligible
indirect compensation,’’ were
implemented for the 2009 forms. See 72
FR 74731 (Nov. 16, 2007). Those
changes were part of a three-pronged
regulatory initiative that included the
DOL’s plan-level disclosure regulations
under 29 CFR 2550.408b–2 and
participant-level disclosure regulations
under 29 CFR 2550.404a–5. At the time
the Schedule C rules were finalized, the
408b–2 disclosure regulations had not
yet been promulgated. Some elements of
the Schedule C, for example, the eligible
indirect compensation provisions, were
adopted in light of the fact that it was
not certain at the time what the 408b–
22 Form 5500–SF filers would not be required to
file the Schedule C, but small defined contribution
pension plans filing the Form 5500–SF, as well as
any defined contribution pension plans required to
file the Form 5500, Schedule H, would be required
to attach the comparison chart required to be
disclosed to participants and beneficiaries under
the DOL’s regulation at 29 CFR 2550.404a–5. Form
5500–SF filers also would continue to be required
to answer a question on total insurance fees and
commissions, that parallels the total insurance fee
and commission question on Schedule A.
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2 final rule would require. Those
provisions were also meant to respond
to concerns from the regulated
community, especially large service
providers with many ERISA-covered
plan clients, about having to create two
different record-keeping systems to meet
the various requirements of Form 5500
Annual Return/Report and 408b–2
disclosures should the later
promulgated 408b–2 provisions differ
from the Form 5500 Annual Return/
Report reporting requirements on
indirect compensation. With the service
provider disclosure rules now final at 29
CFR 2550.408b–2, the Agencies are
proposing various changes to the
Schedule C to better harmonize it with
the disclosure requirements under the
408b–2 final rule.
First, the Schedule C would be
changed to require reporting of indirect
compensation only for ‘‘covered’’
service providers and for compensation
that is required to be disclosed, as
defined in 29 CFR 2550.408b–2(c)(1).
The Agencies expect that this change
would improve Schedule C reporting
because it would essentially require the
pension plan administrator to report the
actual compensation paid to or received
by covered service providers based on
the expected compensation included in
the 408b–2 disclosures that the service
provider furnished to the plan as part of
the process of establishing and
maintaining the service contract or
arrangement with the plan. The
instructions similarly have been
clarified to track more closely the
language of the 408b–2 regulation.
In making this an across-the-board
Schedule C change to provide for
consistency in the annual return/report
requirements, the Agencies recognize
that the changes proposed to the
Schedule C would also apply to certain
welfare plans that are not subject to the
408b–2 regulation. The principal
consequence of the proposed changes
for those welfare plans is to narrow the
classes of service providers that would
be required to be reported and more
clearly define the types of compensation
that must be reported on the Schedule
C. Thus, we believe that the proposed
changes will be improvement for
welfare plan reporting.
Another key element of the proposed
changes to Schedule C consistent with
the final regulations at 29 CFR
2550.408b–2 is the elimination of the
reporting concept of ‘‘eligible indirect
compensation.’’ Under the current
reporting rules, the types of indirect
compensation that can be treated as
‘‘eligible indirect compensation’’ are
fees or expense reimbursement
payments charged to investment funds
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47551
and reflected in the value of the
investment or return on investment of
the participating plan or its participants,
finder’s fees, ‘‘soft dollar’’ revenue, float
revenue, and/or brokerage commissions
or other transaction-based fees for
transactions or services involving the
plan that were not paid directly by the
plan or plan sponsor (whether or not
they are capitalized as investment
costs). Under the current requirements,
rather than disclosing the identity of the
service provider and reporting
information about the services provided
and compensation received by the
service provider, the plan administrator
must merely confirm that the plan
received certain written disclosures that
describe: (1) The existence of the
indirect compensation; (2) the services
provided for the indirect compensation
or the purpose for payment of the
indirect compensation; (3) the amount
(or estimate) of the compensation or a
description of the formula used to
calculate or determine the
compensation; and (4) the identity of
the party or parties paying and receiving
the compensation. The GAO has been
critical of the concept of ‘‘eligible
indirect compensation’’ and other
limitations on Schedule C reporting of
indirect compensation received by plan
service providers. See GAO Private
Pensions: Additional Changes Could
Improve Employee Benefit Plan
Financial Reporting. In its response
published with that report, the DOL
generally agreed that reporting indirect
compensation on Schedule C should be
coordinated with the implementation of
new requirements in the then proposed
regulation under section 408(b)(2) of
ERISA. Part of the reason for the
concept of eligible indirect
compensation was the timing of the
move to the electronic filing system and
attendant forms changes relative to the
timing of the 408b–2 regulation. There
is no counterpart to ‘‘eligible indirect
compensation’’ under 29 CFR
2550.408b–2. In this regard, the
proposed Schedule C would eliminate
current Line 1 (which enables plans to
acknowledge that they had service
providers that received only eligible
indirect compensation). Current Line 2,
used for reporting both direct and
indirect compensation, would be made
new Line 1. To effectuate the
elimination of the ‘‘eligible indirect
compensation’’ reporting concept, there
would no longer be a corresponding
element to current Line 2(f), which asks
whether a listed service provider that
received other direct or indirect
compensation also received eligible
indirect compensation.
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In changing the reporting
requirements to better track the 408b–2
regulation, the Agencies recognize that
part of the reason for having developed
the concept of ‘‘eligible indirect
compensation’’ was concern expressed
by commenters that it would be difficult
to generate specific dollar amounts at
the plan level, especially in the case of
omnibus level charges. In that regard,
the proposed Schedule C instructions
borrow from instructions in the
Schedule A on determining plan-level
allocation of insurance contract fees and
commissions. Specifically, the Schedule
C instructions permit any reasonable
method of allocation to be used to
estimate plan level fees for the Schedule
C, provided the method is disclosed to
the plan administrator. This approach
provides a substantial amount of
flexibility for service providers in
determining the amounts to report. The
DOL invites comments on this proposed
method for plan level allocation of
indirect compensation generated at an
‘‘omnibus’’ level, including whether
there are particular types of indirect
compensation for which it would be
unduly expensive or burdensome to
report a dollar amount or estimate at the
plan level.
To further conform the Schedule C
reporting rules to the disclosure
requirements in 29 CFR 2550.408b–2,
filers would be required to report
‘‘covered’’ service providers who have
received $1,000 or more in total direct
and indirect compensation (i.e., money
or anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including
payments from participants’ accounts).
As on the current Schedule C, plans
would only need to report other service
providers (e.g., an accountant that
received only direct compensation) who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during
the plan year, including payments from
participants’ accounts.
To make reporting of the information
specific to each service provider more
straightforward, instead of having
repeating line items on Schedule C, the
proposal would have filers use a
separate Schedule C for each service
provider required to be reported. With
this formatting change, the proposed
Line 1 of the Schedule C generally
would retain the same identifying
elements as the current Line 2, with the
following changes. Similar to the
proposal to amend the regulation at
2550.408b–2, see 79 FR 13949, 13962
(Mar. 14, 2014), this proposal seeks to
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add to Schedule C a requirement to
report contact information for service
providers that are not natural persons.
Filers would be required to identify a
person or office, including contact
information, that the plan administer
may contact with regard to the
information required to be disclosed on
the Schedule C.
The proposal would also clarify and
expand the existing question that asks
the filer to indicate generally whether
the service provider has a relationship
to the employer, an employee
organization, or a person known to be a
party-in-interest. The proposal would
now state that filers should indicate any
relationship of the service provider to
the plan, for example, employer, plan
sponsor, plan sponsor employee, plan
employee, named fiduciary, employee
organization, and ‘‘Other,’’ with a
description. With the prevalence of
revenue sharing arrangements, the
Agencies believe that better information
on the relationship between service
providers and the plan, various
fiduciaries and parties-in-interest,
including relationships among plan
service providers, is important to
understand the relationship between
compensation and services to the plan.
Under the proposal, filers would be
required on Schedule C, as in the 408b–
2 disclosures for pension plans, to
indicate (by checking a box) whether the
service providers receiving
compensation are fiduciaries within the
meaning of section 3(21) of ERISA.
As noted in the GAO report, GAO
Private Pensions: Targeted Revisions
Could Improve Usefulness Of Form 5500
Information, some filers have expressed
confusion about how to answer the
current question which requires filers to
identify both service and fee codes in
the same line item, despite the
instruction that requires entering all
codes that apply. To address this
concern and to improve quality of the
data, the proposal clarifies the required
reporting on the types of services
provided and the types of compensation
received by individual service providers
by separating the existing compound
question into two separate reporting
elements, one line item to indicate
service codes and the other to indicate
compensation codes. To minimize both
burden and potential confusion, filers
would need to report service codes for
all service providers, regardless of the
type of compensation received, but
would only have to indicate
compensation codes for indirect
compensation.
A new service type would be added
for information technology/computer
support. ‘‘Information technology/
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computer support,’’ for the purposes of
Line 1c, would include computer office
automation, information processing,
local and wide area network support,
services supporting hardware, software,
telecommunications systems, including
automated telephone response systems
and systems security.
The proposed Schedule C instructions
would continue to permit filers to offset
from the total amounts of direct
compensation the amounts received
from a so-called ERISA recapture or
ERISA budget account or similar
account. Because filers are permitted to
report a net figure, however, it is not
possible to determine whether such an
account has been used. With the
increasing use of such accounts, see
generally Advisory Opinion 2013–03A
(Jul. 3, 2013), DOL believes it is
important for the Form 5500 to indicate
whether such accounts are being used as
part of the plan’s fee and revenue
sharing structures. The proposal thus
includes a ‘‘Yes’’/‘‘No’’ question on
Schedule C’s revised Line 1, to ask
whether any such account or
arrangement has been used by the plan
during the plan year.
The proposal would also add a
question asking whether the service
provider arrangement includes
recordkeeping services to a plan without
explicit compensation for some or all of
such recordkeeping services or with
compensation for such recordkeeping
offset or rebated in whole or in part
based on other compensation received
by the service provider, or an affiliate or
subcontractor. If so, the filer would be
required, using the same methodology
used in the service provider’s estimate
of the cost to the plan of recordkeeping
services, to enter as a dollar figure the
amount of compensation the service
provider received for recordkeeping
services. The Agencies believe that this
information will better enable a cost
comparison in an environment where
there are different fee structures and
methods of calculating compensation.
The proposed Line 1 would also
include a data element that asks
whether the service provider listed on
the Schedule C was also identified on
Schedule A as having received
insurance fees and commissions. Filers
are not required to report on Schedule
C insurance fees and commissions that
are already reported on Schedule A. The
question is designed to help users of the
Form 5500 Annual Return/Report data
identify service providers where some
fees and commissions are reported on
Schedule A and some on Schedule C.
In the proposed Line 2, filers would
report direct compensation paid to the
service provider by the plan. The
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Agencies considered having filers break
out payments as follows: Direct
payments by a plan out of a plan
account, charges to a plan forfeiture
account, charges to fee recapture
accounts, charges to a plan trust account
before allocations to individual
participant accounts, direct charges to
individual participant accounts, and
‘‘Other,’’ with a description. Rather than
requiring that detailed breakout on the
Schedule C, the Agencies concluded
that they could still obtain a better
picture of how the plan pays direct
compensation by instead adding a
breakout of how participant accounts
are charged to the Schedule H
‘‘Administrative Expense’’ line and
requiring information regarding
recapture accounts in the form of a
‘‘Yes/No’’ question on Schedule C.
On proposed Line 3, filers would
report the total amount of compensation
received by the covered service provider
identified in Line 1a in connection with
services provided to the plan from
sources other than the plan or plan
sponsor, including charges against plan
investments. The amount of
compensation reported would include
compensation received by an affiliate or
subcontractor in connection with the
services rendered to the plan, where the
compensation is reported as part of a
bundled service arrangement. Total
indirect compensation would now be
required to be reported as a dollar
amount. The Agencies recognize that
service providers accustomed to
disclosing fees by way of a formula may
not be able to quantify exactly the dollar
amount of the compensation received
during the plan year. Thus, although a
dollar amount would be required, the
proposal would permit reporting an
estimated dollar amount. If the dollar
amount is an estimate, the filer still
would be required to indicate that a
formula was used in determining the
actual compensation paid to or received
by the service provider. As with the
current Line 3, filers would continue to
identify the source(s) of the indirect
compensation received by the covered
service provider identified in Line 1,
and would also identify the type of fee
or compensation. For each source, filers
would be required to enter a dollar
figure or estimate of the amount of
compensation, and, if a formula was
used to calculate an estimate, a
description of the formula.
To increase overall fee transparency,
as well as to identify potential conflicts
of interest in related party transactions,
a new question would be added that
would require filers to indicate whether
the arrangement with each covered
service provider required to be reported
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on Schedule C involved any related
party compensation. If ‘‘Yes,’’ the filer
would be required to indicate the
services for which the compensation
was paid, the names of the payor(s) and
recipient(s) of such compensation,
status as an affiliate or subcontractor
(indicated by checkbox), and the
amount of the compensation.
To further ensure consistency
between 29 CFR 2550.408b–2 and
Schedule C, the proposed rule would
also modify the instructions. The
instructions, as proposed, would
increase the threshold for reporting nonmonetary compensation in Schedule C
from $100 to $250. A corresponding
change also would be made to the
Schedule A instructions for reporting
fees and commissions.
The proposed instructions also would
clarify the requirements for reporting
the travel or educational expenses of
plan employees or trustees, including
reimbursement, on both Schedule C and
Schedule H. This clarification is being
made in response to requests for further
guidance following the issuance of
Supplemental FAQs About the 2009
Schedule C (available at https://
www.dol.gov/ebsa/faqs/faq-sch-Csupplement.html). The FAQs state that
for Schedule C purposes, reportable
compensation includes money and
other things of value, such as gifts and
trips, received directly or indirectly by
a person from the plan in connection
with services rendered to the plan or the
person’s position in the plan. In
addition, they explain that
disbursements to a plan trustee for
transportation, lodging, meals, and
similar expenses incurred while
engaging in official plan business are
considered reportable compensation.
The requests for clarification argued that
the DOL should not treat as reportable
compensation expense reimbursements
that are not treated as taxable under the
Code by the IRS.
The DOL continues to believe that
getting information on the value of
trustee expenses, including expense
reimbursement, is important for
compliance purposes. It is persuaded,
however, that amounts that are not
taxable to the trustee need not be
identified as ‘‘indirect’’ compensation.
Therefore, the instructions would be
clarified to provide that trustee and
employee expense reimbursements are
required to be reported on Schedule C
only if the amounts are taxable
compensation for trustees or employees.
Should trustees receive from the plan
travel, education, conferences or similar
expenses, or reimbursements therefore,
that exceed the limits under the Code,
they would have to include them as
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threshold expenses for Schedule C and
include the ‘‘fee code’’ for
‘‘reimbursement’’ when identifying
trustee compensation. For reporting
those amounts paid for or reimbursed by
the plan regardless of whether they are
taxable to the trustee, a proposed new
breakout line item under the
‘‘administrative expenses’’ category
would be added to Schedule H to report
aggregate plan expenditures on trustee
travel, meetings, education and similar
expenses, whether paid directly by the
plan or as a reimbursement to trustees.23
Non-monetary compensation in the
form of travel, conferences,
entertainment, etc., provided by parties
other than the plan, that is not de
minimis, as defined in the instructions,
would continue to be reportable indirect
compensation.
The proposed Schedule C still would
ask filers to identify service providers
who fail or refuse to provide
information to the filer, including a
description of the information that the
service provider failed or refused to
provide. The instructions would
continue to provide that filers, before
identifying a fiduciary or covered
service provider as a person who failed
or refused to provide information on
indirect compensation, should contact
the fiduciary or service provider to
request the necessary information. For
these purposes, if a ‘‘covered’’ service
provider has failed or refused to provide
information regarding indirect
compensation, that service provider
would be presumed to meet the $1,000
reporting threshold.
The Agencies also continue to believe
that it is important to have filers
identify the termination of service
providers on the annual return/report.
That question, however, would be
moved to the Schedule H from the
Schedule C to associate it with a new
compliance question, described below,
asking whether any service providers
were terminated. Although it would be
moved to the Schedule H, the proposal
would remain substantially unchanged,
retaining the requirement to provide
information for all terminated
accountants and actuaries regardless of
the reason for termination because of
the importance of the involvement of
actuaries and accountants in the
preparation of the annual return/report.
The proposal would change the
questions to add a check box for the filer
to indicate whether it was an accountant
or actuary that was terminated. The
instructions for this section would also
23 The proposed question is similar to a question
that was on the Form 5500 prior to 1999. See 1998,
Form 5500, Line 32g(8).
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be updated to provide a ‘‘Tip’’ stating
that if the only reason for a change of
appointment of an enrolled actuary was
a temporary leave of absence due to
non-work circumstances of the enrolled
actuary, the filer would so indicate in
the ‘‘explanation’’ field.
Along with moving the existing
Schedule C question on termination of
actuaries and accountants to the
Schedule H, the proposal would also
add a question on the Schedule H
regarding the termination of any service
provider for a material failure to meet
the terms of a service arrangement or
failure to comply with Title I of ERISA,
including the failure to provide required
disclosures under 29 CFR 2550.408b–2.
Although not requiring identification of
all service providers in all
circumstances, the Agencies believe that
there are service providers other than
actuaries or accountants, such as
fiduciaries, recordkeepers, third party
administrators, and custodians who
play a sufficiently important role in
plan operations that information on
their termination is significant. The
Agencies specifically seek comments on
whether the proposed new question
should be limited to a narrower class of
service providers or specific termination
circumstances.
C. Better Quality, Accessibility, and
Usability of Data (Data Mineability)
Another key component of the
proposal is to make the Form 5500
Annual Return/Report more data
mineable and accessible for research,
policy analysis, and enforcement
purposes. EBSA is responsible for
collecting the Form 5500 Annual
Return/Report, in part, to fulfill the
statutory requirements under Sections
104 and 106 of ERISA, which require
that DOL make annual reports filed
under Title I of ERISA available to the
public. Section 504 of the Pension
Protection Act of 2006, Public Law 109–
280 (PPA), requires DOL to display
certain annual report information on the
Internet within 90 days after filing.
EBSA must also make the data from all
of the reports filed under Title I of
ERISA available to those seeking the
information under the Freedom of
Information Act (FOIA). EBSA fulfills
its FOIA responsibilities by making the
Form 5500 Annual Return/Report data
available for downloading in bulk (see
https://www.dol.gov/ebsa/foia/foia.html).
These bulk data files, which EBSA
updates at the end of each month with
the Form 5500 Annual Return/Report
data collected during that month, are
downloaded by private-sector
organizations that, in some cases, also
make the data available on the Internet.
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Thus, most returns/reports are currently
open to public inspection, and the
contents are public information subject
to publication on the Internet.
Mandatory e-filing, which was
implemented for the 2009 Form filing
year, starting January 1, 2010, has
changed both the regulated
community’s and the government’s
ability to use the Form 5500 Annual
Return/Report data. The data sets
developed from e-filing information has
been helping researchers, businesses,
and other plan professionals. The Form
5500 Annual Return/Report data sets
can be one of the major building blocks
for a private organization to use in
developing information for employees
and employers on plan administration.
In addition, the government can provide
much more timely and complete data as
a result of e-filing more cost effectively.
For instance, the data sets are posted on
the Internet and updated monthly. In
addition, the images of the filings
(facsimiles) and the scanned and
uploaded attachments are made
available at no cost to the requester. As
indicated in the White House Report of
the Task Force on Smart Disclosure, in
commenting on the Form 5500 Annual
Return/Report, ‘‘[s]mart disclosure is
also helping employers and employees
make decisions about 401(k) and other
workplace retirement plans. These data
sets can help employees better
understand their retirement options and
employers better understand the quality
of the plans they offer, with the help of
third parties that analyze the data.’’ Id.
at 13. The SEC has also acknowledged
the importance of innovative
approaches to data collection and use,
citing its enhanced data mining as the
basis for improvements in its
enforcement efforts. See New
Investigative Approaches and
Innovative Use of Data and Analytical
Tools Help Drive Successful
Enforcement Year, SEC, (available at
https://www.sec.gov/News/PressRelease/
Detail/PressRelease/1370543184660).
The Agencies generally plan to
continue the data publication processes
currently in place and provide an even
more robust Form 5500 Annual Return/
Report web-based search application.
This application would allow users to
develop more custom queries to better
target desired data. Further, this
enhanced dissemination service would
include options to download data in
various machine-readable and open
formats (such as Excel or comma
separated value [CSV] files), as specified
in the President’s Open Data policy.
Expanding the downloadable options
would facilitate researching and
comparing plan information. The
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dissemination could also support
predefined queries presented in a
dashboard format to graphically
illustrate individual plan performance
as well as performance in comparison to
plans of similar size or features. Part of
the goal of the proposal is to change the
structure of the data filed as part of the
Form 5500 Annual Return/Report in
order to facilitate those applications and
expand the use and usefulness of the
Form 5500 Annual Return/Report data
generally, as well as to make the Form
5500 Annual Return/Report a better
disclosure tool.24
1. Structured Data Attachments
A critical way in which the Agencies
propose to enhance the mineability of
the Form 5500 Annual Return/Report
data is by structuring and standardizing
the schedules required to be attached to
the form. Currently, for example, the
Line 4i attachments to Schedule H
(Schedule of Assets Held for Investment
at End of Year, Schedule of Assets
Disposed of During Plan Year and the
Schedule of Reportable Transactions)
cannot be searched electronically
because they currently are not filed in
a standardized electronic format. As a
result, policymakers, the Agencies, and
the public have difficulty accessing key
information about the plan’s
investments. The Agencies’ proposal to
standardize the Schedule H, Line 4i
Schedules of Investments is intended to
be responsive to the OIG’s
recommendation that the Agencies
create a searchable reporting format for
the Schedule H, Line 4i Schedules of
Assets and otherwise increase the
accessibility of Form 5500 Annual
Return/Report information, particularly
information on hard-to value assets and
multiple-employer plans. See DOL–OIG
EBSA Needs to Provide Additional
Guidance and Oversight to ERISA Plans
Holding Hard-To-Value Alternative
Investments, at 17. See also Private
Pensions: Targeted Revisions Could
Improve Usefulness of Form 5500
Information, at 37; see also U.S. Gov’t
Accountability Office, GAO–12–665,
Federal Agencies Should Collect Data
And Coordinate Oversight of Multiple
Employer Plans (2012), at 30.
24 The Agencies believe that the proposed
changes intended to improve the quality of the data,
for example, eliminating compound questions,
using simpler language, moving attachments into
text fields that show on the face of the form or
schedule when completed, and adding more
definitions and instructions, would also help make
the Form 5500 Annual Return/Report a more
readable disclosure document. The GAO has
recommended broadly that the Agencies work to
improve the clarity of required disclosures. See
generally GAO Private Pensions: Clarity of Required
Reports and Disclosures Could Be Improved.
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Other currently unstructured data or
new elements would also be collected as
structured data under the proposal,
including the lists of employers
participating in multiple-employer and
controlled group plan members required
to be attached to the Form 5500 Annual
Return/Report or Form 5500–SF; the
Schedule H, Line 4a Schedule of
Delinquent Contributions; and the Line
4j Schedule of Reportable Transactions.
The proposal also would eliminate the
instructions for Schedule A that permit
filing as an attachment ‘‘appropriate
schedules of current rates filed with the
appropriate state insurance department
or by providing a statement regarding
the basis of the rates in an attachment,
in lieu of completing information on
‘‘Contracts With Allocated Funds.’’ The
instructions would instead direct the
filer to enter a statement regarding the
basis of the rates into an open text field
on the Schedule A. Information on
contracts with allocated contracts would
therefore be completed on the Schedule
A as structured data. The Agencies
specifically invite comments as to
whether entering a statement in an open
text field on the Schedule A, relative to
attaching a rate schedule(s) or statement
regarding the basis of the rates, would
create a significant burden or make it
difficult to provide accurate
information.
2. Move Information Collection From
Attachments to Open Text Fields on
Face of Forms and Schedules
This proposal also increases the
accessibility of data by replacing some
of the attachments to the schedules with
text fields. Similar to the proposed
specific data elements for the Schedule
H Line 4i Schedules, which replace the
existing suggested format for an
unstructured attachment, the Agencies
believe that shifting to use of text fields
on the face of the schedules instead of
having information be supplied in nonstandard attachments concentrates
information on the Form 5500 and the
schedules and thus improves data
mineability. For the Schedule G
(Financial Transaction Schedules), the
nonspecific requirement to provide
‘‘detailed descriptions’’ in an open text
field, including a variety of elements to
report loans and leases in default or
uncollectible, has been replaced with
individual questions on each of the
elements originally required to be in the
detailed description. In addition,
attachments to the Schedule G in the
form of ‘‘Overdue Loan Explanation’’
and ‘‘Overdue Lease Explanation’’ for
loans and leases that are overdue or
uncollectible would be replaced with
open data fields on the face of the
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Schedule G. The purpose of these
changes would be to standardize the
information, to make the data less
subject to individual variation where
unwarranted, to simplify reporting on
the Schedule G transactions for filers,
and to make it easier to search and use
the data.
The Agencies also are proposing
expanded data elements on the actuarial
schedules (Schedules MB and SB),
including information previously
reported on PDF attachments. Under the
proposal, single-employer and
multiemployer plans that are currently
required to provide a Schedule of Active
Participant Data as a PDF attachment
would be required to input the data into
Schedules MB and SB. Supplemental
information required by enrolled
actuaries who have not fully reflected
regulatory requirements under ERISA or
the Code in completing the Schedule
MB or SB would be reported on the
schedules rather than on PDF
attachments. A number of questions on
the Schedule SB would be required to
be reported on the schedule rather than
on PDF attachments. This would
include reporting of information on the
plan’s late election to apply funding
balances to quarterly installments; an
adjustment to the amount of the credit
balance reported in the prior year in the
first year a plan is subject to the
minimum funding requirements of Code
section 430 or ERISA section 303; use of
multiple mortality tables and substitute
mortality tables; a change in nonprescribed actuarial assumptions and a
method change for the current plan
year; and a schedule of amortization
bases.
The Agencies also propose to
consolidate certain data reported on the
Schedule SB on PDF or other similar
attachments. The discounted employer
contribution PDF attachment would be
consolidated with the list of
contributions currently included on the
Schedule SB. Also, for plans in at-risk
status for the current plan year, the PDF
attachment describing the at-risk
assumptions for the assumed form of
payment would be consolidated with
the attachment describing the other
actuarial assumptions. Withdrawal
liability payments will be reported
separately from plan year contributions
on the Schedule MB. In addition, for
both Schedules SB and MB, the
schedule of all amortization bases
currently filed as a PDF attachment
would be consolidated with the
schedule of new amortization bases.
New questions would be added
requiring multiemployer plans and
single-employer plans that input data
into the Schedule of Active Participant
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47555
Data to report on the Schedules MB and
SB the average age of active
participants, and the average credited
service of active participants as of the
valuation date. Also, multiemployer
plans and single-employer plans that
have retired participants and
beneficiaries as of the valuation date
and terminated vested participants as of
the valuation date would be required to
input data into two new schedules on
Schedules MB and SB—the Schedule of
Retired Participants and Beneficiaries
Receiving Payment Data and the
Schedule of Terminated Vested
Participant Data. This information on
retired participants and beneficiaries
and terminated vested participants
would be reported according to age
bracket, but information would not be
required to be reported for an age
grouping consisting of 10 or fewer
participants. Additionally, all plans
would report the average age and
average in-pay annual benefit for retired
participants and beneficiaries receiving
payment. Plans with terminated vested
participants would report the average
age and average annual benefit, and
assumed form of payment and the
assumed first age of payment.
Expanding the data elements to
require that new information and
information previously reported on PDF
attachments be reported in a data
mineable format would allow for more
refined projections of the financial
positions of multiemployer and singleemployer plans. This is especially
critical for PBGC’s multiemployer
program, as well as for its singleemployer program. Information reported
in a data mineable format would also
facilitate more refined projections and
calculations for individual plans.
Computer programs could be written to
read the data and provide estimated
funding calculations and projections for
plans. This would provide information
essential to the Agencies’ enforcement
efforts and for their ability to target
plans with likely compliance issues.
Furthermore, the availability of the data
would assist private-sector auditors and
auditors in validating a plan actuary’s
calculations.
The data would also provide new
opportunities for research. Currently,
there is no source of system-wide data
on defined benefit pension plan
participants with age, service, and
average benefit levels. The availability
of such data would allow for more
refined projections of future coverage
and benefits adequacy for plan
participants and beneficiaries. As more
of this data is collected over the years,
the data could be analyzed to identify
trends in plan coverage and benefits.
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Also, proposed system-wide changes in
legislation and regulations could be
more effectively modeled.
As discussed in more detail below,
the Agencies also propose to allow the
plan actuary to sign Schedules MB and
SB electronically. The plan actuary can
access the EFAST2 Web site at
www.efast.dol.gov to register for
electronic credentials to sign or submit
filings.
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3. Plan Characteristics Codes and Other
Identifying Codes Replaced With Yes/
No Questions and Checkboxes on Face
of Forms
In addition, the use of ‘‘codes’’
appearing in the instructions would be
limited and refined to the extent
feasible. New ‘‘Yes’’/‘‘No’’ and check
box questions would replace most Form
5500 and Form 5500–SF questions that
currently require filers to list Plan
Characteristics Codes. These changes
are intended to refine how data will be
collected and overlay all of the other
changes being proposed here. On the
Schedule C, rather than entering,
multiple codes to identify both types of
fees/compensation and kinds of
services, the filer would check as many
boxes as are applicable to indicate all
types of services for each provider
identified. In another element that is for
reporting only sources of compensation
from parties other than the plan or plan
sponsor, filers will separately indicate
all types of fees/compensation. This is
intended to improve the quality of the
data, and make the Schedule C easier to
read from a disclosure perspective. It is
also intended to address concerns raised
by the GAO about the fee and service
codes. See GAO Private Pensions:
Targeted Revisions Could Improve
Usefulness of Form 5500 Information, at
27. Comments are specifically invited
regarding whether additional or
different types of services or fees should
be listed in order to improve the picture
of service providers to the plan.
4. Compound Questions Separated
The Agencies would separate out
reporting for the various types of direct
filing entities to make clearer what the
precise reporting requirements are for
each type of entity. They would also
clarify the instructions to the forms and
schedules by separating compound
questions. In this regard, the Agencies
recognize that putting one question on
each line rather than asking filers to
complete multiple subsections, while
streamlining the completion process,
would nevertheless make some
schedules appear longer, even though
no additional information is actually
required to be reported. This is
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particularly evident for Schedules C and
G, both of which currently contain
multiple compound questions.
5. More Detailed Identifiers,
Instructions, and Definitions
The proposal adds clarifying
definitions and instructions to improve
the consistency of responses. For
example, the proposal clarifies
conventions for identifying filers by
name and identifying number(s). The
proposal also requires plans to use legal
entity and other industry and regulatory
identifiers whenever possible. These
changes are intended to help the
Agencies compare plan participation,
investment options, and investment
performance from year-to-year. It should
also help mitigate confusion about the
legal entities with which the plan
transacts. These changes are intended to
address the concerns raised by the GAO
in recommending that ‘‘the Agencies
develop a central repository for
Employer Identification Numbers (EINs)
and Plan Numbers (PNs) for filers and
service providers to improve the
comparability of form data across
filings.’’ GAO Private Pensions:
Targeted Revisions Could Improve
Usefulness of Form 5500 Information, at
37.
The proposal would add more explicit
instructions, for example, on reporting
delinquent participant contributions
and completing the Line 4i Schedules of
Assets. In addition, because filers would
be asked to identify plan characteristics
and type through questions on the face
of the Form 5500/5500–SF instead of
using codes in the instructions, there are
proposed instructions for various
questions in this information category.
These definitional changes and
additions are intended to help ensure
that data would be reported consistently
and would be more accessible, thus
improving the usefulness of the data.
D. New Group Health Plan Reporting
Requirements and Information
The DOL proposes to expand
reporting to all employee benefit plans
providing group health benefits,
including plans that claim
grandfathered status and retiree-only
plans.25 Currently, generally most plans
25 All ‘‘group health plans’’ that meet the
definition in 733(a) of the Act, including plans that
claim ‘‘grandfathered’’ status under 29 CFR
2950.715–1251, would be required to file a Form
5500 and applicable schedules, including the
proposed Schedule J, regardless of whether such
plans are exempt from certain market reform
requirements under ERISA § 732(a) (exemption for
certain small group health plans that have less than
two participants who are current employees) or
ERISA § 733(c) (group health plans consisting solely
of excepted benefits). Employee welfare benefit
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that provide group health benefits that
have fewer than 100 participants meet
the conditions in existing regulations at
29 CFR 2520.104–20 to be exempt from
the requirement to file the Form 5500
Annual Return/Report because they are
fully insured, unfunded, or a
combination of unfunded and insured.26
Although there may be sources of
aggregate estimates regarding group
health plans, the current lack of plan
level information for employee benefit
plans that provide group health benefits,
especially those that have fewer than
100 participants, complicates not only
DOL’s ability to enforce regulations, but
also diminishes the effectiveness and
efficacy of EBSA’s ability to develop
health care regulations. The Affordable
Care Act also requires the Secretary of
Labor to provide Congress with an
annual report, see, e.g., ‘‘Self-Insured
Health Benefit Plans 2015,’’ 27
containing general information on selfinsured employee health benefit plans
and financial information regarding
employers that sponsor such plans. That
report is supposed to be based on data
contained in the Form 5500 Annual
Return/Report. However, as noted
above, many self-insured health benefit
plans currently are not required to file
annually with the DOL and, even for
those that do file, the Form 5500 Annual
Return/Report currently collects only
limited information.
To remedy this information gap,
under the proposal, all ERISA-covered
plans that provide group health benefits,
regardless of size, and regardless of
whether funded with a trust, unfunded,
or a combination unfunded/insured,
would be required to file a Form 5500
Annual Return/Report, including the
new Schedule J (Group Health Plan
Information), as well as any other
applicable schedules. However, small,
fully-insured group health plans would
plans as defined in ERISA § 3(1) that do not meet
the definition of ‘‘group health plan’’ under 733 of
the Act (i.e., they do not provide medical care) are
not subject to the proposed enhanced reporting
requirements applicable to group health plans.
26 ERISA 733(a) defines a ‘‘group health plan’’ as
‘‘. . . an employee welfare benefit plan to the extent
that the plan provides medical care (as defined in
paragraph (2) and including items and services paid
for as medical care) to employees or their
dependents (as defined under the terms of the plan)
directly or through insurance, reimbursement, or
otherwise.’’ (Emphasis added). ERISA 3(1) defines
an ‘‘employee welfare benefit plan’’ as ‘‘any plan,
fund or program which was . . . established or
maintained by an employer or by an employee
organization . . . to the extent that such plan, fund
or program was established or is maintained for the
purpose of providing for its participants or their
beneficiaries . . . medical, surgical, or hospital care
or benefits.’’
27 Available on the DOL’s Web site at: https://
www.dol.gov/ebsa/pdf/
ACASelfFundedHealthPlansReport2015.pdf.
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be required to only answer a limited
number of questions on the Form 5500
and the new Schedule J. The current
exemptions from financial reporting on
Schedule H, G, and C for insured plans,
unfunded plans, and plans that are
combination of unfunded/insured that
meet the requirements of 29 CFR
2520.104–44 would continue to apply
for all welfare plans, including group
health plans, regardless of size.28 The
current exemption from financial
reporting on Schedule G for welfare
plans that cover fewer than 100
participants as set forth in 29 CFR
2520.104–46 would also continue to
apply.
Currently plans that provide group
health benefits that have fewer than 100
participants that are not unfunded or
insured (e.g., funded using a trust) are
not exempt under 29 CFR 2520.104–20
from the requirement to file a Form
5500 Annual Return/Report and are not
exempt from the financial reporting
requirements under 29 CFR 2520.104–
44. These plans generally file either the
Form 5500–SF or the Form 5500 and the
Schedule H or Schedule I, including
financial and compliance information.
Under the proposed rule, plans that
provide group health benefits that have
fewer than 100 participants that are not
unfunded or insured (e.g., funded using
a trust) would be required to complete
the Schedule H (because Schedule I is
being removed and group health plans
are not permitted to use Form 5500–SF),
as well as Schedule C, if applicable.
However, unless such a plan is invested
in alternative or hard-to-value assets,
completing the Schedule H would only
modestly expand the current financial
and compliance reporting for the
affected small welfare plans. Requiring
reporting on Schedule H by these plans
with fewer than 100 participants that
provide group health benefits would
ensure that such plans are filing at least
as much financial and compliance
information as other small welfare plans
(those that do not provide group health
benefits) that are not unfunded or
insured (e.g., funded using a trust), for
28 Currently, welfare plans that are unfunded,
fully-insured, or a combination of unfunded and
insured are required to file the Form 5500,
including Schedule A ‘‘Insurance Information’’ if
applicable, but, under 29 CFR 2520.104–44, the
plan is not required to engage an independent
qualified public accountant and need not complete
Schedules C or H. The proposal would not change
these reporting provisions. Similarly, the exemption
in 29 CFR 2520.104–20 from filing any Form 5500
for fully insured, unfunded, or combination small
welfare plans that are not group health plans is also
not being changed in this proposal.
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which the reporting requirements
remain largely unchanged.29
As indicated above, small, fully
insured group health plans would be
required to answer only certain
questions on the Form 5500 and on the
Schedule J. This limited filing, which
would be similar in scope to the limited
pension plan reporting for plans
established under section 408 of the
Code that requires such plans to
complete certain Form 5500 questions
and no schedules, see, e.g., 2015 Form
5500 Instructions, Limited Pension Plan
Reporting, is intended to serve as an
annual registration statement with basic
identifying and insurance information.
The DOL considered whether to have
small, fully insured group health plans
file a separate registration statement
either annually or based on certain
events following the establishment of
the plan (e.g., initial, final, change in
insurance carrier). However, we believe
that it will be less burdensome to have
such plans file limited information
through EFAST2, using the Form 5500,
particularly for those small employers
that already use the system to report for
their pension plans. Comments are
specifically solicited in this regard.
In addition, sections 2715A and 2717
of the Public Health Service Act (PHS
Act), as added by the Affordable Care
Act, established new reporting
requirements for non-grandfathered
group health plans and health insurance
issuers offering non-grandfathered
group or individual health insurance
coverage.30 The DOL is considering
whether a group health plan could
satisfy its reporting obligations under
29 The proposal does not change the current
eligibility requirements for small welfare plans that
are not group health plans to use Form 5500–SF.
30 Section 2715A of the PHS Act extends the
transparency reporting provisions set forth in
section 1311(e)(3) of the Affordable Care Act
(applicable to issuers of ‘‘qualified health plans’’
offered through Exchanges) to non-grandfathered
group health plans and health insurance issuers
offering non-grandfathered group or individual
health insurance coverage. In particular, section
1311(e)(3) of the Affordable Care Act requires
disclosure of: claims payment policies and
practices, periodic financial disclosures, and
information on enrollment, disenrollment, number
of denied claims, rating practices, out-of-network
cost-sharing and payments, rights under title I of
the Affordable Care Act, and other information as
determined appropriate by the Secretary of Health
and Human Services Section 2717 of the PHS Act
requires non-grandfathered group health plans and
health insurance issuers offering non-grandfathered
group or individual health insurance coverage to
report on quality of care metrics, for example,
reporting on effective case management, care
coordination, chronic disease management, and
medication and care compliance initiatives.
Although sections 2715A and 2717 of the PHS Act
do not apply to grandfathered group health plans,
the proposal is to require all group health plans
subject to ERISA, including grandfathered group
health plans, to file Schedule J.
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PHS Act section 2715A and 2717, as
incorporated into section 715(a)(1) of
ERISA, by filing a completed Form 5500
and Schedule J, and providing that
information to the parties as required
under PHS Act section 2715A and 2717
(generally HHS, DOL, Treasury, State
insurance commissioners, enrollees and
the public).31 Much of the information
required to be reported under PHS Act
sections 2715A and 2717, for example,
data on enrollment, claims payment
policies and practices, and claims
denials is information that is to be
included in the proposed Schedule J. In
an effort to reduce duplicative reporting
and the attendant costs to plans subject
to ERISA, the DOL is specifically
soliciting comments on the feasibility of
such an approach as a means of
compliance with PHS Act sections
2715A and 2717 as incorporated into
section 715(a)(1) of ERISA.32
1. New Schedule J (Group Health Plan
Information)
The proposed Schedule J (Group
Health Plan Information) would report
information about group health plan
operations and ERISA compliance, plus
compliance with certain provisions of
the Affordable Care Act.33 Group health
plans that are part of a GIA and subject
to the exemption from filing under 29
CFR 2520.104–43 would not be required
to file the Schedule J. A GIA’s Form
5500 Annual Return/Report filing,
31 Nonfederal governmental plans (as defined in
PHS Act section 2791(d)(8)(C)) and health
insurance issuers (as defined in PHS Act section
2791(b)(2) and ERISA section 733(b)(2)) are not
required to file annual reports pursuant to ERISA
sections 103 or 104. Accordingly, any reporting
required of such plans and issuers to satisfy PHS
Act sections 2715A and 2717 will be addressed
separately by HHS in future rulemakings and/or
guidance.
32 Sections 2715A and 2717 of the PHS Act are
also incorporated into section 9815(a)(1) of the
Code. The Treasury Department and the IRS intend
to publish proposed regulations in 26 CFR 54.9815–
2715A and 54.9815–2717 clarifying that group
health plans required to file an annual report
pursuant to section 104 of ERISA that comply with
the reporting requirements in 29 CFR 2520.103–1
(including filing any required schedules to the
annual report) would satisfy the reporting
requirements of sections 2715A and 2717 of the
PHS Act, as incorporated in the Code. Group health
plans that are not required to file an annual report
pursuant to section 104 of ERISA but that are
subject to sections 2715A and 2717 of the PHS Act
as incorporated in the Code, will not be required
to do any reporting to comply with sections 2715A
and 2717 of the PHS Act, as incorporated in the
Code, unless and until the Treasury Department
and the IRS issue subsequent further guidance or
rulemaking regarding any such reporting by such
plans.
33 The Schedule J does not relate to the employer
shared responsibility provisions under section
4980H of the Code, the related reporting
requirements under section 6056 of the Code, or the
reporting requirements for providers of minimum
essential coverage under section 6055 of the Code.
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however, would have to include a
separate Schedule J for each group
health plan participating in the GIA.
The proposed Schedule J would
collect information on the
characteristics of the plan that is
providing group health benefits,
including the approximate number of
participants and beneficiaries covered
under the plan at the end of the plan
year, and the number of persons offered
and receiving coverage under the plan
through COBRA, Consolidated Omnibus
Budget Reconciliation Act of 1985 (Pub.
L. 99–272, 100 Stat. 82), 29 U.S.C. 1161,
et seq., whether the plan offers coverage
for employees, spouses, children, and/or
retirees, and what type of group health
benefits are offered under the plan, for
example, medical/surgical, pharmacy or
prescription drug, mental health/
substance use disorder, wellness
program, preventive care, vision, dental,
or various other types of benefits. With
respect to the collection of COBRA
coverage information, the DOL requests
comments regarding the costs and
feasibility of providing this data,
whether the proposed data elements
would effectively show the annual take
up rate and the total number of
participants electing COBRA coverage,
and whether any additional data
elements regarding COBRA coverage
would be helpful for the regulated
community to evaluate COBRA’s impact
on plans and participants.
The DOL also proposes that plans that
provide group health benefits provide
information on whether their health
plan funding and benefit arrangement is
through a health insurance issuer and
whether benefits are paid through a
trust or from the general assets of the
employer. Schedule J would also ask
whether there were participant and/or
employer contributions.34 With respect
to plans that use a prototype health
insurance policy or arrangement
(sometimes referred to as ‘‘off-the-shelf’’
plans/policies), the DOL is also
requesting that such plans provide, if
applicable, the relevant unique
identifying information (such as a state
assigned policy identification number)
of the prototype/off-the-shelf policy or
arrangement. The DOL requests
comments on this proposed data
element and whether there are specific
health insurance policy identification
systems employed by States or issuers
that would most accurately and cost
effectively provide information about
34 For purposes of Schedule J reporting,
‘‘participant contributions’’ include all elective
contributions under a cafeteria plan (arrangement
under Code section 125.).
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usage of such policies to provide plan
benefits.
Additionally, plans that provide
group health benefits are asked to report
whether one or more of the plan’s
benefit package options are claiming
grandfathered status under the
Affordable Care Act,35 whether the plan
is a high deductible health plan,36 a
health flexible spending account (FSA)
(or includes a health FSA as a
component), or a health reimbursement
arrangement (HRA) 37 (or includes an
HRA as a component). Please note that
due to PHS Act section 2711
(prohibition on annual dollar limits)
and 2713 (preventive services
requirements), HRAs that are subject to
the market reforms (that is, those that
cover two or more active employees and
do not consist solely of excepted
benefits) are considered to comply with
the annual dollar limit prohibition and
preventive service requirement if the
HRA is ‘‘integrated’’ with another group
health plan that complies with the
annual dollar limit prohibition and the
preventive services requirement.38
The proposed Schedule J also would
ask whether the plan received rebates,
refunds, or reimbursements from a
service provider such as a medical loss
ratio (MLR) rebate under the Affordable
Care Act and offset rebates from
favorable claims experience. If so, filers
would be required to report the type of
service provider, the amount received
and how the rebates were used (e.g.,
35 ‘‘Grandfathered’’ health plans generally are
those that were in existence on March 23, 2010, and
haven’t been changed in ways that substantially cut
benefits or increase costs for participants. For
regulations addressing grandfathered status, see 29
CFR 2950.715–1251.
36 A ‘‘high deductible health plan’’ is defined
under section 223(c)(2) of the Code and generally
is a plan that has a higher annual deductible than
a typical health insurance plan and a maximum
limit on the sum of the annual deductible and outof-pocket medical expenses that an enrollee must
pay for covered expenses.
37 An HRA typically consists of a promise by an
employer to reimburse medical expenses, including
insurance premiums, for the year up to a certain
amount, with unused amounts available to
reimburse medical expenses in future years. See IRS
Notice 2002–45.
38 An HRA is a group health plan and is subject
to the market reforms, including the prohibition of
annual dollar limits for essential health benefits and
the requirement to provide coverage of certain
recommended preventive services without cost
sharing. Regulations addressing these annual and
lifetime limit prohibitions state that a stand-alone
HRA offered to active employees violates these
prohibitions but that an ‘‘integrated’’ HRA does not
violate the annual limits prohibition, as long as
other group health plan coverage offered with the
integrated HRA complies with the market
requirements. See 80 FR 72192 at 72261 (Nov. 18,
2015) and DOL Technical Release 2013–03 (Sept.
13, 2013) for a description of the lifetime and
annual limit requirements applicable to HRAs,
including the ‘‘integration’’ requirements.
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returned to participants, premium
holiday, payment of benefits, or other).
In addition, the proposed Schedule J
would request that group health plans
identify any service providers to the
plan (not already reported on Schedule
A (Insurance Information) or Schedule C
(Service Provider Information)) by
providing the name, address, telephone
number, employer identification
number, and, if applicable, the National
Insurance Producer Registry—National
Producer Number (NPN) as established
by the National Association of Insurance
Commissioners (NAIC). Such service
providers include a third party
administrator/claims processor,
including an issuer subject to an
‘‘administrative services only (ASO)’’
contract, mental health benefits
manager, wellness program manager,39
substance use disorder benefits
manager, pharmacy benefit manager/
drug provider, or independent review
organization. Schedule J also asks for
the total premium payment made for
any ‘‘stop loss’’ coverage, as well as
information on the attachment points of
coverage, individual claim limits, and/
or the aggregate claim limit contained in
the policy.
For group health plans that are not
required to complete a Schedule H
(generally, fully insured, unfunded
plans, or combination insured/
unfunded plans), the proposal would
require that information regarding
employer and participant contributions
be reported on the Schedule J, including
employer contributions received,
participant contributions received,
employer contributions receivable,
participant contributions receivable,
other contributions received or
receivable (including non-cash
contributions) and the total of all
contributions. Filers would also be
required to report whether there was a
failure to timely transmit participant
contributions to the plan.
The proposed Schedule J also would
seek claims payment data, including
information on how many post-service
benefit claims (benefit claims) were
submitted during the plan year, how
many benefit claims were approved
during the plan year, how many benefit
claims were denied during the plan
39 A ‘‘wellness program’’ is defined in 29 CFR
2590.702(f) to include ‘‘any program designed to
promote health or prevent disease’’ and includes
programs that condition benefits (including costsharing mechanisms) or the premium or employer
contribution amounts on an individual satisfying a
standard that is related to a health factor as well as
those programs that do not include conditions for
obtaining a reward that are based on an individual
satisfying a standard that is related to a health
factor.
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year,40 how many benefit claim denials
were appealed during the plan year,
how many appealed claims were upheld
as denials, how many were payable after
appeal, and whether there were any
claims for benefits that were not
adjudicated within the required
timeframes. The proposed Schedule J
would also seek data on how many preservice claims were appealed during the
plan year, and how many of those
appeals were upheld during the plan
year as denials and how many were
approved during the plan year after
appeal. With respect to group health
plans, the DOL claims procedure
regulation subdivides claims for benefits
into various categories, including preservice and post-service claims. A preservice claim is defined as any claim for
a benefit under a group health plan with
respect to which the terms of the plan
condition receipt of the benefit, in
whole or in part, on approval of the
benefit in advance of obtaining medical
care. A post-service claim is defined as
any claim for a benefit under a group
health plan that is not a pre-service
claim. See 29 CFR 2560.503–1(m). As
used throughout this proposal, ‘‘claims’’
includes both pre-service and postservice claims.
In addition, plans would be asked to
report whether the plan was unable to
pay claims at any time during the plan
year and, if so, the number of unpaid
claims. Plans would also be asked to
report the total dollar amount of claims
paid during the plan year, and if the
plan provides benefits through an
insurance policy, to identify any
delinquent payments to the insurance
carrier within the time required by the
carrier, and whether any delinquencies
resulted in a lapse in coverage. The
proposal would add a similar question
to Schedule A; delinquencies identified
on Schedule A would not need to be
reported again on Schedule J.
In an effort to collect more robust data
on claims adjudication practices and
policies, the DOL is considering, in
40 A denial as referenced in this notice is given
the same meaning as ‘‘adverse benefit
determination’’ as defined in 29 CFR 2560.503–
1(m)(4). Accordingly, a denial or adverse benefit
determination is a denial, reduction, or termination
of, or a failure to provide or make payments (in
whole or in part) for, a benefit, including any such
denial, reduction, termination, or failure to provide
or make payment that is based on a determination
of a participant’s or beneficiary’s eligibility to
participate in a plan, and including, with respect
to group health plans, a denial, reduction, or
termination of, or a failure to provide or make
payment (in whole or in part) for, a benefit resulting
from the application of any utilization review, as
well as a failure to cover an item or service for
which benefits are otherwise provided because it is
determined to be experimental or investigational or
not medically necessary or appropriate.
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addition to the information requested in
the new Schedule J, whether to require
plans to report more information on
denied claims, such as the dollar
amount of claims that were denied
during the plan year, the denial code,
and/or whether the claims were for
mental health and substance use
disorder benefits or for medical/surgical
benefits. Proposed Schedule J requires
plans to report the dollar value of claims
paid during the plan year. Analyzing
this data in terms of claims adjudication
practices would be limited if the dollar
amount of claims denied during a plan
year is not also reported. The DOL
understands, however, that reporting
information on denied claims may
present definitional and data
classification challenges, e.g., possible
need for a more uniform classification of
denial codes for Form 5500 Annual
Return/Report reporting than may
currently be in place across plans and
issuers. In addition, there may be a need
to establish a uniform measure for
‘‘dollar amount,’’ for example, should it
be based on a provider’s point-of-service
fees, the schedule of fees the plan has
negotiated with service providers,
Medicare reimbursement rates, or statepublished prevailing fees, or some other
‘‘reasonable’’ method for determining
the dollar amount of denied claims.
Therefore, the DOL is specifically
seeking public comments on whether
this is reasonable information to collect
and, if so, the methodology a plan
would employ to determine and report
the ‘‘dollar amount of claims denied’’
during a plan year, denial code, and
type of claim. Further, as noted above,
the Notice of Proposed Rulemaking that
is being published with this Notice
includes proposed conforming
amendments in 29 CFR 2590.715–
2715A and 29 CFR 2590.715–2717 to
clarify that compliance with the
proposed annual reporting requirements
by plans subject to ERISA that provide
group health benefits would satisfy the
reporting requirements under PHS Act
sections 2715A and 2717 incorporated
in ERISA through ERISA section
715(a)(1). The DOL is specifically
seeking public comments in this Notice
on the proposed annual reporting
requirements for plans that provide
group health benefits, including the new
Schedule J, in light of the Supreme
Court’s recent decision in Gobeille v.
Liberty Mutual Insurance Co., 136 S.Ct.
936 (2016).
The proposed Schedule J would also
request compliance information from
plans providing group health benefits.
The proposed compliance section of the
Schedule J asks if all plan assets were
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47559
held in trust, held by an insurance
company qualified to do business in a
State, or as insurance contracts or
policies issued by such an insurance
company consistent with section 403 of
ERISA and 29 CFR 2550.403a-1 and
2550.403b-1, whether plan assets are not
held in trust based on reliance on
Technical Release 92–01, whether the
plan’s summary plan description (SPD)
and summaries of any material
modifications (SMM), and summary of
benefits and coverage (SBC) are in
compliance with the applicable content
requirements, whether coverage
provided by the plan is in compliance
with applicable federal laws and the
DOL’s regulations thereunder, which
may include the portability and
nondiscrimination provisions of the
Health Insurance Portability and
Accountability Act of 1996, Title I of the
Genetic Information Nondiscrimination
Act of 2008, the Mental Health Parity
Act of 1996, the Paul Wellstone and
Pete Domenici Mental Health Parity and
Addiction Equity Act of 2008, the
Newborns’ and Mothers’ Health
Protection Act of 1996, the Women’s
Health and Cancer Rights Act of 1998,
Michelle’s Law, and the Affordable Care
Act. The DOL believes that selfreporting compliance information will
help inform future compliance studies.
Furthermore, the DOL believes that the
inclusion of such compliance questions
will encourage plans to evaluate
whether or not they meet the group
health plan requirements of ERISA,
potentially increasing the voluntary
compliance by ERISA plans.
Finally, the DOL would move the
current questions on the Form 5500 that
ask all welfare plans to report on
whether they are subject to, and if so,
have complied with the Form M–1 filing
requirements, to the Schedule J.41 This
would limit these questions to welfare
plans that provide group health benefits.
Form 5500/Schedule J filers that must
file the Form M–1 would not be
required to answer on the Schedule J
those compliance questions answered
on the Form M–1.
41 Multiple Employer Welfare Arrangements that
provide health benefits must file the M–1 with the
Department. The M–1 questions, which would be
unchanged under the proposal, ask whether the
plan was subject to the Form M–1 filing
requirements during the plan year, whether the
plan is currently in compliance with the Form M–
1 filing requirements, and for the filer to provide
the Receipt Confirmation Code for the most recent
Form M–1 that was required to be filed under the
Form M–1 filing requirements.
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2. Limited Form 5500 Annual Return/
Report Reporting for Small, Fully
Insured Group Health Plans
The DOL proposes to eliminate the
current exemption from filing for small,
fully insured group health plans and
proposes to require only a very limited
Form 5500/Schedule J filing. As noted
above, the DOL has not previously
collected annual report data on small
welfare plans that qualify for the
exemption under the regulations at 29
CFR 2520.104–20. For small fully
insured plans that provide health
benefits, the DOL is proposing to
replace that exemption with a new
limited exemption as an alternative
form of reporting. Specifically, these
small plans would be required to
complete Lines 1–5, i.e. basic
identifying information, on the Form
5500, and Lines 1–8 on Schedule J, i.e.,
basic participation, coverage, insurance
company, and benefit information.
Requiring small, fully insured plans that
provide group health benefits to file
very rudimentary identifying and health
benefit and coverage information would
ensure that the DOL obtains basic
information on all ERISA covered group
health plans. Because these small, fully
insured group health plans are subject
to separate regulatory oversight
indirectly by reason of state insurance
regulation of the insurance provider and
insurance contract, the DOL is seeking
only basic plan and insurance
information to be filed annually and is
not seeking the broader Schedule J
annual information requested of small
self-insured and large plans regarding
plan administration and benefits.
This information would allow the
DOL to track total health plan counts,
and coordinate its enforcement efforts
relating to plans providing benefits
through common issuers. For example,
fully-insured plans using the same
insurance provider often have
documents containing provisions that
are similar. Through these new filings,
the DOL would be able to better identify
those plans that may be affected by
noncompliant provisions and better
coordinate its enforcement efforts with
affected service providers and other
Federal and State agencies. Also, this
information would enhance the DOL’s
policy analysis and research with
respect to participant trends.
E. Proposed Changes To Enhance
Compliance and Oversight
One of the critical purposes of the
Form 5500 Annual Return/Report is to
promote compliance both by requiring
plan administrators to review particular
aspects of plan operations in order to
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meet their annual reporting requirement
and by enabling the Agencies to review
basic plan compliance issues in an
efficient manner. Accordingly, the
Agencies propose adding a series of
compliance questions on the Form 5500
and on the Form 5500–SF, and also the
Form 5500–SUP for those filers who are
not subject to the IRS electronic filing
mandate in 26 CFR 301.6058–2 and
elect to answer these questions on a
paper return.
1. IRS-Only Changes
a. IRS-Only Questions for 2016 Plan
Years and Form 5500–SUP
For certain years prior to 2009, the
Schedules E, P, SSA, and T were
required to be filed to meet annual
return requirements under the Code and
IRS regulations, but they were not
information collections of the DOL or
the PBGC. The DOL electronic filing
mandate applied beginning with the
2009 Form 5500 Annual Return/Report
and resulted in the last of these ‘‘IRSonly’’ schedules being dropped from the
Form 5500 Annual Return/Report
because the IRS could not mandate that
these schedules be filed electronically.
As ‘‘IRS-only’’ schedules, they were not
covered by the DOL electronic filing
requirement. Accordingly, with the
exception of a limited number of
questions on the Schedule E that were
relocated to the Schedule R, the
questions on these schedules were no
longer included on the Form 5500
Annual Return/Report. The questions
were either eliminated altogether or, in
the case of questions on the Schedule
SSA, added to a new IRS form, Form
8955–SSA, Annual Registration
Statement Identifying Separated
Participants With Deferred Vested
Benefits. The 2011 TIGTA report, The
Employee Plans Function Should
Continue Its Efforts to Obtain Needed
Retirement Plan Information, notes that
the lack of information contained on
Schedules E, P, and T can negatively
impacts the IRS’s ability to effectively
focus on specific factors of
noncompliance when selecting
retirement plans for examination. This
lack of information may result in the
IRS selecting relatively compliant plans,
which increases the burden on these
plans and affects the IRS’s ability to
identify and focus on potentially
noncompliant plans. This could result
in participants receiving an incorrect
amount of benefits. The IRS has decided
to make changes to the Form 5500
Annual Return/Report to address these
issues.
The IRS added IRS-only compliance
questions to the 2015 Form 5500 and
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the 2015 Form 5500–SF, but
subsequently directed filers not to
answer the questions for 2015. The IRS
is modifying some of these questions
and intends to make these IRS-only
questions mandatory on the 2016 Form
5500 and Form 5500–SF. See the
Federal Register Notice ‘‘Proposed
Collection; Comment Request for the
Annual Return/Report of Employee
Benefit Plan’’ published by the IRS on
March 31, 2016 (81 FR 18687). Other
IRS-only questions may be added prior
to the form year in which the EFAST2
contract recompete and other forms
revisions are implemented. Regardless
of the timing of implementation of any
of the IRS-only questions on the annual
return, any comments received in
response to this notice with respect to
these questions will be considered in
future revisions of these forms.
The IRS added to the 2016 forms and
schedules various questions related to
common compliance problems that will
make it easier for the IRS to administer
the filing program. Two of the IRS-only
questions added for 2016 are questions
that were optional on the 2014 Form
5500 and 2014 Form 5500–SF. Both
2014 forms request information
regarding the preparer of the annual
return/report and the plan’s trust. IRS
intends that both the 2016 Form 5500
and the 2016 Form 5500–SF include a
box in the signature block of the form
for information regarding the preparer’s
name and address. Similarly, line 6 of
both Schedules H and I of the 2016
Form 5500 Annual Return/Report, and
line 14 of the 2016 Form 5500–SF,
would request information regarding the
name of the plan’s trust, the trust’s
employer identification number (EIN),
the name of the trustee or custodian,
and the trustee or custodian’s telephone
number. This information will enable
the IRS to more efficiently monitor the
compliance of the retirement plan trusts
exempt from tax under Code section
501(a).
The IRS also included several other
compliance questions on the 2016
Forms 5500 and 5500–SF that are
addressed in the 2014 Forms 5500 and
5500–SF and that require entry of plan
characteristics codes. The IRS has found
that characteristic codes result in
inadequate responses and are commonly
misunderstood by filers, and believes it
would be better to enhance these codes
with separate questions. For example,
the IRS replaced characteristic code 2J,
which identifies the plan as including a
cash or deferred arrangement under
Code section 401(k), with a line item on
the 2016 Forms 5500 and 5500–SF.
Similarly, Code 3D, a characteristic code
that currently applies to pre-approved
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pension plans, is replaced with a
separate line item on the 2016 Forms
5500 and 5500–SF.
The IRS also added two questions for
2016 that were questions on the
Schedule T, Qualified Pension Plan
Coverage Information, before it was
eliminated. Specifically, line 4b of the
Schedule T asked if the employer
aggregated plans in testing whether the
plan satisfied the nondiscrimination
and coverage tests of Code sections
401(a)(4) and 410(b). Also, line 4f of the
Schedule T asked whether the plan
satisfied the coverage requirements of
Code section 410(b) on the basis of
either the ratio percentage test or the
average benefit test. These questions
were added to the 2016 Forms 5500 and
5500–SF. These questions are helpful to
the IRS when performing pre-audit
analysis and allowed the IRS to narrow
any inquiries when information was
requested from the plan. The return of
these questions also reflects the
elimination of optional coverage and
nondiscrimination demonstrations in
the IRS determination letter process. See
Rev. Proc. 2015–6, 2015–1 I.R.B. 198
and Announcement 2011–82, 2011–52
I.R.B. 1052.
The IRS also added other IRS-only
questions to the 2016 Forms 5500 and
5500–SF in order to address various
compliance issues. Specifically, there
are new questions as to whether the
plan sponsor used the design-based safe
harbor rules, the current year ADP test,
or prior year ADP test for nonhighly
compensated employees in accordance
with 26 CFR 1.401(k)–2(a)(2)(iii) to
satisfy the nondiscrimination
requirements of Code sections
401(k)(12), (13). The IRS also added
questions as to whether the employer is
an adopter of a master and prototype
plan or a volume submitter plan that is
subject to a favorable opinion or
advisory letter from the IRS, and the
date of that favorable letter. This
question will help determine the plan’s
remedial amendment period and
remedial amendment cycle under Code
section 401(b) and Rev. Proc. 2007–44,
2007–28 I.R.B. 54 (as modified by Rev.
Proc. 2008–56, 2008–2 C.B. 826; and
Rev. Proc. 2009–36, 2009–2 C.B.304);
Notice 2009–97, 2009–2 C.B. 972; and
Notice 2010–48, 2010–27 I.R.B. 9. The
IRS added a similar question for
individually-designed plans as to
whether an individually designed plan
received a favorable determination letter
from the IRS. The IRS has found that
issues have arisen regarding the failure
of plan sponsors to make timely
amendments to their plan document to
reflect changes in the law.
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The IRS also added a question to the
2016 Forms 5500 and 5500–SF as to
whether any distributions during the
plan year were made to an employee
who attained age 62 and had not
separated from service for defined
benefit plans or money purchase
pension plans. The IRS has found
various qualification and taxability
issues related to such distributions.
Those filers who are required by the
electronic filing regulations to file the
Form 5500 Annual Return/Report
electronically will be required to answer
these IRS compliance questions
electronically using EFAST2 for the
2016 and later plan years. The IRS will
provide a paper-only form containing
these IRS compliance items for use by
filers who are not subject to the
electronic filing requirements of the
Treasury regulations and who elect not
to answer the questions through
EFAST2. A draft of the paper-only form,
Form 5500–SUP, Annual Return of
Employee Benefit Plan Supplemental
Information, was released for public
comment in October, 2014. The 2016
Form 5500–SUP is expected to be
modified to reflect the changes
proposed for 2016 plan year.
b. IRS-Only Questions for Later Plan
Years
In addition to the questions the IRS
included on the 2016 Forms 5500 and
5500–SF, the IRS proposes to add new
questions for later plan years. Some of
these additional questions were
previously included on the 2008
Schedule E (ESOP Annual Information).
Specifically, Line 1a of the 2008
Schedule E asked whether the ESOP is
maintained by an S corporation and, if
so, whether any prohibited allocations
were made to any disqualified persons.
Line 2b of the Schedule E asked
whether the employer maintaining the
ESOP paid dividends deductible under
Code section 404(k). Line 4 of the 2008
Schedule E asked if the ESOP held any
preferred stock and under what formula
that preferred stock was convertible into
common stock. Line 6 of the 2008
Schedule E asked if any unallocated
securities were used to pay an exempt
loan and, if so, asked for the method
used. Line 16 of the 2008 Schedule E
asked if the employer made payments in
redemption of stock held by an ESOP to
terminating participants and deducted
them under Code section 404(k). All of
these questions will be added to the
new Schedule E, ESOP Annual
Information. The IRS notes that any
questions added to the proposed
Schedule E with respect to Code section
404(k) will be included pursuant to
Code section 6047(e) rather than Code
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47561
section 6058 (the section pursuant to
which the other IRS-only question are
included on the Form 5500). Thus, the
disclosure rules of Code section 6104(b)
are not applicable and a separate
process will need to be in place so that
any information provided with respect
to Code section 404(k) will be compliant
with the appropriate disclosure rules.
The IRS also proposes to add three
questions to the Forms 5500 and 5500–
SF that will insure that the filers are
aware of certain Code requirements in
areas where the IRS has found
significant noncompliance. In the first
area, the IRS proposes to add a question
for defined benefit pension plans as to
whether the plans comply with the
participation requirements of Code
section 401(a)(26). In the second, the
IRS proposes to ask whether minimum
required distributions were made to 5%
owners in accordance with Code section
401(a)(9). This question addresses issues
as to the qualification of the plan, the
taxability of distributions, and the
possible imposition of excise taxes
under Code section 4974. In the third,
the IRS proposes to add a question as to
whether hardship distributions were
made during the plan year for a section
401(k) plan. The IRS has found various
qualification and taxability issues
related to such distributions.
The IRS also proposes to add a
question to the Forms 5500 and 5500–
SF as to whether the plan provides for
designated Roth contributions under
Code section 402A. The question would
identify plans that have added Roth
contribution features. Designated Roth
contributions and Roth conversions add
a new layer of recordkeeping and tax
reporting for plan administration, and
the IRS has found various issues related
to recordkeeping and reporting.
As noted previously, because the plan
characteristics codes sometimes provide
inadequate responses and are commonly
misunderstood by filers, the IRS
proposes to replace these codes with
separate questions to the Forms 5500
and 5500–SF. For example, the IRS
proposes to replace characteristic codes
2L and 2M regarding Code sections
403(b)(1) and 403(b)(7) arrangements
with separate line items. Also,
characteristic code 1I currently applies
to frozen defined benefit pension plans
that do not provide any new benefit
accruals as of the last day of the plan
year. Neither the Form 5500 nor the
Form 5500–SF, however, currently
requests similar information regarding
frozen defined contribution pension
plans. The IRS proposes to add a
question to these forms for defined
contribution pension plans asking
whether the plans are frozen.
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The IRS also proposes to add a line
item to the Forms 5500 and 5500–SF for
plans electing non-church plan status
under Code section 410(d). 26 CFR
1.410(d)–1(c)(3) provides that a plan
administrator may elect non-church
plan status by attaching a statement to
the Form 5500 Annual Return/Report.
Although such statements can be
attached to the EFAST2 filing as a PDF,
the proposed change would facilitate
the process by which the IRS
determines which plans have elected
non-church plan status and thus allow
the IRS to apply the appropriate criteria
in determining compliance.
There also is a new IRS question on
the Schedule H and Form 5500–SF
regarding unrelated business taxable
income (UBTI) under Code sections 511
and 512. Although qualified plans are
generally required to report UBTI on
Form 990–T, Exempt Organization
Business Income Tax Return, the IRS
has found it difficult to get timely
information regarding this taxable
income.
Lastly, a trustee’s signature would be
added in the trustee information section
on the Schedule H and the Form 5500–
SF. The signature is intended to satisfy
the requirements under Code section
6033(a) for an annual information return
from every Code section 401(a)
organization exempt from tax under
Code section 501(a). As discussed in
more detail below, because this is an
IRS-only signature, filers who file fewer
than 250 returns during the year will be
able to satisfy this signature requirement
by filing the Form 5500–SUP.
c. New Schedule for IRS-Only
Compliance Questions
As noted above, the IRS proposes to
add various IRS-only questions to the
Form 5500 Annual Return/Report and to
the Form 5500–SF and also issue a Form
5500–SUP for those filers who are not
subject to the IRS electronic filing
mandate in 26 CFR 301.6058–2 and
elect to answer these questions on a
paper return. These new IRS-only
compliance questions do not apply to
welfare plans. With respect to the Form
5500 and the Form 5500–SF, the IRS is
considering whether these questions
should be added to these forms
individually based on subject matter or
whether they should be added
collectively on a single IRS-only
schedule. If the questions are added
individually, they would appear on the
forms and schedules based on subject
matter. Thus, for example, ESOP
questions would appear on a new
Schedule E while other compliance
questions may appear on Form 5500–SF
and revised Schedules H, MB, R, and
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SB. On the other hand, if these IRS
compliance questions are added
collectively, they would appear on a
completely new IRS-only schedule.
Comments are specifically requested as
to whether a separate schedule that
would include all of the IRS-only
questions should be made part of the
Form 5500 Annual Return/Report
2. New Schedule H and Form 5500–SF
Compliance Questions
An area of particular recent focus for
DOL has been compliance with ERISA
section 411. Accordingly, the proposal
would add a new question under Part IV
of Schedule H asking whether any
person disqualified under ERISA
section 411 was permitted to serve the
plan. ERISA section 411 disqualifies
people who have been convicted of
certain crimes from serving as an
administrator, fiduciary, officer, trustee,
custodian, counsel, agent, employee,
consultant, or adviser of any employee
benefit plan for a specified period. The
statute also prohibits people who are
currently disqualified from representing
a plan in any capacity, and from having
any decision-making authority or
custody or control of the monies, funds,
assets, or property of an employee
benefit plan. This proposed question on
disqualification would facilitate
competent plan administration and
improve due diligence by encouraging
the plan administrator to determine
whether any of the plan’s fiduciaries,
employees, and service providers
potentially participated in an act
prohibited by ERISA section 411.
Another proposed compliance
question, which also supports the
Agencies’ goals in obtaining better
information on investments and related
fees for defined contribution pension
plans, involves whether the plan is a
participant-directed account plan, and,
if so, whether the plan provided
participants with the fee disclosures
required by 29 CFR 2550.404a–5. As
discussed earlier with respect to the
Form 5500–SF, the proposal also
requires administrators to attach the
comparison chart to Schedule H. These
questions would help plan
administrators comply with 29 CFR
2550.404a–5. This proposed question is
also responsive to the GAO’s
recommendation that the Agencies seek
specific information on QDIAs. GAO
Targeted Revisions Could Improve
Usefulness of Form 5500 Information, at
18. A plan that is a participant-directed
account plan also must report the
number of DIAs under the plan, the
number of DIAs that are index funds,
and whether a designated investment
manager (DIM) was made available to
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participants and beneficiaries. These
new questions appear on both Schedule
H and on the Form 5500–SF.
The proposal also would add a new
compliance question asking whether the
employer sponsoring the plan paid
administrative expenses that were not
reported as service provider
compensation on Schedule C or a plan
administrative expense on Schedule H.
Where the only compensation received
by a service provider in connection with
a plan is direct payment from the plan
sponsor, the information is not required
to be reported on Schedule C. To
minimize burden, while still providing
a clearer picture on the Form 5500
Annual Return/Report of all service
providers to plans, regardless of who
pays those service providers, the
Agencies are proposing only to ask
whether the plan has any such service
providers rather than require
identification and other Schedule C
information for such service providers.
The Agencies are requesting comments
on whether there should be a minimum
threshold compensation amount for this
question and, if so, what the amount
should be.
The proposal also would add a
question asking whether the plan
sponsor or its affiliates provided any
services to the plan in exchange for
direct or indirect compensation. This
information would help the Agencies
obtain a complete picture of the
relationship between the plan and the
plan sponsor, including the extent to
which the sponsor may also be acting as
a fiduciary or service provider. An
affirmative answer may indicate
potential conflicts of interest and would
be useful for DOL enforcement.
Another proposed compliance
question would require filers to indicate
whether the plan had any leveraged
investment acquisitions, the total
amount of those acquisitions, and the
ratio of the leveraged investments to
total plan assets. In addition to helping
ensure that the plan administrator has a
complete picture of the potential risk
and reward associated with the plan’s
assets, these questions would improve
the Agencies’ understanding of plan
operations. Plans with a high ratio of
leveraged investments, such as options,
futures, and margin-type investments,
may be at greater risk. By identifying
these plans, the Agencies would be
better able to target and track
performance of high-risk plans. This
question would only be added to the
Schedule H, and not the Form 5500–SF.
Leveraged investments are not ‘‘eligible
plan assets’’ for purposes of the Form
5500–SF. Small plans that have such
investments must file the Form 5500.
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In the existing section regarding the
IQPA report, filers would be required to
indicate whether the accountant orally
or in writing communicated various
governance issues discovered during the
audit, including errors or irregularities,
illegal acts, material internal control
weaknesses, and the existence of plan
qualification issues. This question is
intended to enhance compliance by
highlighting the existing duty of the
plan administrator to read and review
the audit report and, if necessary, to
engage in a discussion with the auditor
about the report’s contents. In addition
to helping the plan administrator ensure
that the audit is comprehensive, the
answers to these questions would
provide participants with information
about potential problems with the
management of plan assets. Also, in
situations where the plan administrator
reports that the auditor has identified
problems with the audit, the Agencies
would have an opportunity to conduct
a closer review of the plan’s finances.
In addition to the existing question
asking whether the IQPA has relied on
the limited scope audit provisions in 29
CFR 2520.103–8, the proposal would
require filers to attach the certification
of investment information created by
certain banks or insurance companies to
ensure the plan is qualified to be subject
to a limited scope audit. This change
would also encourage plan
administrators to maintain
documentation consistent with the
limited scope audit requirements. The
change is being made in conjunction
with revisions to the DOL’s regulation at
29 CFR 2520.103–8 to set forth specific
requirements for the attachment,
including the requirement that the
certification appear on a separate
document from the list of plan assets
covered by the certification, which list
generally would be required to be
reported on the Schedule H, Line 4i
Schedules of Assets, using the
structured data entry format through
EFAST.
The required attachment of the
proposed, updated certification would
also make the Agencies’ review of
limited scope audits more robust by
enabling them to follow up on plans
that use the limited scope exemption
but fail to attach the necessary
certification. See DOL–OIG: Changes
Are Still Needed in the ERISA Audit
Process to Increase Protections for
Employee Benefit Plan Participants at
17 (EBSA should improve the quality of
its audit documentation reviews by
adding procedures to ensure that ‘‘all
plan assets are either certified by a
qualifying financial institution or tested
by the IQPA’’). Obtaining the
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certification would also allow EBSA to
better determine which of the plan’s
assets are subject to a limited scope
audit and which require a full IQPA
report. Id. at 4 (‘‘EBSA’s review guide
did not specifically address audits in
which the plan custodian certified
some, but not all, plan assets in limited
scope audits.’’)
The Agencies also propose
standardizing information reported on
Schedule H, Line 4a, to foster filers’
compliance with regulations and
guidance governing delinquent
participant contributions and loan
repayments. Under the proposed
changes, filers would complete a
standardized, structured attachment that
includes information about whether the
correction of the delinquency was made
within or outside of the Voluntary
Fiduciary Correction Program (VFCP)
and Prohibited Transaction Exemption
2002–51. As under the current
requirements, filers must continue to
report the deficiency until correction is
made. The proposed changes also
facilitate accurate reporting by requiring
the delinquent contribution information
to be included in supplemental
schedules. Including such information
in supplemental schedules would help
ensure that IQPAs address delinquent
contributions and loan repayments in
their audit reports, consistent with
generally accepted auditing standards.
The proposal also includes new
questions on Schedule G (Financial
Transaction Schedules). To gather
additional information about the plan’s
transactions and relationships,
especially nonexempt prohibited
transactions, the Agencies propose
asking for more detailed information
about the nature of nonexempt
prohibited transactions engaged in by
the plan. In addition to the current
requirement to provide the name and
contact information for the parties
involved with the nonexempt
transaction, and their relationship to the
plan, employer, employee organization,
plan sponsor, or other party-in-interest,
the proposal asks filers to check a box
indicating the nature of the nonexempt
transaction. The check boxes generally
follow the prohibitions of ERISA section
406 and Code section 4975 and include,
for example, sale of any property to/
from the plan, exchange of any property,
lease of any property to/from the plan,
lending of money to/from the plan,
other extension of credit to/from the
plan, furnishing of goods to/from the
plan, etc. The proposal also asks a new
question about whether the transaction
is discrete or ongoing and whether the
transaction has been fully corrected,
either through or outside of the VFCP.
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The proposal also asks for the date the
transaction was fully corrected, a
description of the corrective action and
whether, if a nonexempt transaction
occurred with respect to a disqualified
person, and the person was notified, a
Form 5330 was filed with the IRS to pay
the excise tax on the transaction.
The proposal would add new line
items on Schedule A for reporting
whether any premium payments were
overdue and, if so, the amount
delinquent, and whether there was a
policy or contract reported on the
Schedule that was issued by an
insurance company wholly owned by
the plan or the plan sponsor. An
affirmative answer to questions on
delinquent premium payments and
whether the plans holds a contract
issued by an insurance company that is
wholly owned by the plan or plan
sponsor would alert DOL to potential
insurance cancellation and other
conflict of interest issues.
The DOL issued new guidance in
2015 regarding economically targeted
investments (ETIs) made by ERISAcovered retirement plans. ETIs are
investments that are selected for
benefits they create in addition to the
investment return to the employee
benefit plan investor. The DOL
previously addressed issues relating to
ETIs in Interpretive Bulletin 94–1, 29
CFR 2509.94–1 (IB 94–1) and
Interpretive Bulletin 2008–1, 29 CFR
2509.08–1 (IB 2008–1). IB 94–1 had
corrected a misperception that
investments in ETIs are incompatible
with ERISA’s fiduciary obligations. On
October 17, 2008, the department
replaced IB 94–1 with IB 2008–01.
However, the DOL concluded that in the
seven years since its publication, IB
2008–01 had unduly discouraged
fiduciaries from considering ETIs and
environmental, social and governance
(‘‘ESG’’) factors under appropriate
circumstances, and issued Interpretive
Bulletin 2015–01, 29 CFR 2509.2015–1
(IB–2015–1).
IB–2015–1 confirmed the DOL’s
longstanding view from IB 94–1 that
fiduciaries may not accept lower
expected returns or take on greater risks
in order to secure collateral benefits, but
may take such benefits into account as
‘‘tiebreakers’’ when investments are
otherwise equal with respect to their
economic and financial characteristics.
IB–2015–1 also acknowledges that ESG
factors may have a direct relationship to
the economic and financial value of an
investment. When they do, these factors
are more than just tiebreakers, but rather
are proper components of the fiduciary’s
analysis of the economic and financial
merits of competing investment choices.
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Changes in the financial markets,
particularly improved metrics and tools
allowing for better analyses of
investments, are enabling plan
fiduciaries to make better and more
evidence-based decisions on ETIs and
ESG factors in evaluating the merits of
competing investment choices. Some
private sector sources are developing
structured ESG research data for
evaluating corporate performance. The
DOL is interested in public comments,
including analysis on costs and benefits,
on whether collecting information
related to ETI and ESG investment
activities of ERISA-covered plans on the
Form 5500, such as whether plans
incorporate ESG factors into their
investment analysis, would add value to
this growing data source and allow
ERISA fiduciaries to more easily
consider the role ESG factors could or
should play in their investment
decisions. The DOL requests comments
regarding the best way to use the Form
5500 to collect information with respect
to ESG investment activities that is
standardized, comparable, and reliable
For example, public companies are
already subject to requirements to
disclose material risks, including
relevant risks associated with climate
change, per Securities and Exchange
Commission Interpretation: Commission
Guidance Regarding Disclosure Related
to Climate Change [Release Nos. 33–
9106; 34–61469; FR–82]. The DOL
specifically requests comments on
whether we could use the SEC
disclosure requirements for public
companies as a basis for a Form 5500
information collection.
3. Schedules MB and SB—New
Questions and Identifying Information
for Attachments
The Agencies are proposing to add
new questions to the actuarial schedules
(Schedules MB and SB) to enhance
compliance. On the Schedule SB,
reporting of the target normal cost
would be revised to separate out the
plan-related expenses. By requiring this
breakdown, the Agencies and other
users of Schedule SB data such as firms
conducting actuarial research would be
able to more accurately project
liabilities and future required
contributions.
The Agencies also propose to add a
new question to the Schedule SB to
require single-employer plans with 500
or more participants as of the valuation
date to report projections of expected
benefit payments to be paid for the
entire plan (not including expected
expenses) for each of the next ten plan
years starting with the plan year to
which the filing relates. For this
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purpose the plan would assume that
there were no additional accruals,
experience (e.g., termination, mortality,
and retirement) consistent with the
plan’s valuation assumptions, and that
no new entrants would be covered by
the plan. The requirement would not be
applicable to plans with fewer than 500
participants as of the valuation date.
This information would enable the
Agencies to determine how much of a
plan’s assets are needed to pay benefits
to participants. This information would
also help in assessing the adequacy of
current assets and contributions to
satisfy the disclosed benefit
commitments. In March 2015, PBGC
asked OMB to approve, and in June
2015, OMB approved adding a similar
question for the 2015 Schedule MB, to
be reported on a PDF attachment. The
Agencies are now proposing that the
question be added to the Schedule MB
itself.
4. Form 5500 and Form 5500–SF PBGC
Compliance Questions
For 2016, PBGC is proposing to add
a question to the existing question on
Schedules H and I, Line 5c, that asks, if
a plan is a defined benefit plan, whether
it is covered by the PBGC insurance
program. The new question would ask
filers that checked the box ‘‘Yes’’ to
enter the My PAA generated
confirmation number for the PBGC
premium filing for this plan year. In this
proposal, PBGC is proposing moving the
questions to the Form 5500 and Form
5500–SF. In comparing Form 5500
Annual Return/Report data to PBGC
premium filing data, the agency has
found PBGC-covered plans for which no
premiums have been paid and filers
incorrectly claiming that they have
PBGC-covered plans. By requiring
reporting of the My PAA generated
confirmation number on the Form 5500
and Form 5500–SF, PBGC will be better
able to match Form 5500 Annual
Return/Report filings to PBGC premium
filings, bring in new premium filings, as
well as improve the data collected on
the Forms. Also, for the 21st Century
initiative changes, the Agencies are
proposing to move Line 5c on Schedule
H and I to Line 9a(4) of the Form 5500
and Line 12a(4) of the Form 5500–SF.
The new question described above
about PBGC premium filings would be
added to these lines.
F. Miscellaneous Technical and
Conforming Changes for Forms and
Instructions
Various other technical and
conforming changes to the forms,
schedules, and instructions are being
proposed as part of the substantial
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restructuring of the Form 5500 Annual
Return/Report described in this notice.
Several of the more significant of these
changes are as follows.
On both the Form 5500 and the Form
5500–SF, filers that check the ‘‘singleemployer plan’’ box in accordance with
the instructions, but which have
multiple employers obligated to
contribute to the plan that are members
of a controlled group, would be required
to file an attachment identifying the
participating employers. This
requirement would be similar to the
requirement, effective with the 2014
annual return/report forms, to attach a
list of participating employers with a
good faith percentage of the
contributions to the plan of each
participating employer, for plans that
file as ‘‘multiple-employer’’ plans. To
implement ERISA section 103(g)
resulting from the Cooperative and
Small Employer Charity Pension
Flexibility Act (CSEC Act), Public Law
113–97, 128 Stat. 1101 (April 7, 2014),
the DOL published an interim final rule
in November 2014, 79 FR 66617 (Nov.
10, 2014). The DOL intends that the
CSEC Act reporting changes will be
made final effective with the
implementation of final forms revisions
following this proposal. Under the CSEC
Act interim final rule, filers that check
the ‘‘multiple-employer plan’’ box are
required to provide a list of
participating employers and a good faith
estimate of the percentage of total
contributions made by each
participating employer during the plan
year. The DOL received four comments
on the interim final rule and six
additional comments on an emergency
PRA submission published separately.
A central concern of the commenters
is that the list of participating employers
is essentially the client list developed
by entities that sponsor multipleemployer plans for professional
employer organizations (PEOs) or other
associations. The commenters asserted
that the publication of the participating
employer information could negatively
affect their business model by enabling
competitors to target client employers.
These commenters suggested that the
DOL could not implement the CSEC Act
law change by asking for the required
information to be reported on the Form
5500 because the list of employers is
proprietary information. Certain
commenters suggested, in the
alternative, that if the information was
required to be reported, it should not be
publicly disclosed. One commenter
suggested that the DOL should not
apply the requirement to defined
contribution or welfare plans because
the CSEC legislation focused on ERISA
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minimum funding requirements which
do not apply to the majority of defined
contribution pension plans or to any
group health and welfare plans. That
commenter suggested that the DOL
could instead obtain the participating
employer information through the use of
its subpoena authority or could limit the
requirement by providing an alternate
method of compliance. The commenter
also suggested allowing plans that are
multiple employer welfare arrangements
(MEWAs) that fund benefits through
VEBAs to satisfy the employer list
requirement by submitting the VEBA
information and either removing the
contribution requirement entirely or
clarifying that the filers need only
include gross contribution information
rather than break out the information by
employers and employees.42
The DOL has considered these
comments but has decided not to make
changes to the multiple-employer plan
reporting requirements described in the
interim final rule. The CSEC Act makes
provision of participating employer
information a reporting requirement
under section 103 of ERISA. Section
104(a)(1) of ERISA provides generally
that the contents of the annual report
must be open for public inspection. The
DOL continues to believe that the
reporting requirements made effective
for the 2014 form year by the interim
final rule are a reasonable and
appropriate way to implement
Congress’s directive in the CSEC Act.
Furthermore, the Agencies believe
that this information is important for
plan oversight, research, and
enforcement purposes. Because
participating employers generally are
not otherwise identified on the Form
5500 or its schedules,43 the Agencies
have no other information on the
number or identity of participating
employers in multiple-employer plans.
The Agencies also believe that similar
information would be helpful for
participating members of a plan that
covers members of a controlled group
that files under the reporting rules as a
‘‘single-employer’’ plan. Accordingly,
under the proposal, a new check box
would be added for a plan to identify
that it covers members of a controlled
42 The DOL notes that the CSEC Act reporting
requirements only apply to multiple-employer
plans and thus the requirement only applies to
those MEWAs that are in fact plans. Individual
plans participating in a non-plan MEWA must file
their own Form 5500 Annual Return/Report unless
otherwise exempt.
43 In a requirement added under the PPA, filers
are required to provide certain information on
Schedule R, for each employer that contributed
more than 5% of total contributions to a
multiemployer defined benefit pension plan during
the plan year (measured in dollars).
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group. Plans checking that box would be
required to provide the same basic
identifying and contribution
information as are multiple-employer
plans under the CSEC Act changes.
The Form 5500, as proposed, would
ask filers to identify and provide contact
information for the ‘‘named fiduciary’’
under ERISA section 3(21). The
Agencies note that as for any other
address and identifying information
required on the annual return/report,
named fiduciary addresses and phone
numbers (and those of the employer and
plan administrator) should be the actual
addresses and phone numbers for those
entities/individuals and not the address
of a service provider or entity that is
completing the filing. This has been an
area of inaccurate data entry as the
entity that fills out the form has not
always entered correct data in correct
boxes. As a result, the data is misleading
for participants and beneficiaries and
for the Agencies.
New breakout questions would be
added to both the Form 5500 and the
Form 5500–SF, for defined contribution
pension plans to report the number of
participants with account balances as of
the beginning of the plan year; the
number of participants that made
contributions during the plan year; and
the number of participants that
terminated employment during the plan
year that had their entire account
balance distributed.
The following new information would
also be required to be reported on the
Form 5500 or Form 5500–SF in the
questions that are intended to replace
the current plan characteristics code
structure:
1. The current requirement for
defined benefit pension plans to
identify whether the filing is for a frozen
plan would be extended to defined
contribution pension plans.
2. Defined contribution pension plans
would now be required to identify
whether the plan is a SIMPLE 401(k)
plan under Code sections 401(k)(11) and
401(m)(10).
3. Defined contribution pension plans
would now be required to identify
whether the plan has a designated Roth
feature.
4. Defined contribution pension plans
that have participant-directed brokerage
accounts would now be required to
enter the number of participants using
such accounts during the plan year.
5. Defined contribution pension plans
would have to indicate whether the plan
has an intended qualified default
investment alternative(s) (QDIA) and, if
so, to indicate the type(s) of
alternative(s).
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6. Pension plans would be required to
report if the plan is an eligible
combined plan under Code section
414(x).
7. Pension plans would be required to
report if a rollover from a plan was used
to start up the business sponsoring the
plan (a Rollovers as Business Start-Ups
or ROBS transaction).
8. Pension plans would be required to
report if the plan is electing church plan
status under Code Section 410(d).
9. Defined contributions pension
plans would be required to indicate
whether they provide financial
education and/or financial advice for
participants.
10. Plans would be required to report
if the plan provides long term care
insurance.
11. On the Form 5500, plans that
provide group health benefits would
have to indicate, more specifically,
whether they provide medical/surgical
benefits, pharmacy or prescription drug
benefits, mental health/substance use
disorder benefits, wellness program,
preventive care services, emergency
services, and pregnancy benefits.
The signature section on the Form
5500 would be revised to add a
checkbox to indicate whether the plan
is a Taft-Hartley plan and to provide a
dedicated signature area for both a
‘‘management’’ and a ‘‘labor’’ trustee.
In addition to the changes described
above, the Schedule A and its
instructions would be clarified to
specify that the plan is required to
report the insurance carrier’s NAIC
‘‘Company Code,’’ when reporting the
‘‘NAIC number.’’ Plans that provide
group health benefits through an
insurance contract would also be
required to provide the insurance
carrier’s required health plan
identification number (HPID) under the
Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
Schedule J would require filers to
provide the NAIC Producer Code if
there is a stop loss policy associated
with the plan’s obligation to pay health
benefits. The Agencies invite comment
on whether a particular NAIC type
number or other identifying number, as
well as the HPID, would be best to
produce the most consistent and
accurate identifier of insurance
companies required to be identified on
the Form 5500 Annual Return/Report.
On new Line 2 of the Schedule A,
plans would be required to report if the
policy or contract was issued by an
insurance company that is wholly
owned by the plan or the plan sponsor.
The current questions and
instructions on Schedule A for persons
covered under an insurance contract
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that reported on Schedule A would be
clarified and expanded. The
instructions are clarified to make
explicit that the existing requirement to
report the approximate number of
persons includes participants,
beneficiaries, and dependents covered
under the contract. For welfare benefit
contracts, the question has also been
particularized to require the
approximate number of persons covered
for each type of benefit.
To improve the data, there would be
new checkboxes on the Schedule A to
enable filers to indicate whether the
contract covered accidental death and
disability (AD&D) or long term care
insurance. The existing element on the
Schedule A to identify that plan assets
are in insurance company ‘‘pooled
separate accounts’’ would be broken
into ‘‘pooled separate accounts’’ and
‘‘other’’ separate accounts. If ‘‘other,’’
filers would be required to enter a
description of the separate account.
Plans that provide life insurance would
be required to indicate, on Schedule A,
whether a life insurance contract is
‘‘term life’’ or ‘‘other.’’ If the life
insurance contract is other than ‘‘term
life,’’ the filer would continue to have
to enter a description.
The Schedule C instructions with
regard to exceptions for reporting
employees whose compensation is less
than $25,000 would be clarified to
provide that, for Schedule C purposes,
compensation does not include the
employer portion of FICA and FUTA
taxes as part of the total compensation
of an employee. It does, however,
include salary, bonuses, overtime, and
all indirect compensation from persons
other than the plan received in
connection with the person’s position
with the plan or services provided to the
plan. As discussed above, the
instructions would be modified to
specify that expenses for travel,
education, conferences, meals, etc.,
whether paid directly by the plan or
reimbursed to the employee, have to be
included in determining total
compensation of plan employees, but
only if such payments would be
reportable as taxable income to the
employee.
As with similar clarifying changes to
Schedule C and the Schedule H, Line 4i
Schedules of Assets, plans would now
be required to report on Schedule A the
relationship to the plan, employer,
employee organization, sponsor,
fiduciary, or other party-in-interest of
the agent, broker, or other person to
whom commissions or fees were paid.
When reporting on Schedule A that
an insurance company failed to provide
the information needed to complete the
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annual return/report, if it is ‘‘fee and
commission’’ information that is not
provided, then filers would only need to
check a box to so indicate. Filers would
continue to have a place to describe
other types of information.
In addition to the changes described
above to the Schedule H, filers would be
required to report, in the existing
section on the IQPA report on the
Schedule H, the state in which the IQPA
report was issued.
The existing questions for Form 5500
Annual Return/Report filers to indicate
plan funding and benefit arrangements
would be added to the Form 5500–SF.
In response to the concerns of certain
practitioners regarding their ability to
comply with filing requirements where
PBGC has trusteed a plan and there is
no longer a plan administrator to
complete the filing or the ability to pay
a service provider for the work
necessary to fulfill the filing obligation,
the Agencies are proposing to simplify
the final filing requirements for plans
trusteed by PBGC that have 500 or fewer
participants.
Specifically, the question on whether
the plan has come under the trusteeship
of the PBGC would be moved from
current plan characteristic code 1H on
the Form 5500 and part of Line 4k on
the Schedule H and Line 13b on the
Form 5500–SF to a checkbox on Part I
of the Form 5500. Form 5500 Annual
Return/Report filers that, as of the date
the return/report is filed but not later
than the due date of the return/report
with automatic extension, have been
trusteed by PBGC under section 4041(c)
or 4042 of ERISA, would be required to
check that box and enter the date of
PBGC trusteeship in the space provided.
Plans with 500 or fewer participants
(see Part II, Line 6, asking for participant
count) that check this box would be
required to complete all of Part I and
Lines 1, 2, 3, 6, 9a(3) and 9a(4) of Part
II; this would be the last Form 5500
Annual Return/Report they would need
to file. Form 5500 Annual Return/
Report filers with plans with more than
500 participants (in Part II, Line 6)
would be required to complete the Form
5500 in the same manner as they have
in the past and would need to file a
Form 5500 for a following short plan
year (depending on when the plan was
trusteed).
Similarly, Form 5500–SF filers with
plans that, as of the date the return/
report is filed but not later than the due
date of the return/report with automatic
extension, have been trusteed by PBGC
under section 4041(c) or 4042 of ERISA,
would be required to check a box in Part
1A and enter the date of PBGC
trusteeship in the space provided. Plans
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Fmt 4701
Sfmt 4702
that check this box would be required
to complete all of Part I and Lines 1, 2,
3, 5 (if applicable), 6, 9a(3) and 9a(4) of
Part II.
The proposal to simplify final filing
requirements is limited to PBGCtrusteed plans with 500 or fewer
participants for a number of reasons.
PBGC generally needs the information
contained in the final annual return/
report to calculate its claims for
underfunding and unpaid minimum
funding contributions, to prepare its
financial statements, and to value
participant benefits. Larger plans tend to
have more complex asset structures and
include hard-to-value assets, while
smaller plans are more likely to lack the
resources needed to meet their actuarial
and filing obligations for the final plan
year and final short plan year. It has
been primarily representatives of small
plans that have contacted PBGC and
DOL to request relief from filing
requirements for PBGC-trusteed plans.
In PBGC’s experience, larger plans
usually comply with the filing
requirement for the final plan year and
the final short plan year. The companies
that maintain these larger plans
typically build the cost of plan
administration into their balance sheets,
even if the plan is terminated in an
involuntary or distress termination.
Moreover, in PBGC’s experience, for
most larger plans, the cost of filing the
annual return/report is paid from plan
assets. Even when paid by the plan
sponsor, PBGC believes that the cost of
filing for a larger plan is a relatively
insignificant component of the
sponsor’s overall business expenses.
PBGC also believes that exempting
larger plans from completing certain
schedules or sections of the annual
return/report would not result in a
meaningful cost savings to the plan
sponsor and could result in the inability
to compile important information in the
event that the plan is terminated. An
involuntary or distress termination
involves a complex actuarial and
economic analysis by PBGC that may
continue for a year or more and does not
always result in termination. The
process of preparing the annual return/
report continues through and beyond
the plan year. PBGC believes that
limiting the reporting obligations for
larger plans anticipating termination
might cause a plan to stop the ongoing
process that culminates with the filing,
even though a termination is not
ultimately approved. This would
significantly impair PBGC’s actuarial
and financial analysis for the ongoing
plan.
The Agencies also propose to accept
the electronic-signature by the plan
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actuary on the Schedules MB and SB,
and the electronic-signature by the plan
trustee for trust information on the Form
5500–SF and Schedule H. The plan
actuary or plan trustee can access the
EFAST2 Web site at www.efast.dol.gov
to register for electronic credentials to
sign or submit filings. If a plan actuary
or a plan trustee chooses not to sign
electronically, then the actuary or
trustee must sign the schedule or Form,
and an electronic reproduction must be
attached to the Form 5500 or Form
5500–SF. This electronic reproduction
must be labeled ‘‘Trustee Signature’’ for
trust information on the Schedule H or
Form 5500–SF, and ‘‘Actuary
Signature’’ for the plan actuary on the
Schedule MB or SB, and must be
included as a Portable Document
Format (PDF) attachment or any
alternative electronic attachment
allowable under EFAST2, if it is not
electronically signed.
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G. Electronic Filing of Certain IRS-Only
Forms
The Agencies propose to enable filers
to file IRS Forms 5500–EZ and 5558
through EFAST by creating an
electronic version of each of these
forms. The Agencies believe that the
anticipated increase in electronic filing
resulting from the creation of an
electronic version of these forms would
have various beneficial effects. For
example, the electronic filing of these
forms would benefit the filers and the
Agencies by reducing errors that are
more likely to occur during the manual
preparation and processing of paper
returns and reports. Electronic filing
also results in faster settling of accounts
and better customer service. See Private
Pensions: Targeted Revisions Could
Improve Usefulness of Form 5500
Information.
1. Form 5500–EZ
The Form 5500–EZ, Annual Return of
One-Participant (Owners and Their
Spouse) Retirement Plan, is generally
used by one-participant plans and
certain foreign plans to satisfy their
filing requirements with the IRS under
Code section 6058. The Form 5500–EZ
is currently filed on paper with the IRS.
Although the Form 5500–EZ cannot
currently be filed electronically, oneparticipant plans and foreign plans
(beginning with the 2014 plan year) may
elect to electronically file the Form
5500–SF using the EFAST2 system
instead of filing the paper Form 5500–
EZ with the IRS. One-participant plans
and foreign plans that file the Form
5500–SF rather than file the Form 5500–
EZ are required to complete only certain
lines on the Form 5500–SF. These lines
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are the same as, or are similar to, lines
on the Form 5500–EZ. Accordingly,
one-participant plans and foreign plans
filing the Form 5500–SF are required to
answer only those questions they would
have been required to answer if they
had filed the Form 5500–EZ. The IRS’s
electronic filing mandate regulation
described above applies to filers of the
Form 5500–EZ as well as to filers of
Form 5500 and Form 5500–SF. Oneparticipant plans and foreign plans that
file at least 250 returns during the
applicable calendar year generally are
therefore now required to file the Form
5500–SF electronically using the
EFAST2 system beginning with the
2015 plan year. See T.D. 9695, 79 FR
58256 (Sept. 29, 2014).
The IRS proposes to provide an
electronic version of the Form 5500–EZ
to be filed on the EFAST2 system. This
electronic version would be in addition
to the paper version. Accordingly,
except to the extent they are subject to
the electronic filing mandate, oneparticipant plans and foreign plans
subject to the filing requirements of the
Code would be able to elect to file either
the paper version of the Form 5500–EZ
with the IRS or file the electronic
version through EFAST2. These filers
would no longer be allowed to file the
Form 5500–SF. One-participant plans
and foreign plans that are required by 26
CFR 301.6058–2 to file electronically
would be required to file the electronic
version of the Form 5500–EZ.
Currently, less than 15 percent of oneparticipant plans file the electronic
Form 5500–SF instead of the paper
Form 5500–EZ. The IRS believes that
creating an electronic version of the
Form 5500–EZ to replace the Form
5500–SF for one-participant and foreign
plans would encourage these filers to
file electronically because they would
no longer need to deal with the longer
Form 5500–SF and its instructions. The
IRS further believes that filers would be
more likely to file an electronic Form
5500–EZ instead of a Form 5500–SF
because, unlike when filing the Form
5500–SF, they would not need to make
a separate determination as to which
questions to answer. As with any Form
5500–SF currently filed by a oneparticipant plan for purposes of the
Code, the information filed on the
electronic version of the Form 5500–EZ
on the EFAST2 system will not be
published by the DOL on the Internet.
2. Form 5558
Filers may currently obtain a one-time
extension of time to file a Form 5500
Annual Return/Report and a Form
8955–SSA, by filing IRS paper Form
5558, Application for Extension of Time
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47567
To File Certain Employee Plan Returns,
on or before the normal due date of the
return/report. The IRS proposes to
create an electronic version of the Form
5558 to be processed through EFAST2,
which would enable filers to use the
same system to request an extension
that they use to file Form 5500 Annual
Return/Report. The electronic filing of
this form would benefit the filers and
the Agencies by reducing errors that are
more likely to occur during the manual
preparation and processing of paper
returns and reports. Electronic filing
also results in faster settling of accounts
and better customer service. Under this
proposal, the paper Form 5558 would
continue to be filed with the IRS by
those filers who wish to file the Form
5558 on paper.
The Form 5558 is also currently used
for extensions of time to file Form 5330,
Return of Excise Taxes Related to
Employee Benefit Plans. It is anticipated
that the extension of time to file Form
5330 could not be filed electronically
using EFAST. The Form 5330 is used to
report various violations of the Code
related to retirement plans and requires
a payment of excise taxes to the IRS.
The instructions to the Form 5558 state
that any tax due to be paid under the
Form 5330 must be paid with the Form
5558 and that interest is charged on
taxes not paid by the due date even if
an extension of time to file is granted.
Accordingly, the IRS proposes to create
a new paper form for extensions of time
to file the Form 5330. It is anticipated
that this new extension form would
have provisions similar to those in the
Form 5558 to the extent they apply to
the Form 5330.
H. Regulations Relating to the Proposed
Form
As noted above, certain amendments
to the annual reporting regulations are
necessary to accommodate some of the
proposed revisions to the forms. The
DOL is publishing separately today in
the Federal Register proposed
amendments to the DOL’s annual
reporting regulations. That document
includes a discussion of the findings
required under sections 104 and 110 of
ERISA that are necessary for the DOL to
adopt the Form 5500 Annual Return/
Report, including the Form 5500–SF, if
revised as proposed herein, as an
alternative method of compliance,
limited exemption, and/or simplified
report under the reporting and
disclosure requirements of Part 1 of
Subtitle B of Title I of ERISA.
I. Paperwork Reduction Act Statement
As part of continuing efforts to reduce
paperwork and respondent burden, the
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general public and Federal agencies are
invited to comment on proposed and/or
continuing collections of information in
accordance with the Paperwork
Reduction Act of 1995 (PRA) (44 U.S.C.
3506(c)(2)(A)). This helps to ensure that
requested data will be provided in the
desired format, reporting burden (time
and financial resources) will be
minimized, collection instruments will
be clearly understood, and the impact of
collection requirements on respondents
is properly assessed. Currently, the DOL
is soliciting comments concerning the
proposed revision of the Form 5500
Annual Return/Report, which is an
information collection request subject to
the PRA. A copy of the ICR may be
obtained by contacting the person listed
in the PRA Addressee section below.
The DOL has submitted a copy of the
proposed forms revisions to the Office
of Management and Budget (OMB) in
accordance with 44 U.S.C. 3507(d) for
its review of the DOL’s information
collection. The IRS and the PBGC
intend to submit separate requests for
OMB review and approval based upon
the final forms revisions. The DOL and
OMB are particularly interested in
comments that:
• Evaluate whether the proposed
collection of information is necessary
for the proper performance of the
functions of the Agencies, including
whether the information will have
practical utility;
• Evaluate the accuracy of the
estimate of the burden of the proposed
collection of information, including the
validity of the methodology and
assumptions used;
• Enhance the quality, utility, and
clarity of the information to be
collected; and
• Minimize the burden of the
collection of information on those who
are to respond, including through the
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses.
Written comments must be submitted
to the office shown in the PRA
Addressee within 75 days of publication
of the Notice of Proposed Forms
Revision to ensure their consideration.
PRA Addressee: Address requests for
copies of the ICR to G. Christopher
Cosby, Office of Policy and Research,
U.S. Department of Labor, Employee
Benefits Security Administration, 200
Constitution Avenue NW., Room N–
5718, Washington, DC 20210.
Telephone: (202) 693–8410; Fax: (202)
219–4745; Email: ebsa.opr@dol.gov.
These are not toll-free numbers. ICRs
submitted to OMB also are available at
https://www.RegInfo.gov.
Type of Review: Revision of a
currently approved collection.
Agencies: Employee Benefits Security
Administration (OMB Control No.
1210–0110); Internal Revenue Service
(OMB Control No. 1545–1610); Pension
Benefit Guaranty Corporation (OMB
Control No. 1212–0057).
Title: Form 5500 Series.
Affected Public: Individuals or
households; Business or other for-profit;
Not-for-profit institutions.
Form Number: DOL/IRS/PBGC Form
5500 and Schedules.
Total Respondents: The total number
of annual Form 5500 filers will be
approximately 2.97 million.
Total Responses: See ‘‘Total
Respondents’’ Above.
Frequency of Response: Annually.
Estimated Total Burden Hours: 1.52
million.
Estimated Time per Response,
Estimated Burden Hours, Total Annual
Burden: See below for each Agency.
Total Annualized Costs: $667.7
million.
The Agencies’ burden estimation
methodology excludes certain activities
from the calculation of ‘‘burden.’’ If the
activity is performed for any reason
other than compliance with the
applicable federal tax administration
system or the Title I annual reporting
requirements, it was not counted as part
of the paperwork burden. For example,
most businesses or financial entities
maintain, in the ordinary course of
business, detailed accounts of assets and
liabilities, and income and expenses for
the purposes of operating the business
or entity. These recordkeeping activities
were not included in the calculation of
burden because prudent business or
financial entities normally have that
information available for reasons other
than federal tax or Title I annual
reporting. Only time for gathering and
processing information associated with
the tax return/annual reporting systems,
and learning about the law, was
included. In addition, an activity is
counted as a burden only once if
performed for both tax and Title I
purposes. The Agencies also have
designed the instruction package for the
Form 5500 Annual Return/Report so
that filers generally will be able to
complete the Form 5500 Annual Return/
Report by reading the instructions
without needing to refer to the statutes
or regulations. The Agencies, therefore,
have included in their PRA calculations
a burden for reading the instructions
and find there is no recordkeeping
burden attributable to the Form 5500
Annual Return/Report.
The DOL solicits comments regarding
whether or not any recordkeeping
beyond that which is usual and
customary is necessary to complete the
Form 5500 Annual Return/Report.
Comments are also solicited on whether
the Form 5500 Annual Return/Report
instructions are generally sufficient to
enable filers to complete the Form 5500
Annual Return/Report without needing
to refer to the statutes or regulations.
J. Paperwork and Respondent Burden
Estimated time needed to complete
the forms listed below reflects the
combined requirements of the IRS, the
DOL, and the PBGC. The times will vary
depending on individual circumstances.
The estimated average times are:
Pension plans
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Large
Form 5500 .....................................................................................................
Schedule A ....................................................................................................
Schedule MB .................................................................................................
Schedule SB .................................................................................................
Schedule C ....................................................................................................
Schedule E ....................................................................................................
Schedule G ...................................................................................................
Schedule H ....................................................................................................
Schedule R ....................................................................................................
Form 5500–SF ..............................................................................................
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
PO 00000
Frm 00036
Fmt 4701
1 hr, 52 min .............
2 hr, 55 min .............
8 hr, 27 min .............
6 hr, 38 min .............
3 hr, 28 min .............
3 hr, 18 min .............
13 hr, 51 min.
11 hr, 50 min ...........
1 hr, 54 min .............
..................................
Sfmt 4702
Small, ineligible for
5500–SF
1
2
7
6
3
3
hr,
hr,
hr,
hr,
hr,
hr,
20
55
28
49
20
18
min.
min.
min .............
min .............
min.
min.
8 hr, 12 min.
1 hr, 6 min.
..................................
E:\FR\FM\21JYP3.SGM
21JYP3
Small, eligible for
5500–SF
7 hr, 28 min.
6 hr, 49 min.
2 hr, 54 min.
47569
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
Welfare plans that include health benefits
Small, unfunded, combination
unfunded/fully insured, or funded
with a trust
Large
Form 5500 .......................................
Schedule A ......................................
Schedule C ......................................
Schedule G .....................................
Schedule H ......................................
Schedule J ......................................
Subset of Form 5500 and Schedule
J.
1 hr, 46 min ..................................
3 hr, 42 min ..................................
4 hr, 25 min ..................................
11 hr, 4 min.
12 hr, 46 min ................................
3 hr, 30 min ..................................
.......................................................
Small, fully-insured
1 hr, 15 min.
2 hr, 45 min.
4 hr, 25 min.
8 hr, 41 min.
3 hr, 30 min.
.......................................................
20 min.
Welfare plans that do not include health benefits
Large
Form 5500 .......................................
Schedule A ......................................
Schedule C ......................................
Schedule G .....................................
Schedule H ......................................
Form 5500–SF ................................
Small, ineligible for 5500–SF
1 hr, 46 min ..................................
3 hr, 42 min ..................................
4 hr, 25 min ..................................
11 hr, 4 min.
12 hr, 46 min ................................
.......................................................
Small, eligible for 5500–SF
1 hr, 15 min.
2 hr, 45 min.
4 hr, 25 min.
8 hr, 41 min.
.......................................................
2 hr, 54 min.
Direct filing entities
Master trusts
Form 5500 .........................
Schedule A ........................
Schedule C ........................
Schedule D ........................
Schedule G .......................
Schedule H ........................
CCTs
PSAs
103–12 IEs
1 hr, 51 min .............
2 hr, 56 min .............
3 hr, 43 min .............
45 min ......................
12 hr, 46 min ...........
12 hr, 19 min ...........
1 hr, 31 min .............
2 hr, 50 min .............
1 hr, 18 min .............
24 min ......................
..................................
11 hr, 47 min ...........
1 hr, 25 min .............
2 hr, 49 min .............
41 min ......................
17 min ......................
..................................
11 hr, 43 min ...........
1 hr, 42 min .............
2 hr, 53 min .............
2 hr, 41 min .............
33 min ......................
9 hr, 20 min.
12 hr, 16 min ...........
The aggregate hour burden for the
Form 5500 Annual Return/Report
(including schedules and short form) is
estimated to be 1.52 million hours
annually. The hour burden reflects
filing activities carried out directly by
filers. The cost burden is estimated to be
$667.7 million annually. The cost
burden reflects filing services purchased
by filers. Presented below is a chart
showing the total hour and cost burden
of the revised Form 5500 Annual
Pension plans
GIAs
1 hr, 29 min.
3 hr, 6 min.
1 hr, 52 min.
29 min.
12 hr, 1 min.
Return/Report separately allocated
across the DOL and the IRS. There is no
separate PBGC entry on the chart
because, as explained below, its share of
the paperwork burden is very small
relative to that of the IRS and the DOL.
Welfare plans
Total
Agency
Total
Large
DOL ...........................
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
IRS ............................
Hours 000s ...............
$MM ..........................
Hours 000s ...............
$MM ..........................
The paperwork burden allocated to
the PBGC includes a portion of the
general instructions, basic plan
identification information, a portion of
Schedule MB, a portion of Schedule SB,
a portion of Schedule H, and a portion
of Schedule R. The PBGC’s Estimated
Share of Total Form 5500 Annual
Return/Report Burden is: 1,300 Hours
and $1.6 million per year.
APPENDIX A
1. Form 5500—Annual Return/Report of
Employee Benefit Plan
2. Form 5500–SF—Annual Return Report of
Small Employee Benefit Plan
3. Schedule A—Insurance Information
VerDate Sep<11>2014
21:06 Jul 20, 2016
Jkt 238001
323
$80.4
196
$42.9
Small
251
$103.6
222
$111.3
Large
133
$118.2
12
$2.1
Small
294
$181.4
35
$16.9
4. Schedule C—Service Provider Information
5. Schedule D—DFE/Participating Plan
Information
6. Schedule E—ESOP Information
7. Schedule G—Financial Transaction
Schedules
8. Schedule H—Financial Information
9. Schedule H, Line 4a Schedule of
Delinquent Participant Contributions
10. Schedule H, Line 4i(1) Schedule of Assets
Held for Investment at End of Year
11. Schedule H, Line 4i(2) Schedule of Assets
Disposed of During the Plan Year
12. Schedule H, Line 4j Schedule of
Reportable Transactions
13. Schedule J—Group Health Plan
Information
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Sfmt 4702
Large
457
$198.6
208
$45.0
Small
545
$285.0
257
$128.2
DFEs
32
$6.4
18
$2.9
1,034
$490.0
484
$176.1
14. Schedule MB—Multiemployer Defined
Benefit Pension Plan Actuarial
Information and Certain Money Purchase
Plan Information
15. Schedule R—Retirement Plan Information
16. Schedule SB—Single Employer Defined
Benefit Pension Plan Actuarial
Information
Form 5500 (Annual Return/Report of
Employee Benefit Plan)
Part I Annual Report Identification
Information [Same As Current Part I Except
As Indicated]
For calendar plan year 20XX or fiscal plan
year beginning DD/MM/20XX and ending
DD/MM/20XX+1
E:\FR\FM\21JYP3.SGM
21JYP3
47570
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
A [Current A, Except as indicated in boxes
(3) and (5)] This return/report is for (check
the correct box; for DFE’s check the DFE
type):
(1) b a single-employer plan
(2) b a multiple-employer plan (not
multiemployer) (Filers checking this box
must attach a list of participating employer
information in accordance with the form
instructions)
(3) b [New] a plan for a controlled group
of corporations, a group of trades or
businesses under common control, or an
affiliated service group (see instructions)
(Filers checking this box must attach a list of
controlled group member information in
accordance with the form instructions)
(4) b a multiemployer plan
(5) b [Puts DFE checkboxes on face of
Form 5500 instead of entering ‘‘Codes’’ From
Instructions] a direct filing entity (DFE).
Check DFE type (see instructions):
b Master Trust
b CCT
b PSA
b 103–12 IE
b GIA
B [Current, Except Adds Box (5)] This
return/report is (check as applicable) (see
instructions):
(1) b the first return/report
(2) b an amended return/report
(3) b the final return/report
(4) b a short plan year return/report (less
than 12 months)
(5) b [Current PCC 1H and part of current
Schedule H, Line 4k for PBGC-trusteed plans
revised to include date of trusteeship] a plan
trusteed by PBGC.
Filers checking this box, enter date of
trusteeship. (Filers checking box B(5) for
plans that have 500 or fewer participants at
the beginning of the plan year need to
complete only certain line items on the Form
5500). (See instructions)
C [Current] If the plan is a collectivelybargained plan, check here b
D [Current] Check applicable box if filing
under an extension or through the DFVC
Program:
(1) b Form 5558
(2) b automatic extension
(3) b special extension (enter description)
(4) b the DFVC program
Part II Basic Plan Information Enter all
requested information. (You must use the
same plan/DFE name, PN, and EIN as in the
previous year’s annual return/report, except
as provided in Line 5.)
1a [Current] Name of Plan
1b [Current] Three-digit plan number (PN)
1c [Current] Effective date of plan
2a [Current] Plan sponsor’s name
(employer, if for a single-employer plan) and
address; include room or suite number, city
or town, state or province, country, and ZIP
or foreign postal code (if foreign, see
instructions)
2b(1) [Current] Plan sponsor’s Employer
Identification Number (EIN)
(2) [New] Plan sponsor’s legal entity
identifier (LEI) if available (see instructions)
2c [Current] Sponsor’s telephone number
2d [Current] Business code (see
instructions)
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
3a [Current] Plan administrator’s name and
address
[Current] b Check if same as Plan Sponsor
Name b Check if same as Plan Sponsor
Address
3b [Current] Administrator’s EIN
3c [Current] Administrator’s telephone
number
4a [New] Named Fiduciary’s name and
address (see instructions).
b Check if same as Plan Sponsor Name
b Check if same as Plan Sponsor Address
4b [New] Named Fiduciary’s EIN
4c [New] Named Fiduciary’s telephone
number
5 [Current Line 4, except as indicated] If
the name, EIN or LEI of the plan sponsor has
changed since the last return/report filed for
this plan, enter the name, EIN, LEI, and the
plan number from the last return/report:
5a Sponsor’s Name
5b(1) EIN
(2) [new] LEI if available
5c Plan Number
6 [Current Line 5] Total number of
participants at the beginning of the plan year
7 [Current Line 6, Except 7g(1), (3), and (4)
now added] Number of participants (welfare
plans complete only Lines 7a(1), 7(a)(2), 7b,
7c, 7d, and 7g(3)).
7a(1) Total number of active participants at
the beginning of the plan year
(2) Total number of active participants as
of the end of the plan year
7b Retired or separated participants
receiving benefits as of the end of the plan
year
7c Other retired or separated participants
entitled to future benefits as of the end of the
plan year
7d Subtotal. Add Lines 7a(2), 7b, and 7c.
7e Deceased participants whose
beneficiaries are receiving or are entitled to
receive benefits as of the end of the plan year
7f Total. Add Lines 7d and 7e
7g If you are filing for defined contribution
pension plan, you must complete Line 7g(1)–
(4). Welfare plans complete only Line 7g(3).
Defined benefit pension plans skip to Line
7h.
(1) [New] Number of participants with
account balances as of the beginning of the
plan year
(2) [Current Line 6g] Number of
participants with account balances as of the
end of the plan year
(3) [New] Number of participants that
made contributions during the plan year
(4) [New] Number of participants that
terminated employment during the plan year
that had their entire account balance
distributed as of the end of the plan year
7h Number of participants that terminated
employment during the plan year with
accrued benefits that were less than 100%
vested:
8 [Current Line 7] Enter the total number
of employers obligated to contribute to the
plan (only multiemployer plans complete
this item)
9a [Current Line 8 Plan Characteristics
Codes Entered In A List From Instructions
Now Separate Questions on Face of Form]
Check the appropriate box to indicate the
type of plan. If the plan provides pension
benefits, answer the applicable 9a questions
PO 00000
Frm 00038
Fmt 4701
Sfmt 4702
below. See the instructions for additional
details. (Plans that provide only welfare
benefits check the box for ‘‘Welfare plan’’
and then skip to question 9b.)
b [New] Defined benefit pension plan
b [New] Defined contribution pension plan
b [New] Welfare plan
9a(1) Check the appropriate box(es) to
indicate how the benefits are calculated
(Defined benefit pension plans only)
b [Current PCC 1A] Benefits are primarily
pay related
b [Current PCC 1B] Benefits are primarily
flat dollar (includes dollars per year of
service)
b [Current PCC 1C] Cash balance plan
b [Current PCC 1C] Pension equity plan
(PEP)
b [Current PCC 1C] Other hybrid plan
b [Current PCC 1D] Floor-offset plan
9a(2) Does your plan have any of the
Internal Revenue Code arrangements listed
below? (Defined benefit pension plans only).
Yes b No b
If ‘‘Yes’’, check all that apply.
[Current PCC 1E] b Code Section 401(h)
arrangement
[Current PCC 1F] b Code Section 414(k)
arrangement
9a(3) [Current PCC 1H] Is this a defined
benefit pension plan that was terminated and
closed out for PBGC purposes? (See
instructions.)
Yes b No b
9a(4) [Current Schedule H, Line 5c,
revised to add a new sentence at the end on
PBGC premium filings. For 2016, PBGC
proposed that the new sentence be added to
Line 5c of the Schedule H] If the plan is a
defined benefit pension plan, is it covered
under the PBGC insurance program (see
ERISA section 4021)?
b Yes b No b Not determined
If ‘‘Yes’’ is checked, enter the My PAA
confirmation number from the PBGC
premium filing for this plan year. (See
instructions.)
9a(5) [Current PCC 1I] Is this a frozen
pension benefit plan? (Both defined benefit
and defined contribution pension plans must
answer this question.)
b Yes b No
9a(6) [Current PCC 1D and 2D; new
requirement to enter name of other plan or
arrangement] Are plan benefits subject to
offset for retirement benefits provided in
another plan or arrangement of the employer?
b Yes b No
If ‘‘Yes’’ enter name, EIN, and LEI of the
sponsor and PN of the other plan or
arrangement
9a(7) If this is a defined contribution
pension plan, indicate the type(s) of plan
(check all that apply):
b [Current PCC 2E] Profit-sharing plan
b [Current PCC 2I] Stock bonus plan
b [Current PCC 2C] Money purchase plan
b [Current PCC 2B] Target benefit plan
b [Current PCC 2D] Offset plan
9a(8) If this is a defined contribution
pension plan, check the appropriate box(es)
to indicate the type(s) of arrangements under
E:\FR\FM\21JYP3.SGM
21JYP3
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
which the plan operates for purposes of the
Code (check all that apply):
b [Current PCC 2J] Code section 401(k)
arrangement
b [Current PCC 2K] Code section 401(m)
arrangement
b [New] SIMPLE 401(k) plan under Code
sections 401(k)(11) and 401(m)(10)
b [New] Safe harbor 401(k) plan under Code
sections 401(k)(12) and 401(m)(11)
b [New] Safe harbor 401(k) plan using
automatic contribution arrangements
under Code sections 401(k)(13) and
401(m)(12)
b [Current PCC 2N] Code section 408
accounts or annuities
b [Current PCC 2L] Code section 403(b)(1)
arrangement
b [Current PCC 2M] Code section 403(b)(7)
arrangement
9a(9) If this is a defined contribution
pension plan, check all the appropriate
box(es) to indicate all type(s) of features your
plan has.
b [Current PCC 2S] Automatic Enrollment
b [New] Designated ROTH
b [Current PCC 2A] Age/service weighted or
new comparability or similar plan
b [New] Financial education for participants
b [New] Financial advice for participants
b [New] Other (specify)
9a(10) Is this a participant-directed defined
contribution pension plan? b Yes b No
If ‘‘Yes,’’ check all that apply:
b [Current PCC 2F] ERISA section 404(c)
plan
b [Current PCC 2G] Total participantdirected account plan
b [Current PCC 2H] Partial participantdirected account plan
b [Current PCC 2R] Participant-directed
brokerage accounts.
If you check this box, enter the number of
participants using the participant-directed
brokerage account(s)
9a(11) [Current PCC 2T; new breakouts to
indicate types of default accounts] Does the
plan have default investment alternatives
that are intended to be qualified default
investment alternatives (QDIA) (see
instructions) for participants who fail to
direct assets in their account?
b Yes b No
If ‘‘Yes,’’ check all applicable boxes to
indicate type(s) of QDIA.
b Target date/life cycle fund
b Fixed income
b Money market or equivalent (under 29 CFR
2550.404c–5(e))
b Balanced fund
b Professionally managed account
b Other (specify)
9a(12) [New] Is this an Eligible Combined
Plan under Code section 414(x)?
b Yes b No
9a(13) [New] Check this box if a rollover
from a plan (including an individual
retirement plan) was used to start up the
business (ROBS) sponsoring this plan: b
9a(14) If this is a profit sharing or money
purchase plan combined with an ESOP, or a
plan requiring that all or part of employer
contributions be invested and held, at least
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
for a limited period, in employer securities
check all that apply. (You must attach a
Schedule E if the plan is an ESOP or has
ESOP features).
b [Current PCC 2P] Leveraged ESOP
b [Current PCC 2O] ESOP other than a
leveraged ESOP
b [Current PCC 2Q] ESOP of an S
corporation
b [Current PCC 3I] Other plan requiring that
all or part of employer contributions be
invested and held, at least for a limited
period, in employer securities
9a(15) Other Pension Benefit Features
(Check all that apply):
b [Current PCC 3D; 2016 Schedule R Line
17a] IRS Pre-approved plan.
If you check this box enter:
(1) most recent adoption date
(2) the IRS opinion or advisory letter’s
serial number.
b [Current PCC 3B] Plan covering selfemployed individuals
b [Current PCC 3C] Plan not intended to be
qualified under Internal Revenue Code
b [Current PCC 3D-breakout] Master and
prototype (M&P) plan
b [Current PCC 3D-breakout] Volume
submitter plan
b [New] Plan sponsor(s) received services of
leased employees
b [Current PCC 3J] U.S.-based plan that
covers residents of Puerto Rico and is
qualified under both Code section 401
and section 1165 of Puerto Rico Code
b [New] Electing church plan under Code
Section 410(d).
9b [Current Line 8b; now multiple
questions instead of plan characteristic
codes entered in a list from instructions; PCC
4T, and 4U eliminated] If the plan provides
welfare benefits, complete Lines 9b(1)–9b(4).
Plans that do not provide any welfare
benefits skip to question 10.
9b(1) [Modification and expansion of
current PCC 4A, 4D, 4E] Does the plan
provide health, dental, or vision coverage?
b Yes b No
If ‘‘Yes,’’ check all that apply:
b [New Breakout of current PCC 4A]
medical/surgical benefits
b [New Breakout of current PCC 4A]
pharmacy or prescription drug benefits
b [New Breakout of current PCC 4A] mental
health/substance use disorder benefits
b [New Breakout of current PCC 4A]
wellness program
b [New Breakout of current PCC 4A]
preventive care services
b [New Breakout of current PCC 4A]
emergency services
b [New Breakout of current PCC 4A]
pregnancy benefits
b [Current PCC 4E] vision
b [Current PCC 4D] dental
9b(2) Does the plan provide disability
benefits?
b Yes b No
If ‘‘Yes,’’ check all that apply.
b [Current PCC 4F] Temporary disability
(accident and sickness)
b [Current PCC 4H] Long-term disability
PO 00000
Frm 00039
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Sfmt 4702
47571
9b(3) Does the plan provide welfare
benefits other than health, dental, vision, or
disability?
b Yes b No
If ‘‘Yes,’’ check all that apply.
b [Current PCC 4B] Life insurance
b [Current PCC 4L] Death benefits (include
travel accident but not life insurance)
b [New] Long term care insurance
b [Current PCC 4J] Apprenticeship and
training
b [Current PCC 4C] Supplemental
unemployment
b [Current PCC 4K] Scholarship (funded)
b [Current PCC 4G] Prepaid legal
b [Current PCC 4I] Severance pay
b [Current PCC 4P] Taft-Hartley Financial
Assistance for Employee Housing
Expenses
b [Current PCC 4Q] Other (Enter
description.)
9b(4) If the plan is a welfare plan that does
not provide health benefits, check the
appropriate box to indicate whether the plan
will stop or stopped filing in an earlier year
in reliance on 29 CFR 2520.104–20. (If the
plan provided group health benefits, it is not
eligible for the limited exemption in 29 CFR
2520.104–20 and must file a Form 5500
Annual Return/Report in accordance with
the instructions annually, regardless of plan
size.)
b [Current PCC 4R] Unfunded, fully insured,
or combination unfunded/fully insured
welfare plan that does not provide health
benefits that will not file an annual
report for next plan year pursuant to 29
CFR 2520.104–20. (Plans that check this
box should not check ‘‘final return/
report’’ in Part I, Box B.)
b [Current PCC 4S] Unfunded, fully insured,
or combination unfunded/fully insured
welfare plan that does not provide health
benefits that stopped filing annual
reports in an earlier plan year pursuant
to 29 CFR 2520.104–20. (Plans that check
this box should not check ‘‘first return/
report’’ in Part I, Box B.)
10a [Current Line 9a] Plan funding
arrangement (Check all that apply.)
(1) b Insurance
(2) b Code section 412(e)(3) insurance
contracts
(3) b Trust
(4) b General assets of the sponsor
10b [Current Line 9b] Plan benefit
arrangement (Check all that apply.)
(1) b Insurance
(2) b Code section 412(e)(3) insurance
contracts
(3) b Trust
(4) b General assets of the sponsor
11 [Current Line 10, Except check box
added for Schedule E and Schedule J and
Eliminated For Schedule I] Check all
applicable boxes in 11a and 11b to indicate
which schedules are attached, and, where
indicated, enter the number attached. (See
instructions).
11a Pension Schedules
(1) b Schedule R (Retirement Plan
Information)
(2) b Schedule E (Employee Stock
Ownership Plan Information)
(3) b Schedule MB (Multiemployer
Defined Benefit Plan and Certain Money
E:\FR\FM\21JYP3.SGM
21JYP3
47572
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
Purchase Plan Actuarial Information)—
signed by the plan actuary
(4) b Schedule SB (Single-Employer
Defined Benefit Plan Actuarial
Information)—signed by the plan actuary
11b General Schedules
(1) b Schedule H (Financial Information)
(2) b Schedule A (Insurance Information)
Enter number of Schedules A attached (See
instructions.)
(3) b Schedule C (Service Provider
Information) Enter number of Schedules C
attached (See instructions.)
(4) b Schedule D (DFE/Participating Plan
Information)
(5) b Schedule G (Financial Transaction
Schedules)
(6) b Schedule J (Group Health Plan
Information)
[Current Part III Form M–1 information
moved to Schedule J]
[JURAT and SIGNATURE BLOCK to
appear on first page, as with current form]
CAUTION: A penalty for the late or
incomplete filing of this return/report will be
assessed unless reasonable cause is
established.
Under penalties of perjury and other
penalties set forth in the instructions, I
declare that I have examined this return/
report, including accompanying schedules,
statements and attachments, as well as the
electronic version of this return/report, and
to the best of my knowledge and belief, it is
true, correct, and complete.
SIGN HERE Signature of plan
administrator
Enter Date:
Enter name of individual signing as plan
administrator
SIGN HERE Signature of employer/plan
sponsor
b [New] Check here if two signatures for
Taft-Hartley plan
(1) Management trustee signature (2) Labor
trustee signature
Enter Date:
Enter name(s) of individual(s) signing as
employer or plan sponsor
SIGN HERE Signature of DFE
Enter Date:
Enter name of individual signing as DFE
Preparer’s name (including firm name, if
applicable) and address; include room or
suite number.
Preparer’s telephone number
Line A(2) Schedule
Complete as many entries as needed to
report the required information for all
participating employers.
Multiple-Employer Plan Participating Employer Information
(Heading for this chart must include Name of Plan, and EIN/PN as shown on the Form 5500)
(a) Name of participating employer ..................................
(a) Name of participating employer ..................................
Line A(3) Schedule
(b) EIN ................................
(b) EIN ................................
(c) Percent of Total Contributions.
(c) Percent of Total Contributions.
Complete as many entries as needed to
report the required information for all
participating employers.
Controlled Group Plan Member Information
(Heading for this chart must include Name of Plan, and EIN/PN as shown on the Form 5500). Complete elements (a), (b), and (c) to
provide the name, EIN, and percent of total contributions of each controlled group member.)
(a) Name of controlled group member .............................
(a) Name of controlled group member .............................
Form 5500–SF (Short Form Annual Return/
Report of Small Employee Benefit Plan)
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Part I Annual Report Identification
Information [Same As Current Part I, Except
New Box A(3)]
For calendar plan year 20XX or fiscal plan
year beginning DD/MM/20XX and ending
DD/MM/20XX+1
A [Current except as shown] This return/
report is for:
(1) b a single-employer plan
(2) b a multiple-employer plan (not
multiemployer) (Filers checking this box
must attach a list of participating employer
information in accordance with the form
instructions)
(3) b [New] a plan of a controlled group
of corporations, group of trades or businesses
under common control, or an affiliated
service group (see instructions) (Filers
checking this box must attach a list of
controlled group member information in
accordance with the form instructions)
(4) b a one-participant plan
(5) b foreign plan
B [Current] This return/report is (check as
applicable) (see instructions):
(1) b the first return/report
(2) b the final return/report
(3) b an amended return/report
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(b) EIN ................................
(b) EIN ................................
(c) Percent of Total Contributions.
(c) Percent of Total Contributions.
(4) b a short plan year return/report (less
than 12 months)
(5) b [Part of current Line 13b for PBGCtrusteed plans revised to include date of
trusteeship] A plan trusteed by PBGC. Filers
checking this box, enter the date of
trusteeship ll/ll/ll.
(If you checked box B(5), you only need to
complete only certain line items. (See
Instructions.)
C [Current] Check the applicable box if
filing under an extension or through the
DFVC Program:
(1) b Form 5558
(2) b automatic extension
(3) b special extension (enter description)
(4) b DFVC program
Part II Basic Plan Information—Enter all
requested information [Same As Current
Part II (Lines 1–6), except as shown] (You
must use the same plan name, PN, and EIN
as in the previous year’s annual return/
report, except as provided in Line 5.)
1a Name of Plan
1b Three-digit plan number (PN)
1c Effective date of plan
2a [Current except as shown] Plan
sponsor’s name (employer, if for a singleemployer plan) and address; include room or
suite number, city or town, state or province,
country, and ZIP or foreign postal code (if
foreign, see instructions)
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2b(1) Plan sponsor’s Employer
Identification Number (EIN)
(2) [New] Plan sponsor’s legal entity
identifier (LEI) if available (see instructions)
2c Sponsor’s telephone number
2d Business code (see instructions)
3 [Current except as shown] Plan
administrator’s name and address
b Check if same as Plan Sponsor Name
b Check if same as Plan Sponsor Address
3a Plan Administrator’s Name and address
3b Administrator’s EIN
3c Administrator’s telephone number
4a [New] Named Fiduciary’s name and
address (see instructions).
b Check if same as Plan Sponsor Name
b Check if same as Plan Sponsor Address
4b [New] Named Fiduciary’s EIN
4c [New] Named Fiduciary’s telephone
number
5 [Current Line 4 except to add LEI] If the
name, EIN, or LEI of the plan sponsor has
changed since the last return/report filed for
this plan, enter the name, EIN, LEI, and the
plan number from the last return/report:
5a Sponsor’s Name
5b(1) EIN
(2) [New] LEI (if available)
5c Plan Number
6 [Current Line 5] Total number of
participants at the beginning of the plan year
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7 [Current Line 6] Number of participants
(welfare plans complete only Lines 7a(1),
7a(2), 7b, 7c, and 7d).
7a(1) [Current Line 5d(1)] Total number of
active participants at the beginning of the
plan year
(2) [Current Line 5d(2)] Total number of
active participants as of the end of the plan
year
7b [New] Retired or separated participants
receiving benefits as of the end of the plan
year
7c [New] Other retired or separated
participants entitled to future benefits as of
the end of the plan year
7d [New] Subtotal. Add Lines 7a(2), 7b,
and 7c
7e [New] Deceased participants whose
beneficiaries are receiving or are entitled to
receive benefits as of the end of the plan year
7f [New] Total. Add Lines 7d and 7e
7g If you are filing for defined contribution
pension plan, you must complete Line 7g(1)–
(4). Welfare plans complete only Line 7g(3).
Defined benefit pension plans skip to Line
7h.
(1) [New] Number of participants with
account balances as of the beginning of the
plan year
(2) [Current Line 5c] Number of
participants with account balances as of the
end of the plan year
(3) [New] Number of participants that
made contributions during the plan year
(4) [New] Number of participants that
terminated employment during the plan year
that had their entire account balance
distributed as of the end of the plan year
7h [Current Line 5e] Number of
participants that terminated employment
during the plan year with accrued benefits
that were less than 100% vested
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Part III—Form 5500–SF Eligibility
Information [New ‘‘Part’’ title for existing
eligibility questions]
8a [Current Line 6a] Were all of the plan’s
assets during the plan year invested in
eligible assets? (See instructions.)
b Yes b No
8b [Current Line 6b] Are you claiming a
waiver of the annual examination and report
of an independent qualified public
accountant (IQPA) under 29 CFR 2520.104–
46? (See instructions on waiver eligibility
and conditions.)
b Yes b No
8c [New] Did the plan provide group
health benefits?
b Yes b No
If you answered ‘‘No’’ to Line 8a or 8b, or
‘‘Yes’’ to Line 8c, the plan cannot use Form
5500–SF and must instead file the Form 5500
and any required Schedules and
attachments.
Part IV—Financial Information [Current
Part III, with new breakouts]
9 [Current Line 7] Plan Assets and
Liabilities [Columns for (a) Beginning of Year
(BOY) and (b) End of Year (EOY) Values for
9a–9d]
9a [Current Line 7a] Total plan assets
9b [Current Line 7b] Total plan liabilities
9c [Current Line 7c] Net plan assets
(subtract Line 9b from Line 9a)
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10 [Current Line 8] Income, Expenses, and
Transfers for this Plan Year
10a [Current Line 8a] Contributions
(1) Received or receivable in cash from:
(A) [Current Line 8a(1)] Employers
(B) [Current Line 8a(2)] Participants
(2) [Current Line 8a(3)] Others (including
rollovers from IRAs/other plans)
10b [Current Line 8b] Other income (loss)
10c [Current Line 8c] Total income (add
Lines 10a(1)(A) and (B), 10a(2), 10b and 10c)
10d [Current Line 8d] Benefits paid
(including direct rollovers and insurance
premiums to provide benefits)
10e [Current Line 8e] Certain deemed and/
or corrective distributions (see instructions)
10f [Current Line 8f] Administrative
service providers (salaries, fees,
commissions)
10g [Current Line 8g] Other expenses
10h [Current Line 8h] Total expenses (add
Lines 10e, 10f, 10g, and 10h)
10i [Current Line 8i] Net income (loss)
(subtract Line 10h from Line 10d)
10j [Current Line 8j] Transfers to (from) the
plan (see instructions)
11 [New] Specific Assets [Columns for (a)
Beginning of Year (BOY) and (b) End of Year
(EOY) Values] [New]
11a Cash/cash equivalents
11b [New] Securities, except employer
securities, traded on a public exchange
(1) Stock
(2) Bonds
(3) Other
11c [New breakout] Government securities
issued by the United States or a State
11d [New] Interests in registered
investment companies (Mutual funds, Unit
Investment Trusts, Closed End Funds)
11e [New] Interests in insurance company
pooled separate accounts (PSAs)
11f [New] Interests in insurance
investment and annuity contracts (other than
PSAs)
11g [New] Interests in bank common
collective trusts (CCTs)
11h [New] Interests in bank investment
contracts (other than CCTs)
11i [New] Participant loans
Part V—Plan Characteristics Information
[Current Part IV]
12a [Current Line 8a; Now multiple
questions instead of Plan Characteristic
Codes (PCC) entered in a list from
Instructions] Check the appropriate box to
indicate the type of plan. If the plan provides
pension benefits, answer the applicable 12a
questions below; see the instructions for
additional details. (Plans that provide only
welfare benefits check the box for ‘‘Welfare
Plan’’ and then skip to question 12b.)
b Defined benefit pension plan
b Defined contribution pension plan
b Welfare plan
12a(1) Check the appropriate box(es) to
indicate how the benefits are calculated
(Defined benefit pension plans only.)
b [Current PCC 1A] Benefits are primarily
pay related
b [Current PCC 1B] Benefits are primarily
flat dollar (includes dollars per year of
service)
b [Current PCC 1C breakout] Cash balance
plan
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47573
b [Current PCC 1C breakout] Pension equity
plan (PEP)
b [Current PCC 1C breakout] Other hybrid
plan
b [Current PCC 1D] Floor-offset plan
12a(2) Does your plan have any of the
Internal Revenue Code arrangements listed
below? Check all that apply. Defined benefit
pension plans only)
b [Current PCC 1F] Code Section 414(k)
arrangement
12a(3) [Current PCC 1H] Is this a defined
benefit pension plan that was terminated and
closed out for PBGC purposes (see
instructions)?
b Yes b No
12a(4) [Current Line 6c, revised to add a
new sentence at the end on PBGC premium
filings. For 2016, PBGC proposed that the
new sentence be added to Line 5c of the
Schedule H] If the plan is a defined benefit
pension plan, is it covered under the PBGC
insurance program (see ERISA section 4021)?
b Yes b No b Not determined
If ‘‘Yes’’ is checked, enter the My PAA
confirmation number from the PBGC
premium filing for this plan year. (See
instructions)
12a(5) [Current PCC 1I expanded to
include DC as well as DB pension plans] Is
this a frozen pension benefit plan? (Both
defined benefit and defined contribution
pension plans must answer this question.)
b Yes b No
12a(6) [Current PCC 1D and 2D; new
requirement to provide identifying
information about sponsor of other plan or
arrangement] Are plan benefits subject to
offset for retirement benefits provided in
another plan or arrangement of the employer?
b Yes b No
If ‘‘Yes,’’ enter name, EIN, and LEI of
sponsor and PN of other plan or arrangement
12a(7) If this is a defined contribution
pension plan, indicate the type(s) of plan
(check all that apply):
b [Current PCC 2E] Profit-sharing plan
b [Current PCC 2I] Stock bonus plan
b [Current PCC 2C] Money purchase plan
b [Current PCC 2B] Target benefit plan
b [Current PCC 2D] Offset plan
12a(8) If this is a defined contribution
pension plan, check the appropriate box(es)
to indicate the type(s) of arrangements under
which the plan operates for purposes of the
Code (check all that apply):
b [Current PCC 2J] Code section 401(k)
arrangement
b [Current PCC 2K] Code section 401(m)
arrangement
b [New] SIMPLE 401(k) plan under Code
sections 401(k)(11) and 401(m)(10)
b [New] Safe harbor 401(k) plan under Code
sections 401(k)(12) and 401(m)(11)
b [New] Safe harbor 401(k) plan using
automatic contribution arrangements
under Code sections 401(k)(13) and
401(m)(12)
b [Current PCC 2N] Code section 408
accounts or annuities
b [Current PCC 2L] Code section 403(b)(1)
arrangement
b [Current PCC 2M] Code section 403(b)(7)
arrangement
12a(9) If this is a defined contribution
pension plan, check the appropriate box(es)
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to indicate the type(s) of features your plan
has:
b [Current PCC 2S] Automatic Enrollment
b [New] Designated ROTH
b [Current PCC 2A] Age/service weighted or
new comparability or similar plan
b [New] Financial education for participants
b [New] Financial advice for participants
b [New] Other (specify)
12a(10) If this a participant-directed
defined contribution pension plan, check all
that apply:
b [Current PCC 2F] ERISA section 404(c)
plan
b [Current PCC 2G] Total participantdirected account plan
b [Current PCC 2H] Partial participantdirected account plan
b [Current PCC 2R] Participant-directed
brokerage accounts. If you check this
box, enter the number of participants
using the participant-directed brokerage
account(s)
12a(11) [New] (A) Does the plan have
default investment alternatives that are
intended to be qualified default investment
alternatives (QDIA) (see instructions) for
participants who fail to direct assets in their
account?
b Yes b No
(B) If ‘‘Yes,’’ indicate type(s) of QDIA
(Check all that apply)
b Target date/life cycle fund
b Fixed income
b Money market or equivalent (under
2550.404c–5(e))
b Balanced/target allocation fund
b Professionally managed account
b Other (specify)
12a(12) [New] Is this an Eligible Combined
Plan under Code section 414(x)?
b Yes b No
12a(13) [New] Check this box if a rollover
from a plan (including an individual
retirement plan) was used to start up the
business (ROBS) sponsoring this plan: b
12a(14) Other Pension Benefit Features
(check all that apply):
b [Current PCC 3D; 2016 Line 17a] IRS Preapproved plan. If you check this box
enter: (1) most recent adoption date and
(2) the IRS opinion or advisory letter’s
serial number
b [Current PCC 3B] Plan covering selfemployed individuals
b [Current PCC 3C] Plan not intended to be
qualified under Internal Revenue Code
b [Current PCC 3D-breakout] Master and
prototype (M&P) plan
b [Current PCC 3D-breakout] Volume
submitter plan
b [New] Plan sponsor(s) received services of
leased employees
b [Current PCC 3J] U.S.-based plan that
covers residents of Puerto Rico and is
qualified under both Code section 401
and section 1165 of Puerto Rico Code
b [New] Electing church plan under Code
Section 410(d)
12b If the plan provides welfare benefits,
complete Lines 12b(1)–(3). Plans that do not
provide any welfare benefits skip to question
13.
12b(1) Does the plan provide disability
benefits?
b Yes b No
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19:35 Jul 20, 2016
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If ‘‘Yes,’’ check all that apply.
b [Current PCC 4F] Temporary disability
(accident and sickness)
b [Current PCC 4H] Long-term disability
12b(2) Does the plan provide welfare
benefits other than disability?
b Yes b No
If ‘‘Yes,’’ check all that apply.
b [Current PCC 4B] Life insurance
b [Current PCC 4L] Death benefits (include
travel accident but not life insurance)
b [New] Long term care insurance
b [Current PCC 4J] Apprenticeship and
training
b [Current PCC 4C] Supplemental
unemployment
b [Current PCC 4K] Scholarship (funded)
b [Current PCC 4G] Prepaid legal
b [Current PCC 4I] Severance pay
b [Current PCC 4P] Taft-Hartley Financial
Assistance for Employee Housing
Expenses
b [Current PCC 4Q] Other (Enter
description. Caution: If the plan provides
health benefits, you must file the Form
5500.)
12b(3) If the plan is a welfare plan that
does not provide health benefits, check the
appropriate box to indicate whether the plan
will stop or stopped filing in an earlier year
in reliance on 29 CFR 2520.104–20. (If the
plan provided group health benefits, it is not
eligible for the exemption in 29 CFR
2520.104–20 and must file a return/report
annually, regardless of plan size.)
b [Current PCC 4R] Unfunded, fully
insured, or combination unfunded/fully
insured welfare plan that will not file an
annual report for next plan year pursuant
to 29 CFR 2520.104–20. (Plans that check
this box should not check ‘‘final return/
report’’ in Part I, Box B.)
b [Current PCC 4S] Unfunded, fully
insured, or combination unfunded/fully
insured welfare plan that stopped filing
annual reports in an earlier plan year
pursuant to 29 CFR 2520.104–20. (Plans
that check this box should not check
‘‘first return/report’’ in Part I, Box B.)
13a [New; taken from current Form 5500
Line 9a] Plan funding arrangement (check all
that apply)
(1) b Insurance
(2) b Code section 412(e)(3) insurance
contracts
(3) b Trust
(4) b General assets of the sponsor
13b [New to Form 5500–SF; current Form
5500 Line 9b] Plan benefit arrangement
(check all that apply)
(1) b Insurance
(2) b Code section 412(e)(3) insurance
contracts
(3) b Trust
(4) b General assets of the sponsor
Part VI—Plan Operations Compliance
Questions [Current Part V]
During the plan year:
14a [Current Line 10a revised] Was there
a failure to transmit to the plan any
participant contributions or repayments as of
the earliest date on which such contributions
can reasonably be segregated from the
employer’s general assets as described in 29
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CFR 2510.3–102? Continue to answer ‘‘Yes’’
for any prior year failures until fully
corrected. (See instructions and DOL’s
Voluntary Fiduciary Correction Program.)
b Yes b No Amount
14b [Current Line 10b] Were there any
nonexempt prohibited transactions with any
party-in-interest? (Do not include
transactions reported on Line 14a.)
b Yes b No Amount
14c [Current Line 10c revised] Was this
plan covered by one or more fidelity bonds
naming the plan as insured that provide
coverage for losses due to fraud or dishonesty
by persons who handle plan funds or other
property?
b Yes b No Amount
14d [Current Line 10d] Did the plan have
a loss, whether or not reimbursed by a
fidelity bond covering the plan, that was
caused by fraud or dishonesty?
b Yes b No Amount
14e [Current Line 10e] Were any fees or
commissions paid to any brokers, agents, or
other persons by an insurance carrier,
insurance service, or other organization that
provides some or all of the benefits under the
plan?
b Yes b No Amount
14f [Current Line 10f] Has the plan failed
to provide any benefit when due under the
plan?
b Yes b No Amount
14g [Current Line 10h] If this is an
individual account plan, was there a blackout
period? (See 29 CFR 2520.101–3.)
b Yes b No
14h [Current Line10i] If 14h was answered
‘‘Yes,’’ check the box if you either provided
the required notice or one of the exceptions
to providing the notice applied under 29 CFR
2520.101–3:
b Yes b No
14i [New] Is this a participant-directed
individual account plan (e.g., a 401(k)-type or
403(b) defined contribution pension plan),
subject to the requirements in 29 CFR
2550.404a–5 to disclose plan and investment
related information to participants and
beneficiaries?
b Yes b No
14j [New] If you answered ‘‘Yes’’ to Line
14i, did the plan provide participants and
beneficiaries the plan and investment
disclosures required under 29 CFR
2550.404a–5?
b Yes b No
If you answered ‘‘Yes,’’ you must attach the
investment option comparative chart or
charts that were used to satisfy the disclosure
requirement in 29 CFR 2550.404a–5(d)(2).
14k [New] If you answered ‘‘Yes,’’ to Line
14i, enter the number of designated
investment alternatives (DIAs) available
under the plan and indicate the number of
DIAs that are index funds. Also, check all
that apply to indicate the types of DIAs
available under the plan:
b Domestic Stock/Equity
b Bond/income
b Balanced/target allocation
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asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
b
b
b
b
b
Money Market
Target date/Lifecycle
International/Global Stock/Equity
Sector/economy segment
Other funds (Describe)
14l [New] If you answered ‘‘Yes,’’ to Line
14j, did the plan make available to
participants and beneficiaries a designated
investment manager (DIM)?
b Yes b No
If ‘‘Yes,’’ enter name of DIM.
14m [New] If you answered ‘‘Yes,’’ to Line
14j, did the plan make available to
participants and beneficiaries any brokerage
window, self-directed brokerage account or
similar plan arrangements that enabled
participants to select investments beyond
those designated by the plan?
b Yes b No
If you answered ‘‘Yes’’ to Line 14m, enter
the number of participants that utilized the
account or arrangement and the total amount
held in such account(s):
14n [New] Did the plan trust incur
unrelated business taxable income (UBTI)?
b Yes b No b NA
If ‘‘Yes’’, enter amount.
14o [New] Did any employer or employer
organization sponsoring the plan pay any of
the administrative expenses of the plan that
were not reported on Line 10g?
b Yes b No
14p [New] Did any person who is
disqualified under ERISA Section 411, serve
or was permitted to serve the plan in any
capacity?
b Yes b No
14q [New] Did the plan sponsor or its
affiliates provide any services to the plan in
exchange for direct or indirect
compensation?
b Yes b No
14r [New] Have any of the plan’s service
providers been terminated for a material
failure to meet the terms of a service
arrangement or failure to comply with Title
I of ERISA, including the failure to provide
required disclosures under 29 CFR
2550.408b–2?
b Yes b No
If ‘‘Yes,’’ complete elements (1)–(7) to
identify the service provider.
(1) Name:
(2) EIN:
(3) Enter applicable service code from Line
2c(1) for describe services provided to plan:
(4) Address:
(5) Telephone:
(6) Explanation of reason for termination:
(7) b Check if termination was due to
failure to provide required disclosures under
29 CFR 2550.408b–2.
14s [New (based on 1998 Line 8a)] Is the
plan’s summary plan description (SPD),
including any summary descriptions of
modifications, in compliance with the
content requirements in 29 CFR 2520.102–3?
(See instructions.)
b Yes b No
14t [New] If this is an individual account
plan, were there any checks to participants
or beneficiaries that were uncashed as of the
end of the plan year? b Yes b No. If
‘‘Yes,’’ complete 14t(1)–(4)
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(1) Enter number of uncashed checks
(2) Enter total value of uncashed checks
(3) Describe the procedures followed by the
plan to verify a participant’s or beneficiary’s
address before a check was mailed.
(4) Describe the procedures followed by the
plan to monitor uncashed checks, including
steps to locate ‘‘missing’’ participants.
Part VII—Pension Funding Compliance
[Current Part VI Renumbered]
15 [Current Line 11] Is this a defined
benefit pension plan subject to minimum
funding requirements? (If ‘‘Yes,’’ see
instructions and complete Schedule SB
(Form 5500) and line 14a below)
b Yes b No
15a [Current Line 11a] Enter the unpaid
minimum required contribution for all years
from Schedule SB (Form 5500) Line 44.
16 [Current Line 12] Is this a defined
contribution pension plan subject to the
minimum funding requirements of section
412 of the Code or section 302 of
ERISA?
Line 15a or Lines 15b, 15c, 15d, and 15e
below, as applicable.
16a If a waiver of the minimum funding
standard for a prior year is being amortized
in this plan year, see instructions, and enter
the date of the letter ruling granting the
waiver:
If you completed Line 16a, complete Lines
3, 9, and 10 of Schedule MB (Form 5500),
and skip to line 20.
16b Enter the minimum required
contribution for this plan year.
16c Enter the amount contributed by the
employer to the plan for this plan year:
16d Subtract the amount in Line 16c from
the amount in Line 16b. Enter the result
(enter a minus sign to the left of a negative
amount):
16e Will the minimum funding amount
reported on Line 16d be met by the funding
deadline?
b Yes b No b N/A
Part VIII Plan Termination Information—
[Current Part VII Revised and Expanded]
17a [Current Line 13a; Revised to Ask
About Any Resolution to Terminate] Has a
resolution to terminate the plan been adopted
in any plan year?
b Yes b No If ‘‘Yes,’’ complete Line
17a(1)–(3) below:
(1) [New] Effective date of plan termination
(2) [New] Year the plan assets were
distributed to plan participants and
beneficiaries
(3) [Current Line 13a] Enter the amount of
plan assets that reverted to the employer
this year:
17b [Part of current Line 13b with a new
subpart to report the year.] Were all the plan
assets distributed to participants or
beneficiaries?
b Yes b No
17c [Current Line 13c] Transfer to other
plans. If this plan transferred assets or
liabilities to another plan since the 20XX–1
filing provide the following information with
respect to each plan to which the assets or
liabilities were transferred. Complete as
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47575
many entries as needed to identify all
transfers.
(1) [Current 13c(2)] EIN
(2) [Current 13c(3)] PN
(3) [New] Date of transfer
(4) [Current 13c(1)] Name of Plan:
(5) [New] Type of transfer:
b Merger
b Consolidation
b Spinoff
b Other (Describe)
(6) [Part of current Line 13b] Were all plan
assets transferred to another plan?
b Yes b No
17d [New] Transfers from other plans. If
another plan transferred assets or liabilities
to this plan since the 20XX–1 filing, or in the
case of a first plan filing, transferred assets
or liabilities in conjunction with the creation
of this new plan, provide the following
information with respect to each plan from
which assets or liabilities were transferred:
(1) EIN
(2) PN
(3) Date of transfer
(4) Name of Plan:
(5) Type of transfer: Type of transfer:
b Merger
b Consolidation
b Spinoff
b Other ([New] Describe)
17e [New] Terminated Defined
Contribution Pension Plans: Transfers to
Financial Institution. Did this plan, as part
of the procedures for terminating the plan,
transfer plan assets to interest bearing
federally insured bank accounts in the name
of missing participants?
b Yes b No
If ‘‘Yes,’’ complete elements (1)–(5). List
each financial institution where plan assets
were transferred. You must continue
reporting this information until the final
return/report is filed for the plan.
(1) Financial Institution’s Name
(2) Financial Institution’s EIN
(3) Date of transfer
(4) Number of accounts established
(5) Total amount transferred
Part IX—Trustee Information—[Current Part
III But Not Optional; see IRS Federal
Register Notice ‘‘Proposed Collection;
Comment Request for the Annual Return/
Report of Employee Benefit Plan’’]
18a [Current Line 14a] Name of Trust
18b [Current Line14b] Trust EIN
18c [New] Name of Trustee/Custodian
Check b if custodian
18d [New] Trustee’s or custodian’s
telephone number
[New—intended to be electronic signature]
Date and Signature of Trustee/Custodian
SIGN HERE Signature of plan trustee or
custodian:
Enter Date:
Enter name of individual signing as trustee
or custodian
Part X IRS Compliance Questions [See IRS
Federal Register Notice ‘‘Proposed
Collection; Comment Request for the Annual
Return/Report of Employee Benefit Plan’’]
19a [2016 Line 15a] Is this plan a 401(k)
plan?
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b Yes b No
If ‘‘No,’’ skip b.
19b [2016 Line 15b] How did the plan
satisfy the nondiscrimination requirements
for employee deferrals under section
401(k)(3)? Check all that apply
b Design-based safe harbor method
b ‘‘Prior year’’ ADP test
b ‘‘Current year’’ ADP test
b N/A
20a [2016 Line 16a] What testing method
was used to satisfy the coverage requirements
under section 410(b) for the plan year. Check
all that apply:
b Ratio percentage test
b Average benefit test
b N/A
20b [2016 Line 16b] Did the plan satisfy
the coverage and nondiscrimination
requirements of sections 410(b) and 401(a)(4)
for the plan year by combining this plan with
any other plan under the permissive
aggregation rules?
b Yes b No
21 [New] If this is a defined benefit
pension plan, does the plan comply with
Code section 401(a)(26) participation
requirements?
b Yes b No
22a [2016 Line 17b] If the plan is a master
and prototype plan (M&P) or volume
submitter plan that received a favorable IRS
opinion letter or advisory letter, enter the
date of the letter ll/ll/lla and the
serial number.
22b [2016 Line 17d] If the plan is an
individually-designed plan that received a
favorable determination letter from the IRS,
enter the date of the most recent
determination letter l/l/ll.
23a [2016 Line 19] If this is a section
401(k) plan, were hardship distributions
made during the plan year?
b Yes b No
23b [2016 Line 19] If this is a defined
benefit plan or a money purchase pension
plan, did the plan make any distributions
during the plan year to employees who have
attained age 62 and who were not separated
from service when the distributions were
made? b Yes b No
24 [New] Were required minimum
distributions made to 5% owners who have
attained age 701⁄2 (regardless of whether or
not retired) as required under section
401(a)(9)(C)?
b Yes b No b N/A
25 [New] As of the last day of the plan
year, has the plan ceased to permit
contributions and prohibit entry by new
participants?
b Yes b No
[JURAT and SIGNATURE BLOCK to
appear on first page, as with current form]
CAUTION: A penalty for the late or
incomplete filing of this return/report will be
assessed unless reasonable cause is
established.
Under penalties of perjury and other
penalties set forth in the instructions, I
declare that I have examined this return/
report, including accompanying schedules,
statements and attachments, as well as the
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electronic version of this return/report, and
to the best of my knowledge and belief, it is
true, correct, and complete.
SIGN HERE Signature of plan administrator:
Enter Date:
Enter name of individual signing as plan
administrator
SIGN HERE Signature of employer/plan
sponsor:
Enter Date:
Enter name(s) of individual(s) signing as
employer or plan sponsor
[New] Trustee Signature for Purposes of the
Code:
SIGN HERE Signature of plan trustee or
custodian:
Enter Date:
Enter name of individual signing as trustee
or custodian
Preparer’s name (including firm name, if
applicable) and address; include room or
suite number.
Preparer’s telephone number
Line A(2) Schedule
Complete as many entries as needed to
report the required information for all
participating employers.
Multiple-Employer Plan
Participating Employer Information
[Insert Name of Plan, and EIN/PN as shown
on the Form 5500]
(d) Name of participating employer.
(d) Name of participating employer.
(e) EIN
(e) EIN
(f) Percent of
Total Contributions.
(f) Percent of
Total Contributions.
Line A(3) Schedule
Complete as many entries as needed to
report the required information for all
participating employers.
Controlled Group Plan Member
Information
[Heading for this chart must include Insert
Name of Plan, and EIN/PN as shown on
the Form 5500]
[Complete elements (a), (b), and (c) to provide the name, EIN, and percent of total
contributions of each controlled group
member]
(d) Name of controlled group
member.
(a) Name of controlled group
member.
(e) EIN
(b) EIN
(f) Percent of
Total Contributions.
(c) Percent of
Total Contributions.
Schedule A—Insurance Information
[Current Identifying Information] For
calendar plan year 20XX or fiscal plan year
beginning DD/MM/20XX and ending DD/
MM/20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor’s name as shown on Line
2a of Form 5500
D Employer Identification Number of plan
sponsor (EIN)
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Part I—Information Concerning Insurance
Contract Coverage. Provide information for
each contract on a separate Schedule A.
Individual contracts grouped as a unit in
Parts II and III can be reported on a single
Schedule A.
1. Coverage and General Information:
a. [Current 1a] Name of insurance carrier:
b. [Current 1b] EIN of insurance carrier:
c. [More Specific Than Current 1c By
Requiring ‘‘Company’’ Code Instead of NAIC
Code Generally] NAIC Company Code
d. [Current 1d] Contract or policy
identification number:
e. [New] Health plan identification number
(HPID) (if subject to the Health Insurance
Portability and Accountability Act (HIPAA))
[Current Line 1e moved as breakout by
benefit type in new Line 9]
f. [Current 1(f) and (g)] Policy or contract
year (1) beginning lll(2) ending lll
2. [New] Was the policy or contract issued
by an insurance company that is wholly
owned by the plan or the plan sponsor?
b Yes
b No
[Current 2 Moved to New Part IV]
Part II—Investment and Annuity Contract
Information. [Current Part II] Where
individual contracts are provided, the entire
group of such individual contracts with each
carrier may be treated as a unit for purposes
of this report.
3. [Current Line 4] Current value of plan’s
interest under this contract in the general
account at contract year end.
4. [Current Line 5, with PSAs. ‘‘Other’’ and
Variable Annuity Contracts broken out; new
to provide information on variable annuity
contract features] Current value of plan’s
interest under this contract in separate
accounts and variable annuities at contract
year end.
b Pooled separate accounts
b Other separate accounts
b Variable annuities. If you check this box,
indicate whether the variable annuity
contact has any of the following (check
all that apply):
(i) Types of subaccounts:
b Domestic Stock/Equity
b Bond/income
b Balanced/target allocation
b Money Market
b Target date/Lifecycle
b International/Global Stock/Equity
b Sector/economy segment
b Other subaccounts (Describe)
(ii) Features
b Death benefit
b Guaranteed living benefit
b Other (specify)
5. [Current Line 6] Contracts With
Allocated Funds:
a. State the basis of premium rates
b. Premiums paid to carrier
c. Premiums due but unpaid at the end of
the year
d. If the carrier, service, or other
organization incurred any specific costs in
connection with the acquisition or retention
of the contract or policy:
(i) Enter amount
(ii) Specify the nature of the costs
e. Type of contract:
(i) b Individual policies
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(ii) b Group deferred annuity
(iii) b Other (specify)
f. If contract purchased, in whole or in
part, to distribute benefits from a terminating
plan, check here: b
6. [Current Line 7] Contracts With
Unallocated Funds (Do not include portions
of these contracts maintained in separate
accounts)
a. Type of contract:
(1) b Deposit administration
(2) b Immediate participation guarantee
(3) b Guaranteed investment
(4) b Other (specify)
b. Balance at the end of the previous year
c. Additions:
(1) Contributions deposited during the year
(2) Dividends and credits
(3) Interest credited during the year
(4) Transferred from separate account
(5) Other (specify)
(6) Total additions
d. Total of balance and additions (add
Lines 8b and 8c(6))
e. Deductions:
(1) Disbursed from fund to pay benefits or
purchase annuities during year
(2) Administration charge made by carrier
(3) Transferred to separate account
(4) Other (specify)
(5) Total deductions
f Balance at the end of the current year
(subtract Line 8e(5) from Line 8d)
Part III Welfare Benefit Contract
Information [Current Part III, Except As
Noted By Line] If more than one contract
covers the same group of employees of the
same employer(s) or members of the same
employee organizations(s), the information
may be combined for reporting purposes if
such contracts are experience-rated as a unit.
Where contracts cover individual employees,
the entire group of such individual contracts
with each carrier may be treated as a unit for
purposes of this report.
7. [Current Line 8 Combined With Current
Line 1e Broken Out By Benefit Type; AD&D
and Long Term Care Are New Breakouts]
Benefit type. Check all applicable boxes and
enter approximate number of persons
covered at end of contract year by benefit
type. (See instructions)
Columns for the following questions for
‘‘Benefit Type’’ and for ‘‘Approximate
number of persons covered for each benefit
listed’’
a b Health (other than dental or vision)
b b Dental
c b Vision
d b Life insurance: [new breakout]
b term b other (specify)
e b Temporary disability (accident and
sickness)
f b Long-term disability
g b Supplemental unemployment
h b Prescription drug
i b [New] Accidental death and disability
j b [New] Long term care insurance
k b Other (specify)
8 [Current Line 8i, j, k, l, m] Type of
Contract. (Check applicable box.)
a b Stop-loss (large deductible)
b b HMO contract
c b PPO contract
d b Indemnity contract
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e b Other (specify)
9 [Current Line 9, Including Subparts]
Experience-rated contracts:
9a Premiums:
(1) Amount received
(2) Increase (decrease) in amount due but
unpaid
(3) Increase (decrease) in unearned
premium reserve
(4) Earned ((1) + (2)¥(3))
9b Benefit charges
(1) Claims paid
(2) Increase (decrease) in claim reserves
(3) Incurred claims (add (1) and (2))
(4) Claims charged
9c Remainder of premium:
(1) Retention charges (on an accrual basis)
(A) Commissions
(B) Administrative service or other fees
(C) Other specific acquisition costs
(D) Other expenses
(E) Taxes
(F) Charges for risks or other contingencies
(G) Other retention charges
(H) Total retention
(2) Dividends or retroactive rate refunds.
Check here to indicate whether these
amounts were:
b Paid in cash, or b credited.
9d Status of policyholder reserves at end
of year:
(1) Amount held to provide benefits after
retirement
(2) Claim reserves
(3) Other reserves
9e Dividends or retroactive rate refunds
due. (Do not include amount entered in Line
9c(2).)
10. [Current Line 10, Including Subparts]
Nonexperience-rated contracts:
10a. Total premiums or subscription
charges paid to carrier
10b. If the carrier, service, or other
organization incurred any specific costs in
connection with the acquisition or retention
of the contract or policy, other than reported
in Part IV, Line 13 (Fee and Commission
Information) report amount:
10c [Part of Current Line 10b] Specify
nature of costs of amount reported on line
10b:
11 [New]
a Were there any premium payment
delinquencies for premiums due but unpaid
during the year?
b Yes b No If ‘‘Yes,’’ enter number of
times delinquent and for each delinquency
enter the number of days delinquent.
b If you answered ‘‘Yes’’ to line 11a,
indicate whether any premium delinquency
resulted in a lapse in coverage. If you
answered ‘‘No’’ to line 11a, enter ‘‘N/A’’
b Yes b No b N/A.
Part IV Fee and Commission Information
12 [Current Line 2] Insurance fee and
commission information. Enter in Line 12 the
total fees and total commissions paid in
connection with the insurance carrier and
contract entered in Line 1. List the agents,
brokers, and other persons in descending
order of the amount paid.
12a Total amount of commissions paid.
12b Total amount of fees paid
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47577
13 [Current Line 3] Persons receiving
commissions and fees. (Complete as many
entries as needed to report all persons).
13a [Current 3a] Name and address of the
agent, broker, or other person to whom
commissions or fees were paid.
13b [New] Relationship to plan, employer,
employee organization, sponsor, fiduciary, or
other party-in-interest
13c [Current 3b] Amount of sales and base
commissions paid
13d [Current 3c] Amount of fees and other
commissions paid
13e [Current 3d] Purpose of fees and other
commissions paid
13f [Current 3e] Organization code (see
instructions)
Part V Provision of Information [current Part
IV]
14a [Current Line 11] Did the insurance
company fail to provide any information
necessary to complete Schedule A?
b Yes b No
14b [Current Line 12, Except Checkbox
Added for ‘‘Fee and Commission’’ and
‘‘Other’’ Instead of Just Open Text Field] If
the answer to Line 14a is ‘‘Yes,’’ specify the
information not provided: b Fee and
commission information b Other (specify)
Schedule C (Service Provider Information)
[NEW FORMAT WHERE SEPARATE
SCHEDULE C IS FILED FOR EACH SERVICE
PROVIDER RATHER THAN SINGLE
SCHEDULE C FILED THAT COVERS
MULTIPLE SERVICE PROVIDERS]
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
A Name of plan
B Three-digit plan number [PN]
C Plan sponsor’s name as shown on Line
2a of Form 5500
D Employer Identification Number (EIN)
[New (Revision of current indirect
compensation reporting language to
harmonize with 29 CFR 2550.408b–2)] You
must complete a separate Schedule C, in
accordance with the instructions, for (1) each
covered service provider who received
$1,000 or more in total direct and indirect
compensation (i.e., money or anything else of
monetary value) in connection with services
rendered to the plan or the person’s position
with the plan during the plan year, including
payments from participants’ accounts and (2)
other persons who received $5,000 or more
in direct compensation in connection with
services rendered to the plan or the person’s
position with the plan during the plan year,
including payments from participants’
accounts.
A ‘‘covered service provider’’ for Schedule
C reporting purposes includes: (1) ERISA
fiduciary service providers to the plan or to
a ‘‘plan asset’’ vehicle in which the plan
invests; (2) investment advisers registered
under Federal or State law; (3) persons who
provide recordkeeping or brokerage services
to a participant-directed individual account
plan in connection with designated
investment alternatives (e.g., a ‘‘platform
provider’’); or (4) providers of one or more of
the following services to the plan who
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received compensation from parties other
than from the plan or plan sponsor in
connection with such services: accounting,
auditing, actuarial, banking, consulting,
custodial, insurance, investment advisory,
legal, recordkeeping, securities or other
investment brokerage, third party
administration, or valuation services.
[Deleted—Current Line 1 ‘‘Information on
Persons Receiving Only Eligible Indirect
Compensation’’]
Part I Service Provider Information
1 [Current Line 2, except as indicated]
Information on Service Providers Receiving
Compensation in Connection with Services
Rendered to the Plan or Their Position with
the Plan.
1a [Current Line 2a, but adds requirement
to give contact information for service
providers that are natural persons] Enter
name, EIN and address for the service
provider. For a self-employed individual that
does not have an EIN, you may enter ‘‘None’’
instead of an EIN. If the service provider
identified is not an individual, in addition to
the name, EIN and address of the entity,
provide the name of and address for an
individual or office that the plan would
contact for information about the service
arrangement. (See instructions.)
(1) Name of Service Provider
(2) EIN
(3) LEI (if available)
(4) Address
(5) Name of Contact
(6) Address of Contact
1b [Current Line 2c, except refers to
relationship to plan rather than employer,
plan sponsor or person known to be partyin-interest, and enumerates types of partiesin-interest instead of having all but the
employer or employee organization to be
reported as ‘‘other’’ person known to be a
party-in-interest] Indicate whether the
person identified in Line 1a has one of the
following relationships to the plan. Check
‘‘not applicable’’ if the service provider does
not have one of the listed relationships:
(1) b Employer
(2) b Plan Sponsor
(3) b Named fiduciary
(4) b Plan Sponsor Employee
(5) b Plan Employee
(6) b Employee Organization
(7) b Other party-in-interest (describe)
(8) b Not applicable
1c [Current Line 2b (‘‘Service codes’’
only)] Check the appropriate box(es) to
identify all services provided by the person
identified in Line 1a:
(1) b Plan Administrator
(2) b Contract Administrator/third party
administrator
(3) b Trustee (discretionary)
(4) b Trustee (directed)
(5) b Investment management
(6) b Recordkeeping and information
management (computing, tabulating, data
processing, etc.)
(7) b Claims Processing
(8) b Custodial (securities)
(9) b Custodial (other than securities)
(10) b Insurance agents and brokers
(11) b Insurance services
(12) b Real estate brokerage
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(13) b Securities brokerage
(14) b Investment advisory (participants)
(15) b Investment advisory (plan)
(16) b Consulting (other than investment
advice/management) (Enter description)
(17) b Valuation (appraisals, etc.)
(18) b Accounting (including auditing)
(19) b Actuarial
(20) b Form 5500 Annual Return/Report
preparation
(21) b Legal
(22) b Participant loan processing
(23) b Participant communication
(24) b Information technology/computer
support
(25) b Copying and duplicating
(26) b Other services (Describe)
1d [New] Check here b if the person
identified on Line 1a was a fiduciary within
the meaning of section 3(21) of ERISA at any
time during the plan year.
1e [New] Was the person identified in Line
1a also identified on Schedule A filed for this
plan year as having received insurance fees
and commissions?
b Yes b No
1f [New] Did the service provider
arrangement include use of an ERISA
recapture, ERISA budget, or similar account
during the plan year?
b Yes b No
1g(1) [New] Did the service provider
arrangement include recordkeeping services
to a pension plan without explicit
compensation for some or all of such
recordkeeping services or with compensation
for such recordkeeping offset or rebated in
whole or in part based on other
compensation received by the service
provider, or an affiliate or subcontractor?
Only pension plans answer line 1g(1) and
1g(2).
b Yes b No
1g(2) [New] If you answered ‘‘Yes’’ to line
1g(1), using the same methodology used in
the service provider’s estimate of the cost to
the plan of recordkeeping services, enter as
a dollar figure the amount of compensation
the service provider received for
recordkeeping services.
2 [Current Line 2d] Direct Compensation
Paid by or Charged to Plan. Enter the total
amount of direct payments by the plan to the
person identified in Line 1a. If none, enter ‘‘0-’’.
3 [Current Line 2(g) and Line 3 revised]
Indirect compensation received by covered
service providers from sources other than
the plan or plan sponsor, including charges
against plan investments.
[Current Lines 2f and 2h eliminated]
3a [Current Line 2(g) as revised because
‘‘eligible indirect compensation’’ concept
eliminated] Total amount of compensation
received by the covered service provider
identified in Line 1a in connection with
services provided to the plan from sources
other than the plan or plan sponsor,
including charges against plan investments.
Include compensation received by an affiliate
or subcontractor in connection with the
services rendered to the plan. Do not include
here related party compensation paid among
the person, affiliate or subcontractor reported
on Line 4. (See instructions)
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3b [Current Line 3] For compensation
reported on Line 3a, identify each source
from whom the person identified in Line 1a
received compensation. (See instructions).
Complete as many entries as needed to report
the required information for each source.
(1) Enter name
(2) EIN
(3) LEI (if available)
(4) Enter as a dollar figure the amount or
estimate of compensation received from the
source identified in Line 3b(1).
(5) Check the appropriate box(es) to
identify all type(s) of fees/compensation
received by the provider identified in Line 1a
from the source identified in Line 3b(1).
(A) b Investment management fees
(B) b Sales loads (front end and deferred)
(C) b Account maintenance fees
(D) b ‘‘Soft dollars’’ commissions
(E) b Securities brokerage commissions
and fees
(F) b Shareholder servicing fees
(G) b Sub-transfer agency (subaccounting)
fees
(H) b Finders’ fees/placement fees
(I) b Distribution (12b-1) fees
(J) b Insurance brokerage commissions
and fees
(K) b Insurance mortality and expense
charges
(L) b Insurance wrap fees
(M) b Termination fees (surrender
charges, etc.)
(N) b Float revenue
(O) b Non-monetary compensation (Enter
description)
(P) b Commissions other than securities
and insurance (e.g., real estate commissions)
(Q) b Recordkeeping fees
(R) b Other fees/compensation (Enter
description)
(6) If the amount of compensation reported
in Line 3b(4) was an estimate based on a
formula, check here b and enter a
description of the formula used to determine
the service provider’s eligibility for or the
amount of the compensation.
4a [New] Did the service arrangement
involve any related party compensation? (See
instructions). If the answer to Line 4a is
‘‘Yes,’’ complete Line 4b(1)-(4)
4b(1) Describe the services for which the
compensation was paid
(2) Enter names of
(A) the payor and
(B) the recipient of the compensation
(3) Identify status as an b affiliate or b
subcontractor
(4) Enter the amount of the compensation
Part II Service Providers Who Fail or
Refuse to Provide Information [Current Part
II; because a separate Schedule C would be
provided for each service provider, no need
to provide the name and EIN of the service
provider who failed or refused to provide
information; current Lines 4a and 4b
eliminated]
5a [Current Line 4] Check this box if the
service provider failed or refused to provide
the information necessary to complete this
Schedule.
5b [Current Line 4c] Describe the
information that the service provider failed
or refused to provide.
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Schedule D
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
A Name of plan
B Three-digit plan number (PN)
C Plan or DFE sponsor’s name as shown on
Line 2a of Form 5500:
D Employer Identification Number (EIN)
[Current Part I eliminated]
[Current Part II, with added items for
dollar value of investing plan/DFE interest as
of end of reporting DFE year and check box
whether DFE had investors other than plans
covered by Title I of ERISA that file the
Form 5500 Annual Return/Report].
1 Information on Participating Plans (to be
completed by DFEs) Complete as many
entries as needed to report all participating
plans.
1a Plan name (as shown on Line 1a of the
plan’s most recent Form 5500/Form 5500–
SF):
1b Name of plan sponsor (as shown on line
2a of the plan’s most recent Form 5500/Form
5500–SF):
1c(1) EIN of sponsor of investing plan (as
shown on Line 2b of the plan’s most recent
Form 5500/Form 5500–SF)
1(c)(2) PN of investing plan (as shown on
Line 1b of the plan’s most recent Form 5500/
Form 5500–SF)
1d [New] Dollar value of investing plan/
DFE interest at end of reporting DFE year:
1e [New] If the DFE had investors other
than plans that are required to file the Form
5500 or Form 5500–SF (see instructions),
check here b.
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Schedule E (ESOP Annual Information)
Heading [Change from 2008 to list DOL and
IRS/Treasury instead of just Treasury/IRS]
[Change from 2008 to add Title I Authority
to Code Authority]—This schedule is
required to be filed under section 104 of the
Employee Retirement Income Security Act of
1974 (ERISA) and sections 6058(a) and
6047(e) of the Internal Revenue Code (the
Code).
[Change from 2008, which specified
Schedule E NOT Open to Public Inspection]
Disclosure: This Form is Open to Public
Inspection.
[2008 Basic Identifying Information] For
calendar plan year 20XX or fiscal plan year
beginning DD/MM/20XX and ending DD/
MM/20XX+1
A Name of plan:
B Plan number
C Plan sponsor’s name as shown on Line
2a of Form 5500
D EIN
Part I Employer Stock Acquired with a
Securities Acquisition Loan [New]—
Complete this Part only if the ESOP had an
outstanding securities acquisition loan
within the meaning of Code section
4975(d)(3) and ERISA section 408(b)(3)
during the plan year.
Common Stock
1a [New] Enter the number of common
shares of employer stock held in the ESOP
at the end of the plan year.
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1b [New] Enter percent of issued and
outstanding common stock held in the ESOP
at the end of the plan year.
1c [Current Schedule R, Line 12] Are the
shares readily tradable on an established
securities market? b Yes b No
1d [New] Enter number of allocated
common shares at the end of the plan year.
1e [New] Enter number of unallocated
common shares at the end of the plan year.
1f [2008 Schedule E, Line 5] If common
stock was released from a loan suspense
account, indicate the methods used:
b Principal and interest
b Principal only
b Other (Describe method):
Preferred Stock
1g [2008 Schedule E, Line 4] Did the ESOP
hold preferred stock at the end of the plan
year?
b Yes b No
1h [New breakout] If convertible based on
a ratio, enter ratio.
1i [New breakout] If convertible by some
other method, describe the method of
conversion.
Part II [New breakout] Employer Stock
Acquired Complete this Part only if the ESOP
acquired during the plan year employer
securities not readily tradable on an
established securities market. Complete as
many entries as necessary to report each
separate transaction.
2a [New] Enter seller’s relationship to plan,
employer, or other party-in-interest (if no
relationship, enter ‘‘unrelated third party’’)
2b [New] Is seller a party-in-interest?
b Yes b No
2c [New] Enter total consideration paid for
stock
2d [New] Enter date of transaction
2e [New] Check the applicable box and
enter the identifying information if an
independent fiduciary, trustee, or investment
manager approved the transaction
b Trustee
b Investment Manager
b Independent fiduciary
Name
Street Address
City
State
Zip Code
EIN
2f [New] Identify the independent
appraiser that valued the employer securities.
(If an independent appraiser did not value
the employer securities, enter ‘‘None.’’
CAUTION: See Code section 401(a)(28)(C) if
you enter ‘‘None.’’)
Name
Street Address
City
State
Zip Code
EIN
2g [New] What valuation approach was
used to value the stock acquired? (Check all
that apply.)
b Asset
b Income
b Market
b Book Value
b Other (Enter description):
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47579
Part III Securities Acquisition Loans [2008
Schedule E, Line 2a, with new breakouts as
indicated]—Complete this Part only if the
ESOP had outstanding securities acquisition
loans within the meaning of Code section
4975(d)(3) and ERISA section 408(b)(3)
during the plan year. Complete as many
entries as necessary to report all outstanding
loans.
3a [New breakout] Lender’s relationship to
plan, employer, or other party-in-interest (if
no relationship, enter ‘‘unrelated third
party’’)
3b [New breakout] b Check box if lender
is a party-in-interest?
3c [New breakout] Is the loan guaranteed
by a party-in-interest?
b Yes b No
3d [New breakout] Enter original amount
of loan
3e [2008 Schedule E, Line 9a] Enter date
of loan
3f [New breakout] Enter interest rate (if
variable enter terms)
3g [New breakout] Is the loan in default?
b Yes b No If ‘‘Yes,’’ enter the amount
overdue.
3h [New breakout] (1) Was the loan
refinanced or amended during the plan year?
b Yes b No
If ‘‘Yes,’’ complete Line 3h(2) and (3)
(2) Enter date of amendment or
refinancing.
(3) Enter the outstanding balance at date of
refinancing or amendment
Part IV Other General Information
4a [New] Were employee elective deferrals
used to satisfy any securities acquisition
loan?
b Yes b No
4b [2008 Schedule E, Lines 1a and 1b] If
the ESOP is maintained by an S corporation,
are there any disqualified persons as
described in Code section 409(p)(4)?
b Yes b No
4c [2008 Schedule E, Line 6] Were
unallocated securities or proceeds from the
sale of unallocated securities used to repay
any exempt loan (within the meaning of Code
section 4975(d)(3) and ERISA section
408(b)(3))?
b Yes b No
If ‘‘Yes,’’ attach a description of the
transaction.
4d [2008 Schedule E, Line 2b] Did the
employer maintaining the ESOP pay
dividends (deductible under Code section
404(k)) on the employer’s stock held by the
ESOP during the employer’s tax year in
which the plan year ends?
b Yes b No
If ‘‘Yes,’’ answer (d)(1)–(3).
(1) What was the amount of the deduction
taken?
(2) What was the dividend rate?
(3) Did the employer make payments in
redemption of stock held by an ESOP to
ESOP participants and deduct them under
Code section 404(k)(1)?
b Yes b No
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Schedule G—Financial Transactions
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
[Identification information same as
current Schedule G]
A Name of plan
B Three-digit plan number (PN)
C Plan sponsor’s name as shown on Line
2a of Form 5500
D Employer Identification Number (EIN)
Part I. [Current Part I] Schedule of Loans or
Fixed Income Obligations in Default or
Classified as Uncollectible
1 [Current Line 1] Schedule of Loans in
Default or Classified as Uncollectible.
Complete as many entries as needed to report
all loans in default or classified as
uncollectible. (See Instructions.)
1a [Current Part I(b)] Identity and address
of obligor
Name
Street Address
City
State
Zip Code
1b [New Breakout] Relationship to plan.
(Check all boxes that apply.) Obligor is a:
b [New breakout] participant
b [Current Part I(a)] party-in-interest (e.g.
employer, employee organization,
employee of the plan, or other party-ininterest)
Enter description of the relationship (If no
relationship exists, enter ‘‘unrelated third
party’’)
1c [Part of Current Part I(c)] Check to
indicate whether the loan is:
b in default
b uncollectible
1d [Current Part I(d)] Enter original
amount of loan
1e [Part of Current Part I(c)] Enter original
interest rate. If variable, describe terms.
1f [Part of Current Part I(c)] Date of loan
origination
1g [Part of Current Part I(c)] Maturity date
1h (1) [Part of Current Part I(c)] Was the
loan secured by collateral? b Yes b No If
‘‘Yes,’’ complete elements (2) and (3).
(2) [New breakout] Was the security
interest perfected? b Yes b No
(3) [Part of Current Part I(c)] Enter a
description of collateral and value of
collateral:
Collateral type
Collateral value
1i [Part of Current Part I(c)] Scheduled
payment frequency (e.g., monthly, annually).
Enter description
1j [Current Part I(e) and (f)] Amount
received during reporting year:
Principal
Interest
1k [Current Part I(h) and (i)] Amount
overdue:
Principal
Interest
1l [Current instructions require an
attachment with this information]. Enter a
description of what steps the plan
administrator has taken or will be taking to
collect overdue amounts for each loan listed.
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2 Schedule of Fixed Income Obligations in
Default or Classified as Uncollectible.
[Breaks out fixed income obligations from
loans; current Schedule G has filers
completing same elements for both loans and
fixed income obligations.] Complete as many
entries as needed to report all fixed income
obligations in default or classified as
uncollectible. (See Instructions.)
2a [Current Part I(b)] Identity and address
of obligor
Name
Street Address
City
State
Zip Code
2b [Current Part I(a)] Check b if party-ininterest (e.g. employer, employee
organization, employee of the plan, or other
party-in-interest) was involved in the
transaction.
[New breakout] Enter description of the
relationship. If no relationship exists, enter
‘‘unrelated third party.’’
2c [Part of current Part I(c)] Check to
indicate whether the fixed income obligation
is:
b in default
b uncollectible
2d [New breakout; part of description in
current Part I(c)] Check applicable boxes to
indicate the nature of the fixed income
obligation:
b Bond
b Option
b Swap
b Future contract
b Forward contract
b Other (Enter description)
2e [Part of current Part I(c)] Date of
issuance
2f [Part of current Part I(c)] Maturity date
2g [Part of current Part I(c)] Enter coupon
yield or interest rate
2h [Current Part I(e)] Principal amount of
fixed income obligation
2i [Current Part I(h) and (i)] Amount
overdue:
Principal
Interest
2j [Current instructions require an
attachment with this information] Enter a
description of what steps the plan
administrator has taken or will be taking to
collect overdue amounts for each fixed
income obligation listed.
Part II Schedule of Leases in Default or
Classified as Uncollectible. Complete as
many repeating entries as needed to report all
leases in default or classified as
uncollectible. (See instructions.)
3a [Current Part II(b)] Identity and address
of lessor/lessee:
Name
Street Address
City
State
Zip Code
3b [Current Part II(a) and (c)] Relationship
to plan, employer, employee organization, or
other party-in-interest (if no relationship,
enter ‘‘unrelated third party’’). Check to
indicate whether lessor/lessee is b party-ininterest and enter description of relationship
(including whether plan is lessor or lessee):
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3c [Part of current Part II] Overdue Lease
Explanation. Check to indicate whether the
lease is in b default b uncollectible.
3d [Part of current Part II(d)] Enter the
address of the leased property:
Street Address
City
State
Zip Code
3e [Part of current Part II(d)] Enter date of
lease origination
3f [Current Part II(e)] Original cost of
leased property
3g [Current Part II(f)] Current value of
leased property at time of lease
3h [Current Part II(g)] Gross rental receipts
during the plan year
3i [Current Part II(h)] Expenses paid
during the plan year
3j [Current Part II(i)] Net receipts
3k [Part of current Part II(d)] Scheduled
payment frequency (e.g., monthly, annually)
3l [Part of current Part II(d)] Lease
expiration date
3m [Current Part II(j)] Amount in arrears
3n [Current instructions require an
attachment with this information]. Enter an
explanation of what steps the plan
administrator has taken or will be taking to
collect overdue amounts for each lease listed.
Part III Nonexempt Transactions.
Complete as many entries as needed to report
all nonexempt transactions.
CAUTION: If a nonexempt prohibited
transaction occurred with respect to a
disqualified person, the disqualified person
should generally file a Form 5330 with the
IRS to pay the excise tax on the transaction.
Line 4 [Current Part III(a)]
4a Name and address of party-in-interest
(or parties in interest, if multiple) involved
in the nonexempt prohibited transaction:
Name
Street Address
City
State
Zip Code:
4b [Current Part III(b)] Relationship to
plan, employer, employee organization, plan
sponsor, fiduciary, or other party-in-interest
4c [Revision of Current Part III(c), but
current requirement to provide a description
of transaction replaced with checkboxes;
written description only required for
‘‘other’’] Type of nonexempt transaction
(Check all that apply):
b Sale of any property to/from the plan
b Exchange of any property
b Lease of any property to/from the plan
b Lending of money to/from the plan
b Other extension of credit to/from the plan
b Furnishing of goods to/from the plan
b Furnishing of services to/by the plan
b Furnishing of facilities to/by the plan
b Other transfer to a party-in-interest, of any
income or assets of the plan
b Other use by or for the benefit of a partyin-interest, of any income or assets of the
plan
b Acquisition, on behalf of the plan, of any
employer security or employer real
property in violation of ERISA 407(a)
b Acting in a fiduciary’s individual or any
other capacity in any transaction
involving the plan on behalf of a party
(or represent a party) whose interests are
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
adverse to the interests of the plan or the
interests of its participants and
beneficiaries
b A receipt of any consideration for his or
her personal account by a party-ininterest who is a fiduciary from any
party dealing with the plan in
connection with a transaction involving
the income or assets of the plan
b Other (enter description)
4d [New] Check the appropriate box (see
instructions) to describe nature of
transaction:
b Discrete
b Ongoing
4e [Part of current Part III (c)] Date of the
transaction or, if ongoing, date of first
instance
4f [Part of current Part III (c)] Amount
involved in nonexempt transaction
4g [Current Part III (j)] Net gain (or loss)
on the transaction
4h [New] Has the transaction been fully
corrected (see instructions)? b Yes b No
If ‘‘Yes’’, check the correct box below and
complete (i) and (j):
b Transaction corrected outside VFCP
b Transaction corrected through the VFCP
b Transaction pending correction through
VFCP
4i [New] If the transaction was fully
corrected, enter the date the transaction was
fully corrected: MM/DD/20YY
4j [New] If the nonexempt transaction was
corrected enter a description of the corrective
action (i.e. reversal, disgorgement, loan
repaid, payment to plan, etc.)
4k [New] If the nonexempt transaction
occurred with respect to a disqualified
person, and the person was notified, was a
Form 5330 filed with the IRS?
b Yes
b No
b Unknown
b Not required-VFCP
b Disqualified person was not notified
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Schedule H—Financial Information
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor’s name as shown on line 2a
of Form 5500
D Employer Identification Number of plan
sponsor (EIN)
Part I Asset and Liability Statement
1. [Current Line 1, except reference to
‘‘MTIA’’ changed to ‘‘Master Trust;’’ changes
to individual data elements as indicated]
Current value of plan assets and liabilities at
the beginning and end of the plan year.
Combine the value of plan assets held in
more than one trust. Report the value of the
plan’s interest in a commingled fund
containing the assets of more than one plan
on a line-by-line basis unless the value is
reportable on Lines 1b(5)–1b(8). Do not enter
the value of that portion of an insurance
contract which guarantees, during this plan
year, to pay a specific dollar benefit at a
future date. Round off amounts to the nearest
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
dollar. Master trusts, CCTs, PSAs, and 103–
12 IEs do not complete Lines 1a(1), (2) and
(3), 1g, 1h, and 1i. CCTs, PSAs, and 103–12
IEs also do not complete Lines 1(c)(1) and (2)
and 1d. (See instructions.)
Assets [Columns for (a) Beginning of Year
(BOY) and (b) End of Year (EOY) Values]
[Current Line 1a Moved to Line 1b(1)]
1a [Current 1b] Receivables (less allowance
for doubtful accounts):
(1) [Current 1b(1)] Employer contributions
(2) [Current 1b(2)] Participant
contributions
(3) [Current 1c(8)] Notes receivable from
participants (participant loans)
(4) [Current 1b(3)] Other
1b [Current 1c; with changes as indicated]
General investments—
(1) [Current 1a] Total noninterest-bearing
cash
(2) [Current 1c(1) with new breakouts])
(A) Interest-bearing cash
(B) Certificates of deposit
(C) Money market accounts
(3) [New breakouts] Debt interests/
obligations (other than employer securities,
participant loans, and foreign investments)
(A) [Current 1c(2)] U.S. Government
securities
(B) [New] Other government securities
(C) [Current 1c(3) Corporate debt
instruments (other than employer securities)
(i) Investment grade
(ii) High-yield debt
(D) [New] Exchange Traded Notes
(E) [New] Asset backed securities (other
than real estate)
(F) [New and Partial Current 1c(7)] Other
debt interests
(4) [Current 1c(4)] Corporate stocks (other
than employer securities and foreign
investments):
(A) [New breakout] Publicly traded
(i) Preferred
(ii) Common
(B) [New breakout] Non-publicly traded
(i) Preferred
(ii) Common
(5) [Current 1c(13)] Registered investment
companies (Mutual funds, Unit Investment
Trusts, Closed End Funds)
(6) [New breakout] Eligible Pooled
Investment Vehicles (other than registered
investment companies)
(A) [Current 1c(10] Total value of interest
in pooled separate accounts (PSA)
(B) [Current 1c(9)] Total value of interest
in common collective trusts (CCT)
(C) [Current 1c(12)] Value of interest in
103–12 investment entities (103–12 IEs) (See
instructions)
(D) [Current 1c(11)] Total value of interest
in master trusts
(7) [Current 1c(14)] Value of interest in
funds held in insurance general account
(unallocated contracts)
(A) [New breakout] Deposit administration
(B) [New breakout] Immediate
participation guarantee
(C) [New breakout] Guaranteed investment
contracts
(D) [New breakout] Other unallocated
insurance contracts (Describe)
(8)(A) [Current 1c(5)] Partnership/joint
venture interests
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47581
(i) [New breakout] Value of interest in
limited partnerships
(ii) [New breakout] Value of interest in
venture capital operating companies (VCOC)
(iii) [New breakout] Private equity
(iv) [New breakout] Hedge funds
(v) [New breakout] Other partnership/joint
venture interests (Describe)
(B) [New sub-part question not part of sum
on balance sheet]
(i) Total partnership/joint venture interests
that do not hold plan assets under the DOL’s
plan asset regulation at 29 CFR 2510.3–101.
(ii) Total partnership/joint venture
interests that hold plan assets under the
DOL’s plan asset regulation at 29 CFR
2510.3–101.
(9) [Current 1c(6)] Real Estate Investments
(other than employer real property and
foreign investments)
(A) [New breakout] Developed real
property (other than employer real property)
(B) [New breakout] Undeveloped real
property (other than employer real property)
(C) [New breakout] Publicly Traded Real
Estate Investment Trusts (REITs)
(D) [New breakout] Non-Publicly Traded
Real Estate Investment Trusts (REITs)
(E) [New breakout] Mortgage-Backed
Securities (Including Collateralized Mortgage
Obligations)
(F) [New breakout] Real Estate Operating
Company (REOC)
(G) [New breakout] Other real estate
related investments (Describe)
(10) [New breakout] Commodities (direct
investments)
(A) [New breakout] Precious metals
(B) [New breakout] Other (Describe)
(11) [New breakout] Derivatives
(A) [New breakout] Futures
(B) [New breakout] Forwards
(C) [New breakout] Options
(D) [New breakout] Swaps
(E) [New breakout] Other (Describe, e.g.,
collateralized debt obligations other than real
estate)
(12) [Current 3g on Schedule I] Tangible
Personal Property (including collectibles)
(13) [New breakout] Foreign investments
(Other than those held through registered
investment companies or eligible pooled
investment vehicles)
(A) Equities
(B) Debt interests
(C) Real estate
(D) Currency
(E) Other (Describe)
(14) [New breakout] Value of assets held in
participant-directed brokerage accounts (See
instructions)
(A) Tangible personal property
(B) Loans
(C) Partnership or joint venture interests
(D) Real property
(E) Employer securities
(F) Investments that could result in a loss
in excess of the account balance of the
participant or beneficiary who directed the
transaction, including derivatives
(G) Other (including cash/cash equivalents,
registered investment companies, corporate
equities, corporate debt instruments)
1c [Current 1d except breakout for nonpublicly traded stock and debt] Employerrelated investments
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
(1) Employer securities
(A) Publicly traded stock
(B) Non-publicly traded stock
(C) Publicly traded debt instruments
(D) Non-publicly traded debt
(2) Employer real property
1d [Current 1e] Buildings and other
property used in plan operation
1e [Current 1c(15)] Other ([New] Describe)
1f [Current 1f] Total assets (Add Lines 1a
through 1e.)
Liabilities [Columns for (a) BOY (b) EOY
Values]
1g [Current 1g] Benefit claims payable
1h [Current 1h] Operating payables
1i [Current 1i] Acquisition indebtedness
1j [Current 1j] Other liabilities
1j(1) [New] Enter description
1k [Current 1k] Total liabilities (add all
amounts in Lines 1g through 1j)
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Net Assets
1l [Current] Net assets (subtract Line 1k
from Line 1f)
Part II Income and Expense Statement
2 [Current 2] Plan income, expenses, and
changes in net assets for the year. Include all
income and expenses of the plan, including
any trust(s) or separately maintained fund(s)
and any payments/receipts to/from insurance
carriers. Round off amounts to the nearest
dollar. Master trusts, CCTs, PSAs, and 103–
12 IEs do not complete Lines 2a, 2b, 2e, 2f,
and 2g.
2a [Current 2a] Contributions—
(1) Received or receivable in cash from:
(A) Employers
(B) Participants
(C) Others (including rollovers from IRAs/
other plans)
(2) Noncash contributions
(3) Total contributions. Add Lines 2a(1)(A),
(B), (C), and Line 2a(2).
2b [Current 2b(1)(E) with new breakouts]
Interest on notes receivable from participants
(participant loans)
(1) Received in cash
(2) Receivable in cash
(3) Total. Add Lines 2b(1) and 2b(2).
2c [Current 2b with new breakouts]
Earnings on investments. Provide the total of
all earnings by asset type including interest,
dividends, gain (loss) on sale of property,
unrealized appreciation (depreciation), net
investment gain (loss), as appropriate for
asset type. Report on Lines 2c(1)(A) and
2(c)(2)(A), respectively, interest and
dividends on debt and equity instruments
held directly by the plan.
(1) Interest on debt instruments/obligations
(A) Interest bearing cash (including money
market and certificates of deposit)
(B) U.S. government securities
(C) Other government securities
(D) Corporate debt instruments
(E) Loans (other than to participants)
(F) Other
(G) Total interest. Add Line 2c(1)(A)
through (F)
(2) Dividends (other than employer
securities)
(A) Preferred stock
(B) Common stock
(C) Registered investment company shares
(e.g., mutual funds)
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19:35 Jul 20, 2016
Jkt 238001
(D) Total dividends. Add Line 2c(2)(A)
through (C).
(3) Rents
(4) Net gain (loss) on sale of assets
(A) Aggregate proceeds
(B) Aggregate carrying amount (see
instructions)
(C) Subtract Line 2c(4)(B) from Line
2c(4)(A) and enter result
(5) Unrealized appreciation (depreciation)
of assets
(A) Real estate
(B) Partnership/joint venture interests that
do not hold plan assets
(C) Commodities (direct investments)
(D) Derivatives
(E) Employer securities
(F) Foreign investments (other than those
held through U.S. registered investment
funds)
(G) Employer real property
(H) Other (Describe)
(6) Pooled Investment Vehicles
(A) Net investment gain (loss) from
common/collective trusts
(B) Net investment gain (loss) from pooled
separate accounts
(C) Net investment gain (loss) from master
trusts
(D) Net investment gain (loss) from 103–12
investment entities
(E) Net investment gain (loss) from
registered investment companies (e.g.,
mutual funds)
2d [Current 2d] Total income. Add all
income amounts in column (b).
Expenses—[Current]
2e [Current 2e] Benefit payment and
payments to provide benefits:
(1) Directly to participants or beneficiaries
(A) [New breakout from current 2d(1)]
Direct rollovers
(B) [New] Hardship distributions made
from a section 401(k) plan
(C) [Current 2016 Line 4o] Distributions to
employees who have attained age 62 and
who were not separated from service when
the distributions were made for a defined
benefit plan or a money purchase pension
plan
(D) [Current 2e(1) except rollovers no
longer reported in other] Other
(2) [Current] To insurance carriers for the
provision of benefits
(3) [Current] Other
(4) [Current] Total benefit payments. Add
Lines 2e(1) through (3).
2f [Current] Corrective distributions (See
instructions.)
2g [Current] Certain deemed distributions
of participant loans (See instructions.)
2h [Current] Interest expense
2i [Current 2i with new breakouts as
indicated] Administrative expenses:
(1) [New Breakout (1998 Line 32g(1)]
Salaries and allowances
(2) [Current 2i(2)] Contract administrator
fees
(3) [Current 2i(3)] Investment advisory and
management fees
(4) [New Breakout] IQPA Audit fees
(5) [New based on 1998 Line 32g(2)]
Recordkeeping and other accounting fees
(6) [New Breakout] Bank or Trust
Company Trustee/Custodial Fees
(7) [New Breakout (1998 Line 32g(3))]
Actuarial fees
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(8) [New Breakout (1998 Line 32g(6))]
Legal fees
(9) [New Breakout (1998 Line 32g(7))]
Valuation/appraisal fees
(10) [New Breakout (1998 Line 32g(8))]
Trustee fees/expenses (including travel,
seminars, meetings, etc.)
(11) [Current 2i(4)] Other
(12) [12(C) is Current 2i(5); (A) and (B) are
new breakouts] Total administrative
expenses
(A) Total paid by the plan, except charges
directly against participant accounts
(B) Total payments charged directly against
participant accounts
(i) Transaction-based charges to individual
participant accounts
(ii) Plan level expenses apportioned among
participant accounts
(iii) Indicate how apportioned:
b per capita
b pro rata by account balance
b other (describe):
(C) Total. (The amount shown in (C)
should be the total of elements (A) and (B).
Element (C) should also be the same as the
total of Lines 2i(1) through (11).)
2j [Current 2j] Total expenses. Add all
expense amounts in column (b) (EOY) and
enter total.
Net Income and Reconciliation
2k [Current] Net income (loss). Subtract
Line 2j from Line 2d.
2l [Current] Transfers of assets—
(1) [Current 2l(1)] Transfers to this plan.
Total at EOY
(2) [Current 2l(2)] Transfers from this plan.
Total at EOY
Part III
Accountant’s Opinion.
Subject to certain exceptions, the
administrator of an employee benefit plan
who files a Schedule H must engage an
Independent Qualified Public Accountant
(IQPA) pursuant to ERISA section
103(a)(3)(A) and 29 CFR 2520.103–1(b). This
requirement also applies to a Form 5500
Annual Return/Report filed for a 103–12 IE
and for a GIA (see 29 CFR 2520.103–12 and
29 CFR 2520.103–2). The IQPA’s report must
be attached to the Form 5500 Annual Return/
Report when a Schedule H is attached unless
you check Line 3h(1), (2), (3), or (4) on the
Schedule H. An IQPA Report generally
consists of an Accountant’s Opinion,
Financial Statements, Notes to the Financial
Statements, and Supplemental Schedules.
3 [Current] Complete Lines 3a through 3g
if the opinion of an IQPA is attached to this
Form 5500 Annual Return/Report. Complete
Line 3h if an opinion is not attached.
3a [Current] The attached opinion of an
IQPA for this plan is (see instructions):
(1) b Unqualified
(2) b Qualified
(3) b Disclaimer
(4) b Adverse
3b [Current question; new requirement to
attach certification(s)] Did the IQPA perform
a limited scope audit pursuant to 29 CFR
2520.103–8 and/or 103–12(d)?
b Yes b No
If ‘‘Yes’’ you must attach a copy of the
certification(s). (Although you must attach a
copy of the certification(s), you do not need
to include any attachments to the
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certification itemizing the assets to which the
certification(s) apply.)
3c [Current] Enter the name and EIN of the
IQPA (or accounting firm) below:
(1) Name
(2) EIN
(3) Name of audit engagement partner
3d [New] Identify the state in which the
opinion was issued
3e [New] Did you review and discuss the
IQPA report with the accountant?
b Yes b No
3f [New] Did the accountant advise you
whether the IQPA report, including the
financial statements and/or notes required to
be attached to this return/report or the
IQPA’s communications with those charged
with governance (SAS 114 and 115),
disclosed any of the following (check all that
apply):
(1) b Errors or irregularities
(2) b Illegal acts
(3) b Material internal control weaknesses
(4) b A loss contingency indicating that
assets are impaired or a liability incurred
(5) b That the plan sponsor may not be a
going concern
(6) b The existence of plan qualification
issues pursuant to the Internal Revenue Code
(7) b Any unusual or infrequent events or
transactions occurring subsequent to the plan
year end that might significantly affect the
usefulness of the financial statements in
assessing the plan’s present or future ability
to pay benefits (explain)
3g [New] Did your IQPA have a peer
review performed in accordance with their
state’s requirements?
b Yes b No
If ‘‘Yes,’’ complete elements (1) through
(5).
(1) Name of peer reviewer
(2) Year of their last peer review
(3) Rating received in their last peer review
report
(4) Number of years that the peer reviewer
has been the firm’s peer reviewer
(5) Whether the peer review covered
employee benefit plans
3h [Current 3d] The opinion of an IQPA is
not attached because (check appropriate box):
(1) b This form is filed for a CCT, PSA, or
master trust.
(2) b Pursuant to 29 CFR 2520.104–50, the
IQPA report will be attached to the next
Form 5500 Annual Return/Report.
(3) b The IQPA report was not completed
in time. If you check this box, you must
explain the reason for the failure to comply
with the IQPA requirement in a timely
fashion and indicate date by which an
amended filing will be made with an IQPA
report.
(4) [Current 4k on Schedule I] b The plan
is a small plan and is eligible to claim a small
plan audit waiver of the annual examination
and report of an IQPA under the conditions
set forth in 29 CFR 2520.104–46. (See
instructions). In addition to meeting other
conditions in 29 CFR 2520.104–46, in order
to be a small plan for this purpose, the plan
must have fewer than 100 participants as of
the beginning of the plan year as reported on
Form 5500 or be eligible to claim small plan
status under 29 CFR 103–1(d) and had 120
or fewer participants as of the beginning of
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19:35 Jul 20, 2016
Jkt 238001
the plan year. Defined benefit pension plans
and welfare plans use the number reported
on Form 5500, Line 6 for this measure.
Defined contribution pension plans use the
number reported on Form 5500, Line 7g(1).
(See instructions.)
Part IV Compliance Questions
Employee benefit plans must complete all
lines that apply. Employee benefit plans
must complete all lines that apply. Small
employee benefit plans that were eligible for
and claimed the small plan audit waiver by
checking Line 3g(4), must complete all
elements in Part IV, except such small plans
do not need to attach Schedules G or the Line
4j Schedule of Reportable Transactions, even
if they answer ‘‘Yes’’ to Lines 4b, 4c, 4d, or
4j. CCTs and PSAs complete only Line 4i(1).
Master trusts and 103–12 IEs complete only
Lines 4b, 4c, 4d, 4i, 4j, and 4s. GIAs complete
only Lines 4b, 4c, 4d, 4i, 4j, and 4k.
During the plan year:
4a [Current; but would require use of
specified structured data format to complete
and file Line 4a schedule] Was there a failure
to transmit to the plan any participant
contributions or repayments as of the earliest
date on which such contributions can
reasonably be segregated from the employer’s
general assets as described in 29 CFR 2510.3–
102?? (See instructions). Continue to answer
‘‘Yes’’ for any prior year failures until fully
corrected. (See instructions and DOL’s
Voluntary Fiduciary Correction Program.) If
you answered ‘‘Yes,’’ you must complete the
Line 4a schedule to provide details about the
failure to transmit, including any corrective
action taken.
b Yes b No Amount
4b [Current] Were any loans by the plan or
fixed income obligations due the plan in
default as of the close of the plan year or
classified during the year as uncollectible?
Disregard participant loans secured by the
participant’s account balance. If you
answered ‘‘Yes,’’ see instructions for
requirements to attach Schedule G (Form
5500) Part I. Small plans that were eligible
for and claimed the small plan audit waiver
under 29 CFR 2520.104–46 do not need to
attach Schedule G Part I.
b Yes b No Amount
4c [Current] Were any leases to which the
plan was a party in default or classified
during the year as uncollectible? If you
answered ‘‘Yes,’’ see instructions for
requirements to attach Schedule G (Form
5500) Part II. Small plans that were eligible
for and claimed the small plan audit waiver
under 29 CFR 2520.104–46 do not need to
attach Schedule G Part II.
b Yes b No Amount
4d [Current] Were there any nonexempt
prohibited transactions with any party-ininterest? (Do not include transactions
reported on Line 4a. If you answered ‘‘Yes,’’
see instructions for requirements to attach
Schedule G (Form 5500) Part III. Small plans
that were eligible for and claimed the small
plan audit waiver under 29 CFR 2520.104–
46 do not need to attach Schedule G Part III.
b Yes b No Amount
4e [Current Line 4e revised] Was this plan
covered by one or more fidelity bonds
naming the plan as insured that provide
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Frm 00051
Fmt 4701
Sfmt 4702
47583
coverage for losses due to fraud or dishonesty
by persons who handle plan funds or other
property? (See instructions.)
b Yes b No Amount
4f [Current] Did the plan have a loss,
whether or not reimbursed by the plan’s
fidelity bond, that was caused by fraud or
dishonesty?
b Yes b No Amount
4g [Current Line 4g revised] Did the plan
hold any assets that either did not have a
readily determinable fair value or were not
valued by an independent third party
appraiser? (See instructions)
b Yes b No Amount
4h [Current] Did the plan receive any
noncash contributions whose value was
neither readily determinable on an
established market nor set by an independent
third party appraiser?
b Yes b No Amount
4i [Current Line 4i; Except would now
break out question into 4i(1) and 4i(2) and
require use of specified structured data
format to complete and file Schedules of
Assets]
(1) Did the plan have assets held for
investment at the end of the year? If ‘‘Yes,’’
you must complete the Line 4i(1) Schedule
of Assets Held for Investment at End of Year.
b Yes b No
(2) Did the plan have assets held for
investment that were sold or otherwise
disposed of during the plan year (see
instructions)? If ‘‘Yes,’’ you must complete
the Line 4i(2) Schedule of Assets Disposed of
During the Plan Year.
b Yes b No
4j [Current, but would require use of
specified structured data format to complete
and file Line 4j Schedule of Reportable
Transactions] Were any plan transactions or
series of transactions in excess of 5% of the
current value of plan assets? If ‘‘Yes,’’ you
must complete the Schedule of Reportable
Transactions. (See instructions). Small plans
that were eligible for and claimed the small
plan audit waiver do not need to attach the
Line 4j Schedule of Reportable Transactions.
b Yes b No
[Part of current Line 4k moved to Form
5500; part moved to Part V of Schedule H]
4k [Current 4l] Has the plan failed to
provide any benefit when due under the
plan?
b Yes b No Amount
4l [Current 4m] If this is an individual
account plan, was there a blackout period?
(See instructions and 29 CFR 2520.101–3.)
b Yes b No Amount
4m [Current 4n] If you answered ‘‘Yes’’ to
Line 4l, check the ‘‘Yes’’ box here if you
either provided the required notice or one of
the exceptions to providing the notice
applied under 29 CFR 2520.101–3.
b Yes b No
4n [New] Is this a participant-directed
individual account plan (e.g., a 401(k)-type or
403(b) defined contribution pension plan),
subject to the requirements in 29 CFR
2550.404a5 to disclose plan and investment
related information to participants and
beneficiaries?
b Yes b No
4o [New] If you answered ‘‘Yes’’ to Line
4n, did the plan provide participants and
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21JYP3
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
beneficiaries the plan and investment
disclosures required under 29 CFR
2550.404a–5?
b Yes b No
If you answered ‘‘Yes,’’ you must attach the
investment option comparative chart or
charts that were used to satisfy the disclosure
requirement in 29 CFR 2550.404a–5(d)(2).
4p [New] If you answered ‘‘Yes,’’ to Line
4n, enter the number of designated
investment alternatives (DIAs) available
under the plan and indicate the number of
DIAs that are index funds. Also, check all
that apply to indicate the types of DIAs
available under the plan:
b Domestic Stock/Equity
b Bond/income
b Balanced/target allocation
b Money Market
b Target date/Lifecycle
b International/Global Stock/Equity
b Sector/economy segment
b Other funds (Describe)
4q [New] If you answered ‘‘Yes,’’ to Line
4n, did the plan make available to
participants and beneficiaries a designated
investment manager (DIM)?
b Yes b No Enter name of DIM.
4r [New] If you answered ‘‘Yes,’’ to Line
4n, did the plan make available to
participants and beneficiaries any brokerage
window, self-directed brokerage account or
similar plan arrangements that enabled
participants to select investments beyond
those designated by the plan?
b Yes b No
If you answered ‘‘Yes’’ to Line 4r, enter the
number of participants that utilized the
account or arrangement
4s [New] Did the plan trust incur unrelated
business taxable income (UBTI)?
b Yes b No b NA
If ‘‘Yes,’’ enter amount,
4t [New] Were all plan assets valued at
least annually at fair market value?
b Yes b No
4u [New] Did any employer sponsoring the
plan pay any of the administrative expenses
of the plan that were not reported on
Schedule H, Line 2i?
b Yes b No
4v [New] Did any person who is
disqualified under ERISA Section 411, serve
or was permitted to serve the plan in any
capacity?
b Yes b No
4w [New] Does the plan have investment
acquisitions that are leveraged, including
assets subject to collateralized lending
activities (e.g., securities lending
arrangements, repurchase agreements (repos),
etc.)?
b Yes b No If ‘‘Yes,’’ you must complete
Lines 4w(1), (2), and (3).
(1) Check box to indicate type of activity:
b securities lending, including repurchase
agreements or sell/buy-backs
b other, e.g., transactions that subjected plan
assets to a mortgage, lien, or other
security interest (describe)
(2) (A) amount of cash obligated in
connection with collateralized lending
activities at end of year
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19:35 Jul 20, 2016
Jkt 238001
(B) value of securities obligated in
connection with collateralized lending
activities at end of year
(C) other assets obligated in connection
with collateralized lending activities at end
of year
(3) approximate ratio of collateralized/
leveraged investments to total plan assets at
end of year
4x [New] Did the plan sponsor or its
affiliates provide any services to the plan in
exchange for direct or indirect
compensation?
b Yes b No
4y [New (based on 1998 Line 8a)] Is the
plan’s summary plan description (SPD),
including any summary descriptions of
modifications, in compliance with the
content requirements in 29 CFR 2520.102–3?
(See instructions.)
b Yes b No
4z [New] If this is an individual account
plan, were there any checks to participants
or beneficiaries that were uncashed as of the
end of the plan year? b Yes b No. If
‘‘Yes,’’ complete 4z(1)–(4)
(1) Enter number of uncashed checks
(2) Enter total value of uncashed checks
(3) Describe the procedures followed by the
plan to verify a participant’s or beneficiary’s
address before a check was mailed.
(4) Describe the procedures followed by the
plan to monitor uncashed checks, including
steps to locate ‘‘missing’’ or ‘‘lost’’
participants.
Part V Termination Information on
Accountants, Enrolled Actuaries and Other
Service Provider
(See Instructions.) (Complete as many
entries as needed.)
5 [Current Part III of Schedule C except
adds check boxes to element (c)] Has any
accountant or actuary been terminated?
b Yes b No If ‘‘Yes, complete elements
(a)–(f).
5a Name
5b EIN
5c [Current element (c), but adds check
boxes to distinguish between accountant and
actuary] Position and title (See instructions.)
b Accountant
b Actuary
5d Address
5e Telephone
5f Explanation of reason for termination
6 [New] Have any of the plan’s service
providers, other than an accountant or
actuary who has been identified in Line 5,
been terminated for a material failure to meet
the terms of a service arrangement or failure
to comply with Title I of ERISA, including
the failure to provide required disclosures
under 29 CFR 2550.408b–2? b Yes b No
If ‘‘Yes,’’ complete elements (a)–(e) to
identify the service provider.
6a Name
6b EIN
6c Address
6d Telephone
6e Explanation of reason for termination
6f b Check if termination was due to
failure to provide required disclosures under
29 CFR 2550.408b–2.
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Frm 00052
Fmt 4701
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Part VI Plan Termination Information
7a [Revised to ask about any resolution to
terminate regardless of when adopted] Has
a resolution to terminate the plan been
adopted? You must continue to report a
pending resolution until the plan terminates
and is no longer filing the Form 5500 Annual
Return/Report. (See instructions.)?
b Yes b No If ‘‘Yes,’’ complete Line
7a(1)–(3) below:
(1) [New] Effective date of plan
termination:
(2) [New] Year the plan assets were
distributed to plan participants and
beneficiaries:
(3) [Current 5a] The amount of plan assets
that reverted to the employer this year
7b [Current 5b] Transfer to other plans.
Did this plan transfer assets or liabilities to
another plan since the (20XX–1) filing?
b Yes b No If ‘‘Yes,’’ complete elements
(1)–(5) to provide the following
information with respect to each plan to
which the assets or liabilities were
transferred. Complete as many entries as
needed to identify all transfers.
(1) [Current 5b(2)] EIN
(2) [Current 5b(3)] PN
(3) [New] Date of transfer:
(4) [Current 5b(1)] Name of Plan (Use name
on transferee plan’s Form 5500 Annual
Return/Report filing.):
(5) [New] Type of transfer:
b Merger
b Consolidation
b Spinoff
b Other (Describe)
(6) [Part of current Line 4k] Were all plan
assets transferred to another plan? b Yes
b No
[Current 5c moved to Form 5500]
7c [New] Transfers from other plans. Did
another plan transferred assets or liabilities
to this plan since the (20XX–1) filing, or in
the case of a first plan filing, transfer assets
or liabilities in conjunction with the creation
of this new plan?
b Yes b No If ‘‘Yes,’’ provide the
following information with respect to
each plan from which assets or liabilities
were transferred:
(1) EIN
(2) PN
(3) Date of transfer
(4) Name of Plan (Use name on transferor
Plan’s Form 5500 Annual Return/Report
filing.):
(5) Type of transfer:
b Merger
b Consolidation
b Spinoff
b Other (Describe)
7d [New] Terminated Defined
Contribution Pension Plans: Transfers to
Financial Institution. Did this plan, as part
of the procedures for terminating the plan,
transfer plan assets to interest bearing
federally insured bank accounts in the name
of missing participants? b Yes b No If
‘‘Yes,’’ complete elements (1)–(5). List each
financial institution where plan assets were
transferred. You must continue reporting this
information until the final return/report is
filed for the plan.
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
(1) Financial Institution’s Name
(2) Financial Institution’s EIN
(3) Date of transfer
(4) Number of accounts established
(5) Total amount transferred
7e [Part of current Line 4k with a new
subpart to report the year.] Were all the plan
assets distributed to participants or
beneficiaries? b Yes b No
Part VI—Trustee Information—[Current Part
V but proposed no longer optional starting
2016 See IRS Federal Register Notice
‘‘Proposed Collection; Comment Request for
the Annual Return/Report of Employee
Benefit Plan’’]
8 Complete as many entries as needed to
identify all trusts holding plan assets. Do not
include trusts that are part of pooled
investment funds that hold the assets of two
or more unrelated plans.
8a [Current] Name of Trust
8b [Current] Trust EIN
47585
8c [New] Name of Trustee/Custodian
(1) [New] Trustee/Custodian Address
(2) [New] Telephone Number
(3) [New—intended to be electronic
signature] Date and Signature of Trustee/
Custodian:
Trustee Signature for Purposes of the Code
SIGN HERE Signature of plan trustee or
custodian:
Enter Date:
Enter name of individual signing as trustee
or custodian:
Schedule H Line 4a—Schedule of Delinquent Participant Contributions
(a) Amount remitted late to plan
during plan year
(b) Amount
due, but
unremitted
during the
plan year
(c) Number of
contribution
cycles involved (number of payrolls)
Line 4i(1) Schedule of Assets Held for
Investment at End of Year (Complete as
many entries in each element as needed to
(d)(1) Amount
corrected in
VFCP
(2) Amount not
corrected
under PTE
2002–51
(e) Amount
pending correction in
VFCP
(f) Amount corrected outside VFCP
(g) Check here
if participant
loan repayments are included: b
(h) For any
(i)(1) If reportamount reing for a mulported in Eletiemployer
ment (d), did
plan, amount,
you file your
if any, deterIRS Form
mined during
5330 and pay
the plan year
applicable
to be
excise taxes?
uncollectible
b Yes b No .... (2) Explain
what steps
were taken to
collect overdue amounts
identify all assets held for investment at end
of year)
(a) Assets Held directly by the plan (including assets held through an participant-directed brokerage window) For each asset which the plan holds for investment purposes that is not a type of assets required to be listed in (b) through (e) below, complete elements (i)–(vii).
(i) Check if issuer, borrower, lessor or similar
party is party-ininterest b
(ii) Name of issuer,
borrower, lessor, or
similar party
(iii) Is the asset a
hard-to-value asset?
b Yes b No
(iv) CUSIP, CIK, LEI,
NAIC Company Code,
other registration
number:
(v) Cost
(vi) Indicate Sch. H,
Line 1b asset
category.
(vii) Description of
investment, including,
as applicable, share
class, maturity date,
rate of interest, par or
maturity value,
including whether
asset/investment is
subject to surrender
charge. See instructions for reporting assets held through a
participant-directed
brokerage
account.
(b) Investments in Master Trust (repeat as many entries as needed to identify holdings in master trusts) For each master trust in which the plan invested,
break out plan’s interest in each asset in the master trust(s) in elements (i)–(viii). Do not include master trust holdings in which the plan has no interest.
(i) Enter name, EIN/PN of sponsor of master trust used on master trust’s Form 5500.
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
(ii) Check if issuer, borrower, lessor or similar
party is party-ininterest b
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(iii) Name of issuer,
borrower, lessor, or
similar party
(See instructions)
19:35 Jul 20, 2016
Jkt 238001
(iv) Is the asset a
hard-to-value asset?
b Yes b No
PO 00000
Frm 00053
(v) Enter all that apply:
EIN, CUSIP, CIK, LEI,
NAIC Company Code,
other registration
number:
Fmt 4701
Sfmt 4702
(vi) Cost
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(vii) Indicate Sch. H,
Line 1b asset
category
21JYP3
(viii) Description of
investment, including,
as applicable, share
class, maturity date,
rate of interest, par or
maturity value, including whether asset/investment is subject to
surrender charge.
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
(c) Investments in PSAs and CCTs (repeat as many entries as needed to identify holdings in PSAs and CCTs) If the PSA filed a Form 5500, complete elements (i)–(vii) indicating the value of the plan’s shares in the PSA or CCT. For PSAs or CCTs that have not filed a Form 5500, break out plan’s proportionate interest in each asset in the PSA of CCT in elements (i)–(ix) and include the name and identifying numbers for the non-filing CCT or PSA, as well a description of the
asset held through the non-filing CCT or PSA.
(ii) Check if issuer, borrower, lessor or similar party is party-ininterest b
(i) Enter name, EIN/PN of sponsor of CCT/PSA.
(iv) Name of issuer,
borrower, lessor, or
similar party
(see Instructions)
(iii) Did the PSA or
CCT filed a Form 5500
Yes b No b
(vi) ) Enter all that
apply: EIN, CUSIP,
CIK, LEI, NAIC Company Code: Other registration number:
(v) Is the asset a
hard-to-value asset?
b Yes b No
(vii) Cost
(viii) Indicate Sch. H,
Line 1b asset
category
(ix) Description of investment, including,
as applicable, share
class, maturity date,
rate of interest, par or
maturity value, including whether asset/investment is subject to
surrender charge.
(d) Investments in 102–12 Investment Entities (repeat as many entries as needed to identify holdings in 103–12 IEs). For each 103–12IE in which the plan
invested, complete elements (i)–(vii) indicating the value of the plan’s shares in the in each 103–12IE in elements (i)–(viii).
(ii) Check if issuer, borrower, lessor or similar
party is party-in-interest b
(i)Enter name, EIN of provider of the 103–12 IE.
(iii) Name of issuer, borrower, lessor, or similar
party (See instructions)
(iv) Is the asset a hard-tovalue asset? b Yes b No
Line 4i(2) Schedule of Assets Disposed
of During the Plan Year [Current
elements of Schedule of Assets Acquired
(v) Enter all that apply: EIN,
CUSIP, CIK, LEI, NAIC
Company Code: Other registration number:
(d) Enter all that
apply: EIN,
CUSIP, CIK, LEI,
NAIC Company
Code, Other registration number:
(e) Sch. H, Line
1b category
Schedule H, Line 4j—Schedule of
Reportable Transactions [Current Line
4j Schedule, except (a) is new and
(a) Check here if transaction involved a person/
entity known to be party-ininterest b
(f) Lease rental
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(e) Selling price
For calendar plan year 20XX or fiscal plan
year beginning DD/MM/20XX and ending
DD/MM/20XX+1
A Name of plan
B Three-digit plan number (PN)
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19:35 Jul 20, 2016
Jkt 238001
(Complete as many entries as necessary to
identify all assets sold during plan year
(f) Cost
(b) Check if issuer, borrower, lessor or similar party is party-in-interest b
(g) Selling price
(h) Expenses incurred with disposal of asset
(c) Description of asset
(include interest rate and maturity in case of a loan)
(g) Expense incurred with
transaction
(including all fees)
(h) Cost of asset
C Plan sponsor’s name as shown on Line
2a of Form 5500
D Employer Identification Number (EIN)
Plans that have fewer than 100 participants
at the beginning of the plan year and are fully
insured (see instructions) complete only
basic identifying information and Part I,
Lines 1–8. GIAs must complete a separate
Schedule J for each participating plan.
PO 00000
(i) Net gain (loss)
on transaction
Frm 00054
Fmt 4701
Sfmt 4702
(j) Description of
investment, including maturity
date, rate of interest, collateral, par,
or maturity value
elements as necessary to identify all
reportable transactions.
remaining elements are re-lettered in
sequence] Complete as many repeating
(b) Identity of party
involved
[New Schedule] Schedule J (Form 5500)—
Group Health Plan Information
(vii) Indicate Line 1b asset
category.
and Disposed of During Plan Year;
element (b) currently unlettered]
(a) Enter name, EIN of issuer, borrower, lessor, or similar party
(c) Check if asset
was acquired during
plan year b
(vi) Cost
(viii) Description of investment, including, as applicable, share class, maturity
date, rate of interest, par or
maturity value, including
whether asset/investment is
subject to surrender
charge.
(d) Purchase price
(i) Current value of asset
on transaction date
Part I—Group Health Plan Characteristics
1 Approximate number of persons
(including participants, beneficiaries and
dependents of participants) covered under
the plan at the end of the plan year?
2 The plan offers health coverage to the
following (check all that apply):
b employees
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b
b
b
b
spouses
children
retirees
retirees only
3 Indicate which of the following types of
benefit(s) and design characteristics are
included under the plan. (Check all that
apply):
b medical/surgical benefits
b mental health/substance use disorder
benefits
b pharmacy or prescription drug benefits
b wellness program
b preventive care services
b emergency services
b pregnancy benefits
b vision
b dental
4 Health funding and benefit arrangement
(check all that apply):
4a(1)(a) b health insurance issuer. If you
check this box, enter name(s), EIN, and
National Insurance Product Registry Number
of insurance carriers providing benefits
under the plan.
4a(1)(b) If the health funding or benefit
arrangement is through a prototype/off-theshelf insurance product, enter the
identification number of the prototype/offthe-shelf insurance product.
4a(1)(c) Please check whether one or both
of the following are used to pay premiums:
b employer contributions
b participant contributions
4a(2) b benefits paid from general assets
of the employer
b employer contributions
b participant contributions
4a(3) b trust
b employer contributions
b participant contributions
5 Check all that apply to the plan:
b one or more benefit package options
claiming grandfathered status under the
Affordable Care Act
b high deductible health plan
b health reimbursement arrangement (HRA)
or plan includes an HRA
b health flexible spending account (FSA) or
plan includes an FSA
6a How many persons were offered
COBRA benefits during the plan year?
6b Of the persons counted in line 6a, how
many persons elected COBRA benefits?
6c How many persons were receiving
coverage under the plan through COBRA
during the plan year?
7a Did the plan or plan sponsor receive
any rebates, reimbursement, or refunds other
than those reported on Schedule A from
service providers during the plan year?
b Yes b No If ‘‘Yes,’’ you must complete
Line 7b. If ‘‘No,’’ skip to Line 8.
7b(1) If you answered ‘‘Yes’’ to Line 7a,
enter separately the amount and date
received of each rebate, reimbursement, or
refund. For each rebate, reimbursement, or
refund listed, complete elements 7b(2) and
7b(3).
(2) Type of service provider that provided
each rebate, reimbursement, or refund
b health insurance issuer
b third-party administrator
b pharmacy benefit manager
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b other (specify)
(3) How each rebate, reimbursement, or
refund was used (Check all that apply):
b amount returned to participants
b premium holiday
b payment of benefits
b other
8a If any benefits were provided pursuant
to an insurance policy that was not reported
on Schedule A, were there any premium
payment delinquencies for premiums due but
unpaid during the year? b Yes b No If
‘‘Yes,’’ enter number of times delinquent and
for each delinquency enter the number of
days delinquent
8b If you answered ‘‘Yes’’ to line 8a,
indicate whether any premium delinquency
resulted in a lapse in coverage. If you
answered ‘‘No’’ to line 8a, enter ‘‘N/A’’.
b Yes b No b N/A
Part II—Service Provider and Stop Loss
Insurance Information
(Repeat as many line entries as necessary
to report all service providers under each
category that have not already been reported
on Schedule A or Schedule C.)
9 Third Party Administrator/Claims
Processor, including a health insurance
issuer subject to an ‘‘administrative services
only (ASO)’’ or other agreement: b N/A
a Name, address and telephone number
b EIN
c NAIC NPN
d If third party administrator/claims
processing or similar services are being
provided to the plan through a prototype/offthe-shelf ASO arrangement, enter the
identification number of such insurance
product
10 Mental Health Benefits Manager: b N/
A
a Name, address and telephone number
b EIN
c NAIC NPN
11 Substance Use Disorder Benefits
Manager: b N/A
a Name, address and telephone number
b EIN
c NAIC NPN
12 Pharmacy Benefit Manager/Drug
Provider: b N/A
a Name, address and telephone number
b EIN
c NAIC NPN
13 Independent Review Organization:
b N/A
a Name, address and telephone number
b EIN
c NAIC NPN
14 Wellness Program Manager: b N/A
(may be the same contact information for
wellness program required under 29 CFR
2590.702(f)(2)(v)).
a Name, address and telephone number
b EIN
c NAIC NPN
15 Was there a stop loss policy associated
with the plan’s obligation to pay health
benefits? If so, complete the following
(Include information on all stop loss policies
issued in connection with plan benefits,
including policies with the employer/plan
sponsor as the insured).
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47587
a Name of insurance carrier
b EIN
c NAIC NPN
d Total premium
e Attachment point of coverage
Individual attachment point of coverage (if
applicable)
Aggregate attachment point of coverage (if
applicable)
f Claim Limit
Individual claim limit (if applicable)
Aggregate claim limit (if applicable)
g Policy or contract year from llll
to llll.
h Check this box if the employer/plan
sponsor is the insured b
Part III—Financial Information.
Plans that complete Schedule H skip to
Part IV.
16 Contributions received during the plan
year or receivable as of end of plan year:
a Employer contributions received
b Employer contributions receivable
c Participant contributions received
d Participant contributions receivable
e Other contributions received or
receivable (including non-cash)
f Total contributions. Add Lines 16 a–e.
17 Was there a failure to transmit to the
plan any participant contributions or
repayments as of the earliest date on which
such contributions can reasonably be
segregated from the employer’s general assets
as described in 29 CFR 2510.3–102? b Yes
b No
Part IV—Health Benefit Claims Processing
and Payment.
18a Enter the number of post-service
benefit claims submitted during the plan
year.
(1) How many of those claims were
approved during the plan year?
(2) How many of those claims were denied
during the plan year?
(3) How many of those claims were
pending at the end of the plan year?
18b Enter the number of post-service
benefit claim denials appealed during the
plan year.
(1) How many of those appeals were
upheld during the plan year as denials?
(2) How many of those appeals were
overturned and approved during the plan
year after appeal?
18c Enter the number of pre-service
benefit claims appealed during the plan year.
(1) How many of those appeals were
upheld during the plan year as denials?
(2) How many of those appeals were
approved during the plan year after appeal?
19 Were there any claims for benefits or
appeals of adverse benefit determinations
that were not adjudicated within the required
timeframes? b Yes b No. If ‘‘Yes,’’
enter
(1) Number of claims
(2) Number of appeals
20 Did the plan fail to pay any claims
during the plan year within one (1) month of
being approved for payment? b Yes
b No If ‘‘Yes,’’ enter the
(1) Number of claims not paid within one
(1) month
(2) Total amount not paid within one (1)
month
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(3) Number of claims not paid within three
(3) months or longer
21 Total dollar amount of benefits paid
pursuant to claims during the plan year.
Part V—Compliance Information. [Current
Form 5500 Part III; the move limits plans
required to complete this part to those
providing health benefits] Plans that file the
Form M–1, skip questions 24–30.
22a Were all plan assets held in trust,
held by an insurance company qualified to
do business in a State, or as insurance
contracts or policies issued by such an
insurance company? (See section 403 of
ERISA and 29 CFR 2550.403a–1 and
2550.403b–1)?
b Yes b No If you check ‘‘No,’’ you must
complete Line 22b.
22b Check all that apply and enter an
explanation if checking ‘‘Other’’:
b Plan assets not held in trust based on
reliance on Technical Release 92–01
b Other (explain)
23 Are the plan’s summary plan
description (SPD), including any summary
descriptions of modifications, and summary
of benefits and coverage (SBC) in compliance
with the applicable content requirements?
(See instructions.)
23a Summary Plan Description (SPD):
b Yes b No
23b Summary of Benefits and Coverage
(SBC) bYes bNo
24 Is the coverage provided by the plan
in compliance with the provisions of the
Health Insurance Portability and
Accountability Act of 1996, as incorporated
in ERISA, and the Department’s regulations
thereunder?
b Yes b No b N/A
25 Is the coverage provided by the plan
in compliance with the provisions of Title I
of the Genetic Information
Nondiscrimination Act of 2008 as
incorporated in ERISA, and the Department’s
regulations issued thereunder?
b Yes b No b N/A
26 Is the coverage provided by the plan
in compliance with the Mental Health Parity
Act of 1996 and the Paul Wellstone and Pete
Domenici Mental Health Parity and
Addiction Equity Act of 2008 and the
Department’s regulations issued thereunder?
b Yes b No b N/A
27 Is the coverage provided by the plan
in compliance with the Newborns’ and
Mothers’ Health Protection Act of 1996 and
the Department’s regulations issued
thereunder?
b Yes b No b N/A
28 Is the coverage provided by the plan
in compliance with the Women’s Health and
Cancer Rights Act of 1998?
b Yes b No b N/A
29 Is the coverage provided by the plan
in compliance with Michelle’s Law?
b Yes b No b N/A
30 Is the coverage provided by the plan
in compliance with the Affordable Care Act
and the Department’s regulations issued
thereunder?
b Yes b No b N/A
31a Was the plan subject to the Form M–
1 filing requirements during the plan year?
(See instructions and 29 CFR 2520.101–2.)
b Yes b No If ‘‘Yes’’ is checked,
complete Lines 31b and 31c.
31b Is the plan currently in compliance
with the Form M–1 filing requirements? (See
instructions and 29 CFR 2520.101–2.) b Yes
b No
31c Enter the Receipt Confirmation Code
for the 20XX Form M–1 annual report. If the
plan was not required to file the 20XX Form
M–1 annual report, enter the Receipt
Confirmation Code for the most recent Form
M–1 that was required to be filed under the
Form M–1 filing requirements. (Failure to
enter a valid Receipt Confirmation Code will
subject the Form 5500 Annual Return/Report
filing to rejection as incomplete.)
Receipt Confirmation Code
Schedule MB—Multiemployer Defined
Benefit Plan and Certain Money Purchase
Plan Actuarial Information
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor’s name as shown in Line
2a of the Form 5500 or 5500–SF
D Employer Identification Number (EIN)
E Type of plan: (1) b Multiemployer
Defined Benefit (2) b Money Purchase (see
instructions)
1 [Current]
1a Enter the valuation date:
1b Assets:
(1) Current value of assets
(2) Actuarial value of assets for funding
standard account
1c(1) Accrued liability for plan using
immediate gain method
1c(2) Information for plans using spread
gain methods:
(a) Unfunded liability for methods with
bases
(b) Accrued liability under entry age
normal method
(c) Normal cost under entry age normal
method
1c(3) Accrued liability under unit credit
cost method
1d Information on current liabilities of the
plan:
(1) Amount excluded from current liability
attributable to pre-participation service (see
instructions)
(2) ‘‘RPA ’94’’ information:
(a) Current liability
(b) Expected increase in current liability
due to benefits accruing during the plan year
(c) Expected release from ‘‘RPA ‘94’’
current liability for the plan year
(3) Expected plan disbursements for the
plan year
2 [Current] Operational information as of
the beginning of this plan year:
a Current value of assets (see
instructions)
(1) Number of
participants
b
(2) Current liability
‘‘RPA ‘94’’ current liability/participant count breakdown
(1) For retired participants and beneficiaries receiving payment
(2) For terminated vested participants
(3) For active participants
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
(a) Non-vested benefits
(b) Vested benefits
(c) Total active
(4) Total
c If the percentage resulting from
dividing Line 2a by Line 2(b)(4), column (2),
is less than 70%, enter such percentage.
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3 [Current, except report withdrawal
liability payments separately from employer
contributions and there is minor re-wording
of Lines 3(b) and (c).] Contributions made to
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the plan for the plan year by employer(s)
including withdrawal liability payments and
contributions to the plan made by employees:
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47589
3 Contributions made to the plan for the plan year by employer(s) including withdrawal liability payments and contributions to the plan made
by employees:
(a) Date (MM–DD–YYYY)
(b) Contribution amount paid by
employers
(c) Withdrawal liability payments
(d) Contribution amount paid by
employees
Totals:
critical and declining status, enter the plan
year in which it is projected to emerge.
If the rehabilitation plan is based on
forestalling possible insolvency, check here
b and enter the plan year in which
insolvency is expected.
5 [Current instructions and for 2016 as
data element, except prior Line 5i
(Reorganization) is deleted and Lines 5j–n
are renumbered to reflect MPRA 2014
changes] Actuarial cost method used as the
basis for the plan year’s funding standard
account computations (check all that apply):
5a b Attained age normal
5b b Entry age normal
5c b Accrued benefit (unit credit)
5d b Aggregate
5e b Frozen initial liability
5f b Individual level premium
5g b Individual aggregate
5h b Shortfall
5i [Current Line 5j] b Other (specify):
7 [Current except that information on
amortization charges and credits that was
previously reported for Lines 9c and 9h as
5j [Current Line 5k] If box h is checked,
enter period of use of shortfall method
5k [Current Line 5l] Has a change been
made in funding method for this plan year?
b Yes b No
5l [Current Line 5m] If Line 5k is ‘‘Yes,’’
was the change made pursuant to Revenue
Procedure 2000–40 or other automatic
approval? b Yes b No
5m [Current Line 5n] If Line 5k is ‘‘Yes,’’
and line l is ‘‘No,’’ enter the date (MM/DD/
YYYY) of the ruling letter (individual or
class) approving the change in the funding
method.
6 [Current—except that Lines 6(g)(2) and
6(h)(2) with check boxes are added to be
answered if a statement showing the
actuary’s estimate of the rate of return
(actuarial or market value) and calculation
of the rate is attached.] Checklist of certain
actuarial assumptions:
an attachment would be reported on Line 7
of the form.]
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4 Information on plan status:
4a [Current] Funded percentage for
monitoring plan’s status (Line 1b(2) divided
by Line 1c(3))
4b [Current] Enter code to indicate plan’s
status (see instructions for attachment of
supporting evidence of plan’s status). If code
is ‘‘N,’’ go to Line 5.
4c [Current] Is the plan making the
scheduled progress under any applicable
funding improvement or rehabilitation plan?
b Yes b No
4d [Current] If the plan is in critical
status or critical and declining status, were
any benefits reduced (see instructions)?
b Yes b No
4e [Current] If Line 4d is ‘‘Yes,’’ enter the
reduction in liability resulting from the
reduction in benefits (see instructions),
measured as of the valuation date.
4f [Current] If the rehabilitation plan
projects emergence from critical status or
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Amortization Bases (This will have a variable number of repeating rows; but typically fewer than 50)
(2) Outstanding balance of
remaining payments
(1) Type of base
(3) Valuation date base
was established
(4) Years remaining in
amortization period
(5) Amortization amount
Totals:
8 Miscellaneous information:
8a [Current] If a waiver of a funding
deficiency has been approved for this plan
year, enter the date (MM/DD/YYYY) of the
letter ruling granting the approval.
8b(1)(a) [Current] Is the plan required to
provide a projection of expected benefit
payments? b Yes b No
Plan Year
8b(1)(b) [Current except moved to the face
of the form] If 8b(1)(a) is ‘‘Yes,’’ complete the
schedule below:
Schedule of Projection of Expected Annual Benefit Payments
Current plan year
Current plan year plus 1
Etc.
Current plan year plus 9
8b(2)(a) [Current] Is the plan required to
provide a Schedule of Active Participant Data
? (see instructions) b Yes b No
8b(2)(b) [Current except moved to the face
of the form] If 8b(2)(a) is ‘‘Yes,’’ complete the
schedule below and items 8b(2)(c) and
8b(2)(d).
8b(2)(c) [New] Average age of active
participants as of the valuation date
8b(2)(d) [New] Average credited service of
active participants as of the valuation date
8b(3)(a) [New] Is the plan required to
provide a Schedule of Retired Participants
and Beneficiaries Receiving Payment Data?
(See the instructions) b Yes b No
8b(3)(b) [New] If 8b(3)(a) is ‘‘Yes,’’
complete the schedule below and items
8b(3)(c) and 8b(3)(d).
Schedule of Retired Participants and Beneficiaries Receiving Payment Data
Attained Age
Number
Average Annual In-Pay Benefit Amount
Under 55
Etc.
90 and up
8b(3)(c) [New] Average Age for Retired
Participants and Beneficiaries as of the
valuation date
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8b(3)(d) [New] Average Annual In-Pay
Benefit for Retired Participants and
Beneficiaries as of the valuation date
8b(4)(a) [New] Is the plan required to
provide a Schedule of Terminated Vested
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Participant Data? (See the instructions)
b Yes b No
8b(4)(b) [New] If 8b(4)(a) is ‘‘Yes,’’
complete the schedule below and items
8b(4)(c) through 8b(4)(f).
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47591
Schedule of Terminated Vested Participant Data
Attained Age
Number
Average Annual Benefit Amount
Under 25
25 to 29
Etc.
70 and up
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8b(4)(c) [New] Average age of terminated
vested participants as of the valuation date
8b(4)(d) [New] Average annual benefit of
terminated vested participants as of the
valuation date
8b(4)(e) [New] Assumed form of payment
shown
8b(4)(f) [New] Assumed age of first
payment for benefits shown
8c [Current] Are any of the plan’s
amortization bases operating under an
extension of time under section 412(e) (as in
effect prior to 2008) or section 431(d) of the
Code? b Yes b No
8d [Current] If Line 8c is ‘‘Yes,’’ provide
the following additional information:
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(1) Was an extension granted automatic
approval under section 431(d)(1) of the Code?
b Yes b No
(2) If Line 8d(1) is ‘‘Yes,’’ enter the number
of years by which the amortization period
was extended.
(3) Was an extension approved by the
Internal Revenue Service under section
412(e) (as in effect prior to 2008) or 431(d)(2)
of the Code? b Yes b No
(4) If Line 8d(3) is ‘‘Yes,’’ enter the number
of years by which the amortization period
was extended (not including the number of
years in Line (2))
(5) If Line 8d(3) is ‘‘Yes,’’ enter the date of
the ruling letter approving the extension
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(6) If Line 8d(3) is ‘‘Yes,’’ is the
amortization base eligible for amortization
using interest rates applicable under section
6621(b) of the Code for years beginning after
2007? b Yes b No
8(e) [Current] If box 5h is checked or Line
8c is ‘‘Yes,’’ enter the difference between the
minimum required contribution for the year
and the minimum that would have been
required without using the shortfall method
or extending the amortization base(s).
Line 9 [Current, except a check box is
added to Line 9f to be answered if an
explanation of a prior year credit balance/
funding deficiency discrepancy is attached.]
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9 Funding standard account statement for this plan year:
Charges to funding standard account:
a Prior year funding deficiency, if any
b Employer's normal cost for plan year as of the valuation date
c Amortization charges as of valuation
date:
(1) All bases except funding waivers and
certain bases for which the amortization
period has been extended
.·
·.
Outstanding balance
(2) Funding waivers
(3) Certain bases for which the
amortization period has been extended
d Interest as applicable on Lines 9a, 9b, and 9c
e Total charges. Add Lines 9a through 9d
Credits to funding standard account:
f(1) Prior year credit balance, if any
f(2) [Current, except check box added] If an explanation of a prior year credit
balance/funding deficiency discrepancy is attached, check here
[]
g Employer contributions. Total from columns (b) plus (c) of Line 3
Outstanding balance
..·
h Amortization credits as of the
valuation date
i Interest as applicable to end of plan year on lines 9f, 9g, and 9h
(1) ERISA FFL (accrued liability
FFL)
(2) "RPA' 94" override (90%
current liability FFL)
(3) FFL Credit
k(1) Waived funding deficiency
(2) Other credits
1 Total credits. Add Lines 9fthrough 9i, 9j(3), 9k(l), and 9k(2)
m Credit balance: If Line 91 is greater than Line 9e, enter the difference
n Funding deficiency: If Line 9e is greater than Line 91, enter the difference
o Current year's accumulated reconciliation account:
(1) Due to waived funding deficiency accumulated prior to the 20XX plan year
(2) Due to amortization bases extended or amortized using the interest rate under
section 662l(b) ofthe Code:
(a) Reconciliation outstanding balance as of the valuation date
(b) Reconciliation amount (Line 9c(3) balance minus Line 9o(2)(a))
(3) Total as of valuation date
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.i Full funding limitation (FFL) and credits:
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
10 [Current] Contribution necessary to
avoid an accumulated funding deficiency
(see instructions)
11 [Current] Has a change been made in
the actuarial assumptions for the current plan
year?
If ‘‘Yes,’’ see instructions. b Yes b No
Statement by Enrolled Actuary [Current,
except that information previously reported
on an attachment per the instructions will be
reported on the Schedule.] To the best of my
knowledge, the information supplied in this
schedule and accompanying schedules,
statements, and attachments, if any, is
complete and accurate. Each prescribed
assumption was applied in accordance with
applicable law and regulations. In my
opinion, each other assumption is reasonable
(taking into account the experience of the
plan and reasonable expectations) and such
other assumptions, in combination, offer my
best estimate of anticipated experience under
the plan.
Signature of actuary
Date
Type or print name of actuary
Most recent enrollment number
Firm name
Telephone number (including area code)
Address of firm
If the actuary has not fully reflected any
regulation or ruling promulgated under the
statute in completing this schedule, provide
the information requested in the instructions
in this line and check here b
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
SCHEDULE R (Form 5500) Retirement Plan
Information
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
A Name of plan
B Three-digit plan number (PN)
C Plan sponsor’s name as shown on line
2a of Form 5500
D Employer Identification Number (EIN)
Part I Distributions.
All references to distributions relate only
to payments of benefits during the plan year.
1 [Current] Total value of distributions
paid in property other than in cash or the
forms of property specified in the
instructions
2 [Current] Enter the EIN(s) of payor(s)
who paid benefits on behalf of the plan to
participants or beneficiaries during the year
(if more than two, enter EINs of the two
payors who paid the greatest dollar amounts
of benefits):
EIN(s):
Profit-sharing plans, ESOPs, and stock
bonus plans, skip Line 3.
3 [Current Line 3, with new breakout
numbers for active, terminated vested,
retired] Number of participants (living or
deceased) whose benefits were distributed in
a single sum, during the plan year
[Columns for (1) number of participants/(2)
payment of annuities/(3) payment of lump
sums]
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Active
Terminated Vested
Retired
4 [New] Were required minimum
distributions made to 5% owners who have
attained age 70 1⁄2 (regardless of whether or
not retired) as required under section
401(a)(9) of the Internal Revenue Code?
b Yes b No b N/A
Part II Funding Information
(If the plan is not subject to the minimum
funding requirements of section of 412 of the
Internal Revenue Code or ERISA section 302,
skip this Part)
5 [Current Line 4] Is the plan
administrator making an election under Code
section 412(d)(2) or ERISA section 302(d)(2)?
b Yes b No b N/A
If the plan is a defined benefit pension
plan, go to Line 9.
6 [Current Line 5] If a waiver of the
minimum funding standard for a prior year
is being amortized in this plan year, see
instructions and enter the date of the ruling
letter granting the waiver.
If you completed Line 6, complete Lines 3,
9, and 10 of Schedule MB and do not
complete the remainder of this schedule.
7a [Current Line 6] Enter the minimum
required contribution for this plan year
(include any prior year accumulated funding
deficiency not waived).
7b [Current] Enter the amount
contributed by the employer to the plan for
this plan year
7c [Current] Subtract the amount in Line
7b from the amount in Line 7a. Enter the
result (enter a minus sign to the left of a
negative amount)
If you completed line 7c, skip Lines 9 and
10.
8 [Current Line 7] Will the minimum
funding amount reported on Line 7c be met
by the funding deadline? b Yes b No
b N/A
9 [Current Line 8] If a change in actuarial
cost method was made for this plan year
pursuant to a revenue procedure or other
authority providing automatic approval for
the change or a class ruling letter, does the
plan sponsor or plan administrator agree
with the change?
b Yes b No b N/A
Part III Determination and Amendment
10 [Current Line 9] If this is a defined
benefit pension plan, were any amendments
adopted during this plan year that increased
or decreased the value of benefits? If ‘‘Yes,’’
check the appropriate box. If no, check the
‘‘No’’ box’’: b Increase b Decrease
b Both b No
11a [Current 2016 Line 22a] If the plan
is a master and prototype plan (M&P) or
volume submitter plan that received a
favorable IRS opinion letter or advisory
letter, enter the date of the letter l/l/l and
the serial number lll
11b [Current 2016 Line 22b] If the plan
is an individually-designed plan that
received a favorable determination letter
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47593
from the IRS, enter the date of most recent
determination letter: l/l/l.
[Current Part IV ESOPs—moved to new
Schedule E]
Part IV [current Part V] Additional
Information for Multiemployer Defined
Benefit Pension Plans
12 [Current Line 13] Enter the following
information for each employer that
contributed more than 5% of total
contributions to the plan during the plan year
(measured in dollars). See instructions.
Complete as many entries as needed to report
all applicable employers.
a Name of contributing employer
b EIN
c Dollar amount contributed by employer
d Date collective bargaining agreement
expires (If employer contributes under more
than one collective bargaining agreement,
check box b and see instructions regarding
required attachment. Otherwise, enter the
applicable date.)
e Contribution rate information (If more
than one rate applies, check this box b and
see instructions regarding required
attachment. Otherwise, complete Lines 12e(1)
and 12e(2).)
(1) Contribution rate (in dollars and cents)
(2) Base unit measure:
b Hourly
b Weekly
b Unit of production
b Other (specify)
13 [Current Line 14] Enter the number of
participants on whose behalf no
contributions were made by an employer as
an employer of the participant for:
a The current year
b The plan year immediately preceding
the current plan year
c The second preceding plan year
14. [Current Line 15] Enter the ratio of
the number of participants under the plan on
whose behalf no employer had an obligation
to make an employer contribution during the
current plan year to:
a The corresponding number for the plan
year immediately preceding the current plan
year
b The corresponding number for the
second preceding plan year
15 [Current Line 16] Information with
respect to any employers who withdrew from
the plan during the preceding plan year:
a Enter the number of employers who
withdrew during the preceding plan year:
b If Line 15a is greater than 0, enter the
aggregate amount of withdrawal liability
assessed or estimated to be assessed against
such withdrawn employers.
16 [Current Line 17] If assets and
liabilities from another plan have been
transferred to or merged with this plan
during the plan year, check box and see
instructions regarding supplemental
information to be included as an
attachment. b
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Part V [Current Part VI] Additional
information for Single-Employer and
Multiemployer Defined Benefit Pension
Plans
17 [Current Line 18] If any liabilities to
participants or their beneficiaries under the
plan as of the end of the plan year consist
(in whole or in part) of liabilities to such
participants and beneficiaries under two or
more pension plans as of immediately before
such plan year, check box and see
instructions regarding supplemental
information to be included as an
attachment. b
18 [Current Line 19] If the total number
of participants is 1,000 or more, complete
Lines (a) through (c)
a Enter the percentage of plan assets held
as:
Stock:
Investment-Grade Debt:
High-Yield Debt:
Real Estate:
Other:
b Provide the average duration of the
combined investment-grade and high-yield
debt:
b 0–3 years
b 3–6 years
b 6–9 years
b 9–12 years
b 12–15 years
b 15–18 years
b 18–21 years
b 21 years or more
c What duration measure was used to
calculate Line 18(b)?
b Effective duration b Macaulay duration
b Modified duration b Other
(specify)
Part VI [New Part; all of these questions on
IRS List for 2015 changes and published in
draft on the IRS’s Form 5500–SUP]
Nondiscrimination and Coverage
19a If this is a section 401(k) plan, check
the correct box to indicate how the plan is
intended to satisfy the nondiscrimination
requirements for employee deferrals and
employer matching contributions (as
applicable) under section 401(k)(3) and
401(m)(2)?
b Design-based safe harbor method
b ADP/ACP test b Both
b If the ADP test is used, did the plan
perform ADP testing for the plan year using
the ‘‘current year testing method’’ for
nonhighly compensated employees (Treas.
Reg. sections 1.401(k)–2(a)(2)(ii) b Yes
b No
20a Check the box to indicate the method
used by the plan to satisfy the coverage
requirements under section 410(b): b ratio
percentage test b average benefit test
b N/A
b Does the plan satisfy the coverage and
nondiscrimination tests of sections 410(b)
and 401(a)(4) by combining this plan with
any other plans under the permissive
aggregation rules?
b Yes b No
21 If this is a defined benefit pension
plan, does the plan comply with Code
section 401(a)(26) participation
requirements?
b Yes b No
Part VII
[New Part/New Questions]
Participation Information in Defined
Contribution Pension Plans (Only defined
contribution pension plans need to complete
this Part.)
22a Were employees participating in the
plan eligible to receive employer
contributions even if they did not make any
elective deferrals?
b Yes b No If ‘‘Yes,’’ answer Line 22b.
22b Check the appropriate box to indicate
how the employer’s contribution is
calculated and enter the percent or dollar
amount or other formula:
b % of a participant’s compensation
(provide percentage)
b $ per participant (provide amount)
b Other (specify)
23a Does the plan provide for employer
matching contributions contingent on
employee elective deferrals? b Yes b No
If ‘‘Yes,’’ answer Line 23b–d.
23b Check the appropriate box and enter
the percentage, amount or formula to indicate
the minimum elective deferrals necessary to
qualify for an employer matching
contribution (if there is no minimum, check
‘‘other’’ and enter ‘‘none’’):
b % of a participant’s contribution up to a
limit (provide percentage)
b $ per participant (provide amount)
b Other (specify)
23c Check the appropriate box and enter
the percentage, amount or other formula to
indicate the maximum employer matching
contribution under the terms of the plan.
b % of a participant’s compensation
(provide percentage)
b $ per participant (provide amount)
b Other (Specify)
23d Enter the number of participants
making sufficient elective deferrals to receive
the maximum employer match.
24a Does the plan have automatic
enrollment? b Yes b No If ‘‘Yes,’’
answer Lines 24b(1)–(3).
24b (1) Enter the default elective deferral
as a percentage of a participant’s
compensation in the first year after a
participant is automatically enrolled?
(2) Does the plan have automatic
escalation, assuming a participant has made
no active elections? b Yes b No If
‘‘Yes,’’ enter the maximum elective deferral
as a percentage of a participant’s
compensation.
(3) Enter the number of participants that
have not made any investment decisions and
remain in the plan’s default investment
account(s):
25 Enter the number of participants
making catch-up contributions.
Schedule SB—Single-Employer Defined
Benefit Plan Actuarial Information
[Current header and identifying
information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and
ending DD/MM/20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor’s name as shown in Line
2a of the Form 5500 or 5500–SF
D Employer Identification Number (EIN)
E Type of plan: b Single b Multiple-A
b Multiple-B
F Prior year plan size: b 100 or fewer
b 101–500 b More than 500
Part I Basic Information
1 [Current] Enter the valuation date:
2 [Current] Assets:
a Market value
b Actuarial value
3 [Current] Funding target/participant count breakdown
(1) Number of participants
(3) Total Funding Target
For retired participants and
beneficiaries receiving payment
b
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a
(2) Vested Funding Target
For terminated vested participants
c
For active participants
d
Total
4 Current, except that allocation of total
must be completed by participant groups
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and formatting (1), (2), etc. changed to
conform to other tables on the form.] If the
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plan is in at-risk status, check the box and
complete Lines (a) through (d) b
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a
47595
(2) Funding target reflecting at-risk assumptions, but disregarding transition rule for plans
that have been in at-risk status for fewer than
five consecutive years and disregarding loading factor
For retired participants and beneficiaries receiving payment
b
For terminated vested Participants
c
For active participants
Total
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5 [Current] Effective interest rate ll%
6 Target normal cost [Current, except
allocation of plan-related expenses
separated from the target normal cost.].
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a [New allocation] Target normal cost
(without plan expenses)
b [New allocation] Plan-related expenses
c Total [Reflects current Line 6]
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Part II Beginning of Year Carryover and
Prefunding Balances
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14 [Current instructions for Line 7 with
minor rewording, checkbox added] If Line 7
does not equal Line 13 from the prior year,
provide an explanation in this line and check
here b
15 [Current instructions for Line 8 with
minor rewording, checkbox added] If Line 8
reflects a late election to apply the balances
to quarterly installments, provide an
explanation in this line and check here b
16 [Current instructions for Line 9 with
minor rewording, checkbox added] If Line 9
has been adjusted so that it does not match
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the amount for the pre-effective date plan
year, provide an explanation in this line and
check here b
Part III Funding Percentages
17 [Current Line 14] Funding target
attainment percentage ll%
18 Adjusted funding target attainment
a [Current Line 15] Adjusted funding target
attainment percentage ll%
b [Current instructions for Line 15 with
minor rewording, checkbox added] If an
attachment is included reconciling
differences between valuation results and
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amounts used to calculate the AFTAP, check
here b
19 [Current Line 16] Prior year’s funding
percentage for purposes of determining
whether carryover/prefunding balances may
be used to reduce current year’s funding
requirement ll%
20 [Current Line 17] If the current value of
the assets of the plan is less than 70 percent
of the funding target, enter such percentage
ll%
Part IV Contributions and Liquidity
Shortfalls
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21 [Current line 18 and line 19 attachment] Contributions made to the plan by employer(s) and employees:
(a)
Date (MM/DD/
YYYY)
(d)
(e)
(f)
(g)
(h)
Interest rate to
adjust employer
contributions
Number of days
to discount employer contributions
Discounted/increased employer
contributions at
valuation date
Allocation to contributions in line
22
Amount paid by
employees
(c)
(b)
Amount paid by
employer(s)
Plan year to
which contribution
applies
Total
22 [Current Line 19] Discounted employer
contributions—see instructions for small
plans with a valuation date after the
beginning of the year:
a Contributions allocated toward unpaid
minimum required contributions for prior
years
b Contributions made to avoid
restrictions adjusted to valuation date
c Contributions allocated toward
minimum required contribution for current
year adjusted to valuation date
23 [Current Line 20, except new checkbox
added to Line 23c.] Quarterly contributions
and liquidity shortfalls:
a Did the plan have a ‘‘funding shortfall’’
for the prior year? b Yes b No
b If Line 23a is ‘‘Yes,’’ were required
quarterly installments for the current year
made in a timely manner? b Yes b No
c [Minor rewording of the question and
new check box added] If Line 23a is ‘‘Yes,’’
see instructions. If a liquidity requirement
certification is attached, complete the
following table as applicable and check
here b:
Liquidity shortfalls as of the end of quarter of this plan year
(1) 1st
(2) 2nd
(3) 3rd
(4) 4th
1st segment:
%
2nd segment:
%
3rd segment:
%
b N/A, full yield curve used
%
%
%
Part V Assumptions Used to Determine
Funding Target and Target Normal Cost —
24 [Current Line 21] Discount rate:
a
Segment rates:
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b Applicable month (enter code)
25 [Current Line 22] Weighted average
retirement age
26 [Current Line 23] Mortality Table(s):
26a Mortality table(s) (see instructions)
b Prescribed—combined b Prescribed
separate b Substitute
26b [Attachment to current Line 23, new
checkbox added.] If more than one mortality
table was used, provide an explanation in
this line describing the mortality table used
for each population and the size of that
population and check here. b
26c [Attachment to current Line 23, new
checkbox added.] If substitute mortality
tables are used, provide in this line of a
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summary of plan populations for which
substitute mortality tables are used, plan
populations for which the prescribed tables
are used, and the last plan year for which IRS
approval of the substitute mortality tables
applies and check here b.
Part VI Miscellaneous Items
27 [Current Line 24] Has a change been
made in the non-prescribed actuarial
assumptions for the current plan year? If
‘‘Yes,’’ see instructions regarding required
attachment b Yes b No.
28 [Current Line 25, minor rewording,
new checkbox added.] If a method change
has been made for the current plan year,
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provide a description of the change in this
line and check here. b
29 Participant schedules
29a(i) [Current Line 26] Is the plan
required to provide a Schedule of Active
Participant Data? (See instructions) b Yes
b No
a(ii) [Current Line 26 instructions moved
to the face of the form] If 29a(i) is ‘‘Yes,’’
complete the schedule below and items
29a(iii) and (iv). If the plan is hard frozen and
average annual accrued benefit data is
entered instead of average compensation
data, check this box b (see instructions)
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a(iii) [New] Average age of active
participants as of the valuation date
a(iv) [New] Average credited service of
active participants as of the valuation date
29b(i) [New] Is the plan required to provide
a Schedule of Retired Participants and
Beneficiaries Receiving Payment Data?(See
instructions) b Yes b No.
b(ii) [New] If 29b(i) is ‘‘Yes,’’ complete the
schedule below and items 29b(iii) and b(iv).
Schedule of Retired Participants and Beneficiaries Receiving Payment Data
Attained Age
Number
Average Annual In-Pay Benefit Amount
Under 55
55 to 59
Etc.
90 and up
b(iii) [New] Average Age for Retired
Participants and Beneficiaries as of the
valuation date
b(iv) [New] Average Annual In-Pay Benefit
for Retired Participants and Beneficiaries as
of the valuation date
29c(i) [New] Is the plan required to provide
a Schedule of Terminated Vested Participant
Data? (See the instructions) b Yes b No
c(ii) [New] If c(i)(a) is ‘‘Yes,’’ complete the
schedule below and items c(iii) through c(vi).
Schedule of Terminated Vested Participant Data
Attained Age
Number
Average Annual In-Pay Benefit Amount
Under 25
25 to 29
Etc.
70 and up
c(iii) [New] Average age of terminated
vested participants as of the valuation date
c(iv) [New] Average annual benefit of
terminated vested participants as of the
valuation date
c(v) [New] Assumed form of payment
shown
c(vi) [New] Assumed age of first payment
for benefits shown
Schedule of Projection of Expected Annual Benefit Payments
Current plan year
Current plan year plus 1
Etc.
Current plan year plus 9
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Plan Year
30a [New] Is the plan required to provide
a projection of expected benefit payments?
(see instructions) b Yes b No
b [New] If ‘‘Yes,’’ complete the schedule
below:
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
33 [Current Line 29; reference updated]
Discounted employer contributions allocated
toward unpaid minimum required
contributions from prior years [Current Line
19a] (Line 22a)
34 [Current Line 30; references updated]
Remaining amount of unpaid minimum
required contributions [Current Line 28
minus Line 29] (Line 32 minus Line 33)
31 [Current Line 27] If the plan is subject
to the alternative funding rules, enter
applicable code and see instructions
regarding attachment
Part VII Reconciliation of Unpaid
Minimum Required Contributions For Prior
Years
32 [Current Line 28] Unpaid minimum
required contributions for all prior years
Amortization Installments
a
Part VIII Minimum Required Contribution
For Current Year
35 [Current Line 31] Target normal cost
and excess assets (see instructions):
a [Current Line 6] Target normal cost (Line
6c)
b [Current] Excess assets, if applicable, but
not greater than Line 35a
36 [Current Line 32]
Outstanding balance
Installment
Net shortfall amortization installment
b
47599
Waiver amortization installment
[Current attachment] Schedule of
Amortization Bases
Amortization installments
(i) Type of base
(ii) Present value of remaining installments
(iii) Valuation date base
was established
(iv) Years remaining in
amortization period
(v) Current year installment
Total
38 [Current Line 34; reflects renumbering
of references] Total funding requirement
before reflecting carryover/prefunding
37 [Current Line 33] If a waiver has been
approved for this plan year, enter the date of
the ruling letter granting approval (Month/
Day/Year) and the waived amount
Carryover balance
balances [Current Lines 31aØ31b + 32a +
32b Ø33] (Lines 35a¥35b + 36a + 36b¥37)
Prefunding balance
Total balance
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39 [Current Line 35] Balances
elected for use to offset funding
requirement.
40 [Current Line 36; reflects renumbering
of references] Additional cash requirement
[Current Line 34 minus Line 25] (Line 38
minus Line 39)
41 [Current Line 37; reflects renumbering
of reference] Contributions allocated toward
minimum required contribution for current
year adjusted to valuation date [Current Line
19c] (Line 22c)
42 [Current Line 38; reflects renumbering
of references] Present value of excess
contributions for current year (see
instructions)
a Total [Current Line 37 over Line 36]
(excess, if any, of Line 41 over Line 40)
b Portion included in [Current Line 38a]
Line 42a attributable to use of prefunding
and funding standard carryover balances
43 [Current Line 39; reflects renumbering
of references] Unpaid minimum required
contribution for current year [Current Line
36 over Line 37] (excess, if any, of Line 40
over Line 41)
44 [Current Line 40; reflects renumbering
of references] Unpaid minimum required
contributions for all years
Part IX Pension Funding Under Pension
Relief Act of 2010 (See Instructions)
45 [Current Line 41; reflects renumbering
of references] If an election was made to use
PRA 2010 funding relief for this plan:
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a Schedule elected b 2 plus 7 years
b 15 years
b Eligible plan year(s) for which the
election in [Current Line 41a] Line 45a was
made b 2008 b 2009 b 2010 b 2011
46 [Current Line 42] Amount of
acceleration adjustment
47 [Current Line 43] Excess installment
acceleration amount to be carried over to
future plan years
Statement by Enrolled Actuary—Current—
except that information previously reported
on an attachment per the instructions will be
reported on the Schedule.
To the best of my knowledge, the
information supplied in this schedule and
accompanying schedules, statements, and
attachments, if any, is complete and accurate.
Each prescribed assumption was applied in
accordance with applicable law and
regulations. In my opinion, each other
assumption is reasonable (taking into account
the experience of the plan and reasonable
expectations) and such other assumptions, in
combination, offer my best estimate of
anticipated experience under the plan.
Signature of actuary
Date
Type or print name of actuary
Most recent enrollment number
Firm name
Telephone number (including area code)
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Address of firm
If the actuary has not fully reflected any
regulation or ruling promulgated under the
statute in completing this schedule, provide
the information requested in the instructions
in this line and check here b
APPENDIX B
20XX Instructions for Form 5500 Annual
Return/Report of Employee Benefit Plan
Code section references are to the Internal
Revenue Code unless otherwise noted. ERISA
refers to the Employee Retirement Income
Security Act of 1974.
EFAST2 Processing System
Under the computerized ERISA Filing
Acceptance System (EFAST2), you must
electronically file your 20XX Form 5500.
Your Form 5500 entries will be initially
screened electronically. For more
information, see the instructions for
Electronic Filing Requirement and the
EFAST2 Web site at www.efast.dol.gov. You
cannot file a paper Form 5500 Annual
Return/Report by mail or other delivery
service.
About the Form 5500
The Form 5500, Annual Return/Report of
Employee Benefit Plan, including all
required schedules and attachments (Form
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5500 Annual Return/Report), is used to
report information concerning employee
benefit plans and Direct Filing Entities
(DFEs). Any administrator or sponsor of an
employee benefit plan subject to ERISA must
file information about each benefit plan every
year (pursuant to Code section 6058 and
ERISA sections 104 and 4065). Some plans
participate in certain trusts, accounts, and
other investment arrangements that file the
Form 5500 Annual Return/Report as DFEs.
See Who Must File and When To File.
The Internal Revenue Service (IRS),
Department of Labor (DOL), and Pension
Benefit Guaranty Corporation (PBGC) have
consolidated certain returns and report forms
to reduce the filing burden for plan
administrators and employers. Employers
and administrators who comply with the
instructions for the Form 5500 generally will
satisfy the annual reporting requirements for
the DOL under Title I of ERISA and for PBGC
under Title IV of ERISA and for the IRS
under Code sections 6057(b), 6058, and 6059.
Defined contribution and defined benefit
pension plans may have to file additional
information with the IRS, including Form
5330, Return of Excise Taxes Related to
Employee Benefit Plans, Form 5310–A,
Notice of Plan Merger or Consolidation,
Spinoff, or Transfer of Plan Assets or
Liabilities; Notice of Qualified Separate Lines
of Business, and Form 8955–SSA, Annual
Registration Statement Identifying Separated
Participants with Deferred Vested Benefits.
See www.irs.gov for more information.
Plans covered by the PBGC have special
additional requirements, including premiums
and reporting certain transactions directly
with that agency. See PBGC’s Web site
(www.pbgc.gov/practitioners/) for
information on premium payments and
reporting and disclosure.
Each Form 5500 must accurately reflect the
characteristics and operations of the plan or
arrangement being reported. The
requirements for completing the Form 5500
will vary according to the type of plan or
arrangement. The section What To File
summarizes what information must be
reported for different types of plans and
arrangements. The Quick Reference Charts of
Form 5500, Schedules and Attachments for
(1) Pension Plans; (2) Direct Filing Entities
(Other than GIAs); (3) Group Health Plans
(and GIAs Providing Group Health Benefits);
and (4) Welfare Plans Other Than Group
Health, at the end of these instructions, give
a brief guide to the annual return/report
requirements of the 20XX Form 5500 for the
various types of plans and other entities
filing a Form 5500 Annual Return/Report.
See also the ‘‘Troubleshooters Guide to Filing
the ERISA Annual Reports’’ available on
www.dol.gov/ebsa, which is intended to help
filers comply with the Form 5500 and Form
5500–SF annual reporting requirements and
avoid common reporting errors.
The Form 5500 must be filed electronically
as noted above. See Section 3—Electronic
Filing Requirement and the EFAST2 Web site
at www.efast.dol.gov. Your Form 5500 entries
will be initially screened electronically. Your
entries must satisfy this screening for your
filing to be received. Once received, your
form may be subject to further detailed
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review, and your filing may be rejected based
upon this further review.
ERISA and the Code provide for the
assessment or imposition of penalties for not
submitting the required information when
due. See Penalties.
Annual reports filed under Title I of ERISA
must be made available by plan
administrators to plan participants and
beneficiaries and by the DOL to the public
pursuant to ERISA sections 104 and 106.
Pursuant to Section 504 of the Pension
Protection Act of 2006 (PPA) Pub. L. 109–
280, this availability for defined benefit
pension plans must include the posting of
the Form 5500, Schedule SB or MB, and all
of the Schedule SB or MB attachments on
any plan sponsor intranet Web site (or Web
site maintained by the plan administrator on
behalf of the plan sponsor) that is used for
the purpose of communicating with
employees and not the public. Section 504
also requires DOL to display such
information on DOL’s Web site within 90
days after the filing of the plan’s annual
return/report. To see plan year 2009 and later
forms, including actuarial information, see
www.dol.gov/ebsa. See www.dol.gov/ebsa/
actuarialsearch.html for plan year 2008 and
short plan year 2009 actuarial information
filed under the previous paper-based system.
Changes to Note
[The instructions for the year in which the
revisions are implemented will include such
items in the ‘‘Changes to Note’’ section.]
Table of Contents
[The Instructions will continue include a
Table of Contents in substantially the same
format as the existing Table of Contents,
updated as required.]
How To Get Assistance
If you need help completing this form or
have related questions, call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–3278)
(toll-free) or access the EFAST2 or IRS Web
sites. The EFAST2 Help Line is available
Monday through Friday from 8:00 a.m. to
8:00 p.m., Eastern Time.
You can access the EFAST2 Web site 24
hours a day, 7 days a week at
www.efast.dol.gov to:
• File the Form 5500–SF or Form 5500,
and any needed schedules or attachments.
• Check on the status of a filing you
submitted.
• View filings posted by EFAST2.
• Register for electronic credentials to sign
or submit filings.
• View forms and related instructions.
• Get information regarding EFAST2,
including approved software vendors.
• See answers to frequently asked
questions about the Form 5500–SF, the Form
5500 and its schedules, and EFAST2.
• Access the main EBSA and DOL Web
sites for news, regulations, and publications.
You can access the IRS Web site 24 hours
a day, 7 days a week at www.irs.gov to:
• View forms, instructions, and
publications.
• See answers to frequently asked tax
questions.
• Search publications on-line by topic or
keyword.
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• Send comments or request help by email.
• Sign up to receive local and national tax
news by email.
You can order other IRS forms and
publications at the IRS Web site at
www.irs.gov/orderforms. You can order EBSA
publications by calling 1–866–444–EBSA
(3272).
Section 1: Who Must File
A return/report must be filed every year for
every pension benefit plan, welfare benefit
plan, and for every entity that files as a DFE
as specified below (pursuant to Code section
6058 and ERISA sections 104 and 4065). If
you are a small plan (generally under 100
participants at the beginning of the plan
year), that does not provide group health
benefits, you may be eligible to file the Form
5500–SF instead of the Form 5500. For more
information, see the instructions to the Form
5500–SF.
Pension Benefit Plan
All pension benefit plans covered by
ERISA must file an annual return/report
except as provided in this section. The
return/report must be filed whether or not
the plan is ‘‘tax-qualified,’’ benefits no longer
accrue, contributions were not made this
plan year, or contributions are no longer
made. Pension benefit plans required to file
include both defined benefit plans and
defined contribution plans.
The following are among the pension
benefit plans for which a return/report must
be filed.
1. Profit-sharing plans, stock bonus plans,
money purchase plans, 401(k) plans, etc.
2. 403(b) plans subject to Title I of ERISA.
For more information regarding filing
requirements for these annuity arrangements
under Code section 403(b)(1) and custodial
accounts established under Code section
403(b)(7) for regulated investment company
stock, see Field Assistance Bulletins 2009–02
and 2010–01.
3. Individual retirement accounts (IRAs)
established by an employer under Code
section 408(c).
4. Church pension plans electing coverage
under Code section 410(d).
5. Pension benefit plans that cover
residents of Puerto Rico, the U.S. Virgin
Islands, Guam, Wake Island, or American
Samoa. This includes a plan that elects to
have the provisions of section 1022(i)(2) of
ERISA apply.
6. Plans that satisfy the Actual Deferral
Percentage requirements of Code section
401(k)(3)(A)(ii) by adopting the ‘‘SIMPLE’’
provisions of section 401(k)(11).
See What To File for more information
about what must be completed for pension
plans.
Do Not File a Form 5500 Annual Return/
Report for a Pension Benefit Plan That Is
Any of the Following:
1. An unfunded excess benefit plan. See
ERISA section 4(b)(5).
2. An annuity or custodial account
arrangement under Code sections 403(b)(1) or
(7) not established or maintained by an
employer as described in DOL Regulation 29
CFR 2510.3–2(f).
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3. A Savings Incentive Match Plan for
Employees of Small Employers (SIMPLE) that
involves SIMPLE IRAs under Code section
408(p).
4. A simplified employee pension (SEP) or
a salary reduction SEP described in Code
section 408(k) that conforms to the
alternative method of compliance in 29 CFR
2520.104–48 or 2520.104–49. A SEP is a
pension plan that meets certain minimum
qualifications regarding eligibility and
employer contributions.
5. A church pension benefit plan not
electing coverage under Code section 410(d).
6. A pension plan that is maintained
outside the United States primarily for the
benefit of persons substantially all of whom
are nonresident aliens. However, certain
foreign plans are required to file the Form
5500–EZ with the IRS or may file the Form
5500–SF electronically with EFAST2. See the
instructions to the Form 5500–EZ for the
filing requirements. For more information, go
to www.irs.gov/ep or call 1–877–829–5500.
7. An unfunded pension plan for a select
group of management or highly compensated
employees that meets the requirements of 29
CFR 2520.104–23, including timely filing of
a registration statement with the DOL.
8. An unfunded dues financed pension
benefit plan that meets the alternative
method of compliance provided by 29 CFR
2520.104–27.
9. An individual retirement account or
annuity not considered a pension plan under
29 CFR 2510.3–2(d).
10. A governmental plan.
11. A ‘‘one-participant plan,’’ as defined
below. However, certain one-participant
plans are required to file the Form 5500–EZ,
Annual Return of One-Participant (Owners
and Their Spouses) Retirement Plan with the
IRS or, may file the Form 5500–SF, Short
Form Annual Return/Report of Employee
Benefit Plan, electronically with EFAST2.
For this purpose, a ‘‘one-participant plan’’ is:
a. A pension benefit plan that covers only
an individual or an individual and his or her
spouse who wholly own a trade or business,
whether incorporated or unincorporated; or
b. A pension benefit plan for a partnership
that covers only the partners or the partners
and the partners’ spouses.
See the instructions to the Form 5500–EZ
and the Form 5500–SF for filing
requirements. For more information, go to
www.irs.gov/ep or call 1–877–829–5500.
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Welfare Benefit Plan
Plans that Provide Health Benefits (Group
Health Plans)
All employee benefit plans covered by
Title I of ERISA that provide group health
benefits consisting of medical care as defined
in section 733(a)(2) of ERISA are required to
file a Form 5500 Annual Return/Report,
unless specifically exempt below, regardless
of the plan size or type of funding.
MEWA Reminders: The administrator of a
group health plan required to file a Form M–
1, Report for Multiple Employer Welfare
Arrangements (MEWAs) and Certain Entities
Claiming Exception (ECEs), must also file the
Form 5500 Annual Return/Report for the
group health plan. The administrator of a
group health plan that provides benefits
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wholly or partially through a Multiple
Employer Welfare Arrangement (MEWA) as
defined in ERISA section 3(40) must file a
Form 5500 Annual Return/Report, unless the
plan is part of a Group Insurance
Arrangement (GIA) that files a Form 5500
Annual Return/Report as a DFE on behalf of
all the participating plans.
Welfare Benefit Plans Other Than Group
Health Plans
All welfare benefit plans covered by ERISA
that do not provide health benefits consisting
of medical care as defined in section
733(a)(2) of ERISA are required to file a Form
5500, except as provided in this section.
Welfare benefits other than group health
include disability, life insurance,
apprenticeship and training, scholarship
funds, severance pay, etc. See What To File
for more information.
[CAUTION] If the plan provides both
health benefits and other types of benefits,
then it is subject to the filing requirements for
a plan that provides health benefits,
including the requirement that all such plans
file the Form 5500 regardless of size.
Do Not File a Form 5500 Annual Return/
Report for a Welfare Benefit Plan That Is
Any of the Following:
1. A welfare benefit plan that does not
provide health benefits and that covered
fewer than 100 participants as of the
beginning of the plan year and is unfunded,
fully insured, or a combination of insured
and unfunded, as specified in 29 CFR
2520.104–20.
Note. To determine whether the plan
covers fewer than 100 participants for
purposes of this filing exemption for insured,
unfunded and combination insured/
unfunded welfare plans that do not provide
health benefits, see instructions for Lines 6
and 7 on counting participants in a welfare
plan. See also 29 CFR 2510.3–3(d).
a. An unfunded welfare benefit plan has its
benefits paid as needed directly from the
general assets of the employer or employee
organization that sponsors the plan. Plans
that are NOT unfunded include those plans
that received employee (or former employee)
contributions during the plan year and/or
used a trust or separately maintained fund
(including a Code section 501(c)(9) trust) to
hold plan assets or act as a conduit for the
transfer of plan assets during the year. A
welfare benefit plan with employee
contributions that is associated with a
cafeteria plan under Code section 125 may be
treated for annual reporting purposes as an
unfunded welfare plan if it meets the
requirements of DOL Technical Release 92–
01, 57 FR 23272 (June 2, 1992) and 58 FR
45359 (Aug. 27, 1993). The mere receipt of
COBRA contributions or other after-tax
participant contributions (e.g., retiree
contributions) by a cafeteria plan would not
by itself affect the availability of the relief
provided for cafeteria plans that otherwise
meet the requirements of DOL Technical
Release 92–01. See 61 FR 41220, 41222–23
(Aug. 7, 1996).
b. A fully insured welfare benefit plan has
its benefits provided exclusively through
insurance contracts or policies, the premiums
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47601
of which must be paid directly to the
insurance carrier by the employer or
employee organization from its general assets
or partly from its general assets and partly
from contributions by its employees or
members (which the employer or employee
organization forwards within three (3)
months of receipt). The insurance contracts
or policies discussed above must be issued
by an insurance company or similar
organization that is qualified to do business
in any state.
c. A combination unfunded/insured
welfare benefit plan has its benefits provided
partially as an unfunded plan and partially
as a fully insured plan. An example of such
a plan is a welfare benefit plan that provides
disability benefits as in a above and life
insurance benefits as in b above. See 29 CFR
2520.104–20.
2. A welfare benefit plan maintained
outside the United States primarily for
persons substantially all of whom are
nonresident aliens.
3. A governmental plan.
4. An unfunded or insured welfare benefit
plan maintained for a select group of
management or highly compensated
employees, which meets the requirements of
29 CFR 2520.104–24.
5. An employee benefit plan maintained
only to comply with workers’ compensation,
unemployment compensation, or disability
insurance laws.
6. A group health plan or other welfare
benefit plan that participates in a group
insurance arrangement (GIA) that files a
Form 5500 Annual Return/Report on behalf
of the group health plan or other welfare
benefit plan as specified in 29 CFR 2520.103–
2. See 29 CFR 2520.104–43.
7. An apprenticeship or training plan
meeting all of the conditions specified in 29
CFR 2520.104–22.
8. An unfunded dues financed welfare
benefit plan that does not provide health
benefits exempted by 29 CFR 2520.104–26.
9. A church plan under ERISA section
3(33).
10. A welfare benefit plan that covers only
an individual or an individual and his or her
spouse who wholly own a trade or business,
whether incorporated or unincorporated, or
that covers only the partners or the partners
and the partners’ spouses. See 29 CFR
2510.3–3(b).
Direct Filing Entity (DFE)
Some plans participate in certain trusts,
accounts, and other investment arrangements
that file the Form 5500 Annual Return/
Report as a DFE in accordance with the
Direct Filing Entity (DFE) Filing
Requirements. A Form 5500 Annual Return/
Report must be filed for a master trust. A
Form 5500 Annual Return/Report is not
required but may be filed for a common/
collective trust (CCT), a pooled separate
account (PSA), an investment entity that hold
plan assets permitted under 29 CFR
2520.103–12(103–12 IE), or a group
insurance arrangement (GIA). Plans that
participate in CCTs, PSAs, 103–12 IEs, or
GIAs that file as DFEs, however, generally are
eligible for certain annual reporting relief.
For reporting purposes, a CCT, PSA, 103–12
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IE, or GIA is not considered a DFE unless a
Form 5500 and all required attachments are
filed for it in accordance with the Direct
Filing Entity (DFE) Filing Requirements.
Note. Special requirements also apply to
Schedules D and H attached to the Form
5500 filed by plans participating in master
trusts, CCTs, PSAs, and 103–12 IEs. See these
schedules and their instructions.
Section 2: When To File
Plans and GIAs. File 20XX returns/reports
for plan and GIA years that began in 20XX.
All required forms, schedules, statements,
and attachments must be filed by the last day
of the 7th calendar month after the end of the
plan or GIA year (not to exceed 12 months
in length) that began in 20XX. If the plan or
GIA year differs from the 20XX calendar year,
fill in the fiscal year beginning and ending
dates in the space provided.
Short Years. For a plan year of less than
12 months (short plan year), file the form and
applicable schedules by the last day of the
7th calendar month after the short plan year
ends or by the extended due date, if filing
under an authorized extension of time. Fill
in the short plan year beginning and ending
dates in the space provided and check the
appropriate box in Part I, Line B, of the Form
5500. For purposes of this return/report, the
short plan year ends on the date of the
change in accounting period or upon the
complete distribution of assets of the plan.
Also see the instructions for Final Return/
Report to determine if ‘‘the final return/
report’’ box in Line B should be checked.
DFEs other than GIAs. File 20XX returns/
reports no later than 91⁄2 months after the end
of the DFE year that ended in 20XX. A Form
5500 Annual Return/Report filed for a DFE
must report information for the DFE year (not
to exceed 12 months in length). If the DFE
year differs from the 20XX calendar year, fill
in the fiscal year beginning and ending dates
in the space provided.
Notes. (1) If the filing due date falls on a
Saturday, Sunday, or Federal holiday, the
return/report may be filed on the next day
that is not a Saturday, Sunday, or Federal
holiday. (2) If the 20XX+1 Form 5500 is not
available before the plan or DFE filing is due,
use the 20XX Form 5500 and enter the
20XX+1 fiscal year beginning and ending
dates on the line provided at the top of the
form.
Extension of Time To File
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Using Form 5558
A plan or GIA may obtain a one-time
extension of time to file a Form 5500 Annual
Return/Report (up to 21⁄2 months) by filing
IRS Form 5558, Application for Extension of
Time To File Certain Employee Plan Returns,
on or before the normal due date (not
including any extensions) of the return/
report. You MUST file Form 5558 with the
IRS. Approved copies of the Form 5558 will
not be returned to the filer. A copy of the
completed extension request must, however,
be retained with the filer’s records.
File Form 5558 with the Department of the
Treasury, Internal Revenue Service Center,
Ogden, UT 84201–0045.
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Using Extension of Time To File Federal
Income Tax Return
An automatic extension of time to file the
Form 5500 Annual Return/Report until the
due date of the federal income tax return of
the employer will be granted if all of the
following conditions are met:
(1) the plan year and the employer’s tax
year are the same;
(2) the employer has been granted an
extension of time to file its federal income
tax return to a date later than the normal due
date for filing the Form 5500 Annual Return/
Report; and
(3) a copy of the application for extension
of time to file the federal income tax return
is maintained with the filer’s records. An
extension granted by using this automatic
extension procedure CANNOT be extended
further by filing a Form 5558, nor can it be
extended beyond a total of 91⁄2 months
beyond the close of the plan year.
Note. An extension of time to file the Form
5500 Annual Return/Report does not operate
as an extension of time to file a Form 5500
Annual Return/Report filed for a DFE (other
than a GIA), to file PBGC premiums or
annual financial and actuarial reports (if
required by section 4010 of ERISA) or to file
the Form 8955–SSA (Annual Registration
Statement Identifying Separated Participants
with Deferred Vested Benefits) (required to
be filed with the IRS under Code section
6057(a)).
Other Extensions of Time
The IRS, DOL, and PBGC may announce
special extensions of time under certain
circumstances, such as extensions for
Presidentially-declared disasters or for
service in, or in support of, the Armed Forces
of the United States in a combat zone. See
www.irs.gov, www.efast.dol.gov, and
www.pbgc.gov/practitioners for
announcements regarding such special
extensions. If you are relying on one of these
announced special extensions, check the
appropriate box on Form 5500, Part I, Line
D, and enter a description of the announced
authority for the extension.
Delinquent Filer Voluntary Compliance
(DFVC) Program
The DFVC Program facilitates voluntary
compliance by plan administrators who are
delinquent in filing annual reports under
Title I of ERISA by permitting administrators
to pay reduced civil penalties for voluntarily
complying with their DOL annual reporting
obligations. If the Form 5500 is being filed
under the DFVC Program, check the
appropriate box in Form 5500, Part I, Line D,
to indicate that the Form 5500 is being filed
under the DFVC Program. See
www.efast.dol.gov for additional information.
Plan administrators are reminded that they
can use the online calculator available at
www.dol.gov/ebsa/calculator/
dfvcpmain.html to compute the penalties due
under the program. Payments under the
DFVC Program also may be submitted
electronically. For information on how to pay
DFVC Program payments online, go to
www.dol.gov/ebsa.
[CAUTION] Filers who wish to participate
in the DFVC Program for plan years prior to
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20XX–3 must use the 20XX version of Form
5500 or, if applicable, Form 5500–SF. Use the
Form 5500 Version Selection Tool available
at www.efast.dol.gov for further information.
Section 3: Electronic Filing Requirement
Under the computerized ERISA Filing
Acceptance System (EFAST2), you must file
your 20XX Form 5500 Annual Return/Report
electronically. You may file online using
EFAST2’s web-based filing system or you
may file through an EFAST2-approved
vendor. Detailed information on electronic
filing is available at www.efast.dol.gov. For
telephone assistance, call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–
3278). The EFAST2 Help Line is available
Monday through Friday from 8:00 a.m. to
8:00 p.m., Eastern Time.
[CAUTION] Annual returns/reports filed
under Title I of ERISA must be made
available by plan administrators to plan
participants and beneficiaries and by the
DOL to the public pursuant to ERISA sections
104 and 106. Even though the Form 5500
Annual Return/Report must be filed
electronically, the administrator must keep a
copy of the Form 5500, including schedules
and attachments, with all required signatures
on file as part of the plan’s records and must
make a paper copy available upon request to
participants, beneficiaries, and the DOL as
required by section 104 of ERISA and 29 CFR
2520.103–1. Filers may use electronic media
for record maintenance and retention, so
long as they meet the applicable
requirements.
Generally, questions on the Form 5500
relate to the plan year entered at the top of
the first page of the form. Therefore, answer
all questions on the 20XX Form 5500 with
respect to the 20XX plan year unless
otherwise explicitly stated in the instructions
or on the form itself.
Your entries must be in the proper format
in order for the EFAST2 system to process
your filing. For example, if a question
requires you to enter a dollar amount, you
cannot enter a word. Your software will not
let you submit your return/report unless all
entries are in the proper format. To reduce
the possibility of correspondence and
penalties:
• Complete all lines on the Form 5500
unless otherwise specified. Also complete
and attach, as required, applicable schedules
and attachments.
• Do not enter ‘‘N/A’’ or ‘‘Not Applicable’’
on the Form 5500 Annual Return/Report
unless specifically permitted. ‘‘Yes’’ or ‘‘No’’
questions on the forms and schedules cannot
be left blank, unless specifically permitted.
Answer either ‘‘Yes’’ or ‘‘No,’’ but not both.
All schedules and attachments to the Form
5500 must be properly identified, and must
include the name of the plan or DFE, EIN,
and plan number (PN) as found on the Form
5500, lines, 1a, 2b, and 1b, respectively. At
the top of each attachment, indicate the
schedule and line, if any to which the
attachment relates.
Check your return/report for errors before
signing or submitting it to EFAST2. Your
filing software or, if you are using it, the
EFAST2 web-based filing system will allow
you to check your return/report for errors. If,
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after reasonable attempts to correct your
filing to eliminate any identified problem or
problems, you are unable to address them, or
you believe that you are receiving the
message in error, call the EFAST2 Help Line
at 1–866–GO–EFAST (1–866–463–3278) or
contact the service provider you used to help
prepare and file your annual return/report.
Once you complete the return/report and
finish the electronic signature process, you
can electronically submit it to EFAST2.
When you electronically submit your return/
report, EFAST2 is designed to immediately
notify you if your submission was received
and whether the return/report is ready to be
processed by EFAST2. If EFAST2 does not
notify you that your submission was
successfully received and is ready to be
processed, you will need to take steps to
correct the problem or you may be deemed
a non-filer subject to penalties from DOL,
IRS, and/or PBGC.
Once EFAST2 receives your return/report,
the EFAST2 system should be able to provide
a filing status within 20 minutes. The person
submitting the filing should check back into
the EFAST2 system to determine the filing
status of your return/report. The filing status
message will include a list of filing errors or
warnings that EFAST2 may have identified
in your filing. If EFAST2 did not identify any
filing errors or warnings, EFAST2 will show
the filing status of your return/report as
‘‘Filing_Received.’’ Persons other than the
submitter can check whether the filing was
received by the system by calling the
EFAST2 Help Line at 1–866–GO–EFAST (1–
866–463–3278) and using the automated
telephone system.
To reduce the possibility of
correspondence and penalties from the DOL,
IRS, and/or PBGC, you should do the
following: (1) Before submitting your return/
report to EFAST2, check it for errors, and (2)
after you have submitted it to EFAST2, verify
that you have received a filing status of
‘‘Filing Received’’ and attempt to correct and
resolve any errors or warnings listed in the
status report. For more information on
whether the filing must be corrected and
resubmitted or corrected as an amended
filing, go to the EFAST2 Web site at
www.efast.dol.gov, Frequently Asked
Questions (FAQs), or call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–3278).
Note. Even after being received by the
EFAST2 system, your return/report filing
may be subject to further detailed review by
DOL, IRS, and/or PBGC, and your filing may
be deemed deficient based upon this further
review. See Penalties on Page X.
[CAUTION] Do not enter social security
numbers in response to questions asking for
an employer identification number (EIN).
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on the Form 5500 or on a schedule
or attachment that is open to public
inspection may result in the rejection of the
filing. If you discover a filing disclosed on the
EFAST2 Web site that contains a social
security number, immediately call the
EFAST2 Help Line at 1–866–GO–EFAST (1–
866–463–3278).
Employers without an EIN must apply for
one as soon as possible. The EBSA does not
issue EINs. To apply for an EIN from the IRS:
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• Mail or fax Form SS–4, Application for
Employer Identification Number, obtained at
the IRS Web site at www.irs.gov.
• Call 1–800–829–4933 to receive your EIN
by telephone.
• Select the Online EIN Application link at
www.irs.gov. The EIN is issued immediately
once the application information is validated.
(The online application process is not yet
available for corporations with addresses in
foreign countries).
[CAUTION] Do not attach a copy of the
annual registration statement (IRS Form
8955–SSA) identifying separated participants
with deferred vested benefits, or a previous
year’s Schedule SSA (Form 5500) to your
20XX Form 5500 Annual Return/Report. The
annual registration statement must be filed
directly with the IRS and cannot be attached
to a Form 5500 Annual Return/Report
submission with EFAST2.
Amended Return/Report
File an amended return/report to correct
errors and/or omissions in a previously filed
annual return/report for the 20XX plan year.
The amended Form 5500 and any amended
schedules and/or attachments must conform
to the requirements in these instructions. See
the DOL Web site at www.efast.dol.gov for
information on filing amended returns/
reports for prior years.
[TIP] Check the Line B(2) box for ‘‘an
amended return/report’’ if you filed a
previous 20XX annual return/report that was
given a ‘‘Filing_Received,’’ ‘‘Filing_Error,’’ or
‘‘Filing_Stopped’’ status by EFAST2. Do not
check the Line B box for ‘‘an amended
return/report’’ if your previous submission
attempts were not successfully received by
EFAST2 because of problems with the
transmission of your return/report. For more
information, go to the EFAST2 Web site at
www.efast.dol.gov or call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–3278).
Final Return/Report
If all assets under the plan (including
insurance/annuity contracts) have been
distributed to the participants and
beneficiaries or legally transferred to the
control of another plan, and when all
liabilities for which benefits may be paid
under a welfare benefit plan have been
satisfied, check the final return/report box in
Part I, Line B(3) at the top of the Form 5500.
Do not mark the final return/report box if you
are reporting participants and/or assets at the
end of the plan year. If a trustee has been
appointed for a terminated defined benefit
pension plan pursuant to ERISA section
4042, the last plan year for which the return/
report must be filed is the year in which the
trustee is appointed. If you are in this
situation, you may contact DOL at
PBGCTrusteedPlan@dol.gov. See specific
instructions for Part I, Line B(5) for the
simplified filing requirements for plans with
500 or fewer participants.
Examples:
Mergers/Consolidations
A final return/report should be filed for the
plan year (12 months or less) that ends when
all plan assets were legally transferred to the
control of another plan.
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[TIP] Remember to identify, on Schedule
H, Line 5, the plan to which assets were
transferred. The transferee plan must also
report the merger/consolidation on its own
Form 5500, Schedule H Line 5.
Pension and Welfare Plans That Terminated
Without Distributing All Assets
If the plan was terminated, but all plan
assets were not distributed, a return/report
must be filed for each year the plan has
assets. The return/report must be filed by the
plan administrator, if designated, or by the
person or persons who actually control the
plan’s assets/property.
Group Health Plans and Other Welfare Plans
Still Liable To Pay Benefits
A welfare plan cannot file a final return/
report if the plan is still liable to pay benefits
for claims that were incurred prior to the
termination date, but not yet paid. See 29
CFR 2520.104b–2(g)(2)(ii).
Signature and Date
For purposes of Title I of ERISA, the plan
administrator is required to file the Form
5500. If the plan administrator does not sign
a filing, the filing status will indicate that
there is an error with your filing, and your
filing will be subject to further review,
correspondence, rejection, and civil
penalties. The plan administrator must
electronically sign the Form 5500 Annual
Return/Report or 5500–SF submitted to
EFAST2.
Note. If the plan administrator is an entity,
the electronic signature must be in the name
of a person authorized to sign on behalf of
the plan administrator.
[CAUTION] After submitting your filing,
you must check the Filing Status. If the filing
status is ‘‘Processing Stopped,’’ it is possible
your submission was not sent with a valid
electronic signature as required, and
depending on the error, may be considered
not to have been filed. By looking closer at
the Filing Status, you can see specific error
messages applicable to the transmitted filing
and determine whether it was sent with a
valid electronic signature and what other
errors may need to be corrected.
Authorized Service Provider Signatures. If
the plan administrator elects to have a
service provider who manages the filing
process for the plan get EFAST2 signing
credentials and submit the electronic Form
5500 Annual Return/Report for the plan:
(1) the service provider must receive
specific written authorization from the plan
administrator to submit the plan’s electronic
filing;
(2) the plan administrator must manually
sign a paper copy of the electronically
completed Form 5500 Annual Return/Report,
and the service provider must include a PDF
copy of the manually signed Form 5500 as an
attachment to the electronic Form 5500
Annual Return/Report submitted to EFAST2;
(3) the service provider must communicate
to the plan administrator any inquiries
received from EFAST2, DOL, IRS or PBGC
regarding the filing;
(4) the service provider must communicate
to the plan administrator that, by electing to
use this option, the image of the plan
administrator’s manual signature will be
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included with the rest of the return/report
posted by the Labor Department on the
Internet for public disclosure; and
(5) the plan administrator must keep the
manually signed copy of the Form 5500, with
all required schedules and attachments, as
part of the plan’s records. For more
information on the electronic signature
option, see the EFAST2 All-Electronic Filing
System FAQs at www.dol.gov/ebsa/faqs/faqEFAST2.html.
[CAUTION] Service providers should
consider implications of IRS tax return
preparer rules.
Note. The Code permits either the plan
sponsor/employer or the administrator to
sign the filing. However, any Form 5500
Annual Return/Report that is not
electronically signed by the plan
administrator will be subject to rejection and
civil penalties under Title I of ERISA.
For DFE filings, a person authorized to sign
on behalf of the DFE must sign for the DFE.
The Form 5500 Annual Return/Report
must be filed electronically and signed. To
obtain an electronic signature, go to
www.efast.dol.gov and register in EFAST2 as
a signer. You will be provided with a UserID
and PIN. Both the UserID and PIN are needed
to sign the Form 5500. The plan
administrator must keep a copy of the Form
5500, including schedules and attachments
with all required signatures on file as part of
the plan’s records. See 29 CFR 2520.103–1.
Electronic signatures on annual returns/
reports filed under EFAST2 are governed by
the applicable statutory and regulatory
requirements.
Preparer Information
Enter the ‘‘Preparer’s name (including
firm’s name, if applicable), address, and
telephone number’’ at the bottom of the first
page of Form 5500. A preparer is any person
who prepares an annual return/report for
compensation, or who employs one or more
persons to prepare the annual return/report
for compensation. If the person who prepared
the annual return/report is not the employer
named in Line 2a or the plan administrator
named in Line 3a, you must name the person
on this line. If there are several people who
prepare Form 5500 and applicable schedules,
please name the person who is primarily
responsible for the preparation of the annual
return/report.
Note. You must complete preparer
information if you are required to file at least
250 returns of any type with the IRS during
the calendar year. However, if you are a small
filer (files fewer than 250 returns of any type
with the IRS during the calendar year), and
you do not enter preparer information on the
Form 5500, then you must file the paper
Form 5500–SUP with the IRS. See the
Treasury regulations on ‘‘Employee
Retirement Benefit Plan Returns Required on
Magnetic Media’’ (See 79 FR 58256 at https://
federalregister.gov/a/2014-23161) and
Instructions for Form 5500–SUP for more
information.
Change in Plan Year
Generally, only defined benefit pension
plans need to get approval for a change in the
plan year. See Code section 412(d)(1).
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However, under Rev. Proc. 87–27, 1987–1
C.B. 769, these pension plans may be eligible
for automatic approval of a change in plan
year. If a change in plan year for a pension
or welfare benefit plan creates a short plan
year, file the form and applicable schedules
by the last day of the 7th calendar month
after the short plan year ends or by the
extended due date, if filing under an
authorized extension of time. Fill in the short
plan year beginning and ending dates in the
space provided in Part I and check the
appropriate box in Part I, Line B of the Form
5500. For purposes of this return/report, the
short plan year ends on the date of the
change in accounting period or upon the
complete distribution of assets of the plan.
Also, see the instructions for the Final
Return/Report to determine if ‘‘Final Return/
Report’’ in Line B should be checked.
Penalties
Plan administrators and plan sponsors
must provide complete and accurate
information and must otherwise comply fully
with the filing requirements. ERISA and the
Code provide for the DOL and the IRS,
respectively, to assess or impose penalties for
not giving complete and accurate information
and for not filing complete and accurate
statements and returns/reports. Certain
penalties are administrative (i.e., they may be
imposed or assessed by one of the
governmental agencies delegated to
administer the collection of the annual
return/report data). Others require a legal
conviction.
Administrative Penalties
Listed below are various penalties under
ERISA and the Code that may be assessed or
imposed for not meeting the annual return/
report filing requirements. Generally,
whether the penalty is under ERISA or the
Code, or both, depends upon the Agency for
which the information is required to be filed.
One or more of the following administrative
penalties may be assessed or imposed in the
event of incomplete filings or filings received
after the due date unless it is determined that
your failure to file properly is for reasonable
cause:
1. A penalty of up to $1,100 a day (or
higher amount if adjusted pursuant to the
Federal Civil Penalties Inflation Adjustment
Act of 1990, as amended) for each day a plan
administrator fails or refuses to file a
complete and accurate report. See ERISA
section 502(c)(2) and 29 CFR 2560.502c–2.
2. A penalty of $25 a day (up to $15,000)
for not filing returns for certain plans of
deferred compensation, trusts and annuities,
and bond purchase plans by the due date(s).
See Code section 6652(e).
3. A penalty of $1,000 for each failure to
file an actuarial statement (Schedule MB
(Form 5500) or Schedule SB (Form 5500))
required by the applicable instructions. See
Code section 6692.
Other Penalties
1. Any individual who willfully violates
any provision of Part 1 of Title I of ERISA
shall on conviction be fined not more than
$100,000 or imprisoned not more than 10
years, or both. See ERISA section 501.
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2. A penalty up to $10,000, five (5) years
imprisonment, or both, may be imposed for
making any false statement or representation
of fact, knowing it to be false, or for
knowingly concealing or not disclosing any
fact required by ERISA. See section 1027,
Title 18, U.S. Code, as amended by section
111 of ERISA.
Section 4: What To File
The Form 5500 Annual Return/Report
reporting requirements vary depending on
whether the Form 5500 is being filed for a
‘‘large plan,’’ a ‘‘small plan,’’ and/or a DFE,
and on the particular type of plan (e.g., group
health plan, welfare plan other than group
health, defined benefit pension plan, defined
contribution pension plan) or the kind of
DFE involved (i.e. common/collective trust
(CCT), pooled separate account (PSA), master
trust, 103–12 investment entity (103–12 IE),
or group insurance arrangement (GIA). The
instructions below provide detailed
information about each of the Form 5500
schedules and which plans and DFEs are
required to file them.
The schedules are grouped in the
instructions by type: (1) Pension Benefit
Schedules; and (2) General Schedules
(including the new Schedule J (Group Health
Plan Information). Each schedule is listed
separately with a description of the subject
matter covered by the schedule and the plans
and DFEs that are required to file the
schedule.
Filing requirements also are listed by type
of filer: (1) Filing Requirements for Pension
Benefit Plan; (2) Filing Requirements for
Plans Providing Group Health Benefits; (3)
Filing Requirements for Welfare Benefit Plan
Other Than Group Health; and (4) DFE Filing
Requirements. For each filer type, there is a
list of the schedules that must be filed with
the Form 5500 (including where applicable,
separate lists for large plan filers, small plan
filers, and different types of DFEs). The filing
requirements also are summarized at the end
of these instructions in a series of ‘‘Quick
Reference Charts of Form 5500, Schedules,
and Attachments’’ for the various types of
filers.
Generally, a return/report filed for a
pension benefit plan or welfare benefit plan
other than a group health plan that covered
fewer than 100 participants as of the
beginning of the plan year should be
completed following the requirements below
for a ‘‘small plan,’’ and a return/report filed
for a plan that covered 100 or more
participants as of the beginning of the plan
year should be completed following the
requirements below for a ‘‘large plan.’’
Use the number of participants required to
be entered in Line 6 of the Form 5500 to
determine whether a plan is a ‘‘small plan’’
or ‘‘large plan.’’
Exceptions:
(1) 80–120 Participant Rule: If the number
of participants reported at the beginning of
the year was between 80 and 120 (inclusive),
and a Form 5500 Annual Return/Report or
Form 5500–SF was filed for the prior plan
year, you may elect to complete the return/
report in the same category (‘‘large plan’’ or
‘‘small plan’’) as was filed for the prior
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return/report. Thus, if a Form 5500–SF or a
Form 5500 Annual Return/Report was filed
for the 20XX-1 plan year as a small plan, and
the plan either had fewer than 100
participants as of the beginning of the plan
year as reported on Form 5500 Annual
Return/Report or the plan is eligible to claim
small plan status under 29 CFR 103–1(d) and
had 120 or fewer participants as of the
beginning of the plan year, you may elect to
complete the 20XX Form 5500 and schedules
in accordance with the instructions for a
small plan, including for eligible filers, filing
the Form 5500–SF instead of the Form 5500.
Defined benefit pension plans, welfare plans,
and defined contribution pension plans that
check the ‘‘first plan’’ year box use the
number reported on Form 5500, Line 6 for
this measure. Defined contribution pension
plans use the number reported on Form 5500,
Line 7g(1)).
(2) Short Plan Year Rule: If the plan had
a short plan year of seven (7) months or less
for either the prior plan year or the plan year
being reported on the 20XX Form 5500, an
election can be made to defer filing the
accountant’s report in accordance with 29
CFR 2520.104–50. If such an election was
made for the prior plan year, the 20XX Form
5500 must be completed following the
requirements for a large plan, including the
attachment of the Schedule H and the
accountant’s reports, regardless of the
number of participants entered in Part II,
Line 6 for defined benefit pension plans,
welfare plans, and defined contribution
pension plans that check the ‘‘first plan’’ year
box, or Line 7g(1) for defined contribution
pension plans.
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Form 5500 Schedules
Pension Schedules
Schedule R (Retirement Plan Information)
is required for both tax-qualified and
nonqualified pension benefit plan unless
otherwise specified under Limited Pension
Plan Reporting. For additional information,
see the Schedule R instructions.
Schedule MB (Multiemployer Defined
Benefit Plan and Certain Money Purchase
Plan Actuarial Information) is required for
most multiemployer defined benefit pension
plans and for defined contribution pension
plans that currently amortize a waiver of the
minimum funding requirements specified in
the instructions for the Schedule MB. For
additional information, see the instructions
for the Schedule MB and the Schedule R.
Schedule SB (Single-Employer Defined
Benefit Plan Actuarial Information) is
required for most single-employer defined
benefit pension plans, including multipleemployer defined benefit pension plans. For
additional information, see the instructions
for the Schedule SB.
Schedule E (ESOP Annual Information) is
required for all pension benefit plans with
ESOP benefits. For additional information,
see the Schedule E instructions.
General Schedules
Schedule H (Financial Information) is
required for pension benefit plans and
welfare benefit plans that are not eligible to
file the Form 5500–SF and for all DFE filings.
All plans and DFEs required to file the
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Schedule H are also generally required to
attach to the Form 5500 Annual Return/
Report a ‘‘Schedule of Assets Held for
Investment At End of Year,’’ and, if
applicable, a ‘‘Schedule of Assets Disposed of
During the Plan Year,’’ a ‘‘Schedule of
Reportable Transactions,’’ and a ‘‘Schedule
of Delinquent Participant Contributions.’’
For additional information, see the Schedule
H instructions.
Large employee benefit plans, 103–12 IEs,
and GIAs filing the Schedule H are generally
required to engage an independent qualified
public accountant (IQPA) and attach a report
of the IQPA pursuant to ERISA section
103(a)(3)(A).
Small employee benefit plans are not
required to attach a report of the IQPA if they
meet the conditions for eligibility for a
waiver of the audit requirements as set forth
in 2520.104–46. For these purposes, defined
benefit pension plans, welfare plans, and
defined contribution pension plans that
check the ‘‘first plan’’ year box use the
participant count on Line 6, and defined
contribution pension plans can use the
participant count on Line 7g(1).
Exceptions: Insured, unfunded, or
combination unfunded/insured welfare plans
including group health plans, as described in
29 CFR 2520.104–44(b)(1), and certain
pension plans and arrangements, as
described in 29 CFR 2520.104–44(b)(2) and
in Limited Pension Plan Reporting, are
exempt from completing the Schedule H.
Schedule A (Insurance Information) is
required if any benefits under an employee
benefit plan are provided by an insurance
company, insurance service or other similar
organization, or through a managed care
organization or a health maintenance
organization. This includes investment
contracts with insurance companies, such as
guaranteed investment contracts, pooled
separate accounts, and variable annuities.
Schedule A is not required for fully insured
group health plans with fewer than 100
participants. For additional information, see
the Schedule A instructions.
Note. Do not file Schedule A for
Administrative Services Only (ASO)
contracts. You do not file Schedule A for a
plan if a Schedule A is filed for the contract
as part of the Form 5500 Annual Return/
Report filed directly by a master trust or 103–
12 IE in which that plan invested/
participated during the plan year.
Schedule C (Service Provider Information)
is generally required for all pension plans
filing the Form 5500, master trusts, 103–12
IEs, and GIAs to report the information
required for: (1) each covered service
provider who received $1,000 or more in
total direct and indirect compensation (i.e.,
money or anything else of monetary value in
connection with services rendered to the
plan or the person’s position with the plan
during the plan year) and (2) other persons
who received $5,000 or more in direct
compensation in connection with services
rendered to the plan or the person’s position
with the plan during the plan year. For
additional information, including the
definition of a ‘‘covered service provider,’’
see the Schedule C instructions. Schedule C
is also required for welfare benefit plans,
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47605
including group health plans, unless the plan
is exempt under 29 CFR 2520.104–44 from
completing the accountant’s report
requirement and completing Schedule H.
Schedule D (DFE/Participating Plan
Information) Schedule D is required when
the Form 5500 is filed for a DFE. For
additional information, see the Schedule D
instructions.
Schedule G (Financial Transaction
Schedules) is required for a large plan,
master trust, 103–12 IE, or GIA when
Schedule H (Financial Information) lines 4b,
4c, and/or 4d are checked ‘‘Yes.’’ Part I of the
Schedule G reports loans or fixed income
obligations in default or classified as
uncollectible. Part II of the Schedule G
reports leases in default or classified as
uncollectible. Part III of the Schedule G
reports nonexempt transactions. For
additional information, see the Schedule G
instructions.
[CAUTION] An unfunded, fully insured, or
combination unfunded/insured welfare plan
with 100 or more participants exempt under
29 CFR 2520.104–44 from completing
Schedule H must still complete Schedule G,
Part III, to report nonexempt transactions.
Schedule J (Group Health Plan
Information). All plans that provide group
health benefits must complete the Schedule
J (Group Health Plan Information) to report
coverage, participation, claims, benefit, and
other group health information. Small, fully
insured plans only need to complete lines 1–
8.
Filing Requirements
Pension Benefit Plans
Pension benefit plan filers must complete
the Form 5500 Annual Return/Report,
including the signature block and, unless
otherwise specified, attach the following
schedules and information:
Small Pension Plan
The following schedules (including any
additional information required by the
instructions to the schedules) must be
attached to a Form 5500 filed for a small
pension plan that is neither exempt from
filing nor is filing the Form 5500–SF:
1. Schedule A (as many as needed), to
report insurance, annuity, and investment
contracts held by the plan.
2. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds.
3. Schedule H, to report plan financial
information, unless exempt. See Limited
Pension Plan Reporting.
4. Schedule MB or SB, to report actuarial
information, if applicable.
5. Schedule R, to report retirement plan
information, if applicable.
[CAUTION] Unless you have checked
Schedule H, Line 3h(4) to indicate that the
plan has fewer than 100 participants and is
claiming a small plan audit waiver of the
annual examination and report of an IQPA
under 29 CFR 2520.104–46, you must attach
the report of the independent qualified
public accountant (IQPA) or check Schedule
H, Line 3h(2) to indicate that the plan is
eligible and elects to defer attaching the
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IQPA’s opinion pursuant to 29 CFR
2520.104–50 in connection with a short plan
year of seven months or less.
Large Pension Plan
The following schedules (including any
additional information required by the
instructions to the schedules) must be
attached to a Form 5500 filed for a large
pension plan:
1. Schedule A (as many as needed), to
report insurance, annuity, and investment
contracts held by the plan.
2. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds.
3. Schedule G, to report loans or fixed
income obligations in default or determined
to be uncollectible as of the end of the plan
year, leases in default or classified as
uncollectible, and nonexempt transactions,
i.e., file Schedule G if Schedule H (Form
5500) lines 4b, 4c, and/or 4d are checked
‘‘Yes.’’
4. Schedule H, to report financial
information, unless exempt. See Limited
Pension Plan Reporting.
5. Schedule MB or SB, to report actuarial
information, if applicable.
6. Schedule R, to report retirement plan
information, if applicable.
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Eligible Combined Plans
Section 903 of PPA established rules for a
new type of pension plan, an ‘‘eligible
combined plan,’’ effective for plan years
beginning after December 31, 2009. See Code
section 414(x) and ERISA section 210(e). An
eligible combined plan consists of a defined
benefit pension plan and a defined
contribution pension plan that includes a
qualified cash or deferred arrangement under
Code section 401(k), with the assets of the
two plans held in a single trust, but clearly
identified and allocated between the plans.
The eligible combined plan design is
available only to employers that employed an
average of at least two, but not more than 500
employees, on business days during the
calendar year preceding the plan year as of
which the eligible combined plan is
established and that employs at least two
employees on the first day of the plan year
that the plan is established. Because an
eligible combined plan includes both a
defined benefit pension plan and a defined
contribution pension plan, the Form 5500
filed for the plan must include all the
information, schedules, and attachments that
would be required for either a defined benefit
pension plan (such as a Schedule SB) or a
defined contribution pension plan.
Limited Pension Plan Reporting
The pension benefit plans or arrangements
described below are eligible for limited
annual reporting:
1. IRA Plans: A pension plan using
individual retirement accounts or annuities
(as described in Code section 408) as the sole
funding vehicle for providing pension
benefits need complete only Form 5500, Part
I and Part II, lines 1 through 4, and 9a(8)
(check the box for ‘‘Code section 408
accounts and annuities on Form 5500).
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2. Fully Insured Pension Plan: A pension
benefit plan providing benefits exclusively
through an insurance contract or contracts
that are fully guaranteed and that meet all of
the conditions of 29 CFR 2520.104–44(b)(2)
during the entire plan year must complete all
the requirements listed under this Pension
Benefit Plan Filing Requirements section,
except that such a plan is exempt from
attaching Schedule H, and an independent
qualified public accountant’s opinion, and
from the requirement to engage an IQPA.
[CAUTION] A pension benefit plan that
has insurance contracts of the type described
in 29 CFR 2520.104–44 as well as other assets
must complete all requirements for a pension
benefit plan, except that the value of the
plan’s allocated contracts (see below) should
not be reported in Part I of Schedule H. All
other assets should be reported on Schedule
H and any other required schedules. If
Schedule H is filed, attach an accountant’s
report in accordance with the Schedule H
instructions.
Note. For purposes of the annual return/
report and the alternative method of
compliance set forth in 29 CFR 2520.104–44,
a contract is considered to be ‘‘allocated’’
only if the insurance company or
organization that issued the contract
unconditionally guarantees, upon receipt of
the required premium or consideration, to
provide a retirement benefit of a specified
amount. This amount must be provided to
each participant without adjustment for
fluctuations in the market value of the
underlying assets of the company or
organization, and each participant must have
a legal right to such benefits, which is legally
enforceable directly against the insurance
company or organization. For example,
deposit administration, immediate
participation guarantee, guaranteed
investment contracts, and variable annuities
are NOT allocated contracts for Form 5500
Annual Return/Report purposes.
Welfare Benefit Plans that Provide Group
Health Benefits
Large group health plans must follow the
filing rules for large welfare plans and also
must file the Schedule J (Group Health Plan
Information).
Small group health plans that are
unfunded or a combination of unfunded and
insured file the complete Form 5500 and the
complete Schedule J and Schedule A, if
applicable. Small group health plans that are
fully insured need only complete Lines 1–5
of the Form 5500 and Lines 1–8 of the
Schedule J (and they do not complete
Schedule A). Small group health plans that
are funded with a trust generally follow the
rules for large group health plans funded
with a trust (except small welfare plans are
not required to complete Schedule G or the
other separate schedules listed in 29 CFR
2020.104–46(c)).
Other Welfare Benefit Plans
Welfare benefit plans that do not provide
group health benefits must complete the
Form 5500 Annual Return/Report, including
the signature block and, unless otherwise
specified, attach the following schedules and
information:
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Small Welfare Plan
The following schedules (including any
additional information required by the
instructions to the schedules) must be
attached to a Form 5500 filed for a small
welfare plan that is neither exempt from
filing the annual return/report nor filing the
Form 5500–SF:
1. Schedule A (as many as needed), to
report insurance contracts held by the plan.
2. Schedule H to report plan financial
information, unless exempt.
3. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds,
unless exempt.
Large Welfare Plan
The following schedules (including any
additional information required by the
instructions to the schedules) must be
attached to a Form 5500 filed for a large
welfare plan:
1. Schedule A (as many as needed), to
report insurance and investment contracts
held by the plan.
2. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds,
unless exempt.
3. Schedule G, to report loans or fixed
income obligations in default or determined
to be uncollectible as of the end of the plan
year, leases in default or classified as
uncollectible, and nonexempt transactions,
i.e., file Schedule G if Schedule H (Form
5500) lines 4b, 4c, and/or 4d are checked
‘‘Yes’’ or if a large welfare plan that is not
required to file a Schedule H has nonexempt
transactions.
4. Schedule H, to report financial
information, unless exempt.
[TIP] Attach the report of the independent
qualified public accountant (IQPA) identified
on Schedule H, Line 3c, unless Line 3e(2) or
(3) is checked. Neither Schedule H nor an
IQPA’s opinion is required to be attached to
a Form 5500 filed for an unfunded, fully
insured or combination unfunded/insured
welfare plan that meets the requirements of
29 CFR 2520.104–44. However, Schedule G,
Part III, must be attached to the Form 5500
to report any nonexempt transactions for a
large welfare plan. A large welfare benefit
plan that uses a ‘‘voluntary employees’
beneficiary association’’ (VEBA) under Code
section 501(c)(9) is generally not exempt from
the requirement of engaging an IQPA.
Direct Filing Entity (DFE) Filing
Requirements
Only one Form 5500 Annual Return/Report
should be filed for each DFE for all plans
participating in the DFE; however, the Form
5500 filed for the DFE, including all required
schedules and attachments, must report
information for the DFE year (not to exceed
12 months in length) that ends with or within
the participating plan’s year.
Any Form 5500 filed for a DFE is an
integral part of the annual return/report of
each participating plan, and the plan
administrator may be subject to penalties for
failing to file a complete annual report unless
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both the DFE’s Form 5500 and the plan’s
Form 5500 are properly filed. The
information required for a Form 5500 Annual
Return/Report filed for a DFE varies
according to the type of DFE. The following
paragraphs provide specific guidance for the
reporting requirements for each type of DFE.
date with the current value of the investment
account assets at the beginning of the
applicable fiscal year of the master trust. All
attachments must be properly labeled.
Note. If the plan uses more than one master
trust, a separate annual report for each master
trust must be filed.
Master Trust
The administrator filing a Form 5500
Annual Return/Report for an employee
benefit plan is required to file or have a
designee file a Form 5500 for each master
trust in which the plan participated at any
time during the plan year. For reporting
purposes, a ‘‘master trust’’ is a trust for which
a regulated financial institution (as defined
below) serves as trustee or custodian
(regardless of whether such institution
exercises discretionary authority or control
with respect to the management of assets
held in the trust), and in which assets of
more than one plan sponsored by a single
employer or by a group of employers under
common control are held.
‘‘Common control’’ is determined on the
basis of all relevant facts and circumstances
(whether or not such employers are
incorporated).
A ‘‘regulated financial institution’’ means a
bank, trust company, or similar financial
institution that is regulated, supervised, and
subject to periodic examination by a state or
federal agency. A securities brokerage firm is
not a ‘‘similar financial institution’’ as used
here. See DOL Advisory Opinion 93–21A
(available at www.dol.gov/ebsa).
The Form 5500 submitted for the master
trust must comply with the Form 5500
Annual Return/Report instructions for a
Large Pension Plan, unless otherwise
specified in the forms and instructions. The
master trust must file:
1. Form 5500, except lines C, D, 1c, 2d, and
6 through 10. Be certain to check the ‘‘master
trust’’ box Part I, Line A, as the DFE type.
2. Schedule A (as many as needed) to
report insurance, annuity and investment
contracts held by the master trust.
3. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds.
4. Schedule D, to list all plans that
participated in the master trust during its
year.
5. Schedule G, to report loans or fixed
income obligations in default or determined
to be uncollectible as of the end of the master
trust year, all leases in default or classified
as uncollectible, and nonexempt
transactions.
6. Schedule H, except Lines 1a(1), 1a(2),
1a(3), 1g, 1h, 1i, 2a, 2b, 2e, 2f, 2g, 4a, 4e, 4f,
4g, 4h, 4k, 4l, 4m, and 5, to report financial
information. The opinion of an independent
qualified public accountant (IQPA) is not
required for a master trust.
7. Additional information required by the
instructions to the above schedules,
including, for example, the Schedules of
Assets and the Schedule of Reportable
Transactions. For purposes of the schedule of
reportable transactions, the 5% figure shall
be determined by comparing the current
value of the transaction at the transaction
Common/Collective Trust (CCT) and Pooled
Separate Account (PSA)
A Form 5500 Annual Return/Report is not
required to be filed for a CCT or PSA.
However, the administrator of a large plan or
DFE that participates in a CCT or PSA that
files as specified below is entitled to
reporting relief that is not available to plans
or DFEs participating in a CCT or PSA for
which a Form 5500 Annual Return/Report is
not filed.
For reporting purposes, ‘‘common/
collective trust’’ and ‘‘pooled separate
account’’ are, respectively: (1) a trust
maintained by a bank, trust company, or
similar institution or (2) an account
maintained by an insurance carrier, which is
regulated, supervised, and subject to periodic
examination by a state or federal agency in
the case of a CCT, or by a state agency in the
case of a PSA, for the collective investment
and reinvestment of assets contributed
thereto from employee benefit plans
maintained by more than one employer or
controlled group of corporations as that term
is used in Code section 1563. See 29 CFR
2520.103–3, 103–4, 103–5, and 103–9.
Note. For reporting purposes, a separate
account that is not considered to be holding
plan assets pursuant to 29 CFR 2510.3–
101(h)(1)(iii) does not constitute a pooled
separate account.
The Form 5500 Annual Return/Report
submitted for a CCT or PSA must comply
with the Form 5500 Annual Return/Report
instructions for a Large Pension Plan, unless
otherwise specified in the forms and
instructions.
The CCT or PSA must file:
1. Form 5500, except lines C, D, 1c, 2d, and
6 through 10. Check ‘‘CCT’’ or ‘‘PSA,’’ as
appropriate, in Part I, Line A, as the DFE
type.
2. Schedule D, to list all plans that
participated in the CCT or PSA during its
year.
3. Schedule H, except Lines 1a(1), 1a(2),
1a(3), 1c, 1d, 1g, 1h, 1i, 2a, 2b, 2e, 2f, and
2g, to report financial information. CCTs and
PSAs are not required to attach an IQPA
report or complete Part IV, except Line
4(i)(1). CCTs and PSAs must attach the Line
4i(1) Schedule of Assets Held for Investment
at End of Year.
[CAUTION] Different requirements apply
to Schedule H attached to the Form 5500
filed by plans and DFEs participating in
CCTs and PSAs, depending upon whether a
DFE Form 5500 has been filed for the CCT
or PSA. See the instructions for these
schedules.
29 CFR 2510.3–101 of two or more plans that
are not members of a ‘‘related group’’ of
employee benefit plans. Such an entity for
which a Form 5500 is filed constitutes a
‘‘103–12 IE.’’ A Form 5500 is not required to
be filed for such entities; however, filing a
Form 5500 as a 103–12 IE provides certain
reporting relief, including the limitation of
the examination and report of the
independent qualified public accountant
(IQPA) provided by 29 CFR 2520.103–12(d),
to participating plans and DFEs. For this
reporting purpose, a ‘‘related group’’ of
employee benefit plans consists of each
group of two or more employee benefit plans
(1) each of which receives 10% or more of
its aggregate contributions from the same
employer or from a member of the same
controlled group of corporations (as
determined under Code section 1563(a),
without regard to Code section 1563(a)(4)
thereof); or (2) each of which is either
maintained by, or maintained pursuant to a
collective-bargaining agreement negotiated
by, the same employee organization or
affiliated employee organizations. For
purposes of this paragraph, an ‘‘affiliate’’ of
an employee organization means any person
controlling, controlled by, or under common
control with such organization. See 29 CFR
2520.103–12.
The Form 5500 submitted for an entity
holding plan assets that is permitted under
29 CFR 2520.103–12 to file a Form 5500 must
comply with the Form 5500 instructions for
a Large Pension Plan, unless otherwise
specified in the forms and instructions.
The 103–12 IE must file:
1. Form 5500, except lines C, D, 1c, 2d, and
6 through 10. Check 103–12 IE in part I, Line
A, as the DFE type.
2. Schedule A (as many as needed), to
report insurance, annuity and investment
contracts held by the 103–12 IE.
3. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds.
4. Schedule D, to list all plans that
participated in the 103–12 IE during its year.
5. Schedule G, to report loans or fixed
income obligations in default or determined
to be uncollectible as of the end of the 103–
12 IE year, leases in default or classified as
uncollectible, and nonexempt transactions.
6. Schedule H, except lines 1a(1), 1a(2),
1a(3), 1c, 1d, 1g, 1h, 1i, 2a, 2b, 2e, 2f, 2g, 4a,
4e, 4f, 4g, 4h, 4j, 4k, 4l, 4m, and 5, to report
financial information.
7. Additional information required by the
instructions to the above schedules,
including, for example, the report of the
independent qualified public accountant
(IQPA) identified on Schedule H, Line 3c, the
Line 4i(1) Schedule of Assets Held for
Investment at End of Year, and the Line 4i(2)
Schedule of Assets Disposed of During the
Plan Year. All attachments must be properly
labeled.
103–12 Investment Entity (103–12 IE)
DOL Regulation 2520.103–12 provides an
alternative method of reporting for plans that
invest in an entity (other than a master trust,
CCT, or PSA), whose underlying assets
include ‘‘plan assets’’ within the meaning of
Group Insurance Arrangement (GIA)
Each welfare benefit plan, regardless of
whether it provides group health benefits,
that is part of a group insurance arrangement
is exempt from the requirement to file a Form
5500 Annual Return/Report if a consolidated
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report for all the plans in the arrangement
was filed in accordance with 29 CFR
2520.104–43. For reporting purposes, a
‘‘group insurance arrangement’’ provides
benefits to the employees of two or more
unaffiliated employers (not in connection
with a multiemployer plan or a collectivelybargained multiple-employer plan), fully
insures one or more welfare plans of each
participating employer, uses a trust or other
entity as the holder of the insurance
contracts, and uses a trust as the conduit for
payment of premiums to the insurance
company.
The GIA must file:
1. Form 5500, except lines C and 2d. Check
‘‘GIA’’ in Part I, Line A, as the DFE type.
2. Schedule A (as many as needed), to
report insurance, annuity and investment
contracts held by the GIA.
3. Schedule C (as many as needed) to
report information on service providers who
received compensation at or above the
applicable $1,000 and $5,000 thresholds.
4. Schedule D, to list all plans that
participated in the GIA during its year.
5. Schedule G, to report loans or fixed
income obligations in default or determined
to be uncollectible as of the end of the GIA
year, leases in default or classified as
uncollectible, and nonexempt transactions.
6. Schedule H, except lines 4a, 4e, 4f, 4g,
4h, 4l, 4m, and 5, to report financial
information.
7. Separate Schedules J for each
participating employer, if the GIA provides
group health benefits.
8. Additional information required by the
instructions to the above schedules,
including, for example, the report of the
independent qualified public accountant
(IQPA) identified on Schedule H, Line 3c, the
Schedules of Assets and the Schedule of
Reportable Transactions. (All attachments
must be properly labeled.)
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Section 5: Line-by-Line Instructions for the
20XX Form 5500 and Schedules
Part I—Annual Return/Report Identification
Information
File the 20XX Form 5500 Annual Return/
Report for a plan year that began in 20XX or
a DFE year that ended in 20XX. Enter the
beginning and ending dates in Part I. The
20XX Form 5500 Annual Return/Report must
be filed electronically.
One Form 5500 is generally filed for each
plan or entity described in the instructions to
the boxes in Line A. Do not check more than
one box.
Line A(1)—Box for Single-Employer Plan.
Check this box if the Form 5500 is filed for
a single-employer plan. A single-employer
plan for this Form 5500 reporting purpose is
an employee benefit plan maintained by one
employer or one employee organization.
Note. Do not check this box even if all of
the employers maintaining the plan are
members of the same controlled group or
affiliated service group under Code sections
414(b), (c), or (m). Check Box A(3).
Line A(2)—Box for Multiple-Employer
Plan. Check this box if Form 5500 is being
filed for a multiple-employer plan. A
multiple-employer plan is a plan that is
maintained by more than one employer and
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is not one of the plans described in A(3) or
A(4). A multiple-employer plan can be
collectively bargained and collectively
funded, but if covered by PBGC termination
insurance, must have properly elected before
September 27, 1981, not to be treated as a
multiemployer plan under Code section
414(f)(5) or ERISA sections 3(37)(E) and
4001(a)(3), and have not revoked that
election or made an election to be treated as
a multiemployer plan under Code section
414(f)(6) or ERISA section 3(37)(G).
Participating employers do not file
individually for this type of plan.
Note. Do not check this box if all of the
employers maintaining the plan are members
of the same controlled group or affiliated
service group under Code sections 414(b), (c),
or (m).
‘‘Multiple-Employer Plan Participating
Employer Information.’’ If you checked box
A(2) for ‘‘Multiple-Employer Plan,’’ you must
complete the ‘‘Multiple-Employer Plan
Participating Employer Information’’
attachment. Enter the name of the plan, EIN,
and plan number (PN) as found on the plan’s
Form 5500. Complete as many entries as
needed to report the required information for
all participating employers.
Provide a good faith estimate of each
employer’s percentage of the total
contributions (including employer and
participant contributions) made by all
participating employers during the year. Any
employer who was obligated to make
contributions to the plan for the plan year,
made contributions to the plan for the plan
year, or whose employees were covered
under the plan is a ‘‘participating employer’’
for this purpose. If a participating employer
made no contributions, enter ‘‘-0-’’ in
element (c).
Multiple employer welfare plans that are
exempt under 29 CFR 2520.104–20 or 29 CFR
2520.104–44 from the obligation to file
financial statements with their annual report
are required to include only a list of
participating employers with the
corresponding EIN/PN numbers in elements
(a) and (b) of the ‘‘Multiple Employer Plan
Participating Employer Information’’
attachment included with their Form 5500.
Line A(3)—Box for Controlled Group.
Check this box for a ‘‘controlled group’’ of
corporations that is filing a single Form 5500
for reporting purposes. A ‘‘controlled group’’
is a controlled group of corporations under
Code section 414(b), a group of trades or
businesses under common control under
Code section 414(c), or an affiliated service
group under Code section 414(m).
‘‘Controlled Group Member Information.’’
If you checked box A(3) for ‘‘Controlled
Group Plan,’’ you must complete the
‘‘Controlled Group Member Information’’
attachment. Complete as many entries as
needed to report the required information for
all employers that are participating members
of the controlled group sponsoring the plan.
Provide a good faith estimate of each
employer’s percentage of the total
contributions (including employer and
participant contributions) made by all
employers made during the year. Any
employer that was a member of the
controlled group who was obligated to make
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contributions to the plan for the plan year,
made contributions to the plan for the plan
year, or whose employees were covered
under the plan is a ‘‘participating employer’’
for this purpose. If a participating employer
made no contributions, enter ‘‘-0-’’ in
element (c).
Line A(4)—Multiemployer Plan. Check
this box if the Form 5500 is filed for a
multiemployer plan. A plan is a
multiemployer plan if: (a) more than one
employer is required to contribute, (b) the
plan is maintained pursuant to one or more
collective bargaining agreements between
one or more employee organizations and
more than one employer; (c) an election
under Code section 414(f)(5) and ERISA
section 3(37)(E) has not been made; and (d)
the plan meets any other applicable
conditions of 29 CFR 2510.3–37. A plan that
has made a proper election under ERISA
section 3(37)(G) and Code section 414(f)(6)
on or before August 17, 2007, is also a
multiemployer plan. Participating employers
do not file individually for these plans.
Line A(5)—Direct Filing Entity (DFE). If
filing as a DFE, check the box to indicate the
correct entity type.
Line B(1)—First Return/Report. Check this
box if an annual return/report has not been
previously filed for this plan or DFE. For the
purpose of completing this box, filings made
for ‘‘one participant’’ plans for purposes of
the Code and not Title I are not considered
an annual return/report.
Line B(2)—Amended Return/Report.
Check this box if you have already filed for
the 20XX plan year and are now filing an
amended return/report to correct errors and/
or omissions on the previously filed return/
report. See instructions on page xx.
Check the Line B box for an ‘‘amended
return/report’’ if you filed a previous 20XX
annual return/report that was given a
‘‘Filing_Received,’’ ‘‘Filing_Error,’’ or
‘‘Filing_Stopped’’ status by EFAST2. Do not
check the Line B box for an ‘‘amended
return/report’’ if your previous submission
attempts were not successfully received by
EFAST2 because of problems with the
transmission of your return/report. For more
information, go to the EFAST2 Web site at
www.efast.dol.gov or call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–
3278).
Line B(3)—Final Return/Report. Check this
box if this Form 5500 is the last annual
return/report required to be submitted for
this plan. (See Final Return/Report.)
Note. Do not check box B(3) (Final Return/
Report) if in Line 9b(4), you check the box
to indicate that the plan is an unfunded, fully
insured, or combination unfunded/fully
insured welfare plan (other than a group
health plan) that will not file an annual
report for next plan year pursuant to 29 CFR
2520.104–20. Only check the box on Line
9b(4) for a welfare plan that is not required
to file a Form 5500 for the next plan year
because the welfare plan that does not
provide group health benefits has become
eligible for an annual reporting exemption.
For example, certain unfunded and insured
life insurance or disability plans may be
required to file the 20XX Form 5500 and be
exempt from filing a Form 5500 for the plan
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year 20XX if the number of participants
covered as of the beginning of the 20XX plan
year drops below 100. See Who Must File.
Should the number of participants covered
by such a plan increase to 100 or more in a
future year, the plan must resume filing Form
5500 and check the box on Line 9b(4) to
indicate on that year’s Form 5500 that the
filer is an unfunded, fully insured, or
combination unfunded/fully insured welfare
plan that stopped filing annual reports in an
earlier plan year pursuant to 29 CFR
2520.104–20. See 29 CFR 2520.104–20.
Line B(4)—Short Plan Year Return/Report.
Check this box if this Form 5500 is being
filed for a plan year period of less than 12
months. Provide the dates in Part I, Plan Year
Beginning and Ending.
Line B(5)—Plan Trusteed by PBGC. All
plans that, as of the due date of this return,
have been trusteed by PBGC under section
4041(c) or 4042 of ERISA, must check this
box and enter the date of trusteeship in the
space provided. Plans with 500 or fewer
participants as of the beginning of the plan
year (see Part II, Line 6, asking for participant
count) only complete all of Part I and lines
1, 2, 3, 6, 9a(3) and 9a(4) in Part II. Plans with
more than 500 participants continue to file in
accordance with the requirements for large
defined benefit pension plans.
Line C—Collectively-Bargained Plan.
Check this box when the contributions to the
plan and/or the benefits paid by the plan are
subject to the collective bargaining process
(even if the plan is not established and
administered by a joint board of trustees and
even if only some of the employees covered
by the plan are members of a collective
bargaining unit that negotiates contributions
and/or benefits). The contributions and/or
benefits do not have to be identical for all
employees under the plan.
Line D—Extension and DFVC Program.
Check the appropriate box here if:
• You filed for an extension of time, using
a completed Form 5558, Application for
Extension of Time To File Certain Employee
Plan Returns, and maintain a copy of the
Form 5558 with the filer’s records;
• You are filing using the automatic
extension of time to file Form 5500 Annual
Return/Report until the due date of the
federal income tax return of the employer
and maintain a copy of the employer’s
extension of time to file the income tax
return with the plan’s records;
• You are filing using a special extension
of time to file the Form 5500 Annual Return/
Report that has been announced by the IRS,
DOL, and PBGC. If you checked that you are
using a special extension of time, enter a
description of the extension of time in the
space provided; or
• You are filing under DOL’s Delinquent
Filer Voluntary Compliance (DFVC) Program.
Part II—Basic Plan Information
Line 1a. Enter the formal name of the plan
or DFE. If an annual return/report has
47609
previously been filed on behalf of the plan,
regardless of the type of Form that was filed
(Form 5500, Form 5500–EZ, or Form 5500–
SF), use the same name or abbreviation as
was used on the prior filings. Once you use
an abbreviation, continue to use it for that
plan on all future annual return/report filings
with the IRS, DOL, and PBGC. Do not use the
same name or abbreviation for any other
plan, even if the first plan is terminated.
Line 1b. Enter the three-digit plan or entity
number (PN) that the employer or plan
administrator assigned to the plan or DFE.
This three-digit number, in conjunction with
the employer identification number (EIN)
entered on Line 2b, is used by the IRS, DOL,
and PBGC as a unique 12-digit number to
identify the plan or DFE.
Start at 001 for plans providing pension
benefits, plans providing pension and
welfare benefits, or DFEs (master trusts,
CCTs, and PSAs) except GIAs, as illustrated
in the table below.
Start at 501 for plans providing only
welfare benefits and GIAs. Do not use 888 or
999.
Once you use a plan or DFE number,
continue to use it for that plan or DFE on all
future filings with the IRS, DOL, and PBGC.
Failure to use the same three-digit plan/DFE
number may result in correspondence from
DOL or IRS. Do not use this unique threedigit number for any other plan or DFE, even
if the first plan or DFE is terminated.
YOU SHOULD ASSIGN A PLAN NUMBER (PN) AS DESCRIBED BELOW FOR EACH FORM 5500 (AND FORM 5500–SF) WITH
THE SAME EIN OF PLAN OR DFE SPONSOR ENTERED INTO LINE 2B
Pension benefit plans and Master trusts, CCTs, PSAs, and 103–12 IEs
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Welfare benefit plans, including group health, and GIAs ........................
Exception. If Part II, Line 9a is completed
and 333 (or a higher number in a sequence
beginning with 333) was previously assigned
to the plan, that number may be entered on
Line 1b.
Line 1c. Enter the date the plan first
became effective.
Line 2a. Limit your response to the
information required in each row as specified
below:
1. Enter the name of the plan sponsor or,
in the case of a Form 5500 filed for a DFE,
the name of the insurance company, financial
institution, or other sponsor of the DFE (e.g.,
in the case of a GIA, the trust or other entity
that holds the insurance contract, or in the
case of a master trust, one of the sponsoring
employers). If the plan covers only the
employees of one employer, enter the
employer’s name.
The term ‘‘plan sponsor’’ means:
• The employer, for an employee benefit
plan that a single employer established or
maintains;
• The employee organization in the case of
a plan of an employee organization; or
• The association, committee, joint board
of trustees, or other similar group of
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001 to the first plan or DFE. Consecutively number other plans providing pension benefits with the same plan sponsor or other master
trusts, CCTs, PSAs, or 103–12 IEs with the same sponsor as 002,
003 . . .
501 to the first plan or GIA. Consecutively number others as 502, 503
. . .
representatives of the parties who establish
or maintain the plan, if the plan is
established or maintained jointly by one or
more employers and one or more employee
organizations, or by two or more employers.
Note. In the case of a multiple-employer
plan, file only one annual return/report for
the plan. If an association or other entity is
not the sponsor, enter the name of a
participating employer as sponsor. For a plan
of a controlled group of corporations, the
name of one of the sponsoring members
should be entered. In either case, the same
name must be used in all subsequent filings
of the Form 5500 Annual Return/Report or
Form 5500–SF for the multiple-employer
plan or controlled group (see instructions for
Line 5 concerning change in sponsorship).
2. Enter any ‘‘in care of’’ (C/O) name.
3. Enter the current street address. A post
office box number may be entered in addition
to the street address if the Post Office does
not deliver mail to the sponsor’s street
address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of
the U.S. state or possession and zip code.
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6. Enter the foreign routing code, if
applicable. Leave U.S. state and zip code
blank if entering a foreign routing code and
country name.
7. Enter the foreign country, if applicable.
Do not abbreviate the country name after
‘‘Enter the foreign country.’’
8. Enter the D/B/A (the doing business as)
or trade name of the sponsor if different from
the plan sponsor’s name.
9. Enter any second address. Use only a
street address here, not a P.O. box.
Note. You can also use the IRS Form 8822–
B, Change of Address—Business, to notify
the IRS if the address provided here is a
change in your business mailing address or
your business location.
Line 2b(1). Enter the nine-digit employer
identification number (EIN) assigned to the
plan sponsor/employer, for example, 00–
1234567. In the case of a DFE, enter the
employer identification number (EIN)
assigned to the CCT, PSA, master trust, 103–
12 IE, or GIA.
[CAUTION] Do not use a social security
number in lieu of an EIN. The Form 5500
Annual Return/Report is open to public
inspection, and the contents are public
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information and are subject to publication on
the Internet. Because of privacy concerns, the
inclusion of a social security number or any
portion thereof on this line may result in the
rejection of the filing.
Employers without an EIN must apply for
one as soon as possible. The EBSA does not
issue EINs. To apply for an EIN from the IRS:
• Mail or fax Form SS–4, Application for
Employer Identification Number, obtained at
the IRS Web site at www.irs.gov.
• Call 1–800–829–4933 to receive your EIN
by telephone.
• Select the Online EIN Application link at
www.irs.gov. The EIN is issued immediately
once the application information is validated.
(The online application process is not yet
available for corporations with addresses in
foreign countries or Puerto Rico.)
A multiple-employer plan or plan of a
controlled group of corporations should use
the EIN of the sponsor identified in Line
2b(1). The EIN must be used in all
subsequent filings of the Form 5500 for these
plans (see instructions to Line 5 concerning
change in EIN).
If the plan sponsor is a group of
individuals, such as for the Board of Trustees
for a multiemployer plan, get a single EIN for
the group. When you apply for the EIN,
provide the name of the group, such as ‘‘Joint
Board of Trustees of the Local 187
Machinists’ Retirement Plan.’’ (If filing IRS
Form SS–4, enter the group name on Line 1.)
Note. Except in the case of certain DFEs,
the EIN of the plan sponsor is not the EIN
of the fund (trust or custodial account)
associated with plan.
Line 2b(2). If available, enter the global
legal entity identification number (LEI). With
respect to any company, the LEI is the ‘‘legal
entity identifier’’ assigned by or on behalf of
an internationally recognized standards
setting body and required for reporting
purposes by the U.S. Department of the
Treasury’s Office of Financial Research or a
financial regulator. In the case of a financial
institution, if a ‘‘legal entity identifier’’ has
not been assigned, then provide the RSSD ID
assigned by the National Information Center
of the Board of Governors of the Federal
Reserve System, if any.
Line 2c. Enter the current telephone
number for the plan sponsor. Use numbers
only, including area code, and do not include
any special characters.
Line 2d. Enter the six-digit business code
that best describes the nature of the plan
sponsor’s business from the list of business
codes on pages XX–XY. If more than one
employer or employee organization is
involved, enter the business code for the
main business activity of the employers and/
or employee organizations.
Line 3a. Limit your response to the
information required in each row as specified
below:
1. Enter the current name and address of
the plan administrator unless the
administrator is the sponsor identified in
Line 2. If both the plan administrator name
and address are the same as the plan sponsor
name and address, check the ‘‘Same as Plan
Sponsor’’ box and disregard items 2 through
6 below. If the Form 5500 is submitted for
a DFE, check the appropriate box in Part I,
Line A, and enter the appropriate DFE code.
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The term ‘‘plan administrator’’ means:
• The person or group of persons specified
as the administrator by the instrument under
which the plan is operated;
• The plan sponsor/employer if an
administrator is not so designated; or
• Any other person prescribed by
regulations if an administrator is not
designated and a plan sponsor cannot be
identified.
2. Enter any ‘‘in care of’’ (C/O) name.
3. Enter the current street address. A post
office box number may be entered, in
addition to the street address, if the Post
Office does not deliver mail to the
administrator’s street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of
the U.S. state or possession and zip code.
6. Enter the foreign routing code and
foreign country, if applicable. Leave U.S.
state and zip code blank if entering foreign
routing code and country information.
Line 3b. Enter the plan administrator’s
nine-digit EIN. A plan administrator must
have an EIN for Form 5500 reporting
purposes.
If the plan administrator does not have an
EIN, apply for one as explained in the
instructions for Line 2b. One EIN should be
entered for a group of individuals who are,
collectively, the plan administrator.
Do not use a social security number in lieu
of an EIN. The Form 5500 and its schedules
and attachments are open to public
inspection, and the contents are public
information and are subject to publication on
the Internet. Because of privacy concerns, the
inclusion of a social security number or any
portion thereof on this Form 5500 or any of
it schedules or attachments may result in the
rejection of the filing.
Note. Employees of the plan sponsor who
perform administrative functions for the plan
are generally not the plan administrator
unless specifically designated in the plan
document. If an employee of the plan
sponsor is designated as the plan
administrator, that employee must get an
EIN.
Line 3c. Enter the current telephone
number for the plan administrator.
Line 4. A plan must have at least one
fiduciary (a person or entity) named in the
written plan document, or through a process
described in the plan, as having control over
the plan’s operation. The named fiduciary
can be identified by office or by name. For
some plans, it may be an administrative
committee or a company’s board of directors.
Enter the name and current address of the
‘‘named fiduciary’’ unless the named
fiduciary is the plan sponsor identified in
Line 2. If both the fiduciary name and
address are the same as the plan sponsor
name and address, check the ‘‘Same as Plan
Sponsor’’ box. If the named fiduciary is an
entity such as a committee or board, include
the name and contact information for a
specific individual, as well as the name of
the entity. If you are unable to determine
who is the ‘‘named fiduciary,’’ enter the
name and identifying information of the
person who appointed the plan trustee.
Line 5. If the plan sponsor’s or DFE’s name,
EIN, or LEI have changed since the last
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return/report was filed for this plan or DFE,
enter the plan sponsor’s or DFE’s name, EIN,
LEI, and the plan number as it appeared on
the last return/report filed.
[CAUTION] The failure to indicate on Line
5 that a plan or plan sponsor was previously
identified by a different name, employer
identification number (EIN), LEI, or plan
number could result in correspondence from
the DOL and the IRS.
Line 5a. Enter the plan sponsor’s name as
it appeared on the last return/report filed.
Line 5b(1). Enter the plan sponsor’s EIN as
it appeared on the last return/report filed.
Line 5b(2). Enter the plan sponsor’s LEI (if
available) as it appeared on the last return/
report filed.
Line 5c. Enter the plan sponsor’s plan
number as it appeared on the last return/
report filed.
Lines 6 and 7. All filers must complete
both lines 6 and 7 unless the Form 5500 is
filed for an IRA Plan described in Limited
Pension Plan Reporting or for a DFE.
The description of ‘‘participant’’ in the
instructions below is only for purposes of
these lines.
An individual becomes a participant
covered under an employee welfare benefit
plan on the earliest of:
• the date designated by the plan as the
date on which the individual begins
participation in the plan;
• the date on which the individual
becomes eligible under the plan for a benefit
subject only to occurrence of the contingency
for which the benefit is provided; or
• the date on which the individual makes
a contribution to the plan, whether voluntary
or mandatory.
See 29 CFR 2510.3–3(d)(1). This includes
former employees who are receiving group
health continuation coverage benefits
pursuant to Part 6 of ERISA and who are
covered by the employee welfare benefit
plan. Covered dependents are not counted as
participants. A child who is an ‘‘alternate
recipient’’ entitled to health benefits under a
qualified medical child support order
(QMCSO) should not be counted as a
participant for lines 6 and 7. An individual
is not a participant covered under an
employee welfare plan on the earliest date on
which the individual (a) is ineligible to
receive any benefit under the plan even if the
contingency for which such benefit is
provided should occur, and (b) is not
designated by the plan as a participant. See
29 CFR 2510.3–3(d)(2).
[TIP] Before counting the number of
participants, especially in a welfare benefit
plan, it is important to determine whether the
plan sponsor has established one or more
plans for Form 5500/Form 5500–SF reporting
purposes. As a matter of plan design, plan
sponsors can offer benefits through various
structures and combinations. For example, a
plan sponsor could create (i) one plan
providing major medical benefits, dental
benefits, and vision benefits, (ii) two plans
with one providing major medical benefits
and the other providing self-insured dental
and vision benefits; or (iii) three separate
plans. You must review the governing
documents and actual operations to
determine whether welfare benefits are being
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provided under a single plan or separate
plans.
The fact that you have separate insurance
policies for each different welfare benefit
does not necessarily mean that you have
separate plans. Some plan sponsors use a
‘‘wrap’’ document to incorporate various
benefits and insurance policies into one
comprehensive plan. In addition, whether a
benefit arrangement is deemed to be a single
plan may be different for purposes other than
Form 5500/Form 5500–SF reporting. For
example, special rules may apply for
purposes of HIPAA, COBRA, and Internal
Revenue Code compliance. If you need help
determining whether you have a single
welfare benefit plan for Form 5500/Form
5500–SF reporting purposes, you should
consult a qualified benefits consultant or
legal counsel.
For pension benefit plans, ‘‘alternate
payees’’ entitled to benefits under a qualified
domestic relations order (QDRO) are not to be
counted as participants for this line.
For pension benefit plans, ‘‘participant’’ for
this line means any individual who is
included in one of the categories below:
1. Active participants (i.e., any individuals
who are currently in employment covered by
the plan and who are earning or retaining
credited service under the plan). This
includes any individuals who are eligible to
elect to have the employer make payments
under a Code section 401(k) qualified cash or
deferred arrangement. Active participants
also include any nonvested individuals who
are earning or retaining credited service
under the plan. This does not include (a)
nonvested former employees who have
incurred the break in service period specified
in the plan or (b) former employees who have
received a ‘‘cash-out’’ distribution or deemed
distribution of their entire nonforfeitable
accrued benefit.
2. Retired or separated participants
receiving benefits (i.e., individuals who are
retired or separated from employment
covered by the plan and who are receiving
benefits under the plan). This does not
include any individual to whom an
insurance company has made an irrevocable
commitment to pay all the benefits to which
the individual is entitled under the plan.
3. Other retired or separated participants
entitled to future benefits (i.e., any
individuals who are retired or separated from
employment covered by the plan and who
are entitled to begin receiving benefits under
the plan in the future). This does not include
any individual to whom an insurance
company has made an irrevocable
commitment to pay all the benefits to which
the individual is entitled under the plan.
4. Deceased individuals who had one or
more beneficiaries who are receiving or are
entitled to receive benefits under the plan.
This does not include any individual to
whom an insurance company has made an
irrevocable commitment to pay all the
benefits to which the beneficiaries of that
individual are entitled under the plan.
Line 7g. Enter in element (1) the number
of participants who have account balances at
the beginning of the year. Enter in element
(2) the number of participants included on
Line 7f (total participants at the end of the
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plan year) who have account balances at the
end of the plan year. For example, for a Code
section 401(k) plan the number entered on
Line 7g should be the number of participants
counted on line 7f who have made a
contribution, or for whom a contribution has
been made, to the plan for this plan year or
any prior plan year. Enter in element (3) the
number of participants that made
contributions to the plan (regardless of
whether the employer made contributions)
during the plan year. Both defined
contribution pension plans and welfare plans
complete element (3). Enter in element (4)
the number of participants that terminated
employment during the plan year that had
their entire account balance distributed
during the plan year. Only defined
contribution pension plans complete element
(4).
Welfare plans should leave Line 7g(1), (2),
and (4) blank. Defined benefit pension plans
should also leave Line 7g blank.
Line 7h. Include any individual who
terminated employment during this plan
year, whether or not he or she (a) incurred
a break in service, (b) received an irrevocable
commitment from an insurance company to
pay all the benefits to which he or she is
entitled under the plan, and/or (c) received
a cash distribution or deemed cash
distribution of his or her nonforfeitable
accrued benefit. Multiemployer plans and
multiple-employer plans that are collectively
bargained do not have to complete Line 7h.
Line 8. Only multiemployer plans should
complete Line 8. Multiemployer plans must
enter the total number of employers obligated
to contribute to the plan. For purposes of
Line 8 of the Form 5500, an employer
obligated to contribute is defined as an
employer who, during the 20XX plan year, is
a party to the collective bargaining
agreement(s) pursuant to which the plan is
maintained or who may otherwise be subject
to withdrawal liability pursuant to ERISA
section 4203. Any two or more contributing
entities (e.g., places of business with separate
collective bargaining agreements) that have
the same nine-digit employer identification
number (EIN) must be aggregated and
counted as one employer for this purpose.
Line 9. Benefits Provided Under the Plan.
Answer all questions in Line 9a based on the
reporting year of the plan or arrangement.
Line 9a(1). Defined Benefit Pension
Features; How Benefits Are Calculated. If
benefits are based primarily on pay, check
the box ‘‘Benefits are primarily pay related.’’
If benefits are primarily flat dollar,
including dollars per year of service, check
the box ‘‘Benefits are primarily flat dollar.’’
Check the box for ‘‘Cash balance’’ if the
plan has a ‘‘cash balance’’ formula under
which the accumulated benefit provided
under the formula is expressed as the current
balance of a hypothetical account maintained
for the participant. For this purpose, a ‘‘cash
balance’’ formula is a lump sum based
benefit formula in a defined benefit pension
plan by whatever name (for example,
personal account plan, life cycle plan, cash
account plan, etc.)
Check the box for ‘‘Pension equity plan
(PEP)’’ if the plan has a ‘‘pension equity plan
formula under which the accumulated
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47611
benefit provided under the formula is
expressed as the current value of an
accumulated percentage of the participant’s
final average compensation or is expressed as
a current single-sum dollar amount equal to
a percentage of the participant’s highest
average compensation (with a permitted
lookback period for determining highest
average compensation, such as highest 5 out
of the last 10 years).
Check the box for ‘‘Other hybrid plan’’ if
the plan provides a lump sum based benefit
formula that is different from the cash
balance or pension equity plan formula. Note
that a benefit formula does not constitute a
lump sum based benefit formula unless a
distribution of the benefits under that
formula in the form of a single-sum payment
equals the accumulated benefit under that
formula (except to the extent the single-sum
payment is greater to satisfy the requirements
of Code section 411(d)(6)).
Line 9a(2) Code Section Arrangements for
Defined Benefit Pension Plans. Check the box
for ‘‘Code section 401(h) arrangement’’ if the
plan contains separate accounts under Code
section 401(h) to provide employee health
benefits.
Check the box for ‘‘Code section 414(k)
arrangement’’ if benefits are based partly on
the balance of the separate account of the
participant (also include appropriate defined
contribution pension feature codes).
Line 9a(3) Terminated Defined Benefit
Pension Plan. Check ‘‘yes’’ if the plan is
covered by PBGC and was terminated and
closed out for PBGC purposes before the end
of the plan year (or a prior plan year), and
either (1) the plan terminated in a standard
(or distress) termination and completed the
distribution of plan assets in satisfaction of
all benefit liabilities (or all ERISA Title IV
benefits for distress termination); or (2) a
trustee was appointed for a terminated plan
pursuant to ERISA section 4042.
Line 9a(4) PBGC Covered Defined Benefit
Pension Plan. If you are uncertain whether
the plan is covered under the PBGC
termination insurance program, check the
box ‘‘Not determined’’ and contact the PBGC
either by phone at 1–800–736–2444, by Email
at standard@pbgc.gov, or in writing to
Pension Benefit Guaranty Corporation,
Standard Termination Compliance Division,
Suite 930, Processing and Technical
Assistance Branch, 1200 K Street, NW.,
Washington, DC 20005–4026. If you checked
the box ‘‘Yes,’’ enter the My PAA generated
confirmation number for the premium filing
for this plan year (see filing receipt). If you
amended your premium filing for this plan
year, enter the confirmation number for that
filing and not for the previous filing(s).
Defined contribution pension plans and
welfare plans need not complete this item.
Line 9a(5) Frozen Plans. Check ‘‘Yes’’, if
the plan is frozen. Both defined contribution
and defined benefit pension plans must
indicate whether the plan is frozen.
Line 9a(6) Offset Arrangement. Both
defined benefit and contribution plans that
are part of an offset arrangement must answer
this question. Check ‘‘Yes’’ if plan benefits
are subject to offset for retirement benefits
provided in another plan or arrangement of
the employer. If you have checked ‘‘Yes,’’
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enter the name, EIN, and if available, LEI of
sponsor, and PN of the other plan or
arrangement.
Line 9a(7) Defined Contribution Pension
Plan Type(s). If this is a defined contribution
pension plan, check all the type(s) that apply.
Line 9a(8) Defined Contribution Pension
Plan Arrangements. If this is a defined
contribution pension plan, check all the
type(s) of arrangements under which the plan
operates.
Line 9a(9) Defined Contribution Pension
Plan Features. If this is a defined
contribution pension plan, check all that
apply to indicate features of the plan.
Check automatic enrollment feature if the
plan has elective contributions from payroll
and provides for automatic enrollment in the
plan.
A designated Roth account is a feature in
new or existing 401(k), 403(b) or
governmental 457(b) plans that permit such
plans to accept designated Roth contributions
and certain rollovers. If a plan adopts this
feature, employees can designate some or all
of their elective contributions (also referred
to as elective deferrals) as designated Roth
contributions (which are included in gross
income), rather than traditional, pre-tax
elective contributions.
Check the box for ‘‘Age/service weighted
plan’’ if allocations are based on age, service,
or age and service. New comparability or
similar plan: Allocations are based on
participant classifications and a
classification(s) consists entirely or
predominantly of highly compensated
employees; or the plan provides an
additional allocation rate on compensation
above a specified threshold, and the
threshold or additional rate exceeds the
maximum threshold or rate allowed under
the permitted disparity rules of Code section
401(l).
Check ‘‘Other’’ if the plan has any other
particularized features for defined
contribution pension plans that are not listed
above and enter a short description in the
space provided.
Line 9a(10) Participant-Directed Defined
Contribution Pension Plan. If you check
‘‘Yes’’ to identify that the plan is a
participant-directed defined contribution
plan, check the box for ERISA section 404(c)
plan if the plan, or any part of it, is intended
to meet the conditions of 29 CFR 2550.404c–
1.
Check the box for total participant-directed
account plan if participants have the
opportunity to direct the investment of all
the assets allocated to their individual
accounts, regardless of whether 29 CFR
2550.404c is intended to be met.
Check partial participant-directed account
if participants have the opportunity to direct
the investment of a portion of the assets
allocated to their individual accounts,
regardless of whether 29 CFR 2550.404c is
intended to be met. Do not check both ‘‘total’’
and ‘‘partial’’ participant-directed account.
Check the box for participant-directed
brokerage accounts (also referred to as ‘‘open
brokerage windows’’) if the plan provides
such accounts as an investment option under
the plan. If you check that the plan has
participant-directed brokerage accounts,
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enter the number of participants that
invested through such accounts during the
plan year.
Line 9a(11) Qualified Default Investment
Alternatives (QDIAs). Regardless of whether
the plan is total or partial participantdirected, if the plan uses default investment
alternatives that are intended to be QDIA(s)
for participants who fail to direct assets in
their account, also check the box to so
indicate. If the plan uses a QDIA for
participants who fail to direct assets in their
account, indicate the type of default
investment alternative: target date/life fund;
fixed income; money market or equivalent;
balanced fund; professionally managed
account; or other. If other, specify the type
of account. If you checked the box for
‘‘Other,’’ you may be using an investment
alternative that does not satisfy the QDIA
requirements in the Department of Labor’s
regulation at 29 CFR 2550.404c–5.
Line 9a(12) Eligible Combined Plan Under
Code section 414(x). If the plan is an eligible
combined plan under Code section 414(x),
check ‘‘Yes.’’
Note. In the case of an eligible combined
plan under Code section 414(x) and ERISA
section 210(e), you must answer all
applicable line items for both the defined
benefit pension features and the defined
contribution pension features of the plan.
Line 9a(13). Check this box if a rollover
from a plan was used to start up the business
(ROBS) sponsoring this plan.
Line 9a(14). If the plan is an employee
stock ownership plan (ESOP) or has ESOP
features, check all applicable boxes. You
must also attach a Schedule E if the plan is
an ESOP or has ESOP features.
Line 9a(15) Other Pension Benefit
Features. Check all that apply.
Notes: (1) If a plan sponsor or an employer
adopted a pre-approved plan that includes a
master & prototype plan or a volume
submitter plan, enter the most recent
adoption date and the IRS favorable opinion
or advisory letter’s serial number. (2)
Sponsors of Puerto Rico plans, check the box
to indicate that the plan is not intended to
be qualified under Code sections 401, 403, or
408 only if:
1. only Puerto Rico residents participate;
2. the trust is exempt from income tax
under the laws of Puerto Rico, and
3. the plan administrator has not made the
election under ERISA section 1022(i)(2), and,
therefore, the plan is not intended to qualify
under section 401(a) of the Internal Revenue
Code (U.S).
Line 9b Welfare Benefit Plan
Characteristics. Plans that provide welfare
benefits must answer all applicable questions
in Line 9b. Plans that provide only pension
benefits skip to question 10.
Line 9b(1) Group Health Benefits. If the
plan provides health, dental, or vision
coverage, answer ‘‘Yes’’ and check all that
apply. If you answered ‘‘Yes’’ here, you must
attach Schedule J—Group Health Plan
Information. Plans that offer excepted
benefits that consist of limited scope dental
or vision benefits must still file a Schedule
J.
Line 9b(2) Disability. If the plan provides
disability benefits, answer ‘‘Yes’’ and check
all that apply.
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Line 9b(3) Other Welfare Benefits. If the
plan provides welfare benefits other than
group health or disability, answer ‘‘Yes’’ and
check all that apply. If the type of benefits
is not listed, check ‘‘other’’ and enter a
description.
Line 9b(4) Welfare Plans That Do Not
Provide Health Benefits That Relied on or
Will Be Relying on 29 CFR 2520.104.20.
Welfare plans that provide health benefits
must file the Form 5500 annually and cannot
rely on the exemption from reporting under
29 CFR 2520.104–20.
Line 10 Funding and Benefit
Arrangements. Check all boxes that apply to
indicate the funding and benefit
arrangements used during the plan year. The
‘‘funding arrangement’’ is the method for the
receipt, holding, investment, and transmittal
of plan assets prior to the time the plan
actually provides benefits. The ‘‘benefit
arrangement’’ is the method by which the
plan provides benefits to participants. For
purposes of Line 10:
‘‘Insurance’’ means the plan has an
account, contract, or policy with an
insurance company, insurance service, or
other similar organization, or through a
managed care organization or a health
maintenance organization during the plan or
DFE year. (This includes investments with
insurance companies such as guaranteed
investment contracts (GICs).) An annuity
account arrangement under Code section
403(b)(1) that is required to complete the
Form 5500 should check ‘‘insurance’’ for
both the plan funding arrangement and plan
benefit arrangement. Do not check
‘‘insurance’’ if the sole function of the
insurance company was to provide
administrative services.
‘‘Code section 412(e)(3) insurance
contracts’’ are contracts that provide
retirement benefits under a plan that are
guaranteed by an insurance carrier. In
general, such contracts must provide for level
premium payments over the individual’s
period of participation in the plan (to
retirement age), premiums must be timely
paid as currently required under the contract,
no rights under the contract may be subject
to a security interest, and no policy loans
may be outstanding. If a plan is funded
exclusively by the purchase of such
contracts, the otherwise applicable minimum
funding requirements of section 412 of the
Code and section 302 of ERISA do not apply
for the year and neither the Schedule MB nor
the Schedule SB is required to be filed.
‘‘Trust’’ includes any fund or account that
receives, holds, transmits, or invests plan
assets other than an account or policy of an
insurance company. A custodial account
arrangement under Code section 403(b)(7)
that is required to complete the Form 5500
should check ‘‘trust’’ for both the plan
funding arrangement and the plan benefit
arrangement.
‘‘General assets of the sponsor’’ means
either the plan had no assets or some assets
were commingled with the general assets of
the plan sponsor prior to the time the plan
actually provided the benefits promised.
Example. If the plan holds all its assets
invested in registered investment companies
and other non-insurance company
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investments until it purchases annuities to
pay out the benefits promised under the plan,
box 10a(3) should be checked as the funding
arrangement and box 10b(1) should be
checked as the benefit arrangement.
Note. An employee benefit plan that
checks boxes on Lines 10a(1), 10a(2), 10b(1),
and/or 10b(2) must attach Schedule A (Form
5500), Insurance Information, to provide
information concerning each contract year
ending with or within the plan year. See the
instructions to the Schedule A and enter the
number of Schedules A on Line 11b(2), if
applicable.JY2.
Line 11. Check the boxes on Line 11 to
indicate the schedules being filed and, where
applicable, count the schedules and enter the
number of attached schedules in the space
provided.
20XX Instructions for Schedule A (Form
5500) Insurance Information
General Instructions
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Who Must File
Schedule A (Form 5500) must be attached
to the Form 5500 filed for every defined
benefit pension plan, defined contribution
pension plan, and welfare benefit plan
required to file a Form 5500 Annual Return/
Report if any benefits under the plan are
provided by an insurance company,
insurance service, or other similar
organization, or through a managed care
organization or a health maintenance
organization. This includes investment and
annuity contracts with insurance companies
such as guaranteed investment contracts
(GICs) and variable annuities. In addition,
Schedules A must be attached to a Form 5500
filed for GIAs, master trusts, and 103–12 IEs
for each insurance or annuity contract held
in the master trust, or by the 103–12 IE or
the GIA. Plans with fewer than 100
participants that provide group health
benefits that are fully insured do not
complete Schedule A.
TIP. If Form 5500 Line 10a(1), 10a(2),
10b(1), or 10b(2) is checked, indicating that
either the plan funding arrangement or plan
benefit arrangement includes an account,
policy, or contract with an insurance
company (or similar organization), at least
one Schedule A would be required to be
attached to the Form 5500 filed for a pension
or welfare plan to provide information
concerning the contract year ending with or
within the plan year.
Do not file Schedule A for a contract that
is an Administrative Services Only (ASO)
contract, a fidelity bond or policy, or a
fiduciary liability insurance policy. Also, if a
Schedule A for a contract or policy is filed
as part of a Form 5500 for a master trust or
103–12 IE that holds the contract, do not
include a Schedule A for the contract or
policy on the Form 5500s filed for the plans
participating in the master trust or 103–12 IE.
Schedule A is not required to be attached by
a small, fully insured group health plan.
Check the Schedule A box on the Form
5500 (Part II, Line 11b(2)), and enter the
number attached in the space provided if one
or more Schedules A are attached to the
Form 5500.
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Specific Instructions
Information entered on Schedule A should
pertain to the insurance contract or policy
year ending with or within the plan year (for
reporting purposes, a year cannot exceed 12
months).
Example. If an insurance contract year
begins on July 1 and ends on June 30, and
the plan year begins on January 1 and ends
on December 31, the information on the
Schedule A attached to the 20XX Form 5500
should be for the insurance contract year
ending on June 30, 20XX.
Exception. If the insurance company
maintains records on the basis of a plan year
rather than a policy or contract year, the
information entered on Schedule A may
pertain to the plan year instead of the policy
or contract year.
Include only the contracts issued to or held
by the plan, GIA, master trust, or 103–12 IE
for which the Form 5500 is being filed.
Lines A, B, C, and D. This information
must be the same as reported in Part II of the
Form 5500 to which this Schedule A is
attached.
Do not use a social security number in lieu
of an EIN. The Schedule A and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule A or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under General
Instructions to Form 5500. The EBSA does
not issue EINs.
Part I—Information Concerning Insurance
Contract Coverage, Fees, and Commissions
Line 1a. Enter the name of the insurance
carrier. If you are reporting the same
insurance carrier on multiple Schedules A to
report different contracts, use the same name
on each Schedule A.
Line 1b. Enter the EIN of the insurance
carrier. If you are reporting the same
insurance carrier on multiple Schedules A to
report different contracts, use the same EIN
on each Schedule A.
Line 1c. Enter the five-digit ‘‘Company
Code’’ number assigned by the National
Association of Insurance Commissioners
(NAIC) to the insurance company. Do not use
the NAIC ‘‘group code’’ or a state-issued
identity number for the insurance company.
Line 1d. If individual policies with the
same carrier are grouped as a unit for
purposes of this report, and the group does
not have one identification number, you may
use the contract or identification number of
one of the individual contracts, provided this
number is used consistently to report these
contracts as a group and the plan
administrator maintains the records
necessary to disclose all the individual
contract numbers in the group upon request.
Use separate Schedules A to report
individual contracts that cannot be grouped
as a unit.
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47613
Line 1e. For contracts or policies providing
group health benefits, enter the health plan
identifier (HPID) required under the Health
Insurance Portability and Accountability Act
(HIPAA).
Line 1f. Enter the beginning and ending
dates of the policy year for the contract
identified in elements (1) and (2). Leave 1(f)
blank if separate contracts covering
individual employees are grouped.
Part II—Investment and Annuity Contract
Information
Line 3. Enter the current value of the plan’s
interest at year end in the contract reported
on Line 6 e.g., deposit administration (DA),
immediate participation guarantee (IPG),
guaranteed investment contracts (GIC), or
variable annuity contract.
Exception. Contracts reported on Line 6
need not be included on Line 3 if: (1) the
Schedule A is filed for a defined benefit
pension plan and the contract was entered
into before March 20, 1992; or (2) the
Schedule A is filed for a defined contribution
pension plan and the contract is a fully
benefit-responsive contract, i.e., it provides a
liquidity guarantee by a financially
responsible third party of principal and
previously accrued interest for liquidations,
transfers, loans, or hardship withdrawals
initiated by plan participants exercising their
rights to withdraw, borrow, or transfer funds
under the terms of a defined contribution
pension plan that does not include
substantial restrictions to participants’ access
to plan funds.
Important Reminder. Plans may treat
multiple individual annuity contracts,
including Code section 403(b)(1) annuity
contracts, issued by the same insurance
company as a single group contract for
reporting purposes on Schedule A.
Line 4. Enter the current value of the plan’s
interest under this contract in separate
accounts at contract year end. Check whether
the separate account is a pooled separate
account (PSA), other separate account, or
variable annuity. If other, enter a description
of the separate account.
Line 5 Contracts with Allocated Funds
Line 5a. Enter a description of the basis of
the rates.
Line 5b. Enter the amount of premiums
paid to the carrier.
Line 5c. Enter the amount, if any, of
premiums due but unpaid at the end of year.
Line 5d. If the carrier, service, or other
organization incurred any specific costs in
connection with the acquisition or retention
of the contract or policy, enter the amount
and specify the nature of the costs.
Line 5e. Check the appropriate box to
indicate whether this is for individual
policies, a group deferred annuity or other.
If you check ‘‘Other,’’ you must enter a
description of the type of contract.
Line 5f. If the contract being reported here
was purchased, in whole or in part, to
distribute benefits from a terminating plan,
you must check the box in Line 5f.
Line 6
Contracts with Unallocated Funds
Lines 6a–f. Report contracts with
unallocated funds. Do not include portions of
these contracts maintained in separate
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accounts. Show deposit fund amounts rather
than experience credit records when both are
maintained.
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Part III—Welfare Benefit Contract
Information
Line 7. Since plan coverage may fluctuate
during the year, the administrator should
estimate the number of persons that were
covered for each benefit by the contract at the
end of the policy or contract year.
Persons, for purposes of this line, includes
participants, beneficiaries, and dependents of
participants that are covered under the
insurance contract (such as with family
coverage). Where contracts covering
individual employees are grouped, compute
entries as of the end of the plan year.
Line 8a. Report a stop-loss insurance
policy that is an asset of the plan on
Schedule A.
Note. Employers sponsoring welfare plans
may purchase a stop-loss insurance policy
with the employer as the insured to help the
employer manage its risk associated with its
liabilities under the plan. These employer
contracts with premiums paid exclusively
out of the employer’s general assets without
any employee contributions generally are not
plan assets and are not reportable on
Schedule A, but may be required to be
reported on Schedule J.
Line 11. Indicate whether there were any
premium delinquencies during the reporting
year. You must answer ‘‘Yes’’ or ‘‘No.’’ Do
not leave Line 11a blank. If you answered
‘‘Yes,’’ you must indicate both the number of
times delinquent for premiums due but
unpaid during the year, and for each
delinquency, the number of days delinquent.
If you answered ‘‘no’’ to line 11a, check ‘‘N/
A.’’ If any premium payments that were not
made within the time required by the
insurance carrier that resulted in a lapse of
insurance coverage, you must answer ‘‘Yes’’
to Line 11a even if coverage was retroactively
reinstated.
Part IV—Fee and Commission Information
Lines 12 and 13. Report on Line 12 the
total of all insurance fees and commissions
directly or indirectly attributable to the
contract or policy placed with or retained by
the plan.
Totals. Enter on Line 12 the total of all
such commissions and fees paid to agents,
brokers, and other persons listed on Line 13.
Complete a separate Line 13 item (elements
(a) through (f)) for each person listed.
For purposes of Lines 12 and 13,
commissions and fees include sales and base
commissions and all other monetary and
non-monetary forms of compensation where
the broker’s, agent’s, or other person’s
eligibility for the payment or the amount of
the payment is based, in whole or in part, on
the value (e.g., policy amounts, premiums) of
contracts or policies (or classes thereof)
placed with or retained by an ERISA plan,
including, for example, persistency and
profitability bonuses. The amount (or pro rata
share of the total) of such commissions or
fees attributable to the contract or policy
placed with or retained by the plan must be
reported in Lines 12a and b and in Lines 13c
and d, as appropriate.
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Insurers must provide plan administrators
with an allocation of commissions and fees
attributable to each contract. Any reasonable
method of allocating commissions and fees to
policies or contracts is acceptable, provided
the method is disclosed to the plan
administrator. A reasonable allocation
method could, in the Department of Labor’s
view, allocate fees and commissions to a
Schedule A based on a calendar year
calculation even if the plan year or policy
year was not a calendar year. For additional
information on these Schedule A reporting
requirements, see ERISA Advisory Opinion
2005–02A, available on the Internet at
www.dol.gov/ebsa.
Where benefits under a plan are purchased
from and guaranteed by an insurance
company, insurance service, or other similar
organization, and the contract or policy is
reported on a Schedule A, payments of
reasonable monetary compensation by the
insurer out of its general assets to affiliates
or third parties for performing administrative
activities necessary for the insurer to fulfill
its contractual obligation to provide benefits,
where there is no direct or indirect charge to
the plan for the administrative services other
than the insurance premium, then the
payments for administrative services by the
insurer to the affiliates or third parties do not
need to be reported on lines 12 and 13 of
Schedule A. This would include
compensation for services such as
recordkeeping and claims processing services
provided by a third party pursuant to a
contract with the insurer to provide those
services but would not include compensation
provided by the insurer incidental to the sale
or renewal of a policy, such as finder’s fees,
insurance brokerage commissions and fees,
or similar fees.
Schedule A reporting also is not required
for compensation paid by the insurer to a
‘‘general agent’’ or ‘‘manager’’ for that general
agent’s or manager’s management of an
agency or performance of administrative
functions for the insurer. For this purpose,
(1) a ‘‘general agent’’ or ‘‘manager’’ does not
include brokers representing insureds, and
(2) payments would not be treated as paid for
managing an agency or performance of
administrative functions where the
recipient’s eligibility for the payment or the
amount of the payment is dependent or based
on the value (e.g., policy amounts,
premiums) of contracts or policies (or classes
thereof) placed with or retained by ERISA
plan(s).
Schedule A reporting is not required for
occasional non-monetary gifts or meals of
insubstantial value that are tax deductible for
federal income tax purposes by the person
providing the gift or meal and would not be
taxable income to the recipient. For this
exemption to be available, the gift or gratuity
must be both occasional and insubstantial.
For this exemption to apply, the gift must be
valued at less than $50, the aggregate value
of gifts from one source in a calendar year
must be less than $250, but gifts with a value
of less than $10 do not need to be counted
toward the $250 annual limit. If the $250
aggregate value limit is exceeded, then the
aggregate value of all the gifts will be
reportable. For this purpose, non-monetary
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gifts of less than $10 also do not need to be
included in calculating the aggregate value of
all gifts required to be reported if the $250
limit is exceeded.
Gifts from multiple employees of one
service provider should be treated as
originating from a single source when
calculating whether the $50 or $250
thresholds apply. On the other hand, in
applying the threshold to an occasional gift
received from one source by multiple
employees of a single service provider, the
amount received by each employee should be
separately determined in applying the $50
and $250 thresholds. For example, if 11
employees of a broker attend a business
conference put on by an insurer designed to
educate and explain the insurer’s products
for employee benefit plans, and the insurer
provides, at no cost to the attendees,
refreshments valued at $25 per individual,
the gratuities would not be reportable on
lines 12 and 13 of the Schedule A even
though the total cost of the refreshments for
all the employees would be $275.
These thresholds are for purposes of
Schedule A reporting. Filers are cautioned
that the payment or receipt of gifts and
gratuities of any amount by plan fiduciaries
may violate ERISA and give rise to civil
liabilities and criminal penalties.
Line 13. Identify agents, brokers, and other
persons individually in descending order of
the amount paid. Complete as many entries
as necessary to report all required
information. Complete 13a-f for each person
as specified below.
13a. Enter the name and address of the
agents, brokers, or other persons to whom
commissions or fees were paid.
13b. Enter any relationship of the person
identified in Line 13a to the plan sponsor, to
the participating employer or employee
organization, or to any person known to be
a party-in-interest, for example, employer,
plan sponsor, employee of employer, vicepresident of employer, union officer, affiliate
of plan recordkeeper/fiduciary/investment
manager, etc.
13c. Report all sales and base commissions
here. For purposes of this element, sales and/
or base commissions are monetary amounts
paid by an insurer that are charged directly
to the contract or policy and that are paid to
a licensed agent or broker for the sale or
placement of the contract or policy. All other
payments should be reported in Line 13d as
fees.
13d. Fees to be reported here represent
payments by an insurer attributable directly
or indirectly to a contract or policy to agents,
brokers, and other persons for items other
than sales and/or base commissions (e.g.,
service fees, consulting fees, finders’ fees,
profitability and persistency bonuses,
awards, prizes, and non-monetary forms of
compensation). Fees paid to persons other
than agents and brokers should be reported
here, not in Parts II and III on Schedule A
as acquisition costs, administrative charges,
etc.
13e. Enter the purpose(s) for which fees
were paid.
13f. Enter the most appropriate
organization code for the broker, agent, or
other person entered in Line 13a.
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Code Type of Organization
1 Banking, Savings & Loan Association,
Credit Union, or other similar financial
institution
2 Trust Company
3 Insurance Agent or Broker
4 Agent or Broker other than insurance
5 Third party administrator
6 Investment Company/Mutual Fund
7 Investment Manager/Adviser
8 Labor Union
9 Foreign entity (e.g., an agent or broker,
bank, insurance company, etc., not operating
within the jurisdictional boundaries of the
United States)
0 Other
For plans, GIAs, master trusts, and 103–12
IEs required to file Part I of Schedule C,
commissions and fees listed on the Schedule
A are not required to be reported again on
Schedule C. The amount of the compensation
that must be reported on Schedule A must,
however, be taken into account in
determining whether the agent’s, broker’s, or
other person’s direct or indirect
compensation in relation to the plan or DFE
is $1,000 or more indirect compensation or
combined direct and indirect compensation
or $5,000 or more in direct compensation
and, thus, requiring the compensation not
listed on the Schedule A to be reported on
the Schedule C. See FAQs about the
Schedule C available on the EBSA Web site
at www.dol.gov/ebsa/faqs.
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Part V—Provision of Information
The insurance company, insurance service,
or other similar organization is required
under ERISA section 103(a)(2) to provide the
plan administrator with the information
needed to complete this return/report. If you
do not receive this information in a timely
manner, contact the insurance company,
insurance service, or other similar
organization.
Line 14. If information is missing on
Schedule A due to a refusal by the insurance
company, insurance service, or other similar
organization to provide information, check
‘‘Yes’’ on Line 14. If you answer ‘‘Yes’’ to
Line 14, you must complete Line 14b. If you
received all the information necessary to
receive the Schedule A, check ‘‘No’’ and
leave Line 14b blank.
TIP. The insurance company, insurance
service, or other similar organization is
statutorily required to provide you with all of
the information necessary to complete the
Schedule A, but need not provide the
information on a Schedule A itself.
On Line 14b, check the box if the
information not provided was ‘‘fee and
commission information.’’ For all other types
of information, check ‘‘Other,’’ and enter a
description of the information not provided.
20XX Instructions for Schedule C (Form
5500) (Service Provider Information)
General Instructions
Who Must File
Schedule C (Form 5500) must be attached
to a Form 5500 filed for pension or welfare
benefit plans, master trusts, 103–12 IEs, or
GIAs required to file the Form 5500 to report
certain information concerning service
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providers, except as provided below.
Remember to check the Schedule C box on
the Form 5500 (Part II, Line 11b(3)) and enter
the number attached in the space provided to
indicate the number of Schedules C attached
to the Form 5500.
All plans required to complete a Schedule
C must complete a separate Schedule C, in
accordance with the instructions, to report
the information required for: (1) Each
‘‘covered service provider,’’ as defined
below, who received $1,000 or more in total
direct and indirect compensation (i.e., money
or anything else of monetary value) in
connection with services rendered to the
plan or the person’s position with the plan
during the plan year, including payments
from participants’ accounts and (2) other
persons who received $5,000 or more in
direct compensation in connection with
services rendered to the plan or the person’s
position with the plan during the plan year,
including payments from participants’
accounts.
A ‘‘covered service provider’’ for Schedule
C reporting has the same meaning as
‘‘covered service provider’’ in 29 CFR
2550.408b-2(c)(1)(iii) and includes: (1)
Persons who provide services as an ERISA
fiduciary directly to the plan; (2) persons
who provide services as an ERISA fiduciary
to an investment contract, product, or entity
that holds plan assets (as determined
pursuant to section 3(42) and 401 of the Act
and 29 CFR 2510.3–101) and in which the
plan has a direct equity investment; (3)
persons who provide services to the plan as
investment advisers registered under Federal
or State law; (4) persons who provide
recordkeeping or brokerage services to a
participant-directed individual account plan
in connection with a designated investment
alternative (DIA) (e.g., a ‘‘platform
provider’’); and (5) persons who provide of
one or more of the following services to the
plan who received indirect compensation
from parties other than from the plan or plan
sponsor in connection with such services:
Accounting, auditing, actuarial, banking,
consulting, custodial, insurance, investment
advisory, legal, recordkeeping, securities or
other investment brokerage, third party
administration, or valuation services.
Welfare plans are not subject to the service
provider disclosure regulation at 29 CFR
2550.408b-2, but all plans, including welfare
plans, that are required to file the Schedule
C should use the provisions and definitions
29 CFR 2550.408b-2 as a guide in completing
the Schedule C.
Exceptions.
1. Employees of the plan whose only
compensation in relation to the plan was less
than $25,000 for the plan year. With regard
to reporting plan employees’ salaries, total
salaries (before taxes and other deductions)
paid to employees should be used to
determine whether an employee has received
less than $25,000 during the plan year. Do
not include the employer portion of FICA
and FUTA taxes as part of the total
compensation of an employee. Include
salary, bonuses, overtime. Also include
indirect compensation from persons other
than the plan received in connection with the
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47615
person’s position with the plan or services
provided to the plan. Include expenses for
travel, educational, conference, meals, etc.,
whether paid directly by the plan or
reimbursed to the employee, only if such
payments would be reportable as taxable
income to the employee.
2. Employees of the plan sponsor or other
business entity where the plan sponsor or
business entity is reported on the Schedule
C as a service provider, provided the
employee did not separately receive
reportable direct or indirect compensation in
relation to the plan;
3. Persons whose only compensation in
relation to the plan consists of insurance fees
and commissions listed in a Schedule A filed
for the plan;
4. Payments made directly by the plan
sponsor that are not reimbursed by the plan.
In the case of a multiemployer or multipleemployer plan, where the ‘‘plan sponsor’’
would be the joint board of trustees for the
plan, payments by contributing employers,
directly or through an employer association,
or by participating employee organizations,
should be treated the same as payments by
a plan sponsor; and
5. Welfare plans, including group health
plans, that are required to file the Form 5500
and that do not have to complete the
Schedule H because they meet the conditions
of the DOL’s regulation at 29 CFR 2520.104–
44 or Technical Release 92–01, also do not
have to file the Schedule C.
Part II of the Schedule C must be
completed to report service providers who
fail or refuse to provide information
necessary to complete Part I of this Schedule.
For plans, GIAs, master trusts, and 103–12
IEs required to file Part I of Schedule C,
commissions and fees listed on the Schedule
A are not required to be reported again on
Schedule C. The amount of the compensation
that must be reported on Schedule A must,
however, be taken into account in
determining whether the service provider’s
direct or indirect compensation in relation to
the plan or DFE meets the Schedule C
reporting threshold, thus, requiring the
compensation not listed on the Schedule A
to be reported on the Schedule C.
Lines A, B, C, and D. This information
must be the same as reported in Part II of the
Form 5500 to which this Schedule C is
attached.
Do not use a social security number in Line
D in lieu of an EIN. The Schedule C and its
attachments are open to public inspection,
and the contents are public information
subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule C or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under General
Instructions to Form 5500. The EBSA does
not issue EINs.
Do not list the PBGC or the IRS on
Schedule C as service providers.
Either the cash or accrual basis may be
used for the recognition of transactions
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reported on the Schedule C as long as the
filer uses one method consistently. The basis
used by various service providers may be
different from that of the filing plan or DFE,
as long as each service provider is also using
one method consistently from year to year
and providing the information to the plan
consistently.
If service provider compensation is
reported on a Schedule C filed as a part of
a Form 5500 Annual Return/Report filed for
a master trust or a 103–12 IE, do not report
the same compensation again on the
Schedule C filed for the plans that participate
in the master trust or 103–12 IE. If a service
provider paid or retained by a master trust
performs services only for certain of the
participating plans, the service provider must
be reported on the Schedule C(s) for the
plan(s) for which the services were
performed; only compensation received in
connection with services provided to all
plans participating in the master trust should
be reported at the master trust level.
Schedule C Reportable Compensation
For Schedule C purposes, reportable
compensation includes money and any other
thing of value (for example, gifts, awards,
trips) received by a person, directly or
indirectly, from the plan (including fees
charged as a percentage of assets and
deducted from investment returns and
payments from parties other than the plan) in
connection with services rendered to the
plan or the person’s position with the plan.
Amounts are considered to have been
received in connection with services
rendered to the plan if the person’s eligibility
for a payment is based, in whole or in part,
on services that were rendered to the plan or
on a transaction or series of transactions with
the plan. This includes any compensation
that the covered service provider, an affiliate,
or a subcontractor received in connection
with termination of the contract or
arrangement. Reportable compensation
would not include amounts that would have
been received had the service not been
rendered or the transaction had not taken
place and that cannot be reasonably allocated
to the services performed or transaction(s)
with the plan. The term ‘‘person’’ for this
purpose includes individuals, trades and
businesses (whether incorporated or
unincorporated). See ERISA section 3(9).
Since, in most cases, the ‘‘spread’’ earned
by a broker-dealer in a principal transaction
would not be commission compensation paid
by the covered plan for ‘‘services,’’ but
instead would be considered ‘‘profit’’ for a
non-service transaction, such as a purchase
or sale of securities (i.e., where the brokerdealer acts as principal, not as an agent), the
‘‘spread’’ received would not be
‘‘compensation’’ (direct or indirect) for
Schedule C purposes. For this purpose, the
Department will rely upon the definition of
the term ‘‘commission’’ used by the SEC
under Section 28(e) of the Securities
Exchange Act of 1934, as amended, per SEC
Release No. 34–45194.
Similarly, the broker-dealer’s sale of IPO
securities to the plan does not occur ‘‘in
connection with’’ services to the plan, but
occurs as a result of a separate, non-service
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transaction where the broker-dealer is acting
as a principal (e.g., a dealer who buys and
sells securities from its inventory, as an
underwriter or otherwise, and receives a
‘‘mark-up’’ or ‘‘spread’’ on the price vis-a-vis
its own separate purchase or sale activities as
a dealer). Thus, the broker-dealer is not a
service provider to the plan in its role as a
securities dealer, and its affiliates who may
receive fees for underwriting and/or
managing an underwriting syndicate for an
IPO would not be receiving such fees ‘‘in
connection with’’ services provided to the
covered plan.
The investment of plan assets and payment
of premiums for insurance contracts are not
in and of themselves payments for services
rendered to the plan for purposes of
Schedule C reporting and the investment and
payment of premiums themselves are not
reportable compensation for purposes of Part
I of the Schedule C.
Direct Compensation—Payments
Received from the Plan. Direct
compensation for Schedule C purposes has
the same meaning as ‘‘direct compensation’’
in 29 CFR 2550.408b–2(c)(1)(viii)(B)(1), and
includes payments received directly from the
plan by a service provider in connection with
services rendered to the plan, or a covered
service provider, its affiliate or subcontractor
in connection with the services rendered to
the plan. Direct compensation includes, for
example, direct payments by the plan out of
a plan account, charges to plan forfeiture
accounts and plan fee recapture trust
accounts, charges to a plan’s trust account
before allocations are made to individual
participant accounts, and direct charges to
plan participant individual accounts. For
example, the plan sponsor may pay for
certain plan administrative services by
writing a check from the plan account.
Alternatively, a covered service provider may
be paid a fixed per capita fee from
participants’ accounts in the covered plan
when participants take out plan loans.
Payments made by the plan sponsor, which
are not reimbursed by the plan, are not
subject to Schedule C reporting requirements
even if the sponsor is paying for services
rendered to the plan. Payments by made by
the plan sponsor that are reimbursed by the
plan are treated as direct payments by the
plan.
Indirect Compensation—Amounts
Received from Parties Other Than the
Plan or Plan Sponsor. Indirect
compensation for Schedule C purposes has
the same meaning as ‘‘indirect
compensation’’ in 29 CFR 2550.408b–
2(c)(1)(viii)(B)(2), and includes compensation
received by the covered service provider, an
affiliate or subcontractor in connection with
the services rendered to the plan from any
source other than directly from the plan, plan
sponsor, by an affiliate or subcontractor from
the covered service provider, or by the
covered service provider from an affiliate.
Compensation received from a subcontractor
is indirect compensation unless it is received
in connection with services performed under
the subcontractor’s contract or arrangement
with the covered service provider or an
affiliate for performing one or more services
provided for by the contract or arrangement
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with the plan. Indirect compensation
includes amounts received by the covered
service provider, affiliate or subcontractor
that are charged against the investments of
the plan (e.g., mutual funds or other
investment funds) and reflected in the plan’s
return on investment.
For example, indirect compensation would
include payments that an independent
recordkeeper receives from investment
issuers to compensate the recordkeeper for
administrative services it performs for the
investment issuer when those payments are
received in connection with investments that
such plans make in the issuers’ products. If
a covered service provider, affiliate or
subcontractor receives revenue sharing
payments from an investment fund (e.g.,
mutual fund), investment provider or other
plan service provider or person in connection
with the services the covered service
provider, affiliate or subcontractor rendered
to a covered plan, that compensation would
be ‘‘indirect compensation.’’ Amounts
charged against the fund for other ordinary
operating expenses of the fund, such as
attorneys’ fees, accountants’ fees, printers’
fees, are not reportable indirect
compensation received by the attorneys,
accountants, or printers for Schedule C
purposes. Also, brokerage costs associated
with a broker-dealer effecting securities
transactions within the portfolio of a mutual
fund or for the portfolio of an investment
fund that holds ‘‘plan assets’’ for ERISA
purposes are not reportable compensation
paid to the broker as a plan service provider
for Schedule C purposes.
If a service provider charges the plan a fee
or commission, but agrees to offset the fee or
commission with any revenue received from
a party other than the plan or plan sponsor,
for example, as part of a commission
recapture or other offset arrangement, only
the amount paid directly by the plan after
any revenue sharing offset should be entered
as direct compensation in Line 2. If the
amount deposited into the plan’s trust
account by the record keeper is net of the
record keeper’s service fees, however, the
amount the record keeper retains would be
reportable indirect compensation for
Schedule C purposes. Amounts paid to
persons out of the plan’s ERISA fee recapture
trust account for services rendered to the
plan are considered direct compensation to
the receiving service provider reportable in
Line 1g. If the record keeper retains the
revenue sharing income but reflects some or
all of it on the record keeper’s accounts as
a credit to the plan (as opposed to depositing
in the plan’s trust account), payments by the
record keeper to itself or other persons for
rendering services to the plan that reduce the
plan’s credit balance would be reportable
indirect compensation to the persons
receiving the payments reportable in Line 3.
Compensation paid among the covered
service provider, an affiliate, or a
subcontractor, in connection with the
services provided to the plan is not
reportable indirect compensation. Rather,
those payments may be required to be
reported as Related Party Compensation on
Line 4.
Special rules for non-monetary
compensation of insubstantial value,
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guaranteed benefit insurance policies,
bundled service arrangements, and
allocating compensation among multiple
plans:
Excludable Non-Monetary
Compensation: You may exclude nonmonetary compensation of insubstantial
value (such as gifts or meals of insubstantial
value) that is tax deductible for federal
income tax purposes by the person providing
the gift or meal and would not be taxable
income to the recipient. The gift or gratuity
must be valued at less than $50, and the
aggregate value of gifts from one source in a
calendar year must be less than $250, but
gifts with a value of less than $10 do not
need to be counted toward the $250 limit. If
the $250 aggregate value limit is exceeded,
then the value of all the gifts over $10 will
be reportable. Gifts received by one person
from multiple employees of one entity must
be treated as originating from a single source
when calculating whether the $50 or $250
threshold applies. On the other hand, gifts
received from one person by multiple
employees of one entity can be treated as
separate compensation when calculating the
$50 and $250 thresholds.
These thresholds are for purposes of
Schedule C reporting only. Filers are
cautioned that gifts and gratuities of any
amount paid to or received by plan
fiduciaries may violate ERISA and give rise
to civil liabilities and criminal penalties.
Fully Insured Group Health and
Similarly Fully Insured Benefits: Where
benefits under a plan are purchased from and
guaranteed by an insurance company,
insurance service, or other similar
organization, and the contract or policy is
reported on a Schedule A, payments of
reasonable monetary compensation by the
insurer out of its general assets to persons for
performing administrative activities
necessary for the insurer to fulfill its
contractual obligation to provide benefits,
where there is no direct or indirect charge to
the plan for the administrative services other
than the insurance premium, would not be
treated as indirect compensation for services
provided to the plan for Schedule C reporting
purposes. This would include compensation
for services such as recordkeeping and claims
processing provided by a third party
pursuant to a contract with the insurer to
provide those services, but would not
include compensation provided by the
insurer incidental to the sale or renewal of
a policy, such as finder’s fees, insurance
brokerage commissions and fees, or similar
fees. Insurance investment contracts are not
eligible for this exception.
[CAUTION] Allocating Compensation
Among Multiple Plans: Where reportable
compensation is received by a person in
connection with several plans or DFEs, any
reasonable method of allocating the
compensation among the plans or DFEs may
be used provided that the allocation method
is disclosed to the plan administrator. If a
such a reasonable method of allocation is
used in determining the compensation
attributable to the plan, then in calculating
the $1,000 and $5,000 thresholds for
purposes of determining whether a person
must be identified in Part I, the amount of
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compensation received by the person that is
determined to be attributable to the plan or
DFE filing the Form 5500 should be used, not
the aggregate amount of compensation
received in connection with all the plans or
DFEs.
Specific Instructions
Part I—Service Provider Information
Line 1a. As explained above, a separate
Schedule C must be filed, in accordance with
the instructions, to report the information for:
(1) Each covered service provider who
received $1,000 or more in total direct and
indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to the
plan or the person’s position with the plan
during the plan year, including payments
from participants’ accounts and (2) other
persons who received $5,000 or more in
direct compensation in connection with
services rendered to the plan or the person’s
position with the plan during the plan year,
including payments from participants’
accounts.
Enter in Line 1a the covered service
provider or other person’s name and
complete Lines 1a(1)–(6). If the service
provider identified is not an individual,
provide the name and address for an
individual or office at the service provider
that the plan could contact for information
about the service arrangement in Lines 1a(5)–
(6). If the name of an individual is entered
in Line 1a and the individual does not have
an EIN, enter the EIN of the individual’s
employer. If the person is self-employed and
does not have an EIN, you may enter the
person’s address and telephone number. Do
not use a social security number in lieu of
an EIN. The Schedule C and its attachments
are open to public inspection and are subject
to publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof on
this Schedule C or any of its attachments may
result in the rejection of the filing. Also enter
the service provider’s LEI, if available.
Line 1b. Check the appropriate box to
indicate the relationship of the service
provider identified in Line 1a to the plan.
Check Line 1b(7) ‘‘Other’’ and enter a
description, e.g., vice-president of employer,
union officer, affiliate of the plan sponsor,
recordkeeper, fiduciary, investment manager,
etc., if the service provider has a relationship
to the plan other than ‘‘service provider’’ that
is not one of relationships listed in Line
1b(1)–(6). If the service provider has no
relationship to the plan other than the service
provider relationship being reported on the
Schedule C, check the box in Line 1b(8) for
‘‘not applicable.’’
Line 1c. Types of Services. Check all the
appropriate box(es) to describe the types of
services provided. The ‘‘plan administrator’’
for purposes of Line 1c is the person who has
been designated as the administrator by the
terms of the instrument under which the plan
is operated; or if no plan administrator is
designated, the plan sponsor. See ERISA
section 3(16). The plan administrator should
be identified in the plan’s summary plan
description. For most employee benefit
plans, the plan administrator is the employer,
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47617
a committee of employees, a company
executive, or in some cases a person or
organization hired to be the plan
administration. The plan’s ‘‘third party
administrator’’ often is not the same as the
‘‘plan administrator’’ for this purpose.
Line 1d. Check the box if the person
identified in Line 1a was a fiduciary within
the meaning of section 3(21) of ERISA during
the plan year. Every employee benefit plan
must be established and maintained pursuant
to a written instrument. The instrument must
provide for one or more ‘‘named fiduciaries’’
who jointly or severally have authority to
control and management the operation and
administration of the plan. Under ERISA
section 402(a), ‘‘the term named fiduciary
means a fiduciary who is named in the plan
instrument, or who, under a procedure
specified in the plan, is identified as a
fiduciary (a) by a person who is an employer
or employee organization with respect to the
plan or (b) by such an employer and such
employee organization acting jointly.’’ Other
persons may be functional fiduciaries
because they exercise control over plan
assets, have discretionary authority for
administration or management of the plan, or
provide investment advice for a fee.
Line 1e. Check ‘‘Yes’’ if the person
identified in Line 1a also was identified on
Schedule A as having received insurance fees
and commissions.
Line 1f. Check ‘‘Yes,’’ if the arrangement
with the service provider included the use of
an ERISA recapture, ERISA budget or similar
account during the plan year.
Line 1g. Check ‘‘Yes’’ in Line 1g(1) if the
arrangement with the service provider
identified in Line 1a included recordkeeping
services to a pension plan without explicit
compensation for some or all of such
recordkeeping services or with compensation
for such recordkeeping offset or rebated in
whole or in part based on other
compensation received by the service
provider, or an affiliate or subcontractor. If
‘‘Yes,’’ use the same methodology to develop
a dollar estimate of the cost to the plan of
recordkeeping services provided in the
service provider’s 408–b(2) disclosure, enter
in Line 1g(2), as a dollar figure, the amount
of compensation the service provider
received for recordkeeping services.
Line 2—Direct Compensation. Report the
amount of direct compensation received by
the person or covered service provider
(including its affiliate or subcontractor)
identified in Line 1a.
TIP. The total reported in Line 2 generally
would be those payments that would be
includable as administrative expenses on
Schedule H, Line 2i. Do not leave Line 2
blank. If no direct compensation was
received, enter ‘‘0’’.
Line 3—Indirect Compensation. Complete
Line 3 to report indirect compensation
received by the covered service provider,
affiliate or subcontractor from persons other
than the plan or plan sponsor, including
charges against the plan’s investments.
Note: You must separately report in Line
4 certain related party compensation paid
among the person identified in Line 1a and
the affiliate or subcontractor.
Line 3a. Enter the total amount of indirect
compensation plan from sources other than
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the plan or plan sponsor received by the
covered service provider, affiliate or
subcontractor in connection with services
provided to the plan, including charges
against the plan’s investments. This should
equal the total of the amounts or estimates
reported on the Line 3b(4) entries.
Line 3b. Complete as many entries (Lines
3b(1)–(6)) as necessary to identify all sources
of indirect compensation reported in Line 3a.
If the name of an individual is entered in
Line 3a and the individual does not have an
EIN, enter the EIN of the individual’s
employer. If the person is self-employed and
does not have an EIN, you may enter the
person’s address and telephone number. Do
not use a social security number in lieu of
an EIN. The Schedule C and its attachments
are open to public inspection and are subject
to publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof on
this Schedule C or any of its attachments may
result in the rejection of the filing. Also enter
the service provider’s LEI, if available.
Line 3b(4). Enter as a dollar figure the
amount or estimate of compensation received
from the source. If an estimate is reported,
you must complete Line 3b(6).
Line 3b(5). Types of Compensation. Check
all the appropriate box(es) to describe the
types of compensation received from the
source.
Line 4—Related Party Compensation. You
must report on Line 4 as related party
compensation any compensation that is paid
among the service provider, affiliates and
subcontractors in connection with the
services rendered to the plan if the amount
was set on a per transaction basis, (e.g.,
commissions, soft dollars, finder’s fees or
other similar incentive compensation based
on business placed or retained) or is charged
directly against the plan’s investment and
reflected in the net value of the investment
(e.g., Rule 12b–1 fees, distribution fees,
management fees shareholder servicing fees).
This does not include compensation received
by an employee from his or her employer on
account of work performed by the employee.
Other revenue sharing payments among the
covered service provider, affiliate or
subcontractor in connection with the services
rendered to the plan do not need to be
reported as related party compensation.
Part II—Service Providers Who Fail or
Refuse To Provide Information
Line 5. Check the box in Line 5a to identify
each covered service provider who you
believe failed or refused to provide any of the
information necessary to complete Part I of
this schedule. In Line 5b describe the
information that the service provider failed
or refused to provide.
Important Reminder. Before identifying a
service provider as a person who failed or
refused to provide information, you should
contact the service provider to request the
necessary information and tell them that you
will list them on the Schedule C as a service
provider who failed or refused to provide
information if they do not provide the
necessary information.
On Line 5b, include in the description of
the information that the service failed or
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refused to provide whether you are relying
on the exemption at 29 CFR 2550.408b–
2(c)(1)(ix) with respect to the failure of any
fiduciary or service provider to provide
information required to complete Part I of
Schedule C.
[CAUTION]. The failure of certain service
providers to provide information needed to
complete the annual return/report, including
Schedule C, may give rise to a prohibited
transaction under section 408(b)(2) of ERISA,
see 29 CFR 2550.408b–2(c)(1)(vi), that must
be reported on Schedule H, Line 4d and, as
applicable, attach a Schedule G.
20XX
Instructions for Schedule D
(Form 5500 DFE/Participating Plan
Information)
General Instructions
Who Must File
When the Form 5500 is filed for a Direct
Filing Entity (DFE) that is a master trust
(MT), 103–12 Investment Entity (103–12 IEs),
common/collective trust (CCT), pooled
separate account (PSA), or group insurance
arrangement (GIA) the Schedule D (Form
5500) is required to provide information
about plans participating in the DFE. A Form
5500 Annual Return/Report filed for a CCT,
PSA, MT, 103–12 IE, or GIA should be
identified as a ‘‘DFE’’ on Part I, Line A(5), of
the Form 5500 and the Schedule D box
should be checked on the Form 5500, Part II,
Line 11b(4). For more information, see
instructions for Direct Filing Entity (DFE)
Filing Requirements.
Specific Instructions
Lines A, B, C, and D. The information must
be the same as reported in Part II of the Form
5500 to which this Schedule D is attached.
Do not use a social security number in Line
D in lieu of an EIN. The Schedule D and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule D or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under General
Instructions to Form 5500. The EBSA does
not issue EINs.
Information on Participating Plans
Complete as many repeating entries as
necessary to enter the information specified
below for all plans invested or participated
in the DFE at any time during the DFE year.
[CAUTION] The administrator of each
participating plan is required to provide the
CCT, PSA, MT, and 103–12IE with the plan
number, name of the plan sponsor and EIN
of the plan sponsor being reported on the
plan’s Form 5500 so that the DFE can timely
and accurately complete its Schedule D.
Failure to provide that information to the
DFE may result in the plan’s Form 5500
Annual Return/Report being treated as
incomplete and subject to rejection. See 29
CFR 2520.103–9(b).
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Complete a separate Line 1 (elements (a)
through (e)) for each plan investing or
participating in the DFE.
Line 1a. Enter the name of each plan that
invested or participated in the DFE at any
time during the DFE year.
Line 1b. Enter the name of the sponsor of
each plan investing or participating in the
DFE.
Line 1c. Enter the nine-digit EIN and threedigit PN for each plan named in Line 1a. This
is the EIN and PN entered on lines 2b and
1b of the plan’s Form 5500 or Form 5500–
SF. GIAs should enter the EIN of the sponsor
of the participating plan listed in Line 1(b)
of the Schedule D. Do not use a social
security number in lieu of an EIN. The
Schedule D and its attachments are open to
public inspection, and the contents are
public information and are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof on
this Schedule D or any of its attachments
may result in the rejection of the filing.
Line 1d. Enter the dollar value of each
investing plan’s interest in the DFE as of the
end of the DFE year. GIAs do not complete
Line 1d.
1e. If the DFE had investors other than
plans that are required to file the Form 5500
or Form 5500–SF, such as governmental
plans, ‘‘one-participant’’ plans, or non-plan
investors, check the box in Line 1e.
20XX Instructions for Schedule E (Form
5500) ESOP Annual Information
General instructions
Who Must File
Every employer or plan administrator of a
pension benefit plan that provides ESOP
benefits must file a Schedule E (Form 5500).
Specific Instructions
Lines A, B, C, and D. This information
should be the same as reported in Part II of
the Form 5500 to which this Schedule E is
attached. If necessary, you may abbreviate
the plan name to fit the space provided.
Part I Employer Stock Acquired with a
Securities Acquisition Loan. A ‘‘securities
acquisition loan’’ is an exempt loan to an
ESOP to the extent that the proceeds are used
to acquire employer securities for the plan.
Line 1a. Enter the number of common
shares of employer stock held in the ESOP
at the end of the plan year.
Line 1b. Enter the percent of issued and
outstanding common stock held in the ESOP
at the end of the plan year.
Line 1c. A security is readily tradable on
an established securities market if it is traded
on a national securities exchange that is
registered under section 6 of the Securities
Exchange Act of 1934 or if it is traded on a
foreign national exchange that is officially
recognized, sanctioned, or supervised by a
governmental authority and the security is
deemed by the Securities Exchange
Commission as having a ‘‘ready market’’.
Treasury Regulations 1.401(a)(35)–1(f)(5)(ii).
Line 1d. Enter the number of shares of
common stock that were allocated at the end
of the plan year.
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Line 1e. Enter the number of shares of
common stock that were unallocated at the
end of the plan year.
Line 1f. If common stock was released from
a loan suspense account, check the
appropriate box(es) to indicate the method(s)
used. If you check ‘‘Other’’ you must provide
a description of the method used.
Line 1g. Check ‘‘Yes’’ if the ESOP holds
preferred stock. Under section 409(l)(3) of the
Code preferred stock is stock convertible at
any time into stock that meets the
requirements of sections 409(l)(1) for readily
tradable stock or section 409(l)(2) for nonreadily tradable stock. The stock must be
convertible at a conversion price which (as
of the date of acquisition) is reasonable.
If you answered ‘‘Yes’’ and the preferred
stock was acquired by the ESOP in a
securities acquisition loan, answer Lines 1h–
i.
Lines 1h–i. Respond to these questions
only if preferred stock was acquired by the
ESOP in a securities acquisition loan.
Line 1i. If, for example, the conversion
price is variable or incorporates the issuance
of stock warrants, a description of the
method used must be provided.
Part II Employer Stock Acquired.
Respond to these questions only if during
the plan year any non-readily tradable
employer securities were purchased by the
ESOP, including employer securities
acquired with the proceeds from a securities
acquisition loan.
Line 2b. For purposes of this form, a party
in interest is deemed to include a
disqualified person. See Code section
4975(e)(2). See Instructions for Schedule G
for the definition of party in interest.
Line 2e. Check the appropriate box and
enter the applicable identifying information
if a trustee, investment manager, or
independent fiduciary directly or indirectly
approved the transaction.
Line 2f. Section 401(a)(28(C) of the Code
provides that, in order for an ESOP to be a
qualified plan under the Code, all valuations
of employer securities which are not readily
tradable on an established securities market
with respect to activities carried on by the
plan must be by an independent appraiser.
Line 2g. Check the appropriate box(es) to
indicate what valuation approach(es) were
used to set the value of the stock acquired.
If you check ‘‘Other,’’ enter a description.
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Part III Securities Acquisition Loans.
Complete Part III only if the ESOP had
outstanding securities acquisition loans
within the meaning of Code section
4975(d)(3) and ERISA section 408(b)(3)
during the plan year. Complete as many Line
3 (elements (a)–(h)) as needed to identify
each such loan.
Part IV Other General Information
Line 4b. As described in Code section
409(p), a disqualified person, for purposes of
this section, is generally, any person whose
deemed-owned shares of the S corporation,
as defined in section 409(p)(4)(C), including
synthetic equity shares, as defined in
Treasury Regulations section 1.409(p)–1(f)(2)
are at least ten percent of the deemed-owned
shares of the S corporation and that person’s
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19:35 Jul 20, 2016
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synthetic equity shares of the S corporation.
In addition, disqualified persons include a
person and each of such person’s family
members, as defined in section 409(p)(4)(D),
if the aggregate number of deemed-owned
shares of this family group, including
synthetic equity, is at least twenty percent of
the deemed owned shares of the S
corporation and the synthetic equity shares
of such persons.
Line 4d(3). Payments in redemption of
stock held by an ESOP include reacquisition
payments that are used to make benefit
distributions to participants or beneficiaries.
20XX Instructions for Schedule G (Form
5500) Financial Transaction Schedules
Who Must File
Large plans, small pension plans that are
not exempt from the annual IQPA audit
under 29 CFR 104–46 (see instructions to
Schedule H, Line 3h(4)), master trusts, 103–
12 IEs, and GIAs, must attach Schedule G to
their Form 5500 if they are required to file
a Schedule H and they have the following to
report:
• Loans and/or fixed income obligations in
default or determined to be uncollectible as
of the end of the plan year,
• Leases in default or classified as
uncollectible, and
• Nonexempt transactions that occurred or
remained uncorrected during the plan year.
Check the Schedule G box on the Form
5500 (Part II, Line 11b(5)) if you are attaching
Schedule G. Complete as many entries as
necessary to report the required information.
[CAUTION] The plans described below,
although exempt from certain other financial
reporting requirements, are still required to
file Schedule G, Part III to report nonexempt
transactions:
• An unfunded, fully insured, or
combination unfunded/insured welfare plan,
including group health plans, with 100 or
more participants exempt under 29 CFR
2520.104–44 from completing Schedule H.
• A plan that is required to file a Form M–
1, Report for Multiple Employer Welfare
Arrangements (MEWAs) and Certain Entities
Claiming Exception (ECEs).
The Schedule G consists of three parts:
• Part I to report any loans or fixed income
obligations in default or determined to be
uncollectible as of the end of the plan year.
• Part II to report any leases in default or
classified as uncollectible.
• Part III to report nonexempt transactions.
Specific Instructions
Lines A, B, C, and D. This information
must be the same as reported in Part II of the
Form 5500 to which this Schedule G is
attached.
Do not use a social security number in Line
D in lieu of an EIN. The Schedule G and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule G or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
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47619
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under General
Instructions to Form 5500. The EBSA does
not issue EINs.
Part I—Loans or Fixed Income Obligations
in Default or Classified as Uncollectible
List all loans or fixed income obligations
in default or determined to be uncollectible
as of the end of the plan year or the fiscal
year of the GIA, master trust, or 103–12 IE.
Include:
• Obligations where the required payments
have not been made by the due date;
• Fixed income obligations that have
matured, but have not been paid, for which
it has been determined that payment will not
be made; and
• Loans that were in default even if
renegotiated during the year.
The due date, payment amount, and
conditions for determining default in the case
of a note or a loan are usually contained in
the documents establishing the note or loan.
A loan is in default when the borrower is
unable to pay the obligation upon maturity.
Obligations that require periodic repayment
can default at any time. Generally loans and
fixed income obligations are considered
uncollectible when payment has not been
made and there is little probability that
payment will be made. A fixed income
obligation has a fixed maturity date at a
specified interest rate.
Line 1. Schedule of Loans in Default or
Classified as Uncollectible Complete as many
entries as needed to report all loans in
default or classified as uncollectible.
Do not report on Line 1 participant loans
under an individual account plan with
investment experience segregated for each
account, that are made according to 29 CFR
2550.408b–1, and that are secured solely by
a portion of the participant’s vested accrued
benefit. Report all other participant loans in
default or classified as uncollectible on Part
I, and list each loan individually.
CAUTION: You may not attach an
amortization schedule in lieu of completing
as many repeating Line 1 entries as necessary
to identify loans in default or classified as
uncollectible.
1a. Identity and address of obligor. Enter
the name, street address, city, state, and zip
code for the obligor. A post office box
number may be entered in addition to the
street address if the Post Office does not
deliver mail to the obligor’s street address.
1b. Relationship of Obligor to Plan. Check
the appropriate boxes to indicate whether the
obligor is a party-in-interest or a plan
participant. Also enter a description of the
relationship of the obligor to the plan, such
as employer, employee organization, plan
sponsor, fiduciary, service provider, or other
party in or other party-in-interest, (if no
relationship, enter ‘‘unrelated third party’’).
1c. Status of Loan. Check to the
appropriate box to indicate whether the loan
is in default or has been determined to be
uncollectible. Generally, loans are considered
uncollectible when payment has not been
made and there is little probability that
payment will be made. The documents
establishing the loan normally specify its
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terms, due date, payment amount, and
conditions for determining default. A loan is
in default when the borrower is unable to pay
the obligation when due. Obligations that
require periodic repayment can default at any
time.
1d. Original Principal Amount of Loan.
Enter original amount of loan.
1e. Original Interest Rate of Loan. Enter
original interest rate of the loan. If the
original interest rate of the loan was variable,
enter in the space provided, a description of
the terms of the variable interest rate.
1f. Origination Date. Enter the date the
loan originated.
1g. Original Maturity Date. Enter the
original maturity date of the loan. If the
maturity date was extended to a different
date, include the new maturity date in
element (l) in the description of steps taken
to collect the loan.
1h. Loan Collateral. In Line 1h, check the
appropriate box to indicate whether the loan
secured by collateral. If you answered ‘‘Yes,’’
complete Lines 1h(2) and (3). In Line 1h(2),
indicate whether the security interest in the
collateral was perfected. In Line 1h(3), enter
a description of the collateral type and its
value.
1i. Scheduled Payment Frequency. Enter
the scheduled payment frequency (e.g.,
monthly, annually).
1j. Payments Received. Enter the amount
of principal and interest payments received
during the plan year.
1k. Amount Overdue. Enter separately the
principal and interest amounts overdue as of
the end of the plan year. Include the amount,
of principal and interest that is overdue from
previous plan years.
1l. Steps Taken to Collect. Describe what
steps have been taken or will be taken to
collect overdue amounts, including
renegotiation of original terms of the loan.
Line 2—Schedule of Fixed Income
Obligations in Default or Classified as
Uncollectible.
Complete as many entries as needed to
report all fixed income obligations in default
or classified as uncollectible.
2a. Identity and address of obligor. Enter
the name, street address, city, state, and zip
code for the obligor. A post office box
number may be entered in addition to the
street address if the Post Office does not
deliver mail to the obligor’s street address.
2b. Relationship of Obligor to Plan. Check
the box to indicate whether the obligor is a
party-in-interest. Also enter a description of
the relationship of the obligor to the plan,
such as employer, employee organization,
plan sponsor, fiduciary, service provider, or
other party in or other party-in-interest (if no
relationship, enter ‘‘unrelated third party’’).
2c. Status of Fixed Income Obligation.
Check the appropriate box to indicate
whether the loan is in default or has been
determined to be uncollectible. Generally,
fixed income obligations are considered
uncollectible when payment has not been
made and there is little probability that
payment will be made. The documents
establishing the obligation normally specify
its terms, due date, payment amount, and
conditions for determining default. A fixed
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income obligation is in default when the
obligee is unable to pay the obligation when
due. Obligations that require periodic
repayment can default at any time.
2d. Nature of Fixed Income Obligation.
Check applicable boxes to indicate the nature
of the fixed income obligation. See Schedule
H, Line 1b instructions for more information
on types of fixed income obligations.
2e. Date of issuance. Enter the date the
fixed income obligation was issued.
2f. Maturity date. Enter the original
maturity date of the obligation. If the
maturity date was extended to a different
date, include the new maturity date in the
description of steps taken to collect the
obligation in element (l).
2g. Yield/Interest Rate. Enter yield or
interest rate for the obligation provided for in
the note or contract establishing the
obligation.
2h. Principal amount of fixed income
obligation. Enter the principal amount of the
obligation at the time the plan entered into
the transaction.
2i. Amount Overdue. Enter separately the
principal and interest amounts overdue as of
the end of the plan year. Include the amount
of principal and interest that is overdue from
previous plan years.
2j. Steps Taken to Collect. Enter a
description of what steps the plan
administrator has taken or will be taking to
collect overdue amounts for each loan.
Part II Leases in Default or Classified as
Uncollectible.
List any leases in default or classified as
uncollectible. A lease is an agreement
conveying the right to use property, plant, or
equipment for a stated period. A lease is in
default when the required payment(s) has not
been made. An uncollectible lease is one
where the required payments have not been
made and for which there is little probability
that payment will be made.
3a. Identity and address of obligor. Enter
the name, street address, city, state, and zip
code for the obligor. A post office box
number may be entered in addition to the
street address if the Post Office does not
deliver mail to the obligor’s street address.
3b. Relationship of Obligor to Plan. Check
the appropriate boxes to indicate whether the
obligor is a party-in-interest or a plan
participant. Also enter a description of the
relationship of the obligor to the plan, such
as employer, employee organization, plan
sponsor, fiduciary, service provider, or other
party-in-interest (if no relationship, enter
‘‘unrelated third party’’).
3c. Status of Lease. Check to the
appropriate box to indicate whether the lease
is in default or has been determined to be
uncollectible. Generally, leases are
considered uncollectible when payment has
not been made and there is little probability
that payment will be made. The documents
establishing the lease normally specify its
terms, due date, payment amount, and
conditions for determining default. A lease is
in default when the lessee is unable to pay
the obligation when due. Obligations that
require periodic repayment can default at any
time.
3d. Address of Leased Property. You must
enter the name, street address, city, state, and
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zip code of the leased property. You may not
use a post office box.
3e. Date of Lease Origination. Enter date of
lease origination.
3f. Original Cost of Leased Property. Enter
the cost to acquire the property.
3g. Current Value of Leased Property at
Time of Lease. Enter the value of the leased
property at time the plan entered into the
lease.
3h. Annual Lease Payments Due. Enter the
gross rental amounts due during the plan
year.
3k. Scheduled Payment Frequency.
Indicate the lease payment schedule, i.e.,
monthly, annually.
3l. Lease Expiration Date: Enter the lease
expiration date.
3m. Amount In Arrears. Enter the amount
of payments under the lease that are in
arrears.
3n. Steps Taken to Collect. Enter an
explanation of what steps the plan
administrator has taken or will be taking to
collect overdue amounts for each lease listed.
Part III Nonexempt Transactions
You must report all nonexempt party-ininterest transactions, regardless of whether
they are disclosed in the accountant’s report,
unless the nonexempt transaction is:
1. Statutorily exempt under Part 4 of Title
I of ERISA;
2. Administratively exempt under ERISA
section 408(a);
3. Exempt under Code sections 4975(c) or
4975(d);
4. The holding of participant contributions
in the employer’s general assets for a welfare
plan that meets the conditions of ERISA
Technical Release 92–01;
5. A transaction of a 103–12 IE with parties
other than the plan; or
6. A delinquent participant contribution or
a delinquent participant loan repayment
reported on Schedule H, Line 4a.
Nonexempt transactions with a party-ininterest include any direct or indirect:
A. Sale or exchange, or lease, of any
property between the plan and a party-ininterest.
B. Lending of money or other extension of
credit between the plan and a party-ininterest.
C. Furnishing of goods, services, or
facilities between the plan and a party-ininterest.
D. Transfer to, or use by or for the benefit
of, a party-in-interest, of any income or assets
of the plan.
E. Acquisition, on behalf of the plan, of any
employer security or employer real property
in violation of ERISA section 407(a).
F. Dealing with the assets of the plan for
a fiduciary’s own interest or own account
G. Acting in a fiduciary’s individual or any
other capacity in any transaction involving
the plan on behalf of a party (or represent a
party) whose interests are adverse to the
interests of the plan or the interests of its
participants or beneficiaries.
H. A receipt of any consideration for his or
her own personal account by a party-ininterest who is a fiduciary from any party
dealing with the plan in connection with a
transaction involving the income or assets of
the plan.
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For purposes of this form, party-in-interest
is deemed to include a disqualified person.
See Code Section 4975(e)(2). The term
‘‘party-in-interest’’ means, as to an employee
benefit plan:
A. Any fiduciary (including, but not
limited to, any administrator, officer, trustee
or custodian), counsel, or employee of the
plan;
B. A person providing services to the plan;
C. An employer, any of whose employees
are covered by the plan;
D. An employee organization, any of whose
members are covered by the plan;
E. An owner, direct or indirect, of 50% or
more of:
(1) the combined voting power of all
classes of stock entitled to vote or the total
value of shares of all classes of stock of a
corporation,
(2) the capital interest or the profits interest
of a partnership, or
(3) the beneficial interest of a trust or
unincorporated enterprise that is an
employer or an employee organization
described in C or D;
F. A relative of any individual described in
A, B, C, or E;
G. A corporation, partnership, or trust or
estate of which (or in which) 50% or more
of:
(1) the combined voting power of all
classes of stock entitled to vote or the total
value of shares of all classes of stock of such
corporation,
(2) the capital interest or profits interest of
such partnership, or
(3) the beneficial interest of such trust or
estate is owned directly or indirectly, or held
by, persons described in A, B, C, D, or E;
H. An employee, officer, director (or
individual having powers or responsibilities
similar to those of officers or directors), or a
10% or more shareholder, directly or
indirectly, of a person described in B, C, D,
E, or G, or of the employee benefit plan; or
I. A 10% or more (directly or indirectly in
capital or profits) partner or joint venture of
a person described in B, C, D, E, or G.
If you are unsure whether a transaction is
exempt or not, you should consult with
either the plan’s independent qualified
public accountant or legal counsel or both.
You may indicate that an application for an
administrative exemption is pending.
If the plan is a qualified pension plan and
a nonexempt prohibited transaction occurred
with respect to a disqualified person, the
disqualified person must file an IRS Form
5330, Return of Excise Taxes Related to
Employee Benefit Plans, to pay the excise tax
on the transaction.
4a. Identity and Address of Party Involved
in Non-exempt Transaction. Enter the name,
street address, city, state, and zip code for the
obligor. A post office box number may be
entered in addition to the street address if the
post office does not deliver mail to the
obligor’s street address.
4b. Relationship to Plan. Enter a
description of the relationship of the party
involved in the transaction to the plan, such
as employer, employee organization, plan
sponsor, fiduciary, service provider, or other
party-in-interest.
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4c. Type of Nonexempt Transaction. Check
all of the boxes that apply to the nonexempt
transaction.
4d. Nature of Transaction. Check the
appropriate box to indicate the nature of the
transaction. A transaction is a discrete
transaction if it was a single occurrence that
did not continue in time, for example, the
sale of property between a plan and a partyin-interest is a discrete transaction. An
ongoing transaction is one that is continuous
over a period of time, such as a lease or other
obligation that requires regular payments for
a continuing time period.
4e. Date of Transaction. Enter the date the
transaction occurred or was entered into. If
ongoing, enter the date of the commencement
or first instance.
4f. Principal Amount Of Nonexempt
Transaction. Enter the principal amount of
the transaction.
4g. Net Gain (Or Loss) On the Transaction.
Enter the net gain (or loss) on the transaction.
4h–j. Correction of Transaction. Check the
appropriate box to indicate whether the
transaction has been corrected, and if so,
when and how the transaction was corrected.
The DOL Voluntary Fiduciary Correction
Program (VFCP) describes how to apply the
specific transactions covered (for example,
delinquent participation contributions to
pension and welfare plans) and acceptable
methods for correcting violations. In
addition, applicants that satisfy both the
VFCP requirements and the conditions of
Prohibited Transaction Exemption (PTE)
2002–51 are eligible for immediate relief
from payment of certain prohibited excise
taxes for certain corrected transactions, and
are also relieved from the obligation to file
the Form 5330 with the IRS. For more
information, see 71 FR 20261 (Apr. 19, 2006)
and 71 FR 20135 (Apr. 19, 2006). If
conditions of PTE 2002–51 are satisfied,
corrected transactions should be treated as
exempt under Code section 4975(c) when
answering Schedule G, Part III. Information
about the VFCP is also available on the
internet at www.dol.gov/ebsa.
4k. Filing of Form 5330 and Payment of
Excise Taxes. Check the appropriate box to
indicate whether a Form 5330 with payment
of excise taxes to the IRS was required and
if so, whether the Form 5330 was in fact
filed.
20XX Instructions for Schedule H (Form
5500) (Financial Information)
General Instructions
Who Must File
Schedule H (Form 5500) must be attached
to a Form 5500 filed for any pension or
welfare benefit plan required to file the Form
5500, unless subject to one of the exceptions
listed below or permitted to file the Form
5500–SF. Master trusts, CCTs, PSAs, 103–12
IEs, and GIAs also must complete as part of
their Form 5500 Annual Return/Report filing
some or all of the Schedule H, depending on
type of entity filing. See the instructions to
the Form 5500 in Section 4: Direct Filing
Entity (DFE) Filing Requirements.
Exceptions: (1) Fully insured, unfunded, or
a combination of unfunded/insured welfare
plans, including plans that provide health
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47621
benefits, and fully insured pension plans that
meet the requirements of 29 CFR 2520.104–
44, are exempt from completing the Schedule
H.
(2) Plans that are eligible to file and in fact
file a Form 5500–SF for the 20XX plan year
are not required to file a Schedule H for that
year. See What To File. and Instructions for
Form 5500–SF.
Check the Schedule H box on the Form
5500 (Part II, Line 11b(1)) if a Schedule H is
attached to the Form 5500.
Specific Instructions
Lines A, B, C, and D. This information
must be the same as reported in Part II of the
Form 5500 to which this Schedule H is
attached.
Do not use a social security number in Line
D in lieu of an EIN. The Schedule H and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule H or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under General
Instructions to Form 5500. The EBSA does
not issue EINs.
Part I—Asset and Liability Statement
Note. The cash, modified cash, or accrual
basis may be used for recognition of
transactions in Parts I and II, as long as you
use one method consistently. Round off all
amounts reported on the Schedule H to the
nearest dollar. Any other amounts are subject
to rejection. Check all subtotals and totals
carefully.
If the assets of two or more plans are
maintained in a fund or account that is not
reported on lines 1b(6) through 1b(8),
complete Parts I and II of the Schedule H by
entering the plan’s allocable part of each line
item.
If assets of one plan are maintained in two
or more trust funds, report the combined
financial information in Parts I and II.
Current value means fair market value
where available. Otherwise, it means the fair
value as determined in good faith under the
terms of the plan by a trustee or a named
fiduciary, assuming an orderly liquidation at
time of the determination. See ERISA section
3(26).
Note. Amounts reported in column (a)
must be the same as reported for the end of
the plan year for corresponding line items of
the return/report for the preceding plan year.
Do not include contributions designated for
the 20XX plan year in column (a).
1a(1). Employer contributions. Noncash
basis filers must include contributions due
the plan by the employer but not yet paid.
Do not include other amounts due from the
employer such as the reimbursement of an
expense or the repayment of a loan.
1a(2). Participant contributions. Noncash
basis filers must include contributions
withheld by the employer from participants
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and amounts due directly from participants
that have not yet been received by the plan.
Do not include the repayment of participant
loans.
1a(3). Notes receivable from participants
(participant loans). Enter the current value of
all loans to participants, including residential
mortgage loans that are subject to Code
section 72(p). Include the sum of the value
of the unpaid principal balances, plus
accrued but unpaid interest, if any, for
participant loans made under an individual
account plan with investment experience
segregated for each account, which are made
in accordance with 29 CFR 2550.408b–1 and
secured solely by a portion of the
participant’s vested accrued benefit. When
applicable, combine this amount with the
current value of any other participant loans.
Do not include in column (b) a participant
loan that has been deemed distributed during
the plan year under the provisions of Code
section 72(p) and Treasury Regulations
section 1.72(p)–1, if both of the following
circumstances apply:
1. Under the plan, the participant loan is
treated as a directed investment solely of the
participant’s individual account; and
2. As of the end of the plan year, the
participant is not continuing repayment
under the loan.
If both of these circumstances apply, report
the loan as a deemed distribution on Line 2g.
However, if either of these circumstances
does not apply, the current value of the
participant loan (including interest accruing
thereon after the deemed distribution) must
be included in column (b) without regard to
the occurrence of a deemed distribution.
Note. After a participant loan that has been
deemed distributed is reported on Line 2g, it
is no longer to be reported as an asset on
Schedule H unless, in a later year, the
participant resumes repayment under the
loan. However, such a loan (including
interest accruing thereon after the deemed
distribution) that has not been repaid is still
considered outstanding for purposes of
applying Code section 72(p)(2)(A) to
determine the maximum amount of
subsequent loans. Also, the deemed
distribution is not treated as an actual
distribution for other purposes, such as the
qualification requirements of Code section
401, including, for example, the
determination of top-heavy status under
Code section 416 and the vesting
requirements of Treasury Regulations section
1.411(a)-7(d)(5). See Q&As 12 and 19 of
Treasury Regulations section 1.72(p)-1.
The entry on Line 1a(3), column (b), of
Schedule H (participant loans—end of year)
must include the current value of any
participant loan that was reported as a
deemed distribution on Line 2h for any
earlier year if the participant resumes
repayment under the loan during the plan
year. In addition, the amount to be entered
on Line 2h must be reduced by the amount
of the participant loan that was reported as
a deemed distribution on Line 2h for the
earlier year.
Line 1a(4). Other Receivables. Noncash
basis filers must include amounts due to the
plan that are not includable in Lines 1a(1),
1a(2), and 1a(3). These amounts may include
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investment income earned but not yet
received by the plan and other amounts due
to the plan such as amounts due from the
employer or another plan for expense
reimbursement or from a participant for the
repayment of an overpayment of benefits.
Line 1b(1). Total noninterest-bearing cash.
Total noninterest bearing cash includes,
among other things, cash on hand or cash in
a noninterest bearing checking account.
1b(2). Interest-bearing cash and cash
equivalents. Include all assets that earn
interest in a financial institution account,
such as interest bearing checking accounts,
passbook savings accounts in Line 1b(2)(A).
Report certificates of deposit on Line
1b(2)(B). Report money market accounts on
Line 1b(2)(C).
Line 1b(3). Debt Interests/Obligations.
Enter in the appropriate categories any debt
interests/obligations held directly by the
plan.
Line 1b(3)(A). U.S. Government securities.
Include securities issued or guaranteed by
the U.S. Government or its designated
agencies such as U.S. Savings Bonds,
Treasury Bonds, Treasury Bills, Federal
National Mortgage Association (FNMA), and
Government National Mortgage Association
(GNMA).
Line 1b(3)(B). Other government securities.
Include here state and municipal bonds.
Report bonds issued by foreign governments
in Line 1b(13).
Line 1b(3)(C). Corporate debt instruments
(other than employer securities). Include
investment securities (other than employer
securities defined below in Line 1c(1)) issued
by a corporate entity at a stated interest rate
repayable on a particular future date such as
most bonds, debentures, convertible
debentures, commercial paper and zero
coupon bonds. Do not include debt securities
of governmental units that should be
reported on Line 1b(3)(A). For purposes of
the breakouts on Line 1b(3)(C)(i) and (ii),
investment-grade debt-instruments are those
with an S&P rating of BBB—or higher, a
Moody’s rating of Baa3 or higher, or an
equivalent rating from another rating agency.
High-yield debt instruments are those that
have ratings below these rating levels. If the
debt does not have a rating, it should be
included in the ‘‘high-yield’’ category if it
does not have the backing of a government
entity. Unrated debt with the backing of a
government entity would generally be
included in the ‘‘investment-grade’’ category
unless it is generally accepted that the debt
should be considered as ‘‘high-yield.’’ Use
the ratings in effect as of the beginning of the
plan year. See the instructions for Schedule
R, Line 18.
Line 1b(3)(D). Exchange Traded Notes.
Report here unsecured, unsubordinated debt
securities that are traded on an exchange and
that are not registered investment companies
under the Investment Company Act of 1940.
Line 1b(3)(E). Asset backed securities
(other than real estate). An asset-backed
security generally is one that is collateralized
by a discrete pool of assets (such as loans or
receivables) and that makes payments based
primarily on the performance of those assets.
Do not include here securities backed by real
estate or real estate-related loans.
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Line 1b(3)(F). Other debt instruments.
Include here, debt instruments not otherwise
includable in Lines 1a(3) (participant loans),
1b(3)(A)–(E), 1b(9)(E) (mortgage-backed
securities) or 1b(9)(G) (e.g., construction and
mortgage loans).
Line 1b(4). Corporate Stocks (Other than
Employer Securities, Private Equity, and
Foreign Investments). Include here publicly
traded and non-publicly traded domestic
equities owned directly by the plan. Do not
include employer securities, foreign stocks,
or private equity here.
Line 1b(4)(A). Publicly Traded Corporate
Stocks. Enter in element (i) the total value of
all ‘‘preferred’’ corporate stock that is
publicly traded. Include stock issued by
corporations (other than employer securities
defined in Line 1c(1) below) that is
accompanied by preferential rights such as
the right to share in distributions of earnings
at a higher rate or which has general priority
over the common stock of the same entity.
Include the value of warrants convertible into
preferred stock. Enter in element (ii) the total
value of all ‘‘common’’ corporate stock that
is publicly traded. This includes any stock
(other than employer securities defined in
Line 1c(1)) that represents regular ownership
of the corporation and is not accompanied by
preferential rights. Include the value of
warrants convertible into common stock.
Line 1b(4)(B). Corporate Stocks That Are
Not Publicly Traded. Enter in element (i) the
total value of nonpublicly traded preferred
stock and in element (ii) the total value of
nonpublicly traded common stock. See
instructions for Line 1b(4)(A) for a
description of ‘‘preferred’’ and ‘‘common’’
stock.
Line 1b(5). Registered Investment
Companies (Mutual funds, Unit Investment
Trusts, Closed End Funds). A registered
investment company is an investment
company registered under the Investment
Company Act of 1940. These are mutual
funds (legally known as open-end
companies), closed-end funds (legally known
as closed-end companies), and unit
investment trusts (UITs) (legally known as
unit investment trusts).
Lines 1b(6)(A) and (B). Interests in CCTs
and PSAs. Enter information, in the
appropriate elements as of the beginning and
end of the filing plan or DFE year, about
interests in PSAs and CCTs, regardless of
whether the CCT or PSA has filed its own
Form 5500 Annual Return/Report.
CAUTION: The plan’s or DFE’s interest in
common/collective trusts (CCTs) and pooled
separate accounts (PSAs) must be allocated
and reported in the appropriate categories on
an investment by investment basis on the
Line 4i Schedules, with the box checked to
identify that the investment was held through
a CCT or PSA, unless the CCT or PSA has
filed its own Form 5500, including Schedule
H, and the Line 4i(1) Schedule of Assets Held
for Investment at End of Year. See
instructions for Line 4i(1) Schedule of Assets
Held for Investment at End of Year, element
(a).
Note. For reporting purposes, a separate
account that is not considered to be holding
plan assets pursuant to 29 CFR 2510.3–
101(h)(1)(iii) does not constitute a PSA.
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Line 1b(6)(C). Interests in 103–12
investment entities (103–12 IEs). Enter the
total value of the plan’s interest in all 103–
12 IEs on Line 1b(6)(C)(1)(a).
Line 1b(6)(D). Master Trust. Enter the total
value of the plan’s interest in all master trusts
on Line 1b(6)(D)(1)(a).
CAUTION. If the plan participated in a
master trust, it must separately list on the
Line 4i(1) Schedule of Assets Held for
Investment at End of Year all of the master
trust assets in which the plan had a
proportionate interest, indicating that the
asset was held through the master trust. See
instructions for Line 4i(1) Schedule of Assets
Held for Investment at End of Year, element
(a).
Line 1b(7). Value of Interest in Funds Held
in Insurance General Account (Unallocated
Contracts). Use the same method for
determining the value of the insurance
contracts reported here as you used for Line
3 of Schedule A, or, if Line 3 is not required,
Line 6 of Schedule A.
Line 1b(8). Partnership and Joint Venture
Interests. Enter in the appropriate element
information about partnership and joint
venture interests.
Line 1b(8)(A)(1). Value of Interest in
Limited Partnerships. Include the value of
the plan’s participation in a partnership or
joint venture regardless of whether the
underlying assets of the partnership or joint
venture are considered to be plan assets
under 29 CFR 2510.3–101. Do not include
here the value of a plan’s interest in a
partnership or joint venture that satisfies all
of the requirements for being a 103–12
Investment Entity (103–12 IE), including the
requirement that such an entity timely files
its own Form 5500 Annual Return/Report
and associated schedules and attachments.
Report the value of a 103–12 IE on Line
1b(6)(C). Partnerships and joint ventures
should be reported in one of the partnership/
joint venture categories where it fits best, or
in another category where it fits better. For
example, a real estate partnership that does
not fit into one of the other real estate
reporting categories would be reported on
proposed Line 1c(9)(G) and a joint venture
that invests in foreign investments would be
reported in the appropriate subcategory in
Line 1b(13).
Line 1b(8)(A)(2). Value of Interest in
Venture Capital Operating Companies
(VCOC). A ‘‘venture capital operating
company’’ is an operating company that
meets the conditions of 29 CFR 2510.3–
101(d).
Line 1b(8)(A)(3). Private Equity. Include on
this line private equity stakes and interests in
private equity funds. ‘‘Private equity fund’’ is
commonly used to describe privately
managed pools of capital that invest in
companies that typically are not listed on a
stock exchange. Report stock ownership of
non-publicly traded corporate stocks that are
not private equity investments on Line
1b(4)(B).
Line 1b(8)(A)(4). Hedge Funds. The term
‘‘hedge fund’’ is commonly used to describe
pooled investment vehicles that are privately
organized and administered by professional
managers who engage in active trading of
various types of securities, commodity
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futures, options contracts, and other
investment vehicles, including relatively
illiquid and hard-to-value investments.
Line 1b(8)(A)(5). Other Partnership/Joint
Venture Interests. Report here any other
partnership or joint venture interests in
which the plan has invested that are not
reported on lines 1b(8)(A)–(D).
Line 1b(8)(B). Plan Asset Status Under
DOL Regulation 29 CFR 2510.3–101. Enter
into Line 1b(8)(B)(i) the total of all
partnerships/joint venture interests reported
in Line 1b(8)(A) that do not hold plan assets
under the DOL’s plan asset regulation at 29
CFR 2510.3–101. In Line 1b8(B)(2) enter the
total partnership/joint venture interests that
hold plan assets under the DOL’s plan asset
regulation at 29 CFR 2510.3–101. To avoid
double-counting, do not include amounts
reported on Line 1b(8)(B)(1) and (2) in the
total assets reported on Line 1f.
Line 1b(9). Real Estate Investments (Other
Than Employer Real Property). Enter
information about real estate and real estate
based interests in the appropriate element.
Line 1b(9)(A)–(B). Real property (Other
Than Employer Real Property). Report here
direct ownership interest of the plan in real
property other than employer real property in
the appropriate category.
Line 1b(9)(C)–(D). Real Estate Investment
Trusts (REITs). Report here entities that
invest in real estate that are REITs as set forth
in Code § 856.
Line 1b(9)(E). Mortgage-Backed Securities
(Including Collateralized Mortgage
Obligations). Report here all types of
mortgage-backed securities, which generally
are debt obligations that represent claims to
the cash flows from pools of mortgage loans,
most commonly on residential property.
Collateralized mortgage obligations (CMOs)
are one type of mortgage-backed security.
Line 1b(8)(F). Real Estate Operating
Company (REOC). Report here investments
in ‘‘real estate operating companies’’
(REOCs). A REOC is an operating company
that meets the conditions of 29 CFR 2510.3–
101(e).
Line 1b(9)(G). Other real estate related
investments. Include here any residential
mortgages that are not covered under IRC
72(p), commercial mortgages, construction
loans, and any other real estate-related
investments not includable on lines 1b(9)(A)(F) that are not employer real property
reportable on Line 1c(2) or buildings or other
property used in plan operations reportable
on Line 1d.
Line 1b(10). Commodities (Direct
investments). Enter direct investments in
commodities on Line 1b(10). Enter total value
of precious metals in Line 1b(10)(A) and the
total value of all other commodities in Line
1b(10)(B).
Line 1b(11). Derivatives. Enter information
about direct investments in derivatives in the
appropriate element in Line 1b(11).
Derivatives include futures, forwards,
options, and swaps. Enter a description for
any derivatives reported in Line 1b(11)(E)
‘‘Other.’’
Line 1b(12). Tangible personal property
(including collectibles). Enter the total value
of any collectibles or other personal property
owned by the plan. Include all property that
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has concrete existence and is capable of
being processed, such as goods, wares,
merchandise, furniture, machines,
equipment, animals, automobiles, etc. This
includes collectibles, such as works of art,
rugs, antiques, metals, gems, stamps, coins,
alcoholic beverages, musical instruments,
and historical objects (documents, clothes,
etc.). Do not include any intangible property,
such as patents, copyrights, goodwill,
franchises, notes, mortgages, stocks, claims,
interests, or other property that embodies
intellectual or legal rights.
Line 1b(13). Foreign investments (Other
than through U.S.-registered investment
funds). Enter information about foreign
investments in the appropriate element. Do
not include the value of U.S.-based pooled
investment vehicles that are designed to
invest in foreign securities. Instead, report
such pooled investment vehicles in the
appropriate categories on Line 1b(5)-(7).
Line 1b(14). Participant-directed
brokerage accounts. Report assets held
through participant-directed brokerage
accounts in the appropriate sub-elements on
Line 1b(14). Report in the aggregate all other
investments through participant-directed
brokerage accounts, that are not reportable in
the separate categories in Lines 1b(14)(A)-(F),
including stocks, bonds, registered
investment funds, etc., on Line 1b(14)(G).
Line 1c(1). Employer securities. An
employer security is any security issued by
an employer (including affiliates) of
employees covered by the plan. These may
include common stocks, preferred stocks,
bonds, zero coupon bonds, debentures,
convertible debentures, notes, and
commercial paper. Report in the appropriate
category any types of employer securities
held by the plan.
Line 1c(2). Employer real property. The
term ‘‘employer real property’’ means real
property (and related personal property) that
is leased to an employer of employees
covered by the plan, or to an affiliate of such
employer. For purposes of determining the
time at which a plan acquires employer real
property for purposes of this line, such
property shall be deemed to be acquired by
the plan on the date on which the plan
acquires the property or on the date on which
the lease to the employer (or affiliate) is
entered into, whichever is later.
Line 1d. Buildings and other property
used in plan operation. Include the current
(not book) value of the buildings and other
property used in the operation of the plan.
Report in 1c(9) and 1c(2), as applicable,
rather than Line 1d, buildings or other
property held as plan investments that are
not used in the operation of the plan.
Line 1e. Other. Include all other
investments not includable in lines 1b
through 1d and enter a description.
Line 1f. Total assets. Add all amounts in
lines 1a through 1e.
Note. Do not include the value of future
pension payments on lines 1g, h, i, j, or k.
Line 1g. Benefit claims payable. Noncash
basis plans must include the total amount of
benefit claims that have been processed and
approved for payment by the plan. Include
welfare plan ‘‘incurred but not reported’’
(IBNR) benefit claims on this line.
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Line 1h. Operating payables. Noncash
basis plans must include the total amount of
obligations owed by the plan which were
incurred in the normal operations of the plan
and have been approved for payment by the
plan but have not been paid.
Line 1i. Acquisition indebtedness.
‘‘Acquisition indebtedness,’’ for debtfinanced property other than real property,
means the outstanding amount of the
principal debt incurred:
1. By the organization in acquiring or
improving the property;
2. Before the acquisition or improvement of
the property if the debt was incurred only to
acquire or improve the property; or
3. After the acquisition or improvement of
the property if the debt was incurred only to
acquire or improve the property and was
reasonably foreseeable at the time of such
acquisition or improvement. For further
explanation, see Code section 514(c).
Line 1j. Other liabilities. Noncash basis
plans must include amounts owed for any
liabilities that would not be classified as
benefit claims payable, operating payables, or
acquisition indebtedness and enter a
description of such liabilities.
Line 1k. Total liabilities. Add all amounts
in lines 1g through 1k.
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Net Assets
Line 1l. Net assets. Enter the net assets as
of the beginning and end of the plan year.
(Subtract Line 1k from Line 1f.) The entry in
column (b) must equal the sum of the entry
in column (a) plus Lines 2k and 2l(1), minus
2l(2).
Part II Income and Expense Statement
Line 2. Plan income, expenses, and
changes in net assets for the year. Include all
income and expenses of the plan, including
any trust(s) or separately maintained fund(s)
and any payments/receipts to/from insurance
carriers. Round off amounts to the nearest
dollar. Master trusts, CCTs, PSAs, and 103–
12 IEs do not complete lines 2a, 2b, 2e, 2f,
and 2g.
Line 2a. Contributions. Include the total
cash contributions received and/or (for
accrual basis plans) due to be received.
Note. Plans using the accrual basis of
accounting should not include contributions
designated for years before the 20XX plan
year on Line 2a.
Line 2a (1). Contributions Received or
receivable. Enter contributions received, or
for accrual basis filers receivable, from
employers in element (A), from participants
in element (B). In element (C) enter all other
contributions received or receivable,
including rollovers from other qualified
retirement plans.
Line 2a(1)(B). For welfare plans, report all
employee contributions, including all
elective contributions under a cafeteria plan
(Code section 125). For pension benefit
plans, participant contributions, for purposes
of this item, also include elective
contributions under a qualified cash or
deferred entities arrangement. (Code section
401(k)).
Line 2a(2). Noncash contributions. Use the
current value, at date contributed, of
securities or other noncash property.
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Line 2a(3). Total contributions. Add Lines
2a(1)(A), (B), (C), and Line 2a(2).
Line 2b. Interest Income on Notes
Receivable from Participants (Participant
Loans). Enter interest income on participant
loans. Also include here interest income on
residential mortgage loans to participants
under Code § 72(p).
Line 2c. Earnings on Investments. Report
in Line 2c(1)(A)-(E) the total interest paid
directly to the plan by the issuer . Report the
total of all other earnings on debt interests or
obligations in Line 2c(1)(F).
Report in Line 2c(2)(A) the total dividends
on corporate stocks (other than employer
securities) paid directly to the plan by the
issuer of any corporate stocks. Report the
total of all other earnings on corporate stocks
in Line 2c(2)(B).
In Line 2c(1)-(6), report the total of all
earnings by asset type, including interest,
dividends, gain (loss) on sale of property,
unrealized appreciation (depreciation), and,
if the asset has been sold during the plan
year, the net investment gain (loss), as
appropriate for asset type.
Interest includes interest earned on
interest-bearing cash, including earnings
from sweep accounts, STIF accounts, money
market accounts, certificates of deposit,
government securities etc.
For accrual basis plans, include any
dividends declared for stock held on the date
of record, but not yet received as of the end
of the plan year.
Generally, rents represent the income
earned on the real property. Include ‘‘rent’’
reporting as part of earnings as a ‘‘Net’’
figure. Net rents are determined by taking the
total rent received and subtracting all
expenses directly associated with the
property. If the real property is jointly used
as income producing property and for the
operation of the plan, net that portion of the
expenses attributable to the income
producing portion of the property against the
total rents received.
Net gain (loss) on sale of assets equals the
sum of the net realized gain (or loss) on each
asset held at the beginning of the plan year
which was sold or exchanged during the plan
year, and on each asset that was both
acquired and disposed of within the plan
year.
Note. As current value reporting is
required for the Form 5500 Annual Return/
Report, assets are revalued to current value
at the end of the plan year. For purposes of
this form, the increase or decrease in the
value of assets since the beginning of the
plan year (if held on the first day of the plan
year) or their acquisition date (if purchased
during the plan year) is included as part of
total earnings for particular assets.
The sum of the realized gain (or loss) of
assets sold or exchanged during the plan year
is to be calculated as follows:
1. Include for each category of asset in Line
2c, where applicable, the sum of the amount
received for these former assets;
2. Include for each category of asset in Line
2c, the sum of the current value of these
former assets as of the beginning of the plan
year and the purchase price for assets both
acquired and disposed of during the plan
year.
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If entering a negative number, enter a
minus sign ‘‘–’’ to the left of the number.
Note. Bond write-offs should be reported as
realized losses.
To calculate total unrealized appreciation
of assets in each category subtract the current
value of assets at the beginning of the year
plus the cost of any assets acquired during
the plan year from the current value of assets
at the end of the year to obtain this figure.
If entering a negative number, enter a minus
sign ‘‘–’’ to the left of the number.
Line 2d. Total income. Add all income
amounts (c) and enter total in the space
provided.
Line 2e(1). Include the current value of all
cash, securities, or other property at the date
of distribution. Include all eligible rollover
distributions as defined in Code section
401(a)(31)(D) paid at the participant’s
election to an eligible retirement plan
(including an IRA within the meaning of
section 401(a)(31)(E)).
2e(2). Include payments to insurance
companies and similar organizations,
managed care organizations, and health
maintenance organizations for the provision
of plan benefits (e.g., paid-up annuities,
accident insurance, health insurance, vision
care, dental coverage, stop-loss insurance
whose claims are paid to the plan (or which
is otherwise an asset of the plan)), etc.
2e(3). Include all payments made to other
organizations or individuals providing
benefits. Generally, these are individual
providers of welfare benefits such as legal
services, day care services, training, and
apprenticeship services.
Line 2f. Corrective Distributions. Include
on this line all distributions paid during the
plan year of excess deferrals under Code
section 402(g)(2)(A)(ii), excess contributions
under Code section 401(k)(8), and excess
aggregate contributions under Code section
401(m)(6). Include allocable income
distributed. Also include on this line any
elective deferrals and employee contributions
distributed or returned to employees during
the plan year, as well as any attributable
income that was also distributed.
Line 2g. Certain Deemed Distributions of
Participant Loans. Report on Line 2g a
participant loan that has been deemed
distributed during the plan year under the
provisions of Code section 72(p) and
Treasury Regulations section 1.72(p)–1 only
if both of the following circumstances apply:
1. Under the plan, the participant loan is
treated as a directed investment solely of the
participant’s individual account; and
2. As of the end of the plan year, the
participant is not continuing repayment
under the loan.
If either of these circumstances does not
apply, a deemed distribution of a participant
loan should not be reported on Line 2g.
Instead, the current value of the participant
loan (including interest accruing thereon
after the deemed distribution) must be
included on Line 1a(3), column (b)
(participant loans—end of year), without
regard to the occurrence of a deemed
distribution.
Note. The amount to be reported on Line
2g of Schedule H must be reduced if, during
the plan year, a participant resumes
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repayment under a participant loan reported
as a deemed distribution on Line 2g for any
earlier year. The amount of the required
reduction is the amount of the participant
loan reported as a deemed distribution on
Line 2g for the earlier year. If entering a
negative number, enter a minus sign ‘‘–’’ to
the left of the number. The current value of
the participant loan must then be included in
Line 1a(3), column (b), of Schedule H (Notes
receivable from participants)
Although certain participant loans deemed
distributed are to be reported on Line 2g of
the Schedule H and are not to be reported on
the Schedule H as an asset thereafter (unless
the participant resumes repayment under the
loan in a later year), they are still considered
outstanding loans and are not treated as
actual distributions for certain purposes. See
Q&As 12 and 19 of Treasury Regulations
section 1.72(p)–1.
Lines 2h–2j Expenses. Report expenses on
the appropriate line items below.
CAUTION. Master trust expenses that are
not allocable to all plans investing in the
master trust must be reported at the
individual plan level. Only master trust
expenses that are reasonably equally
attributable to each participating plan may
be reported at the master trust level. This
includes administrative expenses associated
with investments in which not all plans in
the master trust have an interest.
Line 2h. Interest Expense. Interest expense
is a monetary charge for the use of money
borrowed by the plan. This amount should
include the total of interest paid or to be paid
(for accrual basis plans) during the plan year.
Line 2i. Administrative Expenses. Report
all administrative expenses (by specified
category) paid by or charged to the plan,
including those that were not subtracted from
the gross income of CCTs, PSAs, master
trusts, and 103–12 IEs in determining their
net investment gain(s) or loss(es). Expenses
incurred in the general operations of the plan
are classified as administrative expenses.
Include, in the appropriate categories in lines
2i(1)–(11), the total fees paid (or in the case
of accrual basis plans, costs incurred during
the plan year but not paid as of the end of
the plan year) by the plan for plan salaries
and allowances, outside contract
administrator, investment advisory and
management fees, IQPA audit fees,
recordkeeping and other accounting fees,
bank or trust company trustee/custodial fees,
actuarial fees, legal fees, and valuation/
appraisal services.
Line 2i(1). Salaries and Allowances.
Report total salaries and expenses for plan
employees in Line 2i(1).
Line 2i(2). Contract administrator fees.
Enter the total fees paid (or in the case of
accrual basis plans, costs incurred during the
plan year but not paid as of the end of the
plan year) to a contract administrator for
performing administrative services for the
plan. For purposes of the return/report, a
contract administrator is any individual,
partnership, or corporation, responsible for
managing the clerical operations (e.g.,
handling membership rosters, claims
payments, maintaining books and records) of
the plan on a contractual basis. Do not
include salaried staff or employees of the
plan or banks or insurance carriers.
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Line 2i(3). Investment Advisory and
Management Fees. Enter the total fees paid
(or in the case of accrual basis plans, costs
incurred during the plan year but not paid as
of the end of the plan year) to an individual,
partnership or corporation (or other person)
for advice to the plan relating to its
investment portfolio. These may include fees
paid to manage the plan’s investments, fees
for specific advice on a particular
investment, and fees for the evaluation for
the plan’s investment performance.
Line 2i(4). IQPA Audit Fees. Enter in Line
2j(4) fees for the annual audit of the plan by
an independent qualified public accountant
(IQPA); for payroll audits, and any other
audit fees paid by the plan.
Line 2i(5). Recordkeeping and Other
Accounting Fees. Include fees for
accounting/bookkeeping services other than
amounts paid for audit fees reportable in
Line 2i(4).
Line 2i(6). Bank or Trust Company
Trustee/Custodial Fees. Report here bank or
trust company trustee/custodial fees.
Line 2i(7). Actuarial Fees. Include fees for
actuarial services rendered to the plan,
including preparation of Schedules MB or
SB, as applicable.
Line 2i(8). Legal Fees. Include payments to
a lawyer for rendering legal opinions,
litigation, and advice (but not for providing
legal services as a benefit to plan
participants).
Line 2i(9). Valuation/appraisal Fees.
Include the fee(s) for valuations or appraisals
to determine the cost, quality, or value of an
item such as real property, personal property
(gemstones, coins, etc.), and for valuations of
closely held securities for which there is no
ready market.
Line 2i(10). Trustee Fees and Expenses.
Include the total fees and expenses paid to
or on behalf of plan trustees (or in the case
of accrual basis plans, costs incurred during
the plan year but not paid as of the end of
the plan year). Include direct payment by the
plan or reimbursement by the plan to trustees
of expenses associated with trustees such as
lost time, seminars, travel, meetings,
educational conferences, etc. Do not include
in Line 2i(10) amounts paid to plan
employees to perform bookkeeping/
accounting functions that should be included
in Line 2i(5).
Line 2i(11). Other Expenses. Other
expenses are those that cannot be included
in Lines 2-(1) through 2-(10). These may
include plan expenditures such as salaries
and other compensation and allowances,
expenses for office supplies and equipment,
cars, telephone, postage, rent, expenses
associated with the ownership of a building
used in the operation of the plan, and all
miscellaneous expenses. Include premium
payments to the PBGC when paid from plan
assets.
Line 2i(12)(C). Total Administrative
Expenses. Add all administrative expense
amounts in column (b) in lines 2i(1) through
(11) and enter total (b).
Line 2j. Total expenses. Add all expense
amounts in column (b) and enter total (b).
Line 2l. Include in these reconciliation
figures the value of all transfers of assets or
liabilities into or out of the plan resulting
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from, among other things, mergers and
consolidations. A transfer of assets or
liabilities occurs when there is a reduction of
assets or liabilities with respect to one plan
and the receipt of these assets or the
assumption of these liabilities by another
plan. A transfer is not a shifting of one plan’s
assets or liabilities from one investment to
another. A transfer is not a distribution of all
or part of an individual participant’s account
balance that is reportable on IRS Form 1099–
R, Distributions From Pensions, Annuities,
Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc. (See the instructions
for Line 2f). Transfers out at the end of the
year should be reported as occurring during
the plan year.
Note. If this Schedule H is filed for a CCT,
PSA, master trust, or 103–12 IE, report the
value of all asset transfers to the CCT, PSA,
master trust, or 103–12 IE, including those
resulting from contributions to participating
plans on Line 2l(1), and report the total value
of all assets transferred out of the CCT, PSA,
master trust, or 103–12 IE, including assets
withdrawn for disbursement as benefit
payments by participating plans, on Line
2l(2). Contributions and benefit payments are
considered to be made to/by the plan (not to/
by a CCT, PSA, master trust, or 103–12 IE).
Part III—Accountant’s Opinion
Line 3. The administrator of an employee
benefit plan who files a Schedule H generally
must engage an Independent Qualified Public
Accountant (IQPA) pursuant to ERISA
section 103(a)(3)(A) and 29 CFR 2520.103–
1(b). This requirement also applies to a Form
5500 Annual Return/Report filed for a 103–
12 IE and for a GIA (see 29 CFR 2520.103–
12 and 29 CFR 2520.103–2). The IQPA’s
report must be attached to the Form 5500
when a Schedule H is attached unless you
checked Schedule H, Line 3h(1), (2), or (3) or
(4).
[CAUTION] If you checked Schedule H,
Line 3h(3) to indicate that the required
IQPA’s report is not attached to the Form
5500, the filing is subject to rejection as
incomplete and penalties may be assessed.
Notes. (1) An IQPA Report generally
consists of an Accountant’s Opinion,
Financial Statements, Notes to the Financial
Statements, and Supplemental Schedules. 29
CFR 2520.103–1(b) requires that any separate
financial statements prepared in order for the
IQPA to form the opinion and notes to these
financial statements must be attached to the
Form 5500. Any separate statements must
include the information required to be
disclosed in Parts I and II of the Schedule H;
however, they may be aggregated into
categories in a manner other than that used
on the Schedule H. The separate statements
must consist of reproductions of Parts I and
II or statements incorporating by reference
Parts I and II. See ERISA section 103(a)(3)(A),
and the DOL regulations 29 CFR 2520.103–
1(a)(2) and (b), 2520.103–2, and 2520.104–50.
(2) Delinquent participant contributions
reported on Line 4a must be treated as part
of the separate schedules referenced in
ERISA section 103(a)(3)(A) and 29 CFR
2520.103–1(b) and 2520.103–2(b) for
purposes of preparing the IQPA’s opinion
described on Line 3 even though they are not
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required to be listed on Part III of the
Schedule G. If the information contained on
Line 4a is not presented in accordance with
regulatory requirements, i.e., when the IQPA
concludes that the scheduled information
required by Line 4a does not contain all the
required information or contains information
that is inaccurate or is inconsistent with the
plan’s financial statements, the IQPA report
must make the appropriate disclosures in
accordance with generally accepted auditing
standards. Delinquent participant
contributions that are exempt because they
satisfy the DOL Voluntary Fiduciary
Correction Program (VFCP) requirements and
the conditions of prohibited transaction
exemption (PTE) 2002–51 do not need to be
treated as part of the schedule of nonexempt
party-in-interest transactions.
Lines 3a(1) through 3a(4). These boxes
identify the type of opinion offered by the
IQPA.
Line 3a(1). Check if an unqualified opinion
was issued. Generally, an unqualified
opinion is issued when the IQPA concludes
that the plan’s financial statements present
fairly, in all material respects, the financial
status of the plan as of the end of the period
audited and the changes in its financial
status for the period under audit in
conformity with generally accepted
accounting principles (GAAP) or another
comprehensive basis of accounting (OCBOA),
e.g., cash basis.
Line 3a(2). Check if a qualified opinion
was issued. Generally, a qualified opinion is
issued by an IQPA when the plan’s financial
statements present fairly, in all material
respects, the financial status of the plan as of
the end of the audit period and the changes
in its financial status for the period under
audit in conformity with GAAP or OCBOA,
except for the effects of one or more matters
described in the opinion.
Line 3a(3). Check if a disclaimer of opinion
was issued. A disclaimer of opinion is issued
when the IQPA does not express an opinion
on the financial statements because he or she
has not performed an audit sufficient in
scope to enable him or her to form an
opinion on the financial statements.
Line 3a(4). Check if the plan received an
adverse accountant’s opinion. Generally, an
adverse opinion is issued by an IQPA when
the plan’s financial statements do not present
fairly, in all material respects, the financial
status of the plan as of the end of the audit
period and the changes in its financial status
for the period under audit in conformity with
GAAP or OCBOA.
Line 3b. Limited Scope Audit and
Certification of Assets. Check ‘‘Yes’’ if a box
is checked on Line 3a, and the only
limitation on the scope of the plan’s audit
was pursuant to DOL regulations 29 CFR
2520.103–8 and 2520.103–12(d) because the
examination and report of an IQPA did not
extend to: (1) statements or information
regarding assets held by a bank, similar
institution, or insurance carrier that is
regulated and supervised and subject to
periodic examination by a state or federal
agency provided that the statements or
information are prepared by and certified to
by the bank or similar institution or an
insurance carrier, or (2) information included
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with the Form 5500 filed for a 103–12 IE. The
term ‘‘similar institution’’ as used here does
not extend to securities brokerage firms (see
DOL Advisory Opinion 93–21A). See 29 CFR
2520.103–8 and 2520.103–12(d).
[CAUTION] Check ‘‘No’’ if the scope of the
plan’s audit was limited for any reason in
addition to that pursuant to DOL regulations
29 CFR 2520.103–8 and 2520.103–12.
You must attach a copy of the
certification(s) if the audit opinion was
limited in scope pursuant to DOL regulations
29 CFR 2520.103–8 and 2520.103–12(d)
(regardless of whether you checked ‘‘yes’’ for
Line 3b). Although you must attach a copy
of the certification(s), you do not need to
include any attachments to the certification
itemizing the assets to which the
certification(s) apply.
Note. These regulations do not exempt the
plan administrator from engaging an IQPA or
from attaching the IQPA’s report to the Form
5500. If you check Line 3b, you must also
check the appropriate box on Line 3a to
identify the type of opinion offered by the
IQPA.
Line 3c. Enter the name and EIN of the
accountant (or accounting firm) in the space
provided on Line 3c. Do not use a social
security number or any portion thereof in
lieu of an EIN. The Schedule H is open to
public inspection, and the contents are
public information and are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof on
this Schedule H may result in the rejection
of the filing. If the name of an accounting
firm is entered in Line 3c(1), enter the name
of the audit engagement partner in Line 1c(3).
Line 3d. Enter the state in which the
accountant’s opinion was issued.
Line 3e. Check ‘‘Yes’’ if you reviewed and
discussed the IQPA report with the
accountant preparing the report?
Line 3f. If you answered ‘‘Yes,’’ to Line 3e,
check all that apply.
Line 3h(1). Check this box only if the
Schedule H is being filed for a CCT, PSA, or
master trust.
Line 3h(2). Check this box if the plan has
elected to defer attaching the IQPA’s opinion
for the first of two (2) consecutive plan years,
one of which is a short plan year of seven
(7) months or fewer. The Form 5500 for the
first of the two (2) years must be complete
and accurate, with all required attachments,
except for the IQPA’s report, including an
attachment explaining why one of the two (2)
plan years is of seven (7) or fewer months
duration and stating that the annual report
for the immediately following plan year will
include a report of an IQPA with respect to
the financial statements and accompanying
schedules for both of the two (2) plan years.
The Form 5500 for the second year must
include: (a) financial schedules and
statements for both plan years; (2) a report of
an IQPA with respect to the financial
schedules and statements for each of the two
(2) plan years (regardless of the number of
participants covered at the beginning of each
plan year); and (3) a statement identifying
any material differences between the
unaudited financial information submitted
with the first Form 5500 and the audited
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financial information submitted with the
second Form 5500. See 29 CFR 2520.104–50.
Note. Do not check the box on Line 3h(2)
if the Form 5500 is filed for a 103–12 IE or
a GIA. A deferral of the IQPA’s opinion is not
permitted for a 103–12 IE or a GIA. If the box
for 103–12 IE or GIA is checked on Form
5500, Part I, Line A(5), an IQPA’s opinion
must be attached to the Form 5500 and the
type of opinion must be reported on
Schedule H, Line 3a.
Line 3h(4). Small Plan Audit Waiver.
Check ‘‘Yes’’ if you are a small plan claiming
a waiver of the annual examination and
report of an independent qualified public
accountant (IQPA) under 29 CFR 2520.104–
46. Large plans are not eligible for the audit
waiver under 29 CFR 2520.104–46. You are
eligible to claim the waiver if this filing is
for:
1. A small welfare plan, or
2. A small pension plan for a plan year that
began on or after April 18, 2001, that
complies with the conditions of 29 CFR
2520.104–46 summarized below.
Note. For plans that check ‘‘No,’’ the IQPA
report must make the appropriate disclosures
in accordance with generally accepted
auditing standards if the information
reported on Line 4a is not presented in
accordance with regulatory requirements.
The following summarizes the conditions
of 29 CFR 2520.104–46 that must be met for
a small pension plan with a plan year
beginning on or after April 18, 2001, to be
eligible for the waiver. For more information
regarding these requirements, see the EBSA’s
Frequently Asked Questions on the Small
Pension Plan Audit Waiver Regulation and
29 CFR 2520.104–46, which are available at
www.dol.gov/ebsa, or call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–3278)
(toll-free).
Condition 1: At least 95 percent of plan
assets are ‘‘qualifying plan assets’’ as of the
end of the preceding plan year, or any person
who handles assets of the plan that do not
constitute qualifying plan assets is bonded in
accordance with the requirements of ERISA
section 412 (see the instructions for Line 4e),
except that the amount of the bond shall not
be less than the value of such non-qualifying
assets. The determination of the ‘‘percent of
plan assets’’ as of the end of the preceding
plan year and the amount of any required
bond must be made at the beginning of the
plan’s reporting year for which the waiver is
being claimed. For purposes of this line, you
will have satisfied the requirement to make
these determinations at the beginning of the
plan reporting year for which the waiver is
being claimed if they are made as soon after
the date when such year begins as the
necessary information from the preceding
reporting year can practically be ascertained.
See 29 CFR 2580.412–11, 14 and 19 for
additional guidance on these determinations,
and 29 CFR 2580.412–15 for procedures to be
used for estimating these amounts if there is
no preceding plan year.
The term ‘‘qualifying plan assets,’’ for
purposes of this line means:
1. Any assets held by any of the following
regulated financial institutions:
a. A bank or similar financial institution as
defined in 29 CFR 2550.408b-4(c);
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b. An insurance company qualified to do
business under the laws of a state;
c. An organization registered as a brokerdealer under the Securities Exchange Act of
1934; or
d. Any other organization authorized to act
as a trustee for individual retirement
accounts under Code section 408.
2. Shares issued by an investment
company registered under the Investment
Company Act of 1940 (e.g., mutual funds);
3. Investment and annuity contracts issued
by any insurance company qualified to do
business under the laws of a state;
4. In the case of an individual account
plan, any assets in the individual account of
a participant or beneficiary over which the
participant or beneficiary has the opportunity
to exercise control and with respect to which
the participant or beneficiary is furnished, at
least annually, a statement from a regulated
financial institution referred to above
describing the assets held or issued by the
institution and the amount of such assets;
5. Qualifying employer securities, as
defined in ERISA section 407(d)(5); and
6. Participant loans meeting the
requirements of ERISA section 408(b)(1).
Condition 2: The administrator must
disclose the following information in the
summary annual report (SAR) furnished to
participants and beneficiaries, in accordance
with 29 CFR 2520.104b-10. For defined
benefit pension plans that are required
pursuant to section 101(f) of ERISA to furnish
an Annual Funding Notice (AFN), the
administrator must instead either provide the
information to participants and beneficiaries
with the AFN or as a stand-alone notification
at the time a SAR would have been due and
in accordance with the rules for furnishing
an SAR, although such plans do not have to
furnish a SAR.
1. The name of each regulated financial
institution holding or issuing qualifying plan
assets and the amount of such assets reported
by the institution as of the end of the plan
year (this SAR disclosure requirement does
not apply to qualifying employer securities,
participant loans and individual account
assets described in paragraphs 4,5 and 6
above);
2. The name of the surety company issuing
the fidelity bond, if the plan has more than
5% of its assets in non-qualifying plan assets;
3. A notice that participants and
beneficiaries may, upon request and without
charge, examine or receive from the plan
evidence of the required bond and copies of
statements from the regulated financial
institutions describing the qualifying plan
assets; and
4. A notice that participants and
beneficiaries should contact the EBSA
Regional Office if they are unable to examine
or obtain copies of the regulated financial
institution statements or evidence of the
required bond, if applicable.
A Model Notice that plans can use to
satisfy the enhanced SAR (or Annual
Funding Notice) disclosure requirements to
be eligible for the audit waiver is available
as an Appendix to 29 CFR 2520.104–46.
Condition 3: In addition, in response to a
request from any participant or beneficiary,
the administrator, without charge to the
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participant or beneficiary, must make
available for examination, or upon request
furnish copies of, each regulated financial
institution statement and evidence of any
required bond.
Examples. Plan A, which has a plan year
that began on or after April 18, 2001, had
total assets of $600,000 as of the end of the
20XX–1 plan year that included: investments
in various bank, insurance company and
mutual fund products of $520,000;
investments in qualifying employer securities
of $40,000; participant loans (meeting the
requirements of ERISA section 408(b)(1)),
totaling $20,000; and a $20,000 investment in
a real estate limited partnership. Because the
only asset of the plan that did not constitute
a ‘‘qualifying plan asset’’ is the $20,000 real
estate limited partnership investment and
that investment represents less than 5% of
the plan’s total assets, no fidelity bond is
required as a condition for the plan to be
eligible for the waiver for the 20XX plan year.
Plan B is identical to Plan A except that
of Plan B’s total assets of $600,000 as of the
end of the 20XX–1 plan year, $558,000
constitutes ‘‘qualifying plan assets’’ and
$42,000 constitutes non-qualifying plan
assets. Because 7%—more than 5%—of Plan
B’s assets do not constitute ‘‘qualifying plan
assets,’’ Plan B, as a condition to be eligible
for the waiver for the 20XX plan year, must
ensure that it has a fidelity bond in an
amount equal to at least $42,000 covering
persons handling its non-qualifying plan
assets. Inasmuch as compliance with ERISA
section 412 generally requires the amount of
the bond be not less than 10% of the amount
of all the plan’s funds or other property
handled, the bond acquired for ERISA
section 412 purposes may be adequate to
cover the non-qualifying plan assets without
an increase (i.e., if the amount of the bond
determined to be needed for the relevant
persons for ERISA section 412 purposes is at
least $42,000). As demonstrated by the
foregoing example, where a plan has more
than 5% of its assets in non-qualifying plan
assets, the required bond is for the total
amount of the non-qualifying plan assets, not
just the amount in excess of 5%.
If you need further information regarding
these requirements, see 29 CFR 2520.104–46
which is available at www.dol.gov/ebsa or
call the EFAST2 Help Line at 1–866–GO
EFAST (1–866–463–3278) (toll-free).
Part IV—Compliance Questions
Lines 4a through 4z. Plans completing
Schedule H must answer all these lines with
either ‘‘Yes’’ or ‘‘No.’’ Do not leave any
answer blank, unless otherwise directed. For
Lines 4a through 4h and Line 4l, if the
answer is ‘‘Yes,’’ an amount must be entered.
Report investments in CCTs, PSAs, master
trusts, and 103–12 IEs, but not the
investments made by these entities. Plans
with all of their funds held in a master trust
should check ‘‘No’’ on Line 4b and 4c. CCTs
and PSAs complete only Line 4i(1). Master
trusts and 103–12 IEs complete only Lines
4b, 4c, 4d, 4i(1) and (2), 4j, and 4s. GIAs
complete only Lines 4b, 4c, 4d, 4i(1) and (2),
4j, and 4k. Except as otherwise provided, all
plans and DFEs that have not checked on
Form 5500 that this is the ‘‘final’’ return/
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47627
report and have indicated that they have no
assets (‘‘-0-’’) must check ‘‘Yes’’ on Line 4i(1)
and complete the Line 4i(1) Schedule of
Assets Held for Investment at End of Year.
Where applicable, they must also check
‘‘Yes’’ on Line 4i(2) and complete the Line
4i(2) Schedule of Assets Disposed of During
the Plan Year.
Small welfare plans that are required to
complete the Schedule H, do not have to
complete the attachments to Line 4(a), Line
4i(1) and (2), and Line 4j, even if the answer
to any of those questions is ‘‘Yes.’’
Line 4a. Amounts paid by a participant or
beneficiary to an employer and/or withheld
by an employer for contribution to the plan
are participant contributions that become
plan assets as of the earliest date on which
such contributions can reasonably be
segregated from the employer’s general assets
(see 29 CFR 2510.3–102). Plans that check
‘‘Yes’’ must enter the aggregate amount of all
late contributions for the year. The total
amount of the delinquent contributions
should be included on Line 4a of the
Schedule H for the year in which the
contributions were delinquent and should be
carried over and reported again on Line 4a
of the Schedule H, for each subsequent year
until the year after the violation has been
fully corrected, which correction includes
payment of the late contributions and
reimbursement of the plan for lost earnings
or profits. If no participant contributions
were received or withheld by the employer
during the plan year, answer ‘‘No.’’
An employer holding these assets after that
date commingled with its general assets will
have engaged in a prohibited use of plan
assets (see ERISA section 406). If such a
nonexempt prohibited transaction occurred
with respect to a disqualified person (see
Code section 4975(e)(2)), file IRS Form 5330,
Return of Excise Taxes Related to Employee
Benefit Plans, with the IRS to pay any
applicable excise tax on the transaction.
Participant loan repayments paid to and/or
withheld by an employer for purposes of
transmittal to the plan that were not
transmitted to the plan in a timely fashion
must be reported either on Line 4a in
accordance with the reporting requirements
that apply to delinquent participant
contributions or on Line 4d. See Advisory
Opinion 2002–02A, available at
www.dol.gov/ebsa.
[CAUTION] Delinquent participant
contributions reported on Line 4a should be
treated as part of the separate schedules
referenced in ERISA section 103(a)(3)(A) and
29 CFR 2520.103–1(b) and 2520.103–2(b) for
purposes of preparing the IQPA’s opinion
described on Line 3 even though they are not
required to be listed on Part III of the
Schedule G. If the information contained on
Line 4a is not presented in accordance with
regulatory requirements, i.e., when the IQPA
concludes that the scheduled information
required by Line 4a does not contain all the
required information or contains information
that is inaccurate or is inconsistent with the
plan’s financial statements, the IQPA report
must make the appropriate disclosures in
accordance with generally accepted auditing
standards. For more information, see EBSA’s
Frequently Asked Questions About Reporting
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Delinquent Contributions on the Form 5500,
available on the Internet at www.dol.gov/
ebsa. These Frequently Asked Questions
clarify that plans have an obligation to
include delinquent participant contributions
on their financial statements and
supplemental schedules and that the IQPA’s
report covers such delinquent contributions
even though they are not required to be
included on Part III of the Schedule G.
Although all delinquent participant
contributions must be reported on Line 4a,
delinquent contributions for which the DOL
VFCP requirements and the conditions of
PTE 2002–51 have been satisfied do not need
to be treated as nonexempt party-in-interest
transactions.
[TIP] The VFCP describes how to apply,
the specific transactions covered (which
transactions include delinquent participant
contributions to pension and welfare plans),
and acceptable methods for correcting
violations. In addition, applicants that satisfy
both the VFCP requirements and the
conditions of PTE 2002–51 are eligible for
immediate relief from payment of certain
prohibited transaction excise taxes for certain
corrected transactions, and are also relieved
from the obligation to file the IRS Form 5330
with the IRS. For more information, see 71
FR 20261 (Apr. 19, 2006) and 71 FR 20135
(Apr. 19, 2006). Information about the VFCP
is also available on the Internet at
www.dol.gov/ebsa.
All participant contributions that were
delinquent during the plan year must be
reported on Line 4a even if violations have
been corrected.
Line 4a Schedule of Delinquent
Participant Contributions. Complete the
‘‘Line 4a Schedule of Delinquent Participant
Contributions’’ if you entered ‘‘Yes.’’
Element (a). Enter the total amount of
delinquent contributions from this and
previous years that were remitted during the
plan year. Include contributions due in
previous years that were remitted during this
plan year. If you include participant loan
repayments on Line 4a, you must apply the
same supplemental schedule and IQPA
disclosure requirements to the loan
repayments as applied to delinquent
transmittals of participant contributions. If
you include participant loan repayments,
check the box in element (g).
Element (b). Enter the total amount of
delinquent contributions due, but unremitted
during the plan year. You must carry these
over and report them for each subsequent
year until they are fully correct. Include
contributions due in previous plan years, but
still unremitted.
Element (c). Enter the number of payrolls
for which the contributions were delinquent
and uncorrected.
Element (d). Enter in element d(1) the total
amount of delinquent contributions that were
corrected under VFCP. See 71 FR 20261 (Apr.
19, 2006). Information about the VFCP is also
available on the Internet at www.dol.gov/
ebsa. Enter in element d(2) any amount that
were corrected under the VFCP, but not
under PTE 2002–51. See 71 FR 20135 (Apr.
19, 2006). For all amount reported in element
(d), complete element (h) to indicate whether
you filed Form 5330 with the IRS and paid
any applicable excise taxes.
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Element (e). Enter the amount of
delinquent contributions pending correction
in VFCP as of the date of the Form 5500
Annual Return/Report filing.
Element (f). Enter the total amount of
delinquent contributions for which the
contributions were paid and the plan
reimbursed fully for lost earnings or profits
outside of the VFCP. See the VFCP for more
information on how to fully correct
delinquent participant contributions.
Element (g). Check the box in element (g)
if you included delinquent participant loan
repayments on Line 4a and in element (a).
Element (h). Check ‘‘Yes’’ for any amount
reported in element (h) if you filed your
Form 5330 with the IRS and paid all
applicable excise taxes associated with the
delinquent contributions and/or delinquent
participant loan repayments. For more
information on Form 5330, see https://
www.irs.gov/Retirement-Plans/Form-5330Corner.
Element (i). Only multiemployer plans
complete this item. In element (i)(1), enter
the amount of participant contributions from
participating employers in the multiemployer
plan that has been determined during the
plan year to be uncollectible (including
contributions due in previous plan years but
still unremitted). In element (i)(2), explain
what steps were taken to collect overdue
amounts (including whether claims were
submitted on performance bonds) before
determining the amount that is uncollectible.
Line 4b. Plans that check ‘‘Yes’’ must enter
the amount and complete Part I of Schedule
G. The due date, payment amount and
conditions for determining default of a note
or loan are usually contained in the
documents establishing the note or loan. A
loan by the plan is in default when the
borrower is unable to pay the obligation upon
maturity. Obligations that require periodic
repayment can default at any time. Generally,
loans and fixed income obligations are
considered uncollectible when payment has
not been made and there is little probability
that payment will be made. A fixed income
obligation has a fixed maturity date at a
specified interest rate. Do not include
participant loans made under an individual
account plan with investment experience
segregated for each account that were made
in accordance with 29 CFR 2550.408b–1 and
secured solely by a portion of the
participant’s vested accrued benefit. Small
plans that were eligible for and claimed the
small plan audit waiver do not need to attach
Schedule G.
Line 4c. Plans that check ‘‘Yes’’ must enter
the amount and complete Part II of Schedule
G. A lease is an agreement conveying the
right to use property, plant, or equipment for
a stated period. A lease is in default when
the required payment(s) has not been made.
An uncollectible lease is one where the
required payments have not been made and
for which there is little probability that
payment will be made. Small plans that were
eligible for and claimed the small plan audit
waiver do not need to attach Schedule G.
Line 4d. Plans that check ‘‘Yes’’ must enter
the amount and complete Part III of Schedule
G. Small plans that were eligible for and
claimed the small plan audit waiver do not
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need to attach Schedule G. Check ‘‘Yes’’ if
any nonexempt transaction with a party-ininterest occurred regardless of whether the
transaction is disclosed in the IQPA’s report.
Do not check ‘‘Yes’’ or complete Schedule G,
Part III, with respect to transactions that are:
(1) Statutorily exempt under Part 4 of Title
I of ERISA;
(2) Administratively exempt under ERISA
section 408(a);
(3) Exempt under Code sections 4975(c) or
4975(d);
(4) The holding of participant
contributions in the employer’s general assets
for a welfare plan that meets the conditions
of ERISA Technical Release 92–01;
(5) A transaction of a 103–12 IE with
parties other than the plan; or
(6) Delinquent participant contributions or
delinquent participant loan repayments
reported on Line 4a.
Note. See the instructions for Part III of the
Schedule G (Form 5500) concerning
nonexempt transactions and party-in-interest.
You may indicate that an application for an
administrative exemption is pending. If you
are unsure as to whether a transaction is
exempt or not, you should consult with
either the plan’s IQPA or legal counsel or
both.
[TIP] Applicants that satisfy the VFCP
requirements and the conditions of PTE
2002–51 (see the instructions for Line 4a) are
eligible for immediate relief from payment of
certain prohibited transaction excise taxes
for certain corrected transactions, and are
also relieved from the obligation to file the
IRS Form 5330 with the IRS. For more
information, see 71 FR 20261 (Apr. 19, 2006)
and 71 FR 20135 (Apr. 19, 2006). When the
conditions of PTE 2002–51 have been
satisfied, the corrected transactions should
be treated as exempt under Code section
4975(c) for the purposes of answering Line
4d.
Line 4e. Plans that check ‘‘Yes’’ must enter
the aggregate amount of fidelity bond
coverage for all claims. Check ‘‘Yes’’ only if
the plan itself (as opposed to the plan
sponsor or administrator) is a named insured
under a fidelity bond from an approved
surety covering plan officials and that
protects the plan from losses due to fraud or
dishonesty as described in 29 CFR part 2580.
Generally, every plan official of an employee
benefit plan who ‘‘handles’’ funds or other
property of such plan must be bonded.
Generally, a person shall be deemed to be
‘‘handling’’ funds or other property of a plan,
so as to require bonding, whenever his or her
duties or activities with respect to given
funds are such that there is a risk that such
funds could be lost in the event of fraud or
dishonesty on the part of such person, acting
either alone or in collusion with others.
Section 412 of ERISA and 29 CFR part 2580
describe the bonding requirements, including
the definition of ‘‘handling’’ (29 CFR
2580.412–6), the permissible forms of bonds
(29 CFR 2580.412–10), the amount of the
bond (29 CFR part 2580, subpart C), and
certain exemptions such as the exemption for
unfunded plans, certain banks and insurance
companies (ERISA section 412), and the
exemption allowing plan officials to
purchase bonds from surety companies
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authorized by the Secretary of the Treasury
as acceptable reinsurers on federal bonds (29
CFR 2580.412–23).
Information concerning the list of
approved sureties and reinsures is available
on the Internet at www.fms.treas.gov/c570.
For more information on the fidelity bonding
requirements, see Field Assistance Bulletin
2008–04, available on the Internet at
www.dol.gov/ebsa.
Note. Plans are permitted under certain
conditions to purchase fiduciary liability
insurance. These fiduciary liability insurance
policies are not written specifically to protect
the plan from losses due to dishonest acts
and cannot be reported as fidelity bonds on
Line 4e.
Line 4f. Check ‘‘Yes,’’ if the plan suffered
or discovered any loss as a result of any
dishonest or fraudulent act(s) even if the loss
was reimbursed by the plan’s fidelity bond or
from any other source. If the plan suffered
such a loss, enter the full amount of the loss.
If the full amount of the loss has not yet been
determined, provide an estimate and disclose
that the figure is an estimate as determined
in good faith by a plan fiduciary. You must
keep, in accordance with ERISA section 107,
records showing how the estimate was
determined.
CAUTION: Willful failure to report is a
criminal offense. See ERISA section 501.
Line 4g. Check ‘‘Yes’’ if the plan had assets
of which the current value was neither
readily determinable on an established
market nor set by an independent third party
appraiser. Enter in the amount column the
fair market value of the assets referred to on
Line 4g whose value was not readily
determinable on an established market and
which were not valued by an independent
third-party appraiser in the plan year.
Generally, as it relates to these questions, an
appraisal by an independent third party is an
evaluation of the value of an asset prepared
by an individual or firm who knows how to
judge the value of such assets and does not
have an ongoing relationship with the plan
or plan fiduciaries except for preparing the
appraisals.
TIP: Do not check ‘‘Yes’’ on Line 4g for
mutual fund shares or insurance company
investment contracts for which the plan
receives valuation information at least
annually. Also, do not check ‘‘Yes’’ on Line
4g if the plan is a defined contribution
pension plan and the only assets the plan
holds, that do not have a readily
determinable value on an established market,
are: (1) participant loans not in default, or (2)
assets over which the participant exercises
control within the meaning of section 404(c)
of ERISA.
Current value means fair market value
where available. Otherwise, it means the fair
value as determined in good faith under the
terms of the plan by a trustee or a named
fiduciary, assuming an orderly liquidation at
the time of the determination. See ERISA
section 3(26). An accurate assessment of fair
market value is essential to a pension plan’s
ability to comply with the requirements set
forth in the Code (e.g., the exclusive benefit
rule of Code section 401(a)(2), the limitations
on benefits and contributions under Code
section 415, and the minimum funding
requirements under Code section 412) and
must be determined annually.
Examples of assets that may not have a
readily determinable value on an established
market (e.g., NYSE, AMEX, over the counter,
etc.) include real estate, nonpublicly traded
securities, shares in a limited partnership,
derivatives, notes and stock not traded on an
exchange, private equity, and collectibles.
Although the current value of plan assets
must be determined each year, there is no
requirement that the assets (other than
certain nonpublicly traded employer
securities held in ESOPs) be valued every
year by independent third-party appraisers.
Line 4h. Check ‘‘Yes’’ if the plan received
during the plan year noncash contributions
of which the current value was neither
readily determinable on an established
market nor set by an independent third party
appraiser. Enter in the amount column the
fair market value of the assets referred to on
Line 4g whose value was not readily
determinable on an established market and
which were not valued by an independent
third-party appraiser in the plan year. See
instructions for Line 4g.
Line 4i. Schedules of Assets. Check ‘‘Yes’’
in elements (1) and/or (2) and complete, as
appropriate, the ‘‘Line 4i(1) Schedule of
Assets Held for Investment at End of Year’’
and the ‘‘Line 4i(2) Schedule of Assets
Disposed of During the Plan Year.’’ You may
not create your own schedules of assets in
the form of an attachment or otherwise. You
must complete the schedule through IFile or
using EFAST-approved third-party software.
If the plan both disposed of assets during the
plan year and held assets for investment at
end of year, you must complete both the Line
4i(1) and 4i(2) schedules. Generally, all plans
that are ongoing must answer ‘‘Yes’’ to Line
47629
4i(1) and complete the ‘‘Line 4i(1) Schedule
of Assets Held for Investment at End of
Year.’’
Notes: (1) Participant loans under an
individual account plan with investment
experience segregated for each account, that
are made in accordance with 29 CFR
2550.408b-1 and that are secured solely by a
portion of the participant’s vested accrued
benefit, may be aggregated for reporting
purposes in Line 4i. Under identity of
borrower enter ‘‘Participant loans,’’ under
rate of interest enter the lowest rate and the
highest rate charged during the plan year
(e.g., 8%–10%), under the cost and proceeds
columns enter zero, and under current value
enter the total amount of these loans. (2)
Column (d) cost information for the Line
4i(1) Schedule of Assets Held for Investment
at End of Year and the column (c) cost of
acquisitions information for the Line 4i(2)
Schedule of Assets Disposed of During the
Plan Year may be omitted when reporting
investments of an individual account plan
that a participant or beneficiary directed with
respect to assets allocated to his or her
account (including a negative election
authorized under the terms of the plan).
Likewise, cost information for investments in
Code sections 403(b)(1) annuity contracts and
403(b)(7) custodial accounts may also be
omitted. (3) Investments in Code section
403(b)(1) annuity contracts and Code section
403(b)(7) custodial accounts generally may
also be treated as one asset held for
investment for purposes on the Line 4i
schedules. For 403(b)(7) accounts, show the
corresponding Line 1b(5)(A) categories to
show the types of investment accounts.
Line 4i(1). Schedule of Assets Held for
Investment at End of Year. Assets held for
investment purposes for purposes of the Line
4i(1) Schedule of Assets Held for Investment
at End of Year includes all investment assets
held by the plan on the last day of the plan
year other than cash and cash equivalents
reported on Line 1b(1) and (2) that are held
at end of year. You must complete the
Schedule of Assets Held for Investment at
End of Year if you answered ‘‘Yes’’ to Line
4(i)(1).
Line 4i(1) Schedule of Assets Held for
Investment at End of Year (Complete as
many entries in each element as needed to
identify all assets held for investment at end
of year)
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
(a) Assets Held directly by the plan (including assets held through an participant-directed brokerage window) For each asset which the
plan holds for investment purposes that is not a type of assets required to be listed in (b) through (e) below, complete elements (i)–(vii).
(i) Check if issuer,
borrower, lessor
or similar party
is party-in- interest b
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(ii) Name of
issuer, borrower, lessor,
or similar party
19:35 Jul 20, 2016
(iii) Check if
asset is hardto-value asset
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PO 00000
(iv) CUSIP, CIK,
LEI, NAIC
Company
Code, other
registration
number:
Frm 00097
Fmt 4701
(v) Cost
Sfmt 4702
(vi) Indicate Sch.
H, Line 1b
asset category
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(vii) Description of investment, including, as applicable share
class, maturity date, rate of interest, par or maturity value, including whether asset/investment is subject to surrender
charge. See instructions for reporting assets held through a
participant-directed
brokerage
account.
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
(b) Investments in Master Trust (repeat as many entries as needed to identify holdings in master trusts) For each master trust in which
the plan invested, break out plan’s proportionate interest in each asset in the master trust(s) in elements (i)–(viii). Do not include master
trust holdings in which the plan has no interest.
(i) Enter name, EIN/PN of sponsor of master trust used on master trust’s Form 5500.
(ii) Check if
issuer, borrower, lessor or
similar party is
party-in- interest b
(iii) Name of
issuer, borrower, lessor,
or similar party
(See instructions)
(iv) Check if
asset is hardto-value asset
b
(v) Enter all that
apply: EIN,
CUSIP, CIK,
LEI, NAIC
Company
Code, other
registration
number:
(vi) Cost
(vii) Indicate Sch.
H, Line 1b
asset category
(viii) Description of investment, including, as applicable share
class, maturity date, rate of interest, par or maturity value, including whether asset/investment is subject to surrender
charge.
(c) Investments in PSAs and CCTs (repeat as many entries as needed to identify holdings in PSAs and CCTs) If the PSA filed a Form
5500, complete elements (i)–(vii) indicating the value of the plan’s shares in the PSA or CCT. For PSAs or CCTs that have not filed a Form
5500, break out plan’s proportionate interest in each asset in the PSA of CCT in elements (i)–(ix) and include the name and identifying
numbers for the non-filing CCT or PSA, as well a description of the asset held through the non-filing CCT or PSA.
(i) Enter name, EIN/PN of sponsor of CCT/PSA.
(ii) Check if
issuer, borrower, lessor
or similar party
is party-in- interest b
(iii) Check here if
PSA or CCT
filed a Form
5500 b
(iv) Name of
issuer, borrower, lessor,
or similar party
(see Instructions).
(v) Check if
asset is hardto-value asset
b
(vi) Enter all that
apply: EIN,
CUSIP, CIK,
LEI, NAIC
Company
Code: Other
registration
number:
(vii)
Cost
(viii) Indicate
Sch. H, Line
1b asset category
(ix) Description
of investment,
including, as
applicable
share class,
maturity date,
rate of interest, par or maturity value,
and whether
asset/investment is subject to surrender charge.
(d) Investments in 102–12 Investment Entities (repeat as many entries as needed to identify holdings in 103–12 IEs)
(i) Enter name, EIN of provider of the 103–12 IE.
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
(ii) Check if issuer,
borrower, lessor
or similar party is
party-in- interest
b
(iii) Name of issuer,
borrower, lessor,
or similar party
(See instructions)
(iv) Check if asset
is hard-to-value
asset b
Element (a). Assets Held Directly By the
Plan. Investments held by the plan are all
assets held by the plan except interests in
master trusts; interests in pooled separate
accounts (PSAs) and common collective
trusts (CCTs), regardless of whether the PSA
or CCT files a Form 5500; and interests in
103–12 Investment Entities (103–12 IEs). For
each asset held directly by the plan, complete
elements (i)–(vii).
Participant-directed brokerage account
assets reported in the aggregate on Line
1b(14) generally may be treated as one asset
held for investment for purposes here, except
investments in tangible personal property,
loans, partnership or joint venture interests,
real property, employer securities, and
investments that could result in a loss in
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
(v) Enter all that
apply: EIN,
CUSIP, CIK, LEI,
NAIC Company
Code: Other registration number:
(vi) Cost
excess of the account balance of the
participant or beneficiary who directed the
transaction must be reported as separate
aggregations of assets on Line 4i(1)(a), with
an indication of which of the Line 1b(14)
breakouts that the asset was reported as being
held through a participant-directed brokerage
account.
Element a(ii). Check the box in element a(i)
if the issuer of the investment is a person
known to be a party-in-interest to the plan.
This includes when the seller, issuer, lender,
or similar party is the employer, employee
organization, a service provider to the plan,
or other party interest, including a
subcontractor or affiliate.
Element a(iii). Enter the name of the seller,
issuer, lender, or similar party. If the person
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Frm 00098
Fmt 4701
Sfmt 4702
(vii) Indicate Line
1b asset category
(viii) Description of
investment, including, as applicable share
class, maturity
date, rate of interest, par or maturity value, including whether
asset/investment
is subject to surrender charge.
is a plan sponsor, service provider, or direct
filing entity also identified on the Form 5500,
Schedule C or any other of the Schedule H
Line 4 schedules, or is a DFE that files its
own Form 5500, use the same name in all
places.
Element a(iv). Check here if the asset is a
‘‘hard-to-value’’ asset. Assets that are not
listed on any national exchanges or over-thecounter markets, or for which quoted market
prices are not available from sources such as
financial publications, the exchanges, or the
National Association of Securities Dealers
Automated Quotations System (NASDAQ),
are required to be identified as hard-to-value
assets on the Schedule of Assets Held for
Investment at End of Year. Bank collective
investment funds or insurance company
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
pooled separate accounts that are primarily
invested in assets that are listed on national
exchanges or over-the-counter markets and
are valued at least annually need not be
identified as hard-to-value assets. CCTs or
PSAs invested primarily in hard-to-value
assets must also be identified as a hard-tovalue asset. A non-exhaustive list of
examples of assets that would be required to
be identified as hard-to-value on the
proposed schedules of assets is: non-publicly
traded securities, real estate, private equity
funds; hedge funds; and real estate
investment trusts (REITs).
Element a(v). If the person is a plan
sponsor, service provider, or direct filing
entity also identified on the Form 5500,
Schedule C, or Schedule D, or any other of
the Schedule H Line 4 schedules, or is a DFE
that files its own Form 5500, use the same
identification numbers in all places. If the
person identified in element (c), has a CUSIP,
CIK number, LEI, NAIC Company Code, or
other government or market exchange
registration or identity number, you must
include all that apply here.
Element a(vi). Enter the acquisition cost of
the asset.
Element a(vii). Enter in element a(vii) in
which category the asset was part of the total
on Line 1b.
Element a(viii). Enter a description of the
investment, including, as applicable maturity
date, rate of interest, par, or maturity value,
including whether asset/investment is
subject to surrender charge. Include any
restriction on transferability of corporate
securities. (Include lending of securities
permitted under Prohibited Transactions
Exemption 81–6.)
Element (b)—Investments in Master
Trusts. For each master trust in which the
plan invested, complete elements (b)(ii)–(vi)
for each asset in which the plan had an
interest. Do not include assets held by the
master trust in which the plan does not hold
an interest.
Example. A master trust in which Plan A,
Plan B, and Plan C invest, has various assets,
including a parcel of real estate. Only Plan
A and Plan B are invested in the parcel of
real estate. The remaining assets of the
master trust are held proportionately by all
three plans. Plans A and B should report
information on their holding in all of the
assets of the plan, including the parcel of real
estate. Plan C should report only its
proportionate interest in the assets other than
the parcel of real estate.
Element (c)—Investments in PSAs and
CCTs. For all investments in PSAs and CCTs,
enter the name, EIN/PN of the sponsor of the
PSA or CCT, regardless of whether the PSA
or CCT filed a Form 5500 in element (c)(i).
Check the box in element (c)(iii) to indicate
whether the CCT or PSA filed a Form 5500.
If the CCT or PSA did not file a Form 5500,
leave element (c)(iii) blank.
If the CCT or PSA filed a Form 5500, make
sure to report in element (c)(i) the same
name, EIN/PN as reported on the CCT or
PSA’s Form 5500. If the CCT or PSA filed a
Form 5500, enter ‘‘same name’’ in element
(c)(iv).
If the CCT or PSA did not file a Form 5500,
you must provide the name of the issuer,
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19:35 Jul 20, 2016
Jkt 238001
borrower, lessor, or similar party of each
individual asset in the CCT or PSA in
element c(iv). Complete as many entries in
elements (c)(ii)-(ix) as needed to identify the
assets held by each CCT or PSA that did not
file a Form 5500.
For an investment in a CCT or PSA that
filed a Form 5500, check the box in element
c(v) to indicate if the CCT or PSA is primarily
invested in hard-to-value assets.
Element (d). Investments in 103–12
Investment Entities. Complete as many
entries as need to identify holdings in 103–
12 IEs. Do not report in element (d)
investments in any entities other than in an
entity that filed a Form 5500 for itself as a
103–12 IE.
Line 4i(2) Assets Disposed of During Plan
Year.
You must identify on the Line 4i(2)
Schedule each investment asset sold during
the plan year except:
1. Debt obligations of the U.S. or any U.S.
agency.
2. Interests issued by a company registered
under the Investment Company Act of 1940
(e.g., a mutual fund).
3. Bank certificates of deposit with a
maturity of one year or less.
4. Commercial paper with a maturity of 9
months or less if it is valued in the highest
rating category by at least two nationally
recognized statistical rating services and is
issued by a company required to file reports
with the Securities and Exchange
Commission under section 13 of the
Securities Exchange Act of 1934.
5. Participations in a bank common or
collective trust.
6. Participations in an insurance company
pooled separate account.
7. Securities purchased from a brokerdealer registered under the Securities
Exchange Act of 1934 and either: (1) listed
on a national securities exchange and
registered under section 6 of the Securities
Exchange Act of 1934 or (2) quoted on
NASDAQ.
Assets disposed of during the plan year
shall not include any investment that was not
held by the plan on the last day of the plan
year if that investment is reported in the
annual report for that plan year in any of the
following:
1. The schedule of loans or fixed income
obligations in default required by Schedule
G, Part I;
2. The schedule of leases in default or
classified as uncollectible required by
Schedule G, Part II;
3. The schedule of nonexempt transactions
required by Schedule G, Part III; or
4. The schedule of reportable transactions
required by Schedule H, Line 4j.
Line 4i(2). Schedule of Assets Disposed of
During the Plan Year. You must complete
the ‘‘Schedule of Assets Disposed of During
the Plan Year’’ if you answered ‘‘Yes’’ to Line
4(i)(2).
Element (a). Enter the name of the seller,
issuer, lender, or similar party. If the person
is a plan sponsor, service provider, or direct
filing entity also identified on the Form 5500,
Schedule C, or Schedule D, or any other of
the Schedule H Line 4 schedules, use the
same name in all places. If the asset was held
PO 00000
Frm 00099
Fmt 4701
Sfmt 4702
47631
through a master trust, 103–12 IE, CCT, or
PSA provide the name, EIN and PN of the
entity. For DFEs use the same identifying
information used on the entity’s own Form
5500. For CCTs and PSAs, check the
appropriate box to indicate whether or not
the CCT or PSA filed a Form 5500.
Element (b). Indicate in element (b)
whether the seller, issuer, lender, or similar
party is the employer, employee
organization, or other party interest,
including a subcontractor or affiliate.
Element (c). Check if the asset was
acquired during the plan year.
Element (d). In element (e) enter the
employer identification number (EIN) of
issuer, borrower, lessor, similar party. If the
person is a plan sponsor, service provider, or
direct filing entity also identified on the
Form 5500, Schedule C, or Schedule D, or
any other of the Schedule H, Line 4
schedules, use the same name in all places.
Element (e). Enter in element (c) in which
category the asset was part of the total on
Line 1(b).
Element (a).
Element (f). Enter the acquisition cost here.
Element (g). Enter the sale price.
Element (h). Enter the total expenses
incurred with disposal of asset, including
any termination or surrender charges.
Element (i). Enter the net gain (loss) on the
asset.
Element (j). Enter a description of the
investment, including maturity date, rate of
interest, collateral, par, or maturity value.
Line 4j. Check ‘‘Yes’’ and attach to the
Form 5500 the following schedule if the plan
had any reportable transactions (see 29 CFR
2520.103–6 and the examples provided in the
regulation). You may not create your own
schedules of assets, but must complete the
schedules through IFile or using EFASTapproved third-party software.
A reportable transaction includes:
1. A single transaction within the plan year
in excess of 5% of the current value of the
plan assets;
2. Any series of transactions with or in
conjunction with the same person, involving
property other than securities, which amount
in the aggregate within the plan year
(regardless of the category of asset and the
gain or loss on any transaction) to more than
5% of the current value of plan assets;
3. Any transaction within the plan year
involving securities of the same issue if
within the plan year any series of
transactions with respect to such securities
amount in the aggregate to more than 5% of
the current value of the plan assets; and
4. Any transaction within the plan year
with respect to securities with, or in
conjunction with, a person if any prior or
subsequent single transaction within the plan
year with such person, with respect to
securities, exceeds 5% of the current value of
plan assets.
The 5% figure is determined by comparing
the current value of the transaction at the
transaction date with the current value of the
plan assets at the beginning of the plan year.
If this is the initial plan year, you may use
the current value of the plan assets at the end
of the plan year to determine the 5% figure.
If the assets of two or more plans are
maintained in one trust, except as provided
E:\FR\FM\21JYP3.SGM
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Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
below, the plan’s allocable portion of the
transactions of the trust shall be combined
with the other transactions of the plan, if any,
to determine which transactions (or series of
transactions) are reportable (5%)
transactions.
For investments in common/collective
trusts (CCTs), pooled separate accounts
(PSAs), 103–12 IEs, and registered
investment companies determine the 5%
figure by comparing the transaction date
value of the acquisition and/or disposition of
units of participation or shares in the entity
with the current value of the plan assets at
the beginning of the plan year. If the
Schedule H is attached to a Form 5500 filed
for a plan with all plan funds held in a
master trust, check ‘‘No’’ on Line 4j. Plans
with assets in a master trust that have other
transactions should determine the 5% figure
by subtracting the current value of plan
assets held in the master trust from the
current value of all plan assets at the
beginning of the plan year and check ‘‘Yes’’
or ‘‘No,’’ as appropriate. Do not include
individual transactions of CCTs, PSAs,
master trusts, 103–12 IEs, and registered
investment companies in which this plan or
DFE invests.
In the case of a purchase or sale of a
security on the market, do not identify the
person from whom purchased or to whom
sold.
Special rule for certain participantdirected transactions. Transactions under
an individual account plan that a participant
or beneficiary directed with respect to assets
allocated to his or her account (including a
negative election authorized under the terms
of the plan) should not be treated for
purposes of Line 4j as reportable
transactions. The current value of all assets
of the plan, including these participantdirected transactions, should be included in
determining the 5% figure for all other
transactions.
Line 4j. Schedule of Reportable
Transactions. You must complete the
‘‘Schedule of Reportable Transactions’’ if you
answered ‘‘Yes’’ to Line 4(j).
Element (a). Check the box in element (a)
if the seller, issuer, lender, or similar party
is the employer, employee organization,
service provider, or other party interest,
including a subcontractor or affiliate.
Element (b). Enter the name and EIN of the
seller, issuer, lender, or similar party. If the
person is a plan sponsor, service provider, or
direct filing entity also identified on the
Form 5500, Schedule C, or Schedule D, or
any other of the Schedule H Line 4
schedules, use the same name in all places.
Element (c). Enter a description of the
asset, including interest rate and maturity
date in the case of the loan.
Element (d). Enter the purchase price,
regardless of whether the transaction being
reported here is the acquisition or disposal of
an asset.
Element (e). If the transaction was the
disposal of an asset, enter the sale price.
Element (f). If the transaction involved a
lease, enter a description of the lease terms
including annual rental and duration of
lease.
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19:35 Jul 20, 2016
Jkt 238001
Element (g). Enter the total expenses
incurred in connection with the transaction,
including fees and commissions.
Element (h). Enter the cost of the asset.
Element (i). Enter the current value of the
asset on transaction date.
Line 4k. You must check ‘‘Yes’’ if any
benefits due under the plan were not timely
paid or not paid in full. This would include
minimum required distributions to 5%
owners who have attained 701⁄2 whether or
not retired and/or non-5% owners who have
attained 701⁄2 and have retired or separated
from service, see section 401(a)(9) of the
Code. Include in this amount the total of any
outstanding amounts that were not paid
when due in previous years that have
continued to remain unpaid.
Do not enter ‘‘Yes’’ if the only benefits not
paid are those owed to ‘‘missing’’ or ‘‘lost’’
participants, and the plan fiduciaries have
acted in compliance with the Department of
Labor’s Field Assistance Bulletin 2014–01 to
attempt to locate the participants.
Line 4l ‘‘Blackout Period.’’ Check ‘‘Yes’’ if
there was a ‘‘blackout period.’’ A blackout
period is a temporary suspension of more
than three (3) consecutive business days
during which participants or beneficiaries of
a 401(k) or other individual account pension
plan were unable to, or were limited or
restricted in their ability to, direct or
diversify assets credited to their accounts,
obtain loans from the plan, or obtain
distributions from the plan. A ‘‘blackout
period’’ generally does not include a
temporary suspension of the right of
participants and beneficiaries to direct or
diversity assets credited to their accounts,
obtain loans from the plan, or obtain
distributions from the plan if the temporary
suspension is: (1) part of the regularly
scheduled operations of the plan that has
been disclosed to participants and
beneficiaries; (2) due to a qualified domestic
relations order (QDRO) or because of a
pending determination as to whether a
domestic relations order is a QDRO; (3) due
to an action or a failure to take action by an
individual participant or because of an action
or claim by someone other than the plan
regarding a participant’s individual account;
or (4) by application of federal securities
laws. For more information, see 29 CFR
2520.101–3 (available at www.dol.gov/ebsa).
Line 4m. If there was a blackout period,
did you provide the required notice not less
than 30 days nor more than 60 days in
advance of restricting the rights of
participants and beneficiaries to change their
plan investments, obtain loans from the plan,
or obtain distributions from the plan? If so,
check ‘‘Yes.’’ See 29 CFR 2520.101–3 for
specific notice requirements and for
exceptions from the notice requirement.
Also, answer ‘‘Yes’’ if one of the exceptions
to the notice requirement under 29 CFR
2520.101–3 applies.
Line 4n. Disclosures for ParticipantDirected Accounts. All individual account
plans that provide for participant-direction
must provide specified disclosures under 29
CFR 2550.404a-5 with respect to each
participant or beneficiary that, pursuant to
the terms of the plan, has the right to direct
the investment of assets held in, or
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Frm 00100
Fmt 4701
Sfmt 4702
contributed to, his or her individual account.
Included in the required disclosures is a
comparison chart.
4o. If you answered ‘‘Yes’’ to Line 4n,
check the box to indicate whether the plan
provided participants and beneficiaries the
plan and investment disclosures required
under 29 CFR 2550.404a–5(d)(2). If you
answered ‘‘Yes,’’ attach the comparison
chart(s) provided to participants and
beneficiaries.
4p. If you answered ‘‘Yes,’’ to Line 4n,
enter the number of designated investment
alternatives (DIAs) available under the plan,
indicate the number of DIAs that are index
funds, and check the appropriate box(es) to
indicate the types of DIAs available.
4q. If you answered ‘‘Yes,’’ to Line 4n,
check the appropriate box to indicate
whether the plan made available to
participants and beneficiaries a designated
investment manager (DIM). If you answered
‘‘Yes,’’ enter the name of the DIM.
4r. Check ‘‘Yes,’’ if the plan made available
to participants and beneficiaries any
brokerage window, self-directed brokerage
account or similar plan arrangements that
enabled participants to select investments
beyond those designated by the plan. If you
answered ‘‘Yes’’ to Line 4r, enter the number
of participants that utilized the account or
arrangement.
Line 4s. Unrelated business taxable income
generally means the gross income derived
from any unrelated trade or business (as
defined in Code section 513) regularly
conducted and not substantially related to
the plan’s exempt purpose under Code
section 512, less the deductions directly
connected with carrying on the trade or
business. See IRS Publication 598 for more
information. Check ‘‘N/A’’ if this plan does
not have a trust, such as 412(e)(3) fully
insured plans or certain 403(b) annuity plans.
Plans that check ‘‘Yes’’ must enter any
amount of unrelated business taxable
income. Form 990–T, Exempt Organization
Business Income Tax Return, is required for
any gross income of $1000 or more generated
by an employer’s trust by the 15th day of the
4th month following the end of the trust’s tax
year. See Instructions to Form 990–T for
more details.
Note. You are required to complete Line 4s
if you are required to file at least 250 returns
of any type with the IRS during the calendar
year. However, if you are a small filer (file
fewer than 250 returns of any type with the
IRS during the calendar year), and you do not
voluntarily complete this Line 4s, then you
must file the Form 5500–SUP with the IRS
on paper.
Line 4t. Under the Code, all defined
contribution pension plans must provide for
a valuation of investments held by the trust
at least once a year in a manner consistently
followed and uniformly applied. Fair market
value on the valuation date specified in the
plan is to be used for this purpose and the
respective accounts of participants are to be
adjusted accordingly. See Rev. Rul. 80–155.
Plans that check ‘‘No’’ may result in
disqualification of the plan under Treasury
Regulations section 1.401–1(a)(2).
Line 4u. Check ‘‘Yes’’ if the employer
sponsoring the plan paid any of the
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administrative expenses of the plan that were
not reimbursed by the plan.
Line 4v. Check ‘‘Yes’’ if any person who is
disqualified under ERISA Section 411, served
or was permitted to serve the plan in any
capacity. Section 411 of ERISA establishes a
bar against certain persons serving as
employee benefit plan fiduciaries or service
providers because they have been convicted
of any of a broad range of specified crimes.
Prohibited positions and activities include
consultants and advisers to plans and any
entity whose activities are in whole or
substantial part devoted to providing goods
or services to employee benefit plans. As
amended by the Comprehensive Crime
Control Act of 1984, section 411 of ERISA
prohibits such persons from serving plans for
a period of thirteen years after such judgment
or the end of imprisonment resulting from a
disqualifying conviction, whichever is later,
unless the sentencing court, under
appropriate circumstances, has reduced the
period of prohibition to not less than three
years or has determined that service in any
of the prohibited capacities would not be
contrary to the purposes of ERISA. The
prohibition takes effect upon the date of
conviction (the date of entry of judgment by
the trial court) or the end of imprisonment,
whichever is later.
Line 4w. If the plan has investment
acquisitions that are leveraged, including
assets subject to collateralized lending
activities (e.g., securities lending
arrangements, repurchase agreements (repos),
etc.), check ‘‘Yes.’’ If you check ‘‘Yes,’’ check
the appropriate box to indicate whether
securities lending, including repurchase
agreements or sell/buy-backs or ‘‘Other,’’
including transactions that subjected plan
assets to a mortgage, lien, or other security
interest. If you check ‘‘Other,’’ enter a
description. Then separately enter in Line
4w(2) the total amount of cash obligated, the
total value of securities obligated, and the
total value of other assets obligated in
connection with collateralized lending
activities at the end of the plan year. In Line
4w(3) enter the approximate ratio of
collateralized/leveraged investments
(including cash that is obligated) to total plan
assets at the end of the year list total amount
and approximate ratio of leveraged
investments to total plan assets.
Line 4x. Check ‘‘Yes’’ if the plan sponsor
or its affiliates provide any services to the
plan in exchange for direct or indirect
compensation.
Line 4y. See 29 CFR 2520.102–2 and
2520.102–3 for style, format, and content
requirements for summary plan descriptions.
For distribution requirements see 29 CFR
2520.104b.
Line 4z. Defined contribution pension
plans must complete Line 4z. For purposes
of Line 4z, an uncashed check is one that is
no longer negotiable or is subject to limited
payability. Check ‘‘Yes,’’ if there were any
uncashed checks as of the end of the plan
year. If ‘‘Yes,’’ indicate the number of checks
that were uncashed at the end of the plan
year and the total value of the checks. Briefly
describe the procedures followed by the plan
to verify a participant’s or beneficiary’s
address before a check was mailed. Plans
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must ensure that they use measures
reasonably calculated to ensure actual receipt
of materials by plan participants and
beneficiaries, which would include
procedures to keep track of participants’ and
beneficiaries’ current mailing addresses so
that information is less likely to be mailed to
a bad address. See CFR 2520.104b–1(b). Also,
briefly describe the procedures followed by
the plan to address the uncashed checks,
including steps to locate ‘‘missing
participants.’’
Plans should have procedures to keep track
of uncashed checks. The procedures for
ongoing plans should include procedures for
locating ‘‘missing’’ participants. Plans may
use the steps described in FAB 2014–01 to
search for lost participants or beneficiaries,
which may be helpful in particular where a
check was returned as ‘‘undeliverable.’’ The
procedures should also include a method by
which plan fiduciaries keep track or are
made aware of the number of uncashed
checks and the amount involved. Such
procedures could include contractually
requiring any third party administrators to
keep the plan administrator regularly
informed of uncashed checks. For missing
participant and beneficiary searches and
distributions from terminating defined
contribution pension plans, see 29 CFR
2550.404a-3; DOL Field Assistance Bulletin
2014–01 (Aug. 14, 2014).
Part V—Termination Information on Service
Providers
Complete Part V if there was a termination
in the appointment of an accountant or
enrolled actuary during the 20XX plan year
regardless of the reason or to identify any
service providers, other than accountants or
actuaries identified above, that have been
terminated for a material failure to meet the
terms of a service arrangement or failure to
comply with Title I of ERISA, including the
failure to provide required disclosures under
29 CFR 2550.408b-2.
Line 5. Termination Information on
Accountants and Actuaries. Information on
the termination of an accountant or actuary
must be provided on the Form 5500 Annual
Return/Report for the plan year during which
the termination occurred. For example, if an
accountant was terminated in the 20XX plan
year after completing work on an audit for
the 20XX–1 plan year, the termination should
be reported on the Schedule H filed with the
20XX plan year Form 5500 Annual Return/
Report. If the accountant is a firm (such as
a corporation, partnership, etc.), report when
the service provider (not an individual
within the firm) was terminated.
An enrolled actuary is by definition an
individual and not a firm, and you must
report when the individual is terminated.
Provide an explanation of the reasons for
the termination of an accountant or enrolled
actuary. Include a description of any material
disputes or matters of disagreement
concerning the termination, even if resolved
prior to the termination. If an individual is
listed, and the individual does not have an
EIN, the EIN to be entered should be the EIN
of the individual’s employer.
[TIP] If the only reason for change of
appointment was a temporary leave of
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absence due to non-work circumstances of
the enrolled actuary, so indicate in the
‘‘explanation’’ field.
Do not use a social security number in lieu
of an EIN. The Schedule C and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule C or any of its
attachments may result in the rejection of the
filing.
The plan administrator must also provide
the terminated accountant or enrolled
actuary with a copy of the explanation for the
termination provided in Line 5f, along with
a completed copy of the notice below.
Notice to Terminated Accountant or
Enrolled Actuary
I, as plan administrator, verify that the
explanation that is reproduced below or
attached to this notice is the explanation
concerning your termination reported on the
Schedule C (Form 5500) attached to the 20XX
Form 5500, Annual Return/Report of
Employee Benefit Plan, for the
llllllll (enter name of plan).
This Form 5500 is identified in Line 2b by
the nine-digit EINll–ll(enter sponsor’s
EIN), and in Line 1b by the three-digit
PNlll (enter plan number).
You have the opportunity to comment to
the Department of Labor concerning any
aspect of this explanation. Comments should
include the name, EIN, and PN of the plan
and be submitted to: Office of Enforcement,
Employee Benefits Security Administration,
U.S. Department of Labor, 200 Constitution
Avenue, NW., Washington, DC 20210.
[INSERT EMAIL ADDRESS]
Signed
Dated
Line 6. Information on Service Providers
Terminated for Material Failure. Provide
information for any service providers, other
than accountants or actuaries identified
above, that have been terminated for a
material failure to meet the terms of a service
arrangement or failure to comply with Title
I of ERISA, including the failure to provide
required disclosures under 29 CFR
2550.408b-2.
Lines 6a–d. Provide identifying
information in the appropriate lines.
Lines 6e–f. If the reason for termination
was the failure to provide required
disclosures under 29 CFR 2550.408b–2, in
addition to providing an explanation in Line
6e, check the box in Line 6f.
Part VI—Plan Termination Information
Line 7a. Check ‘‘Yes’’ if a resolution to
terminate the plan was adopted during this
or any prior plan year, unless the termination
was revoked and no assets reverted to the
employer. If ‘‘Yes’’ is checked, enter in Line
7a(1) the effective date of plan termination,
enter in Line 7a(2) the plan year in which
assets were distributed to participants and
beneficiaries (including insurance/annuity
contracts) and enter in Line 7a(3) the amount
of plan assets that reverted to the employer
during the plan year in connection with the
implementation of such termination. Enter
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‘‘0’’ if no reversion occurred during the
current plan year.
Line 7b. Transfer to other plans. If the plan
transferred assets or liabilities to another
plan since the date of the most recent filing,
report the EIN and PN of the plan to which
the assets and liabilities were transferred
(i.e., the ‘‘transferee plan’’). In addition,
report the date of the transfer and check the
box that best describes the type of transfer
(see Definitions below). Do not use a social
security number in lieu of an EIN or include
an attachment that contains visible social
security numbers. The Schedule H is open to
public inspection, and the contents are
public information and are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof on
this Schedule H or the inclusion of a visible
social security number or any portion thereof
on an attachment may result in the rejection
of the filing.
Note. A distribution of all or part of an
individual participant’s account balance that
is reportable on Form 1099–R should not be
included on Line 7b. Do not submit Form
1099–R with the Form 5500 Annual Return/
Report.
IRS Form 5310–A, Notice of Plan Merger
or Consolidation, Spinoff, or Transfer of Plan
Assets or Liabilities; Notice of Qualified
Separate Lines of Business, may be required
to be filed at least 30 days before any plan
merger or consolidation or any transfer of
plan assets or liabilities to another plan.
There is a penalty for not filing IRS Form
5310–A on time. In addition, a transfer of
benefit liabilities involving a plan covered by
PBGC insurance may be reportable to the
PBGC. See PBGC Form 10, Post-Event Notice
of Reportable Events, and PBGC Form 10Advance, Advance Notice of Reportable
Events.
Line 7c. Transfers from other plans. If
another plan transferred assets or liabilities
to this plan since the date of the most recent
filing, report the EIN and PN of the plan from
which the assets and liabilities were
transferred (i.e., the ‘‘transferor plan’’), the
date of the transfer, and the box that best
describes the type of transfer.
‘‘Consolidation’’ means a transaction in
which two or more plans transfer all of their
assets and liabilities to a new plan and, as
a result, cease to exist (because the transferor
plans become part of the new transferee
plan). It differs from a Merger because in a
Merger, the transferee plan existed before the
transaction. In a consolidation, the transferee
plan is a new plan that is created in the
Consolidation. Thus, the plan that exists after
the Consolidation follows the PBGC premium
filing rules for new plans.
‘‘Merger’’ means a transaction in which
one or more plans transfer all of their assets
and liabilities to an existing plan and, as a
result, cease to exist (because the transferor
plan(s) become part of the transferee plan). It
differs from a Consolidation because in a
Consolidation, the transferee plan did not
exist before the transaction. In a Merger, the
transferee plan is an existing plan and
follows the rules for a preexisting, ongoing
plan.
‘‘Spinoff’’ means a transaction in which the
transferor plan transfers only part of its assets
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and/or liabilities to the transferee plan. The
transferee plan may be a new plan that is
created in the Spinoff, or it may be a
preexisting plan that simply receives part of
the assets or liabilities of the transferor plan.
Note: If Final Return/Report is checked on
the Form 5500 of Form 5500–SF, information
should be entered an at least one of lines 7a
or 7b. Participant-directed transfers do not
need to be reported on Line 7c. If you
reported transfers of assets and liabilities to
this plan on Line 2l(1), information should be
entered in Line 7c.
Line 7d. Terminated Defined Contribution
Pension Plans: Transfers to Financial
Institutions. If the filer is a defined
contribution pension plan, indicate whether,
as part of the procedures for terminating the
plan, transferred plan assets to a financial
institution(s), establishing interest bearing
federally insured bank accounts in the name
of missing participants in connection with
terminating the plan. If ‘‘Yes,’’ complete
elements (1)–(5). List each financial
institution where plan assets were transferred
and continue reporting until the plan
terminates and the final return/report is filed.
For more information on making provisions
for lost or missing participants, see DOL
Field Assistance Bulletin 2014–01.
Part VII—Trust Information
Line 8a. Enter the ‘‘Name of trust.’’ If a
plan uses more than one trust or custodial
account for its fund, you should enter the
primary trust or custodial account in which
the greatest dollar amount or largest
percentage of the plan assets as of the end of
the plan year is held on this Line. For
example, if a plan uses three different trusts,
X, Y, Z, with the percentages of plan assets,
35%, 45%, and 20%, respectively, trust Y
that held the 45% of plan assets would be
entered in Line 6a.
Line 8b. You may use this line to enter the
‘‘Trust’s Employer Identification Number
(EIN)’’ assigned to the employee benefit trust
or custodial account, if one has been issued
to you. The trust EIN should be used for
transactions conducted for the trust. If you do
not have a trust EIN, enter the EIN you would
use on Form 1099–R, Distributions From
Pensions, Annuities, Retirement or ProfitSharing Plans, IRAs, Insurance Contracts,
etc., to report distributions from employee
benefit plans and on Form 945, Annual
Return of Withheld Federal Income Tax, to
report withheld amounts of income tax from
those payments.
Do not use a social security number in lieu
of an EIN. Form 5500 and its attachments are
open to public inspection, and the contents
are public information and are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof may
result in the rejection of the filing.
Trust EIN can be obtained from the IRS by
applying for one on Form SS–4, Application
for Employer Identification Number. See
Instructions to Line 2b (Form 5500) for
applying for an EIN. Also see the online IRS
EIN application page at https://federal-einonline.com/ for further information.
Line 8c. Enter the name and other
identifying information of the plan trustee or
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custodian. Enter the telephone number for
the plan trustee or custodian.
Note. You must enter trust information
from Lines 8a through 8c if you are required
to file at least 250 returns of any type with
the IRS during the calendar year. However,
if you are a small filer (files fewer than 250
returns of any type with the IRS during the
calendar year), and you do not enter trust
information here, then you must file the
paper Form 5500–SUP with the IRS. See the
Treasury regulations on ‘‘Employee
Retirement Benefit Plan Returns Required on
Magnetic Media.’’ (See 79 FR 58256 at https://
federalregister.gov/a/2014–23161) and
Instructions for Form 5500–SUP for more
information.
Trustee/Custodian Signature
The plan trustee or custodian may
electronically sign this schedule or attach to
the Form 5500 an electronic reproduction of
the Schedule H signed by the plan’s trustee.
This electronic reproduction must be labeled
‘‘Trustee Signature’’ and must be included
as a Portable Document Format (PDF)
attachment or any alternative electronic
attachment allowable under EFAST2 if this is
not electronically signed. If there is more
than one trustee or custodian, the trustee or
custodian authorized by the others may sign.
If the plan trustee or custodian is an entity,
the signature must be the name of a person
authorized to sign on behalf of the plan
trustee or custodian.
Note. Trust information reported in this
Schedule is for the purpose of satisfying the
requirements under Code section 6033(a) for
an annual information return from every
section 401(a) organization exempt from tax
under section 501(a). The statute of
limitations under Code section 6501(a) for
any trust described in section 401(a), which
is exempt from tax under section 501(a), will
not start to run until you timely file with the
appropriate trust information on this
Schedule.
Schedule J (Form 5500) Group Health Plan
Information
General Instructions
Who Must File
Schedule J (Form 5500) must be attached
to a Form 5500 filed for group health plans,
except as provided below. The term ‘‘group
health plan’’ means an employee welfare
benefit plan to the extent that the plan
provides medical care (as defined in ERISA
§ 733(a)(2) and including items and services
paid for as medical care) to employees or
their dependents (as defined under the terms
of the plan) directly or through insurance,
reimbursement, or otherwise. This includes
group health plans that are funded through
a trust, unfunded, fully-insured, or a
combination of more than one of these
funding arrangements. This also includes
plans that claim ‘‘grandfathered’’ status
under 29 CFR 2950.715–1251, and plans that
are exempt from certain market reform
requirements under ERISA § 732(a)
(exemption for certain small group health
plans that have less than two participants
who are current employees) or ERISA
§ 733(c) (group health plans consisting solely
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of excepted benefits). See the Form 5500
Annual Return/Report Instructions ‘‘Who
Must File’’ section for more information. It
also includes retirement plans that provide
retiree health benefits and welfare plans that
provide a variety of benefits, including
medical benefits.
Small (fewer than 100 participants at the
beginning of the plan year), fully-insured
group health plans only need to complete
Part I, Lines 1–8 of Schedule J, except they
must complete the entire Schedule J where
the only policy is a ‘‘stop loss’’ policy,
including stop loss policies with the
employer/plan sponsor as the insured.
If a plan provides multiple types of
benefits such as group health, life, and
disability, only report information about
group health benefit participation, claims,
benefit types, compliance, etc., on Schedule
J.
Plans must complete one Schedule J for all
the health benefit coverages they provide.
GIAs must complete a separate Schedule J for
each participating plan.
Check the Schedule J box on the Form
5500 (Part II, Line 11b(6)) if a Schedule J is
attached to the Form 5500.
Part I of the Schedule J must be completed
to report certain characteristics of the group
health plan.
Part II of the Schedule J must be completed
to report service providers providing services
to the group health plan. You must include
information on third party administrators
and claims processors; mental health benefits
managers, substance use disorder benefits
managers, pharmacy benefit managers (PBM),
independent review organizations (IRO), and
wellness program managers. Multiple entries
for each may be entered. Service providers
that render services in relation to the group
health plan that are reported on the Schedule
C or the Schedule A do not need to be
reported on Schedule J.
Part III of the Schedule J must be
completed by plans that do not file Schedule
H to report financial information.
Part IV of the Schedule J must be
completed to report claims processing and
payment information.
Part V of the Schedule J must be completed
to report compliance information for plans
that do not file the Form M–1. Plans that file
the Form M–1, skip questions 24–30.
For more information and guidance for
group health plans, visit EBSA’s Web site at
www.dol.gov/ebsa. For information on state
regulation of health insurance, contact your
State Insurance Department. For information
on HHS regulation of health insurance, go to
the Web site of the Center for Consumer
Information and Insurance Oversight at
https://www.cms.gov/cciio/.
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Specific Instructions
Part I—Group Health Plan Characteristics
You must enter information related to
certain characteristics of the group health
plan.
Line 1. Report the number of persons
covered by the plan at the end of the plan
year. Persons, for purposes of this line,
include participants, beneficiaries, and
dependents of participants covered under the
plan.
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Line 2. Check all that apply to indicate
who is eligible for coverage under the plan.
Line 3. Check all that apply to indicate the
type of benefits and design characteristics
included under the plan.
Line 4. Check all that apply to indicate the
funding and benefit arrangement(s) for the
plan. If the plan offers benefit package
options that are fully insured (i.e. benefits are
provided under a group policy purchased
from a health insurance issuer to fund the
benefits), in Line 4a(1)(a), check ‘‘Health
Insurance Issuer’’ and enter the name(s), EIN
and National Insurance Product Registry
Number of insurance carriers providing
benefits under the plan. If the health funding
or benefit arrangement is through a health
insurance issuer, and the product is an ‘‘offthe-shelf’’ or ‘‘prototype’’ policy, product, or
arrangement, enter in Line 4a(1)(b) any
unique identification information for the
product or policy (e.g., a state assigned
product identification number). Check all
that apply under 4a(1)(c).
If the plan offers benefit package options
that are self-insured (i.e., provide benefits
from the general assets of the employer or
through a trust), check all that apply under
4a(2) and/or 4a(3).
A Health Insurance Issuer means an
insurance company, insurance service, or
insurance organization (including a health
maintenance organization, as defined in
ERISA § 733(b)(3)), that is licensed to engage
in the business of insurance in a State and
that is subject to State laws regulating
insurance (within the meaning of ERISA
§ 514(b)(2)).
Line 5. Check all characteristics that apply
to the plan. With regard to plans that claim
grandfathered status, certain changes may
cause the plan to relinquish its grandfathered
status such as elimination of benefits, certain
increases in cost-sharing requirements, and
certain decreases in contribution rates by
employers or employee organizations. For
more information about grandfathered group
health plans, see 29 CFR 2590.715–1251.
In general, a health flexible spending
account (FSA) is a benefit designed to
reimburse employees for medical care
expenses (as defined in Code section 213(d),
other than premiums) incurred by the
employee, or the employee’s spouse,
dependents, and any children who, as of the
end of the taxable year, have not attained age
27. See Code section 106(c)(2) and 26 CFR
1.125–5. A health reimbursement
arrangement (HRA) typically consists of a
promise by an employer to reimburse
medical expenses, including insurance
premiums, for the year up to a certain
amount, with unused amounts available to
reimburse medical expenses in future years.
See IRS Notice 2002–45. A high deductible
health plan (HDHP) is a group health plan
subject to specific cost-sharing requirements
as defined in section 223(c)(2) of the Code.
Line 6a. Indicate the total number of
persons offered COBRA continuation
coverage under the plan during the plan year.
Line 6b. From the universe of persons
listed in line 6a, indicate the number of
persons who subsequently elected COBRA
coverage. Include any persons who elected
coverage after the end of the plan year.
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Line 6c. Indicate the number of persons
covered under the plan through COBRA
continuation coverage at any time during the
plan year.
Line 7. Indicate on Line 7a whether the
plan received a rebate, reimbursement, or
refund from a service provider such as a
health insurance issuer, third-party
administrator, or pharmacy benefit manager.
Include multiple entries if necessary. Include
all distributions from service providers
including refunds, dividends,
demutualization payments, rebates, and
excess surplus distributions. Any medical
loss ratio (MLR) rebates received pursuant to
Section 2718 of the Public Health Service Act
must be reported here. Also, include refunds
returned to the plan based on low claims
experience or termination of a service
contract. Do not include dividends or
retroactive rate refunds reported on Schedule
A, Line 9. If you answer ‘‘Yes’’ to Line 7a,
you must complete Line 7b. Complete a
separate entry for Lines 7b(1)–(3) for each
rebate, reimbursement, or refund, entering in
Line 7b(1) the amount(s) and date(s) the
rebate(s), reimbursement(s), or refund(s) were
received. Check the appropriate box in b(2)
to indicate the source and the appropriate
box in b(3) to specify how the funds were
used or allocated.
Line 8. Indicate whether there were any
premium delinquencies during the reporting
year. You must answer ‘‘Yes’’ or ‘‘No.’’ Do
not leave Line 8a blank. If you answered
‘‘Yes,’’ you must indicate both the number of
times delinquent for premiums due but
unpaid during the year, and for each
delinquency, the number of days delinquent.
If you answered ‘‘No’’ to line 8a, check ‘‘N/
A’’ on line 8b. If any premium payments that
were not made within the time required by
the insurance carrier resulted in a lapse of
health insurance coverage, you must answer
‘‘Yes’’ to Line 8b even if coverage was
retroactively reinstated.
Part II—Service Provider and Stop Loss
Insurance Information
Lines 9–13. Enter identifying information
for third party administrator/claims
processor, including insurance issuers
subject to an ‘‘administrative services only’’
(ASO) contract or other agreement that are
not reported on Schedule A or Schedule C,
mental health benefits managers, substance
use disorder benefits managers, pharmacy
benefit manager/drug providers, and
independent review organizations on the
appropriate line. Repeat as many line entries
as necessary to report all service providers
under each category.
Element (c). If applicable, enter the
National Producer Number (NPN) of the
service provider in element (c) for each type
of service provider. The NPN is a unique
NAIC identifier assigned through the
licensing application process or the NAIC
reporting systems to individuals and
business entities (including, but not limited
to producers, adjusters, and navigators)
engaged in insurance related activities
regulated by a state insurance department.
The NPN is used to track those individuals
and business entities on a national basis.
Line 14. Wellness Program Manager. If
there was a wellness program associated with
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the plan, enter the contact information for the
wellness program manager. A ‘‘wellness
program’’ is defined in 29 CFR 2590.702(f) to
include ‘‘any program designed to promote
health or prevent disease’’ and includes
programs that condition benefits (including
cost-sharing mechanisms) or the premium or
employer contribution amounts on an
individual satisfying a standard that is
related to a health factor as well as those
programs that do not include conditions for
obtaining a reward that are based on an
individual satisfying a standard that is
related to a health factor.
Line 15. ‘‘Stop Loss’’ Insurance. If there
was stop loss insurance associated with the
plan, enter the name and identifying
information for the insurance carrier
providing the coverage in elements (a)–(c).
This includes policies entered into by the
plan sponsor for obligations of the plan
sponsor to pay benefits under the plan.
Line 15d. Enter the total premium paid to
the stop loss provider.
Line 15e. Enter the applicable attachment
points for individual claims and aggregate
claims. For this purpose, attachment points
are the threshold dollar amounts which,
when reached, the stop loss coverage begins
to pay benefit claims.
Line 15f. Enter any applicable individual
and aggregate claim limits at which the stop
loss ceases coverage. For example, stop loss
coverage may only cover individual claims
up to a certain dollar amount or cease paying
claims after an aggregate dollar amount is
met.
Line 15g. Enter the policy or contract year
beginning and end dates for the policy
ending with or within the plan year.
Line 15h. Check the box if the employer or
plan sponsor is the insured party under the
stop-loss policy.
Part III—Financial Information
Note: Form 5500 filers that file Schedule H
can skip this section and proceed to Part IV
Claims Processing and Payment.
Line 16a. Report the total cash
contributions received from employer(s). In
the absence of a trust (e.g., where a cafeteria
plan elects not to establish a trust in reliance
on Technical Release No. 92–01), include
employer contributions applied directly to
the payment of benefits or expenses
attendant to the provision of health benefits.
Line 16b. For accrual basis plans, report
the total cash contributions receivable from
employer(s).
Line 16c. Report the total cash
contributions received from employees,
including all elective contributions under a
cafeteria plan (Code section 125 arrangement)
attendant to the provision of health benefits.
Line 16d. For accrual basis plans, report
the total cash contributions receivable from
employees, including all receivable elective
contributions under a cafeteria plan (Code
section 125 arrangement) attendant to the
provision of health benefits.
Line 16e. Report other contributions
received or receivable, including non-cash
contributions, which should be reported at
the current value at the date contributed.
Line 16f. Enter the total contributions. Add
lines 16a-e.
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Line 17. Amounts paid by a participant or
beneficiary to an employer and/or withheld
by an employer for contribution to the plan
are participant contributions that become
plan assets as of the earliest date on which
such contributions can reasonably be
segregated from the employer’s general assets
(see 29 CFR 2510.3–102). For Schedule J
purposes, participant contributions include
all elective contributions under a cafeteria
plan (Code section 125 arrangement).
Indicate whether there was a failure to timely
transmit participant contributions to the plan
during the filing period. Continue to answer
‘‘Yes’’ for any prior year failures until fully
corrected.
Part IV—Health Benefit Claims Processing
and Payment
Every employee benefit plan shall establish
and maintain reasonable procedures
governing the filing of benefit claims,
notification of benefit determinations, and
appeal of adverse benefit determinations. See
29 CFR 2560.503–1 and 2590.715–2719(a).
These questions ask you to quantify the
number of benefit claims processed during
the year. Unless otherwise instructed, do not
provide dollar amounts instead of number of
benefit claims processed.
A pre-service benefit claim means any
claim for a benefit under a group health plan
with respect to which the terms of the plan
condition receipt of the benefit, in whole or
in part, on approval of the benefit in advance
of obtaining medical care and includes
urgent care and concurrent care claims.
A post-service benefit claim means any
claim for a benefit under a group health plan
that is not a pre-service claim and is typically
a request for payment that you or your health
care provider submits to your health insurer
when you get items or services you think are
covered.
‘‘Claims Adjudication’’ is a term used in
the insurance industry to refer to the process
of paying claims submitted or denying them
after comparing claims to the benefit or
coverage requirements.
Line 18a(1)–(3). Enter the number of postservice benefit claims submitted during the
plan year regardless of whether the claim was
approved or denied. Do not include duplicate
claims, i.e., claims denied as previously
considered. Enter the number of post-service
benefit claims paid during the plan year.
Enter the number of post-service benefit
claims denied during the plan year. Do not
include duplicate claims, i.e., denied as
previously considered.
Line 18b(1)–(2). Enter the number of postservice benefit claims appealed during the
plan year. Then, enter the number of postservice claim denials upheld upon appeal
and the number that were payable after
appeal.
Line 18c(1)–(2). Enter the number of preservice benefit claims appealed. Then, enter
the number of pre-service claim denials
upheld upon appeal and the number that
were payable after appeal.
Line 19. Indicate whether there were any
pre-service or post-service benefit claims that
were not adjudicated within the required
time frames. In accordance with 29 CFR
2560.503–1(f)(2)(iii)(A), the plan
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administrator shall notify the claimant of the
plan’s benefit determination (whether
adverse or not) within a reasonable period of
time appropriate to the medical
circumstances, but not later than 15 days
after the receipt of the claim. In accordance
with 29 CFR 2560.503–1(f)(2)(iii)(B) the plan
administrator shall notify the claimant of the
plan’s adverse benefit determination on a
post-service claim within a reasonable period
of time, but not later than 30 days after
receipt of the claim. This period may be
extended one time for up to 15 days in
circumstances where the delay is beyond the
plan’s control and the plan notifies the
claimant of the extension prior to the
expiration of the initial review period of why
the extension is needed and the date by
which the plan expects to render a decision.
Line 20. Indicate whether, at any time
during the year, the group health plan failed
to pay benefit claims within one month of
being approved for payment. If you answer
‘‘Yes,’’ indicate the number of claims the
plan failed to pay, total dollar amount of
claims not paid within one (1) month, and
the number of claims not paid within three
(3) months or longer.
Example. A plan sponsor of an unfunded
plan experienced financial difficulty in
February and was unable to pay health
benefit claims until May. In May, the plan
sponsor’s revenues increased and claims
were paid. The plan must report the number
of claims the plan was unable to pay from
February to May even though the claims were
subsequently paid in May.
Line 21. Enter the total dollar amount of
health benefit claims paid during the year.
Do not include administrative expenses in
the amount of claims paid.
Part V—Compliance Information
Line 22. Trust compliance. Indicate
whether all plan assets are maintained
consistent with ERISA § 403 and 29 CFR
2550.403a–1 and 2550.403b–1. Pursuant to
Technical Release 92–01, the DOL has opted
to take a non-enforcement policy with
respect to violations resulting solely because
of a failure to hold participant contributions
in trust in the case of a cafeteria plan
described in section 125 of the Internal
Revenue Code.
Line 23. General Disclosure Compliance.
Indicate whether the following disclosure
documents are in compliance with the
applicable content requirements:
• Summary plan description (SPD)—See
29 CFR 2520.104b–2.
• Summary of Benefits and Coverage
(SBC)—See 29 CFR 2590.715–2715.
• Summary of material modification
(SMM)—See 29 CFR 2520.104b–3.
• Summary annual reports (SAR)—See 29
CFR 2520.104b–10(d).
A Reporting and Disclosure Guide for
Employee Benefit Plans describing basic
reporting and disclosure requirements under
ERISA can be found at https://www.dol.gov/
ebsa/pdf/rdguide.pdf.
Health Benefit Compliance
Plans that file the Form M–1, skip
questions 24–30. Guidance material and
additional compliance assistance information
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that may be helpful in understanding the
requirements listed below is available in
publications, fact sheets, and frequently
asked questions available on EBSA’s Web site
at www.dol.gov/ebsa. Interested persons may
also call and speak to a benefits advisor about
these laws, by calling the EBSA toll-free
hotline at 1–866–444–3272. A self-auditing
tool to determine compliance with Part 7 of
Title I of ERISA is available at https://
www.dol.gov/ebsa/pdf/cagappa.pdf.
Line 24. HIPAA Compliance. The Health
Insurance Portability and Accountability Act
of 1996 (Pub. L. 104–191) (HIPAA) amended
ERISA to provide for, among other things,
improved portability and continuity of health
insurance coverage.
Line 25. GINA Compliance. The Genetic
Information Nondiscrimination Act of 2008
(Pub. L. 110–233) (GINA) amended ERISA to
prohibit the use of genetic information to
adjust group premiums or contributions,
prohibit the collection of genetic information,
and prohibit requesting individuals to
undergo genetic testing.
Line 26. Mental Health Parity Compliance.
The Mental Health Parity Act of 1996 (Pub.
L. 104–204, as amended by Pub. L. 107–116
and Pub. L. 107–147) (MHPA) amended
ERISA to provide parity in the application of
aggregate lifetime and annual dollar limits for
certain mental health benefits with such
dollar limits on medical and surgical
benefits. The Paul Wellstone and Pete
Domenici Mental Health Parity and
Addiction Equity Act of 2008 (Pub. L. 110–
343) (MHPAEA) amended ERISA by
expanding the MHPA rules to cover benefits
for substance use disorders, and adding new
rules for parity in financial requirements and
treatment limitations.
Line 27. Newborns’ and Mothers’ Health
Protection Compliance. The Newborns’ and
Mothers’ Health Protection Act of 1996 (Pub.
L. 104–204) (Newborns’ Act) amended ERISA
to provide new protections for mothers and
their newborn children with regard to group
health plan coverage of the length of hospital
stays in connection with childbirth.
Line 28. Women’s Health and Cancer
Rights Compliance. The Women’s Health and
Cancer Rights Act of 1998 (Pub. L. 105–277)
(WHCRA) amended ERISA to provide new
rights under group health plans for coverage
of reconstructive surgery in connection with
a mastectomy.
Line 29. Michelle’s Law Compliance.
Michelle’s Law (Pub. L. 110–381) amended
ERISA to provide dependent children with
protections against termination of group
health plan coverage while on a medically
necessary leave of absence from a
postsecondary educational institution.
Line 30. Affordable Care Act Compliance.
The Affordable Care Act amended ERISA to
provide a wide range of protections for
participants of group health plans. For more
information on the Affordable Care Act, see
www.dol.gov/ebsa/healthreform.
Form M–1 Compliance Information.
Line 31a. You must answer either ‘‘Yes’’ or
‘‘No’’ to Line 31a. Do not leave the answer
blank. If the plan is a multiple employer
welfare arrangement or an Entity Claiming
Exception (ECE) subject to the Form M–1,
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Report for Multiple Employer Welfare
Arrangements (MEWAs) and Certain Entities
Claiming Exception (ECEs) filing
requirements, check ‘‘Yes’’ and complete
elements 31b and 31c. If the answer is ‘‘No,’’
skip elements 31b and 31c.
Generally, a Form M–1 must be filed each
year by March 1st following the calendar year
in which a plan operates subject to the Form
M–1 filing requirement. (For example, a plan
MEWA that was operating in 20XX must file
the 20XX Form M–1 annual report by March
1, 20XX+1.) In addition, Form M–1 filings are
necessary in the case of certain registration,
origination, or special events. See the
instructions for Form M–1 at https://
www.askebsa.dol.gov/mewa, and 29 CFR
2520.101–2 for more information regarding
the Form M–1 filing requirements for plan
MEWAs and ECEs.
Line 31b. All plans that answered ‘‘Yes’’ in
Line 31a must complete Line 31b by
answering either ‘‘Yes’’ or ‘‘No.’’ Do not leave
the answer blank if you answered ‘‘Yes’’ in
Line 31a.
Line 31c. All plans that answered ‘‘Yes’’ in
Line 31a must enter a Receipt Confirmation
Code for the 20XX Form M–1 annual report
that was required to be filed with the
Department of Labor under the Form M–1
filing requirements. The Receipt
Confirmation Code is a unique code
generated by the Form M–1 electronic filing
system. You can find this code under the
‘‘completed filings’’ area when you log into
your Form M–1 electronic filing system at
https://www.askebsa.dol.gov/mewa. If a plan
was not required to file a 20XX Form M–1
annual report, enter the Receipt Confirmation
Code for the most recent Form M–1 that was
required to be filed under the Form M–1
filing requirements on or before the date of
filing the 20XX Form 5500. (For example, if
a plan was not required to file a 20XX Form
M–1 annual report by March 1, 20XX+1 for
the 20XX calendar year because it
experienced a registration event between
October 1 and December 31, 20XX, and made
a timely Form M–1 registration filing, the
plan must enter on Line 31c of the 20XX
Form 5500 the Receipt Confirmation Code
issued for the Form M–1 registration filing.)
If a plan that is subject to the Form M–1
filing requirements was not required to file
a 20XX Form M–1 annual report, enter the
Receipt Confirmation Code for the most
recent Form M–1 that was required to be
filed under the Form M–1 filing requirements
on or before the date of filing the 20XX Form
5500. (For example, if a plan was not
required to file a 20XX Form M–1 annual
report by March 1, 20XX for the 20XX
calendar year because it experienced a
registration event between October 1 and
December 31, 20XX, and made a timely Form
M–1 registration filing, the plan must provide
the Receipt Confirmation Code for the Form
M–1 registration filing.)
The failure of a plan required to complete
Schedule J to answer Line 31a, and if
applicable, lines 31b and 31c, or enter a valid
Receipt Confirmation Code in Line 31c, will
subject the Form 5500 filing to rejection as
incomplete and civil penalties may be
assessed pursuant to ERISA Section 502(c)(2)
and 29 CFR 2560.502c–2.
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20XX Instructions for Schedule MB (Form
5500)—Multiemployer Defined Benefit Plan
and Certain Money Purchase Plan Actuarial
Information
General Instructions
Who Must File
As the first step, the plan administrator of
any multiemployer defined benefit pension
plan that is subject to the minimum funding
standards (see Code sections 412 and 431 and
Part 3 of Title I of ERISA) must obtain a
completed Schedule MB (Form 5500) that is
prepared and signed by the plan’s enrolled
actuary as discussed below in the Statement
by Enrolled Actuary section. The plan
administrator must retain with the plan
records the Schedule MB that is prepared
and electronically signed by the plan’s
actuary. The electronic-signature by the plan
actuary is acceptable. The plan actuary can
access the EFAST2 Web site at
www.efast.dol.gov to register for electronic
credentials to sign.
The plan administrator of a multiemployer
defined benefit pension plan must ensure
that the information from the actuary’s
Schedule MB is entered electronically into
the annual return/report being submitted.
When entering the information, whether
using EFAST2-approved software or
EFAST2’s web-based filing system, all the
fields required for the type of plan must be
completed (see instructions for fields that
need to be completed).
Further, if a plan actuary chooses not to
sign electronically, then the actuary must
manually sign the Schedule MB and an
electronic reproduction must be filed with
the Form 5500. The plan administrator of a
multiemployer defined benefit pension plan
must attach to the Form 5500 an electronic
reproduction of the Schedule MB prepared
and signed by the plan’s enrolled actuary.
This electronic reproduction must be labeled
‘‘MB Actuary Signature’’ and must be
included as a Portable Document Format
(PDF) attachment or any alternative
electronic attachment allowable under
EFAST2.
If a money purchase defined contribution
pension plan (including a target benefit plan)
has received a waiver of the minimum
funding standard, and the waiver is currently
being amortized, lines 3, 9, and 10 of
Schedule MB must be completed but it need
not be signed by an enrolled actuary. In such
a case, the Form 5500 or the Form 5500–SF
that is submitted under EFAST2 must
include the Schedule MB with lines 3, 9, and
10 completed, but is not required to include
a signed Schedule MB.
Note. Schedule MB does not have to be
filed with the Form 5500–EZ, but, if required,
it must be retained (in accordance with the
instructions for Form 5500–EZ under the
What to File section). Similarly, if a plan is
a one-participant plan that meets the
requirements for filing a Form 5500–EZ, but
a Form 5500–SF is instead filed for the plan,
the Schedule MB, if required, does not have
to be filed with the Form 5500–SF, but it
must be retained (in accordance with the
instructions for the Form 5500–SF under
Schedule MB in the Specific Instructions
Only for ‘‘One-Participant Plans and Certain
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Foreign Plans’’ section). Also, the funding
standard account for the plan must continue
to be maintained, even if the Schedule MB
is not filed.
Check the Schedule MB box on the Form
5500 (Part II, Line 10a(2)) if a Schedule MB
is attached to the Form 5500.
Lines A through E must be completed for
ALL plans. If the Schedule MB is attached to
a Form 5500 or Form 5500–SF, Lines A, B,
C, and D should include the same
information as reported in Part II of the Form
5500 or Form 5500–SF. You may abbreviate
the plan name.
Do not use a social security number in Line
D in lieu of an EIN. The Schedule MB and
its attachments are open to public inspection
if filed with a Form 5500 or Form 5500–SF,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this Schedule MB or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under the
General Instructions to Form 5500 and How
to File—Electronic Filing Requirement under
the General Instructions to Form 5500–SF.
The EBSA does not issue EINs.
Note. (1) For split-funded plans, the costs
and contributions reported on Schedule MB
must include those relating to both trust
funds and insurance carriers. (2) For plans
with funding standard account amortization
charges and credits, see the instructions for
lines 9c and 9h. (3) For terminating
multiemployer plans, Code section 412(e)(4)
and ERISA section 301(c) provide that
minimum funding standards apply until the
last day of the plan year in which the plan
terminates within the meaning of section
4041A(a)(2) of ERISA. Accordingly, the
Schedule MB is not required to be filed for
any later plan year.
Statement by Enrolled Actuary
An enrolled actuary must sign Schedule
MB with either an electronic signature or a
handwritten signature unless, as described
above, the plan is a money purchase defined
contribution pension plan that has received
a waiver of the minimum funding standard.
The signature of the enrolled actuary may be
qualified to state that it is subject to attached
qualifications. See Treasury Regulations
section 301.6059–1(d) for permitted
qualifications. Except as otherwise provided
in these instructions, a stamped or machine
produced signature is not acceptable. If the
actuary has not fully reflected any final or
temporary regulation, revenue ruling, or
notice promulgated under the statute in
completing the Schedule MB, check the box
on the last line of page 1. If this box is
checked, indicate on this line whether an
accumulated funding deficiency or a
contribution that is not wholly deductible
would result if the actuary had fully reflected
such regulation, revenue ruling, or notice. In
addition, the actuary may offer any other
comments related to the information
contained in Schedule MB.
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The actuary must provide the completed
and signed Schedule MB and transmit it to
the plan administrator to be retained with the
plan records and included (in accordance
with these instructions) with the Form 5500
Annual Return/Report that is submitted
under EFAST2. The plan’s actuary is
permitted to electronically sign the Schedule
MB or sign on page one using the actuary’s
signature or by inserting the actuary’s typed
name in the signature line followed by the
actuary’s handwritten initials. The actuary’s
most recent enrollment number must be
entered on the Schedule MB that is prepared
and signed by the plan’s actuary.
Attachments
All attachments to the Schedule MB must
be properly identified, and must include the
name of the plan, the plan sponsor’s EIN, and
the plan number. Put ‘‘Schedule MB’’ and the
line number to which the attachment relates
at the top of each attachment. Do not include
attachments that contain a visible social
security number. The Schedule MB and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a visible social security number or any
portion thereof on an attachment may result
in the rejection of the filing.
Specific Instructions
Line 1. All entries must be reported as of
the valuation date.
Line 1a. Actuarial Valuation Date. The
valuation for a plan year may be as of any
date in the plan year, including the first or
last day of the plan year. Valuations must be
performed within the period specified by
Code section 431(c)(7) and ERISA section
304(c)(7).
Line 1b(1). Current Value of Assets. Enter
the current value of assets as of the valuation
date. The current value is the same as the fair
market value. Do not adjust for items such as
the existing credit balance or the outstanding
balances of certain amortization bases.
Contributions designated for 20XX should
not be included in this amount. Note that this
entry may be different from the entry in Line
2a. Such a difference may result, for example,
if the valuation date is not the first day of the
plan year, or if insurance contracts are
excluded from assets reported on Line 1b(1)
but not on Line 2a.
Rollover amounts or other assets held in
individual accounts that are not available to
provide defined benefits under the plan
should not be included on Line 1b(1),
regardless of whether they are reported on
the 20XX Schedule H (Form 5500) (Line 1I,
column (a)). Additionally, asset and liability
amounts must be determined in a consistent
manner. Therefore, if the value of any
insurance contracts have been excluded from
the amount reported on Line 1b(1), liabilities
satisfied by such contracts should also be
excluded from the liability values reported
on Lines 1c(1), 1c(2), and 1d(2) of the
Schedule MB.
Line 1b(2). Actuarial Value of Assets.
Enter the value of assets determined in
accordance with Code section 431(c)(2) and
ERISA section 304(c)(2). Do not adjust for
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items such as the existing credit balance or
the outstanding balances of certain
amortization bases, and do not include
contributions designated for 20XX in this
amount.
Line 1c(1). Accrued Liability for
Immediate Gain Methods. Complete this line
only if you use an immediate gain method
(see Rev. Rul. 81–213, 1981–2 C.B. 101, for
a definition of immediate gain method).
Lines 1c(2)(a), (b), and (c). Information for
Plans Using Spread Gain Methods. Complete
these lines only if you use a spread gain
method (see Rev. Rul. 81–213 for a definition
of spread gain method).
Line 1c(2)(a). Unfunded Liability for
Methods with Bases. Complete this line only
if you use the frozen initial liability or
attained age normal cost method.
Lines 1c(2)(b) and (c). Entry Age Normal
Accrued Liability and Normal Cost. For
spread gain methods, these calculations are
used for purposes of the full funding
limitation (see Rev. Rul. 81–13, 1981–1 C.B.
229).
Line 1d(1). Amount Excluded from
Current Liability. Leave Line 1(d)(1) blank.
Line 1d(2)(a). Current Liability. All
multiemployer plans, regardless of the
number of participants, must provide the
information indicated in accordance with
these instructions. The interest rate used to
compute the current liability must be in
accordance with guidelines issued by the IRS
and, pursuant to the Pension Protection Act
of 2006 (PPA), must not be more than 5
percent above and must not be more than 10
percent below the weighted average of the
rates of interest, as set forth by the Treasury
Department, on 30-year Treasury securities
during the 4-year period ending on the last
day before the beginning of the 20XX plan
year.
The current liability must be computed
using the mortality tables referenced in
section 1.431(c)(6)–1 of the Treasury
Regulations.
Each other actuarial assumption used in
calculating the current liability must be the
same assumption used for calculating other
costs for the funding standard account. See
Notice 90–11, 1990–1 C.B. 319. The actuary
must take into account rates of early
retirement and the plan’s early retirement
and turnover provisions as they relate to
benefits, where these would significantly
affect the results. Regardless of the valuation
date, current liability is computed taking into
account only credited service through the
end of the prior plan year. No salary scale
projections should be used in these
computations. Do not include the expected
increase in current liability due to benefits
accruing during the plan year reported on
Line 1d(2)(b) in these computations.
Line 1d(2)(b). Expected Increase in
Current Liability. Enter the amount by which
the current liability is expected to increase
due to benefits accruing during the plan year
on account of credited service and/or salary
changes for the current year. One year’s
salary scale may be reflected.
Line 1d(2)(c). Expected Release From
Current Liability for the Plan Year. Enter the
expected release from current liability on
account of disbursements (including single-
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sum distributions) from the plan expected to
be paid after the valuation date but prior to
the end of the plan year (see also Q&A–7 of
Rev. Rul. 96–21, 1996–1 C.B. 64).
Line 1d(3). Expected Plan Disbursements.
Enter the amount of plan disbursements
expected to be paid for the plan year.
Line 2. All entries must be reported as of
the beginning of the 20XX plan year. Lines
2a and 2b should include all assets and
liabilities under the plan except for assets
and liabilities attributable to: (1) rollover
amounts or other amounts in individual
accounts that are not available to provide
defined benefits, or (2) benefits for which an
insurer has made an irrevocable commitment
as defined in 29 CFR 4001.2.
Line 2a. Current Value of Assets. Enter the
current value of net assets as of the first day
of the plan year. Except for plans with
excluded assets as described above, this entry
should be the same as reported on the 20XX
Schedule H (Form 5500) (line 1l, column (a)).
Note that contributions designated for the
20XX plan year are not included on those
lines.
Line 2b. Current Liability (beginning of
plan year). Enter the current liability as of
the first day of the plan year. Do not include
the expected increase in current liability due
to benefits accruing during the plan year. See
the instructions for Line 1d(2)(a) for actuarial
assumptions used in determining current
liability.
Column (1)—Enter the number of
participants and beneficiaries as of the
beginning of the plan year. If the current
liability figures are derived from a valuation
that follows the first day of the plan year, the
participant and beneficiary count entries
should be derived from the counts used in
that valuation in a manner consistent with
the derivation of the current liability reported
in column (2).
Column (2)—Include the current liability
attributable to all benefits, with subtotals for
vested and nonvested benefits in the case of
active participants.
Line 2c. This calculation is required under
ERISA section 103(d)(11). Do not complete if
Line 2a divided by Line 2b(4), column (2), is
70% or greater.
Line 3. Contributions Made to Plan. Show
all employer contribution amounts (column
b), withdrawal liability payments (column c)
and employee contribution amounts (column
d) for the plan year. Employer contribution
amounts should not include withdrawal
liability payments which should be reported
separately. Include employer contribution
amounts and withdrawal liability payments
made not later than 21⁄2 months (or the later
date allowed under Code section 431(c)(8)
and ERISA section 304(c)(8)) after the end of
the plan year. Show only contribution
amounts and withdrawal liability payments
actually made to the plan by the date this
Schedule MB is signed.
Add the amounts in columns (b), (c) and
(d) and enter the results on the total line. All
contribution amounts and withdrawal
liability payments must be credited toward a
particular plan year.
Line 4. Information on Plan Status. All
multiemployer plans regardless of the
number of participants must provide the
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information indicated in accordance with
these instructions.
Line 4a. All plans enter the funded
percentage for monitoring the plan’s status.
This is Line 1b(2) divided by Line 1c(3).
Line 4b. Enter the code for the status of the
multiemployer plan for the plan year, as
certified by the plan actuary (or as elected by
the plan sponsor in accordance with Code
section 432(b)(4)(A) and ERISA section
305(b)(4)(A)), using one of the following
codes:
Code Plan Status
E Endangered Status
S Seriously Endangered Status
C Critical Status
D Critical and Declining Status
N Not in Endangered or Critical Status
If the plan is certified to be in endangered
status, seriously endangered status, critical
status, or critical and declining status, attach
a copy of the actuarial certification of such
status to this Schedule MB. Also attach an
illustration showing the details (including
year-by-year cash flow projections
demonstrating the solvency of the plan over
the relevant period if the plan is certified as
being in critical and declining status)
providing support for the actuarial
certification of status and label the
illustration ‘‘Schedule MB, Line 4b—
Illustration Supporting Actuarial
Certification of Status.’’ For example, if a
plan is certified as being in critical status
based on Code section 432(b)(2)(B), show the
funded percentage (if applicable) and the
projection of the funding standard account
for the year in which the accumulated
funding deficiency occurs. All supporting
documentation should include descriptions
of the assumptions used.
Line 4c. If, in the plan year in which the
Schedule MB is filed, a certification was
required to be made under Code section
432(b)(3)(A)(ii) and ERISA section
305(b)(3)(A)(ii) with respect to scheduled
progress during the plan year for which the
Schedule MB is filed, check ‘‘Yes’’ or ‘‘No’’
to reflect the certification. Attach
documentation comparing the current status
of the plan to the scheduled progress under
the applicable funding improvement or
rehabilitation plan to this Schedule MB.
Label the documentation ‘‘Schedule MB,
Line 4c—Documentation Regarding
Progress Under Funding Improvement
or Rehabilitation Plan.’’
Lines 4d and 4e. If Code C (Critical Status)
or Code D (Critical and Declining Status) was
entered on Line 4b, an entry on line 4d is
required. For purposes of Lines 4d and 4e, in
determining whether benefits have been
reduced, only adjustable benefits that would
otherwise be protected under Code section
411(d)(6) and ERISA section 204(g) are taken
into account if the plan is certified as in
critical status. Plans that are certified as
being in critical and declining status should
determine whether benefits have been
reduced, including all benefits that were
adjusted (only adjustable benefits that would
otherwise be protected under Code section
411(d)(6) and ERISA section 204(g) are taken
into account), any benefits that have been
suspended under Code section 432(e)(9), and
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47639
any benefit reductions due to partition under
ERISA section 4233. For a plan that has
benefits suspended under Code section
432(e)(9) and/or partitioned under ERISA
section 4233, attach a full description of the
transaction and label the attachment
‘‘Schedule MB, Lines 4d and 4e—
Description of Benefit Reductions Due to
Suspension or Partition.’’ In addition,
only benefit reductions that are first reflected
in Line 1c(3) for the current year’s Schedule
MB should be reported, and this amount
should not include any amounts previously
reported on any prior year’s Schedule MB.
Line 4f. If Code C (Critical Status) or Code
D (Critical and Declining Status) was entered
on Line 4b you must complete Line 4f. If the
rehabilitation plan projects emergence from
critical status or critical and declining status,
enter the plan year in which the plan is
projected to emerge. If the rehabilitation plan
is based on forestalling possible insolvency,
check the box provided and enter the plan
year in which the insolvency is expected.
Line 5. Actuarial Cost Method. Enter the
primary method used. If the plan uses one
actuarial cost method in one year as the basis
of establishing an accrued liability for use
under the frozen initial liability method in
subsequent years, answer as if the frozen
initial liability method was used in all years.
The projected unit credit method is included
in the ‘‘Accrued benefit (unit credit)’’
category of Line 5c. If a method other than
a method listed on Lines 5a through 5g is
used, check the box for Line 5i and specify
the method. For example, if a modified
individual level premium method for which
actuarial gains and losses are spread as a part
of future normal cost is used, check the box
for 5i and describe the cost method.
Check the appropriate box for the
underlying actuarial cost method used as the
basis for this plan year’s funding standard
account computation. If box 5h is checked,
enter the period of use of the shortfall
method in Line 5j. For this purpose, enter the
calendar year (YY) which includes the first
day of the plan year in which the shortfall
method was first used.
Changes in funding methods include
changes in actuarial cost method, changes in
asset valuation method, and changes in the
valuation date of plan costs and liabilities or
of plan assets. Changes in the funding
method of a plan include not only changes
to the overall funding method used by the
plan, but also changes to each specific
method of computation used in applying the
overall method. Generally, these changes
require IRS approval. If the change was made
pursuant to Rev. Proc. 2000–40, 2000–2 C.B.
357, or pursuant to other automatic approval
(such as the Preservation of Access to Care
for Medicare Beneficiaries and Pension Relief
Act of 2010 (PRA 2010), Pub. L. 111–192),
check ‘‘Yes’’ for Line 5l. If approval was
granted for this plan by either an individual
ruling letter or a class ruling letter, enter the
date of the applicable ruling letter in Line
5m. Note that the plan sponsor’s agreement
to certain changes in funding methods
should be reported on Line 9 of Schedule R
(Form 5500).
Shortfall Method: Only certain plans may
elect the shortfall funding method (see
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Treasury Regulations section 1.412(c)(1)–2).
Advance approval from the IRS for the
election of the shortfall method of funding is
NOT required if it is first adopted for the first
plan year to which Code section 412 applies.
In addition, pursuant to PPA section 201(b),
a plan does NOT need advance approval
from the IRS to adopt or cease using the
shortfall method if the plan (1) has not
adopted or ceased using the shortfall method
during the 5-year period ending on the day
before the date the plan is to use the method,
and (2) is not operating under an
amortization period extension and did not
operate under such an extension during such
5-year period. In such a case, check ‘‘Yes’’ for
Line 5l. If a plan utilizes this automatic
approval to apply the shortfall method, the
benefit increase limitations of Code section
412(c)(7) apply.
If a plan is not eligible for automatic
approval as set forth in the preceding
paragraph, advance approval from the IRS is
required if the shortfall funding method is
adopted at a later time, if a specific
computation method is changed, or if the
shortfall method is discontinued. In such a
case there is no automatic limitation on
benefit increases.
Line 6. Actuarial Assumptions. If genderbased assumptions are used in developing
plan costs, enter those rates where
appropriate in Line 6. Note that requests for
gender-based cost information do not suggest
that gender-based benefits are legal. If unisex
tables are used, enter the values in both
‘‘Male’’ and ‘‘Female’’ lines. Check ‘‘N/A’’ for
Line 6b if the question is not applicable.
Attach a statement of actuarial
assumptions (if not fully described by Line
6) and actuarial methods used to calculate
the figures shown in Lines 1 and 9 (if not
fully described by Line 5), and label the
statement ‘‘Schedule MB, Line 6—
Statement of Actuarial Assumptions/
Methods.’’ The statement must describe all
actuarial assumptions used to determine the
liabilities. For example, the statement for
non-traditional plans (e.g., cash balance
plans) must include the assumptions used to
convert balances to annuities.
Also attach a summary of the principal
eligibility and benefit provisions on which
the valuation was based, including the status
of the plan (e.g., eligibility frozen, service/
pay frozen, benefits frozen), optional forms of
benefits, special plan provisions, including
those that apply only to a subgroup of
employees (e.g., those with imputed service),
supplemental benefits, an identification of
benefits not included in the valuation (e.g.,
shutdown benefits), a description of any
significant events that occurred during the
year, a summary of any changes in principal
eligibility or benefit provisions since the last
valuation, a description (or reasonably
representative sample) of plan early
retirement factors, and any change in
actuarial assumptions or cost methods and
justifications for any such change (see section
103(d) of ERISA). Label the summary
‘‘Schedule MB, Line 6—Summary of Plan
Provisions.’’
Line 6a. Current Liability Interest Rate.
Enter the interest rate used to determine
current liability. The interest rate used must
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be in accordance with the guidelines issued
by the IRS and, pursuant to PPA, must not
be more than 5 percent above and must not
be more than 10 percent below the weighted
average of the rates of interest, as set forth by
the Treasury Department, on 30-year
Treasury securities during the 4-year period
ending on the last day before the beginning
of the 20XX plan year. Enter the rate to the
nearest .01 percent.
Line 6b. Check ‘‘Yes,’’ if the rates in the
contract were used (e.g., purchase rates at
retirement).
Line 6c. Mortality Table. The mortality
table published in section 1.431(c)(6)–1 of
the Treasury Regulations must be used in the
calculation of current liability for nondisabled lives. Enter the mortality table code
for non-disabled lives used for valuation
purposes as follows:
Mortality Table
Code
1951 Group Annuity ...........................
1971
Group
Annuity
Mortality
(G.A.M.) ...........................................
1971 Individual Annuity Mortality
(I.A.M.) ............................................
UP–1984 .............................................
1983 I.A.M ..........................................
1983 G.A.M ........................................
1983 G.A.M. (solely per Rev. Rul.
95–28) .............................................
UP–1994 .............................................
Mortality table applicable to current
plan
year
under
section
1.431(c)(6)–1 of the Income Tax
Regulations .....................................
RP–2000 .............................................
RP–2000 (with Blue Collar Adjustment) ...............................................
Other ...................................................
None ...................................................
1
2
3
4
5
6
7
8
9
10
11
A
0
Code 6 includes all sex-distinct versions of
the 1983 G.A.M. table other than the table
published in Rev. Rul. 95–28, 1995–1 C.B.
74. Thus, for example, Code 6 also would
include the 1983 G.A.M. male-only table
used for males, where the 1983 G.A.M. maleonly table with a 6-year setback is used for
females. Code A includes mortality tables
other than those listed in Codes 1 through 9,
including any unisex version of the 1983
G.A.M. table.
Where an indicated table consists of
separate tables for males and females, add F
to the female table (e.g., 1F). When a
projection is used with a table, follow the
code with ‘‘P’’ and the year of projection
(omit the year if the projection is unrelated
to a single calendar year); the identity of the
projection scale should be omitted. When an
age setback or set forward is used, indicate
with ‘‘¥’’ or ‘‘+’’ and the number of years.
For example, if for females the 1951 Group
Annuity Table with Projection C to 1971 is
used with a 5-year setback, enter ‘‘1P71–5.’’
If the table is not one of those listed, enter
‘‘A’’ with no further notation. If the valuation
assumes a maturity value to provide the postretirement income without separately
identifying the mortality, interest and
expense elements, enter on Line 6c, under
‘‘Post-retirement,’’ the value of $1.00 of
monthly pension beginning at the plan’s
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weighted average retirement age, assuming
the normal form of annuity for an unmarried
person. In such a case, leave Lines 6d and 6e
blank.
Line 6d. Valuation Liability Interest Rate.
Enter the assumption as to the expected
interest rate (investment return) used to
determine all the calculated values except for
current liability. If the assumed rate varies
with the year, enter the weighted average of
the assumed rate for 20 years following the
valuation date. Enter rates to the nearest .01
percent.
Line 6e. Expense Loading. If there is no
expense loading, check the ‘‘N/A’’ boxes
under ‘‘Pre-retirement’’ and ‘‘Postretirement’’. For instance, there would be no
expense loading attributable to investments if
the rate of investment return on assets is
adjusted to take investment expenses into
account. If there is a single expense loading
not separately identified as pre-retirement or
post-retirement, enter it under ‘‘Preretirement’’ and check the ‘‘N/A’’ box under
‘‘Post-Retirement.’’ Where expenses are
assumed other than as a percentage of plan
costs or liabilities, enter the assumed preretirement expense as a percentage of the
plan’s normal cost, and enter the postretirement expense as a percentage of plan
liabilities. If the normal cost of the plan is
zero, enter the assumed pre-retirement
expense as a percentage of the sum of Lines
9c(1), 9c(2), and 9c(3), minus Line 9h. Enter
rates to the nearest .1 percent.
Line 6f. Salary Scale. If a uniform level
annual rate of salary increase is used, enter
that annual rate. Otherwise, enter the level
annual rate of salary increase that is
equivalent to the rate(s) of salary increase
used. Enter the annual rate as a percentage
to the nearest .01 percent, used for a
participant from age 25 to assumed
retirement age. If the plan’s benefit formula
is not related to compensation, check the
‘‘N/A’’ box.
Line 6g. Estimated Investment Return—
Actuarial Value. Enter on Line 6g(1) the
estimated rate of return on the actuarial value
of plan assets for the 1-year period ending on
the valuation date. For this purpose, the rate
of return is determined by using the formula
2I/(A + B¥I), where I is the dollar amount
of the investment return under the asset
valuation method used for the plan, A is the
actuarial value of the assets one year ago, and
B is the actuarial value of the assets on the
current valuation date. Enter rates to the
nearest .1 percent. If entering a negative
number, enter a minus sign (‘‘¥’’) to the left
of the number.
Note. Use the above formula even if the
actuary feels that the result of using the
formula does not represent the true estimated
rate of return on the actuarial value of plan
assets for the 1-year period ending on the
valuation date. The actuary may attach a
statement showing both the actuary’s
estimate of the rate of return and the
actuary’s calculations of that rate, and label
the statement ‘‘Schedule MB, Line 6g—
Estimated Rate of Investment Return
(Actuarial Value).’’ Check the box on Line
6g(2) if a statement is attached.
Line 6h. Estimated Investment Return—
Current (Market) Value. Enter on Line 6h(1)
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the estimated rate of return on the current
value of plan assets for the 1-year period
ending on the valuation date. (The current
value is the same as the fair market value—
see Line 1b(1) instructions.) For this purpose,
the rate of return is determined by using the
formula 2I/(A + B¥I), where I is the dollar
amount of the investment return, A is the
current value of the assets one year ago, and
B is the current value of the assets on the
current valuation date. Enter rates to the
nearest .1 percent. If entering a negative
number, enter a minus sign (‘‘¥’’) to the left
of the number.
Note. Use the above formula even if the
actuary feels that the result of using the
formula does not represent the true estimated
rate of return on the current value of plan
assets for the 1-year period ending on the
valuation date. The actuary may attach a
statement showing both the actuary’s
estimate of the rate of return and the
actuary’s calculations of that rate, and label
the statement ‘‘Schedule MB, Line 6h—
Estimated Rate of Investment Return
(Current Value).’’ Check the box on Line
6h(2) if a statement is attached.
Line 7. Schedule of Amortization Bases
Established. List all amortization bases
established in the current or prior plan years
that have an outstanding balance as of the
valuation date for the current plan year. Use
the following table to indicate the type of
base established and enter the appropriate
code under ‘‘Type of base.’’ List amortization
bases and charges and/or credits as of the
valuation date. Bases that are considered
fully amortized because there is a credit for
the plan year on Line 9j(3) should be listed.
If entering a negative number, enter a minus
sign (‘‘¥’’) to the left of the number.
Code Type of Amortization Base
1 Experience gain or loss
2 Shortfall gain or loss
3 Change in unfunded liability due to plan
amendment
4 Change in unfunded liability due to
change in actuarial assumptions
5 Change in unfunded liability due to
change in actuarial cost method
6 Waiver of the minimum funding standard
7 Initial unfunded liability (for new plan)
Line 8a and 8d. Funding Waivers or
Extensions. If a funding waiver or extension
request is approved after the Schedule MB is
filed, an amended Schedule MB must be filed
with Form 5500 to report the waiver or
extension approval (also see instructions for
Line 9k(1)).
Line 8b(1)(a). Schedule of Projection of
Expected Benefit Payments. Check ‘‘Yes’’
only if this is a multiemployer plan covered
by Title IV of ERISA that has 500 or more
total participants as of the valuation date.
Line 8b(1)(b). If Line 8b(1)(a) is ‘‘Yes,’’ on
Line 8b(1)(b), provide a projection of benefits
expected to be paid for the entire plan (not
to include expected expenses) in each of the
next ten years starting with the current plan
year of this filing assuming (1) no additional
accruals, (2) experience (e.g., termination,
mortality, and retirement) are in line with
valuation assumptions, and (3) no new
entrants are covered by the plan.
Line 8b(2)(a). Schedule of Active
Participant Data. Check ‘‘Yes’’ on Line
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8b(2)(a) only if this is a multiemployer plan
covered by Title IV of ERISA that has active
participants. If Line 8(2)(a) is ‘‘Yes,’’
complete the schedule in Line 8b(2)(b) with
the active plan participant data used in the
valuation for this plan year and enter the
average age and average credited service of
the active participants as of the valuation
date on Lines 8b(2)(c) and 8b(2)(d),
respectively.
Include all active participants in the
averages, even ones that are not required to
be shown in the schedule under the
instructions below.
For each column, enter the number of
active participants with the specified number
of years of credited service divided according
to age group. For participants with partial
years of credited service, round the total
number of years of credited service to the
next lower whole number. Years of credited
service are the years credited under the
plan’s benefit formula.
Plans reporting 1,000 or more active
participants on Line 2b(3)(c), column (1), and
using compensation to determine benefits,
must also provide average compensation
data. For each grouping, enter the average
compensation of the active participants in
that group. For this purpose, compensation is
the compensation taken into account for each
participant under the plan’s benefit formula,
limited to the amount defined under section
401(a)(17) of the Code. Do not enter the
average compensation in any grouping that
contains fewer than 20 participants.
Cash balance plans (or any similar plans)
reporting 1,000 or more active participants
on Line 2b(3)(c), column (1), must also
provide average cash balance account data,
regardless of whether all active participants
have cash balance accounts. For each age/
service bin, enter the average cash balance
account of the active participants in that bin.
Do not enter the average cash balance
account in any age/service bin that contains
fewer than 20 active participants.
General Rule. In general, data to be shown
in each age/service bin includes:
1. the number of active participants in the
age/service bin,
2. the average compensation of the active
participants in the age/service bin, and
3. the average cash balance account of the
active participants in the age/service bin,
using $0 for anyone who has no cash balance
account-based benefit.
If the accrued benefit is the greater of a
cash balance benefit or some other benefit,
average in only the cash balance account. If
the accrued benefit is the sum of a cash
balance account benefit and some other
benefit, average in only the cash balance
account. For both the average compensation
and the average cash balance account, do not
enter an amount for age/service bins with
fewer than 20 active participants.
In lieu of the above, two alternatives are
provided for showing compensation and cash
balance accounts. Each alternative provides
for two age/service scatters (one showing
compensation and one showing cash balance
accounts) as follows:
Alternative A:
• Scatter 1—Provide participant count and
average compensation for all active
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47641
participants, whether or not participants
have account-based benefits.
• Scatter 2—Provide participant count and
average cash balance account for all active
participants, whether or not participants
have account-based benefits.
Alternative B:
• Scatter 1—Provide participant count and
average compensation for all active
participants, whether or not participants
have account-based benefits (i.e., identical to
Scatter 1 in Alternative A).
• Scatter 2—Provide participant count and
average cash balance account for only those
active participants with account based
benefits. If the number of participants with
account-based benefits in a bin is fewer than
20, the average account should not be shown
even if there are more than 20 active
participants in this bin on Scatter 1.
In general, information should be
determined as of the valuation date. Average
cash balance accounts may be determined as
of either:
1. the valuation date or
2. the day immediately preceding the
valuation date.
Average cash balance accounts that are
offset by amounts from another plan may be
reported either as amounts prior to taking
into account the offset or as amounts after
taking into account the offset. Do not report
the offset amount. For this or any other
unusual or unique situation, the attachment
should include an explanation of what is
being provided.
Line 8b(3)(a). Schedule of Retired
Participants and Beneficiaries Receiving
Payment Data. Check ‘‘Yes’’ only if this is a
multiemployer plan covered by Title IV of
ERISA that has retired participants and
beneficiaries. If Line 8b(3)(a) is ‘‘Yes,’’
complete the schedule in Line 8b(3)(b) with
the retired plan participant and beneficiaries
receiving payment data used in the valuation
for this plan year and enter the average age
and average in-pay annual benefit as of the
valuation date of the retired participants and
beneficiaries on Lines 8b(3)(c) and 8b(3)(d),
respectively. Do not report average annual inpay benefit information for age brackets
where there are 10 or less retired participants
and beneficiaries receiving payment in the
average.
Line 8b(4)(a). Schedule of Terminated
Vested Participant Data. Check ‘‘Yes’’ only if
this is a multiemployer plan covered by Title
IV of ERISA that has terminated vested
participants. If Line 8b(4)(a) is ‘‘Yes,’’
complete the schedule in Line 8b(4)(b) with
the terminated vested participant data used
in the valuation for this plan year and enter
the average age and average annual benefit as
of the valuation date of the terminated vested
participants in Line 8b(4)(c) and 8b(4)(d),
respectively. Do not report average annual
benefit information for age brackets where
there are 10 or less terminated vested
participants in the average. Include the
assumed form of payment and the assumed
first age of payment in Lines 8b(4)(e) and
8b(4)(f), respectively, for the benefit amounts
shown in the schedule.
Line 9. Shortfall Method. Under the
shortfall method of funding, the normal cost
in the funding standard account is the charge
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per unit of production (or per unit of service)
multiplied by the actual number of units of
production (or units of service) that occurred
during the plan year. Each amortization
installment in the funding standard account
is similarly calculated.
Line 9c. Amortization Charges. The
outstanding balance and amortization
charges and credits must be calculated as of
the valuation date for the plan year. Line
9c(3) should only include information related
to the amortization bases extended and
amortized using the interest rate under
section 6621(b) of the Code.
Line 9d. Interest as Applicable. Interest as
applicable should be charged to the last day
of the plan year.
Line 9f. Note that the credit balance or
funding deficiency at the end of ‘‘Year X’’
should be equal to the credit balance or
funding deficiency at the beginning of ‘‘Year
X+1.’’ If such credit balances or funding
deficiencies are not equal, check the box on
Line 9f(2), attach an explanation and label
the attachment ‘‘Schedule MB, Line 9f—
Explanation of Prior Year Credit
Balance/Funding Deficiency
Discrepancy.’’ For example, if the difference
is because contributions for a prior year that
were not previously reported are received
this plan year, attach a listing of the amounts
and dates of such contributions. As another
example, if the difference is due to the
application of funding relief under the
Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act of 2010
(PRA 2010), Pub. L. 111–192, the attachment
should show how the information on the
Schedule MB filed for any previous plan year
would have differed if it had reflected
application of the special funding relief in
accordance with published guidance (to the
extent that the plan sponsor has applied the
special funding relief).
Line 9h. Amortization Credits. The
outstanding balance and amortization credits
must be calculated as of the valuation date.
Line 9j(1). ERISA Full Funding Limitation.
Instructions for this line are reserved pending
published guidance.
Line 9j(2). ‘‘RPA ’94’’ Override.
Instructions for this line are reserved pending
published guidance.
Line 9j(3). Full Funding Credit. Enter the
excess of (1) the accumulated funding
deficiency, disregarding the credit balance
and contributions for the current year, if any,
over (2) the greater of Lines 9j(1) or 9j(2).
Line 9k(1). Waived Funding Deficiency
Credit. Enter a credit for a waived funding
deficiency for the current plan year (Code
section 431(b)(3)(C)). If a waiver of a funding
deficiency is pending, report a funding
deficiency. If the waiver is granted after Form
5500 or Form 5500–SF is filed, file an
amended Form 5500 or Form 5500–SF, as
applicable, with an amended Schedule MB to
report the funding waiver (see Amended
Return/Report in the instructions for Form
5500 or Line B—Box for Amended Return/
Report in the instructions for Form 5500–SF,
as applicable).
Line 9k(2). Other Credits. Enter a credit in
the case of a plan for which the accumulated
funding deficiency is determined under the
funding standard account if such plan year
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follows a plan year for which such deficiency
was determined under the alternative
minimum funding standard.
Line 9o. Reconciliation Account. The
reconciliation account is made up of those
components that upset the balance equation
of Treasury Regulations section 1.412(c)(3)–
1(b). Valuation assets must not be adjusted by
the reconciliation account balance when
computing the required minimum funding.
Line 9o(1). This amount is equal to the
prior year’s accumulated reconciliation
amount due to prior waived funding
deficiencies, increased with interest at the
valuation rate to the current valuation date.
Line 9o(2)(a). If an amortization extension
is being amortized at an interest rate that
differs from the valuation rate, enter the prior
year’s ‘‘reconciliation amortization extension
outstanding balance,’’ increased with interest
at the valuation interest rate to the current
valuation date, and decreased by the year end
amortization amount based on the
amortization interest rate from the prior plan
year.
Line 9o(3). Enter the sum of Lines 9o(1)
and 9o(2)(b) (each adjusted with interest at
the valuation rate to the current valuation
date, if necessary).
Note. The net outstanding balance of
amortization charges and credits minus the
prior year’s credit balance minus the amount
on Line 9o(3) (each adjusted with interest at
the valuation rate, if necessary) must equal
the unfunded liability.
Line 10. Contribution Necessary to Avoid
Deficiency. Enter the amount from Line 9n.
If applicable, file IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit
Plans, with the IRS to pay the excise tax on
the funding deficiency. There is a penalty for
not filing the Form 5330 on time.
Line 11. In accordance with ERISA section
103(d)(3), attach a justification for any
change in actuarial assumptions for the
current plan year and label the attachment—
‘‘Schedule MB, Line 11—Justification for
Change in Actuarial Assumptions.’’
20XX Instructions for Schedule R (Form
5500) (Retirement Plan Information)
General Instructions
Purpose of Schedule
Schedule R (Form 5500) reports certain
information on retirement plan distributions,
funding, nondiscrimination, coverage, and
the adoption of amendments, as well as
certain information on single-employer and
multiemployer defined benefit pension
plans.
Electronic Attachments. All attachments to
Schedule R must be properly identified, must
include the name of the plan, plan sponsor’s
EIN, and plan number. Place ‘‘Schedule R’’
and the Schedule R line number at the top
of each attachment to identify the
information to which the attachment relates.
Do not include attachments that contain a
visible social security number. The Schedule
R and its attachments are open to public
inspection, and the contents are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a visible
social security number or any portion thereof
on an attachment may result in the rejection
of the filing.
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Who Must File
Schedule R must be attached to a Form
5500 filed for both tax-qualified and
nonqualified pension benefit plans. The parts
of Schedule R that must be completed
depend on whether the plan is subject to the
minimum funding standards of Code section
412 or ERISA section 302 and the type of
plan. See line item requirements under
Specific Instructions for more details.
Exceptions: Schedule R should not be
completed when the Form 5500 Annual
Return/Report is filed for a pension plan that
uses, as the sole funding vehicle for
providing benefits, individual retirement
accounts or annuities (as described in Code
section 408). See the Form 5500 Annual
Return/Report instructions for Limited
Pension Plan Reporting for more information.
Check the Schedule R box on the Form
5500 (Part II, Line 10a(1)) if a Schedule R is
attached to the Form 5500.
Specific Instructions
Lines A, B, C, and D. This information
must be the same as reported in Part II of the
Form 5500 to which this Schedule R is
attached.
Do not use a social security number in Line
D instead of an EIN. Schedule R and its
attachments are open to public inspection,
and the contents are public information and
are subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on Schedule R or any of its
attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement. The EBSA
does not issue EINs.
‘‘Participant’’ for purposes of Schedule R,
means any present or former employee who
at any time during the plan year had an
accrued benefit in the plan (account balance
in a defined contribution pension plan).
Part I—Distributions
‘‘Distribution’’ includes only payments of
benefits during the plan year, in cash, in
kind, by purchase for the distributee of an
annuity contract from an insurance company,
or by distribution of life insurance contracts.
It does not include:
1. Corrective distributions of excess
deferrals, excess contributions, or excess
aggregate contributions, or the income
allocable to any of these amounts;
2. Distributions of automatic contributions
pursuant to Code section 414(w);
3. The distribution of elective deferrals or
the return of employee contributions to
correct excess annual additions under Code
section 415, or the gains attributable to these
amounts; and
4. A loan deemed as a distribution under
Code section 72(p).
Note. It does, however, include a
distribution of a plan loan offset amount as
defined in Treasury Regulations section
1.402(c)–2, Q&A 9(b).
Line 1. Enter the total value of all
distributions made during the year
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(regardless of when the distribution began) in
any form other than cash, annuity contracts
issued by an insurance company, distribution
of life insurance contracts, marketable
securities within the meaning of Code section
731(c)(2), or plan loan offset amounts. Do not
include eligible rollover distributions paid
directly to eligible retirement plans in a
direct rollover under Code section 401(a)(31)
unless such direct rollovers include property
other than that enumerated in the preceding
sentence.
Line 2. Enter the EIN(s) of any payor(s)
(other than the plan sponsor or plan
administrator on Line 2b or 3b of the Form
5500) who paid benefits reportable on IRS
Form 1099–R on behalf of the plan to
participants or beneficiaries during the plan
year. This is the EIN that appears on the IRS
Forms 1099–R that are issued to report the
payments. Include the EIN of the trust if
different than that of the sponsor or plan
administrator. If more than two payors made
such payments during the year, enter the
EINs of the two payors who paid the greatest
dollar amounts during the year. For purposes
of this Line 2, take into account all payments
made during the plan year, in cash or in
kind, that are reportable on IRS Form 1099–
R, regardless of when the payments began,
but take into account payments from an
insurance company under an annuity only in
the year the contract was purchased.
Line 3. Enter in the appropriate location,
broken out by active, terminated vested, and
retired, the number of living or deceased
participants whose benefits under the plan
were distributed during the plan year in the
form of a single-sum distribution, either as an
annuity or a lump sum. For this purpose, a
distribution of a participant’s benefits will
not fail to be a single-sum distribution merely
because, after the date of the distribution, the
plan makes a supplemental distribution as a
result of earnings or other adjustments made
after the date of the single-sum distribution.
Also include any participants whose benefits
were distributed in the form of a direct
rollover to the trustee or custodian of a
qualified plan or individual retirement
account. Profit-sharing plans, ESOPs, and
stock bonus plans skip Line 3.
Line 4. Check ‘‘Yes’’ if the required
minimum distributions were made to 5%
owners who attained age 701⁄2 and older.
Required Minimum Distributions (RMDs)
generally are minimum amounts that a
retirement plan account owner must
withdraw annually starting with the year that
he or she reaches 701⁄2 years of age or, if later,
the year in which he or she retires. However,
if the account owner is a 5% owner of the
business sponsoring the retirement plan, the
RMDs must begin once the account holder is
age 701⁄2, regardless of whether he or she is
retired.
Note. You must complete Line 4 if you are
required to file at least 250 returns of any
type with the IRS during the calendar year.
However, if you are a small filer (files fewer
than 250 returns of any type with the IRS
including information returns (for example,
Forms W–2 and Forms 1099), income tax
returns, employment tax returns, and excise
tax returns during the calendar year), and
you do not complete this line, then you must
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file the paper Form 5500–SUP with the IRS.
See Instructions for Form 5500–SUP for more
information.
Part II—Funding Information
Complete Part II only if the plan is subject
to the minimum funding requirements of
Code section 412 or ERISA section 302.
All qualified defined benefit and defined
contribution pension plans are subject to the
minimum funding requirements of Code
section 412 unless they are described in the
exceptions listed under Code section
412(e)(2). These exceptions include profitsharing or stock bonus plans, insurance
contract plans described in Code section
412(e)(3), and certain plans to which no
employer contributions are made.
Nonqualified employee pension benefit
plans are subject to the minimum funding
requirements of ERISA section 302 unless
specifically exempted under ERISA sections
4(a) or 301(a). The employer or plan
administrator of a single-employer or
multiple-employer defined benefit pension
plan that is subject to the minimum funding
requirements must file Schedule SB as an
attachment to Form 5500. Schedule MB is
filed for multiemployer defined benefit
pension plans and certain money purchase
defined contribution pension plans (whether
they are single-employer or multiemployer
plans). However, Schedule MB is not
required to be filed for a money purchase
defined contribution pension plan that is
subject to the minimum funding
requirements unless the plan is currently
amortizing a waiver of the minimum funding
requirements.
Line 5. Check ‘‘Yes’’ if, for purposes of
computing the minimum funding
requirements for the plan year, the plan
administrator is making an election intended
to satisfy the requirements of Code section
412(d)(2) or ERISA section 302(d)(2). Under
Code section 412(d)(2) and ERISA section
302(d)(2), a plan administrator may elect to
have any amendment, adopted after the close
of the plan year for which it applies, treated
as having been made on the first day of the
plan year if all of the following requirements
are met:
1. The amendment is adopted no later than
two and one-half months (two years for a
multiemployer plan) after the close of such
plan year;
2. The amendment does not reduce the
accrued benefit of any participant
determined as of the beginning of such plan
year; and
3. The amendment does not reduce the
accrued benefit of any participant
determined as of the adoption of the
amendment unless the plan administrator
notified the Secretary of the Treasury of the
amendment and the Secretary either
approved the amendment or failed to
disapprove the amendment within 90 days
after the date the notice was filed. See
Treasury Temporary Regulations section
11.412(c)–7(b) for details on when and how
to make the election and what information to
include on the statement of election, which
must be filed with the Form 5500 Annual
Return/Report.
Line 6. If a money purchase defined
contribution pension plan (including a target
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47643
benefit plan) has received a waiver of the
minimum funding standard, and the waiver
is currently being amortized, complete Lines
3, 9, and 10 of Schedule MB. See instructions
for Schedule MB. Attach Schedule MB to
Form 5500. The Schedule MB for a money
purchase defined contribution pension plan
does not need to be signed by an enrolled
actuary.
Line 7a. The minimum required
contribution for a money purchase defined
contribution pension plan (including a target
benefit plan) for a plan year is the amount
required to be contributed for the year under
the formula set forth in the plan document.
If there is an accumulated funding deficiency
for a prior year that has not been waived, that
amount should also be included as part of the
contribution required for the current year.
Line 7b. Include all contributions for the
plan year made not later than 81⁄2 months
after the end of the plan year. Show only
contributions actually made to the plan by
the date the form is filed. For example, do
not include receivable contributions for this
purpose.
Line 7c. If the minimum required
contribution exceeds the contributions for
the plan year made not later than 81⁄2 months
after the end of the plan year, the excess is
an accumulated funding deficiency for the
plan year. File IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit
Plans, with the IRS to pay the excise tax on
the deficiency. There is a penalty for not
filing IRS Form 5330 on time.
Line 8. Check ‘‘Yes’’ if the minimum
required contribution remaining in Line 7c
will be made not later than 81⁄2 months after
the end of the plan year. If ‘‘Yes,’’ and
contributions are actually made by this date,
then there will be no reportable deficiency
and IRS Form 5330 will not need to be filed.
Line 9. Revenue Procedure 2000–40,
2000–2 C.B. 357, providing for automatic
approval for a change in funding method for
a plan year, generally does not apply unless
the plan administrator or an authorized
representative of the plan sponsor explicitly
agrees to the change. If a change in funding
method made pursuant to such a revenue
procedure (or a class ruling letter) is to be
applicable for the current plan year, this line
generally must be checked ‘‘Yes.’’ In certain
situations, however, the requirement that the
plan administrator or an authorized
representative of the plan sponsor agree to
the change in funding method will be
satisfied if the plan administrator or an
authorized representative of the plan sponsor
is made aware of the change.
In these situations, this line must be
checked ‘‘N/A.’’ See section 6.01(2) of Rev.
Proc. 2000–40. If the plan’s change in
funding method is not made pursuant to a
revenue procedure or other authority
providing automatic approval which requires
plan sponsor agreement, or to a class ruling
letter (e.g., it is pursuant to a regulation or
the Preservation of Access to Care for
Medicare Beneficiaries and Pension Relief
Act of 2010 (PRA 2010), Pub. L. 111–192),
then this line should be checked ‘‘N/A.’’
Part III—Determination and Amendments
Line 10. If this is a defined benefit pension
plan, indicate as follows whether there were
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any amendments adopted during this plan
year that increased or decreased the value of
benefits:
• Check ‘‘No’’ if no amendments were
adopted during this plan year that increased
or decreased the value of benefits.
• Check ‘‘Increase’’ if an amendment was
adopted during the plan year that increased
the value of benefits in any way. This
includes an amendment providing for an
increase in the amount of benefits or rate of
accrual, more generous lump sum factors,
COLAs, more rapid vesting, additional
payment forms, or earlier eligibility for some
benefits.
• Check ‘‘Decrease’’ if an amendment was
adopted during the plan year that decreased
the value of benefits in any way. This
includes a decrease in future accruals,
closure of the plan to new employees, or
accruals being frozen for some or all
participants.
• If the amendments that were adopted
increased the value of some benefits but
decreased the value of others, check ‘‘Both.’’
Line 11a. If a plan sponsor or an employer
adopted a pre-approved plan that includes a
master & prototype plan (a standardized or
nonstandardized M&P) or a volume submitter
plan, enter the date of the most recent
favorable opinion or advisory letter issued by
the IRS and the serial number listed on that
favorable letter.
Line 11b. If it is an individually-designed
plan and received a favorable determination
letter from the IRS, enter the date of the most
recent determination letter. Leave it blank if
this individual-designed plan has never
received a favorable determination letter.
Part IV—Additional Employer Information
for Multiemployer Defined Benefit Pension
Plans
If this is not a multiemployer plan, skip
this Part.
Required attachments. Multiemployer
defined benefit pension plans that are in
Endangered Status or Critical Status must
attach a summary of their Funding
Improvement Plan or Rehabilitation Plan (as
updated, if applicable) and also any update
to a Funding Improvement Plan or
Rehabilitation Plan.
The summary of any Funding
Improvement Plan or Rehabilitation Plan
must reflect such plan in effect at the end of
the plan year (whether the original Funding
Improvement Plan or Rehabilitation Plan or
as updated) and must include a description
of the various contribution and benefit
schedules that are being provided to the
bargaining parties and any other actions
taken in connection with the Funding
Improvement Plan or Rehabilitation Plan,
such as use of the shortfall funding method
or extension of an amortization period. The
summary must also identify the first year and
the last year of the Funding Improvement
Period or the Rehabilitation Period. If an
extended Funding Improvement Period (of 13
or 18 years) or Rehabilitation Period (of 13
years) applies because of an election under
section 205 of the Worker, Retiree, and
Employer Recovery Act of 2008 (‘‘WRERA’’),
the summary must include a statement to
that effect and the date that the election was
filed with the IRS.
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The summary must also include a schedule
of the expected annual progress for the
funded percentage or other relevant factors
under the Funding Improvement Plan or
Rehabilitation Plan. If the sponsor of a
multiemployer plan in Critical Status has
determined that, based on reasonable
actuarial assumptions and upon exhaustion
of all reasonable measures, the plan cannot
emerge from Critical Status by the end of the
Rehabilitation Period as described in Code
section 432(e)(3)(A)(ii), the summary must
include an explanation of the alternatives
considered, why the plan is not reasonably
expected to emerge from Critical Status by
the end of the Rehabilitation Period, and
when, if ever, it is expected to emerge from
Critical Status under the Rehabilitation Plan.
The plan sponsor is required to annually
update a Funding Improvement Plan or
Rehabilitation Plan that was adopted in a
prior year. The update must be filed as an
attachment to the Schedule R. The update
attachment must identify the modifications
made to the Funding Improvement Plan or
Rehabilitation Plan during the plan year,
including contribution increases, benefit
reductions, or other actions.
The attachment described above must be
labeled ‘‘Schedule R, Summary of Funding
Improvement Plan,’’ or ‘‘Schedule R,
Summary of Rehabilitation Plan’’ as
appropriate, and if applicable, ‘‘Schedule R,
Update of Funding Improvement Plan or
Rehabilitation Plan.’’ Each attachment must
also include the plan name, the plan
sponsor’s name and EIN, and the plan
number.
Line 12. This line should be completed
only by multiemployer defined benefit
pension plans that are subject to the
minimum funding standards (see Code
section 412 and Part 3 of Title I of ERISA).
Enter the information on Lines 13a through
13e for any employer that contributed more
than five (5) percent of the plan’s total
contributions for the 20XX plan year. List
employers in descending order according to
the dollar amount of their contributions to
the plan. Complete as many entries as are
necessary to list all employers that
contributed more than five (5) percent of the
plan’s contributions.
Line 12a. Enter the name of the employer
contributing to the plan.
Line 12b. Enter the EIN of the employer
contributing to the plan. Do not enter a social
security number in lieu of an EIN; therefore,
ensure that you have the employer’s EIN and
not a social security number. The Form 5500
Annual Return/Report is open to public
inspection, and the contents are public
information and are subject to publication on
the Internet. Because of privacy concerns, the
inclusion of a social security number or any
portion thereof on this line may result in the
rejection of the filing.
EINs can be obtained from the IRS online,
by telephone, by fax, or by mail depending
on when you need to use the EIN. For more
information, see Section 3: Electronic Filing
Requirement. The EBSA does not issue EINs.
Line 12c. Dollar Amount Contributed.
Enter the total dollar amount contributed to
the plan by the employer for all covered
workers in all locations for the plan year. Do
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not include the portion of an aggregated
contribution that is for another plan, such as
a welfare benefit plan, a defined contribution
pension plan or another defined benefit
pension plan.
Line 12d. Collective Bargaining Agreement
Expiration Date. Enter the date on which the
employer’s collective bargaining agreement
expires. If the employer has more than one
collective bargaining agreement requiring
contributions to the plan, check the box and
include, as an attachment, the expiration date
of each collective bargaining agreement
(regardless of the amount of contributions
arising from such agreement). Label the
attachment: ‘‘Schedule R, line 12d—
Collective Bargaining Agreement
Expiration Date.’’ Include the plan name
and the sponsor’s name and EIN.
Line 12e. Contribution Rate Information.
Enter the contribution rate (in dollars and
cents) per contribution base unit in Line
12e(1) and the base unit measure in Line
12e(2). Indicate whether the base unit is
measured on an hourly, weekly, unit-ofproduction, or other basis. If ‘‘Other,’’ specify
the base unit measure used. If the
contribution rate changed during the plan
year, enter the last contribution rate in effect
for the plan year.
If the employer has different contribution
rates for different classifications of
employees or different places of business,
check the box in the first line of Line 12e and
list in an attachment each contribution rate
and corresponding base unit measure under
which the employer made contributions
(regardless of the amount of contributions
resulting from each rate). Label the
attachment: ‘‘Schedule R, Line 12e—
Information on Contribution Rates and
Base Units.’’ Include the plan name and the
sponsor’s name and EIN.
Line 13. Enter the number of participants
on whose behalf no contributions were made
by an employer as an employer of the
participant. For purposes of Line 13, count
only those participants whose last
contributing employer had withdrawn from
the plan by the beginning of the relevant plan
year. Disregard any participants whose
employers had not withdrawn from the plan,
even if, in the relevant year, no contributions
were made by the employer on behalf of
those participants. Thus, for the limited
purposes of Line 13 and notwithstanding any
contrary definition of such participants
applicable elsewhere, the deferred vested and
retired participants of employers who have
not withdrawn from the plan should not be
included in these numbers.
Note. Withdrawal liability payments are
not to be treated as contributions for the
purpose of determining the number of
participants for Line 13.
Line 13a. Enter the number of participants
for the 20XX plan year described in the Line
13 instructions.
Line 13b. Enter the number of participants
for the 20XX–1 plan year described in the
Line 13 instructions.
Line 13c. Enter the number of participants
for the 20XX–2 plan year described in the
Line 13 instructions.
Line 14. Enter the ratio of number of
participants on whose behalf no employer
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had an obligation to make a contribution for
the 20XX plan year to the corresponding
number for each of the two preceding plan
years. For the purpose of these ratios, count
all participants whose employers have
withdrawn from the plan as well as all
deferred vested and retired participants of
employers still active in the plan (unless the
collective bargaining agreement specifically
requires the employer to make contributions
for such participants).
Line 14a. Enter the ratio of the number of
participants as described in the Line 14
instructions for the 20XX plan year to the
number for the 20XX–1 plan year.
Line 14b. Enter the ratio of the number of
participants as described on the Line 14
instructions for the 20XX plan year to the
number for the 20XX–2 plan year.
Note. Withdrawal liability payments are
not to be treated as contributions for
determining the number of participants on
Line 14.
Line 15a. Enter the number of employers
that withdrew from the plan during the
20XX–1 plan year.
Line 15b. If Line 15a is greater than zero,
enter the aggregate amount of withdrawal
liability assessed against these employers. If
the withdrawal liability for one or more
withdrawing employers has not yet been
determined, include the amounts estimated
to be assessed against them in the aggregate
amount.
The definitions of withdrawal are those
contained in Section 4203 of ERISA. If the
plan is in the building and construction,
entertainment, or another industry that has
special withdrawal rules, withdrawing
employers should only be counted if the
withdrawal adheres to the special rules
applying to its specific industry.
Line 16. If assets and liabilities from
another plan were transferred to or merged
with the assets and liabilities of this plan
during the 20XX plan year, check the box
and provide the following information as an
attachment. The attachment should include
the names and employer identification
numbers of all plans that transferred assets
and liabilities to, or merged with, this plan.
For each plan, including this plan, the
attachment should also include the actuarial
valuation of the total assets and total
liabilities for the year preceding the transfer
or merger, based on the most recent data
available as of the day before the first day of
the 20XX plan year. Label the attachment
‘‘Schedule R, Line 16—Information on
Assets and Liabilities Transferred to or
Merged with This Plan’’ and include the
plan name and the plan sponsor’s name and
EIN.
Part V—Additional Information for SingleEmployer and Multiemployer Defined
Benefit Pension Plans
Line 17. If any liabilities to participants or
their beneficiaries under the plan at the end
of the plan year consist of liabilities under
two (2) or more plans as of the last day of
the plan year immediately before the 20XX
plan year, check the box and provide the
following information as an attachment. The
attachment should include the names,
employer identification numbers, and plan
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numbers of all plans, including the current
plan, that provided a portion of liabilities of
the participants and beneficiaries in
question. The attachment should also include
the funding percentage of each plan as of the
last day of the 20XX–1 plan year. For singleemployer plans, the funding percentage is the
funding target attainment percentage, where
the numerator is the value of plan assets
reduced by the sum of the amount of the
prefunding balance and the funding standard
carryover balance, and the denominator is
the funding target for the plan (for this
purpose, if the plan is in at risk status, then
the funding target is determined as if the plan
were not in at risk status). For multiemployer
plans, the funding percentage is the ratio
where the numerator is the actuarial value of
the plan’s assets and the denominator is the
accrued liability of the plan. For a terminated
plan for which the funding percentage is
required to be reported, write ‘‘Terminated’’
in the space where the plan’s funding
percentage would otherwise have been
reported. Label the attachment ‘‘Schedule R,
Line 17—Funded Percentage of Plans
Contributing to the Liabilities of Plan
Participants’’ and include the plan name
and the plan sponsor’s name and EIN.
Line 18. This line must be completed for
all defined benefit pension plans (except
DFEs) with 1,000 or more participants at the
beginning of the plan year. To determine if
the plan has 1,000 or more participants, use
the participant count shown on Line 3d(1) of
the Schedule SB for single-employer plans or
on Line 2b(4)(1) of the Schedule MB for
multiemployer plans.
Line 18a. Show the beginning-of-year
distribution of assets for the categories
shown. Use the market value of assets and do
not include the value of any receivables.
These percentages, expressed to the nearest
whole percent, should reflect the total assets
held in stocks, investment-grade debt
instruments, high-yield debt instruments,
real estate, or other asset classes, regardless
of how they are listed on the Schedule H.
The percentages in the five categories should
sum to 100 percent. Assets held in trusts,
accounts, mutual funds, and other
investment arrangements should be
disaggregated and properly distributed
among the five asset components. The assets
in these trusts, accounts, mutual funds, and
investment arrangements should not be
included in the ‘‘Other’’ component unless
these investments contain no stocks, bonds,
or real estate holdings. The same
methodology should be used in
disaggregating trust assets as is used when
disclosing the allocation of plan assets on the
sponsor’s 10–K filings to the Securities and
Exchange Commission. Real estate
investment trusts (REITs) should be listed
with stocks, while real estate limited
partnerships should be included in the Real
Estate category.
Investment-grade debt-instruments are
those with an S&P rating of BBB—or higher,
a Moody’s rating of Baa3 or higher, or an
equivalent rating from another rating agency.
High-yield debt instruments are those that
have ratings below these rating levels. If the
debt does not have a rating, it should be
included in the ‘‘high-yield’’ category if it
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does not have the backing of a government
entity. Unrated debt with the backing of a
government entity would generally be
included in the ‘‘investment-grade’’ category
unless it is generally accepted that the debt
should be considered as ‘‘high-yield.’’ Use
the ratings in effect as of the beginning of the
plan year.
Line 18b. Check the box that shows the
average duration of the plan’s combined
investment-grade and high-yield debt
portfolio. If the average duration falls exactly
on the boundary of two boxes, check the box
with the lower duration. To determine the
average duration, use the ‘‘effective duration’’
or any other generally accepted measure of
duration. Report the duration measure used
in Line 19c. If debt instruments are held in
multiple debt portfolios, report the weighted
average of the average durations of the
various portfolios where the weights are the
dollar values of the individual portfolio.
Part VI Nondiscrimination and Coverage
Note. You must complete this part from
Lines 19 through 21 if you are required to file
at least 250 returns of any type with the IRS,
including information returns (for example,
Forms W–2 and Forms 1099), income tax
returns, employment tax returns, and excise
tax returns, during the calendar year.
However, if you are a small filer (files fewer
than 250 returns of any type with the IRS
during the calendar year), and you do not
complete these lines, you must file Form
5500–SUP with the IRS on paper. See the
Treasury regulations on ‘‘Employee
Retirement Benefit Plan Returns Required on
Magnetic Media’’ (See 79 FR 58256 at https://
federalregister.gov/a/2014-23161) and
Instructions for Form 5500–SUP for more
information.
19a. Check ‘‘Yes’’ if the plan includes a
cash or deferred arrangement (CODA), under
which a covered employee may elect to have
the employer either contribute an amount to
the plan’s trust on behalf of the employee or
to pay the employee directly in cash or some
other taxable benefit. The contributions go
into an individual account, with the
employee often choosing the investments
based on options provided under the plan. In
some plans, the employer also makes
contributions, such as contributions that
match the employee’s contributions up to a
certain percentage.
Line 19b. If Line 19a is ‘‘Yes,’’ check the
applicable method used to satisfy the
nondiscrimination requirements of Code
section 401(k). A safe harbor 401(k) plan is
similar to a traditional 401(k) plan but,
among other things, it must provide for
employer contributions. These contributions
may be employer matching contributions,
limited to employees who defer, or employer
contributions made on behalf of all eligible
employees, regardless of whether they make
elective deferrals. The safe harbor 401(k) plan
is not subject to the complex annual
nondiscrimination tests that apply to
traditional 401(k) plans. Check ‘‘Designbased safe harbor method’’ if this is a safe
harbor 401(k) plan that is a SIMPLE 401(k)
plan under Code section 401(k)(11), a safe
harbor 401(k) plan under Code section
401(k)(12), or a qualified automatic
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contribution arrangement under Code section
401(k)(13).
If the plan, by its terms, does not satisfy
the safe harbor method, it generally must
satisfy the regular nondiscrimination test,
known as the actual deferral percentage
(ADP) test. Check the appropriate box to
indicate if the plan uses the ‘‘current year’’
ADP test or the ‘‘prior year’’ ADP test. Check
‘‘current year’’ ADP test if the plan uses the
current year testing method under which the
ADP test is performed by comparing the
current plan year’s ADP for HCEs with the
current plan year’s (rather than the prior plan
year’s) ADP for NHCEs. Check all boxes that
apply for a plan that tests different groups of
employees on a disaggregated basis. Check
‘‘N/A’’ if the plan is not required to test for
nondiscrimination under Code section
401(k)(3), such as a plan in which no HCE
is benefiting.
Line 20a. Check the applicable testing
method used to satisfy the minimum
coverage requirements under Code section
410(b). Check ‘‘N/A’’ if the plan is deemed
to satisfy section 410(b) automatically, such
as a plan in which no HCE is benefitting.
Check all boxes that apply for a plan that
tests different groups of employees on a
disaggregated basis.
Line 20b. Check ‘‘Yes’’ if this plan was
permissively aggregated with another plan to
satisfy requirements under Code sections
410(b) and 401(a)(4). Generally, each single
plan must separately satisfy the coverage and
nondiscrimination requirements. However,
an employer may designate two or more
separate plans as a single plan for purposes
of applying the ratio percentage test of
Treasury Regulations section 1.410(b)–2(b)(2)
or the nondiscretionary classification test of
Treasury Regulations section 1.401(b)–4. Two
or more plans that are permissively
aggregated and treated as a single plan for
purposes of the minimum coverage test of
Code section 410(b) must also be treated as
a single plan for purpose of the
nondiscrimination test under Code section
401(a)(4). See Treasury Regulations sections
1.410(b)–7 and 1.401(a)(4)–(9) for more
information.
Line 21. Check ‘‘Yes’’ if the plan does not
satisfy any exceptions under Treasury
Regulation section 1.401(a)26)–1(b) if it
benefitted at least the lesser of: 50 employees
of the employer, or the greater of: 40 percent
of all employees of the employer, or 2
employees (or if there is only 1 employee,
such employer). The definition of employer
includes all related employers under Code
sections 414(b), (c) or (m). In performing the
participation tests, the employees who are
excludable are generally the same as those
who are excludable for purposes of
performing coverage tests under Code section
410(b), see Treasury Regulation section
1.401(a)(26)–6. In addition, for most plans
the definition of who is benefiting under the
plan for the purposes of the participation
tests is the same as the definition of
benefiting employees for purposes of
coverage tests under Code section 410(b), see
Treasury Regulation section 1.401(a)(26)–5.
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Part VII Participation Information in
Defined Contribution Pension Plans
Line 22. Employer Contributions. Check
‘‘Yes’’ in Line 22a if the employer provided
contributions to the participant’s defined
contribution pension account regardless of
whether the participant made any
contributions. If ‘‘Yes’’ is checked in Line
22a, enter in Line 22b the appropriate line
the formula describing how the amount of
such employer contributions was
determined. See formula examples below.
Example 1: The employer provided 1.5%
of compensation for each participant. Check
the ‘‘% of a participant’s compensation’’
formula and enter ‘‘1.5’’ in the corresponding
amount line.
Example 2: The employer provided one flat
dollar amount ($500) to each participant.
Check the ‘‘$ per participant’’ formula and
enter ‘‘500’’ in the corresponding amount
line.
Example 3: The employer used a different
kind of formula or method. Check ‘‘Other’’
and enter a description in the text field.
Line 23. Employer Matching
Contributions. If the plan offers employer
matching contributions, check ‘‘Yes’’ in Line
23a. If you checked ‘‘Yes’’ in Line 23a, check
the appropriate box in Line 23b to identify
the formula used to determine the amount of
the employer matching contribution for each
participant. If the employer matches
participant contributions at a certain rate up
to a limit, check ‘‘% of a participant’s
contribution up to a limit’’ and enter the
percentage. In Line 23c, enter the maximum
employer contribution by checking the
applicable box and providing either the
percentage of a participant’s compensation or
the dollar amount that corresponds to the
maximum. If the plan uses a different type
of formula, check ‘‘Other’’ and describe the
formula in the open text field. See formula
examples below.
Example 1: The employer provides a 50%
match on participant contributions of up to
6% of the participant’s compensation. When
the participant is contributing at or above the
maximum, the employer contributes 3% of
the participant’s compensation. Check the
‘‘% of a participant’s contribution up to a
limit’’ formula and enter ‘‘50’’. The
maximum match that the employer will
contribute is ‘‘3’’.
Example 2: The employer provides a 50%
match on a participant’s contributions up to
$3,000 contribution by the employee. At that
maximum level the employer would be
contributing $1,500. Check the ‘‘$ per
participant’’ formula and enter ‘‘1500’’ in the
corresponding amount line.
Example 3: The employer provides 100%
match up to the first 3% of employee’s salary
deferrals and 50% for the next 2%. Check the
‘‘Other’’ box and describe the formula in the
open text field.
Line 24. Automatic Enrollment. Answer
‘‘Yes’’ in Line 24a if the plan has automatic
enrollment. If you answer ‘‘Yes,’’ enter the
default elective deferral as a percentage of a
participant’s compensation in the first year
after a participant is automatically enrolled.
In Line 24b, indicate whether the plan has
automatic escalation, assuming a participant
has made no active elections. If the plan has
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automatic escalation, indicate the maximum
elective deferral as a percentage of a
participant’s compensation. In Line 24c enter
the number of participants that remain in the
plan’s default investment account(s) and
have not directed any assets into other plan
investments.
Line 25. Catch-up Contributions. Enter the
number of participants making catch-up
contributions.
20XX Instructions for Schedule SB (Form
5500)—Single-Employer Defined Benefit
Plan Actuarial Information
General Instructions
Note. Final regulations under certain
portions of Code section 430 (sections 430(d),
430(f), 430(g), 430(h), and 430(i)) and Code
section 436 (and the corresponding
provisions of ERISA (sections 206(g) and
303)) were published in the Federal Register
July 31, 2008, and October 15, 2009, and
apply for plan years beginning on or after
January 1, 2010. Proposed regulations
providing additional rules under Code
sections 430(a), 430(j) and 4971 (and the
corresponding provisions of ERISA (section
303)) were published in the Federal Register
on April 15, 2008. The final regulations that
relate to those proposed regulations have a
later effective date than the final regulations
published October 15, 2009. With respect to
provisions for which the final regulations do
not apply to a plan for the plan year, plan
sponsors must follow a reasonable
interpretation of the statute, taking into
account the provisions of the Worker,
Retiree, and Employer Recovery Act of 2008
(‘‘WRERA’’), Public Law 110–458, the
Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act of 2010
(‘‘PRA 2010’’), Public Law 111–192, Moving
Ahead for Progress in the 21st Century Act
(‘‘MAP–21’’), Public Law 112–141, and any
other amendments to the funding rules that
are enacted. For this purpose, plan sponsors
may rely on the provisions of the proposed
regulations or the final regulations, as
applicable, but must take into account the
provisions of WRERA, PRA 2010, MAP–21,
any other amendments to the funding rules
that are enacted, and any applicable
published guidance.
Who Must File
As the first step, the plan administrator of
any single-employer defined benefit pension
plan (including a multiple-employer defined
benefit pension plan) that is subject to the
minimum funding standards (see Code
section 412 and Part 3 of Title I of ERISA)
must obtain a completed Schedule SB
(including attachments) that is prepared and
signed by the plan’s enrolled actuary as
discussed below in the Statement by Enrolled
Actuary section. The plan administrator must
retain with the plan records the Schedule SB
that is prepared and signed by the plan’s
actuary. The electronic-signature by the plan
actuary is acceptable. The plan actuary can
access the EFAST2 Web site at
www.efast.dol.gov to register for electronic
credentials to sign.
The plan administrator must ensure that
the information from the actuary’s Schedule
SB is entered electronically into the annual
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return/report being submitted. When entering
the information, whether using EFAST2approved software or EFAST2’s web-based
filing system, all the fields required for the
type of plan must be completed (see
instructions for fields that need to be
completed).
Further, if a plan actuary chooses not to
sign electronically, then the actuary must
manually sign the Schedule SB and an
electronic reproduction must be filed with
the Form 5500. The plan administrator of a
single-employer defined benefit pension plan
must attach to the Form 5500 or Form 5500–
SF an electronic reproduction of the
Schedule SB (including attachments)
prepared and signed by the plan’s enrolled
actuary. This electronic reproduction must be
labeled ‘‘SB Actuary Signature’’ and must
be included as a Portable Document Format
(PDF) attachment or any alternative
electronic attachment allowable under
EFAST2.
Note. The Schedule SB (Form 5500) does
not have to be filed with the Form 5500–EZ,
but it must be retained (in accordance with
the Instructions for Form 5500–EZ under the
What To File section). Similarly, the
Schedule SB does not have to be filed with
the Form 5500–SF for a one-participant plan
(as defined in the Form 5500–EZ
instructions) that is eligible for the Form
5500–SF and elects to file such form instead
of the Form 5500–EZ. However, the Schedule
SB must be retained in accordance with the
Instructions for Form 5500–SF under the
section headed Specific Instructions Only for
‘‘One-Participant Plans.’’ The enrolled
actuary must complete and sign the Schedule
SB and forward it to the person responsible
for filing the Form 5500–EZ or Form 5500–
SF, even if the Schedule SB is not filed.
Check the Schedule SB box on the Form
5500 (Part II, Line 10a(3)) if a Schedule SB
is attached to Form 5500. Check ‘‘Yes’’ on
Line 11 in Part VI of the Form 5500–SF if a
Schedule SB is required to be prepared for
the plan, even if Schedule SB is not required
to be attached to Form 5500–SF (see
instructions in the Note above, pertaining to
‘‘one-participant plans’’).
Note. This schedule is not filed for a
multiemployer plan nor for a money
purchase defined contribution pension plan
(including a target benefit plan) for which a
waiver of the minimum funding
requirements is currently being amortized.
Information for these plans must be filed
using Schedule MB (Form 5500).
Specific Instructions
Lines A through F. Identifying
Information. Lines A–F must be completed
for all plans. Lines A through D should
include the same information as reported in
corresponding lines in Part II of the Form
5500, Form 5500–SF, or Form 5500–EZ filed
for the plan. You may abbreviate the plan
name (if necessary) to fit in the space
provided.
Do not use a social security number in line
D instead of an EIN. The Schedule SB and
its attachments are open to public inspection
if filed with a Form 5500 or Form 5500–SF,
and the contents are public information and
are generally subject to publication on the
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Internet. Because of privacy concerns, the
inclusion of a social security number or any
portion thereof on the Schedule SB or any of
its attachments may result in the rejection of
the filing.
You can apply for an EIN from the IRS
online, by telephone, by fax, or by mail
depending on how soon you need to use the
EIN. For more information, see Section 3:
Electronic Filing Requirement under General
Instructions to Form 5500. The EBSA does
not issue EINs.
Line E. Type of Plan. Check the applicable
box to indicate the type of plan. A singleemployer plan for this reporting purpose is
an employee benefit plan maintained by one
employer or one employee organization. A
multiple-employer plan is a plan that is
maintained by more than one employer, but
is not a multiemployer plan. (See the
Instructions for Form 5500, box A for
additional information on the definition of a
multiemployer plan.)
1. Check ‘‘Single’’ if the Form 5500, Form
5500–SF, or Form 5500–EZ is filed for a
single-employer plan (including a plan
maintained by more than one member of the
same controlled group).
2. Check ‘‘Multiple-A’’ if the Form 5500 or
Form 5500–SF is being filed for a multipleemployer plan and the plan is subject to the
rules of Code section 413(c)(4)(A) (i.e., it is
funded as if each employer were maintaining
a separate plan). This includes plans
established before January 1, 1989, for which
an election was made to fund in accordance
with Code section 413(c)(4)(A).
3. Check ‘‘Multiple-B’’ if the Form 5500 or
Form 5500–SF is being filed for a multipleemployer plan and the plan is subject to the
rules of Code section 413(c)(4)(B) (i.e., it is
funded as if all participants were employed
by a single employer).
If ‘‘Multiple-A’’ is checked, with the
exception of Part III, the data entered on
Schedule SB should be the sum of the
individual amounts computed for each
employer. The percentages reported in Part
III should be calculated based on the reported
aggregate numbers rather than by summing
up the individual percentages. The Schedule
SB data for each employer’s portion of the
plan must be submitted as an attachment.
This is accomplished by completing and
attaching a Schedule SB for each employer or
by attaching a document containing that
information (e.g., a table showing a row for
each Schedule SB data item and a column for
each employer). Label the attachment
‘‘Schedule SB—Information for Each
Individual Employer.’’
Line F. Prior Year Plan Size. Check the
applicable box based on the highest number
of participants (both active and inactive) on
any day of the preceding plan year, taking
into account participants in all defined
benefit pension plans maintained by the
same employer (or any member of such
employer’s controlled group) who are or were
also employees of that employer or member.
For this purpose, participants whose only
defined benefit pension plan is a
multiemployer plan (as defined in Code
section 414(f)) are not counted, and
participants who are covered in more than
one of the defined benefit pension plans
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47647
described above are counted only once.
Inactive participants include vested
terminated and retired employees as well as
beneficiaries of deceased participants. If this
is the first plan year that a plan described in
this paragraph exists, complete this line
based on the highest number of participants
that the plan was reasonably expected to
have on any day during the first plan year.
General Instructions, Parts I through IX,
Statement by Enrolled Actuary, and
Attachments
Except as noted below, Parts I through VIII
must be completed for all single and
multiple-employer defined benefit pension
plans, regardless of size or type. See
instructions for Line 31 for additional
information to be provided for certain plans
with special circumstances. Part IX is
completed only for those plans for which an
alternative amortization schedule was elected
under section 430(c)(2)(D) of the Code or
section 303(c)(2)(D) of ERISA, as amended by
PRA 2010, and for those plans for which
funding relief was elected under section 107
of Pension Protection Act of 2006, as added
by PRA 2010.
The Pension Protection Act of 2006, as
amended (PPA), provides delayed effective
dates for the funding rules under Code
section 430 for plans meeting certain criteria
(certain multiple-employer plans maintained
by eligible cooperative plans, and eligible
charity plans, as described in PPA section
104). Eligible plans to which these delayed
effective dates apply do not need to complete
the entire Schedule SB, but will have to file
information relating to pre-PPA calculations
in an attachment using the 2007 Schedule B
form. See the instructions for Line 31 for
more information about which lines of
Schedule SB need to be completed and what
additional attachments are required.
PPA provides funding relief for certain
defined benefit pension plans (other than
multiemployer plans) maintained by a
commercial passenger airline or by an
employer whose principal business is
providing catering services to a commercial
passenger airline, based on an alternative 17year funding schedule. Plans using this
funding relief do not need to complete the
entire Schedule SB, but are required to
provide supplemental information as an
attachment to Schedule SB. Alternatively,
these plans can elect to apply the funding
rules generally applicable to single-employer
defined benefit pension plans, but amortize
the funding shortfall over 10 years instead of
the standard 7-year period and use a special
interest rate to determine the funding target.
Plans using this 10-year funding option must
complete the entire Schedule SB and provide
additional information. See the instructions
for Line 31 for more information about which
lines of Schedule SB need to be completed
and what additional attachments are
required.
MAP–21 amended Code section
430(h)(2)(C) and ERISA section 302(h)(2)(C)
to provide that, for certain purposes, each of
the three segment rates described in those
sections is adjusted as necessary to fall
within a specified range that is determined
based on an average of the corresponding
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segment rates for the 25-year period ending
on September 30 of the calendar year
preceding the first day of the plan year.
Accordingly, if the funding target and target
normal cost for a plan are determined using
these segment rates, the segment rates used
to determine the minimum required
contribution and the adjusted funding target
attainment percentage (‘‘AFTAP’’) used to
apply funding-based benefit restrictions
under Code section 436 and ERISA section
206(g) may be different from those used for
other purposes (such as the segment rates
used to determine the deductible limit under
Code section 404(o)). In such cases, report all
information on Schedule SB reflecting the
assumptions used to determine the minimum
required contribution and the AFTAP used to
apply funding-based benefit restrictions.
Note. (1) For a plan funded with insurance
(other than a plan described in Code section
412(e)(3) or ERISA section 301(b)), refer to
section 1.430(d)–1(c)(2) of the Income Tax
Regulations regarding whether to include the
liabilities for benefits covered under
insurance contracts held by the plan and
whether to include the value of the insurance
contracts in plan assets. (2) For terminating
plans, Rev. Rul. 79–237, 1979–2 C.B. 190,
provides that minimum funding standards
apply until the end of the plan year that
includes the termination date. Accordingly,
the Schedule SB is not required to be filed
for any later plan year. However, if a
termination fails to occur—whether because
assets remain in the plan’s related trust (see
Rev. Rul. 89–87, 1989–2 C.B. 81) or for any
other reason (e.g., the PBGC issues a notice
of noncompliance pursuant to 29 CFR
4041.31 for a standard termination)—there is
no termination date, and therefore, minimum
funding standards continue to apply and a
Schedule SB continues to be required.
Statement by Enrolled Actuary
An enrolled actuary must sign Schedule SB
with either an electronic signature or a
handwritten signature. The electronic
signature of the enrolled actuary may be
qualified to state that it is subject to attached
qualifications. See Treasury Regulations
section 301.6059–1(d) for permitted
qualifications. If the actuary has not fully
reflected any final or temporary regulation,
revenue ruling, or notice promulgated under
the statute in completing the Schedule SB,
check the box on the last line of page 1. If
this box is checked, indicate on this line
whether any unpaid required contribution or
a contribution that is not wholly deductible
would result if the actuary had fully reflected
such regulation, revenue ruling, or notice. In
addition, the actuary may offer any other
comments related to the information
contained in Schedule SB. Except as
otherwise provided in these instructions, a
stamped or machine produced signature is
not acceptable.
The actuary must provide the completed
and signed Schedule SB to the plan
administrator to be retained with the plan
records and included (in accordance with
these instructions) with the Form 5500 or
Form 5500–SF that is submitted under
EFAST2. The plan’s actuary is permitted to
electronically sign the Schedule SB, or sign
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on page one using the actuary’s signature or
by inserting the actuary’s typed name in the
signature line followed by the actuary’s
handwritten initials. The actuary’s most
recent enrollment number must be entered
on the Schedule SB that is prepared and
signed by the plan’s actuary.
Attachments
All attachments to the Schedule SB must
be properly identified as attachments to the
Schedule SB, and must include the name of
the plan, plan sponsor’s EIN, plan number,
and line number to which the schedule
relates.
Do not include attachments that contain a
visible social security number. Except for
certain one-participant plans, the Schedule
SB and its attachments are open to public
inspection, and the contents are public
information and are subject to publication on
the Internet. Because of privacy concerns, the
inclusion of a visible social security number
or any portion thereof on an attachment may
result in the rejection of the filing.
Part I—Basic Information
Note. All entries in Part I must be reported
as of the valuation date, reflecting the
assumptions and amounts generally used to
determine the minimum required
contribution. In the case of a plan described
in section 104 of PPA, the information
should be reported as if PPA provisions were
effective for all plan years beginning after
December 31, 2007.
Line 1. Valuation Date. The valuation date
for a plan year must be the first day of the
plan year unless the plan meets the smallplan exception of Code section 430(g)(2)(B)
and ERISA section 303(g)(2)(B). For plans
that qualify for the exception, the valuation
date may be any date in the plan year,
including the first or last day of the plan
year. A plan qualifies for this small-plan
exception if there were 100 or fewer
participants on each day of the prior plan
year. For the definition of participant as it
applies in this case, see the instructions for
Line F.
Line 2a. Market Value of Assets. Enter the
fair market value of assets as of the valuation
date. Include contributions designated for
any previous plan year that are made after
the valuation date (but within the 81⁄2-month
period after the end of the immediately
preceding plan year), adjusted for interest for
the period between the date of payment and
the valuation date as provided in the
applicable regulations.
Contributions made for the current plan
year must be excluded from the amount
reported in Line 2a. If these contributions
were made prior to the valuation date (which
can only occur for small plans with a
valuation date other than the first day of the
plan year), the asset value must be adjusted
to exclude not only the contribution
amounts, but interest on the contributions
from the date of payment to the valuation
date, using the current-year effective interest
rate.
Do not adjust for items such as the funding
standard carryover balance, prefunding
balance, any unpaid minimum required
contributions, or the present value of
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remaining shortfall or waiver amortization
installments. Rollover amounts or other
assets held in individual accounts that are
not available to provide defined benefits
under the plan should not be included on
Line 2a regardless of whether they are
reported on the Schedule H (Form 5500) (line
1l, column (a)) or Form 5500–SF (Line 7c,
column (a)). Additionally, asset and liability
amounts must be determined in a consistent
manner. Therefore, if the value of any
insurance contracts has been excluded from
the amount reported in Line 2a, liabilities
satisfied by such contracts should also be
excluded from the funding target values
reported in Lines 3 and 4.
Line 2b. Actuarial Value of Assets. Do not
adjust the actuarial value of assets for items
such as the funding standard carryover
balance, the prefunding balance, any unpaid
minimum required contributions, or the
present value of any remaining shortfall or
waiver amortization installments. Treat
contributions designated for a current or
prior plan year, rollover amounts, insurance
contracts, and other items in the same
manner as for Line 2a. If an averaging method
is used to value plan assets (as permitted
under Code section 430(g)(3)(B) and ERISA
section 303(g)(3)(B), as amended by WRERA),
enter the value as of the valuation date taking
into account the requirement that such value
must be within 90% to 110% of the fair
market value of assets.
Note. Under Code section 430(g)(3)(B), the
use of averaging methods in determining the
value of plan assets is permitted only in
accordance with methods prescribed in
Treasury regulations. Accordingly, taxpayers
cannot use asset valuation methods other
than fair market value (as described in Code
section 430(g)(3)(A)), except as provided
under Notice 2009–22, 2009–14 I.R.B. 741, or
Treasury regulations.
Line 3. Funding Target/Participant Count
Breakdown. All amounts should be reported
as of the valuation date.
• Column (1)—Enter the number of
participants, including beneficiaries of
deceased participants, who are or who will
be entitled to benefits under the plan.
• Column (2)—Enter the portion of the
funding target attributable to vested benefits.
For this purpose benefits considered to be
vested for PBGC premium purposes must be
included.
• Column (3)—Enter the funding target
attributable to all benefits, both vested and
nonvested.
For columns (2) and (3), the funding target
must be calculated using the methods and
assumptions provided in Code sections
430(h) and (i), ERISA sections 303(h) and (i),
and other related guidance.
Unless the plan sponsor has received
approval to use substitute mortality tables in
accordance with Code section 430(h)(3)(C)
and ERISA section 303(h)(3)(C), the funding
target must be computed using the mortality
tables for non-disabled lives, as described in
section 1.430(h)(3)–1 of the regulations. If
substitute mortality tables have been
approved (or deemed to have been approved)
by the IRS, such tables must be used instead
of the mortality tables described in the
previous sentence, subject to the rules of
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Code section 430(h)(3) and ERISA section
303(h)(3). The funding target may be
computed taking into account the mortality
tables for disabled lives published in Rev.
Rul. 96–7, 1996–1 C.B. 59, and as provided
in Notice 2008–29, 2008–12 I.R.B. 637.
Special rules for plans that are in atrisk status. If a plan is in at-risk status,
report the amount reflecting the additional
assumptions required in Code section
430(i)(1)(B) and ERISA section 303(i)(1)(B).
If the plan has been in at-risk status for any
two or more of the preceding four plan years,
also include the loading factor required in
Code section 430(i)(1)(C) and ERISA section
303(i)(1)(C). If the plan is in at-risk status and
has been in at-risk status for fewer than five
consecutive years, report the funding target
amounts after reflecting the transition rule
provided in Code section 430(i)(5) and ERISA
section 303(i)(5). For example, the funding
target for a plan that is in at-risk status for
20XX and was in at-risk status for the 20XX–
3, 20XX–2 and 20XX–1 plan years (but not
the 20XX–4 plan year) will reflect 80% of the
funding target using the special at-risk
assumptions and 20% of the funding target
determined without regard to the at-risk
assumptions.
Determining whether a plan is in atrisk status. Refer to Code section 430(i)(4)
and ERISA section 303(i)(4) to determine
whether the plan is in at-risk status.
Generally, a plan is in at-risk status for a plan
year if it had more than 500 participants on
any day during the preceding plan year (see
instructions for Line F for the definition of
participants) and the plan’s funding target
attainment percentage (‘‘FTAP’’) for the
preceding plan year fell below specified
thresholds.
A plan with over 500 participants is in atrisk status for 20XX if both:
1. the FTAP for 20XX–1 (Line 17 of the for
20XX–1 Schedule SB) is less than 80%, and
2. the at-risk funding target attainment
percentage for 20XX–1 is less than 70%.
In general, the at-risk funding target
attainment percentage is determined in the
same manner as the FTAP (as described in
the instructions for Line 17), except that the
funding target is determined using the
additional assumptions for plans in at-risk
status. For this purpose, the at-risk funding
target is determined by disregarding the
transition rule of Code section 430(i)(5) and
ERISA section 303(i)(5) for plans that have
been in at-risk status for fewer than five
consecutive years, and disregarding the
loading factor in Code section 430(i)(1)(C)
and ERISA section 303(i)(1)(C). For plans that
were in at-risk status for the 20XX–1 plan
year, the at-risk funding target used to
determine whether the plan is in at-risk
status for the 20XX plan year is the amount
reported in Line 4b of the 20XX–1 Schedule
SB.
Refer to the regulations under section
430(i) of the Code for rules pertaining to new
plans and other special situations.
Line 4. Additional Information for Plans
in At-Risk Status. If the plan is in at-risk
status as provided under Code section
430(i)(4) and ERISA section 303(i)(4), check
the box, complete Lines 4a through 4d, and
include as an attachment the information
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described below. Do not complete Line 4 if
the plan is not in at-risk status for the current
plan year for purposes of determining the
minimum required contribution.
• Column 1—Enter the amount of the
funding target determined as if the plan were
not in at-risk status.
• Column 2—Report the funding target
disregarding the transition rule of Code
section 430(i)(5) and ERISA section 303(i)(5),
and disregarding the loading factor in Code
section 430(i)(1)(C) and ERISA section
303(i)(1)(C).
If the plan is in at-risk status for the current
plan year, include a description of the at-risk
assumptions for the assumed form of
payment (e.g., specify the optional form
resulting in the highest present value) in the
attachment for Part V regarding the actuarial
assumptions. Label this information in the
attachment ‘‘Schedule SB, Line 4—
Additional Information for Plans in AtRisk Status.’’
Line 5. Effective Interest Rate. Enter the
single rate of interest which, if used instead
of the interest rate(s) reported in Line 24 to
determine the present value of the benefits
that are taken into account in determining
the plan’s funding target for a plan year,
would result in an amount equal to the plan’s
funding target determined for the plan year,
without regard to calculations for plans in atrisk status. (This is the funding target
reported in Line 3d, column (3) for plans not
in at-risk status, or in Line 4a for plans in atrisk status.) However, if the funding target for
the plan year is zero, the effective interest
rate is determined as the single rate that
would result in an amount equal to the plan’s
target normal cost determined for the plan
year, without regard to calculations for plans
in at-risk status. See the provisions of Code
section 430(h)(2)(A), ERISA section
303(h)(2)(A), and the applicable regulations.
Enter rate to the nearest .01% (e.g., 5.26%).
Line 6a. Target Normal Cost. (Without
Plan-Related Expenses). Report the present
value of all benefits which have been accrued
or have been earned (or that are expected to
accrue or to be earned) under the plan during
the plan year . Include any increase in
benefits during the plan year that is a result
of any actual or projected increase in
compensation during the current plan year,
even if that increase in benefits is with
respect to benefits attributable to services
performed in a preceding plan year. This
amount must be calculated as of the
valuation date and must generally be based
on the same assumptions used to determine
the funding target reported in Line 3c,
column (3), reflecting the special
assumptions and the loading factor for at-risk
plans, if applicable. If the plan is in at-risk
status for the current plan year and has been
in at-risk status for fewer than five
consecutive years, report the target normal
cost after reflecting the transition rule
provided in Code section 430(i)(5) and ERISA
section 303(i)(5). Do not increase the amount
by plan expenses and do not reduce the
amount by mandatory employee
contributions.
Line 6b. Plan-Related Expenses. Report
any plan-related expenses expected to be
paid from plan assets during the plan year.
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Line 6c. Total Target Normal Cost. Report
the total target normal cost (sum of Lines 6a
and 6b minus mandatory employee
contributions expected to be made during the
plan year, but not less than zero).
Special rule for airlines using 10-year
amortization period under section
402(a)(2) of PPA. Section 402(a)(2) of PPA
(as amended by section 6615 of the U.S.
Troop Readiness, Veterans’ Care, Katrina
Recovery, and Iraq Accountability
Appropriations Act, 2007, Pub. L. 110–28
(121 Stat.112)) states that for plans electing
the 10-year amortization period, the funding
target during that period is determined using
an interest rate of 8.25% rather than the
interest rates or segment rates calculated on
the basis of the corporate bond yield curve.
However, this special 8.25% interest rate
does not apply for other purposes, including
the calculation of target normal cost or the
amortization of the funding shortfall. Report
the target normal cost using the interest rates
or segment rates otherwise applicable under
430(h)(2) and ERISA section 303(h)(2).
Part II—Beginning of Year Carryover
Prefunding Balances
Line 7. Balance at Beginning of Prior Plan
Year After Applicable Adjustments. In
general, report the amount in the
corresponding columns of Line 13 of the
prior-year Schedule SB. See instructions for
Line 14 if the balance from the prior year has
been adjusted so that it does not match the
corresponding amount in Line 13 of the
prior-year Schedule SB. Note that elections to
add excess contributions or reduce balances
have specific deadlines, and generally cannot
be changed once they have been made.
If this is the first year for which the plan
is subject to the minimum funding rules of
Code section 430 or ERISA section 303, leave
both columns blank.
Line 8. Portion Elected for Use To Offset
Prior Year’s Funding Requirement. Report
the amount for each column from the
corresponding column of Line 39 of the
prior-year Schedule SB. If the valuation date
is not the first day of the plan year, report
the amounts from Line 39 of the prior-year
Schedule SB, discounted to the beginning of
the prior plan year using the effective interest
rate for the prior plan year.
Reflect the full amount reported in Line 39
of the prior-year Schedule SB even if the
amount is larger than the minimum required
contribution reported for that year on Line 38
of the prior-year Schedule SB. This can occur
under the special rule for elections to use
balances in excess of the minimum required
contribution under section 1.430(f)–1(f)(1)(ii)
of the regulations, if no timely election is
made to revoke the excess amount.
If this is the first year for which the plan
is subject to the minimum funding rules of
Code section 430 or ERISA section 303, leave
both columns blank.
Special rule for late election to apply
balances to quarterly installments. If an
election was made to use the funding
standard carryover balance or the prefunding
balance to offset the amount of a required
quarterly installment, but the election was
made after the due date of the installment,
the amount reported on Line 8 may not be
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the same as the amount reported on Line 39
for the prior year. Refer to the regulations
under section 430 of the Code for additional
information. See instructions for Line 15 if a
late election to apply the balances to
quarterly installments was made.
Line 9. Amount Remaining. Enter the
amount equal to Line 7 minus Line 8 in each
column. If this is the first year that the plan
is subject to the minimum funding
requirements of Code section 430 or ERISA
section 303, enter the amount of any credit
balance at the end of the prior year (the ‘‘preeffective plan year’’) on Line 9, column (a)
and leave Line 9, column (b) blank. The
amount entered on Line 9, column (a) is
generally the amount reported for the preeffective plan year on Line 9o of the 2007
version of the Schedule B form that was
submitted as an attachment to the Schedule
SB for that pre-effective plan year. See
instructions for Line 16 if there has been any
adjustment to this amount so that it does not
match the amount so reported for the preeffective plan year.
Line 10. Interest on Line 9. Enter the actual
rate of return on plan assets during the
preceding plan year in the space provided.
Enter the rate to the nearest .01% (e.g.,
6.53%). If entering a negative number, enter
a minus sign (‘‘–’’) to the left of the number.
In each column, enter the product of this
interest rate and the amount reported in the
corresponding column of Line 9. If this is the
first year for which the plan is subject to the
minimum funding rules of Code section 430
or ERISA section 303, leave both columns
blank.
Line 11. Prior Year’s Excess Contributions
to be Added to Prefunding Balance.
Line 11a. Enter the amount reported in
Line 42a on the Schedule SB for the prior
plan year.
Line 11b(1). Enter the effective interest rate
for the prior plan year, as reported on Line
5 of the Schedule SB for the prior plan year,
in the space provided. Enter the rate to the
nearest .01% (e.g., 6.35%).
In column (b), enter the product of the
prior year’s effective interest rate in Line
11b(1) and the excess (if any) of the amount
reported on Line 42a for the prior year over
the amount reported on Line 42b for the prior
year.
However, if the valuation date for the prior
plan year was not the first day of the plan
year (permitted for small plans only), enter
the result of the following calculation:
Step 1: Determine the excess (if any) of the
amount reported on Line 42a for the prior
year over the amount reported on Line 42b
for the prior year,
Step 2: Adjust the result in Step 1 to the
first day of the prior year using the effective
interest rate for the prior year,
Step 3: Multiply the result in Step 2 by the
prior year’s effective interest rate in Line
11(b)(1), and
Step 4: Reduce the result in Step 3 by
interest on the result in Step 2 of this
paragraph for the period between the first
day of the prior plan year and the prior-year
valuation date using the effective interest rate
for the prior year.
The amount reported in Line 11(b)(1) is
zero if the prior year’s valuation date was the
last day of the prior plan year.
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Line 11(b)(2). In column (b), enter the
product of the prior year’s actual rate of
return (from Line 10) and the present value
of excess contributions reported on Line 42b
for the prior year. However, if the valuation
date for the prior plan year was not the first
day of the plan year (permitted for small
plans only), enter the result of the following
calculation:
Step 1: Adjust the prior-year amount
reported in Line 42b to the first day of the
prior year, using the effective interest rate for
the prior year,
Step 2: Multiply the result in Step 1 by the
prior year’s actual rate of return (from Line
10), and
Step 3: Reduce the result in Step 2 by
interest on the result in Step 1 for the period
between the first day of the prior plan year
and the prior-year valuation date using the
effective interest rate for the prior year.
Line 11c. Enter the sum of Lines 11a,
11b(1) and 11(b)(2).
Line 11d. Enter the amount of the excess
contributions for the prior year (with interest)
that the plan sponsor elected to use to
increase the prefunding balance. This
amount cannot be greater than the amount
reported on Line 11c. If this is the first year
for which the plan is subject to the minimum
funding rules of Code section 430 or ERISA
section 303, leave Lines 11a–d blank.
Line 12. Other Reductions in Balances Due
to Elections or Deemed Elections. In each
column, enter the amount by which the
employer elects to reduce (or is deemed to
elect to reduce, per Code section 436(f)(3)
and ERISA section 206(g)(5)(C)) the funding
standard carryover balance or prefunding
balance, as applicable, under Code section
430(f) and ERISA section 303(f), other than
any amount reported in Line 8 that is treated
as a reduction in these balances under the
special rule in section 1.430(f)–1(f)(3)(ii)
(relating to amounts elected for use to offset
the minimum required contribution that
exceed the minimum required contribution
for the plan for the plan year, and which are
not revoked by the plan sponsor). This
amount cannot be greater than the sum of the
amounts reported in the corresponding
column of Lines 9, 10 and, if applicable, 11d.
Note that an election (or deemed election)
cannot be made to reduce the prefunding
balance in column (b) until the funding
standard carryover balance in column (a) has
been reduced to zero.
If the valuation date is not the first day of
the plan year, adjust the amounts reported in
Line 12 to the first day of the plan year, using
the effective interest rate for the current plan
year. If the plan did not exist in the prior year
and is not a successor plan, leave both
columns blank. If this is the first year for
which the plan is subject to the minimum
funding rules of Code section 430 or ERISA
section 303, leave column (b) blank.
Line 13. Balance at Beginning of Current
Year.
Column (a)—Enter the sum of the amounts
reported on Lines 9 and 10 of column (a),
minus the amount reported on Line 12 of
column (a).
Column (b)—Enter the sum of the amounts
reported on Lines 9, 10 and 11d of column
(b), minus the amount reported on Line 12
of column (b).
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If this is the first year for which the plan
is subject to the minimum funding rules of
Code section 430 or ERISA section 303, leave
column (b) blank.
Line 14. Discrepancy in Prior Year
Funding Standard Carryover Balance or
Prefunding Balance. If the funding standard
carryover balance or prefunding balance from
the prior year reported on Line 7 has been
adjusted so that it does not match the
corresponding amount in Line 13 of the
prior-year Schedule SB, check the box in
Line 14 and provide an explanation. Note
that elections to add excess contributions or
reduce balances have specific deadlines, and
generally cannot be changed once they have
been made.
Line 15. Late Election to Apply the
Funding Standard Carryover Balance or
Prefunding Balance to Quarterly
Installments. If an election was made to use
the funding standard carryover balance or the
prefunding balance to offset the amount of a
required quarterly installment, and the
election was made after the due date of the
installment, so that the amount reported on
Line 8 is not the same as the amount reported
on Line 39 for the prior year, check the box
on Line 15 and provide an explanation.
Line 16. Credit Balance Discrepancy. If
there has been any adjustment to the credit
balance amount reported in Line 9 so that it
does not match the amount so reported for
the pre-effective plan year, check the box on
Line 16 and provide an explanation.
Part III—Funding Percentages
Enter all percentages in this section by
truncating at .01% (e.g., report 82.649% as
82.64%).
Line 17. Funding Target Attainment
Percentage. Enter the funding target
attainment percentage (FTAP) determined in
accordance with Code section 430(d)(2) and
ERISA section 303(d)(2). The FTAP is the
ratio (expressed as a percentage) which the
actuarial value of plan assets (reduced by the
funding standard carryover balance and
prefunding balance) bears to the funding
target determined without regard to the
additional rules for plans in at-risk status.
This percentage is determined by subtracting
the sum of the amounts reported in Line 13
from Line 2b and dividing the result by the
funding target. The funding target used for
this purpose is the number reported in Line
3d, column (3) for plans that are not in atrisk status and Line 4a for plans that are in
at-risk status. If the plan’s valuation date is
not the first day of the plan year, subtract the
sum of the amounts reported in Line 13,
adjusted for interest between the beginning of
the plan year and the valuation date using
the effective interest rate for the current plan
year, from the amount reported in Line 2b;
and divide by the funding target.
Line 18. Adjusted Funding Target
Attainment Percentage. Enter the adjusted
funding target attainment percentage
(AFTAP) determined in accordance with
Code section 436(j)(2) and ERISA section
206(g)(9)(B). The AFTAP is calculated in the
same manner as the FTAP reported in Line
17, except that both the assets and the
funding target used to calculate the AFTAP
are increased by the aggregate amount of
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purchases of annuities for employees other
than highly compensated employees (as
defined in Code section 414(q)) which were
made by the plan during the preceding two
plan years.
See Code section 436(j)(3) and ERISA
section 206(g)(9)(C) for rules regarding
circumstances in which the actuarial value of
plan assets is not reduced by the funding
standard carryover balance and prefunding
balance for certain fully-funded plans when
determining the AFTAP. Note that this
special rule applies only to the calculation of
the AFTAP and not to the FTAP reported in
Line 17.
Report the final certified AFTAP for the
plan year, even if it does not correspond to
the valuation results reported on this
Schedule SB (for instance, if any adjustments
pertaining to the plan year were made
subsequent to the valuation or the AFTAP).
If no AFTAP was certified for the plan year,
check the box and attach an explanation and
(1) report 100%, if the plan’s adjusted
funding target for the plan year is zero, as
described in section 1.436–1(j)(1)(iv) of the
Treasury regulations, or (2) leave Line 18
blank if the plan’s adjusted funding target for
the plan year is not equal to zero. Label the
attachment, ‘‘Line 18, Reconciliation of
differences between valuation results
and amounts used to calculate AFTAP.’’
For plans with valuation dates other than the
first day of the plan year, report the AFTAP
that is the final certified AFTAP based on the
valuation results for the current plan year at
the time that the Schedule SB is filed
(reflecting contributions for the current plan
year and reflecting other adjustments as
described in applicable guidance), even if
that AFTAP is not used to apply the
restrictions under Code section 436 and
ERISA section 206(g) until the following plan
year.
If the AFTAP reported on Line 18 does not
correspond to the valuation results reported
on this Schedule SB (for instance, if any
adjustments pertaining to the plan year were
made subsequent to the valuation), check the
box and attach a schedule showing each
AFTAP that was certified or recertified for
the plan year, the date of the certification (or
recertification), and a description and the
amount of each adjustment to the funding
target, actuarial value of assets, funding
standard carryover balance and prefunding
balance used to determine the corresponding
AFTAP. Label the attachment, ‘‘Line 18,
Reconciliation of differences between
valuation results and amounts used to
calculate AFTAP.’’ It is not necessary to
include any information pertaining to a range
certification in this attachment.
Special rules for airlines using 10-year
amortization period under section
402(a)(2) of PPA. Section 402(a)(2) of PPA
(as amended) states that for plans electing the
10-year funding amortization period, the
funding target during that period is
determined using an interest rate of 8.25%
rather than the interest rates or segment rates
calculated on the basis of the corporate bond
yield curve. Report the AFTAP for these
plans based on the funding target determined
using the special 8.25% interest rate.
Line 19. Prior Year’s Funding Percentage
for Purposes of Determining Whether
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Carryover/Prefunding Balances May Be Used
To Offset Current Year’s Funding
Requirement. Under Code section 430(f)(3)
and ERISA section 303(f)(3), the funding
standard carryover balance and prefunding
balance may not be applied toward minimum
contribution requirements unless the ratio of
plan assets for the preceding plan year to the
funding target for the preceding plan year (as
described in Code section 430(f)(3)(C) and
ERISA section 303(f)(3)(C)) is 80% or more.
Enter the applicable percentage as
described below, truncated at .01% (e.g.,
report 81.239% as 81.23%). In general, the
percentage is the ratio that the prior-year
actuarial value of plan assets (reduced by the
amount of any prefunding balance, but not
the funding standard carryover balance) bears
to the prior-year funding target determined
without regard to the additional rules for
plans in at-risk status. This percentage is
determined as follows, with all amounts
taken from the prior year’s Schedule SB:
1. For plans that are not in at-risk status,
subtract the amount reported on Line 13,
column (b) (adjusted for interest as described
below, if the valuation date is not the first
day of the plan year) from the amount
reported on Line 2b, and divide the result by
the funding target reported on Line 3d,
column (3).
2. For plans that are in at-risk status,
subtract the amount reported on Line 13,
column (b) (adjusted for interest as described
below, if the valuation date is not the first
day of the plan year) from the amount
reported on Line 2b, and divide the result by
the funding target reported on Line 4a.
If the valuation date for the prior plan year
was not the first day of that plan year, the
amount subtracted from the assets for the
purpose of the above calculations is the
amount reported on Line 13, column(b),
adjusted for interest between the beginning of
the prior plan year and the prior year’s
valuation date, using the effective interest
rate for the prior plan year.
Line 20. Ratio of Current Value of Assets
to Funding Target if Below 70%. This
calculation is required under ERISA section
103(d)(11). If Line 2a divided by the funding
target reported in Line 3d, column (3), is less
than 70%, enter such percentage. Otherwise,
leave this line blank.
Part IV—Contributions and Liquidity
Shortfalls
Line 21. Contributions Made to the Plan.
Show all employer and employee
contributions either designated for this plan
year or those allocated to unpaid minimum
required contributions for a prior plan year.
Do not adjust contributions to reflect interest
in column (b). Show only employer
contributions actually made to the plan
within 81⁄2 months after the end of the plan
year for which this Schedule SB is filed (or
actually made before the Schedule SB is
signed, if earlier).
Certain employer contributions must be
made in quarterly installments. See Code
section 430(j) and ERISA section 303(j).
Contributions made to meet the liquidity
requirement of Code section 430(j)(4) and
ERISA section 303(j)(4) should be reported.
Include contributions made to avoid benefit
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restrictions under Code section 436 and
ERISA section 206(g).
Add the amounts in both columns 21(b)
and 21(h) separately and enter each result in
the corresponding column on the total line.
All contributions except those made to avoid
benefit restrictions under Code section 436
and ERISA section 206(g) must be credited
toward minimum funding requirements for a
particular plan year.
Employer contributions reported in Line 21
that were made on a date other than the
valuation date must be adjusted to reflect
interest for the time period between the
valuation date for the plan year to which the
contribution is allocated and the date the
contribution was made. In general, adjust
each contribution using the effective interest
rate reported on Line 5 for the plan year to
which the contribution is allocated.
Show the dates and amounts of individual
contributions, the year to which the
contributions (or the portion of individual
contributions) are applied, the interest rate(s)
used to adjust the contributions (i.e., the
effective interest rate for timely contributions
and the applicable effective interest rate plus
5% for late quarterly installments) and the
periods during which each rate applies, and
the interest-adjusted contribution. In Line
21(g), allocate the interest-adjusted employer
contributions to Lines 22a, 22b, and 22c to
report the purpose for which they were made
(as described below).
Special note for small plans with
valuation dates after the beginning of
the plan year. If the valuation date is after
the beginning of the plan year and
contributions for the current year were made
during the plan year but before the valuation
date, such contributions are increased with
interest to the valuation date using the
effective interest rate for the current plan
year. These contributions and the interest
calculated as described in the preceding
sentence are excluded from the value of
assets reported in Lines 2a and 2b.
Interest adjustment for contributions
representing late required quarterly
installments—installments due after the
valuation date. If the full amount of a
required installment due after the valuation
date for the current plan year is not paid by
the due date for that installment, increase the
effective interest rate used to discount the
contribution by 5 percentage points for the
period between the due date for the required
installment and the date on which the
payment is made. If all or a portion of the
late required quarterly installment is due to
a liquidity shortfall, the increased interest
rate is used for a period of time
corresponding to the period between the due
date for the installment and the end of that
quarter, regardless of when the contribution
is actually paid.
Interest adjustment for contributions
representing late required quarterly
installments—small plans with
valuation dates after the beginning of
the plan year—installments due prior to
the valuation date. See the regulations
under section 430 for rules regarding interest
adjustments for late quarterly contributions
for quarterly contributions due before the
valuation date.
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Line 22. Discounted Employer
Contributions.
Line 22a. Contributions Allocated Toward
Unpaid Minimum Required Contributions
from Prior Plan Years. Code section
4971(c)(4)(B) provides that any payment to or
under a plan for any plan year shall be
allocated first to unpaid minimum required
contributions for all preceding plan years on
a first-in, first-out basis and then to the
minimum required contribution for the
current plan year. Report any contributions
from Line 21 that are allocated toward
unpaid minimum required contributions
from prior plan years, discounted for interest
from the date the contribution was made to
the valuation date for the plan year for which
the contribution was originally required as
described above. Increase the effective
interest rate for the applicable plan year by
5 percentage points for any portion of the
unpaid minimum required contribution that
represents a late quarterly installment, for the
period between the due date for the
installment and the date of payment. Reflect
the increased interest rate for any portion of
the unpaid minimum required contribution
that represents a late liquidity shortfall
installment, for the period corresponding to
the time between the date the installment
was due and the end of the quarter during
which it was due. The amount reported in
Line 22a cannot be larger than the amount
reported in Line 32.
For the purpose of allocating contribution
amounts to unpaid minimum required
contributions, any unpaid minimum required
contribution attributable to an accumulated
funding deficiency at the end of the last plan
year before Code section 430 or ERISA
section 303 applied to the plan (the ‘‘preeffective plan year’’) is treated as a single
contribution due on the last day of the preeffective plan year (without separately
identifying any portion of the accumulated
funding deficiency attributable to late
quarterly installments or late liquidity
shortfall installments), and the associated
effective interest rate is deemed to be the
valuation interest rate for the pre-effective
plan year.
Line 22b. Contributions Made To Avoid
Benefit Restrictions. Include in this category
current year contributions made to avoid or
terminate benefit restrictions under Code
section 436 and ERISA section 206(g). Adjust
each contribution for interest from the date
the contribution was made to the valuation
date as described above.
Line 22c. Contributions Allocated Toward
Minimum Required Contribution for Current
Year. Include in this category contributions
(including any contributions made in excess
of the minimum required contribution) that
are not included in Line 22a or 22b. Adjust
each contribution for interest from the date
the contribution was made to the valuation
date as described above.
Line 23. Quarterly Contributions and
Liquidity Shortfalls.
Line 23a. Did the Plan Have a Funding
Shortfall for the Prior Plan Year? In
accordance with Code section 430(j)(3) and
ERISA section 303(j)(3), only plans that have
a funding shortfall for the preceding plan
year are subject to an accelerated quarterly
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contribution schedule. For this purpose, a
plan is considered to have a funding shortfall
for the prior year if the funding target
reported on Line 3d, column (3) is greater
than the actuarial value of assets reported on
Line 2b, reduced by the sum of the funding
standard carryover balance and prefunding
balance reported on Line 13, columns (a) and
(b), with all figures taken from the prior
year’s Schedule SB.
If the valuation date for the prior plan year
was not the first day of that plan year, the
amount subtracted from the actuarial value of
assets for the above calculation is the sum of
the amounts reported on Line 13, columns (a)
and (b) of the prior-year Schedule SB, but
adjusted for interest between the beginning of
the prior plan year and the prior year’s
valuation date using the effective interest rate
for the plan for the prior plan year.
However, see Code section 430(f)(4)(B)(ii)
and ERISA section 303(f)(4)(B)(ii) for special
rules in the case of a binding agreement with
the PBGC providing that all or a portion of
the funding standard carryover balance and/
or prefunding balance is not available to
offset the minimum required contribution for
the prior plan year.
Please note that a plan may be considered
to have a funding shortfall for this purpose
even if it is exempt from establishing a
shortfall amortization base under the
provisions of Code section 430(c)(5) and
ERISA section 303(c)(5).
Line 23b. If Line 23a is ‘‘No’’ (i.e., if the
plan did not have a funding shortfall in the
prior plan year), the plan is not subject to the
quarterly contribution rules, and this line
should not be completed. If Line 23a is
‘‘Yes,’’ check the ‘‘Yes’’ box on Line 23b if
required installments for the current plan
year were made in a timely manner;
otherwise, check ‘‘No.’’
Line 23c. If Line 23a is ‘‘No,’’ or the plan
had 100 or fewer participants on every day
of the preceding plan year (as defined for line
F), the plan is not subject to the liquidity
requirement of Code section 430(j)(4) and
ERISA section 303(j)(4) and this line should
not be completed. Check the box and attach
a certification by the enrolled actuary if the
special rule for nonrecurring circumstances
is used, and label the certification
‘‘Schedule SB, Line 23c—Liquidity
Requirement Certification.’’ See Code
section 430(j)(4)(E)(ii)(II) and ERISA section
303(j)(4)(E)(ii)(II).
If the plan is subject to the liquidity
requirement and has a liquidity shortfall for
any quarter of the plan year (see Code section
430(j)(4)(E) and ERISA section 303(j)(4)(E)),
enter the amount of the liquidity shortfall for
each such quarter. If the plan was subject to
the liquidity requirement but did not have a
liquidity shortfall, enter zero. File IRS Form
5330, Return of Excise Taxes Related to
Employee Benefit Plans, with the IRS to pay
the 10% excise tax(es) if there is a failure to
pay any liquidity shortfall by the required
due date, unless a waiver of the 10% tax has
been granted under Code section 4971(f)(4).
Part V—Assumptions Used To Determine
Funding Target and Target Normal Cost
Attach a statement of actuarial
assumptions and funding methods used to
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calculate the Schedule SB entries and label
the statement ‘‘Schedule SB, Part V—
Statement of Actuarial Assumptions/
Methods.’’ The statement must describe all
non-prescribed actuarial assumptions (e.g.,
retirement, withdrawal rates) used to
determine the funding target and target
normal cost, including the assumption as to
the frequency with which participants are
assumed to elect each optional form of
benefit (including lump sum distributions),
whether mortality tables are applied on a
static or generational basis, whether
combined mortality tables are used instead of
separate annuitant and nonannuitant
mortality tables (for plans with 500 or fewer
participants as of the valuation date), and (for
target normal cost) expected plan-related
expenses and increases in compensation. For
applicable defined benefit pension plans
under Code section 411(a)(13)(C) and ERISA
section 203(f)(3) (e.g., cash balance plans) the
statement must include the assumptions used
to convert balances to annuities. In addition,
the statement must describe the method for
determining the actuarial value of assets and
any other aspects of the funding method for
determining the Schedule SB entries that are
not prescribed by law.
Also attach a summary of the principal
eligibility and benefit provisions on which
the valuation was based, including the status
of the plan (e.g., frozen eligibility, service/
pay, or benefits), optional forms of benefits,
special plan provisions, including those that
apply only to a subgroup of employees (e.g.,
those with imputed service), supplemental
benefits, and identification of benefits not
included in the valuation, a description of
any significant events that occurred during
the year, a summary of any changes in
principal eligibility or benefit provisions
since the last valuation, and a description (or
reasonably representative sample) of plan
early retirement reduction factors and
optional form conversion factors. Label the
summary ‘‘Schedule SB, Part V—
Summary of Plan Provisions.’’
Also, include any other information
needed to disclose the actuarial position of
the plan fully and fairly.
Line 24. Discount Rate. All discount rates
are to be reported and used as published by
the IRS, and are to be applied as annual rates
without adjustment.
Line 24a. Enter the three segment rates
used to calculate the funding target and target
normal cost as provided under Code section
430(h)(2)(C) and ERISA section 303(h)(2)(C)
and as published by the IRS, unless the plan
sponsor has elected to use the full yield
curve. If the sponsor has elected to use the
full yield curve, check the ‘‘N/A, full yield
curve used’’ box. Special rules for airlines
using 10-year amortization period under
section 402(a)(2) of PPA (as amended). Enter
the information described above to reflect the
discount rates used to determine the target
normal cost in accordance with Code section
430(h)(2) and ERISA section 303(h)(2). Do
not enter the special 8.25% interest rate used
to determine the funding target under section
402(a)(2) of PPA.
Line 24b. Code section 430(h)(2)(E) and
ERISA section 303(h)(2)(E) provide that the
segment rate(s) used to measure the funding
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target and target normal cost are those
published by Treasury for the month that
includes the valuation date (based on the
average of the monthly corporate bond yield
curves for the 24-month period ending with
the month preceding that month).
Alternatively, at the election of the plan
sponsor, the segment rate(s) used to measure
the funding target and target normal cost may
be those published by Treasury for any of the
four months that precede the month that
includes the valuation date.
Enter the applicable month to indicate
which segment rates were used to determine
the funding target and target normal cost.
Enter ‘‘0’’ if the rates used to determine the
funding target and target normal cost were
published for the month that includes the
valuation date. Enter ‘‘1’’ if the rates were
published for the month immediately
preceding the month that includes the
valuation date, ‘‘2’’ for the second preceding
month, and ‘‘3’’ or ‘‘4,’’ respectively, for the
third or fourth preceding months. For
example, if the valuation date is January 1
and the funding target and target normal cost
were determined based on rates published for
November, enter ‘‘2.’’
Note. The plan sponsor’s interest rate
election under Code section 430(h)(2) or
ERISA section 303(h)(2) (an election to use
the yield curve or an election to use an
applicable month other than the default
month) generally may not be changed unless
the plan sponsor obtains approval from the
IRS. However, see the regulations under
section 430(h)(2) for circumstances in which
a change in interest rate may be made
without obtaining approval from the IRS.
Line 25. Weighted Average Retirement
Age. Enter the weighted average retirement
age for active participants. If the plan is in
at-risk status, enter the weighted average
retirement age as if the plan were not in atrisk status. If each participant is assumed to
retire at his/her normal retirement age, enter
the age specified in the plan as normal
retirement age. If the normal retirement age
differs for individual participants, enter the
age that is the weighted average normal
retirement age; do not enter ‘‘NRA.’’
Otherwise, enter the assumed retirement age.
If the valuation uses rates of retirement at
various ages, enter the nearest whole age that
is the weighted average retirement age.
On an attachment to Schedule SB, list the
rate of retirement at each age and describe
the methodology used to compute the
weighted average retirement age, including a
description of the weight applied at each
potential retirement age, and label the
attachment ‘‘Schedule SB, Line 25—
Description of Weighted Average
Retirement Age.’’
Line 26. Mortality Tables. Mortality tables
described in Code section 430(h)(3), ERISA
section 303(h)(3), and section 1.430(h)(3)–1
of the regulations as published by the IRS
must be used to determine the funding target
and target normal cost for non-disabled
participants and may be used to determine
the funding target and target normal cost for
disabled participants, unless the IRS has
approved (or was deemed to have approved)
the use of a substitute mortality table for the
plan. Standard mortality tables must be
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either applied on a generational basis, or the
tables must be updated to reflect the static
tables published for the year in which the
valuation date occurs. Substitute mortality
tables must be applied in accordance with
the terms of the IRS ruling letter.
Separate standard mortality tables were
published by the IRS for annuitants (rates
applying for periods when a participant is
assumed to receive a benefit under the plan)
and nonannuitants (rates applying to periods
before a participant is assumed to receive a
benefit under the plan). If a plan has 500 or
fewer participants as of the valuation date for
the current plan year as reported in Line 3d,
column (1), the plan sponsor can elect to use
the combined mortality tables published by
the IRS, which reflect combined rates for
both annuitants and nonannuitants.
Line 26a. Mortality Tables Used. Check the
applicable box to indicate which mortality
table was used to determine the funding
target and target normal cost. If one mortality
table was used for certain populations within
the plan and a different mortality table was
used for other populations, check the box for
the table that applied to the largest
population.
1. Check ‘‘Prescribed—combined’’ if the
funding target and target normal cost are
based on the prescribed tables with
combined annuitant/nonannuitant mortality
rates.
2. Check ‘‘Prescribed—separate’’ if the
funding target and target normal cost are
based on the prescribed tables with separate
mortality rates for nonannuitants and
annuitants.
3. Check ‘‘Substitute’’ if the funding target
and target normal cost are based on substitute
mortality tables.
Line 26b. Use of More Than One Mortality
Table. If more than one mortality table was
used, check the box and provide an
explanation describing the mortality table
used for each population and the size of that
population.
Line 26c. Substitute Mortality Tables. If
substitute mortality tables are used, check the
box and provide a summary of plan
populations for which substitute mortality
tables are used, plan populations for which
the prescribed tables are used, and the last
plan year for which the IRS approval of the
substitute mortality tables applies.
Part VI—Miscellaneous Items
Line 27. Change in Non-Prescribed
Actuarial Assumptions. Check the box if a
change has been made in the non-prescribed
actuarial assumptions for the current plan
year. Provide a description of any change in
non-prescribed actuarial assumptions and
justifications for any such change. If the only
assumption changes are statutorily required
changes in the discount or mortality rates, or
changes required for plans in at-risk status,
do not check the box and do not provide a
description of the changes. (See section
103(d) of ERISA.) If the non-prescribed
assumptions have been changed in a way that
decreases the funding shortfall for the current
plan year, approval for such a change may be
required.
Line 28. Change in Method. Check the box
if a change in the method has been made for
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47653
the current plan year. For this purpose, a
change in funding method refers to not only
a change in the overall method used by the
plan, but also each specific method of
computation used in applying the overall
method. Accordingly, funding method
changes include modifications such as a
change in the method for calculating the
actuarial value of assets or a change in the
valuation date (not an exclusive list). Also
check the box if there has been a change in
the method for determining the discount
rates reported in Line 24. In general, any
changes in a plan’s method must be approved
by the IRS. However, see the regulations
under Code section 430 and Announcement
2010–3, 2010–4 I.R.B. 333, for circumstances
in which a change in method may be made
without obtaining approval from the IRS.
Provide a description of the change.
Note. The plan sponsor’s agreement to
certain changes in funding method should be
reported on Line 9 of Schedule R (Form
5500).
Line 29a. Schedule of Active Participant
Data. Check ‘‘Yes’’ on Line 29a(i) only if (a)
the plan is covered by Title IV of ERISA and
(b) the plan has active participants. If Line
29a(i) is ‘‘Yes,’’ complete the schedule in
Line 29a(ii) with the active plan participant
data used in the valuation for this plan year
and enter the average age and average
credited service of the active participants on
Lines 29a(iii) and 29a(iv), respectively.
Include all active participants in the
averages, even ones that are not required to
be shown in the schedule under the
instructions below. For each column, enter
the number of active participants with the
specified number of years of credited service
divided according to age group. For
participants with partial years of credited
service, round the total number of years of
credited service to the next lower whole
number. Years of credited service are the
years credited under the plan’s benefit
formula.
Plans reporting 1,000 or more active
participants on Line 3d, column (1), must
also provide average compensation data. For
each grouping, enter the average
compensation of the active participants in
that group. For this purpose, compensation is
the compensation taken into account for each
participant under the plan’s benefit formula,
limited to the amount defined under section
401(a)(17) of the Code. Do not enter the
average compensation in any grouping that
contains fewer than 20 participants.
In the case of a plan under which benefits
are primarily pay-related and under which
no future accruals are granted (i.e., a ‘‘frozen’’
plan as defined in the instructions for Line
9a(4) of the Form 5500), check the box and
report the average annual accrued benefit in
lieu of average compensation.
Cash balance plans (or any similar plans
that check the box on Line 9a(1) of Form
5500) reporting 1,000 or more active
participants on Line 3d, column (1), must
also provide average cash balance account
data, regardless of whether all active
participants have cash balance accounts. For
each age/service bin, enter the average cash
balance account of the active participants in
that bin. Do not enter the average cash
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balance account in any age/service bin that
contains fewer than 20 active participants.
General Rule. When all active participants
in the plan have a cash balance account, data
to be shown in each age/service bin includes:
1. The number of active participants in the
age/service bin,
2. The average compensation of the active
participants in the age/service bin, and
3. The average cash balance account of the
active participants in the age/service bin.
If the accrued benefit is the greater of a
cash balance benefit or some other benefit,
average in only the cash balance account. If
the accrued benefit is the sum of a cash
balance account benefit and some other
benefit, average in only the cash balance
account. For both the average compensation
and the average cash balance account, do not
enter an amount for age/service bins with
fewer than 20 active participants.
When some active participants do not have
cash balance accounts, an alternative is
provided for showing compensation and cash
balance accounts, requiring two age/service
scatters as follows:
• Scatter 1—Provide participant count and
average compensation for all active
participants, without account-based benefits.
• Scatter 2—Provide participant count and
average cash balance account for only those
active participants with account-based
benefits. If the number of participants with
account-based benefits in a bin is fewer than
20, the average account should not be shown
even if there are 20 or more active
participants in this bin on Scatter 1.
In general, information should be
determined as of the valuation date. Average
cash balance accounts may be determined as
of either:
1. The valuation date or
2. The day immediately preceding the
valuation date.
Average cash balance accounts that are
offset by amounts from another plan may be
reported either as amounts prior to taking
into account the offset or as amounts after
taking into account the offset. Do not report
the offset amount. For this or any other
unusual or unique situation, the attachment
should include an explanation of what is
being provided.
If the plan is a multiple-employer plan,
complete one or more schedules of active
participants in a manner consistent with the
computations for the funding requirements
reported in Part VIII. For example, if the
funding requirements are computed as if
each participating employer maintained a
separate plan, complete a separate Schedule
of Active Participant Data for each
participating employer in the multipleemployer plan on the separate Schedule SB
attached in accordance with the instructions
for Line E.
Line 29b. Schedule of Retired Participants
and Beneficiaries Receiving Payment Data.
Check ‘‘Yes’’ on Line 29b(i) only if (a) the
plan is covered by Title IV of ERISA and (b)
the plan has retired participants and
beneficiaries receiving payment at the
valuation date. If Line 29b(i) is ‘‘Yes,’’
complete the schedule in Line 29b(ii) with
the retired participant and beneficiary data
used in the valuation for this plan year and
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enter the average age and average in-pay
annual benefit of the retired participants and
beneficiaries on Lines 29b(iii) and 29b(iv),
respectively. Do not report average annual
benefit information for age bins where there
are 10 or less retired participants and
beneficiaries receiving payment in the
average.
If the plan is a multiple-employer plan,
complete one or more schedules of retired
participant and beneficiary data in a manner
consistent with the computations for the
funding requirements reported in Part VIII.
For example, if the funding requirements are
computed as if each participating employer
maintained a separate plan, complete a
separate Schedule of Retired Participants
and Beneficiaries Receiving Payment Data
for each participating employer in the
multiple-employer plan on the separate
Schedule SB attached in accordance with the
instructions for Line E.
Line 29c. Schedule of Terminated Vested
Participant Data. Check ‘‘Yes’’ on Line 29c(i)
only if (a) the plan is covered by Title IV of
ERISA and (b) the plan has terminated vested
participants at the valuation date. If Line
29c(i) is ‘‘Yes,’’ complete the schedule in
Line 29c(ii) with the terminated vested
participant data used in the valuation for this
plan year and enter the average age and
average annual benefit of the terminated
vested participants on Lines 29c(iii) and
29c(iv), respectively. Do not report average
annual benefit information for age bins where
there are 10 or less terminated vested
participants in the average. Include the
assumed form of payment and the assumed
first age of payment in Lines 29c(v) and
29c(vi), respectively, for the benefit amounts
shown in the schedule.
If the plan is a multiple-employer plan,
complete one or more schedules of
terminated vested participant data in a
manner consistent with the computations for
the funding requirements reported in Part
VIII. For example, if the funding
requirements are computed as if each
participating employer maintained a separate
plan, complete a separate Schedule of
Terminated Vested Participant Data for each
participating employer in the multipleemployer plan on the separate Schedule SB
attached in accordance with the instructions
for Line E.
Line 30. Projection of Expected Benefit
Payments. Check ‘‘Yes’’ on Line 30a if this
is a single-employer plan covered by Title IV
of ERISA and is required to provide a
projection of expected benefit payments. Do
not report information if the plan has less
than 500 participants as of the valuation date.
If Line 30a is ‘‘Yes,’’ in Line 30b provide
a projection of benefits expected to be paid
(not to include expected expenses) in each of
the next ten years starting with the current
plan year of this filing assuming (1) no
additional accruals, (2) experience (e.g.,
termination, mortality, and retirement) are in
line with valuation assumptions, and (3) no
new entrants are covered by the plan.
Line 31. Alternative Funding Rules. If one
of the alternative funding rules was used for
this plan year, enter the appropriate code
from the table below and follow the special
instructions applicable to that code,
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including completion of any required
attachments.
Code Alternative Funding Rule
1 A CSEC Act plan that is described in
Code section 414(v). This includes certain
multiple-employer plans maintained by rural
cooperatives and other specified cooperative
organizations and certain plans maintained
by more than 1 employer (determined after
application of Code section 414(b) and (c)),
all of which are described in Code section
501(c (3). Do not use Code 1 for a plan that
satisfies the definition of CSEC plan that has
made the election not to be treated as a CSEC
plan.
2 This code, formerly used by certain
plans maintained by PBGC settlements as
described in section 105 of PPA, is no longer
applicable and should not be used.
3 Reserved.
4 Plans with binding agreements with
PBGC to maintain prefunding and/or funding
standard carryover balances described in
Code section 430(f)(4)(B)(ii) and ERISA
section 303(f)(4)(B)(ii).
5 Airlines using 10-year amortization
period for initial post-PPA shortfall
amortization base under section 402(a)(2) of
PPA (as amended).
6 Airlines with frozen plans using
alternative 17-year funding schedule under
section 402(a)(1) of PPA.
7 Interstate transit company described in
section 115 of PPA.
8 A plan subject to 104 of PPA as
amended that is not a CSEC plan. This
includes plans that fit into the definition of
a CSEC plan that elect out of CSEC plan
status and become subject to section 104 of
PPA as amended, and certain plans
maintained by more than 1 employer
(determined without regard to section 414(c))
where all of the employers are described in
section 501(c)(3). Do not use Code 8 for a
PPA section 104 plan that has made an
election to not be treated as an eligible
charity plan.
Special Instructions for Codes 1 through 8
CSEC Plans, as described in Code
section 414(y) and subject to Code
section 433 (code 1).
Reserved
Plans with binding agreements with
the PBGC to maintain prefunding and/
or carryover balances (code 4). Complete
entire Schedule SB and attachments as
outlined in these instructions. In addition,
report on an attachment the amount subject
to the binding agreement with the PBGC,
reported separately for the funding standard
carryover balance and prefunding balance.
Label the attachment ‘‘Schedule SB, Line
31—Balances Subject to Binding
Agreement with PBGC.’’
Airlines using 10-year amortization
period for initial post-PPA shortfall
amortization base (code 5). Complete the
entire Schedule SB and attachments as
outlined in these instructions. Under section
402(a)(2) of PPA (as amended), the funding
target for plans funded using this alternative
is determined using an interest rate of 8.25%
for each of the 10 years during the
amortization period instead of the interest
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rates otherwise required under Code section
430(h)(2) and ERISA section 303(h)(2).
However, this special 8.25% interest rate
does not apply for other purposes, including
the calculation of target normal cost or the
amortization of the funding shortfall.
Airlines with frozen plans using
alternative 17-year funding schedule
(code 6). Complete the following lines on
Schedule SB and provide associated
attachments:
• Lines A through F.
• Part I (including signature of enrolled
actuary)—complete all lines.
• Parts III through VII—complete all lines.
For this purpose, disregard the special
funding rules under section 402(e) of PPA
except for the information reported on the
following lines:
• Lines 21 and 22—Discount contributions
to the applicable valuation date using the
8.85% discount rate provided under section
402(e)(4)(B) of PPA.
• Line 23—Reflect required quarterly
installments based on the minimum required
contribution determined under section 402(e)
of PPA to the extent applicable (i.e., for
purposes of calculating the required annual
payment under Code section 430(j)(3)(D)(ii)(l)
and ERISA section 303(j)(3)(D)(ii)(l)).
• Line 33—Reflect the minimum required
contribution determined under section 402(e)
of PPA when determining the unpaid
minimum required contribution.
Also, attach a worksheet showing the
information below, determined in accordance
with section 402(e) of PPA. Label this
worksheet ‘‘Schedule SB, Line 31—
Alternative 17-Year Funding Schedule
for Airlines.’’
• Date as of which plan benefits were
frozen as required under section 402(b)(2) of
PPA.
• Date on which the first applicable plan
year began.
• Accrued liability under the unit credit
method calculated as of the first day of the
plan year, using an interest rate of 8.85%.
• A summary of all other assumptions
used to calculate the unit credit accrued
liability.
• Fair market value of assets as of the first
day of the plan year.
• Unfunded liability under section
402(e)(3)(A) of PPA.
• Alternative funding schedule:
1. Contribution necessary to amortize the
unfunded liability over the remaining
number of years, assuming payments at the
valuation date for each plan year and using
an interest rate of 8.85%;
2. Employer contributions for the plan
year, discounted for interest to the valuation
date for the plan year, and using a rate of
8.85%; and
3. Contribution shortfall, if any ((1)–(2) but
not less than zero).
Interstate transit company (code 7).
Complete the entire Schedule SB, reflecting
the modifications to the otherwise-required
funding rules under section 115(b) of PPA,
and disregarding the attachment required for
plans reporting the use of the substitute
mortality table in Line 26.
Plans entitled to delayed effective
dates for PPA funding rules (code 8).
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For plan years before Code section 430 and
ERISA section 303 apply to the plan,
complete only the following lines on
Schedule SB:
Lines A through F.
1. Part I (including signature of enrolled
actuary), determined as if PPA provisions
were effective for all plan years beginning
after December 31, 2007.
2. Part III, Line 17, determined as if PPA
provisions were effective for all plan years
beginning after December 31, 2007.
3. Part V, determined as if PPA provisions
were effective for all plan years beginning
after December 31, 2007.
4. If the minimum required contribution
for any year was determined using pension
funding relief under section 107 of PPA ’06,
as added by PRA 2010, complete Part IX,
Lines 45a and 45b.
Also, report other information for the
current plan year using a 2007 Schedule B
(Form 5500). Label this attachment ‘‘20XX
Schedule SB, Line 31—Actuarial
Information Based on Pre-PPA Funding
Rules.’’ Complete all items, and attach the
form and all applicable attachments to the
Schedule SB. Note that under PPA, the third
segment rate determined under Code section
430(h)(2)(C)(iii) and ERISA section
303(h)(2)(C)(iii) is substituted for the current
liability interest rate under Code section
412(b)(5)(B) and ERISA section 302(b)(5)(B)
(as in effect before PPA).
Part VII—Reconciliation of Unpaid
Minimum Required Contributions for Prior
Years
Line 32. Unpaid Minimum Required
Contributions for Prior Years. Enter the total
amount of any unpaid minimum required
contributions for all years from Line 44 of the
Schedule SB for the prior plan year.
If this is the first year that the plan is
subject to the minimum funding
requirements of Code section 430 or ERISA
section 303, enter the amount of any
accumulated funding deficiency at the end of
the prior year (the pre-effective plan year).
This is the amount reported on Line 9p of the
2007 Schedule B form that was submitted as
an attachment to the Schedule SB for the preeffective plan year.
Line 33. Discounted Employer
Contributions Allocated Toward Unpaid
Minimum Required Contributions from Prior
Years. Enter the total amount of discounted
contributions made for the current plan year
allocated toward unpaid minimum required
contributions from prior years as reported in
Line 22a.
Line 34. Remaining Unpaid Minimum
Required Contributions. Enter the amount in
Line 32 minus the amount in Line 33.
Part VIII—Minimum Required Contribution
for Current Year
Line 35. Target Normal Cost and Excess
Assets.
Line 35a. Target Normal Cost (Line 6c).
Enter the target normal cost as reported in
Line 6c.
Line 35b. Excess Assets. Enter the excess,
if any, of the value of assets reported on Line
2b reduced by any funding standard
carryover balance and prefunding balance on
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47655
Line 13, columns (a) and (b), over the
funding target reported on Line 3d, column
(3). If the valuation date is not the first day
of the plan year, excess assets are determined
as the value of assets reported on Line 2b
reduced by any funding standard carryover
balance and prefunding balance reported on
Line 13, columns (a) and (b), adjusted for
interest at the effective interest rate for the
period between the beginning of the plan
year and the valuation date, minus the
funding target reported on Line 3d, column
(3) (but not less than zero). Limit the amount
reported in Line 35b so that it is not greater
than the target normal cost reported in Line
35a.
Line 36. Amortization Installments.
Line 36a. Shortfall Amortization Bases
and Amortization Installments.
Outstanding balance. If the plan’s funding
shortfall (determined under Code section
430(c)(4) and ERISA section 303(c)(4)) is
zero, all amortization bases and related
installments are considered fully amortized.
In this case, enter zero. Otherwise, enter the
sum (but not less than zero) of the
outstanding balances of all shortfall
amortization bases (including any new
shortfall amortization base established for the
current plan year). The outstanding balance
for each amortization base established in past
years is equal to the present value as of the
valuation date of any remaining amortization
installments for each base (including the
amortization installment for the current plan
year), using the interest rates reported on
Line 24.
A plan is generally exempt from the
requirement to establish a new shortfall
amortization base for the current plan year if
the funding target reported on Line 3d,
column (3), is less than or equal to the
reduced value of assets as described below.
For the purpose of determining whether a
plan is exempt from the requirement to
establish a new shortfall amortization base
for the current plan year, the reduced value
of assets is the amount reported on Line 2b,
reduced by the full value of the prefunding
balance reported on Line 13, column (b),
adjusted for interest for the period between
the beginning of the plan year and the
valuation date using the effective interest rate
for the current plan year, if the valuation date
is not the first day of the plan year. However,
the assets are reduced by the prefunding
balance if and only if the plan sponsor has
elected to use any portion of the prefunding
balance to offset the minimum required
contribution for the current plan year, as
reported on Line 39. The assets are not
reduced by the amount of any funding
standard carryover balance for this
calculation regardless of whether any portion
of the funding standard carryover balance is
used to offset the minimum required
contribution for the plan year.
If the plan is not exempt from the
requirement to establish a new shortfall
amortization base for the current plan year,
the amount of that base is generally equal to
the difference between the funding shortfall
as of the valuation date (determined under
Code section 430(c)(4) and ERISA section
303(c)(4)) and the sum of any outstanding
balances of any previously established
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shortfall and waiver amortization bases. The
new shortfall amortization base may be either
greater than or less than zero.
For the purpose of determining the amount
of any new shortfall amortization base, the
funding shortfall is equal to the amount of
the funding target reported on Line 3d,
column (3), minus the reduced value of
assets, but not less than zero.
If the plan’s valuation date is the first day
of the plan year, then the reduced value of
assets for the purpose of determining the
amount of any new shortfall amortization
base is the amount reported on Line 2b,
reduced by the sum of the funding standard
carryover balance and the prefunding balance
reported on Line 13, columns (a) and (b).
However, if the plan’s valuation date is not
the first day of the plan year, then the
reduced value of assets for the purpose of
determining the amount of any new shortfall
amortization base is the amount reported on
Line 2b, reduced by the sum of the funding
standard carryover balance and the
prefunding balance reported on Line 13,
columns (a) and (b), adjusted for interest for
the period between the beginning of the plan
year and the valuation date (using the
effective interest rate for the current plan
year). See Code section 430(f)(4)(B)(ii) and
ERISA section 303(f)(4)(B)(ii) for special rules
in the case of a binding agreement with the
PBGC providing that all or a portion of the
funding standard carryover balance and/or
prefunding balance is not available to offset
the minimum required contribution for the
plan year.
Shortfall amortization installment—Enter
the sum (but not less than zero) of:
1. Any shortfall amortization installments
that were established to amortize shortfall
amortization bases established in prior years,
excluding amortization installments for bases
that have been or are deemed to be fully
amortized, and
2. The shortfall amortization installment
that corresponds to any new shortfall
amortization base established for the current
plan year. This amount is the level
amortization payment that will amortize the
new shortfall amortization base over 7 annual
payments, using the interest rates reported in
Line 21 for the current plan year.
Note. (1) Shortfall amortization
installments for a given shortfall amortization
base are not re-determined from year to year
regardless of any changes in interest rates or
valuation dates. (2) If an election was made
to use an alternative shortfall amortization
schedule under Code section 430(c)(2)(D) and
ERISA section 303(c)(2)(D) added by PRA
2010, the shortfall amortization installment is
the amount determined in accordance with
the shortfall amortization schedule chosen
and guidance issued by Treasury and the IRS.
Include any increase to the shortfall
amortization installment for this year due to
the installment acceleration amount, as
provided in Code section 430(c)(7) and
ERISA section 303(c)(7).
Line 36b. Waiver Amortization Bases and
Amortization Installments.
Outstanding balance—If the plan’s funding
shortfall (determined under Code section
430(c)(4) and ERISA section 303(c)(4)) is
zero, all waiver amortization bases and
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related installments are considered fully
amortized. In this case, enter zero. Otherwise,
enter the present value as of the valuation
date of all remaining waiver amortization
installments (including any installment for
the current plan year), using the interest rates
reported on Line 24. Do not include any new
waiver amortization base established for a
waiver of minimum funding requirements for
the current plan year.
Waiver amortization installments—Enter
the sum of any remaining waiver
amortization installments that were
established to amortize any waiver
amortization bases for prior plan years,
unless such bases have been or are deemed
to be fully amortized. Do not include an
amortization installment for any new waiver
amortization base established for a waiver of
minimum funding requirements for the
current plan year.
Note. If a waiver of minimum funding
requirements has been granted for the current
plan year, a waiver amortization base is
established as of the valuation date for the
current plan year equal to the amount of the
funding waiver reported in Line 37. The
waiver amortization installment that
corresponds to any waiver amortization base
established for the current year is the level
amortization payment that will amortize the
new waiver amortization base over 5 annual
payments, using the same segment interest
rates or rates from the full yield curve
reported on Line 24 for the current plan year,
but with the first payment due on the
valuation date for the following plan year.
The amount of the waiver amortization base
and the waiver amortization installments for
this base are not reported in Line 36b for the
year in which they are established. Rather,
these are included in the entries for Line 36b
on the Schedule SB for the following plan
year.
Note. Waiver amortization installments
(including the waiver amortization
installments of any waiver amortization base
established for the prior plan year) are not redetermined from year to year regardless of
any changes in interest rates or valuation
dates.
Required Schedule of Amortization
Bases. If there are any shortfall or waiver
amortization bases, complete the schedule
listing all bases (other than a base established
for a funding waiver for the current plan
year) showing for each base:
1. The type of base (shortfall or waiver),
2. The present value of any remaining
installments (including the installment for
the current plan year),
3. The valuation date as of which the base
was established,
4. The number of years remaining in the
amortization period, and
5. The amortization installment.
If a base is negative (i.e., a ‘‘gain base’’),
show amounts in parentheses or with a
negative sign in front of them. All amounts
must be calculated as of the valuation date
for the plan year.
If any of the shortfall amortization bases
shown on this schedule are being amortized
using an alternative amortization schedule in
accordance with Code section 430(c)(2)(D) or
ERISA section 303(c)(2)(D), identify the
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amortization schedule being used and show
separately the amount of any installment
acceleration amount added to the shortfall
amortization installment for the current plan
year under Code section 430(c)(7) or ERISA
section 303(c)(7).
Line 37. Funding Waiver. If a waiver of
minimum funding requirements has been
approved for the current plan year, enter the
date of the ruling letter granting the approval
and the waived amount (reported as of the
valuation date) in the spaces provided. If a
waiver is pending, do not complete this line.
If a pending waiver is granted after Form
5500 Annual Return/Report is filed, file an
amended Form 5500 with an amended
Schedule SB.
Line 38. Total Funding Requirement
Before Reflecting Carryover/Prefunding
Balances. Enter the target normal cost in Line
35a, minus the excess assets in Line 35b, plus
the amortization installments reported in
Lines 36a and 36b, reduced by any waived
amounts reported in Line 37.
Line 39. Balances Elected for Use to Offset
Funding Requirement. If the percentage
reported on Line 19 is at least 80%, and the
plan has a funding standard carryover
balance and/or prefunding balance (as
reported on Line 13, columns (a) and (b)), the
plan sponsor may elect to credit all or a
portion of such balances against the
minimum required contribution. Enter the
amount of any balance elected for use for this
purpose in the applicable column of Line 39,
and enter the total in the column headed
‘‘Total Balance.’’ No portion of the
prefunding balance can be used for this
purpose unless the full amount of any
remaining funding standard carryover
balance (Line 13, column (a)) is used. The
amounts entered on Line 39 cannot be larger
than the corresponding amounts on Line 13
(unless the plan’s valuation date is not the
first day of the plan year, as discussed
below).
If the plan’s valuation date is not the first
day of the plan year, adjust the portion of the
funding standard carryover balance and
prefunding balance used to offset the
minimum required contribution for interest
between the beginning of the plan year and
the valuation date using the effective interest
rate for the current plan year.
Special rule for late election to apply
balances to quarterly installments. If an
election was made to use the funding
standard carryover balance or the prefunding
balance to offset the amount of a required
quarterly installment, but the election was
made after the due date of the installment,
the amount reported on Line 39 may not be
the same amount that is subtracted from the
plan’s balances in the following plan year (to
be reported in Line 8 of Schedule SB for the
following plan year). Refer to the regulations
under Section 430 of the Code for additional
information.
Special rule for elections to use
balances in excess of the minimum
required contribution. Section 1.430(f)–
1(f)(3)(ii) of the regulations provides an
exception to the general rule requiring that
any elections to use the funding standard
carryover balance and/or prefunding balance
to offset the minimum required contribution
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are irrevocable. Under this exception, such
an election may be revoked to the extent that
the amount of the election exceeds the
minimum required contribution for the plan
year as reported in Line 38. If a timely
election is made to revoke the excess amount,
report only the amount of the election used
to offset the minimum required contribution
on Line 39. If the excess amount is not
revoked by means of a timely election, report
the full amount of the election on Line 39
even if it exceeds the minimum required
contribution reported on Line 38.
Line 40. Additional Cash Requirement.
Enter the amount in Line 38 minus the
amount in the ‘‘Total Balance’’ column in
Line 39. (The result cannot be less than zero.)
This represents the contribution needed to
satisfy the minimum funding requirement for
the current year, adjusted for interest to the
valuation date.
Line 41. Contributions Allocated Toward
Minimum Required Contribution for Current
Year, Adjusted to Valuation Date. Enter the
amount reported in Line 22c.
Line 42. Present Value of Excess
Contributions for Current Year.
Line 42a. If Line 41 is greater than Line 40,
enter the amount by which Line 41 exceeds
line 40. Otherwise, enter ‘‘0.’’ This amount
(plus interest, if applicable) is the maximum
amount by which the plan sponsor may elect
to increase the prefunding balance.
Line 42b. Enter the amount of any portion
of the amount shown on Line 42a that results
solely from the use of the funding standard
carryover balance and/or prefunding balance
to offset the minimum required contribution.
Line 43. Unpaid Minimum Required
Contribution for Current Year. If Line 41 is
less than Line 40, enter the amount by which
Line 40 exceeds Line 41. Otherwise, enter
‘‘0’’.
Line 44. Unpaid Minimum Required
Contributions for All Years. Enter the sum of
the remaining unpaid minimum required
contributions from Line 34 and the unpaid
minimum required contribution for the
current year from Line 43. If this amount is
greater than zero, file Form 5330, Return of
Excise Taxes Related to Employee Benefit
Plans and pay the 10% excise tax on the
unpaid minimum required contributions.
Part IX—Election to Use Pension Funding
Relief under PRA 2010
Note. This section is completed only if:
(1) an election was made to use an
alternative shortfall amortization schedule
for any election year under Code section
430(c)(2)(D) or ERISA section 303(c)(2)(D), or
(2) in the case of a plan subject to a delayed
effective date for PPA funding rules under
section 104 of PPA, an election was made to
determine the minimum required
contribution for any election year using the
extended amortization periods under section
107 of PPA ’06, as added by PRA 2010
(complete Lines 45a and 45b only).
Line 45a. Schedule elected. Check the
applicable box to indicate which alternative
shortfall amortization schedule is being used,
the 2 plus 7-year schedule or the 15-year
being used, the 2 plus 7-year schedule or the
15-year schedule.
Line 45b. Eligible plan year(s) for which
the election in Line 45a was made. Check the
box(es) to indicate the eligible plan years for
which the election was made to use an
alternative amortization schedule under Code
section 430(c)(2)(D) or ERISA section
303(c)(2)(D) or the relief under section 107 of
PPA ’06 as added by PRA 2010. Note that an
election to use an alternative amortization
schedule may only be made with respect to
one or two eligible plan years. Refer to Code
section 430(c)(2)(D)(v) or ERISA section
303(c)(2)(D)(v) for the definition of eligible
plan years.
Line 46. Amount of acceleration
adjustment. Enter the total amount included
in the shortfall amortization installments
reported for the current year on Line 36a as
a result of increases due to any installment
acceleration amount under Code section
430(c)(7) or ERISA section 303(c)(7), taking
into account any amounts carried over from
previous years and the annual limitation in
Code section 430(c)(7)(C)(ii) or ERISA section
303(c)(7)(C)(ii).
47657
Line 47. Excess installment acceleration
amount to be carried over to future plan
years. Enter the amount of any excess
installment acceleration amount for the
current year (including any amounts carried
to the current year from prior years) that will
be carried over to future plan years in
accordance with Code section
430(c)(7)(C)(iii) or ERISA section
303(c)(7)(C)(iii).
Quick Reference Charts
Note. The following series of quick
reference charts set forth a general summary
of filing requirements for pension plans,
welfare plans that provide group health
benefits, welfare plans other than group
health, and direct filing entities. Not all rules
and requirements are reflected for the various
types of filers.
CAUTION: Refer to specific Form 5500
Annual Return/Report instructions for
complete information on filing requirements
(e.g., Who Must File and What To File). These
charts do not include filing requirements for
small plans eligible to file the Form 5500–SF
or the new registration alternative for small
fully insured group health plans.
Make sure you are reading the right chart
for your type of plan or filing entity:
1. Pension Plans Required to File the Form
5500
2. Direct Filing Entities Other Than Group
Insurance Arrangements (GIAs)
3. Welfare Plans and GIAs That Provide
Group Health Benefits
4. Welfare Plans Other Than Group Health
Pension Plans Required to File the Form
5500
(Does not include filing requirements for
small plans eligible to file the Form 5500–
SF). This chart provides only general
guidance. Not all rules and requirements are
reflected. Refer to specific Form 5500 Annual
Return/Report instructions for complete
information on filing requirements (e.g., Who
Must File and What To File).
Small Pension Plan
Form 5500 ...........................
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Large Pension Plan
Must complete .................................................................
Schedule A (Insurance Information).
Must complete if plan has insurance contracts ..............
Must complete unless eligible to File Form 5500–SF.
Pension plans and welfare plans with fewer than 100
participants at the beginning of the plan year that are
not exempt from filing an annual return/report may be
eligible to file the Form 5500–SF, a simplified report.
In addition to the limitation on the number of participants, a Form 5500–SF may only be filed for a plan
that is exempt from the requirement that the plan’s
books and records be audited by an independent
qualified public accountant (but not by reason of enhanced bonding), has 100 percent of its assets invested in certain secure investments with a readily
determinable fair market value, holds no employer
securities, and is not a multiemployer plan. See Who
Must File. Defined contribution pension plans (other
than those that check the ‘‘first plan year’’ box, which
use Line 6) that otherwise meet the conditions for filing the Form 5500–SF use the count on Line 7g(1)—
number of participants with account balances at the
beginning of the year—to determine whether they are
a small plan.
Must complete if plan has insurance contracts.
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Large Pension Plan
Schedule C (Service Provider Information).
Schedule D (DFE/Participating Plan Information).
Schedule G (Financial
Schedules).
Schedule H (Financial Information).
Line 4a Schedule of Delinquent Participant Contributions.
Line 4i(1) Schedule of Assets Held for Investment
at EOY.
Line 4i(2) Schedule of Assets Disposed of During
the Plan Year.
Line 4j Schedule of Reportable Transactions.
Schedule J ..........................
Schedule MB (Actuarial Information).
Schedule R (Pension Plan
Information).
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Schedule SB (Actuarial Information).
Accountant’s Opinion
(IQPA Report).
Small Pension Plan
Must complete Part I if (1) each covered service provider who received $1,000 or more in total direct and
indirect compensation (i.e., money or anything else of
monetary value in connection with services rendered
to the plan or the person’s position with the plan during the plan year, including payments from participants’ accounts and (2) other persons who received
$5,000 or more in direct compensation in connection
with services rendered to the plan or the person’s position with the plan during the plan year, including
payments from participants’ accounts; and Part II if a
service provider failed to provide information necessary for the completion of Part I.
Not required ....................................................................
Must complete Part I if (1) each covered service provider who received $1,000 or more in total direct and
indirect compensation (i.e., money or anything else of
monetary value in connection with services rendered
to the plan or the person’s position with the plan during the plan year, including payments from participants’ accounts and (2) other persons who received
$5,000 or more in direct compensation in connection
with services rendered to the plan or the person’s position with the plan during the plan year, including
payments from participants’ accounts; and Part II if a
service provider failed to provide information necessary for the completion of Part I.
Not required
Must complete if Schedule H, Lines 4b, 4c, or 4d are
answered ‘‘Yes.’’.
Must complete .................................................................
Must complete if Schedule H, Lines 4b, 4c, or 4d are
answered ‘‘Yes’’ and plan is not eligible for the audit
waiver under 29 CFR 2520.104–46.
Must complete
Must check ‘‘yes’’ to Schedule H, Line 4a and complete
if plan had delinquent contributions (see instructions).
Must check ‘‘yes’’ to Schedule H, Line 4a and complete
if plan had delinquent contributions (see instructions).
Must check ‘‘yes’’ to Schedule H, Line 4i(1) and complete if plan held assets at end of year (all plans except those that are filing final return/report with -0assets at year end)). If invested in a CCT or PSA
that has not filed a Form 5500, must break out the
underlying investments of the CCT and PSA, indicating assets held through a CCT or PSA. If invested
in a CCT or PSA that has filed the Form 5500, may
report individual CCTs and PSAs at the CCT/PSA
level, indicating the Line 1b category for type of CCT/
PSA investment.
Must check ‘‘yes’’ to Schedule H, Line 4i(2) and complete if plan disposed of assets during the plan year.
Certain readily tradable assets not required to be reported (see instructions).
Must check ‘‘yes’’ to Schedule H, Line 4j and complete
if plan had transactions involving 5% or more of plan
assets.
Pension plans do NOT need to complete unless providing retiree health benefits or otherwise providing
‘‘group health benefits’’.
Must complete if multiemployer defined benefit pension
plan or money purchase plan subject to minimum
funding standards.
Must complete. ................................................................
Money purchase defined contribution pension plans
that are amortizing a funding waiver are required to
complete Lines 3, 9, and 10 of the Schedule MB in
accordance with the instructions. Also see instructions for Line 6 and 7a of Schedule R.
Schedule R should not be completed when the Form
5500 Annual Return/Report is filed for a pension plan
that uses, as the sole funding vehicle for providing
benefits, individual retirement accounts or annuities
(as described in Code section 408). See the Form
5500 instructions for Limited Pension Plan Reporting
for more information.
Must complete if single-employer or multiple-employer
defined benefit pension plan, including an eligible
combined plan and subject to minimum funding
standards.
Must attach ......................................................................
Must check ‘‘yes’’ to Schedule H, Line 4i(1) and complete if plan held assets at end of year (all plans except those that are filing final return/report with -0assets at year end)). If invested in a CCT or PSA
that has not filed a Form 5500, must break out the
underlying investments of the CCT and PSA, indicating assets held through a CCT or PSA. If invested
in a CCT or PSA that has filed the Form 5500, may
report individual CCTs and PSAs at the CCT/PSA
level, indicating the Line 1b category for type of CCT/
PSA investment.
Must check ‘‘yes’’ to Schedule H, Line 4i(2) and complete if plan disposed of assets during the plan year.
Certain readily tradable assets not required to be reported (see instructions).
Must check ‘‘yes’’ to Schedule H, Line 4j and complete
if plan had transactions involving 5% or more of plan
assets.
Pension plans do NOT need to complete unless providing retiree health benefits or otherwise providing
‘‘group health benefits’’.
Must complete if multiemployer defined benefit pension
plan or money purchase plan subject to minimum
funding standards.
Must complete.
Money purchase defined contribution pension plans
that are amortizing a funding waiver are required to
complete Lines 3, 9, and 10 of the Schedule MB in
accordance with the instructions. Also see instructions for Line 6 and 7a of Schedule R.
Schedule R should not be completed when the Form
5500 Annual Return/Report is filed for a pension plan
that uses, as the sole funding vehicle for providing
benefits, individual retirement accounts or annuities
(as described in Code section 408). See the Form
5500 instructions for Limited Pension Plan Reporting
for more information.
Must complete if single-employer or multiple-employer
defined benefit pension plan, including an eligible
combined plan and subject to minimum funding
standards.
Required unless Schedule H, Line 3h(4) is checked to
indicate that the plan is a small plan that meets the
requirements of 29 CFR 2520.104–46.
Direct Filing Entities Other Than Group
Insurance Arrangements (GIAs)). This chart
provides only general guidance. Not all rules
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
and requirements are reflected. Refer to
specific Form 5500 Annual Return/Report
instructions for complete information on
PO 00000
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filing requirements (e.g., Who Must File and
What To File).
E:\FR\FM\21JYP3.SGM
21JYP3
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
47659
Master Trusts
CCTs/PSAs
103–12 IEs
Form 5500 .....................................
Must complete ..............................
CCTs and PSAs are not required
to file a Form 5500, but filing by
the CCT/PSA relieves investing
plans of certain reporting obligations.
Schedule of Participating Employers.
Schedule A (Insurance Information).
Schedule C (Service Provider Information).
Not required ..................................
Not required ..................................
Certain collective investment vehicles that hold plan assets are
permitted to elect to file a Form
5500, which filing relieves investing plans of certain reporting obligations.
Not required
Must complete if plan has insurance contracts.
Must complete Part I if (1) each
covered service provider who
received $1,000 or more in total
direct and indirect compensation (i.e., money or anything
else of monetary value in connection with services rendered
to the plan or the person’s position with the plan during the
plan year, including payments
from participants’ accounts and
(2) other persons who received
$5,000 or more in direct compensation in connection with
services rendered to the plan or
the person’s position with the
plan during the plan year, including payments from participants’ accounts; and Part II if a
service provider failed to provide information necessary for
the completion of Part I.
Must complete ..............................
Not required ..................................
Schedule D (DFE/Participating
Plan Information).
Schedule G (Financial Schedules)
Schedule H (Financial Information).
Line 4a Schedule of Delinquent
Participant Contributions.
Line 4i(1) Schedule of Assets
Held for Investment at EOY.
Line 4i(2) Schedule of Assets
Disposed of During the Plan
Year.
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Line 4j Schedule of Reportable
Transactions.
Schedule J ....................................
Schedule MB (Actuarial Information).
Schedule R (Pension Plan Information).
Schedule SB (Actuarial Information).
Accountant’s Opinion (IQPA Report).
19:35 Jul 20, 2016
Must complete ..............................
Must complete if Schedule H,
Lines 4b, 4c, or 4d are answered ‘‘Yes.’’.
Must complete ..............................
Must complete ..............................
Must complete if Schedule H,
Lines 4b, 4c, or 4d are answered ‘‘Yes.’’.
Must complete
Not required ..................................
Not required ..................................
Not required
Must check ‘‘yes’’ to Schedule H,
Line 4i(1) and complete if master trust held assets at end of
year (all plans except those that
are filing final return/report with
-0- assets at year end).
Must check ‘‘yes’’ to Schedule H,
Line 4i(2) and complete if master trust disposed of assets during the plan year. Certain readily tradable assets not required
to be reported (see instructions).
Must check ‘‘yes’’ to Schedule H,
Line 4j and complete if master
trust had transactions involving
5% or more of assets.
Not required ..................................
Not required ..................................
Must check ‘‘yes’’ to Schedule H,
Line 4i(1) and complete if plan
held assets at end of year (all
plans except those that are filing final return/report with -0assets at year end).
Not required ..................................
Not required ..................................
Must check ‘‘yes’’ to Schedule H,
Line 4i(1) and complete if 103–
12 IE held assets at end of
year (all plans except those that
are filing final return/report with
-0- assets at year end)
Must check ‘‘yes’’ to Schedule H,
Line 4i(2) and complete if 103–
12 IE disposed of assets during
the plan year. Certain readily
tradable assets not required to
be reported (see instructions)
Not required
Not required ..................................
Not required ..................................
Not required
Not required
Not required ..................................
Not required ..................................
Not required
Not required ..................................
Not required ..................................
Not required
Not required ..................................
Not required ..................................
Must attach
Welfare Plans and Group Insurance
Arrangements (GIAs) That Provide Health
Benefits 44 This chart provides only general
VerDate Sep<11>2014
Not required ..................................
Jkt 238001
Not required ..................................
Must complete if plan has insurance contracts.
Must complete Part I if (1) each
covered service provider who
received $1,000 or more in total
direct and indirect compensation (i.e., money or anything
else of monetary value in connection with services rendered
to the plan or the person’s position with the plan during the
plan year, including payments
from participants’ accounts and
(2) other persons who received
$5,000 or more in direct compensation in connection with
services rendered to the plan or
the person’s position with the
plan during the plan year , including payments from participants’ accounts; and Part II if a
service provider failed to provide information necessary for
the completion of Part I.
Must complete
guidance. Not all rules and requirements are
reflected. Refer to specific Form 5500 Annual
Return/Report instructions for complete
PO 00000
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information on filing requirements (e.g., Who
Must File and What To File).
E:\FR\FM\21JYP3.SGM
21JYP3
47660
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
Large welfare plans providing
health benefits
Small welfare plans providing health
benefits
Group insurance arrangements that
provide health benefits (GIAs)
Form 5500 ..............
Must complete ......................................
Must complete.
Schedule of Participating Employers.
Schedule A (Insurance Information).
Multiple employer plans and plans covering members of a controlled group
must complete.
Must complete if plan has insurance
contracts.
Schedule C (Service Provider Information).
Must complete Part I for (1) each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including payments from participants’ accounts) and (2) other persons who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during the plan year, including payments from participants’ accounts;
and Part II if a service provider
failed to provide information necessary for the completion of Part I.
Exception: Unfunded, fully insured,
or combination unfunded/fully insured group health plans are exempt
under 29 CFR 2520.104–44 from
completing Schedule C.
Not required for plans ..........................
Must complete. Exception: Small fully
insured group health plans complete
only certain questions.
Multiple employer plans and plans covering members of a controlled group
must complete.
Must complete if plan has insurance
contracts. Exception: Small fully insured group health plans do not
complete.
Must complete Part I for (1) each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including payments from participants’ accounts) and (2) other persons who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during the plan year, including payments from participants’ accounts;
and Part II if a service provider
failed to provide information necessary for the completion of Part I.
Exception: Unfunded, fully insured,
or combination unfunded/fully insured group health plans are exempt
under 29 CFR 2520.104–44 from
completing Schedule C.
Not required for plans ..........................
Schedule D (DFE/
Participating
Plan Information).
Schedule G (Finan- Must complete if Schedule H, Lines
cial Schedules).
4b, 4c, or 4d are answered ‘‘Yes.’’.
Unfunded, fully insured, or combination
unfunded/fully insured welfare plans
are
exempt
under
29
CFR
2520.104–44 from completing Parts
I and II but must still complete
Schedule G, Part III to report nonexempt transactions.
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Schedule H (Financial Information).
Line 4a Schedule
of Delinquent
Participant Contributions.
Line 4i(1) Schedule
of Assets Held
for Investment at
EOY.
Line 4i(2) Schedule
of Assets Disposed of During
the Plan Year.
VerDate Sep<11>2014
Not required .........................................
Must complete
Must complete
Must complete Part I for (1) each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including payments from participants’ accounts and (2) other persons who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during the plan year, including payments from participants’ accounts;
and Part II if a service provider
failed to provide information necessary for the completion of Part I.
Must complete to report participating
plans.
Must complete if Schedule H, Lines
4b, 4c, or 4d for a GIA, are answered ‘‘Yes.’’
Unfunded, fully insured, or combination
unfunded/fully insured welfare plans
are
exempt
under
29
CFR
2520.104–44 from completing Parts
I and II but GIA’s must still complete
Schedule G, Part III to report nonexempt transactions for participating
plans.
Must complete
Must complete if plan is partly or fully
funded with a trust (including a
VEBA). Unfunded, fully insured, or
combination unfunded/fully insured
group health plans are exempt
under 29 CFR 2520.104–44 from
completing Schedule H.
Must complete if required to complete
Schedule H.
Must complete if plan is partly or fully
funded with a trust (including a
VEBA). Unfunded, fully insured, or
combination unfunded/fully insured
group health plans are exempt
under 29 CFR 2520.104–44 from
completing Schedule H.
Not required .........................................
If required to complete Schedule H,
must check ‘‘yes’’ to Schedule H,
Line 4i(1) and complete if plan held
assets at end of year (all plans except those that are filing final return/
report with -0- assets at year end).
If required to complete Schedule H,
must check ‘‘yes’’ to Schedule H,
Line 4i(2) and complete if plan disposed of assets during the plan
year. Certain readily tradable assets
not required to be reported (see instructions).
Not required .........................................
Must complete
Not required .........................................
Must complete
19:35 Jul 20, 2016
Jkt 238001
PO 00000
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E:\FR\FM\21JYP3.SGM
Not required
21JYP3
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
47661
Large welfare plans providing
health benefits
Line 4j Schedule of
Reportable
Transactions.
Schedule J .............
Schedule MB (Actuarial Information).
Schedule R (Pension Plan Information).
Schedule SB (Actuarial Information).
Accountant’s Opinion (IQPA Report).
Small welfare plans providing health
benefits
Group insurance arrangements that
provide health benefits (GIAs)
If required to complete Schedule H,
must check ‘‘yes’’ to Schedule H,
Line 4j and complete if plan had
transactions involving 5% or more of
plan assets.
Must complete ......................................
Not required .........................................
Must complete
Must complete a separate Schedule J
for each participating employer.
Not required .........................................
Must complete entire Schedule J if not
fully insured. If fully insured, must
complete Lines 1–8.
Not required .........................................
Not required
Not required .........................................
Not required .........................................
Not required
Not required .........................................
Not required .........................................
Not required
Must complete if plan is partly or fully
funded with a trust (including a
VEBA). Unfunded, fully insured, or
combination unfunded/fully insured
group health plans are exempt
under 29 CFR 2520.104–44 from
the IQPA report.
Not required .........................................
Must attach.
Welfare Plans Other Than Group Health
This chart provides only general guidance.
Not all rules and requirements are reflected.
Refer to specific Form 5500 Annual Return/
Report instructions for complete information
on filing requirements (e.g., Who Must File
and What To File).
Small welfare plans NOT providing
health plan benefits
Form 5500 ..............
Must complete ......................................
Schedule of Participating Employers.
Schedule A (Insurance Information).
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Large welfare plans NOT providing
health plan benefits
Multiple employer plans and plans covering members of a controlled group
must complete.
Must complete if plan has insurance
contracts.
Must complete, except (1) unfunded,
fully insured, or combination unfunded/fully insured welfare plans
covering fewer than 100 participants
at the beginning of the plan year
that meet the requirements of 29
CFR 2520.104–20 are exempt from
filing an annual report.
(2) Welfare plans with fewer than 100
participants at the beginning of the
plan year that are not exempt from
filing an annual return/report may be
eligible to file the Form 5500–SF, a
simplified report.
Note: If plan provides group health
benefits, follow the filing instructions
for group health plans.
Multiple employer plans and plans covering members of a controlled group
must complete.
Must complete if plan has insurance
contracts.
44 Pension plans that also provide health benefits
must follow the rules for pension plan filings and
VerDate Sep<11>2014
21:06 Jul 20, 2016
Jkt 238001
Group insurance arrangements
(GIAs) NOT providing health benefits
Must complete
Must complete
Must complete
must also attach a Schedule J to report on health
benefits.
PO 00000
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E:\FR\FM\21JYP3.SGM
21JYP3
47662
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
Large welfare plans NOT providing
health plan benefits
Schedule C (Service Provider Information).
Schedule D (DFE/
Participating Plan
Information).
Schedule G (Financial Schedules).
Schedule H (Financial Information).
Line 4a Schedule
of Delinquent
Participant Contributions
Line 4i(1) Schedule
of Assets Held
for Investment at
EOY
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Line 4i(2) Schedule
of Assets Disposed of During
the Plan Year
Line 4j Schedule of
Reportable
Transactions
Schedule J .............
Schedule MB (Actuarial Information).
Schedule R (Pension Plan Information).
Schedule SB (Actuarial Information).
VerDate Sep<11>2014
Small welfare plans NOT providing
health plan benefits
Group insurance arrangements
(GIAs) NOT providing health benefits
Must complete Part I for (1) each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including payments from participants’ accounts) and (2) other persons who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during the plan year, including payments from participants’ accounts;
and Part II if a service provider
failed to provide information necessary for the completion of Part I.
Unfunded, fully insured, or combination unfunded/fully insured welfare
plans are exempt under 29 CFR
2520.104–44
from
completing
Schedule C.
Not required .........................................
Must complete Part I for (1) each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including payments from participants’ accounts) and (2) other persons who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during the plan year, including payments from participants’ accounts;
and Part II if a service provider
failed to provide information necessary for the completion of Part I.
Exception: Unfunded, fully insured,
or combination unfunded/fully insured welfare benefit plans are exempt under 29 CFR 2520.104–44
from completing Schedule C.
Not required .........................................
Must complete Part I for (1) each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e., money or
anything else of monetary value in
connection with services rendered to
the plan or the person’s position with
the plan during the plan year, including payments from participants’ accounts and (2) other persons who
received $5,000 or more in direct
compensation in connection with
services rendered to the plan or the
person’s position with the plan during the plan year, including payments from participants’ accounts;
and Part II if a service provider
failed to provide information necessary for the completion of Part I.
Must complete if Schedule H, Lines
4b, 4c, or 4d are ‘‘Yes.’’ Unfunded,
fully insured, or combination unfunded/fully insured welfare plans
are
exempt
under
29
CFR
2520.104–44 from completing Parts
I and II but must still complete
Schedule G, Part III to report nonexempt transactions.
Must complete if plan is partly or fully
funded with a trust (including a
VEBA). Unfunded, fully insured, or
combination unfunded/fully insured
welfare plans are exempt under 29
CFR 2520.104–44 from completing
Schedule H.
Must complete if required to complete
Schedule H.
Not required .........................................
Must complete if Schedule H, Lines
4b, 4c, or 4d are answered ‘‘Yes.’’
Not required .........................................
Must complete
Not required .........................................
Not required
Must check ‘‘Yes’’ to Schedule H, Line
4i(1) and complete if plan held assets at end of year (all plans except
those that are filing final return/report with -0- assets at year end).
Must check ‘‘Yes’’ to Schedule H, Line
4i(2) and complete if plan disposed
of assets during the plan year. Certain readily tradable assets not required to be reported (see instructions).
Must check ‘‘Yes’’ to Schedule H, Line
4j and complete if plan had transactions involving 5% or more of plan
assets.
Not required .........................................
Not required .........................................
Not required .........................................
Must complete
Not required .........................................
Must complete
Not required .........................................
Must complete
Not required .........................................
Not required .........................................
Not required
Not required
Not required .........................................
Not required .........................................
Not required
Not required .........................................
Not required .........................................
Not required
21:06 Jul 20, 2016
Jkt 238001
PO 00000
Frm 00130
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E:\FR\FM\21JYP3.SGM
Must complete to report participating
plans.
21JYP3
Federal Register / Vol. 81, No. 140 / Thursday, July 21, 2016 / Proposed Rules
Large welfare plans NOT providing
health plan benefits
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Accountant’s Opinion (IQPA Report).
Small welfare plans NOT providing
health plan benefits
Large welfare plans must complete if
plan is partly or fully funded with a
trust (including a VEBA). Unfunded,
fully insured, or combination unfunded/fully insured welfare plans
are
exempt
under
29
CFR
2520.104–44 from the IQPA report.
Not required .........................................
ERISA Compliance Quick Checklist
Compliance with the Employee Retirement
Income Security Act (ERISA) begins with
knowing the rules. Plan administrators and
other plan officials can use this checklist as
a quick diagnostic tool for assessing a plan’s
compliance with certain important ERISA
rules; it is not a complete description of all
ERISA’s rules and it is not a substitute for a
comprehensive compliance review. Use of
this checklist is voluntary. Do not file it with
your Form 5500.
If you answer ‘‘No’’ to any of the questions
below, you should review your plan’s
operations because you may not be in full
compliance with ERISA’s requirements.
1. Have you provided plan participants
with a summary plan description, summaries
of any material modifications of the plan, and
annual summary financial reports or annual
pension funding reports?
2. Do you maintain copies of plan
documents at the principal office of the plan
administrator for examination by participants
and beneficiaries?
3. Do you respond to written participant
inquires for copies of plan documents and
information within 30 days?
4. Does your plan include written
procedures for making benefit claims and
appealing denied claims, and are you
complying with those procedures?
5. Is your plan covered by fidelity bonds
protecting the plan against losses due to
fraud or dishonesty by persons who handle
plan funds or other property?
6. Are the plan’s investments diversified so
as to minimize the risk of large losses?
7. If the plan permits participants to select
the investments in their plan accounts, has
the plan provided them with enough
information to make informed decisions?
8. Has a plan official determined that the
investments are prudent and solely in the
interest of the plan’s participants and
beneficiaries, and evaluated the risks
associated with plan investments before
making the investments?
9. Did the employer or other plan sponsor
send participant contributions to the plan on
a timely basis?
10. Did the plan pay participant benefits on
time and in the correct amounts?
11. Did the plan give participants and
beneficiaries 30 days advance notice before
imposing a ‘‘blackout period’’ of at least three
consecutive business days during which
participants or beneficiaries of a 401(k) or
other individual account pension plan were
unable to change their plan investments,
obtain loans from the plan, or obtain
distributions from the plan?
If you answer ‘‘Yes’’ to any of the
questions below, you should review your
VerDate Sep<11>2014
19:35 Jul 20, 2016
Jkt 238001
plan’s operations because you may not be in
full compliance with ERISA’s requirements.
1. Has the plan engaged in any financial
transactions with persons related to the plan
or any plan official? (For example, has the
plan made a loan to or participated in an
investment with the employer?)
2. Has the plan official used the assets of
the plan for his/her own interest?
3. Have plan assets been used to pay
expenses that were not authorized in the plan
document, were not necessary to the proper
administration of the plan, or were more than
reasonable in amount?
If you need help answering these questions
or want additional guidance about ERISA
requirements, a plan official should contact
the U.S. Department of Labor Employee
Benefits Security Administration office in
your region or consult with the plan’s legal
counsel or professional employee benefit
advisor.
APPENDIX C
Form 5500–SF
Instructions
20XX Instructions for Form 5500–SF (Short
Form Annual Return/Report of Small
Employee Benefit Plan)
Code section references are to the Internal
Revenue Code unless otherwise noted. ERISA
refers to the Employee Retirement Income
Security Act of 1974.
Changes to Note [The instructions for the
year in which the revisions are implemented
will include such items in the ‘‘Changes to
Note’’ section.]
Table of Contents [The final version of the
Instructions for 20XX will include a Table of
Contents in substantially the same format as
the existing Table of Contents]
EFAST2 Processing System
Under the computerized ERISA Filing
Acceptance System (EFAST), you must
electronically file your 20XX Form 5500–SF,
Short Form Annual Return/Report of Small
Employee Benefit Plan. You may file your
20XX Form 5500–SF online using EFAST2’s
web-based filing system or you may file
through an EFAST2-approved vendor. You
cannot file a paper Form 5500–SF by mail or
other delivery service. For more information,
see the instructions for How To File—
Electronic Filing Requirement on page xx and
the EFAST2 Web site at www.efast.dol.gov.
How To Get Assistance
If you need help completing this form, or
have other questions, call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–3278)
(toll free) or access the EFAST2 or IRS Web
sites. The EFAST2 Help Line is available
PO 00000
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47663
Group insurance arrangements (GIAs)
NOT providing health benefits
Must attach.
Monday through Friday from 8:00 a.m. to
8:00 p.m., Eastern Time.
You can access the EFAST2 Web site 24
hours a day, 7 days a week at
www.efast.dol.gov to:
• File the Form 5500–SF or 5500 and any
needed schedules or attachments.
• Check on the status of a filing you
submitted.
• View filings posted by EFAST2.
• Register for electronic credentials to sign
or submit filings.
• View forms and related instructions.
• Get information regarding EFAST2,
including approved software vendors.
• See answers to frequently asked
questions about the Form 5500–SF, the Form
5500 and its schedules, and EFAST2.
• Access the main Employee Benefits
Security Administration (EBSA) and DOL
Web sites for news, regulations, and
publications.
You can access the IRS Web site 24 hours
a day, 7 days a week at www.irs.gov to:
• View forms, instructions, and
publications.
• See answers to frequently asked tax
questions.
• Search publications online by topic or
keyword.
• Send comments or request help by email.
• Sign up to receive local and national tax
news by email.
You can order other IRS forms and
publications at the IRS Web site at
www.irs.gov/orderforms. You can order EBSA
publications by calling 1–866–444–EBSA
(3272).
General Instructions
The Form 5500–SF, Short Form Annual
Return/Report of Small Employee Benefit
Plan, is a simplified annual reporting form
for use by certain small pension and welfare
benefit plans. To be eligible to use the Form
5500–SF, the plan must:
• Be a small plan (i.e., generally have
fewer than 100 participants at the beginning
of the plan year);
• Meet the conditions for being exempt
from the requirement that the plan’s books
and records be audited by an independent
qualified public accountant (IQPA);
• Have 100% of its assets invested in
certain secure investments with a readily
determinable fair value;
• Hold no employer securities;
• Not be a multiemployer plan; and
• Not provide health benefits.
Plans required to file an annual return/
report that are not eligible to file the Form
5500–SF, must file a Form 5500, Annual
Return/Report of Employee Benefit Plan,
with all required schedules and attachments
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(Form 5500), or Form 5500–EZ, Annual
Return of One-Participant (Owners and Their
Spouses) Retirement Plan.
To reduce the possibility of
correspondence and penalties, we remind
filers that the Internal Revenue Service (IRS),
Department of Labor (DOL), and Pension
Benefit Guaranty Corporation (PBGC) have
consolidated their annual return/report forms
to minimize the filing burden for employee
benefit plans. Administrators and sponsors of
employee benefit plans generally will satisfy
their IRS and DOL annual reporting
requirements for the plan under ERISA
sections 104 and 4065 and Code sections
6058 and 6059 by filing either the Form 5500,
Form 5500–SF, or Form 5500–EZ. Defined
contribution and defined benefit pension
plans may have to file additional information
with the IRS including: Form 8955–SSA,
Annual Registration Statement Identifying
Separated Participants with Deferred Vested
Benefits.; Form 5330, Return of Excise Taxes
Related to Employee Benefit Plans; Form
5310–A, Notice of Plan Merger or
Consolidation, Spinoff, or Transfer of Plan
Assets or Liabilities; Notice of Qualified
Separate Lines of Business. See www.irs.gov
for more information. Defined benefit
pension plans covered by the PBGC have
special additional requirements, including
filing premiums and reporting certain
transactions directly with that agency. See
the PBGC’s Web site at www.pbgc.gov/
practitioners for information on premium
filings and reporting and disclosure
requirements.
Note. The Form 5500–EZ generally is used
by ‘‘one-participant plans or certain foreign
plans’’ (as defined under Specific
Instructions Only for ‘‘One-Participant Plans
and certain foreign plans’’) that are not
subject to the requirements of section 104(a)
of ERISA to satisfy certain annual reporting
and filing obligations imposed by the Code.
A ‘‘one-participant plan and certain foreign
plan’’ may also be eligible to file Form 5500–
SF. See Specific Instructions Only for ‘‘OneParticipant Plans and certain foreign plans.’’
A ‘‘one-participant plan or certain foreign
plan’’ that is eligible to file Form 5500–SF
may elect to file Form 5500–SF electronically
with EFAST2 rather than filing a Form 5500–
EZ on paper with the IRS. A ‘‘one-participant
plan or certain foreign plan’’ that is not
eligible to file Form 5500–SF must file Form
5500–EZ on paper with the IRS. For more
information on filing with the IRS, go to
www.irs.gov or call 1–877–829–5500.
[CAUTION] Abbreviated filing
requirements apply for one-participant plan
filers who are eligible to file Form 5500–SF.
See Specific Instructions Only for ‘‘OneParticipant Plans’’ on page XX.
The Form 5500–SF must be filed
electronically. See How To File—Electronic
Filing Requirement instructions and the
EFAST2 Web site at www.efast.dol.gov. Your
Form 5500–SF entries will be initially
screened electronically. Your entries must
satisfy this screening for your filing to be
received. Once received, your form may be
subject to further detailed review, and your
filing may be rejected based upon this further
review.
ERISA and the Code provide for the
assessment or imposition of penalties for not
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submitting the required information when
due. See Penalties.
Annual returns/reports filed under Title I
of ERISA must be made available by plan
administrators to plan participants and
beneficiaries and by the DOL to the public
pursuant to ERISA sections 104 and 106.
Pursuant to Section 504 of the Pension
Protection Act of 2006 (PPA), this availability
for defined benefit pension plans must
include the posting of identification and
basic plan information and actuarial
information (Form 5500–SF, Schedule SB or
MB, and all of the Schedule SB or MB
attachments) on any plan sponsor intranet
Web site (or Web site maintained by the plan
administrator on behalf of the plan sponsor)
that is used for the purpose of
communicating with employees and not the
public. Section 504 also requires DOL to
display such information on DOL’s Web site
within 90 days after the filing of the plan’s
annual return/report. To see 2009 and later
Forms 5500–SF, including actuarial
information, see www.dol.gov/ebsa. See
www.dol.gov/ebsa/actuarialsearch.html for
2008 and short plan year 2009 actuarial
information filed under the previous paperbased system.
Pension and Welfare Plans Required To File
Annual Return/Report
All pension benefit plans and welfare
benefit plans covered by ERISA must file a
Form 5500 or Form 5500–SF for a plan year
unless they are eligible for a filing
exemption. (See Code sections 6058 and 6059
and ERISA sections 104 and 4065). An
annual return/report must be filed even if the
plan is not ‘‘tax qualified,’’ benefits no longer
accrue, contributions were not made during
this plan year, or contributions are no longer
made. Pension benefit plans required to file
include both defined benefit pension plans
and defined contribution pension plans.
Profit-sharing plans, stock bonus plans,
money purchase plans, 401(k) plans, Code
section 403(b) plans covered by Title I of
ERISA, and IRA plans established by an
employer are among the pension benefit
plans for which an annual return/report must
be filed. Welfare benefit plans provide
benefits such as medical, dental, life
insurance, apprenticeship and training,
scholarship funds, severance pay, disability,
etc. Plans that cover residents of Puerto Rico,
the U.S. Virgin Islands, Guam, Wake Island,
or American Samoa also must file unless they
are eligible for a filing exemption. This
includes a plan that elects to have the
provisions of section 1022(i)(2) of ERISA
apply.
For more information about annual return/
report filings for Code section 403(b) plans
covered by Title I of ERISA, see Field
Assistance Bulletins 2009–02 and 2010–01,
available on the DOL Web site at
www.dol.gov.
Plans Exempt From Filing
Under regulations and applicable
guidance, some pension benefit plans and
many welfare benefit plans with fewer than
100 participants are exempt from filing an
annual return/report. Do not file a Form
5500–SF for an employee benefit plan that is
any of the following:
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1. An unfunded excess benefit plan. See
ERISA section 4(b)(5).
2. A pension benefit plan maintained
outside the United States primarily for the
benefit of persons substantially all of whom
are nonresident aliens. However, certain
foreign plans are required to file the Form
5500–EZ with the IRS. See the instructions to
the Form 5500–EZ for the filing
requirements. For more information, go to
www.irs.gov/ep or call 1–877–829–5500.
3. An annuity or custodial account
arrangement under Code section 403(b)(1) or
(7) not established or maintained by an
employer as described in DOL Regulations 29
CFR 2510.3–2(f).
4. A simplified employee pension (SEP)
described in Code section 408(k) that
conforms to the alternative method of
compliance described in 29 CFR 2520.104–48
or 29 CFR 104–49. A SEP is a pension plan
that meets certain minimum qualifications
regarding eligibility and employer
contributions.
5. A Savings Incentive Match Plan for
Employees of Small Employers (SIMPLE) that
involves SIMPLE IRAs under Code section
408(p).
6. A church pension benefit plan not
electing coverage under Code section 410(d).
7. An unfunded dues financed pension
benefit plan that meets the alternative
method of compliance provided by 29 CFR
2520.104–27.
8. An individual retirement account or
annuity not considered a pension plan under
29 CFR 2510.3–2(d).
9. A ‘‘one-participant plan,’’ as defined on
page 7. However, certain one-participant
plans are required to file the Form 5500–EZ,
Annual Return of One-Participant (Owners
and Their Spouses) Retirement Plan, with the
IRS or, if eligible, may file the Form 5500–
SF, Short Form Annual Return/Report of
Employee Benefit Plan, electronically with
EFAST2. See page 7.
10. A governmental plan.
11. An unfunded pension benefit plan or
an unfunded or insured welfare benefit plan:
(a) whose benefits go only to a select group
of management or highly compensated
employees, and (b) which meets the terms of
29 CFR 2520.104–23 (including the
requirement that a registration statement be
timely filed with DOL) or 29 CFR 2520.104–
24.
12. A welfare benefit plan that covers fewer
than 100 participants as of the beginning of
the plan year and is unfunded, fully insured,
or a combination of insured and unfunded,
and does not provide group health benefits.
Plans that provide group health benefits,
regardless of size or funding method must
file the Form 5500 and the Schedule J (Group
Health Plan Information) and other schedules
as applicable and cannot file the Form 5500–
SF. See Form 5500 Annual Return/Report
Instructions. For this purpose:
a. An unfunded welfare benefit plan has its
benefits paid as needed directly from the
general assets of the employer or the
employee organization that sponsors the
plan.
Note. Plans that are NOT unfunded include
those plans that received employee (or
former employee) contributions during the
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plan year and/or used a trust or separately
maintained fund (including a Code section
501(c)(9) trust) to hold plan assets or act as
a conduit for the transfer of plan assets
during the plan year. A welfare benefit plan
with employee contributions that is
associated with a cafeteria plan under Code
section 125 may be treated for annual
reporting purposes as an unfunded welfare
benefit plan if it meets the requirements of
DOL Technical Release 92–01, 57 FR 23272
(June 2, 1992) and 58 FR 45359 (Aug. 27,
1993). The mere receipt of COBRA
contributions or other after-tax participant
contributions (e.g., retiree contributions) by a
cafeteria plan would not by itself affect the
availability of the relief provided for cafeteria
plans that otherwise meet the requirements
of DOL Technical Release 92–01. See 61 FR
41220, 41222–23 (Aug. 7, 1996).
b. A fully insured welfare benefit plan has
its benefits provided exclusively through
insurance contracts or policies, the premiums
of which must be paid directly to the
insurance carrier by the employer or
employee organization from its general assets
or partly from its general assets and partly
from contributions by its employees or
members (which the employer or employee
organization forwards within 3 months of
receipt). The insurance contracts or policies
discussed above must be issued by an
insurance company or similar organization
that is qualified to do business in any state.
c. A combination unfunded/insured
welfare benefit plan has its benefits provided
partially as an unfunded plan and partially
as a fully insured plan. An example of such
a plan is a welfare benefit plan that provides
medical benefits as in ‘‘a’’ above and life
insurance benefits as in ‘‘b’’ above. See 29
CFR 2520.104–20.
Note. A voluntary employees’ beneficiary
association, as used in Code section 501(c)(9)
(VEBA), should not be confused with the
employer or employee organization that
sponsors the plan. See ERISA section 3(4).
13. Plans maintained only to comply with
workers’ compensation, unemployment
compensation, or disability insurance laws.
14. A welfare benefit plan maintained
outside the United States primarily for
persons substantially all of whom are
nonresident aliens.
15. A church welfare benefit plan under
ERISA section 3(33).
16. An unfunded dues financed welfare
benefit plan that meets the alternative
method of compliance provided by 29 CFR
2520.104–26.
17. A welfare benefit plan that participates
in a group insurance arrangement that files
a return/report on its behalf under 29 CFR
2520.104–43. A group insurance arrangement
generally is an arrangement that provides
benefits to the employees of two or more
unaffiliated employers (not in connection
with a multiemployer plan or a collectively
bargained multiple-employer plan), fully
insures one or more welfare benefit plans of
each participating employer, uses a trust (or
other entity such as a trade association) as
the holder of the insurance contracts, and
uses a trust as the conduit for payment of
premiums to the insurance company.
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18. An apprenticeship or training plan
meeting all of the conditions specified in 29
CFR 2520.104–22.
For more information on plans that are
exempt from filing an annual return/report,
call the EFAST2 Help Line at 1–866–GO–
EFAST (1–866–463–3278). For oneparticipant plan filers, see the Instructions
for Form 5500–EZ or call the IRS Help Line
at 1–877–829–5500.
Who May File Form 5500–SF
If your plan is required to file an annual
return/report, you may file the Form 5500–
SF instead of the Form 5500 only if you meet
all of the eligibility conditions listed below.
1. The plan (a) covered fewer than 100
participants at the beginning of the plan year
20XX, or (b) under 29 CFR 2520.103–1(d)
was eligible to and filed as a small plan for
plan year 20XX–1 and did not cover more
than 120 participants at the beginning of plan
year 20XX. (See instructions for Lines 6 and
7, on counting the number of participants.);
2. The plan did not hold any employer
securities at any time during the plan year;
3. At all times during the plan year, the
plan was 100% invested in certain secure,
easy to value assets that meet the definition
of ‘‘eligible plan assets’’ (see the instructions
for Line 8a), such as mutual fund shares,
investment contracts with insurance
companies and banks valued at least
annually, publicly traded securities held by
a registered broker dealer, cash and cash
equivalents, and plan loans to participants;
4. The plan is eligible for the waiver of the
annual examination and report of an
independent qualified public accountant
(IQPA) under 29 CFR 2520.104–46 (but not
by reason of enhanced bonding), which
requirement includes, among others, giving
certain disclosures and supporting
documents to participants and beneficiaries
regarding the plan’s investments (see
instructions for Line 8b);
5. The plan is not a multiemployer plan;
and
6. The plan does not provide group health
benefits.
Notes. (1) Employee Stock Ownership
Plans (ESOPs) and Direct Filing Entities
(DFEs) may not file the Form 5500–SF. (2)
One-participant plans and certain foreign
plans should follow the Specific Instructions
Only for ‘‘One-Participant Plans and Certain
Foreign Plans’’ in place of the instructions 1–
5 above to see if Form 5500–SF may be filed
instead of Form 5500–EZ.
What To File
Plans required to file an annual return/
report that meet all of the conditions for
filing the Form 5500–SF may complete and
file the Form 5500–SF in accordance with its
instructions. Single-employer defined benefit
pension plans using the Form 5500–SF must
also file the Schedule SB (Form 5500),
Single-Employer Defined Benefit Plan
Actuarial Information, and its required
attachments. Money purchase plans
amortizing a funding waiver using the Form
5500–SF must also file the Schedule MB
(Form 5500), Multiemployer Defined Benefit
Plan and Certain Money Purchase Plan
Actuarial Information, and its required
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attachments. For information about Schedule
SB and Schedule MB, see the 20XX
Instructions for Form 5500, Annual Return/
Report of Employee Benefit Plan. Oneparticipant plans see Specific Instructions
Only for ‘‘One-Participant Plans and Certain
Foreign Plans.’’
Eligible Combined Plans. The Pension
Protection Act of 2006 (PPA) established
rules for a new type of pension plan, an
‘‘eligible combined plan,’’ effective for plan
years beginning after December 31, 2009. See
Code section 414(x) and ERISA section
210(e). An eligible combined plan consists of
a defined benefit pension plan and a defined
contribution pension plan that includes a
qualified cash or deferred arrangement under
Code section 401(k), with the assets of the
two plans held in a single trust, but clearly
identified and allocated between the plans.
The eligible combined plan design is
available only to employers that employed an
average of at least two, but not more than 500
employees, on business days during the
calendar year preceding the plan year as of
which the eligible combined plan is
established and that employs at least two
employees on the first day of the plan year
that the plan is established. Because an
eligible combined plan includes both a
defined benefit pension plan and a defined
contribution pension plan, the Form 5500–SF
filed for the plan must include all the
information, schedules, and attachments that
would be required for either a defined benefit
pension plan (such as a Schedule SB) or a
defined contribution pension plan.
When to File
File the 20XX Form 5500–SF for plan years
that began in 20XX. The form, and any
required schedules and attachments, must be
filed by the last day of the 7th calendar
month after the end of the plan year (not to
exceed 12 months in length) that began in
20XX.
Short Years. For a plan year of less than
12 months (short plan year), file the form and
applicable schedules by the last day of the
7th calendar month after the short plan year
ends or by the extended due date, if filing
under an authorized extension of time. Fill
in the short plan year beginning and ending
dates in the space provided and check the
appropriate box in Part I, Line B, of the Form
5500–SF. For purposes of this return/report,
a short plan year ends on the date of the
change in accounting period or upon the
complete distribution of assets of the plan.
Also see the instructions for Final Return/
Report to determine if ‘‘the final return/
report’’ box in Line B should be checked.
Extension of Time To File
Using Form 5558
If filing under an extension of time based
on the filing of an IRS Form 5558,
Application for Extension of Time To File
Certain Employee Plan Returns, check the
appropriate box on the Form 5500–SF, Part
I, Line C. A one-time extension of time to file
the Form 5500–SF (up to 21⁄2 months) may
be obtained by filing Form 5558 on or before
the normal due date (not including any
extensions) of the return/report. [The
language on how to file the Form 5558 will
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be changed if filers will be able, as proposed,
to file the Form 5558 through EFAST2]. You
must file the Form 5558 with the Department
of Treasury, Internal Revenue Service
Center, Ogden, UT 84201–0045. Approved
copies of the Form 5558 will not be returned
to the filer. A copy of the completed
extension request must be retained with the
plan’s records.
Using Extension of Time To File Federal
Income Tax Return
An automatic extension of time to file
Form 5500–SF until the due date of the
federal income tax return of the employer
will be granted if all of the following
conditions are met: (1) the plan year and the
employer’s tax year are the same; (2) the
employer has been granted an extension of
time to file its federal income tax return to
a date later than the normal due date for
filing the Form 5500–SF; and (3) a copy of
the application for extension of time to file
the federal income tax return is maintained
with the filer’s records. An extension of time
granted by using this automatic extension
procedure CANNOT be extended further by
filing an IRS Form 5558, nor can it be
extended beyond a total of 9 1⁄2 months
beyond the close of the plan year.
Notes. (1) If the filing due date falls on a
Saturday, Sunday, or Federal holiday, the
return/report may be filed on the next day
that is not a Saturday, Sunday, or Federal
holiday. (2) If the 20XX Form 5500 is not
available before the plan filing, use the
20XX–1 Form 5500 and enter the 20XX fiscal
year beginning and ending dates on the line
provided at the top of the form.
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Other Extensions of Time
The IRS, DOL, and PBGC may announce
special extensions of time under certain
circumstances, such as extensions for
Presidentially-declared disasters or for
service in, or in support of, the Armed Forces
of the United States in a combat zone. See
www.irs.gov, www.efast.dol.gov, and
www.pbgc.gov/practitioners for
announcements regarding such special
extensions. If you are relying on one of these
announced special extensions, check the
appropriate box on the Form 5500–SF, Part
I, line C, and enter a description of the
announced authority for the extension.
Delinquent Filer Voluntary Compliance
(DFVC) Program
The DFVC Program facilitates voluntary
compliance by plan administrators who are
delinquent in filing annual return/report
forms under Title I of ERISA by permitting
administrators to pay reduced civil penalties
for voluntarily complying with their DOL
annual reporting obligations. If the Form
5500–SF is being filed under the DFVC
Program, check the appropriate box on Form
5500–SF, Part I, line C to indicate that the
Form 5500–SF is being filed under the DFVC
Program. See www.efast.dol.gov for
additional information.
Plan administrators are reminded that they
can use the online calculator available at
www.dol.gov/ebsa/calculator/
dfvcpmain.html to compute the penalties due
under the program. Payments under the
DFVC Program also may be submitted
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electronically. For information on how to pay
DFVC Program payments online, go to
www.dol.gov/ebsa.
5500) or Schedule SB (Form 5500)) required
by the applicable instructions. See Code
section 6692.
Change in Plan Year
Generally, only defined benefit pension
plans need to get approval for a change in
plan year. See Code section 412(d)(1).
However, under Rev. Proc. 87–27, 1987–1
C.B. 769, these pension plans may be eligible
for automatic approval of a change in plan
year.
If a change in plan year for a pension or
a welfare benefit plan creates a short plan
year, file the form and applicable schedules
by the last day of the 7th calendar month
after the short plan year ends or by the
extended due date, if filing under an
authorized extension of time. Fill in the short
plan year beginning and ending dates in the
space provided in Part I and check the
appropriate box in Part I, line B of the Form
5500–SF. For purposes of this return/report,
the short plan year ends on the date of the
change in accounting period or upon the
complete distribution of assets of the plan.
Also, see the instructions for Final Return/
Report to determine if ‘‘final return/report’’
in line B should be checked.
Other Penalties
1. Any individual who willfully violates
any provision of Part 1 of Title I of ERISA
shall on conviction be fined not more than
$100,000 or imprisoned not more than 10
years, or both. See ERISA section 501.
2. A penalty up to $10,000, five (5) years
imprisonment, or both, may be imposed for
making any false statement or representation
of fact, knowing it to be false, or for
knowingly concealing or not disclosing any
fact required by ERISA. See section 1027,
Title 18, U.S. Code, as amended by section
111 of ERISA.
Penalties
Plan administrators and plan sponsors
must provide complete and accurate
information and must otherwise comply fully
with the filing requirements. ERISA and the
Code provide for the DOL and the IRS,
respectively, to assess or impose penalties for
not giving complete and accurate information
and for not filing complete and accurate
statements and returns/reports. Certain
penalties are administrative (that is, they may
be imposed or assessed in an administrative
proceeding by one of the governmental
agencies delegated to administer the
collection of the Form 5500–SF data). Others
require a legal conviction.
Administrative Penalties
Listed below are various penalties under
ERISA and the Code that may be assessed or
imposed for not meeting the annual return/
report filing requirements. Generally,
whether the penalty is under ERISA or the
Code, or both, depends upon the agency for
which the information is required to be filed.
One or more of the following administrative
penalties may be assessed or imposed in the
event of incomplete filings or filings received
after the due date unless it is determined that
your failure to file properly is for reasonable
cause.
1. A penalty of up to $1,100 a day (or
higher amount if adjusted pursuant to the
Federal Civil Penalties Inflation Adjustment
Act of 1990, as amended) for each day a plan
administrator fails or refuses to file a
complete and accurate annual return/report.
See ERISA section 502(c)(2) and 29 CFR
2560.502c–2.
2. A penalty of $25 a day (up to $15,000)
for not filing the annual return/report for
certain plans of deferred compensation,
trusts and annuities, and bond purchase
plans by the due date(s). See Code section
6652(e).
3. A penalty of $1,000 for not filing an
actuarial statement (Schedule MB (Form
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How to File—Electronic Filing Requirement
Under the computerized ERISA Filing
Acceptance System (EFAST2), you must file
your 20XX Form 5500–SF electronically. You
may file your 20XX Form 5500–SF online
using EFAST2’s web-based filing system or
you may file through an EFAST2-approved
vendor. Detailed information on electronic
filing is available at www.efast.dol.gov. For
telephone assistance, call the EFAST2 Help
Line at 1–866–GO–EFAST (1–866–463–
3278). The EFAST2 Help Line is available
Monday through Friday from 8:00 a.m. to
8:00 p.m., Eastern Time.
[CAUTION] Annual returns/reports filed
under Title I of ERISA, including those filed
using the Form 5500–SF, must be made
available by the plan administrators to plan
participants and beneficiaries and by the
DOL to the public pursuant to ERISA sections
104 and 106. Even though the Form 5500–SF
must be filed electronically, the plan
administrator must keep a copy of the Form
5500–SF, including schedules and
attachments, with all required signatures on
file as part of the plan’s records, and must
make a paper copy available on request to
participants, beneficiaries, and the DOL as
required by section 104 of ERISA and 29 CFR
2520.103–1. Filers may use electronic media
for record maintenance and retention, so
long as they meet the applicable
requirements.
Generally, questions on the Form 5500–SF
relate to the plan year entered at the top of
the first page of the form. Therefore, answer
all questions on the 20XX Form 5500–SF
with respect to the 20XX plan year unless
otherwise explicitly stated in the instructions
or on the form itself.
Your entries must be in the proper format
in order for the EFAST2 system to process
your filing. For example, if a question
requires you to enter a dollar amount, you
cannot enter a word. Your software will not
let you submit your return/report unless all
entries are in the proper format. To reduce
the possibility of correspondence and
penalties:
• Complete all lines on the Form 5500–SF
unless otherwise specified. Also complete
and electronically attach, as required, any
applicable schedules and attachments.
• Do not enter ‘‘N/A’’ or ‘‘Not Applicable’’
on the Form 5500–SF or Schedules SB (Form
5500) and MB (Form 5500) unless
specifically permitted. ‘‘Yes’’ or ‘‘No’’
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questions on the form and schedules cannot
be left blank, unless specifically permitted.
Answer ‘‘Yes’’ or ‘‘No,’’ but not both.
• Use the correct employer identification
number (EIN) and plan number (PN) for the
plan.
You should check your return/report for
errors before signing or submitting it to
EFAST2. Your filing software or, if you are
using it, the EFAST2 web-based filing system
will allow you to check your return/report for
errors. If, after reasonable attempts to correct
your filing to eliminate any identified
problem or problems, you are unable to
address them, or you believe that you are
receiving the message in error, call the
EFAST2 Help Line at 1–866–GO–EFAST
(1–866–463–3278) or contact the service
provider you used to help prepare and file
your annual return/report.
Once you complete the return/report and
finish the electronic signature process, you
can electronically submit it to EFAST2.
When you electronically submit your return/
report, EFAST2 is designed to immediately
notify you if your submission was received
and whether the return/report is ready to be
processed by EFAST2. If EFAST2 does not
notify you that your submission was
successfully received and is ready to be
processed, you will need to take steps to
correct the problem or you may be deemed
a non-filer subject to penalties from DOL,
IRS, and/or PBGC.
Once EFAST2 receives your return/report,
the EFAST2 system should be able to provide
a filing status within 20 minutes. Check back
into the EFAST2 system to determine the
filing status of your return/report. The filing
status message will include a list of any filing
errors or warnings that EFAST2 may have
identified in your filing. If EFAST2 did not
identify any filing errors or warnings,
EFAST2 will show the filing status of your
return/report as ‘‘Filing_Received.’’ Persons
other than the submitter can check whether
the filing was received by the system by
calling the EFAST2 Help Line at 1–866–GO–
EFAST (1–866–463–3278) and using the
automated telephone system.
To reduce the possibility of
correspondence and penalties from the DOL,
IRS, and/or PBGC, you should do the
following: (1) Before submitting your return/
report to EFAST2, check it for errors, and (2)
after you have submitted it to EFAST2, verify
that you have received a filing status of
‘‘Filing_Received’’ and attempt to correct and
resolve any errors or warnings listed in the
status report.
Note. Even after being received by the
EFAST2 system, your return/report filing
may be subject to further detailed review by
DOL, IRS, and/or PBGC, and your filing may
be deemed deficient based upon this further
review. See Penalties on page 5.
The Form 5500–SF, Schedules SB (Form
5500) and MB (Form 5500), and any
attachments that are filed under ERISA are
open to public inspection, and the contents
are public information subject to publication
on the Internet.
[CAUTION] Do not enter social security
numbers in response to questions asking for
an employer identification number (EIN).
Because of privacy concerns, the inclusion of
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a social security number or any portion
thereof on the Form 5500–SF or on a
schedule or attachment that is open to public
inspection may result in the rejection of the
filing. If you discover a filing disclosed on the
EFAST2 Web site that contains a social
security number, immediately call the
EFAST2 Help Line at 1–866–GO–EFAST (1–
866–463–3278).
Do not attach a copy of the annual
registration statement identifying separated
participants with deferred vested benefits or
a previous year’s Schedule SSA (Form 5500)
to your 20XX Form 5500–SF annual return/
report. The annual registration statement
must be filed directly with the IRS and
cannot be attached to a Form 5500–SF
submission with EFAST2.
Employers without an employer
identification number (EIN) must apply to
the IRS for one as soon as possible. The
EBSA does not issue EINs. To apply for an
EIN from the IRS:
• Mail or fax Form SS–4, Application for
Employer Identification Number, obtained at
the IRS Web site at www.irs.gov.
• Call 1–800–829–4933 to receive your EIN
by telephone.
• Select the Online EIN Application link at
www.irs.gov.
The EIN is issued immediately once the
application information is validated. (The
online application process is not yet
available for corporations with addresses in
foreign countries or Puerto Rico.)
Signature and Date
For purposes of Title I of ERISA, the plan
administrator is required to file the Form
5500 or 5500–SF. The plan administrator
must electronically sign the Form 5500 or
5500–SF submitted to EFAST2.
[CAUTION] After submitting your filing,
you must check the Filing Status. If the filing
status is ‘‘Processing Stopped’’, it is possible
your submission was not sent with a valid
electronic signature as required, and
depending on the error, may be considered
not to have been filed. By looking closer at
the Filing Status, you can see specific error
messages applicable to the transmitted filing
and determine whether it was sent with a
valid electronic signature and what other
errors may need to be corrected.
Note. If the plan administrator is an entity,
the electronic signature must be in the name
of a person authorized to sign on behalf of
the plan administrator.
If the plan administrator does not sign a
filing, the filing status will indicate that there
is an error with your filing, and your filing
will be subject to further review,
correspondence, rejection, and civil
penalties.
Authorized Service Provider Signatures. If
the plan administrator elects to have a
service provider who manages the filing
process for the plan get EFAST2 signing
credentials and submit the electronic Form
5500–SF for the plan:
(1) the service provider must receive
specific written authorization from the plan
administrator to submit the plan’s electronic
filing;
(2) the plan administrator must manually
sign a paper copy of the electronically
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47667
completed Form 5500–SF, and the service
provider must include a PDF copy of the
entire three-page Form 5500–SF, excluding
any attachments and associated schedules,
submitted to EFAST2;
(3) the service provider must communicate
to the plan administrator any inquiries
received from EFAST2, DOL, IRS or PBGC
regarding the filing;
(4) the service provider must communicate
to the plan administrator that, by electing to
use this option, the image of the plan
administrator’s manual signature will be
included with the rest of the return/report
posted by the Labor Department on the
Internet for public disclosure; and
(5) the plan administrator must keep the
manually signed copy of the Form 5500–SF,
with all required schedules, as part of the
plan’s records. For more information on the
electronic signature option, see EFAST2 AllElectronic Filing System FAQs at
www.dol.gov/ebsa/faqs/faq-EFAST2.html.
[CAUTION] Service providers should
consider implications of IRS tax return
preparer rules.
Note. The Code permits either the plan
sponsor/employer or the administrator to
sign the filing. Therefore, in the case of a
Form 5500–SF filed for a ‘‘one-participant
plan’’ not subject to Title I of ERISA that is
filing a Form 5500–SF with EFAST2 in lieu
of filing a Form 5500–EZ on paper with the
IRS (see Specific Instructions Only for ‘‘OneParticipant Plans and certain foreign plans’’),
either may sign. However, any other Form
5500–SF that is not electronically signed by
the plan administrator will be subject to
rejection and civil penalties under Title I of
ERISA.
The Form 5500–SF annual return/report
must be filed electronically and signed. To
obtain an electronic signature, go to
www.efast.dol.gov and register in EFAST2 as
a signer. You will be provided with a UserID
and a PIN. Both the UserID and PIN are
needed to sign the Form 5500–SF. The plan
administrator must keep a copy of the Form
5500–SF, including schedules and
attachments, with all required signatures on
file as part of the plan’s records. See 29 CFR
2520.103–1. Electronic signatures on annual
returns/reports filed under EFAST2 are
governed by the applicable statutory and
regulatory requirements.
Trustee/Custodian Signature
The plan trustee or custodian may
electronically sign this schedule or attach to
the Form 5500 an electronic reproduction of
the Schedule H signed by the plan’s trustee.
This electronic reproduction must be labeled
‘‘Trustee Signature’’ and must be included
as a Portable Document Format (PDF)
attachment or any alternative electronic
attachment allowable under EFAST2 if this is
not electronically signed. If there is more
than one trustee or custodian, the trustee or
custodian authorized by the others may sign.
If the plan trustee or custodian is an entity,
the signature must be the name of a person
authorized to sign on behalf of the plan
trustee or custodian.
Note. Trust information reported in this
Form is for purpose of satisfying the
requirements under Code section 6033(a) for
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an annual information return from every
section 401(a) organization exempt from tax
under section 501(a). The statute of
limitations under Code section 6501(a) for
any trust described in section 401(a), which
is exempt from tax under section 501(a), will
not start to run until you timely file with the
appropriate trust information on this Form.
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
Preparer Information
Enter the ‘‘Preparer’s name (including
firm’s name, if applicable), address, and
telephone number’’ at the bottom of the first
page of Form 5500–SF. A preparer is any
person who prepares an annual return/report
for compensation, or who employs one or
more persons to prepare for compensation. If
the person who prepared the annual return/
report is not the employer named in line 2a
or the plan administrator named in line 3a,
you must name the person on this line. If
there are several people who prepare Form
5500–SF and applicable schedules, please
name the person who is primarily
responsible for the preparation of the annual
return/report.
Note. You must complete preparer
information if you are required to file at least
250 returns of any type with the IRS during
the calendar year. However, if you are a small
filer (files fewer than 250 returns of any type
with the IRS during the calendar year), and
you do not enter preparer information on the
Form 5500, then you must file the paper
Form 5500–SUP with the IRS. See the
Treasury regulations on ‘‘Employee
Retirement Benefit Plan Returns Required on
Magnetic Media’’ (See 79 FR 58256 at https://
federalregister.gov/a/2014-23161) and
Instructions for Form 5500–SUP for more
information.
Specific Instructions Only for ‘‘OneParticipant Plans and Certain Foreign
Plans’’
A ‘‘one-participant plan’’ is: (1) A pension
benefit plan that covers only an individual or
an individual and his or her spouse who
wholly own a trade or business, whether
incorporated or unincorporated; or (2) a
pension benefit plan for a partnership that
covers only the partners or the partners and
the partners’ spouses. Thus, a ‘‘oneparticipant plan’’ can cover more than one
participant. On the other hand, merely
covering only one participant does not make
you eligible to file as a ‘‘one-participant
plan’’ unless you are one of the types of plans
described above.
A foreign plan is maintained outside the
United States primarily for nonresident
aliens, if (1) a plan is maintained by a
domestic employer; or (2) a plan is
maintained by a foreign employer with
income derived from sources within the
United States (including foreign subsidiaries
of domestic employers) if contributions to the
plan are deducted on its U.S. income tax
return.
The Form 5500–EZ generally is used by
one-participant plans and certain foreign
plans that are not subject to the requirements
of section 104(a) of ERISA to satisfy certain
annual reporting and filing obligations
imposed by the Code. One-participant plans
and certain foreign plans may file the Form
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19:35 Jul 20, 2016
Jkt 238001
5500–SF electronically in place of a Form
5500–EZ (on paper) to satisfy the filing
obligations under the Code. One-participant
plans and foreign plans that file the Form
5500–SF electronically complete only certain
questions on the Form 5500–SF. These are
the questions that would be completed if the
filer filed Form 5500–EZ on paper. For more
information on filing with the IRS, go to
www.irs.gov or call 1–877–829–5500.
Notes. (1) A Form 5500–SF may be filed for
one-participant plans and certain foreign
plans that are either defined contribution
pension plans (which include profit-sharing
and money purchase pension plans, but not
an ESOP or stock bonus plan) or defined
benefit pension plans. (2) The filer of a oneparticipant plan or a foreign plan that is
required by the Code or regulations to file at
least 250 returns of any type, including
information returns (for example, Forms W–
2 and Forms 1099), income tax returns,
employment tax returns, and excise tax
returns, with the IRS during the calendar
year, must use the Form 5500–SF to file the
information required on the Form 5500–EZ,
but will not be required to attach to the filing
a Schedules SB or MB. For more information,
see IRS regulations on ‘‘Employee Retirement
Benefit Plan Returns Required on Magnetic
Media’’ (See T.D. 9695, 79 FR 58256 at https://
federalregister.gov/a/2014-23161). (3)
Information filed on Form 5500–EZ is
required to be made available to the public.
Form 5500–SF is open to public inspection
and the contents are public information
subject to publication on the Internet.
However, the information on Form 5500–SF
will not be subject to publication on the
internet for a ‘‘one-participant plan or a
foreign plan’’ that is electronically filed using
a Form 5500–SF with EFAST2 in lieu of
filing a Form 5500–EZ on paper with the IRS.
Eligible one-participant plans and certain
foreign plans need complete only the
following questions on the Form 5500–SF:
1. Part I, Lines A, B, and C;
2. Part II, Lines 1a–5b; 5d(1), 5d(2), and
5(e);
3. Part III, Lines 7a–c, and 8a;
4. Part IV, Line 9a;
5. Part V, Lines 10g; and 10l
6. Part VI, Lines 11–12e.
7. Part VIII, Lines 14a–14d; and
8. Part IX, Lines 18 a, b, c, d, Line 19, and
Line 20.
Note. For Lines 7a through 7c, an eligible
one-participant plan or certain foreign plan
need complete only for total plan assets, total
plan liabilities, and net plan assets for
beginning of year and end of year, and is not
required to complete Line 7a(1) through
7a(8).
Schedule MB (Form 5500). If a money
purchase defined contribution pension plan
(including a target benefit plan) has received
a waiver of the minimum funding standard,
and the waiver is currently being amortized,
complete Lines 3, 9, and 10 of Schedule MB
(Form 5500). See the Instructions for
Schedule MB in the Instructions for Form
5500 Annual Return/Report. One-participant
plans and foreign plans, however, do not
attach Schedule MB to the Form 5500–SF.
Instead, these plans must keep the completed
Schedule MB in accordance with the
applicable records retention requirements.
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Fmt 4701
Sfmt 4702
Schedule SB (Form 5500). One-participant
plans and foreign plans do not attach
Schedule SB (Form 5500) to the Form 5500–
SF. Instead, these plans must keep the
completed Schedule SB that is signed by the
plan actuary in accordance with the
applicable records retention requirements.
Actuaries of one-participant plans and
foreign plans that are defined benefit pension
plans subject to the minimum funding
standards for this plan year, must complete
Schedule SB (Form 5500) and forward the
completed and signed Schedule SB to the
plan administrator no later than the filing
due date. See the Instructions for Schedule
SB in the Instructions for Form 5500.
Filing Form 5500–EZ with the IRS. If you
are filing a paper form, you must file the
Form 5500–EZ with the IRS using the
following address: Department of the
Treasury, Internal Revenue Service Center,
Ogden, UT 84201–0027. You may order the
paper Form 5500–EZ and its instructions by
visiting the IRS Web site at www.irs.gov/
formspubs/.
Filing an amendment. If you are filing an
amendment for a ‘‘one-participant plan’’ or a
‘‘foreign plan’’ that filed a Form 5500–SF
electronically, you may submit the
amendment either electronically using the
Form 5500–SF with EFAST2 or on paper
using the Form 5500–EZ with the IRS. If you
are filing an amendment for a ‘‘oneparticipant plan’’ that previously filed on a
paper Form 5500–EZ, you must submit the
amendment using the paper Form 5500–EZ
with the IRS. However, if you are filing an
amendment for a one-participant plan or a
foreign plan that is required by the Treasury
regulations (See T.D. 9695, 79 FR 58256 at
https://federalregister.gov/a/2014-23161 to file
electronically using the Form 5500–SF, you
must submit the amendment electronically
using the Form 5500–SF with EFAST2.
Specific Line-by-Line Instructions (Form
5500–SF)
Part I—Annual Report Identification
Information
File the 20XX Form 5500–SF annual report
for a plan year that began in 20XX. Enter the
beginning and ending dates in Part I. The 20
XX Form 5500–SF annual report must be
filed electronically.
Check only one of the Line A box choices.
Line A(1)—Box for Single-Employer Plan.
Check this box if the Form 5500–SF is filed
for a single-employer plan. A singleemployer plan for purposes of the Form
5500–SF is an employee benefit plan
maintained by one employer or one
employee organization.
Note. Do not check this box even if all of
the employers maintaining the plan are
members of the same controlled group or
affiliated service group under Code sections
414(b), (c), or (m). Check Box A(3).
Line A(2)—Box for Multiple-Employer
Plan. Check this box if the Form 5500–SF is
being filed for a multiple-employer plan. A
multiple-employer plan is a plan that is
maintained by more than one employer and
is not the type of plan described in A(3). For
purposes of the Form 5500–SF, a multipleemployer plan is a plan that is maintained by
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more than one employer and is not a singleemployer plan or a multiemployer plan.
Multiple-employer plans can be collectively
bargained and collectively funded, but if
covered by PBGC termination insurance, they
must have properly elected before September
27, 1981, not to be treated as a multiemployer
plan under Code section 414(f)(5) or ERISA
sections 3(37)(E) and 4001(a)(3), and have not
revoked that election or made an election to
be treated as a multiemployer plan under
Code section 414(f)(6) or ERISA section
3(37)(G). Participating employers do not file
individually for multiple-employer plans.
Note. Do not check this box if all of the
employers maintaining the plan are members
of the same controlled group or affiliated
service group under Code sections 414(b), (c),
or (m).
Except as provided below, multipleemployer pension plans required to file a
Form 5500–SF must include an attachment
using the format below that (1) lists each
participating employer in the plan during the
plan year, identified by name and employer
identification number (EIN), and (2) includes
a good faith estimate of each employer’s
percentage of the total contributions
(including employer and participant
contributions) made by all participating
employers during the year. Any employer
who was obligated to make contributions to
47669
the plan for the plan year, made
contributions to the plan for the plan year,
or whose employees were covered under the
plan is a ‘‘participating employer’’ for this
purpose. If a participating employer made no
contributions, enter ‘‘-0-’’ in element (c).
The attachment must be properly
identified at the top with the label ‘‘Multipleemployer Plan Participating Employer
Information,’’ and the name of the plan, EIN,
and plan number (PN) as found on the plan’s
Form 5500–SF.
Complete as many entries as needed to
report the required information for all
participating employers.
Multiple-Employer Plan Participating Employer Information
(Insert Name of Plan, and EIN/PN as shown on the
Form 5500–SF)
(a) Name of participating employer
[CAUTION]Multiemployer plans cannot
use the Form 5500–SF to satisfy their annual
reporting obligations. They must file the
Form 5500. For these purposes, a plan is a
multiemployer plan if: (a) More than one
employer is required to contribute; (b) the
plan is maintained pursuant to one or more
collective bargaining agreements between
one or more employee organizations and
more than one employer; (c) an election
under Code section 414(f)(5) and ERISA
section 3(37)(E) has not been made; and (d)
the plan meets any other applicable
conditions of 29 CFR 2510.3–37. A plan that
made a proper election under ERISA section
3(37)(G) and Code section 414(f)(6) on or
before Aug. 17, 2007, is also a multiemployer
plan.
(b) EIN
(c) Percent of Total Contributions
Line A(3)—Box for Controlled Group.
Check this box for a ‘‘controlled group’’ of
corporations that is filing a single Form
5500–SF for reporting purposes. A
‘‘controlled group’’ is a controlled group of
corporations under Code section 414(b), a
group of trades or businesses under common
control under Code section 414(c), or an
affiliated service group under Code section
414(m).
Plans sponsored by controlled groups
required to file a Form 5500–SF must include
an attachment using the format below that (1)
lists each controlled group member in the
plan during the plan year, identified by name
and employer identification number (EIN),
and (2) includes a good faith estimate of each
employer’s percentage of the total
contributions (including employer and
participant contributions) made by all
members during the year. Any employer who
was obligated to make contributions to the
plan for the plan year, made contributions to
the plan for the plan year, or whose
employees were covered under the plan is a
‘‘controlled group member’’ for this purpose.
If a controlled group member made no
contributions, enter ‘‘-0-’’ in element (c).
‘‘Controlled Group Plan Member
Information’’ Attachment. If you checked
box A(3) for ‘‘Controlled Group Plan,’’ you
must complete the ‘‘Controlled Group
Member Information’’ attachment. Enter the
name of the plan, EIN, and plan number (PN)
as found on the plan’s Form 5500–SF.
Complete as many entries as needed to report
the required information for all participating
employers.
Controlled Group Member Information
(Heading for this chart must include Insert Name of
Plan, and EIN/PN as shown on the Form 5500–
SF)(Complete elements (a), (b), and (c) to provide
the name, EIN, and percent of total contributions of
each controlled group member.)
asabaliauskas on DSK3SPTVN1PROD with PROPOSALS
(a) Name of controlled group member
Line A(4)—Box for One-Participant Plan.
Check this box if the Form 5500–SF is being
filed for a plan that is a ‘‘one-participant
plan’’ (see page 7). Check the one-participant
plan box only for those plans that are
submitting the Form 5500–SF in place of a
Form 5500–EZ (on paper) to satisfy the
annual return/report filing obligations under
the Code. Plans checking the box for oneparticipant plan should not check either the
box for single-employer plan or the box for
multiple-employer plan. See Specific
Instructions Only for ‘‘One-Participant Plans
and Certain Foreign Plans.’’
Line A(5)—Box for Foreign Plans. Check
this box if the Form 5500–SF is being filed
for a plan that is a ‘‘foreign plan’’(see page
XX). Check the foreign plan box only for
those plans that are submitting the Form
5500–SF in place of a Form 5500–EZ (on
paper) to satisfy the annual return/report
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19:35 Jul 20, 2016
Jkt 238001
(b) EIN
(c) Percent of Total Contributions
filing obligations under the Code. Plans
checking the box for foreign plan should not
check either the box for single-employer plan
or the box for multiple-employer plan. See
Specific Instructions Only for ‘‘OneParticipant Plans and Certain Foreign
Plans.’’
Line B(1)—Box for First Return/Report.
Check this box if an annual return/report has
not been previously filed for this plan. For
the purpose of completing this box, the Form
5500–EZ is not considered an annual return/
report.
Line B(2)—Box for Final Return/Report.
Check this box if this is the final report for
the plan. Only check this box if all assets
under the plan (including insurance/annuity
contracts) have been distributed to the
participants and beneficiaries or legally
transferred to the control of another plan, and
when all liabilities for which benefits may be
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Frm 00137
Fmt 4701
Sfmt 4702
paid under a welfare benefit plan have been
satisfied. Do not mark the final return/report
box if you are reporting participants and/or
assets at the end of the plan year. If a trustee
is appointed for a terminated defined benefit
pension plan pursuant to ERISA section
4042, the last plan year for which a return/
report must be filed is the year in which the
trustee is appointed. See Box B(5) for the
simplified filing requirements for PBGCtrusteed plans.
Examples:
Mergers/Consolidations. A final return/
report should be filed for the plan year (12
months or less) that ends when all plan
assets were legally transferred to the control
of another plan.
Pension and Welfare Plans That
Terminated Without Distributing All Assets.
If the plan was terminated but all plan assets
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were not distributed, a return/report must be
filed for each year the plan has assets. The
return/report must be filed by the plan
administrator, if designated, or by the person
or persons who actually control the plan’s
assets/property.
Welfare Plans Still Liable To Pay Benefits.
A welfare plan cannot file a final return/
report if the plan is still liable to pay benefits
for claims that were incurred prior to the
termination date, but not yet paid. See 29
CFR 2520.104b–2(g)(2)(ii).
Line B(3)—Box for Amended Return/
Report. Check this box if you have already
filed for the 20XX plan year and are now
filing an amended return/report to correct
errors and/or omissions on the previously
filed return/report.
[TIP] Check the Line B box for an
‘‘amended return/report’’ if you filed a
previous 20XX annual return/report that was
given a ‘‘Filing_Received,’’ ‘‘Filing_Error,’’ or
‘‘Filing_Stopped’’ status by EFAST2. Do not
check the Line B box for an ‘‘amended
return/report’’ if your previous submission
attempts were not successfully received by
EFAST2 because of problems with the
transmission of your return/report. For more
information, go to the EFAST2 Web site at
www.efast.dol.gov or call the EFAST2 Help
line at 1–866–GO–EFAST (1–866–463–3278).
If you need to file an amended return/
report to correct errors and/or omissions in
a previously filed annual return/report for
the 20XX plan year AND you are eligible to
file the Form 5500–SF, you may use the Form
5500–SF even if the original filing was a
Form 5500. If you filed a Form 5500–SF, but
determine that you were not eligible to file
the Form 5500–SF, you must use the Form
5500 or Form 5500–EZ to amend your return/
report.
Line B(4)—Box for Short Plan Year
Return/Report. Check this box if this Form
5500–SF is being filed for a plan year period
of less than 12 months. Provide the dates in
Part I, Plan Year Beginning and Ending.
Line B(5)—Box for Plan Trusteed by
PBGC. Plans that, as of the due date of this
return, have been trusteed by PBGC under
section 4041(c) or 4042 of ERISA, must check
this box and enter the date of trusteeship in
the space provided. Plans that check this box
must complete all of Part I, Lines 1, 2, 3, 5
of Part II, and Lines 11a(3) and 11a(4) of Part
IV.
Line C—Box for Extensions and DFVC
Program. Check the appropriate box here if:
1. You filed for an extension of time to file
this form with the IRS using Form 5558,
Application for Extension of Time To File
Certain Employee Plan Returns, and maintain
a copy of the Form 5558 with the filer’s
records;
2. You are filing using the automatic
extension of time to file the Form 5500–SF
return/report until the due date of the federal
income tax return of the employer and
maintain a copy of the employer’s extension
of time to file the income tax return with the
plan’s records;
3. You are filing using a special extension
of time to file the Form 5500–SF annual
return/report that has been announced by the
IRS, DOL, or PBGC. If you checked that you
are using a special extension of time, enter
a description of the extension of time in the
space provided.; or
4. You are filing under the DFVC Program.
Part II—Basic Plan Information
Line 1a. Enter the formal name of the plan
or enough information to identify the plan.
Abbreviate if necessary. If an annual return/
report has previously been filed on behalf of
the plan, regardless of the type of Form that
was filed (Form 5500, Form 5500–EZ, or
Form 5500–SF), use the same name or
abbreviations that were used on the prior
filings. Once you use an abbreviation,
continue to use it for that plan on all future
annual return/report filings with the IRS,
DOL, and PBGC. Do not use the same name
or abbreviation for any other plan, even if the
first plan is terminated.
Line 1b. Enter the three-digit plan or entity
number (PN) that the employer or plan
administrator assigned to the plan. This
three-digit number, in conjunction with the
employer identification number (EIN)
entered on Line 2b, is used by the IRS, DOL,
and PBGC as a unique 12-digit number to
identify the plan.
Start at 001 for plans providing pension
benefits. Start at 501 for welfare plans. Do not
use 888 or 999.
Once you use a plan number, continue to
use it for that plan on all future filings with
the IRS, DOL, and PBGC. Failure to use the
same three-digit plan/DFE number may result
in correspondence from DOL or IRS. Do not
use this unique three-digit number for any
other plan, even if the first plan is
terminated.
You should assign a plan number (PN) as described below for each Form 5500 (and Form 5500–SF) with the same EIN of plan or DFE
sponsor entered into Line 2b
Pension benefit plans .........................................
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Welfare benefit plans ..........................................
Exception. If Part II, elements of Line 11a
are completed and 333 (or a higher number
in a sequence beginning with 333) was
previously assigned to the plan, that number
may be entered on Line 1b.
Line 1c. Enter the date the plan first
became effective.
Line 2a. Limit your response to the
information required in each row as specified
below:
1. Enter the plan sponsor’s (employer, if for
a single-employer plan) name, current postal
address (only use a P.O. Box number if the
Post Office does not deliver mail to the
employer’s street address), foreign routing
code where applicable, and ‘‘D/B/A’’ (doing
business as) or trade name of the employer
if different from the employer’s name.
2. Enter any ‘‘in care of’’ (C/O) name.
3. Enter the current street address. A post
office box number may be entered, in
addition to the street address, if the Post
Office does not deliver mail to the sponsor’s
street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of
the U.S. state or possession and zip code.
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001 to the first plan. Consecutively number other plans providing pension benefits with the
same plan sponsor as 002, 003 . . .
501 to the first plan or GIA. Consecutively number others as 502, 503 . . .
6. Enter the foreign routing code, if
applicable. Leave U.S. state and zip code
blank if entering a foreign routing code and
country name.
7. Enter the foreign country, if applicable.
Do not abbreviate the country name after
‘‘Enter foreign country.’’
8. Enter the D/B/A (the doing business as)
or trade name of the sponsor if different from
the plan sponsor’s name.
9. Enter any second address. Use only a
street address here, not a P.O. box.
Notes. (1) In the case of a multipleemployer plan, file only one annual return/
report for the plan. If an association or other
entity is not the sponsor, enter the name of
a participating employer as sponsor. For a
plan of a controlled group of corporations,
the name of one of the sponsoring members
should be entered. In either case, the same
name must be used in all subsequent filings
of the Form 5500 return/report or Form
5500–SF for the multiple-employer plan or
controlled group. (See instructions for Line 5
concerning change in sponsorship). (2) You
can also use the IRS Form 8822–B to notify
the IRS if the address provided here is a
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change in your business mailing address or
your business location.
Line 2b. Enter the employer’s nine-digit
employer identification number (EIN).
[CAUTION] Do not use a social security
number in lieu of an EIN. The Form 5500–
SF is open to public inspection, and the
contents are public information and are
subject to publication on the Internet.
Because of privacy concerns, the inclusion of
a social security number or any portion
thereof on this line may result in the rejection
of the filing.
Employers without an EIN number must
apply to the IRS for one as soon as possible.
The EBSA does not issue EINs. To apply for
an EIN from the IRS:
• Mail or fax Form SS–4, Application for
Employer Identification Number, obtained at
the IRS Web site at www.irs.gov.
• Call 1–800–829–4933 to receive your EIN
by telephone.
• Select the Online EIN Application link at
www.irs.gov.
The EIN is issued immediately once the
application information is validated. (The
online application process is not yet
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available for corporations with addresses in
foreign countries).
A multiple-employer plan or plan of a
controlled group of corporations should use
the EIN number of the sponsor identified in
Line 2b(1). The EIN must be used in all
subsequent filings of the Form 5500–SF (or
any subsequent Form 5500 or Form 5500–EZ
in a year where the plan is not eligible to file
the Form 5500–SF) for these plans. (See
instructions to Line 4 concerning change in
EIN).
Note. EINs for funds (trusts or custodial
accounts) associated with plans are generally
not required to be furnished on the Form
5500–SF. The IRS, however, will issue EINs
for such funds for other reporting purposes.
EINs may be obtained as explained above.
Plan sponsors should use the trust EIN
described above when opening a bank
account or conducting other transactions for
a trust that requires an EIN.
Line 2b(2). If available, enter the global
legal entity identification number (LEI). With
respect to any company, the LEI is the ‘‘legal
entity identifier’’ assigned by or on behalf of
an internationally recognized standards
setting body and required for reporting
purposes by the U.S. Department of the
Treasury’s Office of Financial Research or a
financial regulator. In the case of a financial
institution, if a ‘‘legal entity identifier’’ has
not been assigned, then provide the RSSD ID
assigned by the National Information Center
of the Board of Governors of the Federal
Reserve System, if any.
Line 2c. Enter the telephone number for
the plan sponsor. Use numbers only,
including area code, and do not include any
special characters.
Line 2d. Enter the six-digit business code
that best describes the nature of the plan
sponsor’s business from the list of business
codes on pages XX–XY. If more than one
employer or employee organization is
involved, enter the business code for the
main business activity of the employers and/
or employee organizations.
Line 3a. Limit your response to the
information required in each row as specified
below:
1. Enter the name and address of the plan
administrator unless the administrator is the
sponsor identified in Line 2. If both the plan
administrator name and address are the same
as the plan sponsor name and address, check
the ‘‘Same as Plan Sponsor’’ box and
disregard items 2 through 6 below.
2. Enter any ‘‘in care of’’ (C/O) name.
3. Enter the current street address. A post
office box number may be entered, in
addition to the street address, if the Post
Office does not deliver mail to the
administrator’s street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of
the U.S. state or possession and zip code.
6. Enter the foreign routing code and
foreign country, if applicable. Leave U.S.
state and zip code blank if entering foreign
routing code and country information.
Plan administrator for this purpose means:
• The person or group of persons specified
as the administrator by the instrument under
which the plan is operated;
• The plan sponsor/employer if an
administrator is not so designated; or
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• Any other person prescribed by
applicable regulations if an administrator is
not designated and a plan sponsor cannot be
identified.
Line 3b. Enter the plan administrator’s
nine-digit EIN. A plan administrator must
have an EIN for Form 5500–SF reporting. If
the plan administrator does not have an EIN,
it must apply to the IRS for one as explained
in the instructions for Line 2b. One EIN
should be entered for a group of individuals
who are, collectively, the plan administrator.
Note. Employees of the plan sponsor who
perform administrative functions for the plan
are generally not the plan administrator
unless specifically designated in the plan
document. If an employee of the plan
sponsor is designated as the plan
administrator, that employee must obtain an
EIN.
Do not use a social security number in lieu
of an EIN. The Form 5500–SF and its
schedules and attachments are open to public
inspection, and the contents are public
information and are subject to publication on
the Internet. Because of privacy concerns, the
inclusion of a social security number or any
portion thereof on this Form 5500–SF or any
of it schedules or attachments may result in
the rejection of the filing.
Line 3c. Enter the telephone number for
the plan administrator.
Line 4. Enter the name and identifying
information of the ‘‘named fiduciary.’’ A plan
must have at least one fiduciary (a person or
entity) named in the written plan, or through
a process described in the plan, as having
control over the plan’s operation. The named
fiduciary can be identified by office or by
name. For some plans, it may be an
administrative committee or a company’s
board of directors. If the named fiduciary is
an entity such as a committee or board,
include the name and contact information for
a specific individual, as well as the name of
the entity. If you are unable to determine
who is the ‘‘named fiduciary,’’ enter the
name and identifying information of the
person who appointed the plan trustee.
Line 5. If the plan sponsor’s name, EIN, or
LEI have changed since the last annual
return/report was filed for this plan, enter the
plan sponsor’s name, EIN, LEI, and the plan
number as it appeared on the last annual
return/report filed.
[CAUTION] Failure to indicate on Line 5
that a plan or plan sponsor was previously
identified by a different name, employer
identification number (EIN), LEI, or plan
number could result in correspondence from
the DOL and the IRS.
Line 5a. Enter the plan sponsor’s name as
it appeared on the last return/report filed.
Line 5b(1). Enter the plan sponsor’s EIN as
it appeared on the last return/report filed.
Line 5b(2). Enter the plan sponsor’s LEI (if
available) as it appeared on the last return/
report filed.
Line 5c. Enter the plan sponsor’s plan
number as it appeared on the last return/
report filed.
Line 6. Enter in element (a) the total
number of participants at the beginning of
the plan year. Enter in element (b) the total
number of participants at the end of the plan
year.
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47671
Line 7. Enter in element (a) the total
number of participants with account balances
as of the end of the plan year. Welfare benefit
plans and defined benefit pension plans do
not complete element (c). Enter in element
(a)(1) the total number of active participants
at the beginning of the plan year. Enter in
element (a)(2) the total number of active
participants at the end of the plan year.
The description of ‘‘participant’’ in the
following instructions is only for purposes of
these lines.
An individual becomes a participant
covered under an employee welfare benefit
plan on the earliest of:
• The date designated by the plan as the
date on which the individual begins
participation in the plan;
• The date on which the individual
becomes eligible under the plan for a benefit
subject only to occurrence of the contingency
for which the benefit is provided; or
• The date on which the individual makes
a contribution to the plan, whether voluntary
or mandatory.
See 29 CFR 2510.3–3(d)(1). Covered
dependents are not counted as participants.
A child who is an ‘‘alternate recipient’’
entitled to health benefits under a qualified
medical child support order (QMCSO)
should not be counted as a participant for
Line 6. An individual is not a participant
covered under an employee welfare plan on
the earliest date on which the individual (a)
is ineligible to receive any benefit under the
plan even if the contingency for which such
benefit is provided should occur, and (b) is
not designated by the plan as a participant.
See 29 CFR 2510.3–3(d)(2).
[TIP] Before counting the number of
participants, especially in a welfare benefit
plan, it is important to determine whether the
plan sponsor has established one or more
plans for Form 5500/Form 5500–SF reporting
purposes. As a matter of plan design, plan
sponsors can offer benefits through various
structures or combinations.
The fact that you have separate insurance
policies for each different welfare benefit
does not necessarily mean that you have
separate plans. Some plan sponsors use a
‘‘wrap’’ document to incorporate various
benefits and insurance policies into one
comprehensive plan. In addition, whether a
benefit arrangement is deemed to be a single
plan may be different for purposes other than
Form 5500/Form 5500–SF reporting. For
example, special rules may apply for
purposes of Internal Revenue Code
compliance. If you need help determining
whether you have a single welfare benefit
plan for Form 5500/Form 5500–SF reporting
purposes, you should consult a qualified
benefits consultant or legal counsel.
[CAUTION] Plans that provide health
benefits cannot file the Form 5500–SF
regardless of size and must file the Form
5500.
For pension benefit plans, ‘‘alternate
payees’’ entitled to benefits under a qualified
domestic relations order (QDRO) are not to be
counted as participants for this line.
For pension benefit plans, ‘‘participant’’ for
this line means any individual who is
included in one of the categories below.
1. Active participants (i.e., any individuals
who are currently in employment covered by
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the plan and who are earning or retaining
credited service under the plan). This
includes any individuals who are eligible to
elect to have the employer make payments
under a Code section 401(k) qualified cash or
deferred arrangement. Active participants
also include any nonvested individuals who
are earning or retaining credited service
under the plan. This does not include (a)
nonvested former employees who have
incurred the break in service period specified
in the plan or (b) former employees who have
received a ‘‘cash-out’’ distribution or deemed
distribution of their entire nonforfeitable
accrued benefit.
2. Retired or separated participants
receiving benefits (i.e., individuals who are
retired or separated from employment
covered by the plan and who are receiving
benefits under the plan). This does not
include any individual to whom an
insurance company has made an irrevocable
commitment to pay all the benefits to which
the individual is entitled under the plan.
3. Other retired or separated participants
entitled to future benefits (i.e., any
individuals who are retired or separated from
employment covered by the plan and who
are entitled to begin receiving benefits under
the plan in the future). This does not include
any individual to whom an insurance
company has made an irrevocable
commitment to pay all the benefits to which
the individual is entitled under the plan.
4. Deceased individuals who had one or
more beneficiaries who are receiving or are
entitled to receive benefits under the plan.
This does not include any individual to
whom an insurance company has made an
irrevocable commitment to pay all the
benefits to which the beneficiaries of that
individual are entitled under the plan.
Line 7g. Enter in element (1) the number
of participants who have an account balances
at the beginning of the year. Enter in element
(2) the number of participants included on
Line 7f (total participants at the end of the
plan year) who have account balances at the
end of the plan year. For example, for a Code
section 401(k) plan the number entered on
Line 7g should be the number of participants
counted on Line 7f who have made a
contribution, or for whom a contribution has
been made, to the plan for this plan year or
any prior plan year. Enter in element (3) the
number of participants that made
contributions to the plan (regardless of
whether the employer made contributions)
during the plan year. Both defined
contribution pension plans and welfare plans
complete element (3). Enter in element (4)
the number of participants that terminated
employment during the plan year that had
their entire account balance distributed as of
the end of the plan year. Only defined
contribution pension plans complete element
(4).
Defined contribution plans must complete
all of Lines 7g(1)–(4). Welfare plans must
complete Line 7g(3) and should leave Line
7g(1), (2), and (4) blank. Defined benefit
pension plans should skip Line 7g and
should leave it blank.
Line 7h. Include any individual who
terminated employment during this plan
year, whether or not he or she (a) incurred
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a break in service, (b) received an irrevocable
commitment from an insurance company to
pay all the benefits to which he or she is
entitled under the plan, and/or (c) received
a cash distribution or deemed cash
distribution of his or her nonforfeitable
accrued benefit.
Part III—Form 5500–SF Eligibility
Information.
If your plan is required to file an annual
return/report, you may file the Form 5500–
SF instead of the Form 5500 only if you meet
all of the eligibility conditions listed below.
1. The plan (a) covered fewer than 100
participants at the beginning of the plan year
20XX, or (b) under 29 CFR 2520.103–1(d)
was eligible to and filed as a small plan for
plan year 20XX–1and covered 120 or fewer
participants at the beginning of plan year
20XX (see instructions; defined benefit
pension plans, welfare plans, and defined
contribution pension plans that check the
‘‘first plan year’’ box use the number on Line
6; defined contribution pension plans use the
number on Line 7g(1);
2. The plan did not hold any employer
securities at any time during the plan year;
3. At all times during the plan year, the
plan was 100% invested in certain secure,
easy to value assets such as mutual fund
shares, investment contracts with insurance
companies and banks valued at least
annually and that are not invested in ‘‘hardto-value’’ assets, publicly traded securities
held by a registered broker dealer, cash and
cash equivalents, and plan loans to
participants that meet the definition of
‘‘eligible plan assets’’ (see the instructions for
Line 8a);
4. The plan is eligible for the waiver of the
annual examination and report of an
independent qualified public accountant
(IQPA) under 29 CFR 2520.104–46 (but not
by reason of enhanced bonding), which
requirement includes, among others, giving
certain disclosures and supporting
documents to participants and beneficiaries
regarding the plan’s investments (see
instructions for Line 8b);
5. The plan is not a multiemployer plan;
and
6. The plan did not provide group health
benefits.
Special conditions for filing the Form
5500–SF apply to ‘‘one-participant plans.’’
See Specific Instructions for ‘‘OneParticipant Plans’’ on page 7.
Line 8a. Eligible Plan Assets. To be eligible
to file the Form 5500–SF, all of the plan’s
assets must be ‘‘eligible plan assets.’’ Answer
Line 8a ‘‘Yes’’ or ‘‘No.’’ Do not leave this
question blank. If the answer to Line 8a is
‘‘No’’ you CANNOT file the Form 5500–SF
and must file the Form 5500. See discussion
under Who May File Form 5500–SF.
For the purposes of this line, ‘‘eligible plan
assets’’ are assets that have a readily
determinable fair market value for purposes
of this annual reporting requirement as
described in 29 CFR 2520.103–1(c)(2)(ii)(C),
are not employer securities, and are held or
issued by one of the following regulated
financial institutions: a bank or similar
financial institution as defined in 29 CFR
2550.408b–4(c) (for example, banks, trust
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companies, savings and loan associations,
domestic building and loan associations, and
credit unions); an insurance company
qualified to do business under the laws of a
state; organizations registered as brokerdealers under the Securities Exchange Act of
1934; investment companies registered under
the Investment Company Act of 1940; or any
other organization authorized to act as a
trustee for individual retirement accounts
under Code section 408. Examples of assets
that would qualify as eligible plan assets for
this annual reporting purpose are mutual
fund shares, investment contracts with
insurance companies or banks that provide
the plan with valuation information at least
annually, publicly traded stock held by a
registered broker dealer, cash and cash
equivalents held by a bank. Participant loans
meeting the requirements of ERISA section
408(b)(1) are also ‘‘eligible plan assets’’ for
this purpose whether or not they have been
deemed distributed. ‘‘Eligible plan assets’’ do
not include leveraged investments. Small
plans that have such investments must file
the Form 5500.
Line 8b. In addition to all of the plan’s
assets being eligible plan assets as defined in
Line 8a, to be eligible to file the Form 5500–
SF the plan also must meet the conditions for
the exemption from the requirement to be
audited annually by an independent
qualified public accountant (IQPA) in 29 CFR
2520.104–46 and covered fewer than 100
participants as of the beginning of 20XX or,
under 29 CFR 2520.103–1(d), was eligible to
and filed as a small plan for plan year 20XX–
1 and did not cover more than 120
participants at the beginning of plan year
20XX. For these purposes, defined benefit
pension plans, welfare plans, and defined
contribution pension plans that check the
‘‘first plan’’ year box use the participant
count on Line 6, and defined contribution
pension plans can use the participant count
on Line 7g(1).
To be able to file the Form 5500–SF, the
filer must meet the following three
requirements for the audit waiver under 29
CFR 2520.104–46:
(1) as the last day of the preceding plan
year, at least 95% of a small pension plan’s
assets were ‘‘qualifying plan assets;’’
(2) the plan includes the required audit
waiver disclosure in the Summary Annual
Report (SAR) furnished to participants and
beneficiaries, in accordance with 29 CFR
2520.104b–10. For defined benefit pension
plans that are required pursuant to section
101(f) of ERISA to furnish an Annual
Funding Notice (AFN), the administrator
must instead either provide the information
to participants and beneficiaries with the
AFN or as a stand-alone notification at the
time an SAR would have been due and in
accordance with the rules for furnishing an
SAR, although such plans do not have to
furnish an SAR; and
(3) in response to a request from any
participant or beneficiary, the plan
administrator must furnish without charge
copies of statements from the regulated
financial institutions holding or issuing the
plan’s ‘‘qualifying plan assets.’’
[CAUTION] In order to be eligible to file
the Form 5500–SF, a small pension plan
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must meet the audit waiver conditions by
virtue of having 95% or more of its assets as
‘‘qualifying plan assets’’ in accordance with
29 CFR 2520.104–46(b)(1)(i)(A)(1). If the
small plan satisfies the conditions of the
audit waiver by virtue of having an enhanced
fidelity bond under 29 CFR 2520.104–
46(b)(1)(i)(A)(2), the plan does not satisfy the
conditions for filing the Form 5500–SF and
must file the Form 5500, along with the
appropriate schedules and attachments.
Also, although many ‘‘qualifying plan assets’’
for audit waiver purposes will also be
‘‘eligible plan assets’’ as described in the
instructions for Line 6a, the definitions are
not the same. If, as of the last day of the
preceding plan year, the plan was 100%
invested in ‘‘eligible plan assets,’’ the plan
would satisfy the ‘‘qualifying plan asset’’
prong of the audit waiver conditions. Holding
all the plan’s investments in ‘‘qualifying plan
assets,’’ however, would not necessarily
satisfy the conditions for filing the Form
5500–SF. For example, real estate held by a
bank as trustee for a plan could be a
qualifying plan asset for purposes of the
small pension plan audit waiver conditions
but it would not be an ‘‘eligible plan asset’’
for purposes of the plan being eligible to file
the Form 5500–SF because real estate would
not have a readily determinable fair market
value as described in 29 CFR 2520.103–
1(c)(2)(ii)(C).
Line 8c. If you answer ‘‘yes’’ because the
plan provided health benefits, whether
through insurance or otherwise, you must file
the Form 5500 and cannot file the Form
5500–SF regardless of plan size or, if any,
investment type.
Part IV—Financial Information
Note. The cash, modified cash, or accrual
basis may be used for recognition of
transactions in Parts I and II, as long as you
use one method consistently. Round off all
amounts reported on the Form 5500–SF to
the nearest dollar. Any other amounts are
subject to rejection. Check all subtotals and
totals carefully.
Current value means fair market value
where available. Otherwise, it means the fair
value as determined in good faith under the
terms of the plan by a trustee or named
fiduciary, assuming an orderly liquidation at
the time of the determination. See ERISA
section 3(26).
Line 9. Plan Assets and Liabilities.
Amounts reported on the Form 5500–SF for
the beginning of the plan year must be the
same as reported for the end of the plan year
for the corresponding lines on the return/
report for the preceding plan year.
Line 9a. Enter the total amount of plan
assets at the beginning of the plan year in
column (a). Do not include contributions
designated for the 20XX plan year in column
(a).
Enter the total amount of plan assets at the
end of the plan year in column (b). Do not
include in column (b) a participant loan that
has been deemed distributed during the plan
year under the provisions of Code section
72(p) and Treasury Regulations section
1.72(p)–1 if both the following circumstances
apply: (1) Under the plan, the participant
loan is treated as a directed investment solely
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of the participant’s individual account; and
(2) As of the end of the plan year, the
participant is not continuing repayment
under the loan.
If the deemed distributed participant loan
is included in column (a) and both of these
circumstances apply, include the value of the
loan as a deemed distribution on Line 8e.
However, if either of these two circumstances
does not apply, the current value of the
participant loan (including interest accruing
thereon after the deemed distribution) should
be included in column (b) without regard to
the occurrence of a deemed distribution.
After a participant loan that has been
deemed distributed it is included in the
amount reported on Line 10e, it is no longer
to be reported as an asset on Line 9a unless,
in a later year, the participant resumes
repayment under the loan. However, such a
loan (including interest accruing thereon
after the deemed distribution) that has not
been repaid is still considered outstanding
for purposes of applying Code section
72(p)(2)(A) to determine the maximum
amount of subsequent loans. Also, the
deemed distribution is not treated as an
actual distribution for other purposes, such
as the qualification requirements of Code
section 401, including, for example, the
determination of top-heavy status under
Code section 416 and the vesting
requirements of Treasury Regulations section
1.411(a)–7(d)(5). See Q&As 12 and 19 of
Treasury Regulations section 1.72(p)–1.
The entry on Line 9a, column (b) (plan
assets at end of year) must include the
current value of any participant loan
included as a deemed distribution in the
amount reported for any earlier year if,
during the plan year, the participant resumes
repayment under the loan. In addition, the
amount to be entered on Line 10e must be
reduced by the amount of the participant
loan reported as a deemed distribution for
the earlier year.
Line 9b. Enter the total liabilities at the
beginning and end of the plan year.
Liabilities to be entered here do not include
the value of future pension payments to
participants. The amount to be entered in
Line 9b for accrual basis filers includes,
among other things:
1. Benefit claims that have been processed
and approved for payment by the plan but
have not been paid (including all incurred
but not reported (IBNR) welfare benefit
claims);
2. Accounts payable obligations owed by
the plan that were incurred in the normal
operations of the plan but have not been
paid; and
3. Other liabilities such as acquisition
indebtedness and any other amount owed by
the plan.
Line 9c. Enter the net assets as of the
beginning and end of the plan year. (Subtract
Line 9b from Line 9a). Line 9c, column (b),
must equal the sum of Line 9c, column (a),
plus Line 10j (net income (loss)) and Line
10k (transfers to (from) the plan).
Line 10—Income, Expenses, and Transfers
for this Plan Year.
Line 10a. Receivables. Include the total
cash contributions received and/or (for
accrual basis plans) due to be received.
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Line 10a(1). Contributions—Employer and
Employee. Plans using the accrual basis of
accounting must not include contributions
designated for years before the 20XX plan
year on Line 10a(1). For welfare plans, report
all employee contributions, including all
elective contributions under a cafeteria plan
(Code section 125). For pension plans,
participant contributions, for purposes of this
line item, also include elective contributions
under a qualified cash or deferred
arrangement (Code section 401(k)).
Line 10a(2). Enter the current value, at date
contributed, of all other contributions,
including rollovers from other plans.
Line 10b. Enter all other plan income for
the plan year. Do not include transfers from
other plans that are reported on Line 10k.
Examples of other income received and/or
receivable include:
1. Interest on investments (including
money market accounts, sweep accounts,
etc.)
2. Dividends. (Accrual basis plans should
include dividends declared for all stock held
by the plan even if the dividends have not
been received as of the end of the plan year.)
3. Net gain or loss from the sale of assets.
4. Other income such as unrealized
appreciation (depreciation) in plan assets.
To compute this amount, subtract the
current value of all assets at the beginning of
the year plus the cost of any assets acquired
during the plan year from the current value
of all assets at the end of the year minus
assets disposed of during the plan year.
Line 10c. Enter the total of all cash
contributions (Line 10a(1) through Line
10a(3)) and other plan income (Line 10b)
during the plan year. If entering a negative
number, enter a minus sign (‘‘¥’’) to the left
of the number.
Line 10d. Include: (1) payments made (and,
for accrual basis filers, payments due) to or
on behalf of participants or beneficiaries in
cash, securities, or other property (including
rollovers of an individual’s accrued benefit or
account balance). Include all eligible rollover
distributions as defined in Code section
401(a)(31)(D) paid at the participant’s
election to an eligible retirement plan
(including an IRA within the meaning of
Code section 401(a)(31)(E)); (2) payments to
insurance companies and similar
organizations for the provision of plan
benefits (e.g., paid-up annuities, accident
insurance, etc.); and (3) payments made to
other organizations or individuals providing
benefits. Generally, these payments
discussed in (3) are made to individual
providers of welfare benefits such as legal
services, day care services, and training and
apprenticeship services. If securities or other
property are distributed to plan participants
or beneficiaries, include the current value as
of the date of distribution.
Line 10e. Include on this line all
distributions paid during the plan year of
excess deferrals under Code section
402(g)(2)(A)(ii), excess contributions under
Code section 401(k)(8), and excess aggregate
contributions under Code section 401(m)(6).
Include allocable income distributed. Also
include on this line any elective deferrals
and employee contributions distributed or
returned to employees during the plan year
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as well as any attributable income that was
also distributed.
For Line 10e, also include in the total
amount a participant loan included in Line
10b, column (a) that has been deemed
distributed during the plan year under the
provisions of Code section 72(p) and
Treasury Regulations section 1.72(p)–1 only
if both of the following circumstances apply:
1. Under the plan, the participant loan is
treated as a directed investment solely of the
participant’s individual account; and
2. As of the end of the plan year, the
participant is not continuing repayment
under the loan.
If either of these circumstances does not
apply, a deemed distribution of a participant
loan should not be included in the total on
Line 10e. Instead, the current value of the
participant loan (including interest accruing
thereon after the deemed distribution) should
be included on Lines 9a, column (b) (plan
assets—end of year), and 10b (participant
loans—end of year), without regard to the
occurrence of a deemed distribution.
Note. The amount to be reported on Line
10d must be reduced if, during the plan year,
a participant resumes repayment under a
participant loan reported as a deemed
distribution on Line 2g of Schedule H of a
prior Form 5500 Annual Return/Report or
Line 10e of a prior Form 5500–SF for any
earlier year. The amount of the required
reduction is the amount of the participant
loan that was reported as a deemed
distribution on such line for any earlier year.
If entering a negative number, enter a minus
sign (‘‘¥’’) to the left of the number. The
current value of the participant loan must
then be included on line 9a, column (b) (plan
assets—end of year).
Although certain participant loans deemed
distributed are to be reported on Line 10e,
and are not to be reported on the Form 5500–
SF or on the Schedule H of the Form 5500
Annual Return/Report as an asset thereafter
(unless the participant resumes repayment
under the loan in a later year), they are still
considered outstanding loans and are not
treated as actual distributions for certain
purposes. See Q&As 12 and 19 of Treasury
Regulations section 1.72(p)–1.
Line 10f. The amount to be reported for
expenses involving administrative service
providers (salaries, fees, and commissions)
includes the total fees paid (or in the case of
accrual basis plans, costs incurred during the
plan year but not paid as of the end of the
plan year) by the plan for, among others:
1. Salaries to employees of the plan;
2. Fees and expenses for accounting,
actuarial, legal, investment management,
investment advice, and securities brokerage
services;
3. Contract administrator fees; and
4. Fees and expenses for individual plan
trustees, including reimbursement for travel,
seminars, and meeting expenses.
Line 10g. Other expenses (paid and/or
payable) include other administrative and
miscellaneous expenses paid by or charged to
the plan, including among others office
supplies and equipment, telephone, and
postage.
Line 10h. Enter the total of all benefits paid
or due reported on Lines 10d and 10e and all
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other plan expenses reported on Lines 10f
and 10g during the year.
Line 10i. Subtract Line 10i from Line 10b.
Line 10j. Enter the net value of all assets
transferred to and from the plan during the
plan year including those resulting from
mergers and spinoffs. A transfer of assets or
liabilities occurs when there is a reduction of
assets or liabilities with respect to one plan
and the receipt of these assets or the
assumption of these liabilities by another
plan. Transfers out at the end of the year
should be reported as occurring during the
plan year.
Note. A distribution of all or part of an
individual participant’s account balance that
is reportable on Form 1099–R, Distributions
From Pensions, Annuities, Retirement or
Profit-Sharing Plans, IRAs, Insurance
Contracts, etc., should not be included on
Line 8j but must be included in benefit
payments reported on Line 10d. Do not
submit IRS Form 1099–R with the Form
5500–SF.
Lines 11(a)–(i). Enter the totals for the
various categories as appropriate.
[CAUTION] Filers that have assets that do
not fit into any of these breakout categories
must file the Form 5500. If, the plan is
invested in any assets other than eligible plan
assets, which includes the requirement of
being readily marketable, you must file the
Form 5500 and required schedules. For
example, if the plan holds real estate,
nonpublicly traded securities, shares in a
limited partnership, derivatives, notes and
stock not traded on an exchange, private
equity, and collectibles, or other alternative
or hard-to-value assets, then the plan is
required to file a Form 5500.
For reporting purposes, ‘‘common/
collective trust’’ and ‘‘pooled separate
account’’ are, respectively: (1) a trust
maintained by a bank, trust company, or
similar institution; or (2) an account
maintained by an insurance carrier, which is
regulated, supervised, and subject to periodic
examination by a state or federal agency in
the case of a CCT, or by a state agency in the
case of a PSA, for the collective investment
and reinvestment of assets contributed
thereto from employee benefit plans
maintained by more than one employer or
controlled group of corporations as that term
is used in Code section 1563. See 29 CFR
2520.103–3, 103–4, 103–5, and 103–9. To be
eligible plan assets for Form 5500–SF
reporting purposes, a bank or insurance
company contract, including a CCT or PSA
must not only be valued at least annually, but
must itself be invested primarily in readily
marketable assets.
Note. For reporting purposes, a separate
account that is not considered to be holding
plan assets pursuant to 29 CFR 2510.3–
101(h)(1)(iii) does not constitute a pooled
separate account.
Part IV—Plan Characteristics
Line 12. Benefits Provided Under the Plan.
Pension plans must answer all applicable
questions in Line 11a that applied during the
reporting year of the plan or arrangement.
Defined benefit pension plans must complete
Lines 12(1)–(3), 12a(4) and 12a(9)–(11).
Defined contribution pension plans must
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complete Lines 12a(4)–12a(11). Welfare
benefit plans must complete Lines 11b(1)–(3).
Line 12a(1). Defined Benefit Pension Plans;
How Benefits Are Calculated. If benefits are
based primarily on pay, check the box
‘‘Benefits are primarily pay related.’’ If
benefits are primarily flat dollar, including
dollars per year of service, check the box
‘‘Benefits are primarily flat dollar.’’
Check the box for ‘‘Cash balance plan’’ if
the plan has a ‘‘cash balance’’ formula under
which the accumulated benefit provided
under the formula is expressed as the current
balance of a hypothetical account maintained
for the participant. For this purpose, a ‘‘cash
balance’’ formula is a lump sum based
benefit formula in a defined benefit pension
plan by whatever name (for example,
personal account plan, life cycle plan, cash
account plan, etc.).
Check the box for ‘‘Pension equity plan
(PEP)’’ if the plan has a ‘‘pension equity plan
formula under which the accumulated
benefit provided under the formula is
expressed as the current value of an
accumulated percentage of the participant’s
final average compensation or is expressed as
a current single-sum dollar amount equal to
a percentage of the participant’s highest
average compensation (with a permitted
lookback period for determining highest
average compensation, such as highest 5 out
of the last 10 years).
Check the box for ‘‘Other hybrid plan’’ if
the plan provides a lump sum based benefit
formula that is different from the cash
balance or pension equity plan formula.
Note that a benefit formula does not
constitute a lump sum based benefit formula
unless a distribution of the benefits under
that formula in the form of a single-sum
payment equals the accumulated benefit
under that formula (except to the extent the
single-sum payment is greater to satisfy the
requirements of Code section 411(d)(6)).
Line 12a(2). Code Section Arrangements
for Defined Benefit Pension Plans. Check the
box for ‘‘Code section 414(k) arrangement’’ if
benefits are based partly on the balance of the
separate account of the participant (also
include appropriate defined contribution
pension feature codes).
Line 12a(3). Terminated Defined Benefit
Pension Plan. Check ‘‘Yes’’ if the plan is
covered by PBGC and was terminated and
closed out for PBGC purposes before the end
of the plan year (or a prior plan year), and
either (1) the plan terminated in a standard
(or distress) termination and completed the
distribution of plan assets in satisfaction of
all benefit liabilities (or all ERISA Title IV
benefits for distress termination); or (2) a
trustee was appointed for a terminated plan
pursuant to ERISA section 4042.
Line 12a(4). PBGC Covered Defined
Benefit Pension Plan. If you are uncertain
whether the plan is covered under the PBGC
termination insurance program, check the
box ‘‘Not determined’’ and contact the PBGC
either by phone at 1–800–736–2444, by Email
at standard@pbgc.gov, or in writing to
Pension Benefit Guaranty Corporation,
Standard Termination Compliance Division,
Suite 930, Processing and Technical
Assistance Branch, 1200 K Street, NW.,
Washington, DC 20005–4026. If you checked
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the box ‘‘Yes,’’ enter the My PAA generated
confirmation number for the premium filing
for this plan year (see filing receipt). If you
amended your premium filing for this plan
year, enter the confirmation number for that
filing and not for the previous filing(s).
Defined contribution pension plans and
welfare plans do not need to complete this
item.
Line 12a(5). Frozen Plans. Check ‘‘Yes’’ if
the plan is frozen.
Line 12a(6). Offset Arrangement. Both
defined benefit and contribution plans that
are part of an offset arrangement must answer
this question. Check ‘‘Yes’’ if plan benefits
are subject to offset for retirement benefits
provided in another plan or arrangement of
the employer. If you have checked ‘‘Yes,’’
enter the name, EIN of sponsor, and PN of
the other plan or arrangement.
Line 12a(7). Defined Contribution Pension
Plan Type(s). Defined contribution pension
plans only complete this line. Check all
type(s) that apply.
Line 12a(8). Defined Contribution Pension
Plan Arrangements. If this is a defined
contribution pension plan, check the type(s)
of arrangements under which the plan
operates. (Check all that apply.)
Line 12a(9). Defined Contribution Pension
Plan Features. If this is a defined
contribution pension plan, check all that
apply to indicate features of the plan.
Check automatic enrollment feature if the
plan has elective contributions from payroll
and provides for automatic enrollment in the
plan.
A designated Roth account is a feature in
new or existing 401(k), 403(b), or
governmental 457(b) plans that permit such
plans to accept designated Roth contributions
and certain rollovers. If a plan adopts this
feature, employees can designate some or all
of their elective contributions (also referred
to as elective deferrals) as designated Roth
contributions (which are included in gross
income), rather than traditional, pre-tax
elective contributions.
Check the box for ‘‘Age/service weighted
plan’’ if allocations are based on age, service,
or age and service.
New comparability or similar plan:
Allocations are based on participant
classifications and a classification(s) consists
entirely or predominantly of highly
compensated employees; or the plan
provides an additional allocation rate on
compensation above a specified threshold,
and the threshold or additional rate exceeds
the maximum threshold or rate allowed
under the permitted disparity rules of Code
section 401(l).
Check ‘‘other’’ if the plan has any other
particularized features for defined
contribution pension plans that are not listed
above and enter a short description in the
space provided.
Line 12a(10). Participant-Directed Defined
Contribution Pension Plan. Check the box for
ERISA section 404(c) plan if the plan, or any
part of it, is intended to meet the conditions
of 29 CFR 2550.404c–1.
Check the box for total participant-directed
account plan if participants have the
opportunity to direct the investment of all
the assets allocated to their individual
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accounts, regardless of whether 29 CFR is
intended to be met.
Check partial participant-directed account
if participants have the opportunity to direct
the investment of a portion of the assets
allocated to their individual accounts,
regardless of whether 29 CFR is intended to
be met. Do not check both ‘‘total’’ and
‘‘partial’’ participant-directed account.
Check the box for participant-directed
brokerage accounts if the plan provides such
accounts as an investment option under the
plan. If you check this box, enter the number
of participants using the participant-directed
brokerage account(s).
Line 12a(11). Qualified Default Investment
Alternatives (QDIAs). Regardless of whether
the plan is total or partial participantdirected, if the plan uses default investment
alternative(s) (DIA) that are intended to be
QDIA(s) for participants who fail to direct
assets in their account, also check the box to
so indicate. If the plan uses a QDIA for
participants who fail to direct assets in their
account, indicate type of default investment
alternative: target date/life fund; fixed
income; money market or equivalent;
balanced fund; professionally managed
account; or other. If other, specify the type
of account. If you checked the box for
‘‘Other,’’ you may be using an investment
alternative that does not satisfy the QDIA
requirements in the Department of Labor’s
regulation at 29 CFR 2550.404c–5.
Line 12a(12) Eligible Combined Plan
Under Code section 414(x). If the plan is an
eligible combined plan under Code section
414(x), check ‘‘Yes.’’
Note. In the case of an eligible combined
plan under Code section 414(x) and ERISA
section 210(e), you must answer all
applicable for both the defined benefit
pension features and the defined
contribution pension features of the plan.
Line 12a(13). Check this box if a rollover
from a plan was used to start up the business
(ROBS) sponsoring this plan.
Line 12a(14). Other Pension Benefit
Features. Check all that apply.
Notes: (1) If a plan sponsor or an employer
adopted a pre-approved plan that includes a
master & prototype plan or a volume
submitter plan, enter the most recent
adoption date and the IRS favorable opinion
or advisory letter’s serial number. (2)
Sponsors of Puerto Rico plans, check the box
to indicate that the plan is not intended to
be qualified under Code sections 401, 403, or
408 only if:
i. only Puerto Rico residents participate,
ii. the trust is exempt from income tax
under the laws of Puerto Rico, and
iii. the plan administrator has not made the
election under ERISA section 1022(i)(2), and,
therefore, the plan is not intended to qualify
under section 401(a) of the Internal Revenue
Code (U.S).
Line. 12b Welfare Benefit Plan
Characteristics. Welfare plans must answer
all applicable questions in Line 12b. Plans
that provide group health benefits cannot file
the Form 5500–SF; they must file the Form
5500. Pension plans skip to Line 13.
Line 12b(1). Disability Benefits. If the plan
provides disability benefits, answer ‘‘Yes’’
and check all that apply.
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47675
Line 12b(2). Other Welfare Benefits. If the
plan provides welfare benefits other than
disability, answer ‘‘Yes’’ and check all that
apply. If the type of benefits is not listed,
check ‘‘other’’ and enter a description.
Line 13. Funding and Benefit
Arrangements. Check all boxes that apply to
indicate the funding and benefit
arrangements used during the plan year. The
‘‘funding arrangement’’ is the method for the
receipt, holding, investment, and transmittal
of plan assets prior to the time the plan
actually provides benefits. ‘‘The benefit
arrangement’’ is the method by which the
plan provides benefits to participants. For
purposes of Line 13:
‘‘Insurance’’ means the plan has an
account, contract, or policy with an
insurance company, insurance service, or
other similar organization during the plan or
DFE year. (This includes investments with
insurance companies such as guaranteed
investment contracts (GICs).) An annuity
account arrangement under Code section
403(b)(1) that is required to complete the
Form 5500 should mark ‘‘insurance’’ for both
the plan funding arrangement and plan
benefit arrangement. Do not check
‘‘insurance’’ if the sole function of the
insurance company was to provide
administrative services.
‘‘Code section 412(e)(3) insurance
contract’’ are contracts that provide
retirement benefits under a plan that are
guaranteed by an insurance carrier. In
general, such contracts must provide for level
premium payments over the individual’s
period of participation in the plan (to
retirement age), premiums must be timely
paid as currently required under the contract,
no rights under the contract may be subject
to a security interest, and no policy loans
may be outstanding. If a plan is funded
exclusively by the purchase of such
contracts, the otherwise applicable minimum
funding requirements of section 412 of the
Code and section 302 of ERISA do not apply
for the year and neither the Schedule MB nor
the Schedule SB is required to be filed.
‘‘Trust’’ includes any fund or account that
receives, holds, transmits, or invests plan
assets other than an account or policy of an
insurance company. A custodial account
arrangement under Code section 403(b)(7)
that is required to complete the Form 5500
should mark ‘‘trust’’ for both the plan
funding arrangement and the plan benefit
arrangement.
‘‘General assets of the sponsor’’ means
either the plan had no assets or some assets
were commingled with the general assets of
the plan sponsor prior to the time the plan
actually provided the benefits promised.
Example. If the plan holds all its assets
invested in registered investment companies
and other non-insurance company
investments until it purchases annuities to
pay out the benefits promised under the plan,
box 13a(3) should be checked as the funding
arrangement and box 12b(1) should be
checked as the benefit arrangement.
Note. An employee benefit plan that
checks boxes 13a(1), 13a(2), 13b(1), and/or
13b(2) must answer line 14e to report
insurance fee and commission information.
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Part VI—Plan Operations Compliance
Questions
Line 14. Answer all lines either ‘‘Yes’’ or
‘‘No.’’ Do not leave any answer blank unless
otherwise directed. For Lines 14a, b, c, d, e,
f, and n, if the answer is ‘‘Yes,’’ an amount
must be entered.
Note. ‘‘One-participant plans’’ should
complete only Line 14g.
Line 14a. Amounts paid by a participant or
beneficiary to an employer and/or withheld
by an employer for contribution to the plan
are participant contributions that become
plan assets as of the earliest date on which
such contributions can reasonably be
segregated from the employer’s general
assets. See 29 CFR 2510.3–102. In the case of
a plan with fewer than 100 participants at the
beginning of the plan year, any amount
deposited with such plan not later than the
7th business day following the day on which
such amount is received by the employer (in
the case of amounts that a participant or
beneficiary pays to an employer), or the 7th
business day following the day on which
such amount would otherwise have been
payable to the participant in cash (in the case
of amounts withheld by an employer from a
participant’s wages), shall be deemed to be
contributed or repaid to such plan on the
earliest date on which such contributions or
participant loan repayments can reasonably
be segregated from the employer’s general
assets. See 29 CFR 2510.3–102(a)(2). Plans
that check ‘‘Yes,’’ must enter the aggregate
amount of all late contributions for the year.
The total amount of the delinquent
contributions must be included on Line 14a
for the year in which the contributions were
delinquent and must be carried over and
reported again on Line 14a for each
subsequent year (or on Line 4a of Schedule
H of the Form 5500 if not eligible to file the
Form 5500–SF in the subsequent year) until
the year after the violation has been fully
corrected by payment of the late
contributions and reimbursement of the plan
for lost earnings or profits. If no participant
contributions were received or withheld by
the employer during the plan year, answer
‘‘No.’’
An employer holding participant
contributions commingled with its general
assets after the earliest date on which such
contributions can reasonably be segregated
from the employer’s general assets will have
engaged in a prohibited use of plan assets
(see ERISA section 406). If such a nonexempt
prohibited transaction occurred with respect
to a disqualified person (see Code section
4975(e)(2)), file IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit
Plans, with the IRS to pay any applicable
excise tax on the transaction.
Participant loan repayments paid to and/or
withheld by an employer for purposes of
transmittal to the plan that were not
transmitted to the plan in a timely fashion
must be reported either on Line 14a in
accordance with the reporting requirements
that apply to delinquent participant
contributions or on Line 14b. See Advisory
Opinion 2002–02A, available at
www.dol.gov/ebsa.
Applicants that satisfy both the DOL
Voluntary Fiduciary Correction Program
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(VFCP) and the conditions of Prohibited
Transaction Exemption (PTE) 2002–51 are
eligible for immediate relief from payment of
certain prohibited transaction excise taxes for
certain corrected transactions, and are also
relieved from the requirement to file the IRS
Form 5330 with the IRS. For more
information on how to apply under the
VFCP, the specific transactions covered
(which transactions include delinquent
participant contributions to pension and
welfare plans), and acceptable methods for
correcting violations. See 71 FR 20261 (Apr.
19, 2006) and 71 FR 20135 (Apr. 19, 2006).
All delinquent participant contributions
must be reported on Line 14a at least for the
year in which they were delinquent even if
violations have been fully corrected by the
close of the plan year. Information about the
VFCP is also available on the Internet at
www.dol.gov/ebsa.
Line 14b. Plans that check ‘‘Yes’’ must
enter the amount. Check ‘‘Yes’’ if any
nonexempt transaction with a party-ininterest occurred. Do not check ‘‘Yes’’ with
respect to transactions that are: (1) statutorily
exempt under Part 4 of Title I of ERISA; (2)
administratively exempt under ERISA
section 408(a); (3) exempt under Code
sections 4975(c) or 4975(d); (4) the holding
of participant contributions in the employer’s
general assets for a welfare plan that meets
the conditions of ERISA Technical Release
92–01; or (5) delinquent participant
contributions or delinquent loan repayments
reported on Line 14a. You may indicate that
an application for an administrative
exemption is pending. If you are unsure
whether a transaction is exempt or not, you
should consult either with a qualified public
accountant, legal counsel, or both. If the plan
is a qualified pension plan and a nonexempt
prohibited transaction occurred with respect
to a disqualified person, an IRS Form 5330
is required to be filed with the IRS to pay the
excise tax on the transaction.
Nonexempt transactions. Nonexempt
transactions with a party-in-interest include
any direct or indirect:
A. Sale or exchange, or lease, of any
property between the plan and a party-ininterest.
B. Lending of money or other extension of
credit between the plan and a party-ininterest.
C. Furnishing of goods, services, or
facilities between the plan and a party-ininterest.
D. Transfer to, or use by or for the benefit
of, a party-in-interest, of any income or assets
of the plan.
E. Acquisition, on behalf of the plan, of any
employer security or employer real property
in violation of ERISA section 407(a).
F. Dealing with the assets of the plan for
a fiduciary’s own interest or own account.
G. Acting in a fiduciary’s individual or any
other capacity in any transaction involving
the plan on behalf of a party (or represent a
party) whose interests are adverse to the
interests of the plan or the interests of its
participants or beneficiaries.
H. Receipt of any consideration for his or
her own personal account by a party-ininterest who is a fiduciary from any party
dealing with the plan in connection with a
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transaction involving the income or assets of
the plan.
Party-in-Interest. For purposes of this
form, party-in-interest is deemed to include
a disqualified person. See Code section
4975(e)(2). The term ‘‘party-in-interest’’
means, as to an employee benefit plan:
A. Any fiduciary (including, but not
limited to, any administrator, officer, trustee,
or custodian), counsel, or employee of the
plan;
B. A person providing services to the plan;
C. An employer, any of whose employees
are covered by the plan;
D. An employee organization, any of whose
members are covered by the plan;
E. An owner, direct or indirect, of 50% or
more of:
1. the combined voting power of all classes
of stock entitled to vote or the total value of
shares of all classes of stock of a corporation;
2. the capital interest or the profits interest
of a partnership; or
3. the beneficial interest of a trust or
unincorporated enterprise which is an
employer or an employee organization
described in C or D;
F. A relative of any individual described in
A, B, C, or E;
G. A corporation, partnership, or trust or
estate of which (or in which) 50% or more
of:
1. the combined voting power of all classes
of stock entitled to vote or the total value of
shares of all classes of stock of such
corporation,
2. the capital interest or profits interest of
such partnership, or
3. the beneficial interest of such trust or
estate, is owned directly or indirectly, or held
by persons described in A, B, C, D, or E;
H. An employee, officer, director (or an
individual having powers or responsibilities
similar to those of officers or directors), or a
10% or more shareholder directly or
indirectly, of a person described in B, C, D,
E, or G, or of the employee benefit plan; or
I. A 10% or more (directly or indirectly in
capital or profits) partner or joint venturer of
a person described in B, C, D, E, or G.
[TIP] Applicants that satisfy the VFCP
requirements and the conditions of PTE
2002–51 (see the instructions for Line 12a)
are eligible for immediate relief from
payment of certain prohibited transaction
excise taxes for certain corrected transactions
and the requirement to file the Form 5330
with the IRS. For more information, see 71 FR
20261 (Apr. 19, 2006) and 71 FR 20135 (Apr.
19, 2006). When the conditions of PTE 2002–
51 have been satisfied, the corrected
transactions should be treated as exempt
under Code section 4975(c) for the purposes
of answering Line 14b.
Line 14c. Plans that check ‘‘Yes’’ must
enter the aggregate amount of fidelity bond
coverage for all claims. Check ‘‘Yes’’ only if
the plan itself (as opposed to the plan
sponsor or administrator) is a named insured
under a fidelity bond that is from an
approved surety covering plan officials and
that protects the plan from losses due to
fraud or dishonesty as described in 29 CFR
part 2580. Generally, every plan official of an
employee benefit plan who ‘‘handles’’ funds
or other property of such plan must be
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bonded. Generally, a person shall be deemed
to be ‘‘handling’’ funds or other property of
a plan, so as to require bonding, whenever
his or her duties or activities with respect to
given funds are such that there is a risk that
such funds could be lost in the event of fraud
or dishonesty on the part of such person,
acting either alone or in collusion with
others. Section 412 of ERISA and 29 CFR part
2580 describe the bonding requirements,
including the definition of ‘‘handling’’ (29
CFR 2580.412–6), the permissible forms of
bonds (29 CFR 2580.412–10), the amount of
the bond (29 CFR part 2580, subpart C), and
certain exemptions such as the exemption for
unfunded plans, certain banks and insurance
companies (ERISA section 412), and the
exemption allowing plan officials to
purchase bonds from surety companies
authorized by the Secretary of the Treasury
as acceptable reinsurers on federal bonds (29
CFR 2580.412–23). Information concerning
the list of approved sureties and reinsurers is
available on the Internet at
www.fms.treas.gov/c570. For more
information on the fidelity bonding
requirements, see Field Assistance Bulletin
2008–04, available at www.dol.gov/ebsa.
Note. Plans are permitted under certain
conditions to purchase fiduciary liability
insurance. These fiduciary liability insurance
policies are not written specifically to protect
the plan from losses due to dishonest acts
and cannot be reported as fidelity bonds on
Line 13c.
Line 14d. Check ‘‘Yes’’ if the plan had
suffered or discovered any loss as a result of
any dishonest or fraudulent act(s) even if the
loss was reimbursed by the plan’s fidelity
bond or from any other source. If ‘‘Yes’’ is
checked enter the full amount of the loss. If
the full amount of the loss has not yet been
determined, provide an estimate as
determined in good faith by a plan fiduciary.
You must keep, in accordance with ERISA
section 107, records showing how the
estimate was determined.
[CAUTION] Willful failure to report is a
criminal offense. See ERISA section 501.
Line 14e. If any benefits under the plan are
provided by an insurance company,
insurance service, or other similar
organization or if the plan has investments
with insurance companies such as
guaranteed investment contracts (GICs),
report the total of all insurance fees and
commissions paid to agents, brokers and/or
other persons directly or indirectly
attributable to the contract(s) placed with or
retained by the plan.
For purposes of Line 14e, commissions and
fees include sales or base commissions and
all other monetary and non-monetary forms
of compensation where the broker’s, agent’s,
or other person’s eligibility for the payment
or the amount of the payment is based, in
whole or in part, on the value (e.g., policy
amounts, premiums) of contracts or policies
(or classes thereof) placed with or retained by
an ERISA plan, including, for example,
persistency and profitability bonuses. The
amount (or pro rata share of the total) of such
commissions or fees attributable to the
contract or policy placed with or retained by
the plan must be reported. Insurers must
provide plan administrators with a
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proportionate allocation of commissions and
fees attributable to each contract. Any
reasonable method of allocating commissions
and fees to policies or contracts is acceptable,
provided the method is disclosed to the plan
administrator. A reasonable allocation
method could allocate fees and commissions
based on a calendar year calculation even if
the plan year or policy year was not a
calendar year. For additional information on
these reporting requirements, see ERISA
Advisory opinion 2005–02A, available on the
Internet at www.dol.gov/ebsa.
Where benefits under a plan are purchased
from and guaranteed by an insurance
company, insurance service, or other similar
organization, and the total fees and
commissions are reported on the Form 5500–
SF, payments of reasonable monetary
compensation by the insurer out of its
general assets to affiliates or third parties for
performing administrative activities
necessary for the insurer to fulfill its
contractual obligation to provide benefits,
where there is no direct or indirect charge to
the plan for administrative services other
than the insurance premium, then the
payments for administrative services by the
insurer to the affiliates or third parties do not
need to be reported on Line 14e. This would
include compensation for services such as
recordkeeping and claims processing services
provided by a third party pursuant to a
contract with the insurer to provide those
services but would not include compensation
provided by the insurer incidental to the sale
or renewal of a policy, such as finders’ fees,
insurance brokerage commissions and fees,
or similar fees.
Reporting also is not required for
compensation paid by the insurer to a
‘‘general agent’’ or ‘‘manager’’ for that general
agent’s or manager’s management of an
agency or performance of administrative
functions for the insurer. For this purpose,
(1) a ‘‘general agent’’ or ‘‘manager’’ does not
include brokers representing insureds, and
(2) payments would not be treated as paid for
managing an agency or performance of
administrative functions where the
recipient’s eligibility for the payment or the
amount of the payment is dependent or based
on the value (e.g., policy amounts,
premiums) of contracts or policies (or classes
thereof) placed with or retained by ERISA
plan(s).
Reporting is not required for occasional
gifts or meals of insubstantial value which
are tax deductible for federal income tax
purposes by the person providing the gift or
meal and would not be taxable income to the
recipient. For this exemption to be available,
the gift or gratuity must be both occasional
and insubstantial. For this exemption to
apply, the gift must be valued at less than
$50, the aggregate value of gifts from one
source in a calendar year must be less than
$250, but gifts with a value of less than $10
do not need to be counted toward the $250
annual limit. If the $250 aggregate value limit
is exceeded, then the aggregate value of all
the gifts will be reportable. For this purpose,
non-monetary gifts of less than $10 also do
not need to be included in calculating the
aggregate value of all gifts required to be
reported if the $250 limit is exceeded.
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Gifts from multiple employees of one
service provider should be treated as
originating from a single source when
calculating whether the $50 or $250
thresholds apply. On the other hand, in
applying the threshold to an occasional gift
received from one source by multiple
employees of a single service provider, the
amount received by each employee should be
separately determined in applying the $50
and $250 thresholds. For example, if 11
employees of a broker attend a business
conference put on by an insurer designed to
educate and explain the insurer’s products
for employee benefit plans, and the insurer
provides, at no cost to the attendees,
refreshments valued at $25 per individual,
the gratuities would not be reportable on this
line even though the total cost of the
refreshments for all the employees would be
$275.
These thresholds are for purposes of Line
13e reporting. Filers are cautioned that the
payment or receipt of gifts and gratuities of
any amount by plan fiduciaries may violate
ERISA and give rise to civil liabilities and
criminal penalties.
Important Reminder. The insurance
company, insurance service, or other similar
organization is required under ERISA section
103(a)(2) to provide the plan administrator
with the information needed to complete this
return/report. Your insurance company must
provide you with the information you need
to answer this question. If your insurance
company, insurance service, or other similar
organization does not automatically send you
this information, you should make a written
request for the information. If you have
difficulty getting the information from your
insurance company, contact the nearest office
of the DOL’s Employee Benefits Security
Administration.
Line 14f. You must check ‘‘Yes’’ if any
benefits due under the plan were not timely
paid or not paid in full. Include in this
amount the total of any outstanding amounts
that were not paid when due in previous
years that have continued to remain unpaid.
Line 14g. Code section 401(k) and other
individual account pension plans must
complete Line 10h. Other filers should leave
Line 10h blank. Check ‘‘Yes’’ if there was a
‘‘blackout period.’’ A blackout period is a
temporary suspension of more than three
consecutive business days during which
participants or beneficiaries of a 401(k) or
other individual account pension plan were
unable, or were limited or restricted in their
ability, to direct or diversify assets credited
to their accounts, obtain loans from the plan,
or obtain distributions from the plan. A
‘‘blackout period’’ generally does not include
a temporary suspension of the right of
participants and beneficiaries to direct or
diversify assets credited to their accounts,
obtain loans from the plan, or obtain
distributions from the plan if the temporary
suspension is: (1) part of the regularly
scheduled operations of the plan that has
been disclosed to participants and
beneficiaries; (2) due to a qualified domestic
relations order (QDRO) or because of a
pending determination as to whether a
domestic relations order is a QDRO; (3) due
to an action or a failure to take action by an
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individual participant or because of an action
or claim by someone other than the plan
regarding a participant’s individual account;
or (4) by application of federal securities
laws. For more information, see the DOL’s
regulation at 29 CFR 2520.101–3 (available at
www.dol.gov/ebsa).
Line 14h. Code section 401(k) and other
individual account pension plans who
answered ‘‘Yes’’ to Line 14h must complete
Line 14i. Other filers should leave Line 14i
blank. If there was a blackout period, did you
provide the required notice not less than 30
days nor more than 60 days in advance of
restricting the rights of participants and
beneficiaries to change their plan
investments, obtain loans from the plan, or
obtain distributions from the plan? If so,
check ‘‘Yes.’’ See 29 CFR 2520.101–3 for
specific notice requirements and for
exceptions from the notice requirement.
Also, answer ‘‘Yes’’ if one of the exceptions
to the notice requirement under 29 CFR
2520.101–3 applies.
Line 14i. Disclosures for ParticipantDirected Accounts. All individual account
plans that provide for participant-direction
must provide specified disclosures under 29
CFR 2550.404a–5 with respect to each
participant or beneficiary that, pursuant to
the terms of the plan, has the right to direct
the investment of assets held in, or
contributed to, his or her individual account.
Included in the required disclosures is a
comparison chart. If subject to the disclosure
requirements under 29 CFR 2550.404a–5,
answer ‘‘Yes’’ and attach to your Form 5500–
SF, a copy of the comparison chart for the
plan year.
Line 14j. If you answered ‘‘Yes’’ to Line
14j, check the box to indicate whether the
plan provide participants and beneficiaries
the plan and investment disclosures required
under 29 CFR 2550.404a–5(d)(2) and, if you
answered ‘‘Yes,’’ attach the comparison
chart(s) provided to participants and
beneficiaries.
Line 14k. If you answered ‘‘Yes,’’ to Line
14j, enter the number of designated
investment alternatives (DIAs) available
under the plan and indicate the number of
DIAs that are index funds.
Line 14l. If you answered ‘‘Yes,’’ to Line
14j, check the appropriate box to indicate
whether the plan made available to
participants and beneficiaries a designated
investment manager (DIM). If you answered
‘‘Yes,’’ enter name of DIM.
Line 14m. Check ‘‘Yes,’’ if the plan make
available to participants and beneficiaries
any brokerage window, self-directed
brokerage account or similar plan
arrangements that enabled participants to
select investments beyond those designated
by the plan. If you answered ‘‘Yes’’ to Line
14n, enter the number of participants that
utilized the account or arrangement.
Line 14n. Unrelated Business Taxable
Income. Unrelated business taxable income
generally means the gross income derived
from any unrelated trade or business (as
defined in Code section 513) regularly
conducted and not substantially related to
the plan’s exempt purpose under Code
section 512, less the deductions directly
connected with carrying on the trade or
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business. See IRS Publication 598 for more
information. Check ‘‘N/A’’ if this plan does
not have a trust, such as 412(e)(3) fully
insured plans or certain 403(b) annuity plans.
Plans that check ‘‘Yes’’ must enter any
amount of unrelated business taxable
income. Form 990–T, Exempt Organization
Business Income Tax Return, is required to
be filed for any gross income of $1000 or
more generated by an employer’s trust by the
15th day of the 4th month following the end
of the trust’s tax year. See Instructions to
Form 990–T for more details.
Line 14o. Check ‘‘Yes’’ if an employer
sponsoring the plan pays any of the
administrative expenses of the plan that were
not reported on Line 10g.
Line 14p. Check ‘‘Yes’’ if any person who
is disqualified under ERISA Section 411,
served or was permitted to serve the plan in
any capacity. Section 411 of ERISA
establishes a bar against certain persons
serving as employee benefit plan fiduciaries
or service providers because they have been
convicted of any of a broad range of specified
crimes. Prohibited positions and activities
include consultants and advisers to plans
and any entity whose activities are in whole
or substantial part devoted to providing
goods or services to employee benefit plans.
As amended by the Comprehensive Crime
Control Act of 1984, section 411 of ERISA
prohibits such persons from serving plans for
a period of thirteen years after such judgment
or the end of imprisonment resulting from a
disqualifying conviction, whichever is later,
unless the sentencing court, under
appropriate circumstances, has reduced the
period of prohibition to not less than three
years or has determined that service in any
of the prohibited capacities would not be
contrary to the purposes of ERISA. The
prohibition takes effect upon the date of
conviction (the date of entry of judgment by
the trial court) or the end of imprisonment,
whichever is later.
Line 14q. Check ‘‘Yes’’ if the plan sponsor
or its affiliates provide any services to the
plan in exchange for direct or indirect
compensation.
Line 14r. Termination of Service
Providers. Identify any service providers that
have been terminated for a material failure to
meet the terms of a service arrangement or
failure to comply with Title I of ERISA,
including the failure to provide required
disclosures under 29 CFR 2550.408b–2. If the
reason for termination was the failure to
provide required disclosures under 29 CFR
2550.408b–2, in addition to providing an
explanation in (6), check the box in element
(7).
Line 14s. See 29 CFR 2520.102–2 and
2520.102–3 for style, format, and content
requirements for summary plan descriptions.
For distribution requirements see 29 CFR
2520.104b.
Line 14t. Defined contribution pension
plans must complete Line 14t. For purposes
of Line 14t, an uncashed check is one that
is no longer negotiable or is subject to limited
payability. Check ‘‘Yes,’’ if there were any
uncashed checks as of the end of the plan
year. If ‘‘Yes,’’ indicate the number of checks
that were uncashed at the end of the plan
year and the total value of the checks. Briefly
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describe the procedures followed by the plan
to verify a participant’s or beneficiary’s
address before a check was mailed. Plans
must ensure that they use measures
reasonably calculated to ensure actual receipt
of materials by plan participants and
beneficiaries, which would include
procedures to keep track of participants’ and
beneficiaries’ current mailing addresses so
that information is less likely to be mailed to
a bad address. See CFR 2520.104b–1(b). Also,
briefly describe the procedures followed by
the plan to address the uncashed checks,
including steps to locate ‘‘lost participants.’’
Plans should have procedures to keep track
of uncashed checks. The procedures for
ongoing plans should include procedures for
locating ‘‘missing’’ participants. Plans may
use the steps described in FAB 2014–01 to
search for missing participants or
beneficiaries, which may be helpful in
particular where a check was returned as
‘‘undeliverable.’’ The procedures should also
include a method by which plan fiduciaries
keep track or are made aware of the number
of uncashed checks and the amount
involved. Such procedures could include
contractually requiring any third party
administrators to keep the plan administrator
regularly informed of uncashed checks. For
missing participant and beneficiary searches
and distributions from terminating defined
contribution pension plans, see 29 CFR
2550.404a–3; DOL Field Assistance Bulletin
2014–01 (Aug. 14, 2014).
Part VI—Pension Funding Compliance
Complete Part VI only if the plan is subject
to the minimum funding requirements of
Code section 412 or ERISA section 302.
All qualified defined benefit and defined
contribution pension plans are subject to the
minimum funding requirements of Code
section 412 unless they are described in the
exceptions listed under Code section
412(e)(2). These exceptions include profitsharing or stock bonus plans, insurance
contract plans described in Code section
412(e)(3), and certain plans to which no
employer contributions are made.
Nonqualified employee pension benefit
plans are subject to the minimum funding
requirements of ERISA section 302 unless
specifically exempted under ERISA sections
4(a) or 301(a).
The employer or plan administrator of a
single-employer or multiple-employer
defined benefit pension plan that is subject
to the minimum funding requirements must
file the Schedule SB (Form 5500) as an
attachment to the Form 5500–SF. The
employer or plan administrator of a money
purchase plan that is currently amortizing a
waiver of the minimum funding
requirements must complete Lines 3, 9, and
10 of the Schedule MB (Form 5500) and file
it as an attachment to the Form 5500–SF.
Line 15. If ‘‘Yes’’ is checked, attach a
completed and signed Schedule SB (Form
5500), and complete Line 15a. See the
instructions for the Schedule SB in the
Instructions for Form 5500. If this is a
defined contribution pension plan, leave
blank.
Line 15a. Enter the amount from Line 40
of Schedule SB (Form 5500).
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Line 16. Check the ‘‘Yes’’ box if the plan
is a defined contribution pension plan
subject to the minimum funding
requirements of Code section 412 and ERISA
section 302. Those money purchase plans
(including target benefit plans) that are
amortizing a waiver of the minimum funding
standard for a prior year should fill out Line
16a and then skip to Line 17. Those defined
contribution pension plans answering ‘‘Yes’’
to the Line 15 question that do not fill out
Line 16a should fill out Lines 16b–16e.
Line 16a. If a money purchase defined
contribution pension plan (including a target
benefit plan) has received a waiver of the
minimum funding standard, and the waiver
is currently being amortized, complete Lines
3, 9, and 10 of Schedule MB (Form 5500). See
instructions for Schedule MB in the
Instructions for Form 5500 Annual Return/
Report. The Schedule MB for a money
purchase defined contribution pension plan
does not need to be signed by an enrolled
actuary.
Line 16b. The minimum required
contribution for a money purchase defined
contribution pension plan (including a target
benefit plan) for a plan year is the amount
required to be contributed for the year under
the formula set forth in the plan document.
If there is an accumulated funding deficiency
for a prior year that has not been waived, that
amount should also be included as part of the
contribution required for the current year.
Line 16c. Include all contributions for the
plan year made not later than 81⁄2 months
after the end of the plan year. Show only
contributions actually made to the plan by
the date the form is filed. For example, do
not include receivable contributions for this
purpose
Line 16d. If the minimum required
contribution exceeds the contributions for
the plan year made not later than 81⁄2 months
after the end of the plan year, the excess is
an accumulated funding deficiency for the
plan year. File IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit
Plans, with the IRS to pay the excise tax on
the deficiency. There is a penalty for not
filing Form 5330 on time.
Line 16e. Check ‘‘Yes’’ if the minimum
required contribution remaining in Line 15d
will be made not later than 81⁄2 months after
the end of the plan year. If ‘‘Yes,’’ and
contributions are actually made by this date,
then there will be no reportable deficiency
and IRS Form 5330 will not need to be filed.
Part VII—Plan Terminations and Transfers
of Assets
Line 17a. Check ‘‘Yes’’ if a resolution to
terminate the plan was adopted during this
or any prior plan year, unless the termination
was revoked and no assets reverted to the
employer. If ‘‘Yes’’ is checked, enter in Line
17a(1) the effective date of plan termination,
enter in Line 18a(2) the plan year in which
assets were distributed to participants and
beneficiaries (including insurance/annuity
contracts) and enter in Line 17a(3) the
amount of plan assets that reverted to the
employer during the plan year in connection
with the implementation of such termination.
Enter ‘‘0’’ if no reversion occurred during the
current plan year.
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Line 17b. Transfer to other plans. If the
plan transferred assets or liabilities to
another plan since the date of the most recent
filing, report the EIN and PN of the plan to
which the assets and liabilities were
transferred (i.e., the ‘‘transferee plan’’). In
addition, report the date of the transfer and
check the box that best describes the type of
transfer (see Definitions below). Do not use
a social security number in lieu of an EIN or
include an attachment that contains visible
social security numbers. The Form 5500–SF
is open to public inspection, and the contents
are public information and are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof on
this Schedule H or the inclusion of a visible
social security number or any portion thereof
on an attachment may result in the rejection
of the filing.
Note. A distribution of all or part of an
individual participant’s account balance that
is reportable on Form 1099–R should not be
included on Line 17b. Do not submit Form
1099–R with the Form 5500 Annual Return/
Report.
IRS Form 5310–A, Notice of Plan Merger
or Consolidation, Spinoff, or Transfer of Plan
Assets or Liabilities; Notice of Qualified
Separate Lines of Business, may be required
to be filed at least 30 days before any plan
merger or consolidation or any transfer of
plan assets or liabilities to another plan.
There is a penalty for not filing IRS Form
5310–A on time. In addition, a transfer of
benefit liabilities involving a plan covered by
PBGC insurance may be reportable to the
PBGC. See PBGC Form 10, Post-Event Notice
of Reportable Events, and PBGC Form 10Advance, Advance Notice of Reportable
Events.
Line 17c. Transfer from other plans. If
another plan transferred assets or liabilities
to this plan since the date of the most recent
filing, report the EIN and PN of sponsor of
the plan from which the assets and liabilities
were transferred (i.e., the ‘‘transferor plan’’),
the date of the transfer, and the box that best
describes tot type of transfer.
‘‘Consolidation’’ means a transaction in
which two or more plans transfer all of their
assets and liabilities to a new plan and, as
a result, cease to exist (because the transferor
plans become part of the new transferee
plan). It differs from a Merger because in a
Merger, the transferee plan existed before the
transaction. In a consolidation, the transferee
plan is a new plan that is created in the
Consolidation. Thus, the plan that exists after
the Consolidation follows the PBGC premium
filing rules for new plans.
‘‘Merger’’ means a transaction I which one
or more plans transfer all of their assets and
liabilities to an existing plan and, as a result,
cease to exist (because the transferor plan(s)
become part of the transferee plan). It differs
from a Consolidation because in a
Consolidation, the transferee plan did not
exist before the transaction. In a Merger, the
transferee plan is an existing plan and
follows the rules for a preexisting, ongoing
plan.
‘‘Spinoff’’ means a transaction in which the
transferor plan transfers only part of its assets
and/or liabilities to the transferee plan. The
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transferee plan may be a new plan that is
created in the Spinoff, or it may be a
preexisting plan that simply receives part of
the assets or liabilities of the transferor plan.
Note: If Final Return/Report is checked on
the Form 5500 or Form 5500–SF, information
should be entered an at least one of Lines
17a, 17b, or 17c. Participant-directed
transfers do not need to be reported on Line
17c. If you reported transfers of assets and
liabilities to this plan on Line 10k,
information should be entered in Line 17d.
Line 17d. Defined Contribution Pension
Plan—Transfers to financial institution. If
the filer is a defined contribution pension
plan, indicate whether, as part of the
procedures for terminating the plan,
transferred plan assets to a financial
institution(s), establishing interest bearing
federally insured bank accounts in the name
of missing participants in connection with
terminating the plan. If ‘‘Yes,’’ complete
elements (1)–(5). List each financial
institution where plan assets were transferred
and continue reporting until the plan
terminates and the final return/report is filed.
For more information on making provisions
for lost or missing participants, see DOL
Field Assistance Bulletin 2014–01.
Part VIII—Trust Information
Line 18a. Enter the ‘‘Name of trust.’’ If a
plan uses more than one trust or custodial
account for its fund, you should enter the
primary trust or custodial account in which
the greatest dollar amount or largest
percentage of the plan assets as of the end of
the plan year is held on this line. For
example, if a plan uses three different trusts,
X, Y, Z, with the percentages of plan assets,
35%, 45%, and 20%, respectively, trust Y
that held the 45% of plan assets would be
entered in Line 18a.
Line 18b. Enter the ‘‘Trust’s Employer
Identification Number (EIN)’’ assigned to the
employee benefit trust or custodial account,
if one has been issued to you. The trust EIN
should be used for transactions conducted for
the trust. If you do not have a trust EIN, enter
the EIN you would use on Form 1099–R,
Distributions From Pensions, Annuities,
Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc., to report
distributions from employee benefit plans
and on Form 945, Annual Return of Withheld
Federal Income Tax, to report withheld
amounts of income tax from those payments.
Do not use a social security number in lieu
of an EIN. Form 5500 and its attachments are
open to public inspection, and the contents
are public information and are subject to
publication on the Internet. Because of
privacy concerns, the inclusion of a social
security number or any portion thereof may
result in the rejection of the filing.
Trust EINs can be obtained from the IRS by
applying for one on Form SS–4, Application
for Employer Identification Number. See
Instructions to Line 2b (Form 5500) for
applying for an EIN. Also see IRS EIN
application link page for further information.
Line 18c. Enter the name of the plan
trustee or custodian.
Line 18d. Enter the telephone number for
the plan trustee or custodian.
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Part IX—IRS Compliance Questions [New]
Note. If you are required to file an annual
return of employee benefit plans under Code
section 6058, you must complete this part
from Lines 18 through 24, unless you are
required to file fewer than 250 returns of any
type with the IRS, including information
returns (for example, Forms W–2 and Forms
1099), income tax returns, employment tax
returns, and excise tax returns during the
calendar year, then you can alternatively file
Form 5500–SUP with the IRS on paper. See
the Treasury regulations on ‘‘Employee
Retirement Benefit Plan Returns Required on
Magnetic Media’’ (See T.D. 9695, 79 FR
58256 at https://federalregister.gov/a/201423161) and Instructions for Form 5500–SUP
for more information.
Line 19a. Check ‘‘Yes’’ if the plan includes
a cash or deferred arrangement (CODA),
under which a covered employee may elect
to have the employer either contribute an
amount to the plan’s trust on behalf of the
employee or to pay the employee directly in
cash or some other taxable benefit. The
contributions go into an individual account,
with the employee often choosing the
investments based on options provided
under the plan. In some plans, the employer
also makes contributions, such as
contributions that match the employee’s
contributions up to a certain percentage.
Line 19b.
If Line 19a is ‘‘Yes,’’ check the applicable
method used to satisfy the nondiscrimination
requirements of Code section 401(k). A safe
harbor 401(k) plan is similar to a traditional
401(k) plan but, among other things, it must
provide for employer contributions. These
contributions may be employer matching
contributions, limited to employees who
defer, or employer contributions made on
behalf of all eligible employees, regardless of
whether they make elective deferrals. The
safe harbor 401(k) plan is not subject to the
complex annual nondiscrimination tests that
apply to traditional 401(k) plans. Check
‘‘Design-based safe harbor method’’ if this is
a safe harbor 401(k) plan that is a SIMPLE
401(k) plan under Code section 401(k)(11), a
safe harbor 401(k) plan under Code section
401(k)(12), or a qualified automatic
contribution arrangement under Code section
401(k)(13).
If the plan, by its terms, does not satisfy
the safe harbor method, it generally must
satisfy the regular nondiscrimination test,
known as the actual deferral percentage
(ADP) test. Check the appropriate box to
indicate if the plan uses the ‘‘current year’’
ADP test or the ‘‘prior year’’ ADP test. Check
‘‘current year’’ ADP test if the plan uses the
current year testing method under which the
ADP test is performed by comparing the
current plan year’s ADP for HCEs with the
current plan year’s (rather than the prior plan
year’s) ADP for NHCEs. Check all boxes that
apply for a plan that tests different groups of
employees on a disaggregated basis. Check
‘‘N/A’’ if the plan is not required to test for
nondiscrimination under Code section
401(k)(3), such as a plan in which no HCE
is benefitting.
Line 20a. Check the applicable testing
method used to satisfy the minimum
coverage requirements under Code section
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410(b). Check ‘‘N/A’’ if the plan is deemed
to satisfy section 410(b) automatically, such
as a plan in which no HCE is benefitting.
Check all boxes that apply for a plan that
tests different groups of employees on a
disaggregated basis.
Line 20b. Check ‘‘Yes’’ if this plan was
permissively aggregated with another plan to
satisfy requirements under Code sections
410(b) and 401(a)(4). Generally, each single
plan must separately satisfy the coverage and
nondiscrimination requirements. However,
an employer may designate two or more
separate plans as a single plan for purposes
of applying the ratio percentage test of
Treasury Regulations section 1.410(b)–2(b)(2)
or the nondiscretionary classification test of
Treasury Regulations section 1.401(b)–4. Two
or more plans that are permissively
aggregated and treated as a single plan for
purposes of the minimum coverage test of
Code section 410(b) must also be treated as
a single plan for purpose of the
nondiscrimination test under Code section
401(a)(4). See Treasury Regulations sections
1.410(b)–7 and 1.401(a)(4)–(9) for more
information.
Line 21. Check ‘‘Yes’’ if the plan does not
satisfy any exceptions under Treasury
Regulation section 1.401(a)26)–1(b) if it
benefitted at least the lesser of: 50 employees
of the employer, or the greater of: 40 percent
of all employees of the employer, or 2
employees (or if there is only 1 employee,
such employer). The definition of employer
includes all related employers under Code
sections 414(b), (c) or (m). In performing the
participation tests, the employees who are
excludable are generally the same as those
who are excludable for purposes of
performing coverage tests under Code section
410(b), see Treasury Regulation section
1.401(a)(26)–6. In addition, for most plans
the definition of who is benefiting under the
plan for the purposes of the participation
tests is the same as the definition of
benefiting employees for purposes of
coverage tests under Code section 410(b), see
Treasury Regulation section 1.401(a)(26)–5.
Line 22a. If a plan sponsor or an employer
adopted a pre-approved plan that includes a
master & prototype plan (a standardized or
nonstandardized M&P) or a volume submitter
plan, enter the date of the most recent
favorable opinion or advisory letter issued by
the IRS and the serial number listed on that
favorable letter.
Line 22b. If it is an individually-designed
plan and received a favorable determination
letter from the IRS, enter the date of the most
recent determination letter. Leave it blank if
this individually-designed plan has never
received a favorable determination letter.
Line 23a. A section 401(k) plan may (in
accordance with the plan document) allow
participants to receive hardship distributions
under Code section 401(k)(2)(B)(i)(IV). A
distribution from a participant’s elective
deferral account can only be made if the
distribution is because of an immediate and
heavy financial need, and the amount should
be limited to what is necessary to satisfy that
financial need. Hardship withdrawals are
subject to income taxes and a 10% additional
tax on distributions before age 591⁄2’’.
Employees who take a hardship distribution
cannot repay it to the plan.
PO 00000
Frm 00148
Fmt 4701
Sfmt 4702
Line 23b. This is for a defined benefit plan
or a money purchase pension plan only.
Check ‘‘Yes’’ if the plan made any
distributions during the plan year to
employees who have attained age 62 and
who were not separated from service when
the distributions were made, as permitted
under Code section 401(a)(36).
Note. Any distribution above made prior to
age 591⁄2 would be subject to an additional
10% tax under Code section 72(t).
Line 24. Check ‘‘Yes’’ if required minimum
distributions were made to 5% owners who
attained age 701⁄2 and older. Required
Minimum Distributions (RMDs) generally are
minimum amounts that a retirement plan
account owner must withdraw annually
starting with the year that he or she reaches
701⁄2 years of age or, if later, the year in
which he or she retires. However, if the
account owner is a 5% owner of the business
sponsoring the retirement plan, the RMDs
must begin once the account holder is age
701⁄2, regardless of whether he or she is
retired.
Line 25. Check ‘‘Yes’’ if the plan has
ceased employer and/or employee
contributions and prohibited entry by new
participants.
ERISA Compliance Quick Checklist
Compliance with the Employee Retirement
Income Security Act (ERISA) begins with
knowing the rules. Plan administrators and
other plan officials can use this checklist as
a quick diagnostic tool for assessing a plan’s
compliance with certain important ERISA
rules; it is not a complete description of all
ERISA’s rules and it is not a substitute for a
comprehensive compliance review. Use of
this checklist is voluntary, and it is not be
filed with your Form 5500–SF.
If you answer ‘‘No’’ to any of the questions
below, you should review your plan’s
operations because you may not be in full
compliance with ERISA’s requirements.
1. Have you provided plan participants
with a summary plan description, summaries
of any material modifications of the plan, and
annual summary financial reports or annual
pension funding reports?
2. Do you maintain copies of plan
documents at the principal office of the plan
administrator for examination by participants
and beneficiaries?
3. Do you respond to written participant
inquires for copies of plan documents and
information within 30 days?
4. Does your plan include written
procedures for making benefit claims and
appealing denied claims, and are you
complying with those procedures?
5. Is your plan covered by fidelity bonds
protecting the plan against losses due to
fraud or dishonesty by persons who handle
plan funds or other property?
6. Are the plan’s investments diversified so
as to minimize the risk of large losses?
7. I f the plan permits participants to select
the investments in their plan accounts, has
the plan provided them with enough
information to make informed decisions?
8. Has a plan official determined that the
investments are prudent and solely in the
interest of the plan’s participants and
beneficiaries, and evaluated the risks
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associated with plan investments before
making the investments?
9. Did the employer or other plan sponsor
send participant contributions to the plan on
a timely basis?
10. Did the plan pay participant benefits on
time and in the correct amounts?
11. Did the plan give participants and
beneficiaries 30 days advance notice before
imposing a ‘‘blackout period’’ of at least three
consecutive business days during which
participants or beneficiaries of a 401(k) or
other individual account pension plan were
unable to change their plan investments,
obtain loans from the plan, or obtain
distributions from the plan?
If you answer ‘‘Yes’’ to any of the
questions below, you should review your
plan’s operations because you may not be in
full compliance with ERISA’s requirements.
1. Has the plan engaged in any financial
transactions with persons related to the plan
or any plan official? (For example, has the
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plan made a loan to or participated in an
investment with the employer?)
2. Has the plan official used the assets of
the plan for his/her own interest?
3. Have plan assets been used to pay
expenses that were not authorized in the plan
document, were not necessary to the proper
administration of the plan, or were more than
reasonable in amount?
If you need help answering these questions
or want additional guidance about ERISA
requirements, a plan official should contact
the U.S. Department of Labor Employee
Benefits Security Administration office in
your region or consult with the plan’s legal
counsel or professional employee benefit
advisor.
Statutory Authority
Accordingly, pursuant to the authority in
sections 101, 103, 104, 109, 110 and 4065 of
ERISA and sections 6058 and 6059 of the
Code, the Form 5500 Annual Return/Report
PO 00000
Frm 00149
Fmt 4701
Sfmt 9990
47681
and the instructions thereto are proposed to
be amended as set forth herein.
Signed at Washington, DC, this 20th day of
June 2016.
Phyllis C. Borzi,
Assistant Secretary, Employee Benefits
Security Administration, U.S. Department of
Labor.
Signed at Washington, DC, this 20th day of
June 2016.
Robert S. Choi, Director,
Employee Plans, Tax Exempt and
Government Entities Division, Internal
Revenue Service.
Signed at Washington, DC, this 20th day of
June 2016.
W. Thomas Reeder,
Director, Pension Benefit Guaranty
Corporation.
[FR Doc. 2016–14893 Filed 7–11–16; 4:15 pm]
BILLING CODE 4510–29–P
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[Federal Register Volume 81, Number 140 (Thursday, July 21, 2016)]
[Proposed Rules]
[Pages 47533-47681]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-14893]
[[Page 47533]]
Vol. 81
Thursday,
No. 140
July 21, 2016
Part III
Department of Labor
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Employee Benefits Security Administration
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29 CFR Parts 2520 and 2590Department of Treasury
Internal Revenue Service
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26 CFR Part 301 Pension Benefit Guaranty Corporation
29 CFR Part 4065
Proposed Revision of Annual Information Return/Reports; Proposed Rules
Federal Register / Vol. 81 , No. 140 / Thursday, July 21, 2016 /
Proposed Rules
[[Page 47534]]
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DEPARTMENT OF LABOR
Employee Benefits Security Administration
29 CFR Parts 2520 and 2590
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 301
PENSION BENEFIT GUARANTY CORPORATION
29 CFR Part 4065
RIN 1210-AB63
Proposed Revision of Annual Information Return/Reports
AGENCY: Employee Benefits Security Administration, Labor, Internal
Revenue Service, Treasury, Pension Benefit Guaranty Corporation.
ACTION: Notice of proposed forms revisions.
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SUMMARY: This document contains proposed changes to the Form 5500
Annual Return/Report forms, including the Form 5500, Annual Return/
Report of Employee Benefit Plan (Form 5500 Annual Return/Report), and
the Form 5500-SF, Short Form Annual Return/Report of Small Employee
Benefit Plan (Form 5500-SF). The annual returns/reports are filed for
employee pension and welfare benefit plans under the Employee
Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue
Code (Code). The proposed revisions in this Notice reflect efforts of
the Department of Labor, the Internal Revenue Service, and the Pension
Benefit Guaranty Corporation (collectively Agencies) to improve
employee benefit plan reporting for filers, the public, and the
Agencies by modernizing financial information filed regarding plans;
updating fee and expense information on plan service providers with a
focus on harmonizing annual reporting requirements with the Department
of Labor's final disclosure requirements enhancing mineability of data
filed on annual return/reports; requiring reporting by all group health
plans covered by Title I of ERISA, including adding a new Schedule J
(Group Health Plan Information); and improving compliance under ERISA
and the Code through selected new questions regarding plan operations,
service provider relationships, and financial management of the plan.
These revisions, which are being proposed in conjunction with a
recompete of the ERISA Filing and Acceptance System (EFAST2) contract,
if adopted, generally would apply for plan years beginning on or after
January 1, 2019. EFAST2 is expected to begin processing the Plan Year
2019 Form 5500 Annual Return/Report beginning January 1, 2020. The
proposed revisions would affect employee pension and welfare benefit
plans, plan sponsors, administrators, and service providers to plans
subject to annual reporting requirements under ERISA and the Code.
DATES: Written comments must be received by the Department of Labor on
or before October 4, 2016.
ADDRESSES: To facilitate the receipt and processing of written comment
letters on the proposed regulation, EBSA encourages interested persons
to submit their comments electronically. You may submit comments,
identified by RIN 1210-AB63, by any of the following methods:
Federal eRulemaking Portal: https://www.regulations.gov.
Follow instructions for submitting comments.
Email: e-ORI@dol.gov. Include RIN 1210-AB63 in the subject line of
the message.
Mail: Office of Regulations and Interpretations, Employee Benefits
Security Administration, Attn: RIN 1210-AB63; Annual Reporting and
Disclosure, Room N-5655, U.S. Department of Labor, 200 Constitution
Avenue NW., Washington, DC 20210.
Hand Delivery/Courier: Office of Regulations and Interpretations,
Employee Benefits Security Administration, Attn: RIN 1210-AB63; Annual
Reporting and Disclosure, Room N-5655, U.S. Department of Labor, 200
Constitution Avenue NW., Washington, DC 20210.
Instructions: All comments received must include the agency name
and Regulatory Identifier Number (RIN) for this rulemaking (RIN 1210-
AB63). Persons submitting comments electronically are encouraged not to
submit paper copies. All comments received will be made available to
the public, posted without change to https://www.regulations.gov and
https://www.dol.gov/ebsa, and made available for public inspection at
the Public Disclosure Room, N-1513, Employee Benefits Security
Administration, U.S. Department of Labor, 200 Constitution Avenue NW.,
Washington, DC 20210, including any personal information provided.
FOR FURTHER INFORMATION CONTACT: Mara S. Blumenthal, Employee Benefits
Security Administration (EBSA), U.S. Department of Labor, (202) 693-
8523, for questions relating to changes to the Form 5500, Form 5500-SF,
Schedules A, C, D, G, and H, as well as the general reporting
requirements under Title I of ERISA; Suzanne Bach, EBSA, U.S.
Department of Labor, 202-693-8440, for questions relating to the
collection of group health plan information; Leslie Larson, Internal
Revenue Service (IRS), at the IRS taxpayer assistance answering service
at 1-877-829-5500 (a toll-free number), for questions relating to
Schedule R, Schedule E, as well as the general reporting requirements
under Internal Revenue Code (Code); Steven Klubock, IRS, at 1-877-829-
5500, for IRS questions relating to the Schedules MB and SB; and Grace
Kraemer or Theresa Anderson, Pension Benefit Guaranty Corporation
(PBGC), (202) 326-4000 for questions relating to Schedules MB and SB of
the Form 5500, and Lines 14 and 19 of Schedule R, as well as questions
relating to the general reporting requirements under Title IV of ERISA.
For further information on an item not mentioned above, contact Ms.
Blumenthal. The telephone numbers referenced above are not toll-free
numbers, except as otherwise provided.
Customer service information: Individuals interested in obtaining
information from the DOL concerning Title I of ERISA may call the EBSA
Toll-Free Hotline at 1-866-444-EBSA (3272) or visit the DOL's Web site
(www.dol.gov/ebsa).
SUPPLEMENTARY INFORMATION:
Sections 101 and 104 of Title I and section 4065 of Title IV of the
Employee Retirement Income Security Act of 1974 (ERISA) and sections
6057(b), 6058(a), and 6059(a) of the Internal Revenue Code of 1986
(Code), and related regulations, impose annual reporting and filing
obligations on pension and welfare benefit plans, as well as on certain
other entities. Plan administrators, employers, and others generally
satisfy these annual reporting obligations by filing the Form 5500,
Annual Return/Report of Employee Benefit Plan together with any
required schedules and attachments (Form 5500 Annual Return/Report), or
Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit
Plan (Form 5500-SF).\1\ Specifically, filing of the
[[Page 47535]]
Form 5500 or, for eligible filers the Form 5500-SF, with any required
schedules and attachments in accordance with the instructions and
related regulations, constitutes compliance under Title I of ERISA with
the applicable limited exemption, alternative method of compliance, and
simplified reporting prescribed in 29 CFR 2520.103-1, et seq. Such
filings will also satisfy an applicable plan administrator's annual
reporting obligation under section 4065 of Title IV of ERISA. Filing of
a Form 5500 or Form 5500-SF, together with the required attachments and
schedules in accordance with the instructions, by plan administrators,
employers, and certain other entities also satisfies the annual filing
and reporting requirements under Code sections 6057(b), 6058(a) and
6059(a).\2\
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\1\ Certain one-participant plans and foreign plans that are not
subject to the requirements of section 104(a) of ERISA are required
to file Form 5500-EZ with the IRS on paper, or voluntarily file
electronically using Form 5500-SF to satisfy certain annual
reporting and filing obligations imposed by the Code. Beginning with
the 2015 plan year, however, some filers are required to file their
annual returns electronically using Form 5500-SF instead of filing a
paper Form 5500-EZ if the filer is required to file at least 250
returns of any type with the IRS. See Treasury Regulations section
301.6058-2 for more information on mandatory electronic filing of
employee retirement benefit plan returns.
\2\ Some filing requirements under these provisions are not
within the scope of this Notice. For example, multiple employer
welfare arrangements and certain entities claiming exception are
required to file with the DOL the Form M-1 (Report for Multiple
Employer Welfare Arrangements (MEWAs) and Certain Entities Claiming
Exception (ECEs)).
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The Form 5500 Annual Return/Report serves as the principal source
of information and data available to the DOL, the IRS, and the PBGC
(collectively the Agencies) concerning the operations, funding, and
investments of approximately 806,000 pension and welfare benefit plans.
These plans cover roughly 143 million workers, retirees, and dependents
of private sector pension and welfare plans \3\ with estimated assets
of $8.7 trillion.\4\ Accordingly, the Form 5500 Annual Return/Report is
essential to each Agency's enforcement, research, and policy
formulation programs. They are also an important source of information
and data for use by other federal agencies, Congress, and the private
sector in assessing employee benefit, tax, and economic trends and
policies. The Form 5500 Annual Return/Report also serves as the primary
means by which the operations of plans can be monitored by plan
participants and beneficiaries and by the general public.
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\3\ Source: U.S. Department of Labor, EBSA calculations using
the March 2014 Current Population Survey Annual Social and Economic
Supplement and the 2013 Medical Expenditure Panel Survey.
\4\ EBSA projected ERISA covered pension, welfare, and total
assets based on the 2013 Form 5500 Annual Return/Report filings with
the U.S. Department of Labor (DOL), reported SIMPLE assets from the
Investment Company Institute (ICI) Report: The U.S. Retirement
Market, Second Quarter 2015, and the Federal Reserve Statistical
Release Z.1 Financial Accounts of the United States (Sept. 18,
2015).
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Generally, the Agencies have conducted a notice and comment
rulemaking initiative to implement significant overhauls of the
structure of the forms and schedules coincident with changes to the
EFAST system. Past revisions to the forms and schedules have addressed
changes to applicable law, changes in employee benefit plans and
financial markets, and corresponding shifts in agency priorities and
needs. The Agencies have also made changes to reduce costs and make
filing and processing more efficient. In interim years, the Agencies
have made other discrete changes as set forth annually in the ``Changes
to Note'' section in the instructions, some of which have involved
targeted rulemaking activity to implement reporting changes required by
law.\5\ The Agencies' last major tri-agency revision to the Form 5500
Annual Return/Report was proposed in 2006, 71 FR 41615 (Jul. 21, 2006),
and finalized in 2007, effective for the 2009 form series. 72 FR 64731
(Nov. 16, 2007).
---------------------------------------------------------------------------
\5\ See, e.g., Revisions to Annual Return/Report--Multiple-
Employer Plans, Interim Final Rule, 79 FR 66617 (Nov. 10, 2014);
Filings Required of Multiple Employer Welfare Arrangements and
Certain Other Related Entities, Final Rule, 78 FR 13781 (Mar. 1,
2013).
---------------------------------------------------------------------------
This forms revision proposal generally is being coordinated with a
recompete of the contract for the ERISA Filing Acceptance System II
(EFAST2)--the wholly electronic system operated by a private-sector
contractor for the processing of Form 5500 Annual Return/Report. The
majority of proposed forms revisions are currently targeted for
implementation in the Plan Year 2019 Form 5500 Annual Return/Report.
Development of EFAST changes pursuant to a new contract could begin in
spring 2018, with processing under the new contract starting on January
1, 2020. However, this planned implementation timeline may be impacted
if there are modifications to the recompete contract acquisition plan.
As a result, some forms revisions may be implemented in earlier or
later form years, including but not limited to the IRS and PBGC changes
for 2016 as shown in the proposed data elements in Appendix A. To the
extent changes are made separately from a more general implementation
of the proposed revisions, the Agencies will seek appropriate clearance
under the Paperwork Reduction Act of 1995 (PRA) to implement the
changes in connection with any given year's forms.
The Agencies expect that the EFAST2 recompete would continue to
deliver a user-friendly Web site, filing applications and web services,
and contact center services similar to what is currently being
provided. The existing EFAST2 web-based filing search application is
expected to be enhanced and provided by EBSA. The Agencies expect that
EFAST2 would continue to have the same or improved functionality and
web services and is expected primarily to rely on existing EFAST2
software, components and logic. EFAST2 would continue to include a
user-friendly web portal that provides registration, filing submission,
filing acceptance, filing data dissemination, and help desk services.
As part of the comprehensive review of how well the Form 5500
Annual Return/Report serves to implement the existing employee benefit
plan filing requirements under Titles I and IV of ERISA and under the
Code, the Agencies have considered intervening changes to the legal and
regulatory environment for employee benefit plans, plan sponsors, plan
service providers and others since the last major revision of the Form
5500 Annual Return/Report. This includes implementation of the Dodd-
Frank Wall Street Reform and Consumer Protection Act, Public Law 111-
203, 124 Stat. 1376, (Jul. 21, 2010); statutory changes to ERISA and
the Code relating to defined benefit pension plans in the Moving Ahead
for Progress in the 21st Century Act (MAP 21) (Pub. L. 112-141); the
Cooperative and Small Employer Charity Pension Flexibility Act (CSEC
Act) (Pub. L. 113-98); the Highway and Transportation Funding Act
(HATFA) (Pub. L. 113-159); the Multiemployer Pension Reform Act of
2014, Division O of the Consolidated and Further Continuing
Appropriations Act, 2015, (Pub. L. 113-235) (MPRA), and various
regulatory actions adopted by the Agencies since the last major changes
to the forms and instructions, including the DOL's final regulations at
29 CFR 2550.404a-5, 404c-5, and 408b-2.
In addition, the enactment of the Patient Protection and Affordable
Care Act (Affordable Care Act) \6\ expanded DOL's already growing
oversight responsibilities with respect to the provision of group
health benefits to workers in private sector employer-sponsored plans
that provide group health benefits (also referred to herein as ``group
health plans''). In that regard,
[[Page 47536]]
the DOL has re-evaluated the existing reporting scheme for group health
plans, which scheme was established well before the enactment of the
Health Insurance Portability and Accountability Act of 1996, Public Law
104-191, 110 Stat. 1936 (Aug. 21, 1996); Title I of the Genetic
Information Nondiscrimination Act of 2008, Public Law 110-233, 122
Stat. 881 (May 21, 2008); the Mental Health Parity Act of 1996, Public
Law 104-204, 110 Stat. 2944 (Sept. 26, 1996) and the Mental Health
Parity and Addiction Equity Act of 2008, Public Law 110-343, 122 Stat.
3881 (Oct. 3, 2008); the Newborns' and Mothers' Health Protection Act
of 1996, Public Law 104-204, 110 Stat. 2935 (Sept. 26, 1996); the
Women's Health and Cancer Rights Act of 1998, Public Law 105-277, 112
Stat. 2681-436 (Oct. 21, 1998); and Michelle's Law, Public Law 110-381,
122 Stat. 4081 (Oct. 9, 2008), as well as the Affordable Care Act.
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\6\ The Patient Protection and Affordable Care Act, Public Law
111-148, was enacted on March 23, 2010, and the Health Care and
Education Reconciliation Act of 2010, Public Law 111-152, was
enacted on March 30, 2010. These statutes generally are collectively
known as the ``Affordable Care Act.''
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After reviewing the existing reporting scheme and the DOL's
experience with oversight and enforcement, the DOL determined that, in
order for it to more effectively fulfill its responsibilities under the
expanded requirements under these laws, all plans that provide group
health benefits should be subject to some level of annual reporting,
with a focus on compliance issues. As described in more detail below,
under the proposal, those plans that provide group health benefits that
are already required to file a Form 5500 Annual Return/Report--
generally all large plans and small plans that are funded with a trust
or that are otherwise not eligible for the annual reporting relief for
unfunded and insured plans--would have to file group health plan
information on a new separate schedule (Schedule J (Group Health Plan
Information)), as well as complete those elements of the Form 5500 and
schedules that those plans are already required to complete, as
modified by this proposal. Plans that provide group health benefits
that have fewer than 100 participants currently exempt from filing an
annual report under 29 CFR 2520.104-20 because they are either
completely ``unfunded'' or partially insured and partially unfunded now
would be required to file a Form 5500 (except for those questions
applicable only to pension plans) and the new Schedule J. Under the
proposal, plans that provide group health benefits that have fewer than
100 participants that currently are exempt from annual reporting under
29 CFR 2520.104-20 because they are fully insured would be required to
file with answers to certain questions on the Form 5500 and the
Schedule J.
Certain information collection requirements imposed under the Code,
but not required under ERISA, had to be removed from the Form 5500
Annual Return/Report when DOL implemented its EFAST2 electronic filing
requirement beginning with the 2009 Form 5500 Annual Return/Report. The
Code did not permit the IRS to mandate electronic filing of ``IRS-
only'' components of the Form 5500 Annual Return/Report with respect to
filers of fewer than 250 returns, and regulations did not mandate such
electronic filing with respect to any filers. Specifically, Schedules
E, P, SSA, and T were not included in the 2009 Form 5500 Annual Return/
Report. Some of those information collection requirements can now be
added back to the Form 5500 Annual Return/Report. On September 29,
2014, the Treasury Department issued final regulations under Code
sections 6058 and 6059 mandating electronic filing of the Form 5500
Annual Return/Report (including actuarial schedules) for certain
filers. T.D. 9695, 79 FR 58256 (Sept. 29, 2014). In general, 26 CFR
301.6058-2 provides that, in order to satisfy the filing requirements
of Code section 6058, a Form 5500 Annual Return/Report must be filed
electronically if the filer is required to file at least 250 returns of
any type during the calendar year that includes the first day of the
applicable plan year. Similarly, 26 CFR 301.6059-2 provides in general
that, in order to satisfy the filing requirements of Code section 6059,
actuarial reports filed with a Form 5500 Annual Return/Report must be
filed electronically by filers required to file at least 250 returns
during that calendar year. The regulations are generally effective for
plan years beginning on or after January 1, 2015, but only for filings
with a filing deadline (not taking into account filing extensions)
after December 31, 2015.
Finally, the Agencies took into account recommendations in reports
from the Government Accountability Office (GAO), the DOL's Office of
Inspector General (DOL-OIG), the United States Treasury Inspector
General for Tax Administration (TIGTA), and the ERISA Advisory Council
that have been issued since the last major revision of the Form 5500
Annual Return/Report information collection requirements in connection
with the 2009 return/report. See, e.g., U.S. Gov't Accountability
Office, GAO-10-54, Private Pensions: Additional Changes Could Improve
Employee Benefit Plan Financial Reporting (2009) (available at
www.gao.gov/assets/300/298052.pdf); U.S. Gov't Accountability Office,
GAO-14-441, Private Pensions: Targeted Revisions Could Improve
Usefulness of Form 5500 Information (2014) (available at www.gao.gov/products/GAO-14-441); 2013 ERISA Advisory Council Report: Private
Sector Pension De-risking and Participant Protections, Dep't of Labor,
(available at www.dol.gov/ebsa/publications/2013ACreport2.html); Dep't
of Labor Office Of Inspector Gen., 05-14-003-12-12, EBSA Could Improve
Its Usage of Form 5500 Data (2014) (available at www.oig.dol.gov/public/reports/oa/2014/05-14-003-12-121.pdf); U.S. Gov't Accountability
Office, GAO-14-92, Private Pensions: Clarity of Required Reports and
Disclosures Could Be Improved (2013) (available at www.gao.gov/assets/660/659211.pdf); U.S. Gov't Accountability Office, GAO-14-92, Private
Pensions: Clarity Of Required Reports And Disclosures Could Be
Improved, Report to Congressional Requesters (2013) (available at
www.gao.gov/assets/660/659211.pdf); U.S. Dep't of Labor Office of
Inspector Gen., 09-13-001-12-121, Employee Benefits Security
Administration Needs to Provide Additional Guidance And Oversight to
ERISA Plans Holding Hard-to-Value Alternative Investments (2013)
(available at www.oig.dol.gov/public/reports/oa/2013/09-13-001-12-121.pdf); U.S. Gov't Accountability Office, GAO-12-665, Private Sector
Pensions: Federal Agencies Should Collect Data and Coordinate Oversight
of Multiple-employer Plans (2012) (available at www.gao.gov/assets/650/648285.pdf); U.S. Dep't of Labor Office Of Inspector Gen., 09-12-002-
12-121, Changes Are Still Needed In The ERISA Audit Process To Increase
Protections For Employee Benefit Plan Participants (2012) (available at
www.oig.dol.gov/public/reports/oa/2012/09-12-002-12-121.pdf); U.S.
Gov't Accountability Office, GAO-12-325, 401(K) Plans: Increased
Educational Outreach and Broader Oversight May Help Reduce Plan Fees
(2012) (available at www.gao.gov/products/GAO-12-325); U.S. Gov't
Accountability Office, GAO-08-692, Defined Benefit Plans: Guidance
Needed to Better Inform Plans of the Challenges and Risks of Investing
in Hedge Funds and Private Equity (2012) (available at www.gao.gov/products/GAO-08-692); Treasury Inspector Gen. for Tax Administration,
The Employee Plans Function Should Continue Its Efforts to Obtain
Needed Retirement Plan Information (2011) (available at
www.treasury.gov/tigta/auditreports/2011reports/
[[Page 47537]]
201110108fr.pdf); 2011 ERISA Advisory Council Report: Hedge Funds and
Private Equity Investments, Dep't of Labor, (available at www.dol.gov/ebsa/publications/2011ACreport3.html); 2013 ERISA Advisory Council
Report: Locating Missing and Lost Participants, Dep't of Labor,
(available at www.dol.gov/ebsa/publications/2013ACreport3.html#2); 2010
ERISA Advisory Council Report: Employee Benefit Plan Auditing and
Financial Reporting Models, Dep't of Labor, (available at www.dol.gov/ebsa/publications/2010ACreport2.html); 2008 ERISA Advisory Council
Report: Working Group on Hard-to-Value Assets and Target Date Funds,
Dep't of Labor, (available at www.dol.gov/ebsa/publications/2008ACreport1.html.)
The DOL also is publishing elsewhere in today's Federal Register a
Notice of Proposed Rulemaking with proposed amendments to the annual
reporting regulations at Part 2520 of Chapter XXV of Title 29 of the
Code of Federal Regulations to implement certain proposed Form 5500
Annual Return/Report changes under Title I of ERISA. To avoid
unnecessary duplication of effort, public comments submitted in
response to this Notice of Proposed Forms Revisions will be treated as
public comments on the Notice of Proposed Rulemaking to the extent they
include information relevant to the proposed regulatory amendments.
Although the Agencies' historical practice of undertaking major
updates of the Form 5500 Annual Return/Report generally has coincided
with the move to and upgrades of the EFAST processing system, the
Agencies also engage in an annual update process of the forms,
schedules, and instructions. Some annual changes that are anticipated
to be implemented by the IRS and the PBGC in connection with the 2016
plan year forms are discussed below. Those changes and other annual
updates have involved, or may in the future involve, separate public
notice and comment processes, for example, under the Paperwork
Reduction Act (PRA). The Agencies intend that any annual update changes
adopted during the pendency of the changes proposed in this Notice will
be incorporated into what is published as part of the Notice of Final
Forms Revisions as part of this process.\7\
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\7\ Minor changes not requiring notice and comment rulemaking or
system changes or changes required by enactment of new laws may also
be made between the publication of the Notice of Final Forms
Revisions and the date when the revised forms, schedules, and
instructions are available for e-filing through EFAST2.
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As with previous major forms revisions cycles, the Agencies
anticipate actively engaging in outreach and education regarding the
forms revisions well in advance of the plan year for which the majority
of the revisions would be effective.
II. Appendices
A. Data Elements for Forms and Schedules
Appendix A shows the questions/data elements that are on each form
and schedule in the line-by-line sequence the items would appear on
that form and schedule, as well as newly ``structured'' attachments,
rather than showing mock-ups of ``final'' forms, schedules, and
structured attachments. The Agencies expect that the final forms and
schedules will have substantially the same format as the existing forms
and schedules.\8\ The lists of data elements for each individual form,
schedule, and ``structured'' attachment to the Schedule H, show all of
the questions that would appear on that form, schedule, or attachment--
current questions, renumbered questions, revised questions, and new
questions. The data elements are numbered in the sequence that the
Agencies would expect to use in the final version of the forms and
schedules. Next to the data elements, the Agencies have, to the extent
feasible, indicated in brackets:
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\8\ The Agencies intend to publish mock-ups of the forms on the
DOL's Web site as part of the third party software developer
certification process and in furtherance of public education efforts
about the changes to be implemented.
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(1) ``[Current]'' if it is the same question with the same line
number on both the proposal and the current form or schedule; \9\
``[Current (2016)]'' indicates IRS changes and/or PBGC changes that
would first be made part of the forms and schedules for the 2016 form
year, respectively.
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\9\ The Agencies used the 2015 forms, schedules, and
instructions as the ``current'' form version. With respect to IRS-
only changes, the changes for 2016 that appear in the notice
published by the IRS under the PRA, 81 FR 18687 (Mar. 31, 2016), are
used in the proposed data elements and instructions and are so
labeled, instead of showing the changes in the information
collection under the Code that appear on the 2015 Form 5500 series,
which the IRS has directed filers not to answer. See IRS Compliance
Questions on the 2015 Form 5500 Series Returns (https://www.irs.gov/Retirement-Plans/IRS-Compliance-Questions-on-the-2015-Form-5500-Series-Returns).
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(2) ``[Current Line X]'' if the item is already on the form or
schedule, but is renumbered in the proposal, to show where the item
appears on the current form or schedule;
(3) ``[Current with revisions]'' to indicate, with a short
explanation, that the item is already on the form or schedule, but
would be revised; and
(4) ``[New]'' if the item is a new question or new to that form or
schedule.
Dates generally are shown in the data element sheets (as well as
the instructions) as ``20XX'' for the Form filing year; ``20XX-1'' for
the prior year, etc.
The Agencies believe this approach of showing the intended changes
to the wording of the data elements, but not providing a ``mock up'' of
the forms and schedules, will reduce costs associated with publication
of the proposed form changes in the Federal Register and provide
greater flexibility for the related EFAST2 development processes. The
Agencies also believe that this approach (i.e., taking the questions
out of the disclosable form structure), gives a better opportunity to
review the format, sequencing, and grouping of how the information
would be asked and entered on each of the forms and schedules and how
it ultimately could potentially be better presented for disclosure
purposes. The Agencies seek comments on whether reordering or
regrouping questions on the Form 5500 and schedules could enhance
presentation of the information for disclosure purposes or minimize
burden from a data-gathering, data-entry, recordkeeping, or other
perspective, as well as suggestions on the structure or appearance of
the forms as both on-line and printed documents.
B. Proposed Instructions for Form 5500 Annual Return/Report
Appendix B to this document shows the proposed instructions for the
Form 5500 and its schedules. The proposed instructions include possible
additional instructions and definitions for existing line items, as
well as instructions for new items, and the proposed instructions
reflect the elimination of current instructions for existing line items
or schedules that would be deleted under the proposal. The Agencies
expect that the revised instructions for the year in which the majority
of the proposed forms changes are implemented, which will be generally
coincident with the contracting and procurement process for EFAST2,
will also reflect changes in intervening years, changes to law, and any
needed additional clarifications and interpretations to the
instructions for existing and proposed line items, as well as changes
made in response to comments on the proposal. For ease of use by the
different types of filers and to eliminate the need for the footnotes
and exceptions in the current single
[[Page 47538]]
``Quick Reference Chart,'' the Agencies propose separate charts for the
various types of filers (pension plans, direct filing entities (DFEs),
group health plans, and welfare plans other than group health plans).
These charts appear at the end of Appendix B (Form 5500 Annual Return/
Report Instructions). The Agencies believe this proposed change should
help filers focus on the specific requirements applicable to the type
of plan or entity for which the Form 5500 Annual Return/Report is being
filed.
OMB Control Numbers, PRA Notice, and up to date Business Codes are
not shown here, but will continue to be included in both the Form 5500
Annual Return/Report and Form 5500-SF instructions published on the
EFAST2 Web site for the form year(s) in which the changes are
implemented.
C. Proposed Instructions for Form 5500-SF
Appendix C to this document shows the proposed instructions for the
Form 5500-SF.
III. Request for Comments
The Agencies believe that the modernization and restructuring of
the Form 5500 Annual Return/Report being proposed in this Notice would
support the Agencies' ability to implement strong and effective
enforcement programs and better respond to inquiries from plan
participants and beneficiaries, employers, other plan sponsors, and the
public regarding employee benefit plans. Further, the Agencies believe
that the proposed revisions would help them more effectively develop
and implement regulations and other compliance assistance guidance, and
use data for purposes of economic research, policy formulation, and
monitoring benefits related developments and activities among ERISA-
covered employee benefit plans.
The Agencies generally invite comments and suggestions as to other
alternative solutions and whether and how such alternatives would be
more, or less, beneficial compared to the proposed changes to the
forms, schedules, and instructions. Commenters are asked to take into
account the costs and burdens to plans, participants and beneficiaries,
plan fiduciaries, plan service providers, and other affected parties,
in commenting on the proposed annual reporting changes, including any
suggested alternatives.
The request for comments includes areas on the existing forms,
schedules, and instructions that the Agencies have not proposed
changing, but which may benefit from further guidance, especially with
regard to how an existing provision or instruction would apply for a
particular segment of the filing population.
IV. Discussion of Proposed Changes
The proposed revisions in this Notice reflect priorities of and
efforts by the DOL, IRS, and PBGC to improve reporting for filers and
the public, other governmental users, as well as the Agencies by: (1)
Modernizing financial information filed regarding plans; (2) updating
fee and expense information on plan service providers, with a focus on
harmonizing annual reporting requirements with the DOL's final
disclosure requirements at 29 CFR 2550.408b-2; (3) enhancing
mineability of data filed on annual return/reports; (4) requiring
reporting by all group health plans covered by Title I of ERISA,
including adding a new Schedule J (Group Health Plan Information); and
(5) improving compliance under ERISA and the Code through selected new
questions regarding plan operations, service provider relationships,
and financial management of the plan. The changes in this proposal to
the forms, schedules, instructions, and DOL regulatory exemptions and
requirements are intended to further these objectives.
A. Modernize Financial and Plan Operations Information
An overriding objective of these proposed forms revisions is to
modernize the Form 5500 Annual Return/Report financial information
collection so that the presentation of plan trust financial and balance
sheet information better reflects the investment portfolios and asset
management practices of employee benefit plans. The basic objective of
general purpose financial reporting is to provide information about the
reporting entity for the Agencies' enforcement, research, and policy
formulation programs; to assist other federal agencies, Congress, and
the private sector in assessing employee benefit, tax, and economic
trends and policies; and to assist plan participants and beneficiaries
and the general public in better monitoring the activities and
investments of employee benefit plans.
The financial statements contained in the current Schedule H (Large
Plan Financial Information) and Schedule I (Small Plan Financial
Information) are based on data elements that have remained largely
unchanged since the Form 5500 Annual Return/Report was established in
1975. Over the past four decades, the U.S. private pension system has
shifted from defined benefit (DB) pension plans toward defined
contribution (DC) pension plans, often participant-directed 401(k)-type
DC pension plans. The financing of retirement benefits has changed
dramatically coincident with the shift from DB to DC pension plans. In
1978, when legislation was enacted authorizing 401(k) plans that allow
employees to contribute to their own retirement plan on a pre-tax
basis, participants contributed only 29 percent of the contributions to
DC pension plans and only 11 percent of total contributions to both DB
and DC pension plans. ``In the years following 1978, employee
contributions to DC pension plans steadily rose to a peak of
approximately 60 percent in 1999, where it has remained.'' See Dep't of
Labor, Private Pension Plan Bulletin Abstract of 2012 Form 5500 Annual
Reports, at 1 (2015). Simultaneously, the number of single-employer DB
pension plans has decreased from 92,000 in 1990 to just under 29,000
single-employer pension plans in 2009. See U.S. Gov't Accountability
Office, GAO-09-291, Defined Benefit Pensions: Survey Results of the
Nation's Largest Private Defined Benefit Plan Sponsors Highlights
(2009) (available at https://www.gao.gov/new.items/d09291.pdf).
The shift from DB pension plans to DC pension plans has led to
increased responsibility for participants to manage their own
retirement savings, which includes having to select among investment
options in their retirement plans. See Private Pension Plan Bulletin
Abstract Of 2012 Form 5500 Annual Reports, at 2 (Of the 516,000 section
401(k)-type plans in 2012, 87.8 percent allowed participants to direct
investment of all of their assets, and 3.1 percent allowed participants
to direct investment of a portion of their assets.) The need for more
relevant and comparable financial information is not limited to 401(k)
and other DC pension plans; it also extends to DB pension plans.
Reports from GAO, the DOL-OIG, the ERISA Advisory Council, and the
TIGTA also have focused on the need for increased transparency and
accountability generally in connection with employee benefit plan
investments in hard-to-value and alternative assets, as well as assets
held through pooled investment vehicles.
1. Changes to Schedule H (Financial Information)--Balance Sheet and
Income Statement
Section 103 of ERISA requires plans to include in their annual
report a statement of assets and liabilities of the plan, aggregated by
categories and
[[Page 47539]]
reported at current value. It also requires plans to report a statement
of earnings (losses) and expenses. Although the Form 5500 Annual
Return/Report has undergone major revisions since its initial
implementation in 1975, there has been little change to the basic
balance sheet and income statement information on the Form 5500 Annual
Return/Report since the return/report was first established. Under the
proposal, Schedule H, Parts I and II, would retain the essential asset/
liability and income/expense structure of the current reporting
requirement. The Agencies are proposing, however, to modify the asset
breakouts on the balance sheet component of the Schedule H to enable
more accurate and detailed reporting on the types of assets held by a
plan, including alternative investments, hard-to-value assets, and
investments through collective investment vehicles. The proposed
changes take into account the fact that many of these more
sophisticated and complex investments do not fit neatly into any of the
existing reporting categories. As a result, filers inconsistently
report on the various existing categories, and important financial
information is obscured by consolidation of many diverse investments
into the catch-all ``other'' category on the balance sheet on the
Schedule H. The proposal would also update the income/expense statement
of the Schedule H to get a better picture of earnings and expenses
associated with plan investments and operations.
In addition to the Agencies' assessment that Form 5500 Annual
Return/Report financial reporting would benefit from improved
transparency and accountability, the proposal to change the asset
categories on the Schedule H balance sheet is supported by recent
reports from both the GAO and the DOL-OIG. The GAO has noted that the
plan asset categories on the Schedule H are not representative of
current plan investments and provide little insight into the
investments themselves, the level of associated risk, or the structures
of these investments. GAO-14-441, Private Pensions: Targeted Revisions
Could Improve Usefulness of Form 5500 Information, at 11-12. The
proposed changes to the Schedule H also are consistent with the DOL-OIG
recommendation that the Form 5500 Annual Return/Report be revised to
improve reporting of hard-to-value and alternative investments. U.S.
Dep't of Labor Office of Inspector Gen., 09-13-001-12-121, Employee
Benefits Security Administration Needs to Provide Additional Guidance
And Oversight to ERISA Plans Holding Hard-To-Value Alternative
Investments, at 4, 19.
Accordingly, the Agencies are proposing the following changes to
the Schedule H balance sheet and income statement. Current Line 1a,
``total noninterest bearing cash,'' would be reported as a breakout
element under General Investments. This would also result in Line 1b
``Receivables'' and Line 1c ``General Investments'' being renumbered as
Lines 1a and 1b respectively. Participant loans would continue to be
reported as a separate line item, but would be reported as a breakout
element under renumbered Line 1a as a ``receivable'' rather than under
its current reporting classification under the heading ``General
Investments.'' This change is responsive to amendments made to
``Generally Accepted Accounting Principles'' (GAAP) by the Financial
Accounting Standards Board (FASB), which required participant loans to
be classified as notes receivable from participants. See Financial
Accounting Standards Board, No. 2010-25, Plan Accounting--Defined
Contribution Pension Plans (Topic 962) (2010). As notes receivable,
participant loans would continue to be reported at their unpaid
principal balance plus any accrued but unpaid interest.
Under proposed Line 1b (currently Line 1c) ``General Investments,''
the Agencies would add both new categories and new breakouts within
existing categories. Cash and cash equivalents would be the first
category under ``General Investments.'' As indicated above,
``noninterest bearing cash (such as cash on hand or cash in a non-
interest bearing checking account)'' would no longer be separated from
``General Investments.'' Instead it would be a sub-breakout under
``cash and cash equivalents.'' The category would also have sub-
breakouts for interest bearing cash (assets that earn interest in a
financial institution account such as interest bearing checking
accounts, passbook savings accounts, or money market bank deposit
accounts). While the breakouts are new, the information is already
required to be reported on current Line 1c(1).
The next category under ``General Investments,'' would continue to
be for reporting ``Debt Interests/Obligations.'' The Form 5500 Annual
Return/Report currently provides little in the way of detail or
transparency about the range of plan investments in bonds, loans, and
other debt instruments and obligations. For example, a single line item
for ``other loans'' on the Schedule H currently covers, as indicated in
the Form 5500 Annual Return/Report instructions, the value of loans for
construction, securities loans, commercial and/or residential mortgage
loans that are not subject to Code section 72(p), and other
miscellaneous loans. See, e.g., 2015, Schedule H, Form 5500 Annual
Return/Report Instructions.
The general debt heading, as proposed, would keep the existing
breakout for corporate debt instruments. Breakouts under that category,
however, would be investment grade debt and high-yield debt, rather
than ``preferred'' and ``all other,'' as on the current Schedule H.
This change is intended to have the Schedule H financial information
for all reporting plans regarding corporate debt instruments correspond
to the more detailed financial information on Schedule R for defined
benefit pension plans that have 1,000 participants or more. In
addition, U.S. government securities would be broken out from other
government securities. The instructions for the current forms advise
filers to report such investments on the Schedule H financial
statements in ``Other'' debt instruments. This proposal, however,
includes more investment categories on the Schedule H to improve
transparency from the current ``other'' categories. For example, there
would be a breakout for other loans (other than loans to participants),
exchange traded notes, and asset backed securities (other than real
estate),\10\ and debt obligations associated with real property would
be reported under the real property category, rather than generally
under ``Other Debt Obligations.'' Thus, with respect to reporting such
leveraged or collateralized transactions on the balance sheet portion
of Schedule H, filers would be advised in the instructions to account
for such transactions in the appropriate asset category in accordance
with the individual characteristics of the investment.
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\10\ The SEC similarly is working towards more transparency with
regard to some of these assets. See Securities and Exchange
Commission, Asset-backed Securities Disclosure and Registration, 79
FR 57,184 (Sept. 24, 2014). FINRA has also published an Investor
Alert related on exchange traded notes to increase investor
awareness of the associated risks. See Exchange-Traded Notes: Avoid
Unpleasant Surprises, FINRA, www.finra.org/Investors/ProtectYourself/InvestorAlerts/TradingSecurities/P131262. See also
U.S. Gov't Accountability Office, GAO-12-324, Recent Developments
Highlight Challenged Of Hedge Fund And Private Equity Investing
(2012) (discussing plan investment in distressed debt).
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The next category under ``General Investments'' would continue to
be ``Corporate Stocks.'' Under the corporate securities category,
filers would still distinguish between ``preferred'' and
[[Page 47540]]
``common'' stock for reporting direct holdings of corporate securities.
There would be new breakouts, however, for ``publicly traded'' and
``non-publicly traded'' securities under both the ``preferred'' and
``common'' stock elements. This proposed change is intended to present
a more complete picture of plan investments in hard-to-value assets.
The existing reporting line items for certain collective investment
vehicles that are treated as holding plan assets under the DOL's plan
asset regulation at 29 CFR 2510.3-101 (i.e., bank common or collective
trusts (CCTs), insurance company pooled separate accounts (PSAs),
entities meeting the conditions of DOL regulation 29 CFR 2510.103-12
(103-12 IEs), and master trusts) generally would be retained, but
grouped together for reporting under a new category entitled ``Eligible
Pooled Investment Funds (Other Than Registered Investment Companies).''
To increase transparency and improve the quality of data collected
across various components of the Form 5500 Annual Return/Report, the
proposal would significantly reconfigure existing reporting of assets
held through the various types of pooled investment vehicles that have
plan assets.
Under the proposal, a plan's investments in CCTs and PSAs would be
reported in the aggregate on single line items for each vehicle type on
the Schedule H Line 1b balance sheet information regardless of whether
the CCT or PSA files a Form 5500 Annual Return/Report as a DFE. This is
a change from the current rule that has filers break out the underlying
assets in the respective line items on the Schedule H balance sheet
under ``general investments'' if the CCT or PSA has not filed a Form
5500 Annual Return/Report and in the aggregate on the CCT or PSA line
if the Form 5500 Annual Return/Report has been filed. Instead, as
discussed in more detail below, the Line 4i(1) Schedule of Assets held
for Investment of either the plan or the CCT or PSA, depending on
whether the CCT or PSA has filed, would be where the breakout of
underlying assets would be reported.
With respect to 103-12 IE reporting on Schedule H, the proposal
generally continues the existing reporting requirements. Specifically,
similar to the requirements for plans that invest in CCTs and PSAs, a
plan that invests in an entity that files as a 103-12 IE would, in
identifying each individual 103-12 IE on the Line 4i Schedules of
Assets, have to include the value of the plan's investment in each 103-
12 IE.
Reporting regarding investments in master trusts by plans and
reporting by master trusts, as described in more detail below, would be
substantially revised, including reporting on the plan's asset and
liability statements on Schedule H, Part I. Specifically, as they did
prior to 1999, plans would report their total holdings in master trusts
on Schedule H, Line 1b, on an aggregate basis, and the reporting
concept of the master trust investment account (MTIA) would be
eliminated. The participating plans' fractional interest in the various
holdings of the master trust (which currently are reflected in the MTIA
Form 5500 Annual Return/Report) now would be shown on the various
plans' Schedule H, Line 4i(1) Schedule of Assets Held for Investment at
End of Year and Line 4i(2) Schedule of Assets Disposed of During the
Plan Year, as well as on the filings by the master trust itself.
The DOL views the proposed changes to annual reporting regarding
these pooled investment vehicles as important and necessary in light of
the large amount of plan assets (an estimated $1.1 trillion) held by
CCTs, PSAs, master trusts, and 103-12 IEs. See U.S. Gov't
Accountability Office, GAO 12-121, Limited Scope Audits Provide
Inadequate Protections To Retirement Plan Participants, at 1 (2014).
As part of the focus on better reflecting and understanding how
plans are investing, the Agencies also propose to replace the single
line existing category entitled ``Value of Interest in Funds Held in
Insurance General Accounts (Unallocated Contracts)'' by adding
breakouts of various types of unallocated contracts. The proposal would
add to the existing general category breakouts for deposit
administration, immediate participation guarantees, guaranteed
investment contracts, and ``other'' unallocated insurance contracts.
These classes of contracts parallel the existing Schedule A reporting
on insurance contracts with unallocated funds. Comments are
specifically solicited on whether this breakout is sufficient or
whether the value of investments in other or additional classes of
insurance contracts, such as variable annuity contracts,\11\ should be
listed on the Schedule H.
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\11\ As discussed below, the proposal would add new questions to
Schedule A regarding variable annuities.
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The Agencies are also proposing changes to the existing category
entitled, ``Partnership/Joint Venture Interests.'' To clarify the
reporting of these general partnership and joint venture investments,
new sub-categories are being added to report the value of interest in
``limited partnerships,'' ``venture capital operating companies
(VCOCs),'' ``private equity,'' ``hedge funds,'' and ``other
partnership/joint venture interests.'' The Agencies' proposal was
informed by the GAO's findings that there was a need for more detail on
plan investment in hedge funds and private equity funds due to
substantial increases in the percentage of plans investing in hedge
funds and private equity. U.S. Gov't Accountability Office, GAO-12-324,
Recent Developments Highlight Challenges With Hedge Fund And Private
Equity Investing, at 19 (2012). In making this recommendation, GAO
acknowledged that although there is no universally accepted definition,
the term ``hedge fund'' is commonly used to describe pooled investment
vehicles that are privately organized and administered by professional
managers who engage in active trading of various types of securities,
commodity futures, options contracts, and other investment vehicles,
including relatively illiquid and hard-to-value investments. Similarly,
``private equity fund'' is commonly used to describe privately managed
pools of capital that invest in companies that typically are not listed
on a stock exchange. See, e.g., 2011 ERISA Advisory Council Report:
Hedge Funds and Private Equity Investments (noting that plan sponsors
have increased investment of defined benefit pension plan assets in
hedge funds and/or private equity funds due to the need to increase
diversification, decrease volatility, and enhance the plan's overall
performance). The Agencies specifically invite comments on whether
these definitions are adequate for purposes of Form 5500 Annual Return/
Report financial reporting.
In addition, because investments in the ``Partnership/Joint venture
interests'' may or may not be holding plan assets under the DOL's plan
asset regulation at 29 CFR 2510.3-101, the Agencies are proposing an
off-balance sheet item in this category where filers would indicate the
total value of such investments that are plan asset vehicles and those
that are not.
The real estate category on the Schedule H balance sheet would be
expanded and include sub-categories to include investments in
particular types of assets or pooled investment funds designed to
invest primarily in real estate or real estate mortgages. In the
Agencies' view, the current reporting requirements do not accurately
reveal the extent and type of a plan's real estate and related
holdings. The
[[Page 47541]]
proposed new breakouts are: Developed real property (other than
employer real property), undeveloped real property (other than employer
real property), real estate investment trusts (REITs), mortgage-backed
securities (including collateralized mortgage obligations (CMOs)), real
estate operating companies (REOCs), and ``Other'' real estate related
investments. Adding these breakouts is consistent with the Agencies'
objective of improving reporting on investments that constitute
alternative or hard-to-value assets. See OECD/IOPS Good Practices on
Pension Funds' Use of Alternative Investments and Derivatives, OECD,
(available at https://www.oecd.org/finance/private-pensions/oecdiopsgoodpracticesonpensionfundsuseofalternativeinvestmentsandderivatives.htm.) Creating more specific categories also should help address
concerns about inconsistencies in real property reporting cited by the
report, GAO Targeted Revisions Could Improve Usefulness Of Form 5500
Information, at 10.
A significant new reporting category is for investments in
derivatives. The sub-categories in the derivatives category would be
futures, forwards, options, swaps, and ``Other.'' As in the other
general categories, filers would enter a description for assets listed
as ``Other.'' Obtaining more specific information about the extent to
which plans are engaged in hedging or in the listed types of derivative
transactions would help address concerns raised by the GAO about
limitations on usefulness of data on investments in derivatives under
the current reporting structure. See generally U.S. Gov't
Accountability Office, GAO-08-692, Defined Benefit Plans: Guidance
Needed To Better Inform Plans Of The Challenges And Risks Of Investing
In Hedge Funds And Private Equity, at 25, 42-43 (expressing specific
concerns about the way in which pension plans report investments in
derivatives and suggesting that plan sponsors are currently reporting
these types of investments in various different categories on the
Schedule H, limiting the usefulness of the data.)
The Agencies are also proposing a new category for foreign
investments with breakouts to separately report holdings of foreign
equities and debt interests. The Agencies propose that, for this
reporting purpose, foreign equities would include American Depository
Receipts, U.S.-traded foreign stocks and stocks traded on foreign
markets. Foreign debt would include both long-term and short-term
foreign debt investments, but would not include for purposes of a Form
5500 Annual Return/Report such foreign securities held through U.S.
registered investment funds or exchange traded funds, CCTs, PSAs, 103-
12 IEs, or master trusts. There also would be subcategories for foreign
real estate, currency, and ``Other,'' with a description required for
anything reported in the ``Other'' category.
The Agencies also are proposing a new asset category on the
Schedule H, ``Tangible Personal Property,'' which category currently
appears on the Schedule I, but not on the Schedule H. Under the
proposal, the Schedule H would list on its face the main types of
assets as reportable in this category, i.e. direct investments in
tangible personal property, with sub-categories for collectibles,
precious metals, and ``Other.'' There would also be a separate breakout
category for commodities, which would be divided into ``Precious
Metals'' and ``Other.'' Moving this category from the Schedule I to the
Schedule H for all filers required to complete the Schedule H,
including former Schedule I filers, would add transparency to these
plan investment holdings. To the extent plans have direct investments
in tangible personal property and commodities (as opposed to futures
contracts or exchange traded funds), they are likely to be reported
unhelpfully from a transparency perspective as ``Other'' on the
existing Schedule H.
Finally, the Agencies propose making reporting more transparent for
assets held through participant-directed brokerage accounts. The
proposal generally follows the same breakout requirements as the
current rules. The current rules provide that assets held through
participant-directed brokerage accounts may be reported either: (1) As
individual investments in the applicable asset and liability categories
in Part I and the income and expense categories in Part II, or (2) by
including on the ``Other'' lines (Line 1c(15) on the balance sheet and
2c on the income statement) the total aggregate value of the assets and
the total aggregate investment income (loss) before expenses, provided
the assets are not loans, partnership or joint venture interests, real
property, employer securities, or investments, including derivatives,
that could result in a loss in excess of the account balance of the
participant or beneficiary who directed the transaction. Under the
proposal, filers would provide the total current value of all assets
held through participant-directed brokerage accounts, except there
would be separate sub-totals for brokerage account investments in
tangible personal property, loans, partnership or joint venture
interests, real property, employer securities, and investments that
could result in a loss in excess of the account balance of the
participant or beneficiary who directed the transaction. The current
Form 5500 Annual Return/Report reporting rules already require that
these types of assets be reported separately from other participant-
directed brokerage account assets, similar to the reporting rules for
investments in CCTs and PSAs that do not file their own Form 5500
Annual Return/Report. On the proposed Line 4i Schedules of Assets,
assets held through a participant-directed brokerage account would be
permitted to be reported in the aggregate as a single asset held
directly by the plan. The broker would be identified as the issuer/
borrower/etc. In the element requiring the filer to indicate on what
line the assets were reported on Line 1b, the filer would enter all the
subcategories for types of investments held through a participant-
directed brokerage account.
The Agencies considered requiring filers to break out all assets
held through a participant-directed brokerage account on the Line 4i
Schedules of Assets. The Agencies also considered continuing to require
filers to break out those specific assets that are currently required
to be broken out on Line 1c. For example, the Agencies considered
requiring a breakout of information on whether participants are
investing in alternative and hard-to-value assets through participant-
directed brokerage accounts. The Agencies determined, on balance,
considering the benefits to the information and the relative potential
burden, that having on the proposed balance sheet (Line 1b) a general
breakout of asset types held through participant-directed brokerage
accounts would be sufficient, and that details of each individual asset
so held would not be required.
The proposal to continue to allow filers to report assets held in
participant-directed brokerage accounts in the aggregate is intended to
be responsive to comments on the DOL's Request for Information,
Question 38, 79 FR 49469, 49473 (Aug. 14, 2014) (RFI), which
specifically asked whether changes should be made to the Schedule H to
require more detail about investments made through brokerage windows.
While some commenters on the RFI thought it made sense for the DOL to
consider changes to the Form 5500 Annual Return/Report with respect to
brokerage windows, others were concerned about the burden and costs
such changes would impose on sponsors and participants and were unclear
about the relative benefit of
[[Page 47542]]
more information. The Agencies do not believe that there would be a
substantial additional burden imposed by requiring aggregate
participant-directed brokerage account assets to be reported separately
instead of the current practice of reporting such assets in the catch-
all ``Other'' category. Similarly, the Agencies believe that there
would not be a substantial burden change in the proposed requirement to
break out, on the Line 4i Schedules of Assets, the types of investments
held in participant-directed brokerage accounts that are not eligible
for aggregated reporting under current annual reporting rules.
One of the goals of the proposed change is to get better
information on securities lending \12\ practices and how they impact
plan finances and operations. As indicated in the Financial Stability
Oversight Council's (FSOC) Annual Report for 2014 (available at https://www.treasury.gov/initiatives/fsoc/Documents/FSOC%202014%20Annual%20Report.pdf), the global value of securities
loans was approximately $1.8 trillion in 2013. Pension plans are a
large segment of the entities engaged in such transactions.
Accordingly, the Agencies believe that more precise information is
needed to understand how these transactions impact plans and how plans
fit into the overall markets. The Agencies explored adding new breakout
line items on the asset/liability and income expense statements to
identify in more detail securities lending transactions. It is the
understanding of the Agencies, however, that filers are reporting
securities lending arrangements and similar transactions on the
financial statements in various different ways, depending on whether
the plan is borrowing or lending securities and the structure of the
arrangement or transaction, including transactions such as repurchase
agreements and sell/buy-back transactions where, technically, the plan
no longer owns the securities. Accordingly, the Agencies believe that
the best way to get information on securities financing transactions,
without creating particularized line items that might not work for all
types of transactions, is to instruct filers to report assets in the
appropriate categories on the Schedule H and then identify the
transactions in response to the newly proposed compliance questions.
The new compliance question would ask whether the plan has investment
acquisitions that are leveraged, including assets subject to
collateralized lending activities (e.g., securities lending
arrangements, repurchase agreements (repos), etc.). If ``Yes,'' the
plan would be required to identify whether the plan engaged in
securities lending arrangements, including repurchase agreements or
sell/buy-backs, or other transactions that subjected plan assets to a
mortgage, lien, or other security interest, and to describe the
arrangement. The plan would then have to report, as a total, the amount
of cash obligated in connection with collateralized lending activities
at end of year, the value of securities obligated in connection with
collateralized lending activities at end of year, the value of other
assets obligated in connection with collateralized lending activities
at end of year, and the approximate ratio of collateralized/leveraged
investments to total plan assets at end of year. The Agencies
specifically request comments on whether there could be effective
breakout line items on the balance sheet that would more clearly show
assets that are subject to securities lending or similar arrangements
or whether there are specific instructions that would be helpful for
filers to know where to categorize the various components of such
transactions on both the balance sheet and earnings statements on the
Schedule H.
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\12\ The term ``securities loans'' generally refers to the
collateralized loan of a security from one party to another. Such a
loan can have a pre-specified term, such as one business day, one
week, or one month, or it can be ``open.'' An open loan is ongoing
until one of the parties to the trade decides to end it.
---------------------------------------------------------------------------
Under the ``Income and Expense'' statement in Part II of the
Schedule H, the Agencies propose retaining the same basic structure for
reporting income as on the current Schedule H, but with additional
breakout categories. Notably, the ``interest'' income category includes
a new breakout for government securities other than U.S. government
securities, and the unrealized appreciation (depreciation) of assets
category would be broken out to report separately partnership/joint
venture interests, commodities investments, derivatives, employer
securities, foreign investments (other than those held through U.S.
registered investment funds), and employer real property, in addition
to the existing breakouts for real estate, CCTs, PSAs, MTIAs, 103-12
IEs, and registered investment companies. These proposed changes are
intended to better support investment monitoring by asset class and
provide more consistent data for research and policy purposes.
The proposal would also add new breakout categories to the
``Administrative Expenses'' category of the Income and Expenses section
of the balance sheet. The Agencies have determined that to get a better
picture of plan expenses, particularly those related to service
providers, more detail in this category is warranted. Accordingly, data
elements would be added for ``Salaries and allowances,'' ``Independent
Qualified Public Accountant (IQPA) Audit fees,'' ``Recordkeeping and
Other Accounting Fees,'' ``Bank or Trust Company Trustee/Custodial
Fees'' ``Actuarial fees'' ``Legal fees,'' ``Valuation/appraisal fees,''
and ``Trustee fees/expenses (including travel, seminars, meetings.''
\13\
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\13\ Other than IQPA Audit Fees and Bank or Trust Company
Trustee/Custodial Fees, these questions were on the Form 5500 prior
to 1999. See 1998 Form 5500, Line 32(g).
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The Agencies are also proposing to change administrative expense
reporting to identify when participant accounts are charged directly.
The Agencies believe that this information is important to better
understand how compensation arrangements impact participants,
especially in defined contribution pension plans. The Agencies
considered requiring filers to break out direct expenses on a service
provider by service provider basis on Schedule C to show how and when
they are charged to participant accounts rather than at the plan level.
To minimize reporting burden under the proposal, however, the
information would be reported only in the aggregate. Therefore, instead
of requesting this information on the Schedule C, the Agencies have
proposed revising the expense information on Schedule H. Specifically,
the ``Total'' administrative expense line item on Schedule H would now
require that administrative expenses charged directly against
participant accounts be separately reported from those direct expenses
charged to other plan asset sources. Filers would separate transaction-
based charges to individual participant accounts and plan level
expenses apportioned among participant accounts. With respect to the
latter, filers would indicate whether the expenses were apportioned per
capita, pro rata by account balance, or ``Other'' apportionment method
that they would describe. This would give the Agencies and other users
of the Form 5500 Annual Return/Report data a better idea of how and
when participants are being charged administrative expenses, which is
particularly important for defined contribution pension plans.
[[Page 47543]]
2. Proposed Changes to Schedule H, Line 4i Schedules of Assets
As indicated above, the proposed modernization of the financial
reporting required on the Schedule H would include structural, data
element, and instruction changes to the Line 4i Schedules of Assets.
The current Line 4i Schedules (``Schedule of Assets Held for Investment
at End of Year'' and ``Schedule of Assets Acquired and Disposed Within
Year'') are required under section 103 of ERISA to be included in the
annual report, as currently implemented in the DOL's regulations at 29
CFR 2520.103-11.\14\ These schedules are filed by plans required to
file the Schedule H and by certain DFEs. The schedules are a central
element of the financial disclosure structure of ERISA because they are
the only place in the Form 5500 Annual Return/Report where plans are
required to list individual plan investments, identified by major
characteristics, such as issue, maturity date, rate of interest, cost,
and current value. Accordingly, these schedules are the only part of
the Form 5500 Annual Return/Report that can be used to evaluate the
year-to-year performance of a plan's individual investments. The
reported information, however, suffers from several shortcomings.
---------------------------------------------------------------------------
\14\ To see the proposed changes to the DOL's regulations to
implement these data element and instruction revisions, please see
the DOL's Notice of Proposed Rulemaking--Annual Reporting, published
elsewhere today in the Federal Register.
---------------------------------------------------------------------------
Perhaps most fundamentally, this information currently is not
reported in a data-capturable format. Thus, although an image or
picture of the attachments that are currently filed as non-standard
attachments to filers' electronic Form 5500 Annual Return/Report
filings is available through the EFAST2 public disclosure function, it
is not viewable as part of the Schedule H, nor is the information
included in the data sets that DOL prepares from the return/report
filing data and publishes on its Web site (www.dol.gov/ebsa/foia/foia-5500.html). Also, the Line 4i Schedules of Assets are not always found
in the same place in each Form 5500 Annual Return/Report filing. For
example, the Line 4i Schedules of Assets are often incorporated in the
larger audit report of the plan's IQPA that itself is filed as a
nonstandard attachment to the Form 5500 Annual Return/Report.\15\ The
schedules also do not require standardized methods for identifying and
describing assets on the Line 4i Schedules of Assets. Under the current
reporting rules, the same stock or mutual fund may be identified with
various different names or by use of different abbreviations. The
creation of more detailed and structured Line 4i Schedules of Assets is
a specific recommendation of both the DOL-OIG and the GAO. See DOL
Inspector Gen. EBSA Needs To Provide Additional Guidance And Oversight
To ERISA Plans Holding Hard-To-Value Alternative Investments, at 4-5;
GAO Private Pensions: Targeted Revisions Could Improve Usefulness of
Form 5500 Information, at 37.
---------------------------------------------------------------------------
\15\ See EFAST2 FAQ 24a, (available at www.dol.gov/ebsa/faqs/faq-EFAST2.html) (advising filers of options in EFAST2 for filing
the accountant's opinion and accompanying financial statements,
indicating that they do not need to be ``tagged'' separately for
filing purposes.)
---------------------------------------------------------------------------
The first proposed improvement would require filers to complete
standardized Line 4i Schedules of Assets in a data-capturable format.
The Agencies anticipate that EFAST2 would have separate ``structured''
locations for entering the data into the Form 5500 Annual Return/Report
filing, using a standardized format that would enable incorporation of
the Line 4i Schedules of Assets information into the datasets that
EFAST and EBSA make available from each year's Form 5500 Annual Return/
Report and Form 5500-SF filings and enable DOL to more readily disclose
the information, as required under Title I of ERISA.
As under the current reporting structure, there would continue to
be two separate schedules of assets.\16\ The first would be the
existing Schedule of Assets Held for Investment at End of Year. The
second would modify the existing ``Schedule of Assets Acquired and
Disposed of Within Year'' to a ``Schedule of Assets Disposed of During
the Plan Year.'' The objective of the current Schedule of Assets
Acquired and Disposed of Within Year was to ensure that the Form 5500
Annual Return/Report (which generally captures financial information at
the beginning and the end of the plan year) captured information on
assets that may not have been held either at the beginning of the year
or end of year because they were bought and sold within the same year.
That structure, however, suffers from a significant gap in information
about alternative investments and hard-to-value assets because neither
of the current Schedules of Assets provides information on the sale of
such assets if purchased in one year and sold in the middle of a
subsequent year. The change in the Schedule of Assets Disposed of
During the Plan Year to cover all investment assets disposed of during
the plan year would close that gap, while continuing to capture
transactions that involve the purchase and sale of investment assets
within the same plan year.
---------------------------------------------------------------------------
\16\ The current Line 4i question generally asks whether the
plan held assets for investment, referring to both Schedules of
Assets. Because all filers, except filers for terminated plans,
answer ``Yes'' to indicate that they have assets held at end of
year, answers to the current question do not reveal whether the plan
also had assets acquired and disposed of during the plan year. The
proposal would separate the question into two parts: Line 4i(1)
asking whether the plan held investments at the end of the year; and
Line 4i(2) asking whether the plan disposed of assets during the
plan year. If the answer was ``Yes'' to either question, the
corresponding Schedule of Assets would need to be attached.
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Both of the proposed Line 4i Schedules of Assets would continue to
require filers to enter, as applicable, the existing data elements (1)
identifying the issuer, borrower, lessor, or similar party; (2)
describing the investment and identifying, as applicable, the issue,
maturity date, rate of interest, par, or maturity value, including
whether the asset/investment is subject to surrender charge; (3)
reporting the cost of the asset; and (4) reporting the current value of
the asset.
A new data element on the Line 4i(1) Schedule of Assets Held for
Investment would require the filer to indicate whether the plan or
reporting DFE held the investments directly, through a master trust,
CCT, PSA, or a 103-12 IE. If the assets are held through a DFE, the
filer (whether a plan or an investing DFE) would be required to list
each DFE as an investment and enter for each DFE in which the filer was
invested, the name, employer identification number (EIN), and plan
number (PN) used by the DFE on its own Form 5500. If a PSA or CCT in
which the reporting plan or DFE invests has not filed a Form 5500
Annual Return/Report, the filer would have to check a box to indicate
that the CCT or PSA has not filed a Form 5500 Annual Return/Report, and
the investing plan or DFE would have to break out the underlying assets
of the CCT or PSA on its own Line 4i(1) Schedule of Assets Held for
Investment at End of Year. This aspect of the proposal is intended
better to coordinate the information currently reported by plans and
investing DFEs on Schedule D and on the Line 4i(1) Schedule of Assets
Held for Investment at End of Year.
The current instructions tell filers to use an asterisk to identify
investments that involved a party-in-interest on the Line 4i Schedule
of Assets Held for Investment at End of Year. Review of Form 5500
Annual Return/Report data, however, suggests that many filers may not
be aware of the requirement, which is currently explained only in the
instructions for Schedule H of the Form
[[Page 47544]]
5500 Annual Return/Report. Identification of the involvement of a
party-in-interest, therefore, has been inconsistent and incomplete. To
address the issue, the proposal would replace the current requirement
to include an asterisk with a check box to indicate whether the
investment involved a party-in-interest.
To indicate the type of asset generally, filers generally would be
required to indicate on the Line 4i Schedule of Assets the category
under which the value of the asset was included on the Schedule H asset
statement (proposed Line 1b), or if held through a CCT or PSA that has
not filed, where the individual assets would have been included on Line
1b if not held through the CCT or PSA.
The proposal would add to the Line 4i(1) Schedule of Assets Held
for Investment at End of Year a requirement to report investment
identifiers such as CUSIP (Committee on Uniform Securities
Identification Procedures), CIK (Central Index Key), and LEI (Legal
Entity Identifier), if applicable, for each asset. Filers would also be
expected to provide any other uniform number applicable to the entity
or asset being reported, such as the Financial Instrument Global
Identifier (FIGI), which is now coming into more common usage.\17\ The
use of CUSIP in particular has been recognized by the GAO as a way to
improve end-users' ability to aggregate analyses of the information
contained on the Schedules of Assets. GAO Private Pensions: Targeted
Revisions Could Improve Usefulness Of Form 5500 Information, at 17.
---------------------------------------------------------------------------
\17\ See U.S. Bank Adopts Bloomberg's New Industry-standard for
Trustee Reporting, Bloomberg, (available at https://www.bloomberg.com/company/announcements/u-s-bank-adopts-bloombergs-new-industry-standard-for-trustee-reporting/) (reporting that U.S.
Bank is the first corporate trustee to adopt Bloomberg's
transparent, open-source methodology.)
---------------------------------------------------------------------------
The Agencies recognize that some identifiers, particularly the LEI,
are not yet widely used. The LEI is included in the proposal in
anticipation of increased use by the time the rule becomes final. The
LEI is intended to identify legally distinct entities that engage in a
financial transaction. It has support from both industry and government
agencies who view having a universal identifier of parties to financial
transactions, such as the LEI, as an important response to the 2008
financial crisis and the best way to track and understand the true
nature of risk exposures across the financial system. See, e.g.,
Statement on Legal Entity Identification for Financial Contracts, 75 FR
74146, 74147 (Nov. 30, 2010) (noting that precise and accurate
identification of legal entities engaged in financial transactions is
important to private markets and government regulation); Executive
Office of the President of the United States, Nat'l Science and
Technology Council, Smart Disclosure and Consumer Decision-making:
Report of the Task Force on Smart Disclosure, at 13 (2013) (noting that
the Administration is working to promote a LEI system). The use of LEI
to identify pension plan transactions is particularly important because
pension plan investments make up a large percentage of all investment
assets and, as previously discussed, plans are increasingly invested in
alternative investments that involve complicated financial structures
and transactions.
Under the proposal, filers would continue to be required to set
forth the current value of each investment asset listed on the Line 4i
Schedules of Assets. To improve reporting on hard-to-value assets where
the current value is by definition not readily available, filers would
be required to check a box for each individual investment listed to
indicate whether the asset is ``hard-to-value.'' This requirement is
meant to supplement the current compliance question on the Schedule H
that asks whether the plan held any investment assets whose value was
not readily determinable on an established market or set by a third
party independent appraisal. See, e.g., 2015 Form 5500 Annual Return/
Report Instructions for Schedule H. The aggregate compliance question,
by itself, does not provide particularly useful information on hard-to-
value assets. An examination of Form 5500 Annual Return/Report filings
suggests substantial non-compliance or inaccurate reporting in the ways
plans answer the question. See also DOL-OIG EBSA Needs To Provide
Additional Guidance And Oversight To ERISA Plans Holding Hard-To-Value
Alternative Investments, at 4-5, 18, and 19 (recognizing that the Form
5500 Annual Return/Report has a ``limited ability to capture
information on hard-to-value investments'' and recommending that EBSA
``improve Form 5500 [Annual Return/Report] data collection, analysis,
and targeting of plans with hard-to-value investments.''). The Agencies
believe that the requirement for filers to indicate for each specific
investment asset whether the asset is hard-to-value is in keeping with
the goals of obtaining better information regarding plan assets.
The instructions would also include a clearer definition of hard-
to-value assets for this purpose. Specifically, assets that are not
listed on any national exchanges or over-the-counter markets, or for
which quoted market prices are not available from sources such as
financial publications, the exchanges, or the National Association of
Securities Dealers Automated Quotations System (NASDAQ), would be
required to be identified as hard-to-value assets on the Line 4i
Schedules of Assets. CCTs and PSAs that are invested primarily in hard-
to-value assets must themselves be identified as hard-to-value assets,
regardless of whether they are valued at least annually. Similar to the
existing treatment in the instructions for registered investment
companies, CCTs, and PSAs under the current rules, those registered
investment companies, CCTs, and PSAs that are valued at least annually
and are invested primarily in assets that are listed on any national
exchanges or over-the-counter markets, or for which quoted market
prices are available from sources such as financial publications, the
exchanges, or the NASDAQ, however, would not need to be identified as
hard-to-value assets on the Line 4i Schedules of Assets.
A non-exhaustive list of examples of assets that would be required
to be identified as hard-to-value on the proposed Schedules of Assets
includes: Non-publicly traded securities, real estate, private equity
funds; hedge funds; and real estate investment trusts (REITs). The
Agencies believe this definition is generally consistent with the FASB
audit and accounting requirements defining assets with a readily
determinable fair value. See, e.g., FASB Accounting Standards
Codification TM (ASC) (Topic 820).
As discussed above, filers generally would be permitted to
aggregate participant-directed brokerage account reporting on the Line
4i Schedules of Assets by indicating the value of all the brokerage
account investments as a single entry (identifying the brokerage
account information). In the element requiring filers to indicate the
location where the asset was aggregated for purposes of balance sheet
reporting on Line 1b, the filer would have to indicate all of the
following applicable categories of investments: Tangible personal
property, loans, partnership or joint venture interests, real property,
employer securities, investments that could result in a loss in excess
of the account balance of the participant or beneficiary who directed
the transaction, and any asset that would be categorized as ``Other.''
For the second of the Line 4i Schedules of Assets, which would
correlate under the proposal to Schedule H, Line 4i(2), as noted above,
[[Page 47545]]
the Agencies propose to change ``Schedule of Assets Acquired and
Disposed Within Year'' to ``Schedule of Assets Disposed of During the
Plan Year.'' Filers currently report some information regarding the
disposal of hard-to-value assets and alternative investments either on
the Schedule H, Line 4i Schedule of Assets if the assets were both
acquired and disposed of during the plan year, or, if the value of the
transaction was five percent or more of total plan assets, on the
Schedule H, Line 4j ``Schedule of Reportable Transactions.'' The
Agencies believe, however, that requiring reporting of hard-to-value
assets and alternative investments acquired in one year and disposed of
in another year, including investments that fall under the five percent
limit of Line 4j,\18\ would provide the Agencies with a more complete
report of the plan's annual investments. The limitations on what assets
need to be reported on the Schedule of Assets Disposed of During the
Plan Year would remain unchanged from the current exceptions from
reporting on the Schedules of Assets not held at the end of the plan
year. Thus, the following would continue to be excluded from the Line
4i(2) Schedule of Assets Disposed of During the Plan Year:
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\18\ Title I of ERISA contemplates reporting transactions
involving three percent or more of plan assets. ERISA section
103(b)(3)(H). By prior rulemaking, the DOL has limited that
reporting requirement to transactions involving five percent or more
of plan assets. The Agencies continue to believe that generally
keeping the limit at transactions involving five percent or more of
plan assets, with this change to the Line 4i schedules, will provide
sufficient information about significant transactions during the
plan year.
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1. Debt obligations of the U.S. or any U.S. agency.
2. Interests issued by a company registered under the Investment
Company Act of 1940 (e.g., a mutual fund).
3. Bank certificates of deposit with a maturity of one year or
less.
4. Commercial paper with a maturity of 9 months or less if it is
valued in the highest rating category by at least two nationally
recognized statistical rating services and is issued by a company
required to file reports with the Securities and Exchange Commission
under section 13 of the Securities Exchange Act of 1934.
5. Participations in a bank common or collective trust (CCT).
6. Participations in an insurance company pooled separate account
(PSA).
7. Securities purchased from a broker-dealer registered under the
Securities Exchange Act of 1934 and either: (1) Listed on a national
securities exchange and registered under section 6 of the Securities
Exchange Act of 1934 or (2) quoted on NASDAQ.
Likewise, assets disposed of during the plan year would continue to
exclude any investment that was not held by the plan on the last day of
the plan year if that investment is reported in the annual report for
that plan year in any of the following schedules:
1. The schedule of loans or fixed income obligations in default
required by Schedule G, Part I;
2. The schedule of leases in default or classified as uncollectible
required by Schedule G, Part II;
3. The schedule of nonexempt transactions required by Schedule G,
Part III; or
4. The schedule of reportable transactions required by Schedule H,
line 4j.
The new proposed Line 4i(2) Schedule of Assets Disposed of Within
Year, generally would have the same data elements as the current
Schedule of Assets Acquired and Disposed of Within Year. To implement
the change in the schedule from ``acquired and disposed of during the
plan year'' to ``disposed of during the plan year,'' however, filers
would have to indicate the acquisition date. Basic parallel changes
would be made to the Line 4i(2) Schedule to keep it generally
consistent with the Line 4i(1) Schedule.
Under the proposal, the Line 4j Schedule of Reportable (5%)
Transactions would remain essentially unchanged. The current schedule
of reportable transactions requires the filer to include information on
the identity of the party involved in the reportable transaction or
series of transactions. Consistent with the Line 4i Schedules of
Assets, a checkbox is being added to this schedule to indicate whether
the reportable transaction or series of transactions involved a person
known to be a party-in-interest. Under the proposal, the Line 4j
Schedule of Reportable (5%) Transactions would be structured in a
standard format for data input and collection purposes; filers would
not be able to use a nonstandard attachment.
3. Proposed Changes to DFE Reporting
As described in parts A.1 and A.2 above in the context of the new
Schedule H balance sheet information and the updated schedules of
assets, respectively, the proposal includes changes as to what
information about DFEs and their underlying investments needs to be
reported by both the plan and the DFE. The proposal includes
correlative changes to the Schedule D that are described below,
including the elimination of the requirement of plans to complete
Schedule D. The Agencies considered a number of alternatives in
developing a proposal to address problems and concerns with regard to
the consistency and quality of the reporting of assets held through
collective investment vehicles, including DFEs. The Agencies considered
whether both DFEs and plans should be required, on their Line 4i
Schedule of Assets, to show the underlying investments of DFEs. The
Agencies also considered eliminating filings for PSAs, CCTs, and 103-12
IEs and simply requiring plans to report on the Line 4i Schedules of
Assets the plan's proportionate share of each of the underlying assets
held by each PSA, CCT, or 103-12 IE in which the plan is invested. The
Agencies invite comments on the most effective and efficient way to
address the inconsistent and limited reporting of information invested
through DFEs. The Agencies are particularly interested in information
on how investments in DFEs relate to investment alternatives in
participant-directed accounts and how much of the underlying assets of
DFEs consist of hard-to-value and alternative investments.
This revised reporting structure for both the Schedule H and the
Line 4i Schedules of Assets for reporting investments through pooled
investment vehicles is intended to enable the Agencies, plan
fiduciaries and service providers, and other users of the data to have
a better and more complete picture of the investments of plans. For
nearly 44 percent of all assets held by large pension plans, the public
information on plans' investments on the Form 5500 Annual Return/Report
is limited to the class of the pooled investment arrangements rather
than the financial class of the underlying investments (including hard-
to-value and alternative investments). See Dep't of Labor, 2010 Form
5500 Direct Filing Entity Bulletin: Abstract of 2010 Form 5500 Annual
Reports (2013), at 6. The proposed changes to reporting information
about assets held through DFEs on the Line 4i Schedules of Assets, as
well as the proposed changes to the Schedule H balance sheet
information, is also supported by the GAO's recommendation that the
Agencies take steps to reduce the difficulty associated with matching a
plan's investments with those reported in the DFE's filing. GAO Private
Pensions: Targeted Revisions Could Improve Usefulness of Form 5500
Information, at 14-15.
The proposed filing requirements for master trusts, CCTs and PSAs,
103-12
[[Page 47546]]
IEs, group insurance arrangements (GIAs), and the plans that invest
through these vehicles and the proposed revisions to Schedule D
reporting are described more fully below.
a. DFE Reporting--Master Trusts
Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 Annual Return/Report as
a DFE. In general, a master trust for Form 5500 Annual Return/Report
filing purposes is a trust maintained by a bank or similar institution
to hold the assets of more than one plan sponsored by a single employer
or by a group of employers under common control. Unlike CCTs and PSAs,
not every plan participating in the master trust necessarily has a
proportionate share of all of the assets of the master trust. To get
information about each plan's holdings within the master trust, the
annual return/report has historically asked for information about so-
called MTIAs. The Agencies understand that the MTIA reporting
requirements are unique to the Form 5500 Annual Return/Report, do not
fully correspond to actual trust accounting practices used for master
trusts, and may not be well understood or consistently complied with by
plans that use master trusts for investment and reinvestment of assets.
Accordingly, the proposal would eliminate MTIA reporting and replace it
with what is intended to be a simpler approach.
Under the MTIA reporting concept, each pool of assets held in a
master trust is treated as a separate MTIA if: (1) Each plan that has
an interest in the pool has the same fractional interest in each of the
assets in the pool as its fractional interest in the pool, and (2) each
such plan cannot dispose of its interest in any asset in the pool
without disposing of its interest in the pool. Under this test, it is
possible for a single asset to be an MTIA if ownership of the asset
meets the above test. Currently, a separate Form 5500 Annual Return/
Report must be filed for each MTIA, among other things, listing the
underlying assets of the MTIA on Schedule H and the aggregate value of
each investing plan's ownership interest in the MTIA on Schedule D. The
filing of each MTIA is deemed to be part of the Form 5500 Annual
Return/Report of the investing plan, and the plan administrator is,
therefore, ultimately responsible for MTIAs filing their Form 5500
Annual Return/Report, even if the bank or other third party is the
person that files for the MTIA.
According to GAO, MTIAs account for roughly 20.4% of the total
assets of large defined contribution pension plans. See Private
Pensions: Targeted Revisions Could Improve Usefulness Of Form 5500
Information, at 14. Accuracy of filings showing investments in master
trusts (regardless of reporting structure) is therefore important to
have a complete picture of plan investments. To facilitate consistent
reporting, the Agencies now propose to eliminate the concept of a
separate MTIA filing as part of the changes to Schedules D and H and
the Line 4i Schedules of Assets. Prior to 1999, master trusts were
required to file the Form 5500 Annual Return/Report; information about
MTIAs was provided in an attachment to the consolidated master trust
filing. See, e.g., 1998 Form 5500 Annual Return/Report and
Instructions. Under the proposal, master trust filing would return to
something closer to the pre-1999 structure.
Specifically, a Form 5500 Annual Return/Report would be required to
be filed for each master trust in which a plan has an interest. The
master trust, like a MTIA under the current rules, would be required to
include as part of its Form 5500 Annual Return/Report, a Schedule D to
list all participating plans. The Schedule D listing of participating
plans would include the requirement to report the total value of each
participating plan's investment assets in the master trust. Plans would
report their investments in master trusts in detail on their Schedule
H, Line 4i(1) Schedule of Assets Held for Investment at End of Year,
including the name and EIN of the master trust used on the master
trust's Form 5500 Annual Return/Report. Plans would also list the
aggregate value of their investment in master trusts on the Schedule H
balance sheet.
The proposal also would change the instructions to address what the
Agencies understand to be inconsistency in the way master trust
expenses are reported. Specifically, under the proposal, the master
trust's report would include expenses that are allocable equally to all
plans investing in the master trust. All other expenses would have to
be allocated to the individual participating plans and reported at the
individual plan level.
Finally, the regulations and instructions would provide that to be
a master trust for reporting purposes, either the master trust must
operate on a calendar year or the master trust and all of the plans
invested in the master trust must operate on the same fiscal year.
Where the master trust is on a calendar year and a participating plan
on a fiscal year other than a calendar year, similar to Schedule A
reporting of insurance contracts, the information reported by the plan
would be for the master trust year ending within the plan year.
The combined changes for reporting by both investing plans and
master trusts on both the Schedule H balance sheet and the Line 4i
Schedules are intended better to effectuate the purposes underlying the
current combination of MTIA, Schedule H (including the Line 4i
Schedules), and Schedule D reporting. This should make it easier to
understand the finances of the master trust as a whole, as well as the
finances of the plans investing through a master trust. The Agencies
invite comments to provide alternative suggestions on how to improve
the transparency and accuracy of reporting plans' proportionate
ownership of interests in assets held through a master trust.
b. DFE Reporting--CCTs and PSAs
As with the existing rules, under the proposal, a Form 5500 Annual
Return/Report may be, but is not required to be, filed for a CCT or a
PSA. The proposal would change the filing requirements with respect to
CCTs and PSAs as follows. As discussed above, regardless of whether a
CCT or PSA in which the plan invests files a Form 5500 Annual Return/
Report as a DFE, the plan would report the interests in the CCT or PSA
on the CCT or PSA line of the Schedule H balance sheet (Part I, Line
1b), although there would be breakouts within those categories to give
a general idea of the types of assets held through the CCT or PSA. The
changes should result in a clearer statement of total plan assets
invested through these collective investment vehicles.
The current requirement to break out the assets of non-filing CCTs
or PSAs would be retained, but the proposal would shift the details of
the underlying investments to the newly structured Line 4i(1) Schedule
of Assets. Under the proposed revisions, investing plans, on their own
Line 4i Schedules of Assets, would be required to list each underlying
investment, identifying that the investment was held through a non-
filing CCT or PSA, including the CCT's or PSA's name and other
identifying information, as well as the information on the underlying
asset.\19\
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\19\ As discussed above, if the CCT or PSA files a Form 5500
Annual Return/Report, the holdings in the CCT or PSA could be listed
on the plan's Line 4i(1) Schedule of Assets at the CCT/PSA level
(corresponding to the breakout categories on the balance sheet
statement). Thus, the PSA or CCT filing of a Form 5500 Annual
Return/Report, including the Line 4i(1) Schedule of Assets Held for
Investment, would relieve each participating plan from reporting
detailed information regarding the underlying investments.
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[[Page 47547]]
In this regard, the Agencies note that under current DOL
regulations CCTs and PSAs are required to provide information about the
underlying assets of the CCT or PSA to participating plans and provide
plans with relief from reporting the underlying assets of the CCT or
PSA if the CCT or PSA files the Form 5500 Annual Return/Report, but
that CCTs and PSAs are not required themselves to file the Schedules of
Assets. The regulation would be amended to provide that plans are
relieved from breaking out the individual assets on the Schedule H,
Line 4i Schedules of Assets, if the CCT or PSA instead files its own
Form 5500, including the Schedule H and the Schedule of Assets Held for
Investment. Also, the regulation would indicate that providing the
information needed for a plan to complete the Line 4i Schedules of
Assets constitutes compliance with the requirement to transmit
information regarding the assets held by the CCT or PSA. With this
change, information regarding the underlying investments of CCTs and
PSAs, which have been provided only to plan fiduciaries, will now be
part of the annual return/report data set; it will be filed either by
the participating plans or by the CCT or PSA.
c. DFE Reporting--103-12 IE
The DOL's regulation at 29 CFR 2520.103-12 provides that an entity
in which two or more unrelated plans invest that is not a CCT, PSA, or
master trust, and which is deemed to hold plan assets under the DOL's
regulations at 29 CFR 2510.3-101 that voluntarily chooses to file a
Form 5500 Annual Return/Report for itself on behalf of its investing
plans, is treated as a ``103-12 IE'' filing entity for Form 5500 Annual
Return/Report reporting purposes. Under the proposal, reporting for
these pooled investment vehicles generally remains unchanged, except to
the extent that the data elements for the existing forms and schedules
have changed for all filers. For a plan to be able to report
investments in such entities as a single investment on the balance
sheet portion of Schedule H, as under the current reporting rules, the
entity in which the plan invested would have to complete its own Form
5500, together with a Schedule H and Line 4i Schedules of Assets, as
well as Schedules A, C, D, G, as revised in the proposal, and the
entity's own IQPA report. Under the proposal, similar to reporting
assets held through participant-directed brokerage accounts, filers
would have to indicate all the Line 1b balance sheet breakout
categories for types of underlying investment of each 103-12 IE, but
would not have to identify each individual investment.
d. DFE Reporting--GIAs
The reporting requirements for GIAs would generally remain
unchanged, except GIAs would be subject to the same changes in
reporting as comparable welfare plans, including the new requirements
for welfare plans that provide health benefits. As under the current
rules, welfare plans that are fully insured, including group health
plans, would still have the exemption from filing the Form 5500 Annual
Return/Report if they participate in a GIA that has filed its Form 5500
Annual Return/Report. GIAs would continue to be required to file all
the same forms, schedules, and attachments as a large group health plan
funded with a trust. GIAs that provide group health coverage would be
required to file a separate Schedule J for each separate employer's
participating plan.
e. DFE Reporting--Changes to Schedule D
The Agencies propose to continue the Schedule D requirement for
DFEs in which plans invest, but not for plans participating in DFEs.
DFEs would continue to report identifying information about the
participating plan and the dollar value of each investing plan's
interests in the DFE as of the end of the DFE reporting year.
Participating plans, because they would now be reporting detailed
information about investments in DFEs on their Line 4i Schedules of
Assets, would no longer have to complete the Schedule D.
4. Better Information on Plan Terminations, Mergers, and Consolidations
The Agencies propose revisions to existing Schedule H and Form
5500-SF questions on plan terminations, mergers, and consolidations.
First, the Agencies propose expanding the question that asks whether
the plan has adopted a resolution to terminate so that it also asks for
the effective date of the plan termination, the year in which assets
were distributed to plan participants and beneficiaries, and whether
the plan transferred assets or liabilities to another plan.
Second, the proposal would add a question asking filers to indicate
whether another plan transferred assets or liabilities to the reporting
plan (other than pursuant to a direct rollover). If the plan received a
transfer of assets or liabilities from another plan, the filer would be
asked to provide the date and type of transfer (merger, consolidation,
spinoff, other). This new information is intended to provide better
information on transfers of participant benefit obligations over the
years.
Third, if the plan is a defined contribution pension plan that
terminated and transferred plan assets to a financial institution and
established accounts in the name of missing participants, the filer
would be asked to provide the name and EIN of the financial
institution, the date the assets were transferred to the institution,
the number of accounts established, and the total amount transferred.
Although the question would not ask the filer to identify individual
affected participants or beneficiaries, this requirement is designed to
help missing participants locate information about their accounts, in
some cases years after the plan termination when the plan or plan
sponsor may no longer exist or have records of the accounts it
established. Asking for information about accounts created for missing
participants after plan termination would also be responsive to the
ERISA Advisory Council's recommendations that the DOL use the Form 5500
Annual Return/Report to obtain more consistent reporting on accounts
that hold missing participant plan assets. See 2013 ERISA Advisory
Council Report: Locating Missing and Lost Participants, Dep't of Labor
(available at www.dol.gov/ebsa/publications/2013ACreport3.html#2).
In this 2013 report, the Advisory Council noted that another issue
with ``lost'' or ``missing'' participants for ongoing plans as well as
terminating plans, especially 401(k) plans, is ``uncashed'' checks,
particularly checks sent to participants who have left employment where
the Code permits the plan to ``cash out'' the participant. Id. The
report noted that a plan was not necessarily able to tell whether
uncashed checks were sent to the wrong address (a ``lost'' or
``missing'' participant issue) or whether a participant received the
check but had not cashed it. To get better information about the
magnitude of the problem with respect to defined contribution pension
plans and to make plan fiduciaries aware that they should, at a
minimum, have procedures in place to verify that a participant's
address is good before a check is mailed and to keep track of the
number of uncashed checks and the amount involved, the proposal would
also add to both the Schedule H and the Form 5500-SF a compliance
question for defined contribution pension plans asking whether there
were any uncashed checks at the end of the plan year. If there were any
uncashed checks at the end of the year, filers would be required
[[Page 47548]]
to report how many uncashed checks there were and the total dollar
value of the uncashed checks. Defined contribution pension plan filers
would also be asked to describe briefly in an open text field the
procedures that they followed to verify a participant's address and
with respect to monitoring the uncashed checks. The proposed
instructions provide that for Form 5500 Annual Return/Report reporting
purposes, an uncashed check is one that is no longer negotiable or is
subject to limited payability.
In proposing to add a compliance question instead of telling filers
how to account for the assets associated with uncashed checks on the
Schedule H, the Agencies recognize that the ERISA Advisory Council
indicated that there are questions regarding how the underlying assets
represented by uncashed checks should be reported on the Form 5500
Annual Return/Report. Because of the variety of situations that might
result in uncashed checks and the different ways uncashed checks might
be accounted for in an ongoing plan, the Agencies have chosen to add a
compliance question, leaving flexibility in the balance sheet reporting
on Schedule H and on the Form 5500-SF and, where applicable, the IQPA
report.
The ERISA Advisory Council and some of the witnesses who testified
recommended that the DOL publish guidance to advise plan fiduciaries
how to handle uncashed checks, among other issues regarding missing or
lost participants and beneficiaries and how to address the assets
associated with those participants or beneficiaries. In making this
recommendation, it was recognized that there was a tension between the
mandatory distribution requirements under the Code and fiduciary
responsibilities. In the absence of further guidance with regard to how
to handle uncashed checks, the DOL notes (as stated above) that plans
should at least have policies and procedures in place to verify
participant addresses, for searching for missing participants and for
fiduciaries to keep track of or be made aware of the number of uncashed
checks and the total value of such checks that remained uncashed at the
end of the plan year. Depending on the type of plan, the terms of the
plan, and the status of the plan sponsor, there may be actions needed
to satisfy fiduciary obligations with regard to benefit payments.
5. Changes to Financial Reporting for Small Plans
a. Changes to Form 5500-SF
In general, small plans that are invested only in ``eligible'' plan
assets and otherwise meet the existing requirements for eligibility to
file the Form 5500-SF would continue to be able to file the Form 5500-
SF.\20\ Welfare plans with fewer than 100 participants that do not
provide group health benefits and that are required to file an annual
return/report and that meet the eligibility requirements for the Form
5500-SF will still be able to use the Form 5500-SF to satisfy their
filing requirement. Welfare plans with fewer than 100 participants that
provide group health benefits are not eligible to use the Form 5500-
SF.\21\ For Form 5500-SF filers, there would be a modest additional
breakout on the balance sheet information to give a basic picture of
the types of eligible assets in which Form 5500-SF eligible small plans
are invested. Specifically, filers would have to categorize the plans'
investments into one of the following categories: (1) Cash/cash
equivalents; (2) money market funds; (3) publicly traded stock
(preferred/common); (4) publicly traded bonds, including government
securities; (5) interests in registered investment companies (mutual
funds, unit investment trusts, closed end funds); (6) interests in
PSAs; (7) interests in CCTs; and (8) interests in insurance policies/
contracts other than PSAs, e.g. annuity contracts. In contrast to the
Schedule H balance sheet financial breakout categories, there would be
no ``Other'' category for the balance sheet financials on the Form
5500-SF. If a small plan were to be invested in any assets other than
those in the eight listed categories, it would not be eligible to file
the Form 5500-SF.
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\20\ The Form 5500-SF was developed and adopted for 2009 Form
5500 Annual Return/Report in part to provide a simplified report
required under the Pension Protection Act of 2006. The DOL continues
to believe, as discussed when implementing the 2009 forms revisions,
72 FR 64731 (Nov. 16, 2007), that the requirement in the PPA to
provide ``'simplified'' reporting for plans with fewer than 25
participants is satisfied by making available the simplified
reporting in the 5500-SF only to those plans invested in eligible
assets--generally easy to value assets. Section 1103(b) of the
Pension Protection Act of 2006, (PPA) 120 Stat. 780, 1057, requires
the Secretary of the Treasury/IRS and the Secretary of Labor to
provide for the filing of a simplified annual return for any
retirement plan which covers fewer than 25 participants on the first
day of the plan year and which (1) meets the minimum coverage
requirements of section 410(b) of the Internal Revenue Code without
being combined with any other plan of the business that covers the
employees of the business; (2) does not cover a business that is a
member of an affiliated service group, a controlled group of
corporations, or a group of businesses under common control; and (3)
does not cover a business that uses the services of leased employees
(within the meaning of section 414(n) of the Code). The PPA
provision does not include specific requirements as to the form or
content of the simplified filing.
\21\ Currently welfare plans with fewer than 100 participants,
including those that provide group health benefits, that are not
exempt from the requirement to file an annual return/report (e.g.,
those that are funded with a trust) are permitted to file the Form
5500-SF, if otherwise eligible.
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As discussed in more detail below, the proposal would eliminate the
current Form 5500 and Form 5500-SF line items that require the filer to
input ``plan characteristics codes'' onto the form from a list in the
instructions. Instead, the filer would complete a series of separate
questions. In general, those changes involve requesting information
about plan characteristics as a series of ``Yes''/``No'' and check box
questions to make the forms easier to complete, make the forms more
straightforward as a disclosure document, and improve the quality of
the data. In addition, as with Form 5500 Schedule H filers, the
proposal would require that the Form 5500-SF filed for a participant-
directed individual account plan must include an electronic copy of the
comparative chart of designated investment alternatives (DIAs)
currently required to be provided to participants of such plans under
29 CFR 2550.404a-5. The Agencies believe that although this information
would not be filed in a data captured structure and, thus, would not be
as readily data mineable, attaching the already required 404a-5
comparison chart would allow participants and beneficiaries in
participant-directed individual account plans to access the most recent
and prior year comparative charts through the EFAST Form 5500 Annual
Return/Report public disclosure feature. It would also enable the
Agencies to monitor more effectively compliance by participant-directed
individual account plans with this important disclosure requirement. It
also would provide important information regarding investment features
and investment fees and expenses. We also understand that private third
parties would be able to use the copies of the comparative charts to
develop more individualized tools to help plan sponsors, plan
fiduciaries, and participants and beneficiaries evaluate and compare
their plans' investment options. The Agencies believe that a
requirement that the plan administrator of a participant-directed
individual account plan attach an electronic copy of an existing
document should be less burdensome than adding new questions that would
require the same data to be entered onto the form or schedules to
collect the information.
[[Page 47549]]
The Agencies seek comment as to whether there would be any real
additional burden, other than transition costs to move to the new
method, to enter the data in a structured format rather than attaching
a copy of the existing document.
b. Changes to Filing Exemptions and Requirements for Small Plans Not
Eligible To File the Form 5500-SF
As discussed above, various oversight and advisory bodies have
identified a significant need for better information regarding employee
benefit plan investments, in particular regarding plans invested in
hard-to-value and alternative investments. In that regard, the Agencies
are proposing a number of changes for small plans that are not Form
5500-SF eligible filers. First, the Schedule I would be eliminated.
Like the Form 5500-SF, the Schedule I does not require small plan
filers to provide detailed plan asset information. Since small plan
filers are the majority of annual return/report filers overall (taking
into account both Form 5500-SF and Form 5500 filers), this shortcoming
impairs the utility of the Form 5500 Annual Return/Report as a tool to
obtain a meaningful picture of small plan investments in hard-to-value
and other assets. As the GAO has noted, the limited financial
information provided on the Schedule I creates a challenge for
participants, beneficiaries, oversight agencies, researchers, and other
users of the Form 5500 or Form 5500 data. GAO Targeted Revisions Could
Improve Usefulness of Form 5500 Information, at 18. Accordingly, under
the proposed change, small plans that are not eligible to file the Form
5500-SF and that currently file the Schedule I would be required to
complete the Schedule H and the applicable Line 4i Schedules of assets.
Small plans with simple investment portfolios would not see a
significant increase in their annual reporting burden. Although this
would result in additional reporting details for those small plans with
complex portfolios that include hard-to-value or alternative
investments, the Agencies believe that such small plans should have
more transparent financial statements. In light of changes in the
financial environment and increasing concern about investments in hard-
to-value assets and alternative investments, the Agencies continue to
believe that requiring small plans invested in such assets to report
separate financial information regarding hard-to-value investments is
important for regulatory, enforcement, and disclosure purposes.
Although such small plans would be required to complete the Schedule H
instead of the Schedule I, including the Line 4i(1) and 4i(2) Schedules
of Assets, to minimize increased burden, small plans that meet the
specified requirements, as they can under the current rules, would
continue to be eligible for a waiver of the annual examination and
report of an independent qualified public accountant (IQPA) under 29
CFR 2520.104-46. As is currently the case, under the proposal, all
welfare plans with fewer than 100 participants that are required to
file an annual return/report are eligible for a waiver of the annual
examination and report of an IQPA under 29 CFR 2520.104-46(b)(2).
The Agencies are also proposing to change the rules for determining
when a plan is exempt from the requirement to include an IQPA report
with its filing. In that regard, the Agencies are proposing to add to
the Form 5500 a new question, for defined contribution pension plans
only, asking for the number of participants with account balances at
the beginning of the plan year. Defined contribution pension plans
would determine whether they have to file as a large plan and whether
they have to attach an IQPA report based on the number of participants
with account balances as of the beginning of the plan year, as reported
on the face of the Form 5500 or Form 5500-SF. Currently, the IQPA
requirement is based on the total number of participants (including
those eligible but not participating in a Code section 401(k) or 403(b)
plan) at the beginning of the plan year. With the changes in the
reporting requirements for small plans (for example, the elimination of
the Schedule I), this would minimize burden, but would still provide a
picture of the types of investments and fees of small plans (plans with
fewer than 100 participants that have an account balance) without
requiring them to cover the cost of an audit. For first plan year
filings, the plan would have to have fewer than 100 participants with
account balances both at the beginning of the plan year and the end of
the plan year.
The proposal would also require a Schedule C to be filed by small
pension plans that are not eligible to file the Form 5500-SF, small
welfare plans that provide group health benefits that are not unfunded
or insured (e.g., funded using a trust), and other small welfare plans
that are not unfunded or insured plans and are not eligible to file the
Form 5500-SF. Currently, only large plans must file a Schedule C, thus
excluding a large portion of plans from having to disclose service
provider fees. The Agencies recognize the burdens small plans face in
complying with disclosure obligations, but requiring certain small
plans to file a Schedule C would address some of the GAO's concerns
that not all critical information on indirect compensation is being
reported to the Agencies. See GAO Targeted Revisions Could Improve
Usefulness of Form 5500 Information, at 25-26 (``Given these various
exceptions to fee reporting requirements, Schedule C may not provide
participants, the government, or the public with information about a
significant portion of plan expenses and limits the ability to identify
fees that may be questionable.''). In addition, the rule would better
align financial information reporting with recently adopted disclosure
rules to broaden the fees that are reported by the affected plans. Id.
at 50.
6. New Information on Employer Matching Contributions, Employee
Participation Rates, and Plan Design for Defined Contribution Pension
Plans
The Agencies are proposing changes that are intended to collect
better information on pension plan coverage and performance as
retirement savings vehicles. The focus is on participant-directed
defined contribution pension plans, which are becoming the primary
source of retirement savings for many of America's workers.
Specifically, the proposal would add new questions to the Form 5500,
Form 5500-SF, and Schedule R on participation, contributions, and asset
allocation by age, and participant-level diversification. The questions
ask for the number of participants making catch-up contributions,
investing in default investment options, maximizing the employer match,
and deferring compensation. Also, questions would be added to the Form
5500 and Form 5500-SF to collect information on the number of
participants in defined contribution pension plans with account
balances as of the beginning of the plan year and on the number of
participants that terminated employment during the plan year that had
their entire account balance distributed. There are also new questions
about whether the plan uses a default investment alternative for
participants who fail to direct assets in their account and which type
of investment alternative is used.
7. Changes to Reporting on Schedule G (Financial Transaction Schedules)
The proposal would reconfigure Schedule G's reporting to require
more uniform and detailed information on loans, fixed income
obligations, and
[[Page 47550]]
leases in default, including swaps/options and derivative transactions.
By creating specific data elements on the existing Schedule G line
items for plans to identify specifically swaps and options that would
otherwise generically have been reported as loans or fixed income
obligations in default or uncollectible, the proposed Schedule G is
intended to provide a more complete picture of issues of default,
uncollectibility, or conflict of interest (nonexempt) transactions with
respect to plan investment in these types of hard-to-value assets.
8. Re-introduction of Schedule E To Improve Information on Employee
Stock Ownership Plans (ESOPs)
Prior to 2009, the Schedule E (ESOP Annual Information) was an IRS
component of the Form 5500 Annual Return/Report used to collect
information regarding ESOPs. As with the other ``IRS-only'' schedules
that are part of the Form 5500 Annual Return/Report, the Schedule E was
removed from the 2009 Form 5500 Annual Return/Report when DOL mandated
electronic filing of the Form 5500 Annual Return/Report as part of
EFAST2 due to statutory limits on the IRS's authority to mandate
electronic filing of such information for filers of fewer than 250
returns. A limited number of the questions on the Schedule E were moved
to the Schedule R beginning with the 2009 Form 5500 Annual Return/
Report. The Schedule R is not an ``IRS-only'' schedule nor were the
questions that were moved to the Schedule R IRS-only. Accordingly,
filing of the current ESOP information on the Schedule R was subject to
DOL's electronic filing mandate under Title I of ERISA.
The Agencies propose to bring back to the Form 5500 Annual Return/
Report a revised version of the Schedule E, which now generally would
be required reporting under both Title I of ERISA and the Code and thus
would be open to public inspection. The new version would include some
of the questions on the pre-2009 Schedule E, revisions to other
questions, and additional new questions. The questions moved to the
Schedule R for the 2009 revisions would be removed from the Schedule R
and instead be included on the new and revised Schedule E. The Agencies
believe the use of a single schedule for all ESOP questions would
simplify the filing of Form 5500 Annual Return/Report for both ESOP and
non-ESOP filers. In addition, a single schedule for ESOPs would also be
a more effective and efficient information collection tool for the
Agencies.
The questions on the proposed Schedule E are divided into sections
based on whether the ESOP stock was acquired by a securities
acquisition loan, whether the stock is readily tradable on an
established securities market (including stock acquired by securities
acquisition loans), whether the ESOP has an outstanding securities
acquisition loan, and some miscellaneous questions.
Part I of the proposed Schedule E would apply only if the ESOP
acquired common or preferred stock with the proceeds of a securities
acquisition loan. Several questions relate to the valuation of the
stock acquired by the ESOP and, in particular, cases where a premium is
paid for a controlling interest in a company where, in fact, a
controlling interest is not acquired. Questions would also be included
regarding the release of common stock from a suspense account and its
allocation. For example, a question would ask for the method used when
stock is released from the suspense account (similar to Line 5 of the
2008 Schedule E) in accordance with Treasury regulations. See 26 CFR
54.4975-7(b)(8). As with Line 4 of the 2008 Schedule E, the proposed
Schedule E would also ask if the ESOP holds preferred stock and further
ask for the method by which the preferred stock is convertible into
common stock.
Part II of the proposed Schedule E would ask questions related to
compliance issues when stock that is not readily tradable on an
established securities market is acquired by an ESOP. Specifically,
with respect to each acquisition of stock, the proposed schedule would
ask for information on the relationship of the seller of the stock to
the plan or to the employer, and whether the seller is a party-in-
interest or a disqualified person under the prohibited transaction
rules of Title I of ERISA and the Code, respectively. Further, the
proposed schedule would ask for the total consideration paid and the
date of the transaction. The proposed schedule would also ask if the
stock was valued by an independent appraiser and, if not, the identity
of the person who valued the stock. Lastly, Part II would ask for the
valuation method(s) used to value the stock. Each of these questions
would assist the Agencies in identifying possible issues in the
acquisition of stock, including whether the stock was properly valued
and whether a prohibited transaction may have occurred.
Part III of the proposed Schedule E asks questions applicable to
ESOPs with outstanding securities acquisition loans. Unlike the 2008
Schedule E which only asked whether the ESOP had a securities
acquisition loan, the proposed Schedule E would ask for more
information regarding these loans. The proposed schedule asks for basic
information regarding the amount and date of the loan, as well as the
interest rate on the loan. In order to address possible prohibited
transactions and situations where the ESOP may have paid too much for
the stock, the proposed Schedule E also would ask for the lender's
relationship to the plan and the plan sponsor, whether the lender is a
disqualified person or a party-in-interest, and whether the loan was
guaranteed by a disqualified person or a party-in-interest. Part III
also would ask questions regarding whether the loan is in default and
whether the loan has been refinanced. A loan that is in default raises
issues as to whether the plan sponsor is making substantial and
recurring payments to the ESOP and whether the ESOP has been
terminated, in which case all of the ESOP shares should be distributed.
Part IV of the proposed Schedule E would include miscellaneous
questions. Specifically, to address compliance concerns under Title I
of ERISA, the proposed schedule would ask whether employee elective
deferrals were used to satisfy any securities acquisition loan. With
the exception of the elective deferral question, which addresses a DOL
compliance issue and not an issue under the Code, the Part IV questions
are carried over from the 2008 Schedule E and continue to address
significant compliance issues under the Code, including whether the
amount of the dividend is reasonable and whether the requirements of 26
CFR 1.404(k)-3T are satisfied. Specifically, the proposed Schedule E
would ask whether the ESOP is maintained by an S corporation and
whether there are any disqualified persons under Code section 409(p)(4)
(lines 1a and 1b of the 2008 Schedule E), whether any unallocated
securities (or proceeds from unallocated securities) were used to repay
an exempt loan (Line 6 of the 2008 Schedule E), and whether the plan
sponsor paid dividends deductible under Code section 404(k) (Line 2b of
the 2008 Schedule E). This last question is further broken down on the
proposed schedule to include information as to the amount of the
deduction, the dividend rate, and whether the dividends were used to
reacquire stock held by the ESOP.
As described above, several of the questions on the proposed
Schedule E would be IRS-only questions. These questions are subject to
the electronic filing rules imposed by Treasury
[[Page 47551]]
regulations, but they are not subject to the DOL electronic filing
mandate. The IRS-only questions would be identified on the Schedule E
itself or in the Schedule E instructions. Accordingly, although filers
would be required to answer most questions on the proposed Schedule E
electronically using EFAST2, some filers who are not subject to the IRS
electronic filing requirements and elect not to answer the questions
through EFAST2 would have the option of answering the IRS-only
questions on the IRS's Form 5500 SUP ``Annual Return of Employee
Benefit Plan Supplemental Information,'' which is a separate paper
based IRS-only information collection system maintained by the IRS
outside of the EFAST2 system.
B. Improve Fee and Service Provider Transparency (Schedules C and H)
The Agencies continue to make efforts to improve the reporting and
disclosure of service provider compensation. The key focus of the
proposed changes in this regard is to harmonize Form 5500, Schedule C,
reporting of indirect compensation with the disclosures required under
the DOL's final regulation under Title I of ERISA on service provider
compensation at 29 CFR 2550.408b-2. As discussed above in the section
on small plan reporting changes, the proposal would also expand
Schedule C reporting to those pension plans required to file the Form
5500, regardless of size.\22\ The current Form 5500, Schedule C
indirect compensation reporting rules, including the exception from
reporting of ``eligible indirect compensation,'' were implemented for
the 2009 forms. See 72 FR 74731 (Nov. 16, 2007). Those changes were
part of a three-pronged regulatory initiative that included the DOL's
plan-level disclosure regulations under 29 CFR 2550.408b-2 and
participant-level disclosure regulations under 29 CFR 2550.404a-5. At
the time the Schedule C rules were finalized, the 408b-2 disclosure
regulations had not yet been promulgated. Some elements of the Schedule
C, for example, the eligible indirect compensation provisions, were
adopted in light of the fact that it was not certain at the time what
the 408b-2 final rule would require. Those provisions were also meant
to respond to concerns from the regulated community, especially large
service providers with many ERISA-covered plan clients, about having to
create two different record-keeping systems to meet the various
requirements of Form 5500 Annual Return/Report and 408b-2 disclosures
should the later promulgated 408b-2 provisions differ from the Form
5500 Annual Return/Report reporting requirements on indirect
compensation. With the service provider disclosure rules now final at
29 CFR 2550.408b-2, the Agencies are proposing various changes to the
Schedule C to better harmonize it with the disclosure requirements
under the 408b-2 final rule.
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\22\ Form 5500-SF filers would not be required to file the
Schedule C, but small defined contribution pension plans filing the
Form 5500-SF, as well as any defined contribution pension plans
required to file the Form 5500, Schedule H, would be required to
attach the comparison chart required to be disclosed to participants
and beneficiaries under the DOL's regulation at 29 CFR 2550.404a-5.
Form 5500-SF filers also would continue to be required to answer a
question on total insurance fees and commissions, that parallels the
total insurance fee and commission question on Schedule A.
---------------------------------------------------------------------------
First, the Schedule C would be changed to require reporting of
indirect compensation only for ``covered'' service providers and for
compensation that is required to be disclosed, as defined in 29 CFR
2550.408b-2(c)(1). The Agencies expect that this change would improve
Schedule C reporting because it would essentially require the pension
plan administrator to report the actual compensation paid to or
received by covered service providers based on the expected
compensation included in the 408b-2 disclosures that the service
provider furnished to the plan as part of the process of establishing
and maintaining the service contract or arrangement with the plan. The
instructions similarly have been clarified to track more closely the
language of the 408b-2 regulation.
In making this an across-the-board Schedule C change to provide for
consistency in the annual return/report requirements, the Agencies
recognize that the changes proposed to the Schedule C would also apply
to certain welfare plans that are not subject to the 408b-2 regulation.
The principal consequence of the proposed changes for those welfare
plans is to narrow the classes of service providers that would be
required to be reported and more clearly define the types of
compensation that must be reported on the Schedule C. Thus, we believe
that the proposed changes will be improvement for welfare plan
reporting.
Another key element of the proposed changes to Schedule C
consistent with the final regulations at 29 CFR 2550.408b-2 is the
elimination of the reporting concept of ``eligible indirect
compensation.'' Under the current reporting rules, the types of
indirect compensation that can be treated as ``eligible indirect
compensation'' are fees or expense reimbursement payments charged to
investment funds and reflected in the value of the investment or return
on investment of the participating plan or its participants, finder's
fees, ``soft dollar'' revenue, float revenue, and/or brokerage
commissions or other transaction-based fees for transactions or
services involving the plan that were not paid directly by the plan or
plan sponsor (whether or not they are capitalized as investment costs).
Under the current requirements, rather than disclosing the identity of
the service provider and reporting information about the services
provided and compensation received by the service provider, the plan
administrator must merely confirm that the plan received certain
written disclosures that describe: (1) The existence of the indirect
compensation; (2) the services provided for the indirect compensation
or the purpose for payment of the indirect compensation; (3) the amount
(or estimate) of the compensation or a description of the formula used
to calculate or determine the compensation; and (4) the identity of the
party or parties paying and receiving the compensation. The GAO has
been critical of the concept of ``eligible indirect compensation'' and
other limitations on Schedule C reporting of indirect compensation
received by plan service providers. See GAO Private Pensions:
Additional Changes Could Improve Employee Benefit Plan Financial
Reporting. In its response published with that report, the DOL
generally agreed that reporting indirect compensation on Schedule C
should be coordinated with the implementation of new requirements in
the then proposed regulation under section 408(b)(2) of ERISA. Part of
the reason for the concept of eligible indirect compensation was the
timing of the move to the electronic filing system and attendant forms
changes relative to the timing of the 408b-2 regulation. There is no
counterpart to ``eligible indirect compensation'' under 29 CFR
2550.408b-2. In this regard, the proposed Schedule C would eliminate
current Line 1 (which enables plans to acknowledge that they had
service providers that received only eligible indirect compensation).
Current Line 2, used for reporting both direct and indirect
compensation, would be made new Line 1. To effectuate the elimination
of the ``eligible indirect compensation'' reporting concept, there
would no longer be a corresponding element to current Line 2(f), which
asks whether a listed service provider that received other direct or
indirect compensation also received eligible indirect compensation.
[[Page 47552]]
In changing the reporting requirements to better track the 408b-2
regulation, the Agencies recognize that part of the reason for having
developed the concept of ``eligible indirect compensation'' was concern
expressed by commenters that it would be difficult to generate specific
dollar amounts at the plan level, especially in the case of omnibus
level charges. In that regard, the proposed Schedule C instructions
borrow from instructions in the Schedule A on determining plan-level
allocation of insurance contract fees and commissions. Specifically,
the Schedule C instructions permit any reasonable method of allocation
to be used to estimate plan level fees for the Schedule C, provided the
method is disclosed to the plan administrator. This approach provides a
substantial amount of flexibility for service providers in determining
the amounts to report. The DOL invites comments on this proposed method
for plan level allocation of indirect compensation generated at an
``omnibus'' level, including whether there are particular types of
indirect compensation for which it would be unduly expensive or
burdensome to report a dollar amount or estimate at the plan level.
To further conform the Schedule C reporting rules to the disclosure
requirements in 29 CFR 2550.408b-2, filers would be required to report
``covered'' service providers who have received $1,000 or more in total
direct and indirect compensation (i.e., money or anything else of
monetary value in connection with services rendered to the plan or the
person's position with the plan during the plan year, including
payments from participants' accounts). As on the current Schedule C,
plans would only need to report other service providers (e.g., an
accountant that received only direct compensation) who received $5,000
or more in direct compensation in connection with services rendered to
the plan or the person's position with the plan during the plan year,
including payments from participants' accounts.
To make reporting of the information specific to each service
provider more straightforward, instead of having repeating line items
on Schedule C, the proposal would have filers use a separate Schedule C
for each service provider required to be reported. With this formatting
change, the proposed Line 1 of the Schedule C generally would retain
the same identifying elements as the current Line 2, with the following
changes. Similar to the proposal to amend the regulation at 2550.408b-
2, see 79 FR 13949, 13962 (Mar. 14, 2014), this proposal seeks to add
to Schedule C a requirement to report contact information for service
providers that are not natural persons. Filers would be required to
identify a person or office, including contact information, that the
plan administer may contact with regard to the information required to
be disclosed on the Schedule C.
The proposal would also clarify and expand the existing question
that asks the filer to indicate generally whether the service provider
has a relationship to the employer, an employee organization, or a
person known to be a party-in-interest. The proposal would now state
that filers should indicate any relationship of the service provider to
the plan, for example, employer, plan sponsor, plan sponsor employee,
plan employee, named fiduciary, employee organization, and ``Other,''
with a description. With the prevalence of revenue sharing
arrangements, the Agencies believe that better information on the
relationship between service providers and the plan, various
fiduciaries and parties-in-interest, including relationships among plan
service providers, is important to understand the relationship between
compensation and services to the plan. Under the proposal, filers would
be required on Schedule C, as in the 408b-2 disclosures for pension
plans, to indicate (by checking a box) whether the service providers
receiving compensation are fiduciaries within the meaning of section
3(21) of ERISA.
As noted in the GAO report, GAO Private Pensions: Targeted
Revisions Could Improve Usefulness Of Form 5500 Information, some
filers have expressed confusion about how to answer the current
question which requires filers to identify both service and fee codes
in the same line item, despite the instruction that requires entering
all codes that apply. To address this concern and to improve quality of
the data, the proposal clarifies the required reporting on the types of
services provided and the types of compensation received by individual
service providers by separating the existing compound question into two
separate reporting elements, one line item to indicate service codes
and the other to indicate compensation codes. To minimize both burden
and potential confusion, filers would need to report service codes for
all service providers, regardless of the type of compensation received,
but would only have to indicate compensation codes for indirect
compensation.
A new service type would be added for information technology/
computer support. ``Information technology/computer support,'' for the
purposes of Line 1c, would include computer office automation,
information processing, local and wide area network support, services
supporting hardware, software, telecommunications systems, including
automated telephone response systems and systems security.
The proposed Schedule C instructions would continue to permit
filers to offset from the total amounts of direct compensation the
amounts received from a so-called ERISA recapture or ERISA budget
account or similar account. Because filers are permitted to report a
net figure, however, it is not possible to determine whether such an
account has been used. With the increasing use of such accounts, see
generally Advisory Opinion 2013-03A (Jul. 3, 2013), DOL believes it is
important for the Form 5500 to indicate whether such accounts are being
used as part of the plan's fee and revenue sharing structures. The
proposal thus includes a ``Yes''/``No'' question on Schedule C's
revised Line 1, to ask whether any such account or arrangement has been
used by the plan during the plan year.
The proposal would also add a question asking whether the service
provider arrangement includes recordkeeping services to a plan without
explicit compensation for some or all of such recordkeeping services or
with compensation for such recordkeeping offset or rebated in whole or
in part based on other compensation received by the service provider,
or an affiliate or subcontractor. If so, the filer would be required,
using the same methodology used in the service provider's estimate of
the cost to the plan of recordkeeping services, to enter as a dollar
figure the amount of compensation the service provider received for
recordkeeping services. The Agencies believe that this information will
better enable a cost comparison in an environment where there are
different fee structures and methods of calculating compensation.
The proposed Line 1 would also include a data element that asks
whether the service provider listed on the Schedule C was also
identified on Schedule A as having received insurance fees and
commissions. Filers are not required to report on Schedule C insurance
fees and commissions that are already reported on Schedule A. The
question is designed to help users of the Form 5500 Annual Return/
Report data identify service providers where some fees and commissions
are reported on Schedule A and some on Schedule C.
In the proposed Line 2, filers would report direct compensation
paid to the service provider by the plan. The
[[Page 47553]]
Agencies considered having filers break out payments as follows: Direct
payments by a plan out of a plan account, charges to a plan forfeiture
account, charges to fee recapture accounts, charges to a plan trust
account before allocations to individual participant accounts, direct
charges to individual participant accounts, and ``Other,'' with a
description. Rather than requiring that detailed breakout on the
Schedule C, the Agencies concluded that they could still obtain a
better picture of how the plan pays direct compensation by instead
adding a breakout of how participant accounts are charged to the
Schedule H ``Administrative Expense'' line and requiring information
regarding recapture accounts in the form of a ``Yes/No'' question on
Schedule C.
On proposed Line 3, filers would report the total amount of
compensation received by the covered service provider identified in
Line 1a in connection with services provided to the plan from sources
other than the plan or plan sponsor, including charges against plan
investments. The amount of compensation reported would include
compensation received by an affiliate or subcontractor in connection
with the services rendered to the plan, where the compensation is
reported as part of a bundled service arrangement. Total indirect
compensation would now be required to be reported as a dollar amount.
The Agencies recognize that service providers accustomed to disclosing
fees by way of a formula may not be able to quantify exactly the dollar
amount of the compensation received during the plan year. Thus,
although a dollar amount would be required, the proposal would permit
reporting an estimated dollar amount. If the dollar amount is an
estimate, the filer still would be required to indicate that a formula
was used in determining the actual compensation paid to or received by
the service provider. As with the current Line 3, filers would continue
to identify the source(s) of the indirect compensation received by the
covered service provider identified in Line 1, and would also identify
the type of fee or compensation. For each source, filers would be
required to enter a dollar figure or estimate of the amount of
compensation, and, if a formula was used to calculate an estimate, a
description of the formula.
To increase overall fee transparency, as well as to identify
potential conflicts of interest in related party transactions, a new
question would be added that would require filers to indicate whether
the arrangement with each covered service provider required to be
reported on Schedule C involved any related party compensation. If
``Yes,'' the filer would be required to indicate the services for which
the compensation was paid, the names of the payor(s) and recipient(s)
of such compensation, status as an affiliate or subcontractor
(indicated by checkbox), and the amount of the compensation.
To further ensure consistency between 29 CFR 2550.408b-2 and
Schedule C, the proposed rule would also modify the instructions. The
instructions, as proposed, would increase the threshold for reporting
non-monetary compensation in Schedule C from $100 to $250. A
corresponding change also would be made to the Schedule A instructions
for reporting fees and commissions.
The proposed instructions also would clarify the requirements for
reporting the travel or educational expenses of plan employees or
trustees, including reimbursement, on both Schedule C and Schedule H.
This clarification is being made in response to requests for further
guidance following the issuance of Supplemental FAQs About the 2009
Schedule C (available at https://www.dol.gov/ebsa/faqs/faq-sch-C-supplement.html). The FAQs state that for Schedule C purposes,
reportable compensation includes money and other things of value, such
as gifts and trips, received directly or indirectly by a person from
the plan in connection with services rendered to the plan or the
person's position in the plan. In addition, they explain that
disbursements to a plan trustee for transportation, lodging, meals, and
similar expenses incurred while engaging in official plan business are
considered reportable compensation. The requests for clarification
argued that the DOL should not treat as reportable compensation expense
reimbursements that are not treated as taxable under the Code by the
IRS.
The DOL continues to believe that getting information on the value
of trustee expenses, including expense reimbursement, is important for
compliance purposes. It is persuaded, however, that amounts that are
not taxable to the trustee need not be identified as ``indirect''
compensation. Therefore, the instructions would be clarified to provide
that trustee and employee expense reimbursements are required to be
reported on Schedule C only if the amounts are taxable compensation for
trustees or employees. Should trustees receive from the plan travel,
education, conferences or similar expenses, or reimbursements
therefore, that exceed the limits under the Code, they would have to
include them as threshold expenses for Schedule C and include the ``fee
code'' for ``reimbursement'' when identifying trustee compensation. For
reporting those amounts paid for or reimbursed by the plan regardless
of whether they are taxable to the trustee, a proposed new breakout
line item under the ``administrative expenses'' category would be added
to Schedule H to report aggregate plan expenditures on trustee travel,
meetings, education and similar expenses, whether paid directly by the
plan or as a reimbursement to trustees.\23\ Non-monetary compensation
in the form of travel, conferences, entertainment, etc., provided by
parties other than the plan, that is not de minimis, as defined in the
instructions, would continue to be reportable indirect compensation.
---------------------------------------------------------------------------
\23\ The proposed question is similar to a question that was on
the Form 5500 prior to 1999. See 1998, Form 5500, Line 32g(8).
---------------------------------------------------------------------------
The proposed Schedule C still would ask filers to identify service
providers who fail or refuse to provide information to the filer,
including a description of the information that the service provider
failed or refused to provide. The instructions would continue to
provide that filers, before identifying a fiduciary or covered service
provider as a person who failed or refused to provide information on
indirect compensation, should contact the fiduciary or service provider
to request the necessary information. For these purposes, if a
``covered'' service provider has failed or refused to provide
information regarding indirect compensation, that service provider
would be presumed to meet the $1,000 reporting threshold.
The Agencies also continue to believe that it is important to have
filers identify the termination of service providers on the annual
return/report. That question, however, would be moved to the Schedule H
from the Schedule C to associate it with a new compliance question,
described below, asking whether any service providers were terminated.
Although it would be moved to the Schedule H, the proposal would remain
substantially unchanged, retaining the requirement to provide
information for all terminated accountants and actuaries regardless of
the reason for termination because of the importance of the involvement
of actuaries and accountants in the preparation of the annual return/
report. The proposal would change the questions to add a check box for
the filer to indicate whether it was an accountant or actuary that was
terminated. The instructions for this section would also
[[Page 47554]]
be updated to provide a ``Tip'' stating that if the only reason for a
change of appointment of an enrolled actuary was a temporary leave of
absence due to non-work circumstances of the enrolled actuary, the
filer would so indicate in the ``explanation'' field.
Along with moving the existing Schedule C question on termination
of actuaries and accountants to the Schedule H, the proposal would also
add a question on the Schedule H regarding the termination of any
service provider for a material failure to meet the terms of a service
arrangement or failure to comply with Title I of ERISA, including the
failure to provide required disclosures under 29 CFR 2550.408b-2.
Although not requiring identification of all service providers in all
circumstances, the Agencies believe that there are service providers
other than actuaries or accountants, such as fiduciaries,
recordkeepers, third party administrators, and custodians who play a
sufficiently important role in plan operations that information on
their termination is significant. The Agencies specifically seek
comments on whether the proposed new question should be limited to a
narrower class of service providers or specific termination
circumstances.
C. Better Quality, Accessibility, and Usability of Data (Data
Mineability)
Another key component of the proposal is to make the Form 5500
Annual Return/Report more data mineable and accessible for research,
policy analysis, and enforcement purposes. EBSA is responsible for
collecting the Form 5500 Annual Return/Report, in part, to fulfill the
statutory requirements under Sections 104 and 106 of ERISA, which
require that DOL make annual reports filed under Title I of ERISA
available to the public. Section 504 of the Pension Protection Act of
2006, Public Law 109-280 (PPA), requires DOL to display certain annual
report information on the Internet within 90 days after filing. EBSA
must also make the data from all of the reports filed under Title I of
ERISA available to those seeking the information under the Freedom of
Information Act (FOIA). EBSA fulfills its FOIA responsibilities by
making the Form 5500 Annual Return/Report data available for
downloading in bulk (see https://www.dol.gov/ebsa/foia/foia.html). These
bulk data files, which EBSA updates at the end of each month with the
Form 5500 Annual Return/Report data collected during that month, are
downloaded by private-sector organizations that, in some cases, also
make the data available on the Internet. Thus, most returns/reports are
currently open to public inspection, and the contents are public
information subject to publication on the Internet.
Mandatory e-filing, which was implemented for the 2009 Form filing
year, starting January 1, 2010, has changed both the regulated
community's and the government's ability to use the Form 5500 Annual
Return/Report data. The data sets developed from e-filing information
has been helping researchers, businesses, and other plan professionals.
The Form 5500 Annual Return/Report data sets can be one of the major
building blocks for a private organization to use in developing
information for employees and employers on plan administration. In
addition, the government can provide much more timely and complete data
as a result of e-filing more cost effectively. For instance, the data
sets are posted on the Internet and updated monthly. In addition, the
images of the filings (facsimiles) and the scanned and uploaded
attachments are made available at no cost to the requester. As
indicated in the White House Report of the Task Force on Smart
Disclosure, in commenting on the Form 5500 Annual Return/Report,
``[s]mart disclosure is also helping employers and employees make
decisions about 401(k) and other workplace retirement plans. These data
sets can help employees better understand their retirement options and
employers better understand the quality of the plans they offer, with
the help of third parties that analyze the data.'' Id. at 13. The SEC
has also acknowledged the importance of innovative approaches to data
collection and use, citing its enhanced data mining as the basis for
improvements in its enforcement efforts. See New Investigative
Approaches and Innovative Use of Data and Analytical Tools Help Drive
Successful Enforcement Year, SEC, (available at https://www.sec.gov/News/PressRelease/Detail/PressRelease/1370543184660).
The Agencies generally plan to continue the data publication
processes currently in place and provide an even more robust Form 5500
Annual Return/Report web-based search application. This application
would allow users to develop more custom queries to better target
desired data. Further, this enhanced dissemination service would
include options to download data in various machine-readable and open
formats (such as Excel or comma separated value [CSV] files), as
specified in the President's Open Data policy. Expanding the
downloadable options would facilitate researching and comparing plan
information. The dissemination could also support predefined queries
presented in a dashboard format to graphically illustrate individual
plan performance as well as performance in comparison to plans of
similar size or features. Part of the goal of the proposal is to change
the structure of the data filed as part of the Form 5500 Annual Return/
Report in order to facilitate those applications and expand the use and
usefulness of the Form 5500 Annual Return/Report data generally, as
well as to make the Form 5500 Annual Return/Report a better disclosure
tool.\24\
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\24\ The Agencies believe that the proposed changes intended to
improve the quality of the data, for example, eliminating compound
questions, using simpler language, moving attachments into text
fields that show on the face of the form or schedule when completed,
and adding more definitions and instructions, would also help make
the Form 5500 Annual Return/Report a more readable disclosure
document. The GAO has recommended broadly that the Agencies work to
improve the clarity of required disclosures. See generally GAO
Private Pensions: Clarity of Required Reports and Disclosures Could
Be Improved.
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1. Structured Data Attachments
A critical way in which the Agencies propose to enhance the
mineability of the Form 5500 Annual Return/Report data is by
structuring and standardizing the schedules required to be attached to
the form. Currently, for example, the Line 4i attachments to Schedule H
(Schedule of Assets Held for Investment at End of Year, Schedule of
Assets Disposed of During Plan Year and the Schedule of Reportable
Transactions) cannot be searched electronically because they currently
are not filed in a standardized electronic format. As a result,
policymakers, the Agencies, and the public have difficulty accessing
key information about the plan's investments. The Agencies' proposal to
standardize the Schedule H, Line 4i Schedules of Investments is
intended to be responsive to the OIG's recommendation that the Agencies
create a searchable reporting format for the Schedule H, Line 4i
Schedules of Assets and otherwise increase the accessibility of Form
5500 Annual Return/Report information, particularly information on
hard-to value assets and multiple-employer plans. See DOL-OIG EBSA
Needs to Provide Additional Guidance and Oversight to ERISA Plans
Holding Hard-To-Value Alternative Investments, at 17. See also Private
Pensions: Targeted Revisions Could Improve Usefulness of Form 5500
Information, at 37; see also U.S. Gov't Accountability Office, GAO-12-
665, Federal Agencies Should Collect Data And Coordinate Oversight of
Multiple Employer Plans (2012), at 30.
[[Page 47555]]
Other currently unstructured data or new elements would also be
collected as structured data under the proposal, including the lists of
employers participating in multiple-employer and controlled group plan
members required to be attached to the Form 5500 Annual Return/Report
or Form 5500-SF; the Schedule H, Line 4a Schedule of Delinquent
Contributions; and the Line 4j Schedule of Reportable Transactions. The
proposal also would eliminate the instructions for Schedule A that
permit filing as an attachment ``appropriate schedules of current rates
filed with the appropriate state insurance department or by providing a
statement regarding the basis of the rates in an attachment, in lieu of
completing information on ``Contracts With Allocated Funds.'' The
instructions would instead direct the filer to enter a statement
regarding the basis of the rates into an open text field on the
Schedule A. Information on contracts with allocated contracts would
therefore be completed on the Schedule A as structured data. The
Agencies specifically invite comments as to whether entering a
statement in an open text field on the Schedule A, relative to
attaching a rate schedule(s) or statement regarding the basis of the
rates, would create a significant burden or make it difficult to
provide accurate information.
2. Move Information Collection From Attachments to Open Text Fields on
Face of Forms and Schedules
This proposal also increases the accessibility of data by replacing
some of the attachments to the schedules with text fields. Similar to
the proposed specific data elements for the Schedule H Line 4i
Schedules, which replace the existing suggested format for an
unstructured attachment, the Agencies believe that shifting to use of
text fields on the face of the schedules instead of having information
be supplied in non-standard attachments concentrates information on the
Form 5500 and the schedules and thus improves data mineability. For the
Schedule G (Financial Transaction Schedules), the nonspecific
requirement to provide ``detailed descriptions'' in an open text field,
including a variety of elements to report loans and leases in default
or uncollectible, has been replaced with individual questions on each
of the elements originally required to be in the detailed description.
In addition, attachments to the Schedule G in the form of ``Overdue
Loan Explanation'' and ``Overdue Lease Explanation'' for loans and
leases that are overdue or uncollectible would be replaced with open
data fields on the face of the Schedule G. The purpose of these changes
would be to standardize the information, to make the data less subject
to individual variation where unwarranted, to simplify reporting on the
Schedule G transactions for filers, and to make it easier to search and
use the data.
The Agencies also are proposing expanded data elements on the
actuarial schedules (Schedules MB and SB), including information
previously reported on PDF attachments. Under the proposal, single-
employer and multiemployer plans that are currently required to provide
a Schedule of Active Participant Data as a PDF attachment would be
required to input the data into Schedules MB and SB. Supplemental
information required by enrolled actuaries who have not fully reflected
regulatory requirements under ERISA or the Code in completing the
Schedule MB or SB would be reported on the schedules rather than on PDF
attachments. A number of questions on the Schedule SB would be required
to be reported on the schedule rather than on PDF attachments. This
would include reporting of information on the plan's late election to
apply funding balances to quarterly installments; an adjustment to the
amount of the credit balance reported in the prior year in the first
year a plan is subject to the minimum funding requirements of Code
section 430 or ERISA section 303; use of multiple mortality tables and
substitute mortality tables; a change in non-prescribed actuarial
assumptions and a method change for the current plan year; and a
schedule of amortization bases.
The Agencies also propose to consolidate certain data reported on
the Schedule SB on PDF or other similar attachments. The discounted
employer contribution PDF attachment would be consolidated with the
list of contributions currently included on the Schedule SB. Also, for
plans in at-risk status for the current plan year, the PDF attachment
describing the at-risk assumptions for the assumed form of payment
would be consolidated with the attachment describing the other
actuarial assumptions. Withdrawal liability payments will be reported
separately from plan year contributions on the Schedule MB. In
addition, for both Schedules SB and MB, the schedule of all
amortization bases currently filed as a PDF attachment would be
consolidated with the schedule of new amortization bases.
New questions would be added requiring multiemployer plans and
single-employer plans that input data into the Schedule of Active
Participant Data to report on the Schedules MB and SB the average age
of active participants, and the average credited service of active
participants as of the valuation date. Also, multiemployer plans and
single-employer plans that have retired participants and beneficiaries
as of the valuation date and terminated vested participants as of the
valuation date would be required to input data into two new schedules
on Schedules MB and SB--the Schedule of Retired Participants and
Beneficiaries Receiving Payment Data and the Schedule of Terminated
Vested Participant Data. This information on retired participants and
beneficiaries and terminated vested participants would be reported
according to age bracket, but information would not be required to be
reported for an age grouping consisting of 10 or fewer participants.
Additionally, all plans would report the average age and average in-pay
annual benefit for retired participants and beneficiaries receiving
payment. Plans with terminated vested participants would report the
average age and average annual benefit, and assumed form of payment and
the assumed first age of payment.
Expanding the data elements to require that new information and
information previously reported on PDF attachments be reported in a
data mineable format would allow for more refined projections of the
financial positions of multiemployer and single-employer plans. This is
especially critical for PBGC's multiemployer program, as well as for
its single-employer program. Information reported in a data mineable
format would also facilitate more refined projections and calculations
for individual plans. Computer programs could be written to read the
data and provide estimated funding calculations and projections for
plans. This would provide information essential to the Agencies'
enforcement efforts and for their ability to target plans with likely
compliance issues. Furthermore, the availability of the data would
assist private-sector auditors and auditors in validating a plan
actuary's calculations.
The data would also provide new opportunities for research.
Currently, there is no source of system-wide data on defined benefit
pension plan participants with age, service, and average benefit
levels. The availability of such data would allow for more refined
projections of future coverage and benefits adequacy for plan
participants and beneficiaries. As more of this data is collected over
the years, the data could be analyzed to identify trends in plan
coverage and benefits.
[[Page 47556]]
Also, proposed system-wide changes in legislation and regulations could
be more effectively modeled.
As discussed in more detail below, the Agencies also propose to
allow the plan actuary to sign Schedules MB and SB electronically. The
plan actuary can access the EFAST2 Web site at www.efast.dol.gov to
register for electronic credentials to sign or submit filings.
3. Plan Characteristics Codes and Other Identifying Codes Replaced With
Yes/No Questions and Checkboxes on Face of Forms
In addition, the use of ``codes'' appearing in the instructions
would be limited and refined to the extent feasible. New ``Yes''/``No''
and check box questions would replace most Form 5500 and Form 5500-SF
questions that currently require filers to list Plan Characteristics
Codes. These changes are intended to refine how data will be collected
and overlay all of the other changes being proposed here. On the
Schedule C, rather than entering, multiple codes to identify both types
of fees/compensation and kinds of services, the filer would check as
many boxes as are applicable to indicate all types of services for each
provider identified. In another element that is for reporting only
sources of compensation from parties other than the plan or plan
sponsor, filers will separately indicate all types of fees/
compensation. This is intended to improve the quality of the data, and
make the Schedule C easier to read from a disclosure perspective. It is
also intended to address concerns raised by the GAO about the fee and
service codes. See GAO Private Pensions: Targeted Revisions Could
Improve Usefulness of Form 5500 Information, at 27. Comments are
specifically invited regarding whether additional or different types of
services or fees should be listed in order to improve the picture of
service providers to the plan.
4. Compound Questions Separated
The Agencies would separate out reporting for the various types of
direct filing entities to make clearer what the precise reporting
requirements are for each type of entity. They would also clarify the
instructions to the forms and schedules by separating compound
questions. In this regard, the Agencies recognize that putting one
question on each line rather than asking filers to complete multiple
subsections, while streamlining the completion process, would
nevertheless make some schedules appear longer, even though no
additional information is actually required to be reported. This is
particularly evident for Schedules C and G, both of which currently
contain multiple compound questions.
5. More Detailed Identifiers, Instructions, and Definitions
The proposal adds clarifying definitions and instructions to
improve the consistency of responses. For example, the proposal
clarifies conventions for identifying filers by name and identifying
number(s). The proposal also requires plans to use legal entity and
other industry and regulatory identifiers whenever possible. These
changes are intended to help the Agencies compare plan participation,
investment options, and investment performance from year-to-year. It
should also help mitigate confusion about the legal entities with which
the plan transacts. These changes are intended to address the concerns
raised by the GAO in recommending that ``the Agencies develop a central
repository for Employer Identification Numbers (EINs) and Plan Numbers
(PNs) for filers and service providers to improve the comparability of
form data across filings.'' GAO Private Pensions: Targeted Revisions
Could Improve Usefulness of Form 5500 Information, at 37.
The proposal would add more explicit instructions, for example, on
reporting delinquent participant contributions and completing the Line
4i Schedules of Assets. In addition, because filers would be asked to
identify plan characteristics and type through questions on the face of
the Form 5500/5500-SF instead of using codes in the instructions, there
are proposed instructions for various questions in this information
category. These definitional changes and additions are intended to help
ensure that data would be reported consistently and would be more
accessible, thus improving the usefulness of the data.
D. New Group Health Plan Reporting Requirements and Information
The DOL proposes to expand reporting to all employee benefit plans
providing group health benefits, including plans that claim
grandfathered status and retiree-only plans.\25\ Currently, generally
most plans that provide group health benefits that have fewer than 100
participants meet the conditions in existing regulations at 29 CFR
2520.104-20 to be exempt from the requirement to file the Form 5500
Annual Return/Report because they are fully insured, unfunded, or a
combination of unfunded and insured.\26\ Although there may be sources
of aggregate estimates regarding group health plans, the current lack
of plan level information for employee benefit plans that provide group
health benefits, especially those that have fewer than 100
participants, complicates not only DOL's ability to enforce
regulations, but also diminishes the effectiveness and efficacy of
EBSA's ability to develop health care regulations. The Affordable Care
Act also requires the Secretary of Labor to provide Congress with an
annual report, see, e.g., ``Self-Insured Health Benefit Plans 2015,''
\27\ containing general information on self-insured employee health
benefit plans and financial information regarding employers that
sponsor such plans. That report is supposed to be based on data
contained in the Form 5500 Annual Return/Report. However, as noted
above, many self-insured health benefit plans currently are not
required to file annually with the DOL and, even for those that do
file, the Form 5500 Annual Return/Report currently collects only
limited information.
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\25\ All ``group health plans'' that meet the definition in
733(a) of the Act, including plans that claim ``grandfathered''
status under 29 CFR 2950.715-1251, would be required to file a Form
5500 and applicable schedules, including the proposed Schedule J,
regardless of whether such plans are exempt from certain market
reform requirements under ERISA Sec. 732(a) (exemption for certain
small group health plans that have less than two participants who
are current employees) or ERISA Sec. 733(c) (group health plans
consisting solely of excepted benefits). Employee welfare benefit
plans as defined in ERISA Sec. 3(1) that do not meet the definition
of ``group health plan'' under 733 of the Act (i.e., they do not
provide medical care) are not subject to the proposed enhanced
reporting requirements applicable to group health plans.
\26\ ERISA 733(a) defines a ``group health plan'' as ``. . . an
employee welfare benefit plan to the extent that the plan provides
medical care (as defined in paragraph (2) and including items and
services paid for as medical care) to employees or their dependents
(as defined under the terms of the plan) directly or through
insurance, reimbursement, or otherwise.'' (Emphasis added). ERISA
3(1) defines an ``employee welfare benefit plan'' as ``any plan,
fund or program which was . . . established or maintained by an
employer or by an employee organization . . . to the extent that
such plan, fund or program was established or is maintained for the
purpose of providing for its participants or their beneficiaries . .
. medical, surgical, or hospital care or benefits.''
\27\ Available on the DOL's Web site at: https://www.dol.gov/ebsa/pdf/ACASelfFundedHealthPlansReport2015.pdf.
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To remedy this information gap, under the proposal, all ERISA-
covered plans that provide group health benefits, regardless of size,
and regardless of whether funded with a trust, unfunded, or a
combination unfunded/insured, would be required to file a Form 5500
Annual Return/Report, including the new Schedule J (Group Health Plan
Information), as well as any other applicable schedules. However,
small, fully-insured group health plans would
[[Page 47557]]
be required to only answer a limited number of questions on the Form
5500 and the new Schedule J. The current exemptions from financial
reporting on Schedule H, G, and C for insured plans, unfunded plans,
and plans that are combination of unfunded/insured that meet the
requirements of 29 CFR 2520.104-44 would continue to apply for all
welfare plans, including group health plans, regardless of size.\28\
The current exemption from financial reporting on Schedule G for
welfare plans that cover fewer than 100 participants as set forth in 29
CFR 2520.104-46 would also continue to apply.
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\28\ Currently, welfare plans that are unfunded, fully-insured,
or a combination of unfunded and insured are required to file the
Form 5500, including Schedule A ``Insurance Information'' if
applicable, but, under 29 CFR 2520.104-44, the plan is not required
to engage an independent qualified public accountant and need not
complete Schedules C or H. The proposal would not change these
reporting provisions. Similarly, the exemption in 29 CFR 2520.104-20
from filing any Form 5500 for fully insured, unfunded, or
combination small welfare plans that are not group health plans is
also not being changed in this proposal.
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Currently plans that provide group health benefits that have fewer
than 100 participants that are not unfunded or insured (e.g., funded
using a trust) are not exempt under 29 CFR 2520.104-20 from the
requirement to file a Form 5500 Annual Return/Report and are not exempt
from the financial reporting requirements under 29 CFR 2520.104-44.
These plans generally file either the Form 5500-SF or the Form 5500 and
the Schedule H or Schedule I, including financial and compliance
information. Under the proposed rule, plans that provide group health
benefits that have fewer than 100 participants that are not unfunded or
insured (e.g., funded using a trust) would be required to complete the
Schedule H (because Schedule I is being removed and group health plans
are not permitted to use Form 5500-SF), as well as Schedule C, if
applicable. However, unless such a plan is invested in alternative or
hard-to-value assets, completing the Schedule H would only modestly
expand the current financial and compliance reporting for the affected
small welfare plans. Requiring reporting on Schedule H by these plans
with fewer than 100 participants that provide group health benefits
would ensure that such plans are filing at least as much financial and
compliance information as other small welfare plans (those that do not
provide group health benefits) that are not unfunded or insured (e.g.,
funded using a trust), for which the reporting requirements remain
largely unchanged.\29\
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\29\ The proposal does not change the current eligibility
requirements for small welfare plans that are not group health plans
to use Form 5500-SF.
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As indicated above, small, fully insured group health plans would
be required to answer only certain questions on the Form 5500 and on
the Schedule J. This limited filing, which would be similar in scope to
the limited pension plan reporting for plans established under section
408 of the Code that requires such plans to complete certain Form 5500
questions and no schedules, see, e.g., 2015 Form 5500 Instructions,
Limited Pension Plan Reporting, is intended to serve as an annual
registration statement with basic identifying and insurance
information. The DOL considered whether to have small, fully insured
group health plans file a separate registration statement either
annually or based on certain events following the establishment of the
plan (e.g., initial, final, change in insurance carrier). However, we
believe that it will be less burdensome to have such plans file limited
information through EFAST2, using the Form 5500, particularly for those
small employers that already use the system to report for their pension
plans. Comments are specifically solicited in this regard.
In addition, sections 2715A and 2717 of the Public Health Service
Act (PHS Act), as added by the Affordable Care Act, established new
reporting requirements for non-grandfathered group health plans and
health insurance issuers offering non-grandfathered group or individual
health insurance coverage.\30\ The DOL is considering whether a group
health plan could satisfy its reporting obligations under PHS Act
section 2715A and 2717, as incorporated into section 715(a)(1) of
ERISA, by filing a completed Form 5500 and Schedule J, and providing
that information to the parties as required under PHS Act section 2715A
and 2717 (generally HHS, DOL, Treasury, State insurance commissioners,
enrollees and the public).\31\ Much of the information required to be
reported under PHS Act sections 2715A and 2717, for example, data on
enrollment, claims payment policies and practices, and claims denials
is information that is to be included in the proposed Schedule J. In an
effort to reduce duplicative reporting and the attendant costs to plans
subject to ERISA, the DOL is specifically soliciting comments on the
feasibility of such an approach as a means of compliance with PHS Act
sections 2715A and 2717 as incorporated into section 715(a)(1) of
ERISA.\32\
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\30\ Section 2715A of the PHS Act extends the transparency
reporting provisions set forth in section 1311(e)(3) of the
Affordable Care Act (applicable to issuers of ``qualified health
plans'' offered through Exchanges) to non-grandfathered group health
plans and health insurance issuers offering non-grandfathered group
or individual health insurance coverage. In particular, section
1311(e)(3) of the Affordable Care Act requires disclosure of: claims
payment policies and practices, periodic financial disclosures, and
information on enrollment, disenrollment, number of denied claims,
rating practices, out-of-network cost-sharing and payments, rights
under title I of the Affordable Care Act, and other information as
determined appropriate by the Secretary of Health and Human Services
Section 2717 of the PHS Act requires non-grandfathered group health
plans and health insurance issuers offering non-grandfathered group
or individual health insurance coverage to report on quality of care
metrics, for example, reporting on effective case management, care
coordination, chronic disease management, and medication and care
compliance initiatives. Although sections 2715A and 2717 of the PHS
Act do not apply to grandfathered group health plans, the proposal
is to require all group health plans subject to ERISA, including
grandfathered group health plans, to file Schedule J.
\31\ Nonfederal governmental plans (as defined in PHS Act
section 2791(d)(8)(C)) and health insurance issuers (as defined in
PHS Act section 2791(b)(2) and ERISA section 733(b)(2)) are not
required to file annual reports pursuant to ERISA sections 103 or
104. Accordingly, any reporting required of such plans and issuers
to satisfy PHS Act sections 2715A and 2717 will be addressed
separately by HHS in future rulemakings and/or guidance.
\32\ Sections 2715A and 2717 of the PHS Act are also
incorporated into section 9815(a)(1) of the Code. The Treasury
Department and the IRS intend to publish proposed regulations in 26
CFR 54.9815-2715A and 54.9815-2717 clarifying that group health
plans required to file an annual report pursuant to section 104 of
ERISA that comply with the reporting requirements in 29 CFR
2520.103-1 (including filing any required schedules to the annual
report) would satisfy the reporting requirements of sections 2715A
and 2717 of the PHS Act, as incorporated in the Code. Group health
plans that are not required to file an annual report pursuant to
section 104 of ERISA but that are subject to sections 2715A and 2717
of the PHS Act as incorporated in the Code, will not be required to
do any reporting to comply with sections 2715A and 2717 of the PHS
Act, as incorporated in the Code, unless and until the Treasury
Department and the IRS issue subsequent further guidance or
rulemaking regarding any such reporting by such plans.
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1. New Schedule J (Group Health Plan Information)
The proposed Schedule J (Group Health Plan Information) would
report information about group health plan operations and ERISA
compliance, plus compliance with certain provisions of the Affordable
Care Act.\33\ Group health plans that are part of a GIA and subject to
the exemption from filing under 29 CFR 2520.104-43 would not be
required to file the Schedule J. A GIA's Form 5500 Annual Return/Report
filing,
[[Page 47558]]
however, would have to include a separate Schedule J for each group
health plan participating in the GIA.
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\33\ The Schedule J does not relate to the employer shared
responsibility provisions under section 4980H of the Code, the
related reporting requirements under section 6056 of the Code, or
the reporting requirements for providers of minimum essential
coverage under section 6055 of the Code.
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The proposed Schedule J would collect information on the
characteristics of the plan that is providing group health benefits,
including the approximate number of participants and beneficiaries
covered under the plan at the end of the plan year, and the number of
persons offered and receiving coverage under the plan through COBRA,
Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. 99-272,
100 Stat. 82), 29 U.S.C. 1161, et seq., whether the plan offers
coverage for employees, spouses, children, and/or retirees, and what
type of group health benefits are offered under the plan, for example,
medical/surgical, pharmacy or prescription drug, mental health/
substance use disorder, wellness program, preventive care, vision,
dental, or various other types of benefits. With respect to the
collection of COBRA coverage information, the DOL requests comments
regarding the costs and feasibility of providing this data, whether the
proposed data elements would effectively show the annual take up rate
and the total number of participants electing COBRA coverage, and
whether any additional data elements regarding COBRA coverage would be
helpful for the regulated community to evaluate COBRA's impact on plans
and participants.
The DOL also proposes that plans that provide group health benefits
provide information on whether their health plan funding and benefit
arrangement is through a health insurance issuer and whether benefits
are paid through a trust or from the general assets of the employer.
Schedule J would also ask whether there were participant and/or
employer contributions.\34\ With respect to plans that use a prototype
health insurance policy or arrangement (sometimes referred to as ``off-
the-shelf'' plans/policies), the DOL is also requesting that such plans
provide, if applicable, the relevant unique identifying information
(such as a state assigned policy identification number) of the
prototype/off-the-shelf policy or arrangement. The DOL requests
comments on this proposed data element and whether there are specific
health insurance policy identification systems employed by States or
issuers that would most accurately and cost effectively provide
information about usage of such policies to provide plan benefits.
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\34\ For purposes of Schedule J reporting, ``participant
contributions'' include all elective contributions under a cafeteria
plan (arrangement under Code section 125.).
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Additionally, plans that provide group health benefits are asked to
report whether one or more of the plan's benefit package options are
claiming grandfathered status under the Affordable Care Act,\35\
whether the plan is a high deductible health plan,\36\ a health
flexible spending account (FSA) (or includes a health FSA as a
component), or a health reimbursement arrangement (HRA) \37\ (or
includes an HRA as a component). Please note that due to PHS Act
section 2711 (prohibition on annual dollar limits) and 2713 (preventive
services requirements), HRAs that are subject to the market reforms
(that is, those that cover two or more active employees and do not
consist solely of excepted benefits) are considered to comply with the
annual dollar limit prohibition and preventive service requirement if
the HRA is ``integrated'' with another group health plan that complies
with the annual dollar limit prohibition and the preventive services
requirement.\38\
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\35\ ``Grandfathered'' health plans generally are those that
were in existence on March 23, 2010, and haven't been changed in
ways that substantially cut benefits or increase costs for
participants. For regulations addressing grandfathered status, see
29 CFR 2950.715-1251.
\36\ A ``high deductible health plan'' is defined under section
223(c)(2) of the Code and generally is a plan that has a higher
annual deductible than a typical health insurance plan and a maximum
limit on the sum of the annual deductible and out-of-pocket medical
expenses that an enrollee must pay for covered expenses.
\37\ An HRA typically consists of a promise by an employer to
reimburse medical expenses, including insurance premiums, for the
year up to a certain amount, with unused amounts available to
reimburse medical expenses in future years. See IRS Notice 2002-45.
\38\ An HRA is a group health plan and is subject to the market
reforms, including the prohibition of annual dollar limits for
essential health benefits and the requirement to provide coverage of
certain recommended preventive services without cost sharing.
Regulations addressing these annual and lifetime limit prohibitions
state that a stand-alone HRA offered to active employees violates
these prohibitions but that an ``integrated'' HRA does not violate
the annual limits prohibition, as long as other group health plan
coverage offered with the integrated HRA complies with the market
requirements. See 80 FR 72192 at 72261 (Nov. 18, 2015) and DOL
Technical Release 2013-03 (Sept. 13, 2013) for a description of the
lifetime and annual limit requirements applicable to HRAs, including
the ``integration'' requirements.
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The proposed Schedule J also would ask whether the plan received
rebates, refunds, or reimbursements from a service provider such as a
medical loss ratio (MLR) rebate under the Affordable Care Act and
offset rebates from favorable claims experience. If so, filers would be
required to report the type of service provider, the amount received
and how the rebates were used (e.g., returned to participants, premium
holiday, payment of benefits, or other). In addition, the proposed
Schedule J would request that group health plans identify any service
providers to the plan (not already reported on Schedule A (Insurance
Information) or Schedule C (Service Provider Information)) by providing
the name, address, telephone number, employer identification number,
and, if applicable, the National Insurance Producer Registry--National
Producer Number (NPN) as established by the National Association of
Insurance Commissioners (NAIC). Such service providers include a third
party administrator/claims processor, including an issuer subject to an
``administrative services only (ASO)'' contract, mental health benefits
manager, wellness program manager,\39\ substance use disorder benefits
manager, pharmacy benefit manager/drug provider, or independent review
organization. Schedule J also asks for the total premium payment made
for any ``stop loss'' coverage, as well as information on the
attachment points of coverage, individual claim limits, and/or the
aggregate claim limit contained in the policy.
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\39\ A ``wellness program'' is defined in 29 CFR 2590.702(f) to
include ``any program designed to promote health or prevent
disease'' and includes programs that condition benefits (including
cost-sharing mechanisms) or the premium or employer contribution
amounts on an individual satisfying a standard that is related to a
health factor as well as those programs that do not include
conditions for obtaining a reward that are based on an individual
satisfying a standard that is related to a health factor.
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For group health plans that are not required to complete a Schedule
H (generally, fully insured, unfunded plans, or combination insured/
unfunded plans), the proposal would require that information regarding
employer and participant contributions be reported on the Schedule J,
including employer contributions received, participant contributions
received, employer contributions receivable, participant contributions
receivable, other contributions received or receivable (including non-
cash contributions) and the total of all contributions. Filers would
also be required to report whether there was a failure to timely
transmit participant contributions to the plan.
The proposed Schedule J also would seek claims payment data,
including information on how many post-service benefit claims (benefit
claims) were submitted during the plan year, how many benefit claims
were approved during the plan year, how many benefit claims were denied
during the plan
[[Page 47559]]
year,\40\ how many benefit claim denials were appealed during the plan
year, how many appealed claims were upheld as denials, how many were
payable after appeal, and whether there were any claims for benefits
that were not adjudicated within the required timeframes. The proposed
Schedule J would also seek data on how many pre-service claims were
appealed during the plan year, and how many of those appeals were
upheld during the plan year as denials and how many were approved
during the plan year after appeal. With respect to group health plans,
the DOL claims procedure regulation subdivides claims for benefits into
various categories, including pre-service and post-service claims. A
pre-service claim is defined as any claim for a benefit under a group
health plan with respect to which the terms of the plan condition
receipt of the benefit, in whole or in part, on approval of the benefit
in advance of obtaining medical care. A post-service claim is defined
as any claim for a benefit under a group health plan that is not a pre-
service claim. See 29 CFR 2560.503-1(m). As used throughout this
proposal, ``claims'' includes both pre-service and post-service claims.
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\40\ A denial as referenced in this notice is given the same
meaning as ``adverse benefit determination'' as defined in 29 CFR
2560.503-1(m)(4). Accordingly, a denial or adverse benefit
determination is a denial, reduction, or termination of, or a
failure to provide or make payments (in whole or in part) for, a
benefit, including any such denial, reduction, termination, or
failure to provide or make payment that is based on a determination
of a participant's or beneficiary's eligibility to participate in a
plan, and including, with respect to group health plans, a denial,
reduction, or termination of, or a failure to provide or make
payment (in whole or in part) for, a benefit resulting from the
application of any utilization review, as well as a failure to cover
an item or service for which benefits are otherwise provided because
it is determined to be experimental or investigational or not
medically necessary or appropriate.
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In addition, plans would be asked to report whether the plan was
unable to pay claims at any time during the plan year and, if so, the
number of unpaid claims. Plans would also be asked to report the total
dollar amount of claims paid during the plan year, and if the plan
provides benefits through an insurance policy, to identify any
delinquent payments to the insurance carrier within the time required
by the carrier, and whether any delinquencies resulted in a lapse in
coverage. The proposal would add a similar question to Schedule A;
delinquencies identified on Schedule A would not need to be reported
again on Schedule J.
In an effort to collect more robust data on claims adjudication
practices and policies, the DOL is considering, in addition to the
information requested in the new Schedule J, whether to require plans
to report more information on denied claims, such as the dollar amount
of claims that were denied during the plan year, the denial code, and/
or whether the claims were for mental health and substance use disorder
benefits or for medical/surgical benefits. Proposed Schedule J requires
plans to report the dollar value of claims paid during the plan year.
Analyzing this data in terms of claims adjudication practices would be
limited if the dollar amount of claims denied during a plan year is not
also reported. The DOL understands, however, that reporting information
on denied claims may present definitional and data classification
challenges, e.g., possible need for a more uniform classification of
denial codes for Form 5500 Annual Return/Report reporting than may
currently be in place across plans and issuers. In addition, there may
be a need to establish a uniform measure for ``dollar amount,'' for
example, should it be based on a provider's point-of-service fees, the
schedule of fees the plan has negotiated with service providers,
Medicare reimbursement rates, or state-published prevailing fees, or
some other ``reasonable'' method for determining the dollar amount of
denied claims. Therefore, the DOL is specifically seeking public
comments on whether this is reasonable information to collect and, if
so, the methodology a plan would employ to determine and report the
``dollar amount of claims denied'' during a plan year, denial code, and
type of claim. Further, as noted above, the Notice of Proposed
Rulemaking that is being published with this Notice includes proposed
conforming amendments in 29 CFR 2590.715-2715A and 29 CFR 2590.715-2717
to clarify that compliance with the proposed annual reporting
requirements by plans subject to ERISA that provide group health
benefits would satisfy the reporting requirements under PHS Act
sections 2715A and 2717 incorporated in ERISA through ERISA section
715(a)(1). The DOL is specifically seeking public comments in this
Notice on the proposed annual reporting requirements for plans that
provide group health benefits, including the new Schedule J, in light
of the Supreme Court's recent decision in Gobeille v. Liberty Mutual
Insurance Co., 136 S.Ct. 936 (2016).
The proposed Schedule J would also request compliance information
from plans providing group health benefits. The proposed compliance
section of the Schedule J asks if all plan assets were held in trust,
held by an insurance company qualified to do business in a State, or as
insurance contracts or policies issued by such an insurance company
consistent with section 403 of ERISA and 29 CFR 2550.403a-1 and
2550.403b-1, whether plan assets are not held in trust based on
reliance on Technical Release 92-01, whether the plan's summary plan
description (SPD) and summaries of any material modifications (SMM),
and summary of benefits and coverage (SBC) are in compliance with the
applicable content requirements, whether coverage provided by the plan
is in compliance with applicable federal laws and the DOL's regulations
thereunder, which may include the portability and nondiscrimination
provisions of the Health Insurance Portability and Accountability Act
of 1996, Title I of the Genetic Information Nondiscrimination Act of
2008, the Mental Health Parity Act of 1996, the Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008, the
Newborns' and Mothers' Health Protection Act of 1996, the Women's
Health and Cancer Rights Act of 1998, Michelle's Law, and the
Affordable Care Act. The DOL believes that self-reporting compliance
information will help inform future compliance studies. Furthermore,
the DOL believes that the inclusion of such compliance questions will
encourage plans to evaluate whether or not they meet the group health
plan requirements of ERISA, potentially increasing the voluntary
compliance by ERISA plans.
Finally, the DOL would move the current questions on the Form 5500
that ask all welfare plans to report on whether they are subject to,
and if so, have complied with the Form M-1 filing requirements, to the
Schedule J.\41\ This would limit these questions to welfare plans that
provide group health benefits. Form 5500/Schedule J filers that must
file the Form M-1 would not be required to answer on the Schedule J
those compliance questions answered on the Form M-1.
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\41\ Multiple Employer Welfare Arrangements that provide health
benefits must file the M-1 with the Department. The M-1 questions,
which would be unchanged under the proposal, ask whether the plan
was subject to the Form M-1 filing requirements during the plan
year, whether the plan is currently in compliance with the Form M-1
filing requirements, and for the filer to provide the Receipt
Confirmation Code for the most recent Form M-1 that was required to
be filed under the Form M-1 filing requirements.
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[[Page 47560]]
2. Limited Form 5500 Annual Return/Report Reporting for Small, Fully
Insured Group Health Plans
The DOL proposes to eliminate the current exemption from filing for
small, fully insured group health plans and proposes to require only a
very limited Form 5500/Schedule J filing. As noted above, the DOL has
not previously collected annual report data on small welfare plans that
qualify for the exemption under the regulations at 29 CFR 2520.104-20.
For small fully insured plans that provide health benefits, the DOL is
proposing to replace that exemption with a new limited exemption as an
alternative form of reporting. Specifically, these small plans would be
required to complete Lines 1-5, i.e. basic identifying information, on
the Form 5500, and Lines 1-8 on Schedule J, i.e., basic participation,
coverage, insurance company, and benefit information. Requiring small,
fully insured plans that provide group health benefits to file very
rudimentary identifying and health benefit and coverage information
would ensure that the DOL obtains basic information on all ERISA
covered group health plans. Because these small, fully insured group
health plans are subject to separate regulatory oversight indirectly by
reason of state insurance regulation of the insurance provider and
insurance contract, the DOL is seeking only basic plan and insurance
information to be filed annually and is not seeking the broader
Schedule J annual information requested of small self-insured and large
plans regarding plan administration and benefits.
This information would allow the DOL to track total health plan
counts, and coordinate its enforcement efforts relating to plans
providing benefits through common issuers. For example, fully-insured
plans using the same insurance provider often have documents containing
provisions that are similar. Through these new filings, the DOL would
be able to better identify those plans that may be affected by
noncompliant provisions and better coordinate its enforcement efforts
with affected service providers and other Federal and State agencies.
Also, this information would enhance the DOL's policy analysis and
research with respect to participant trends.
E. Proposed Changes To Enhance Compliance and Oversight
One of the critical purposes of the Form 5500 Annual Return/Report
is to promote compliance both by requiring plan administrators to
review particular aspects of plan operations in order to meet their
annual reporting requirement and by enabling the Agencies to review
basic plan compliance issues in an efficient manner. Accordingly, the
Agencies propose adding a series of compliance questions on the Form
5500 and on the Form 5500-SF, and also the Form 5500-SUP for those
filers who are not subject to the IRS electronic filing mandate in 26
CFR 301.6058-2 and elect to answer these questions on a paper return.
1. IRS-Only Changes
a. IRS-Only Questions for 2016 Plan Years and Form 5500-SUP
For certain years prior to 2009, the Schedules E, P, SSA, and T
were required to be filed to meet annual return requirements under the
Code and IRS regulations, but they were not information collections of
the DOL or the PBGC. The DOL electronic filing mandate applied
beginning with the 2009 Form 5500 Annual Return/Report and resulted in
the last of these ``IRS-only'' schedules being dropped from the Form
5500 Annual Return/Report because the IRS could not mandate that these
schedules be filed electronically. As ``IRS-only'' schedules, they were
not covered by the DOL electronic filing requirement. Accordingly, with
the exception of a limited number of questions on the Schedule E that
were relocated to the Schedule R, the questions on these schedules were
no longer included on the Form 5500 Annual Return/Report. The questions
were either eliminated altogether or, in the case of questions on the
Schedule SSA, added to a new IRS form, Form 8955-SSA, Annual
Registration Statement Identifying Separated Participants With Deferred
Vested Benefits. The 2011 TIGTA report, The Employee Plans Function
Should Continue Its Efforts to Obtain Needed Retirement Plan
Information, notes that the lack of information contained on Schedules
E, P, and T can negatively impacts the IRS's ability to effectively
focus on specific factors of noncompliance when selecting retirement
plans for examination. This lack of information may result in the IRS
selecting relatively compliant plans, which increases the burden on
these plans and affects the IRS's ability to identify and focus on
potentially noncompliant plans. This could result in participants
receiving an incorrect amount of benefits. The IRS has decided to make
changes to the Form 5500 Annual Return/Report to address these issues.
The IRS added IRS-only compliance questions to the 2015 Form 5500
and the 2015 Form 5500-SF, but subsequently directed filers not to
answer the questions for 2015. The IRS is modifying some of these
questions and intends to make these IRS-only questions mandatory on the
2016 Form 5500 and Form 5500-SF. See the Federal Register Notice
``Proposed Collection; Comment Request for the Annual Return/Report of
Employee Benefit Plan'' published by the IRS on March 31, 2016 (81 FR
18687). Other IRS-only questions may be added prior to the form year in
which the EFAST2 contract recompete and other forms revisions are
implemented. Regardless of the timing of implementation of any of the
IRS-only questions on the annual return, any comments received in
response to this notice with respect to these questions will be
considered in future revisions of these forms.
The IRS added to the 2016 forms and schedules various questions
related to common compliance problems that will make it easier for the
IRS to administer the filing program. Two of the IRS-only questions
added for 2016 are questions that were optional on the 2014 Form 5500
and 2014 Form 5500-SF. Both 2014 forms request information regarding
the preparer of the annual return/report and the plan's trust. IRS
intends that both the 2016 Form 5500 and the 2016 Form 5500-SF include
a box in the signature block of the form for information regarding the
preparer's name and address. Similarly, line 6 of both Schedules H and
I of the 2016 Form 5500 Annual Return/Report, and line 14 of the 2016
Form 5500-SF, would request information regarding the name of the
plan's trust, the trust's employer identification number (EIN), the
name of the trustee or custodian, and the trustee or custodian's
telephone number. This information will enable the IRS to more
efficiently monitor the compliance of the retirement plan trusts exempt
from tax under Code section 501(a).
The IRS also included several other compliance questions on the
2016 Forms 5500 and 5500-SF that are addressed in the 2014 Forms 5500
and 5500-SF and that require entry of plan characteristics codes. The
IRS has found that characteristic codes result in inadequate responses
and are commonly misunderstood by filers, and believes it would be
better to enhance these codes with separate questions. For example, the
IRS replaced characteristic code 2J, which identifies the plan as
including a cash or deferred arrangement under Code section 401(k),
with a line item on the 2016 Forms 5500 and 5500-SF. Similarly, Code
3D, a characteristic code that currently applies to pre-approved
[[Page 47561]]
pension plans, is replaced with a separate line item on the 2016 Forms
5500 and 5500-SF.
The IRS also added two questions for 2016 that were questions on
the Schedule T, Qualified Pension Plan Coverage Information, before it
was eliminated. Specifically, line 4b of the Schedule T asked if the
employer aggregated plans in testing whether the plan satisfied the
nondiscrimination and coverage tests of Code sections 401(a)(4) and
410(b). Also, line 4f of the Schedule T asked whether the plan
satisfied the coverage requirements of Code section 410(b) on the basis
of either the ratio percentage test or the average benefit test. These
questions were added to the 2016 Forms 5500 and 5500-SF. These
questions are helpful to the IRS when performing pre-audit analysis and
allowed the IRS to narrow any inquiries when information was requested
from the plan. The return of these questions also reflects the
elimination of optional coverage and nondiscrimination demonstrations
in the IRS determination letter process. See Rev. Proc. 2015-6, 2015-1
I.R.B. 198 and Announcement 2011-82, 2011-52 I.R.B. 1052.
The IRS also added other IRS-only questions to the 2016 Forms 5500
and 5500-SF in order to address various compliance issues.
Specifically, there are new questions as to whether the plan sponsor
used the design-based safe harbor rules, the current year ADP test, or
prior year ADP test for nonhighly compensated employees in accordance
with 26 CFR 1.401(k)-2(a)(2)(iii) to satisfy the nondiscrimination
requirements of Code sections 401(k)(12), (13). The IRS also added
questions as to whether the employer is an adopter of a master and
prototype plan or a volume submitter plan that is subject to a
favorable opinion or advisory letter from the IRS, and the date of that
favorable letter. This question will help determine the plan's remedial
amendment period and remedial amendment cycle under Code section 401(b)
and Rev. Proc. 2007-44, 2007-28 I.R.B. 54 (as modified by Rev. Proc.
2008-56, 2008-2 C.B. 826; and Rev. Proc. 2009-36, 2009-2 C.B.304);
Notice 2009-97, 2009-2 C.B. 972; and Notice 2010-48, 2010-27 I.R.B. 9.
The IRS added a similar question for individually-designed plans as to
whether an individually designed plan received a favorable
determination letter from the IRS. The IRS has found that issues have
arisen regarding the failure of plan sponsors to make timely amendments
to their plan document to reflect changes in the law.
The IRS also added a question to the 2016 Forms 5500 and 5500-SF as
to whether any distributions during the plan year were made to an
employee who attained age 62 and had not separated from service for
defined benefit plans or money purchase pension plans. The IRS has
found various qualification and taxability issues related to such
distributions.
Those filers who are required by the electronic filing regulations
to file the Form 5500 Annual Return/Report electronically will be
required to answer these IRS compliance questions electronically using
EFAST2 for the 2016 and later plan years. The IRS will provide a paper-
only form containing these IRS compliance items for use by filers who
are not subject to the electronic filing requirements of the Treasury
regulations and who elect not to answer the questions through EFAST2. A
draft of the paper-only form, Form 5500-SUP, Annual Return of Employee
Benefit Plan Supplemental Information, was released for public comment
in October, 2014. The 2016 Form 5500-SUP is expected to be modified to
reflect the changes proposed for 2016 plan year.
b. IRS-Only Questions for Later Plan Years
In addition to the questions the IRS included on the 2016 Forms
5500 and 5500-SF, the IRS proposes to add new questions for later plan
years. Some of these additional questions were previously included on
the 2008 Schedule E (ESOP Annual Information). Specifically, Line 1a of
the 2008 Schedule E asked whether the ESOP is maintained by an S
corporation and, if so, whether any prohibited allocations were made to
any disqualified persons. Line 2b of the Schedule E asked whether the
employer maintaining the ESOP paid dividends deductible under Code
section 404(k). Line 4 of the 2008 Schedule E asked if the ESOP held
any preferred stock and under what formula that preferred stock was
convertible into common stock. Line 6 of the 2008 Schedule E asked if
any unallocated securities were used to pay an exempt loan and, if so,
asked for the method used. Line 16 of the 2008 Schedule E asked if the
employer made payments in redemption of stock held by an ESOP to
terminating participants and deducted them under Code section 404(k).
All of these questions will be added to the new Schedule E, ESOP Annual
Information. The IRS notes that any questions added to the proposed
Schedule E with respect to Code section 404(k) will be included
pursuant to Code section 6047(e) rather than Code section 6058 (the
section pursuant to which the other IRS-only question are included on
the Form 5500). Thus, the disclosure rules of Code section 6104(b) are
not applicable and a separate process will need to be in place so that
any information provided with respect to Code section 404(k) will be
compliant with the appropriate disclosure rules.
The IRS also proposes to add three questions to the Forms 5500 and
5500-SF that will insure that the filers are aware of certain Code
requirements in areas where the IRS has found significant
noncompliance. In the first area, the IRS proposes to add a question
for defined benefit pension plans as to whether the plans comply with
the participation requirements of Code section 401(a)(26). In the
second, the IRS proposes to ask whether minimum required distributions
were made to 5% owners in accordance with Code section 401(a)(9). This
question addresses issues as to the qualification of the plan, the
taxability of distributions, and the possible imposition of excise
taxes under Code section 4974. In the third, the IRS proposes to add a
question as to whether hardship distributions were made during the plan
year for a section 401(k) plan. The IRS has found various qualification
and taxability issues related to such distributions.
The IRS also proposes to add a question to the Forms 5500 and 5500-
SF as to whether the plan provides for designated Roth contributions
under Code section 402A. The question would identify plans that have
added Roth contribution features. Designated Roth contributions and
Roth conversions add a new layer of recordkeeping and tax reporting for
plan administration, and the IRS has found various issues related to
recordkeeping and reporting.
As noted previously, because the plan characteristics codes
sometimes provide inadequate responses and are commonly misunderstood
by filers, the IRS proposes to replace these codes with separate
questions to the Forms 5500 and 5500-SF. For example, the IRS proposes
to replace characteristic codes 2L and 2M regarding Code sections
403(b)(1) and 403(b)(7) arrangements with separate line items. Also,
characteristic code 1I currently applies to frozen defined benefit
pension plans that do not provide any new benefit accruals as of the
last day of the plan year. Neither the Form 5500 nor the Form 5500-SF,
however, currently requests similar information regarding frozen
defined contribution pension plans. The IRS proposes to add a question
to these forms for defined contribution pension plans asking whether
the plans are frozen.
[[Page 47562]]
The IRS also proposes to add a line item to the Forms 5500 and
5500-SF for plans electing non-church plan status under Code section
410(d). 26 CFR 1.410(d)-1(c)(3) provides that a plan administrator may
elect non-church plan status by attaching a statement to the Form 5500
Annual Return/Report. Although such statements can be attached to the
EFAST2 filing as a PDF, the proposed change would facilitate the
process by which the IRS determines which plans have elected non-church
plan status and thus allow the IRS to apply the appropriate criteria in
determining compliance.
There also is a new IRS question on the Schedule H and Form 5500-SF
regarding unrelated business taxable income (UBTI) under Code sections
511 and 512. Although qualified plans are generally required to report
UBTI on Form 990-T, Exempt Organization Business Income Tax Return, the
IRS has found it difficult to get timely information regarding this
taxable income.
Lastly, a trustee's signature would be added in the trustee
information section on the Schedule H and the Form 5500-SF. The
signature is intended to satisfy the requirements under Code section
6033(a) for an annual information return from every Code section 401(a)
organization exempt from tax under Code section 501(a). As discussed in
more detail below, because this is an IRS-only signature, filers who
file fewer than 250 returns during the year will be able to satisfy
this signature requirement by filing the Form 5500-SUP.
c. New Schedule for IRS-Only Compliance Questions
As noted above, the IRS proposes to add various IRS-only questions
to the Form 5500 Annual Return/Report and to the Form 5500-SF and also
issue a Form 5500-SUP for those filers who are not subject to the IRS
electronic filing mandate in 26 CFR 301.6058-2 and elect to answer
these questions on a paper return. These new IRS-only compliance
questions do not apply to welfare plans. With respect to the Form 5500
and the Form 5500-SF, the IRS is considering whether these questions
should be added to these forms individually based on subject matter or
whether they should be added collectively on a single IRS-only
schedule. If the questions are added individually, they would appear on
the forms and schedules based on subject matter. Thus, for example,
ESOP questions would appear on a new Schedule E while other compliance
questions may appear on Form 5500-SF and revised Schedules H, MB, R,
and SB. On the other hand, if these IRS compliance questions are added
collectively, they would appear on a completely new IRS-only schedule.
Comments are specifically requested as to whether a separate schedule
that would include all of the IRS-only questions should be made part of
the Form 5500 Annual Return/Report
2. New Schedule H and Form 5500-SF Compliance Questions
An area of particular recent focus for DOL has been compliance with
ERISA section 411. Accordingly, the proposal would add a new question
under Part IV of Schedule H asking whether any person disqualified
under ERISA section 411 was permitted to serve the plan. ERISA section
411 disqualifies people who have been convicted of certain crimes from
serving as an administrator, fiduciary, officer, trustee, custodian,
counsel, agent, employee, consultant, or adviser of any employee
benefit plan for a specified period. The statute also prohibits people
who are currently disqualified from representing a plan in any
capacity, and from having any decision-making authority or custody or
control of the monies, funds, assets, or property of an employee
benefit plan. This proposed question on disqualification would
facilitate competent plan administration and improve due diligence by
encouraging the plan administrator to determine whether any of the
plan's fiduciaries, employees, and service providers potentially
participated in an act prohibited by ERISA section 411.
Another proposed compliance question, which also supports the
Agencies' goals in obtaining better information on investments and
related fees for defined contribution pension plans, involves whether
the plan is a participant-directed account plan, and, if so, whether
the plan provided participants with the fee disclosures required by 29
CFR 2550.404a-5. As discussed earlier with respect to the Form 5500-SF,
the proposal also requires administrators to attach the comparison
chart to Schedule H. These questions would help plan administrators
comply with 29 CFR 2550.404a-5. This proposed question is also
responsive to the GAO's recommendation that the Agencies seek specific
information on QDIAs. GAO Targeted Revisions Could Improve Usefulness
of Form 5500 Information, at 18. A plan that is a participant-directed
account plan also must report the number of DIAs under the plan, the
number of DIAs that are index funds, and whether a designated
investment manager (DIM) was made available to participants and
beneficiaries. These new questions appear on both Schedule H and on the
Form 5500-SF.
The proposal also would add a new compliance question asking
whether the employer sponsoring the plan paid administrative expenses
that were not reported as service provider compensation on Schedule C
or a plan administrative expense on Schedule H. Where the only
compensation received by a service provider in connection with a plan
is direct payment from the plan sponsor, the information is not
required to be reported on Schedule C. To minimize burden, while still
providing a clearer picture on the Form 5500 Annual Return/Report of
all service providers to plans, regardless of who pays those service
providers, the Agencies are proposing only to ask whether the plan has
any such service providers rather than require identification and other
Schedule C information for such service providers. The Agencies are
requesting comments on whether there should be a minimum threshold
compensation amount for this question and, if so, what the amount
should be.
The proposal also would add a question asking whether the plan
sponsor or its affiliates provided any services to the plan in exchange
for direct or indirect compensation. This information would help the
Agencies obtain a complete picture of the relationship between the plan
and the plan sponsor, including the extent to which the sponsor may
also be acting as a fiduciary or service provider. An affirmative
answer may indicate potential conflicts of interest and would be useful
for DOL enforcement.
Another proposed compliance question would require filers to
indicate whether the plan had any leveraged investment acquisitions,
the total amount of those acquisitions, and the ratio of the leveraged
investments to total plan assets. In addition to helping ensure that
the plan administrator has a complete picture of the potential risk and
reward associated with the plan's assets, these questions would improve
the Agencies' understanding of plan operations. Plans with a high ratio
of leveraged investments, such as options, futures, and margin-type
investments, may be at greater risk. By identifying these plans, the
Agencies would be better able to target and track performance of high-
risk plans. This question would only be added to the Schedule H, and
not the Form 5500-SF. Leveraged investments are not ``eligible plan
assets'' for purposes of the Form 5500-SF. Small plans that have such
investments must file the Form 5500.
[[Page 47563]]
In the existing section regarding the IQPA report, filers would be
required to indicate whether the accountant orally or in writing
communicated various governance issues discovered during the audit,
including errors or irregularities, illegal acts, material internal
control weaknesses, and the existence of plan qualification issues.
This question is intended to enhance compliance by highlighting the
existing duty of the plan administrator to read and review the audit
report and, if necessary, to engage in a discussion with the auditor
about the report's contents. In addition to helping the plan
administrator ensure that the audit is comprehensive, the answers to
these questions would provide participants with information about
potential problems with the management of plan assets. Also, in
situations where the plan administrator reports that the auditor has
identified problems with the audit, the Agencies would have an
opportunity to conduct a closer review of the plan's finances.
In addition to the existing question asking whether the IQPA has
relied on the limited scope audit provisions in 29 CFR 2520.103-8, the
proposal would require filers to attach the certification of investment
information created by certain banks or insurance companies to ensure
the plan is qualified to be subject to a limited scope audit. This
change would also encourage plan administrators to maintain
documentation consistent with the limited scope audit requirements. The
change is being made in conjunction with revisions to the DOL's
regulation at 29 CFR 2520.103-8 to set forth specific requirements for
the attachment, including the requirement that the certification appear
on a separate document from the list of plan assets covered by the
certification, which list generally would be required to be reported on
the Schedule H, Line 4i Schedules of Assets, using the structured data
entry format through EFAST.
The required attachment of the proposed, updated certification
would also make the Agencies' review of limited scope audits more
robust by enabling them to follow up on plans that use the limited
scope exemption but fail to attach the necessary certification. See
DOL-OIG: Changes Are Still Needed in the ERISA Audit Process to
Increase Protections for Employee Benefit Plan Participants at 17 (EBSA
should improve the quality of its audit documentation reviews by adding
procedures to ensure that ``all plan assets are either certified by a
qualifying financial institution or tested by the IQPA''). Obtaining
the certification would also allow EBSA to better determine which of
the plan's assets are subject to a limited scope audit and which
require a full IQPA report. Id. at 4 (``EBSA's review guide did not
specifically address audits in which the plan custodian certified some,
but not all, plan assets in limited scope audits.'')
The Agencies also propose standardizing information reported on
Schedule H, Line 4a, to foster filers' compliance with regulations and
guidance governing delinquent participant contributions and loan
repayments. Under the proposed changes, filers would complete a
standardized, structured attachment that includes information about
whether the correction of the delinquency was made within or outside of
the Voluntary Fiduciary Correction Program (VFCP) and Prohibited
Transaction Exemption 2002-51. As under the current requirements,
filers must continue to report the deficiency until correction is made.
The proposed changes also facilitate accurate reporting by requiring
the delinquent contribution information to be included in supplemental
schedules. Including such information in supplemental schedules would
help ensure that IQPAs address delinquent contributions and loan
repayments in their audit reports, consistent with generally accepted
auditing standards.
The proposal also includes new questions on Schedule G (Financial
Transaction Schedules). To gather additional information about the
plan's transactions and relationships, especially nonexempt prohibited
transactions, the Agencies propose asking for more detailed information
about the nature of nonexempt prohibited transactions engaged in by the
plan. In addition to the current requirement to provide the name and
contact information for the parties involved with the nonexempt
transaction, and their relationship to the plan, employer, employee
organization, plan sponsor, or other party-in-interest, the proposal
asks filers to check a box indicating the nature of the nonexempt
transaction. The check boxes generally follow the prohibitions of ERISA
section 406 and Code section 4975 and include, for example, sale of any
property to/from the plan, exchange of any property, lease of any
property to/from the plan, lending of money to/from the plan, other
extension of credit to/from the plan, furnishing of goods to/from the
plan, etc. The proposal also asks a new question about whether the
transaction is discrete or ongoing and whether the transaction has been
fully corrected, either through or outside of the VFCP. The proposal
also asks for the date the transaction was fully corrected, a
description of the corrective action and whether, if a nonexempt
transaction occurred with respect to a disqualified person, and the
person was notified, a Form 5330 was filed with the IRS to pay the
excise tax on the transaction.
The proposal would add new line items on Schedule A for reporting
whether any premium payments were overdue and, if so, the amount
delinquent, and whether there was a policy or contract reported on the
Schedule that was issued by an insurance company wholly owned by the
plan or the plan sponsor. An affirmative answer to questions on
delinquent premium payments and whether the plans holds a contract
issued by an insurance company that is wholly owned by the plan or plan
sponsor would alert DOL to potential insurance cancellation and other
conflict of interest issues.
The DOL issued new guidance in 2015 regarding economically targeted
investments (ETIs) made by ERISA-covered retirement plans. ETIs are
investments that are selected for benefits they create in addition to
the investment return to the employee benefit plan investor. The DOL
previously addressed issues relating to ETIs in Interpretive Bulletin
94-1, 29 CFR 2509.94-1 (IB 94-1) and Interpretive Bulletin 2008-1, 29
CFR 2509.08-1 (IB 2008-1). IB 94-1 had corrected a misperception that
investments in ETIs are incompatible with ERISA's fiduciary
obligations. On October 17, 2008, the department replaced IB 94-1 with
IB 2008-01. However, the DOL concluded that in the seven years since
its publication, IB 2008-01 had unduly discouraged fiduciaries from
considering ETIs and environmental, social and governance (``ESG'')
factors under appropriate circumstances, and issued Interpretive
Bulletin 2015-01, 29 CFR 2509.2015-1 (IB-2015-1).
IB-2015-1 confirmed the DOL's longstanding view from IB 94-1 that
fiduciaries may not accept lower expected returns or take on greater
risks in order to secure collateral benefits, but may take such
benefits into account as ``tiebreakers'' when investments are otherwise
equal with respect to their economic and financial characteristics. IB-
2015-1 also acknowledges that ESG factors may have a direct
relationship to the economic and financial value of an investment. When
they do, these factors are more than just tiebreakers, but rather are
proper components of the fiduciary's analysis of the economic and
financial merits of competing investment choices.
[[Page 47564]]
Changes in the financial markets, particularly improved metrics and
tools allowing for better analyses of investments, are enabling plan
fiduciaries to make better and more evidence-based decisions on ETIs
and ESG factors in evaluating the merits of competing investment
choices. Some private sector sources are developing structured ESG
research data for evaluating corporate performance. The DOL is
interested in public comments, including analysis on costs and
benefits, on whether collecting information related to ETI and ESG
investment activities of ERISA-covered plans on the Form 5500, such as
whether plans incorporate ESG factors into their investment analysis,
would add value to this growing data source and allow ERISA fiduciaries
to more easily consider the role ESG factors could or should play in
their investment decisions. The DOL requests comments regarding the
best way to use the Form 5500 to collect information with respect to
ESG investment activities that is standardized, comparable, and
reliable For example, public companies are already subject to
requirements to disclose material risks, including relevant risks
associated with climate change, per Securities and Exchange Commission
Interpretation: Commission Guidance Regarding Disclosure Related to
Climate Change [Release Nos. 33-9106; 34-61469; FR-82]. The DOL
specifically requests comments on whether we could use the SEC
disclosure requirements for public companies as a basis for a Form 5500
information collection.
3. Schedules MB and SB--New Questions and Identifying Information for
Attachments
The Agencies are proposing to add new questions to the actuarial
schedules (Schedules MB and SB) to enhance compliance. On the Schedule
SB, reporting of the target normal cost would be revised to separate
out the plan-related expenses. By requiring this breakdown, the
Agencies and other users of Schedule SB data such as firms conducting
actuarial research would be able to more accurately project liabilities
and future required contributions.
The Agencies also propose to add a new question to the Schedule SB
to require single-employer plans with 500 or more participants as of
the valuation date to report projections of expected benefit payments
to be paid for the entire plan (not including expected expenses) for
each of the next ten plan years starting with the plan year to which
the filing relates. For this purpose the plan would assume that there
were no additional accruals, experience (e.g., termination, mortality,
and retirement) consistent with the plan's valuation assumptions, and
that no new entrants would be covered by the plan. The requirement
would not be applicable to plans with fewer than 500 participants as of
the valuation date. This information would enable the Agencies to
determine how much of a plan's assets are needed to pay benefits to
participants. This information would also help in assessing the
adequacy of current assets and contributions to satisfy the disclosed
benefit commitments. In March 2015, PBGC asked OMB to approve, and in
June 2015, OMB approved adding a similar question for the 2015 Schedule
MB, to be reported on a PDF attachment. The Agencies are now proposing
that the question be added to the Schedule MB itself.
4. Form 5500 and Form 5500-SF PBGC Compliance Questions
For 2016, PBGC is proposing to add a question to the existing
question on Schedules H and I, Line 5c, that asks, if a plan is a
defined benefit plan, whether it is covered by the PBGC insurance
program. The new question would ask filers that checked the box ``Yes''
to enter the My PAA generated confirmation number for the PBGC premium
filing for this plan year. In this proposal, PBGC is proposing moving
the questions to the Form 5500 and Form 5500-SF. In comparing Form 5500
Annual Return/Report data to PBGC premium filing data, the agency has
found PBGC-covered plans for which no premiums have been paid and
filers incorrectly claiming that they have PBGC-covered plans. By
requiring reporting of the My PAA generated confirmation number on the
Form 5500 and Form 5500-SF, PBGC will be better able to match Form 5500
Annual Return/Report filings to PBGC premium filings, bring in new
premium filings, as well as improve the data collected on the Forms.
Also, for the 21st Century initiative changes, the Agencies are
proposing to move Line 5c on Schedule H and I to Line 9a(4) of the Form
5500 and Line 12a(4) of the Form 5500-SF. The new question described
above about PBGC premium filings would be added to these lines.
F. Miscellaneous Technical and Conforming Changes for Forms and
Instructions
Various other technical and conforming changes to the forms,
schedules, and instructions are being proposed as part of the
substantial restructuring of the Form 5500 Annual Return/Report
described in this notice. Several of the more significant of these
changes are as follows.
On both the Form 5500 and the Form 5500-SF, filers that check the
``single-employer plan'' box in accordance with the instructions, but
which have multiple employers obligated to contribute to the plan that
are members of a controlled group, would be required to file an
attachment identifying the participating employers. This requirement
would be similar to the requirement, effective with the 2014 annual
return/report forms, to attach a list of participating employers with a
good faith percentage of the contributions to the plan of each
participating employer, for plans that file as ``multiple-employer''
plans. To implement ERISA section 103(g) resulting from the Cooperative
and Small Employer Charity Pension Flexibility Act (CSEC Act), Public
Law 113-97, 128 Stat. 1101 (April 7, 2014), the DOL published an
interim final rule in November 2014, 79 FR 66617 (Nov. 10, 2014). The
DOL intends that the CSEC Act reporting changes will be made final
effective with the implementation of final forms revisions following
this proposal. Under the CSEC Act interim final rule, filers that check
the ``multiple-employer plan'' box are required to provide a list of
participating employers and a good faith estimate of the percentage of
total contributions made by each participating employer during the plan
year. The DOL received four comments on the interim final rule and six
additional comments on an emergency PRA submission published
separately.
A central concern of the commenters is that the list of
participating employers is essentially the client list developed by
entities that sponsor multiple-employer plans for professional employer
organizations (PEOs) or other associations. The commenters asserted
that the publication of the participating employer information could
negatively affect their business model by enabling competitors to
target client employers. These commenters suggested that the DOL could
not implement the CSEC Act law change by asking for the required
information to be reported on the Form 5500 because the list of
employers is proprietary information. Certain commenters suggested, in
the alternative, that if the information was required to be reported,
it should not be publicly disclosed. One commenter suggested that the
DOL should not apply the requirement to defined contribution or welfare
plans because the CSEC legislation focused on ERISA
[[Page 47565]]
minimum funding requirements which do not apply to the majority of
defined contribution pension plans or to any group health and welfare
plans. That commenter suggested that the DOL could instead obtain the
participating employer information through the use of its subpoena
authority or could limit the requirement by providing an alternate
method of compliance. The commenter also suggested allowing plans that
are multiple employer welfare arrangements (MEWAs) that fund benefits
through VEBAs to satisfy the employer list requirement by submitting
the VEBA information and either removing the contribution requirement
entirely or clarifying that the filers need only include gross
contribution information rather than break out the information by
employers and employees.\42\
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\42\ The DOL notes that the CSEC Act reporting requirements only
apply to multiple-employer plans and thus the requirement only
applies to those MEWAs that are in fact plans. Individual plans
participating in a non-plan MEWA must file their own Form 5500
Annual Return/Report unless otherwise exempt.
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The DOL has considered these comments but has decided not to make
changes to the multiple-employer plan reporting requirements described
in the interim final rule. The CSEC Act makes provision of
participating employer information a reporting requirement under
section 103 of ERISA. Section 104(a)(1) of ERISA provides generally
that the contents of the annual report must be open for public
inspection. The DOL continues to believe that the reporting
requirements made effective for the 2014 form year by the interim final
rule are a reasonable and appropriate way to implement Congress's
directive in the CSEC Act.
Furthermore, the Agencies believe that this information is
important for plan oversight, research, and enforcement purposes.
Because participating employers generally are not otherwise identified
on the Form 5500 or its schedules,\43\ the Agencies have no other
information on the number or identity of participating employers in
multiple-employer plans. The Agencies also believe that similar
information would be helpful for participating members of a plan that
covers members of a controlled group that files under the reporting
rules as a ``single-employer'' plan. Accordingly, under the proposal, a
new check box would be added for a plan to identify that it covers
members of a controlled group. Plans checking that box would be
required to provide the same basic identifying and contribution
information as are multiple-employer plans under the CSEC Act changes.
---------------------------------------------------------------------------
\43\ In a requirement added under the PPA, filers are required
to provide certain information on Schedule R, for each employer that
contributed more than 5% of total contributions to a multiemployer
defined benefit pension plan during the plan year (measured in
dollars).
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The Form 5500, as proposed, would ask filers to identify and
provide contact information for the ``named fiduciary'' under ERISA
section 3(21). The Agencies note that as for any other address and
identifying information required on the annual return/report, named
fiduciary addresses and phone numbers (and those of the employer and
plan administrator) should be the actual addresses and phone numbers
for those entities/individuals and not the address of a service
provider or entity that is completing the filing. This has been an area
of inaccurate data entry as the entity that fills out the form has not
always entered correct data in correct boxes. As a result, the data is
misleading for participants and beneficiaries and for the Agencies.
New breakout questions would be added to both the Form 5500 and the
Form 5500-SF, for defined contribution pension plans to report the
number of participants with account balances as of the beginning of the
plan year; the number of participants that made contributions during
the plan year; and the number of participants that terminated
employment during the plan year that had their entire account balance
distributed.
The following new information would also be required to be reported
on the Form 5500 or Form 5500-SF in the questions that are intended to
replace the current plan characteristics code structure:
1. The current requirement for defined benefit pension plans to
identify whether the filing is for a frozen plan would be extended to
defined contribution pension plans.
2. Defined contribution pension plans would now be required to
identify whether the plan is a SIMPLE 401(k) plan under Code sections
401(k)(11) and 401(m)(10).
3. Defined contribution pension plans would now be required to
identify whether the plan has a designated Roth feature.
4. Defined contribution pension plans that have participant-
directed brokerage accounts would now be required to enter the number
of participants using such accounts during the plan year.
5. Defined contribution pension plans would have to indicate
whether the plan has an intended qualified default investment
alternative(s) (QDIA) and, if so, to indicate the type(s) of
alternative(s).
6. Pension plans would be required to report if the plan is an
eligible combined plan under Code section 414(x).
7. Pension plans would be required to report if a rollover from a
plan was used to start up the business sponsoring the plan (a Rollovers
as Business Start-Ups or ROBS transaction).
8. Pension plans would be required to report if the plan is
electing church plan status under Code Section 410(d).
9. Defined contributions pension plans would be required to
indicate whether they provide financial education and/or financial
advice for participants.
10. Plans would be required to report if the plan provides long
term care insurance.
11. On the Form 5500, plans that provide group health benefits
would have to indicate, more specifically, whether they provide
medical/surgical benefits, pharmacy or prescription drug benefits,
mental health/substance use disorder benefits, wellness program,
preventive care services, emergency services, and pregnancy benefits.
The signature section on the Form 5500 would be revised to add a
checkbox to indicate whether the plan is a Taft-Hartley plan and to
provide a dedicated signature area for both a ``management'' and a
``labor'' trustee.
In addition to the changes described above, the Schedule A and its
instructions would be clarified to specify that the plan is required to
report the insurance carrier's NAIC ``Company Code,'' when reporting
the ``NAIC number.'' Plans that provide group health benefits through
an insurance contract would also be required to provide the insurance
carrier's required health plan identification number (HPID) under the
Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Schedule J would require filers to provide the NAIC Producer Code if
there is a stop loss policy associated with the plan's obligation to
pay health benefits. The Agencies invite comment on whether a
particular NAIC type number or other identifying number, as well as the
HPID, would be best to produce the most consistent and accurate
identifier of insurance companies required to be identified on the Form
5500 Annual Return/Report.
On new Line 2 of the Schedule A, plans would be required to report
if the policy or contract was issued by an insurance company that is
wholly owned by the plan or the plan sponsor.
The current questions and instructions on Schedule A for persons
covered under an insurance contract
[[Page 47566]]
that reported on Schedule A would be clarified and expanded. The
instructions are clarified to make explicit that the existing
requirement to report the approximate number of persons includes
participants, beneficiaries, and dependents covered under the contract.
For welfare benefit contracts, the question has also been
particularized to require the approximate number of persons covered for
each type of benefit.
To improve the data, there would be new checkboxes on the Schedule
A to enable filers to indicate whether the contract covered accidental
death and disability (AD&D) or long term care insurance. The existing
element on the Schedule A to identify that plan assets are in insurance
company ``pooled separate accounts'' would be broken into ``pooled
separate accounts'' and ``other'' separate accounts. If ``other,''
filers would be required to enter a description of the separate
account. Plans that provide life insurance would be required to
indicate, on Schedule A, whether a life insurance contract is ``term
life'' or ``other.'' If the life insurance contract is other than
``term life,'' the filer would continue to have to enter a description.
The Schedule C instructions with regard to exceptions for reporting
employees whose compensation is less than $25,000 would be clarified to
provide that, for Schedule C purposes, compensation does not include
the employer portion of FICA and FUTA taxes as part of the total
compensation of an employee. It does, however, include salary, bonuses,
overtime, and all indirect compensation from persons other than the
plan received in connection with the person's position with the plan or
services provided to the plan. As discussed above, the instructions
would be modified to specify that expenses for travel, education,
conferences, meals, etc., whether paid directly by the plan or
reimbursed to the employee, have to be included in determining total
compensation of plan employees, but only if such payments would be
reportable as taxable income to the employee.
As with similar clarifying changes to Schedule C and the Schedule
H, Line 4i Schedules of Assets, plans would now be required to report
on Schedule A the relationship to the plan, employer, employee
organization, sponsor, fiduciary, or other party-in-interest of the
agent, broker, or other person to whom commissions or fees were paid.
When reporting on Schedule A that an insurance company failed to
provide the information needed to complete the annual return/report, if
it is ``fee and commission'' information that is not provided, then
filers would only need to check a box to so indicate. Filers would
continue to have a place to describe other types of information.
In addition to the changes described above to the Schedule H,
filers would be required to report, in the existing section on the IQPA
report on the Schedule H, the state in which the IQPA report was
issued.
The existing questions for Form 5500 Annual Return/Report filers to
indicate plan funding and benefit arrangements would be added to the
Form 5500-SF.
In response to the concerns of certain practitioners regarding
their ability to comply with filing requirements where PBGC has
trusteed a plan and there is no longer a plan administrator to complete
the filing or the ability to pay a service provider for the work
necessary to fulfill the filing obligation, the Agencies are proposing
to simplify the final filing requirements for plans trusteed by PBGC
that have 500 or fewer participants.
Specifically, the question on whether the plan has come under the
trusteeship of the PBGC would be moved from current plan characteristic
code 1H on the Form 5500 and part of Line 4k on the Schedule H and Line
13b on the Form 5500-SF to a checkbox on Part I of the Form 5500. Form
5500 Annual Return/Report filers that, as of the date the return/report
is filed but not later than the due date of the return/report with
automatic extension, have been trusteed by PBGC under section 4041(c)
or 4042 of ERISA, would be required to check that box and enter the
date of PBGC trusteeship in the space provided. Plans with 500 or fewer
participants (see Part II, Line 6, asking for participant count) that
check this box would be required to complete all of Part I and Lines 1,
2, 3, 6, 9a(3) and 9a(4) of Part II; this would be the last Form 5500
Annual Return/Report they would need to file. Form 5500 Annual Return/
Report filers with plans with more than 500 participants (in Part II,
Line 6) would be required to complete the Form 5500 in the same manner
as they have in the past and would need to file a Form 5500 for a
following short plan year (depending on when the plan was trusteed).
Similarly, Form 5500-SF filers with plans that, as of the date the
return/report is filed but not later than the due date of the return/
report with automatic extension, have been trusteed by PBGC under
section 4041(c) or 4042 of ERISA, would be required to check a box in
Part 1A and enter the date of PBGC trusteeship in the space provided.
Plans that check this box would be required to complete all of Part I
and Lines 1, 2, 3, 5 (if applicable), 6, 9a(3) and 9a(4) of Part II.
The proposal to simplify final filing requirements is limited to
PBGC-trusteed plans with 500 or fewer participants for a number of
reasons. PBGC generally needs the information contained in the final
annual return/report to calculate its claims for underfunding and
unpaid minimum funding contributions, to prepare its financial
statements, and to value participant benefits. Larger plans tend to
have more complex asset structures and include hard-to-value assets,
while smaller plans are more likely to lack the resources needed to
meet their actuarial and filing obligations for the final plan year and
final short plan year. It has been primarily representatives of small
plans that have contacted PBGC and DOL to request relief from filing
requirements for PBGC-trusteed plans.
In PBGC's experience, larger plans usually comply with the filing
requirement for the final plan year and the final short plan year. The
companies that maintain these larger plans typically build the cost of
plan administration into their balance sheets, even if the plan is
terminated in an involuntary or distress termination. Moreover, in
PBGC's experience, for most larger plans, the cost of filing the annual
return/report is paid from plan assets. Even when paid by the plan
sponsor, PBGC believes that the cost of filing for a larger plan is a
relatively insignificant component of the sponsor's overall business
expenses.
PBGC also believes that exempting larger plans from completing
certain schedules or sections of the annual return/report would not
result in a meaningful cost savings to the plan sponsor and could
result in the inability to compile important information in the event
that the plan is terminated. An involuntary or distress termination
involves a complex actuarial and economic analysis by PBGC that may
continue for a year or more and does not always result in termination.
The process of preparing the annual return/report continues through and
beyond the plan year. PBGC believes that limiting the reporting
obligations for larger plans anticipating termination might cause a
plan to stop the ongoing process that culminates with the filing, even
though a termination is not ultimately approved. This would
significantly impair PBGC's actuarial and financial analysis for the
ongoing plan.
The Agencies also propose to accept the electronic-signature by the
plan
[[Page 47567]]
actuary on the Schedules MB and SB, and the electronic-signature by the
plan trustee for trust information on the Form 5500-SF and Schedule H.
The plan actuary or plan trustee can access the EFAST2 Web site at
www.efast.dol.gov to register for electronic credentials to sign or
submit filings. If a plan actuary or a plan trustee chooses not to sign
electronically, then the actuary or trustee must sign the schedule or
Form, and an electronic reproduction must be attached to the Form 5500
or Form 5500-SF. This electronic reproduction must be labeled ``Trustee
Signature'' for trust information on the Schedule H or Form 5500-SF,
and ``Actuary Signature'' for the plan actuary on the Schedule MB or
SB, and must be included as a Portable Document Format (PDF) attachment
or any alternative electronic attachment allowable under EFAST2, if it
is not electronically signed.
G. Electronic Filing of Certain IRS-Only Forms
The Agencies propose to enable filers to file IRS Forms 5500-EZ and
5558 through EFAST by creating an electronic version of each of these
forms. The Agencies believe that the anticipated increase in electronic
filing resulting from the creation of an electronic version of these
forms would have various beneficial effects. For example, the
electronic filing of these forms would benefit the filers and the
Agencies by reducing errors that are more likely to occur during the
manual preparation and processing of paper returns and reports.
Electronic filing also results in faster settling of accounts and
better customer service. See Private Pensions: Targeted Revisions Could
Improve Usefulness of Form 5500 Information.
1. Form 5500-EZ
The Form 5500-EZ, Annual Return of One-Participant (Owners and
Their Spouse) Retirement Plan, is generally used by one-participant
plans and certain foreign plans to satisfy their filing requirements
with the IRS under Code section 6058. The Form 5500-EZ is currently
filed on paper with the IRS. Although the Form 5500-EZ cannot currently
be filed electronically, one-participant plans and foreign plans
(beginning with the 2014 plan year) may elect to electronically file
the Form 5500-SF using the EFAST2 system instead of filing the paper
Form 5500-EZ with the IRS. One-participant plans and foreign plans that
file the Form 5500-SF rather than file the Form 5500-EZ are required to
complete only certain lines on the Form 5500-SF. These lines are the
same as, or are similar to, lines on the Form 5500-EZ. Accordingly,
one-participant plans and foreign plans filing the Form 5500-SF are
required to answer only those questions they would have been required
to answer if they had filed the Form 5500-EZ. The IRS's electronic
filing mandate regulation described above applies to filers of the Form
5500-EZ as well as to filers of Form 5500 and Form 5500-SF. One-
participant plans and foreign plans that file at least 250 returns
during the applicable calendar year generally are therefore now
required to file the Form 5500-SF electronically using the EFAST2
system beginning with the 2015 plan year. See T.D. 9695, 79 FR 58256
(Sept. 29, 2014).
The IRS proposes to provide an electronic version of the Form 5500-
EZ to be filed on the EFAST2 system. This electronic version would be
in addition to the paper version. Accordingly, except to the extent
they are subject to the electronic filing mandate, one-participant
plans and foreign plans subject to the filing requirements of the Code
would be able to elect to file either the paper version of the Form
5500-EZ with the IRS or file the electronic version through EFAST2.
These filers would no longer be allowed to file the Form 5500-SF. One-
participant plans and foreign plans that are required by 26 CFR
301.6058-2 to file electronically would be required to file the
electronic version of the Form 5500-EZ.
Currently, less than 15 percent of one-participant plans file the
electronic Form 5500-SF instead of the paper Form 5500-EZ. The IRS
believes that creating an electronic version of the Form 5500-EZ to
replace the Form 5500-SF for one-participant and foreign plans would
encourage these filers to file electronically because they would no
longer need to deal with the longer Form 5500-SF and its instructions.
The IRS further believes that filers would be more likely to file an
electronic Form 5500-EZ instead of a Form 5500-SF because, unlike when
filing the Form 5500-SF, they would not need to make a separate
determination as to which questions to answer. As with any Form 5500-SF
currently filed by a one-participant plan for purposes of the Code, the
information filed on the electronic version of the Form 5500-EZ on the
EFAST2 system will not be published by the DOL on the Internet.
2. Form 5558
Filers may currently obtain a one-time extension of time to file a
Form 5500 Annual Return/Report and a Form 8955-SSA, by filing IRS paper
Form 5558, Application for Extension of Time To File Certain Employee
Plan Returns, on or before the normal due date of the return/report.
The IRS proposes to create an electronic version of the Form 5558 to be
processed through EFAST2, which would enable filers to use the same
system to request an extension that they use to file Form 5500 Annual
Return/Report. The electronic filing of this form would benefit the
filers and the Agencies by reducing errors that are more likely to
occur during the manual preparation and processing of paper returns and
reports. Electronic filing also results in faster settling of accounts
and better customer service. Under this proposal, the paper Form 5558
would continue to be filed with the IRS by those filers who wish to
file the Form 5558 on paper.
The Form 5558 is also currently used for extensions of time to file
Form 5330, Return of Excise Taxes Related to Employee Benefit Plans. It
is anticipated that the extension of time to file Form 5330 could not
be filed electronically using EFAST. The Form 5330 is used to report
various violations of the Code related to retirement plans and requires
a payment of excise taxes to the IRS. The instructions to the Form 5558
state that any tax due to be paid under the Form 5330 must be paid with
the Form 5558 and that interest is charged on taxes not paid by the due
date even if an extension of time to file is granted. Accordingly, the
IRS proposes to create a new paper form for extensions of time to file
the Form 5330. It is anticipated that this new extension form would
have provisions similar to those in the Form 5558 to the extent they
apply to the Form 5330.
H. Regulations Relating to the Proposed Form
As noted above, certain amendments to the annual reporting
regulations are necessary to accommodate some of the proposed revisions
to the forms. The DOL is publishing separately today in the Federal
Register proposed amendments to the DOL's annual reporting regulations.
That document includes a discussion of the findings required under
sections 104 and 110 of ERISA that are necessary for the DOL to adopt
the Form 5500 Annual Return/Report, including the Form 5500-SF, if
revised as proposed herein, as an alternative method of compliance,
limited exemption, and/or simplified report under the reporting and
disclosure requirements of Part 1 of Subtitle B of Title I of ERISA.
I. Paperwork Reduction Act Statement
As part of continuing efforts to reduce paperwork and respondent
burden, the
[[Page 47568]]
general public and Federal agencies are invited to comment on proposed
and/or continuing collections of information in accordance with the
Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3506(c)(2)(A)). This
helps to ensure that requested data will be provided in the desired
format, reporting burden (time and financial resources) will be
minimized, collection instruments will be clearly understood, and the
impact of collection requirements on respondents is properly assessed.
Currently, the DOL is soliciting comments concerning the proposed
revision of the Form 5500 Annual Return/Report, which is an information
collection request subject to the PRA. A copy of the ICR may be
obtained by contacting the person listed in the PRA Addressee section
below.
The DOL has submitted a copy of the proposed forms revisions to the
Office of Management and Budget (OMB) in accordance with 44 U.S.C.
3507(d) for its review of the DOL's information collection. The IRS and
the PBGC intend to submit separate requests for OMB review and approval
based upon the final forms revisions. The DOL and OMB are particularly
interested in comments that:
Evaluate whether the proposed collection of information is
necessary for the proper performance of the functions of the Agencies,
including whether the information will have practical utility;
Evaluate the accuracy of the estimate of the burden of the
proposed collection of information, including the validity of the
methodology and assumptions used;
Enhance the quality, utility, and clarity of the
information to be collected; and
Minimize the burden of the collection of information on
those who are to respond, including through the use of appropriate
automated, electronic, mechanical, or other technological collection
techniques or other forms of information technology, e.g., permitting
electronic submission of responses.
Written comments must be submitted to the office shown in the PRA
Addressee within 75 days of publication of the Notice of Proposed Forms
Revision to ensure their consideration.
PRA Addressee: Address requests for copies of the ICR to G.
Christopher Cosby, Office of Policy and Research, U.S. Department of
Labor, Employee Benefits Security Administration, 200 Constitution
Avenue NW., Room N-5718, Washington, DC 20210. Telephone: (202) 693-
8410; Fax: (202) 219-4745; Email: ebsa.opr@dol.gov. These are not toll-
free numbers. ICRs submitted to OMB also are available at https://www.RegInfo.gov.
Type of Review: Revision of a currently approved collection.
Agencies: Employee Benefits Security Administration (OMB Control
No. 1210-0110); Internal Revenue Service (OMB Control No. 1545-1610);
Pension Benefit Guaranty Corporation (OMB Control No. 1212-0057).
Title: Form 5500 Series.
Affected Public: Individuals or households; Business or other for-
profit; Not-for-profit institutions.
Form Number: DOL/IRS/PBGC Form 5500 and Schedules.
Total Respondents: The total number of annual Form 5500 filers will
be approximately 2.97 million.
Total Responses: See ``Total Respondents'' Above.
Frequency of Response: Annually.
Estimated Total Burden Hours: 1.52 million.
Estimated Time per Response, Estimated Burden Hours, Total Annual
Burden: See below for each Agency.
Total Annualized Costs: $667.7 million.
The Agencies' burden estimation methodology excludes certain
activities from the calculation of ``burden.'' If the activity is
performed for any reason other than compliance with the applicable
federal tax administration system or the Title I annual reporting
requirements, it was not counted as part of the paperwork burden. For
example, most businesses or financial entities maintain, in the
ordinary course of business, detailed accounts of assets and
liabilities, and income and expenses for the purposes of operating the
business or entity. These recordkeeping activities were not included in
the calculation of burden because prudent business or financial
entities normally have that information available for reasons other
than federal tax or Title I annual reporting. Only time for gathering
and processing information associated with the tax return/annual
reporting systems, and learning about the law, was included. In
addition, an activity is counted as a burden only once if performed for
both tax and Title I purposes. The Agencies also have designed the
instruction package for the Form 5500 Annual Return/Report so that
filers generally will be able to complete the Form 5500 Annual Return/
Report by reading the instructions without needing to refer to the
statutes or regulations. The Agencies, therefore, have included in
their PRA calculations a burden for reading the instructions and find
there is no recordkeeping burden attributable to the Form 5500 Annual
Return/Report.
The DOL solicits comments regarding whether or not any
recordkeeping beyond that which is usual and customary is necessary to
complete the Form 5500 Annual Return/Report. Comments are also
solicited on whether the Form 5500 Annual Return/Report instructions
are generally sufficient to enable filers to complete the Form 5500
Annual Return/Report without needing to refer to the statutes or
regulations.
J. Paperwork and Respondent Burden
Estimated time needed to complete the forms listed below reflects
the combined requirements of the IRS, the DOL, and the PBGC. The times
will vary depending on individual circumstances. The estimated average
times are:
----------------------------------------------------------------------------------------------------------------
Pension plans
----------------------------------------------------------------------------------
Small, ineligible for 5500- Small, eligible for 5500-
Large SF SF
----------------------------------------------------------------------------------------------------------------
Form 5500.................... 1 hr, 52 min.............. 1 hr, 20 min..............
Schedule A................... 2 hr, 55 min.............. 2 hr, 55 min..............
Schedule MB.................. 8 hr, 27 min.............. 7 hr, 28 min.............. 7 hr, 28 min.
Schedule SB.................. 6 hr, 38 min.............. 6 hr, 49 min.............. 6 hr, 49 min.
Schedule C................... 3 hr, 28 min.............. 3 hr, 20 min..............
Schedule E................... 3 hr, 18 min.............. 3 hr, 18 min..............
Schedule G................... 13 hr, 51 min.............
Schedule H................... 11 hr, 50 min............. 8 hr, 12 min..............
Schedule R................... 1 hr, 54 min.............. 1 hr, 6 min...............
Form 5500-SF................. .......................... .......................... 2 hr, 54 min.
----------------------------------------------------------------------------------------------------------------
[[Page 47569]]
----------------------------------------------------------------------------------------------------------------
Welfare plans that include health benefits
------------------------------------------------------------------------------
Small, unfunded,
combination unfunded/
Large fully insured, or funded Small, fully-insured
with a trust
----------------------------------------------------------------------------------------------------------------
Form 5500........................ 1 hr, 46 min............. 1 hr, 15 min............
Schedule A....................... 3 hr, 42 min............. 2 hr, 45 min............
Schedule C....................... 4 hr, 25 min............. 4 hr, 25 min............
Schedule G....................... 11 hr, 4 min.............
Schedule H....................... 12 hr, 46 min............ 8 hr, 41 min............
Schedule J....................... 3 hr, 30 min............. 3 hr, 30 min............
Subset of Form 5500 and Schedule ......................... ........................ 20 min.
J.
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Welfare plans that do not include health benefits
------------------------------------------------------------------------------
Small, ineligible for Small, eligible for 5500-
Large 5500-SF SF
----------------------------------------------------------------------------------------------------------------
Form 5500........................ 1 hr, 46 min............. 1 hr, 15 min............
Schedule A....................... 3 hr, 42 min............. 2 hr, 45 min............
Schedule C....................... 4 hr, 25 min............. 4 hr, 25 min............
Schedule G....................... 11 hr, 4 min.............
Schedule H....................... 12 hr, 46 min............ 8 hr, 41 min............
Form 5500-SF..................... ......................... ........................ 2 hr, 54 min.
----------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
Direct filing entities
--------------------------------------------------------------------------------------------------------------------
Master trusts CCTs PSAs 103-12 IEs GIAs
--------------------------------------------------------------------------------------------------------------------------------------------------------
Form 5500.......................... 1 hr, 51 min.......... 1 hr, 31 min.......... 1 hr, 25 min......... 1 hr, 42 min......... 1 hr, 29 min.
Schedule A......................... 2 hr, 56 min.......... 2 hr, 50 min.......... 2 hr, 49 min......... 2 hr, 53 min......... 3 hr, 6 min.
Schedule C......................... 3 hr, 43 min.......... 1 hr, 18 min.......... 41 min............... 2 hr, 41 min......... 1 hr, 52 min.
Schedule D......................... 45 min................ 24 min................ 17 min............... 33 min............... 29 min.
Schedule G......................... 12 hr, 46 min......... ...................... ..................... 9 hr, 20 min.........
Schedule H......................... 12 hr, 19 min......... 11 hr, 47 min......... 11 hr, 43 min........ 12 hr, 16 min........ 12 hr, 1 min.
--------------------------------------------------------------------------------------------------------------------------------------------------------
The aggregate hour burden for the Form 5500 Annual Return/Report
(including schedules and short form) is estimated to be 1.52 million
hours annually. The hour burden reflects filing activities carried out
directly by filers. The cost burden is estimated to be $667.7 million
annually. The cost burden reflects filing services purchased by filers.
Presented below is a chart showing the total hour and cost burden of
the revised Form 5500 Annual Return/Report separately allocated across
the DOL and the IRS. There is no separate PBGC entry on the chart
because, as explained below, its share of the paperwork burden is very
small relative to that of the IRS and the DOL.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Pension plans Welfare plans Total
Agency ----------------------------------------------------------------------------- Total
Large Small Large Small Large Small DFEs
--------------------------------------------------------------------------------------------------------------------------------------------------------
DOL................................... Hours 000s.............. 323 251 133 294 457 545 32 1,034
$MM..................... $80.4 $103.6 $118.2 $181.4 $198.6 $285.0 $6.4 $490.0
IRS................................... Hours 000s.............. 196 222 12 35 208 257 18 484
$MM..................... $42.9 $111.3 $2.1 $16.9 $45.0 $128.2 $2.9 $176.1
--------------------------------------------------------------------------------------------------------------------------------------------------------
The paperwork burden allocated to the PBGC includes a portion of
the general instructions, basic plan identification information, a
portion of Schedule MB, a portion of Schedule SB, a portion of Schedule
H, and a portion of Schedule R. The PBGC's Estimated Share of Total
Form 5500 Annual Return/Report Burden is: 1,300 Hours and $1.6 million
per year.
APPENDIX A
1. Form 5500--Annual Return/Report of Employee Benefit Plan
2. Form 5500-SF--Annual Return Report of Small Employee Benefit Plan
3. Schedule A--Insurance Information
4. Schedule C--Service Provider Information
5. Schedule D--DFE/Participating Plan Information
6. Schedule E--ESOP Information
7. Schedule G--Financial Transaction Schedules
8. Schedule H--Financial Information
9. Schedule H, Line 4a Schedule of Delinquent Participant
Contributions
10. Schedule H, Line 4i(1) Schedule of Assets Held for Investment at
End of Year
11. Schedule H, Line 4i(2) Schedule of Assets Disposed of During the
Plan Year
12. Schedule H, Line 4j Schedule of Reportable Transactions
13. Schedule J--Group Health Plan Information
14. Schedule MB--Multiemployer Defined Benefit Pension Plan
Actuarial Information and Certain Money Purchase Plan Information
15. Schedule R--Retirement Plan Information
16. Schedule SB--Single Employer Defined Benefit Pension Plan
Actuarial Information
Form 5500 (Annual Return/Report of Employee Benefit Plan)
Part I Annual Report Identification Information [Same As Current Part I
Except As Indicated]
For calendar plan year 20XX or fiscal plan year beginning DD/MM/
20XX and ending DD/MM/20XX+1
[[Page 47570]]
A [Current A, Except as indicated in boxes (3) and (5)] This
return/report is for (check the correct box; for DFE's check the DFE
type):
(1) [ballot] a single-employer plan
(2) [ballot] a multiple-employer plan (not multiemployer)
(Filers checking this box must attach a list of participating
employer information in accordance with the form instructions)
(3) [ballot] [New] a plan for a controlled group of
corporations, a group of trades or businesses under common control,
or an affiliated service group (see instructions) (Filers checking
this box must attach a list of controlled group member information
in accordance with the form instructions)
(4) [ballot] a multiemployer plan
(5) [ballot] [Puts DFE checkboxes on face of Form 5500 instead
of entering ``Codes'' From Instructions] a direct filing entity
(DFE). Check DFE type (see instructions):
[ballot] Master Trust
[ballot] CCT
[ballot] PSA
[ballot] 103-12 IE
[ballot] GIA
B [Current, Except Adds Box (5)] This return/report is (check as
applicable) (see instructions):
(1) [ballot] the first return/report
(2) [ballot] an amended return/report
(3) [ballot] the final return/report
(4) [ballot] a short plan year return/report (less than 12
months)
(5) [ballot] [Current PCC 1H and part of current Schedule H,
Line 4k for PBGC-trusteed plans revised to include date of
trusteeship] a plan trusteed by PBGC.
Filers checking this box, enter date of trusteeship. (Filers
checking box B(5) for plans that have 500 or fewer participants at
the beginning of the plan year need to complete only certain line
items on the Form 5500). (See instructions)
C [Current] If the plan is a collectively-bargained plan, check
here [ballot]
D [Current] Check applicable box if filing under an extension or
through the DFVC Program:
(1) [ballot] Form 5558
(2) [ballot] automatic extension
(3) [ballot] special extension (enter description)
(4) [ballot] the DFVC program
Part II Basic Plan Information Enter all requested information. (You
must use the same plan/DFE name, PN, and EIN as in the previous year's
annual return/report, except as provided in Line 5.)
1a [Current] Name of Plan
1b [Current] Three-digit plan number (PN)
1c [Current] Effective date of plan
2a [Current] Plan sponsor's name (employer, if for a single-
employer plan) and address; include room or suite number, city or
town, state or province, country, and ZIP or foreign postal code (if
foreign, see instructions)
2b(1) [Current] Plan sponsor's Employer Identification Number
(EIN)
(2) [New] Plan sponsor's legal entity identifier (LEI) if
available (see instructions)
2c [Current] Sponsor's telephone number
2d [Current] Business code (see instructions)
3a [Current] Plan administrator's name and address
[Current] [ballot] Check if same as Plan Sponsor Name [ballot]
Check if same as Plan Sponsor Address
3b [Current] Administrator's EIN
3c [Current] Administrator's telephone number
4a [New] Named Fiduciary's name and address (see instructions).
[ballot] Check if same as Plan Sponsor Name
[ballot] Check if same as Plan Sponsor Address
4b [New] Named Fiduciary's EIN
4c [New] Named Fiduciary's telephone number
5 [Current Line 4, except as indicated] If the name, EIN or LEI
of the plan sponsor has changed since the last return/report filed
for this plan, enter the name, EIN, LEI, and the plan number from
the last return/report:
5a Sponsor's Name
5b(1) EIN
(2) [new] LEI if available
5c Plan Number
6 [Current Line 5] Total number of participants at the beginning
of the plan year
7 [Current Line 6, Except 7g(1), (3), and (4) now added] Number
of participants (welfare plans complete only Lines 7a(1), 7(a)(2),
7b, 7c, 7d, and 7g(3)).
7a(1) Total number of active participants at the beginning of
the plan year
(2) Total number of active participants as of the end of the
plan year
7b Retired or separated participants receiving benefits as of
the end of the plan year
7c Other retired or separated participants entitled to future
benefits as of the end of the plan year
7d Subtotal. Add Lines 7a(2), 7b, and 7c.
7e Deceased participants whose beneficiaries are receiving or
are entitled to receive benefits as of the end of the plan year
7f Total. Add Lines 7d and 7e
7g If you are filing for defined contribution pension plan, you
must complete Line 7g(1)-(4). Welfare plans complete only Line
7g(3). Defined benefit pension plans skip to Line 7h.
(1) [New] Number of participants with account balances as of the
beginning of the plan year
(2) [Current Line 6g] Number of participants with account
balances as of the end of the plan year
(3) [New] Number of participants that made contributions during
the plan year
(4) [New] Number of participants that terminated employment
during the plan year that had their entire account balance
distributed as of the end of the plan year
7h Number of participants that terminated employment during the
plan year with accrued benefits that were less than 100% vested:
8 [Current Line 7] Enter the total number of employers obligated
to contribute to the plan (only multiemployer plans complete this
item)
9a [Current Line 8 Plan Characteristics Codes Entered In A List
From Instructions Now Separate Questions on Face of Form] Check the
appropriate box to indicate the type of plan. If the plan provides
pension benefits, answer the applicable 9a questions below. See the
instructions for additional details. (Plans that provide only
welfare benefits check the box for ``Welfare plan'' and then skip to
question 9b.)
[ballot] [New] Defined benefit pension plan
[ballot] [New] Defined contribution pension plan
[ballot] [New] Welfare plan
9a(1) Check the appropriate box(es) to indicate how the benefits
are calculated (Defined benefit pension plans only)
[ballot] [Current PCC 1A] Benefits are primarily pay related
[ballot] [Current PCC 1B] Benefits are primarily flat dollar
(includes dollars per year of service)
[ballot] [Current PCC 1C] Cash balance plan
[ballot] [Current PCC 1C] Pension equity plan (PEP)
[ballot] [Current PCC 1C] Other hybrid plan
[ballot] [Current PCC 1D] Floor-offset plan
9a(2) Does your plan have any of the Internal Revenue Code
arrangements listed below? (Defined benefit pension plans only).
Yes [ballot] No [ballot]
If ``Yes'', check all that apply.
[Current PCC 1E] [ballot] Code Section 401(h) arrangement
[Current PCC 1F] [ballot] Code Section 414(k) arrangement
9a(3) [Current PCC 1H] Is this a defined benefit pension plan
that was terminated and closed out for PBGC purposes? (See
instructions.)
Yes [ballot] No [ballot]
9a(4) [Current Schedule H, Line 5c, revised to add a new
sentence at the end on PBGC premium filings. For 2016, PBGC proposed
that the new sentence be added to Line 5c of the Schedule H] If the
plan is a defined benefit pension plan, is it covered under the PBGC
insurance program (see ERISA section 4021)?
[ballot] Yes [ballot] No [ballot] Not determined
If ``Yes'' is checked, enter the My PAA confirmation number from
the PBGC premium filing for this plan year. (See instructions.)
9a(5) [Current PCC 1I] Is this a frozen pension benefit plan?
(Both defined benefit and defined contribution pension plans must
answer this question.)
[ballot] Yes [ballot] No
9a(6) [Current PCC 1D and 2D; new requirement to enter name of
other plan or arrangement] Are plan benefits subject to offset for
retirement benefits provided in another plan or arrangement of the
employer?
[ballot] Yes [ballot] No
If ``Yes'' enter name, EIN, and LEI of the sponsor and PN of the
other plan or arrangement
9a(7) If this is a defined contribution pension plan, indicate
the type(s) of plan (check all that apply):
[ballot] [Current PCC 2E] Profit-sharing plan
[ballot] [Current PCC 2I] Stock bonus plan
[ballot] [Current PCC 2C] Money purchase plan
[ballot] [Current PCC 2B] Target benefit plan
[ballot] [Current PCC 2D] Offset plan
9a(8) If this is a defined contribution pension plan, check the
appropriate box(es) to indicate the type(s) of arrangements under
[[Page 47571]]
which the plan operates for purposes of the Code (check all that
apply):
[ballot] [Current PCC 2J] Code section 401(k) arrangement
[ballot] [Current PCC 2K] Code section 401(m) arrangement
[ballot] [New] SIMPLE 401(k) plan under Code sections 401(k)(11) and
401(m)(10)
[ballot] [New] Safe harbor 401(k) plan under Code sections
401(k)(12) and 401(m)(11)
[ballot] [New] Safe harbor 401(k) plan using automatic contribution
arrangements under Code sections 401(k)(13) and 401(m)(12)
[ballot] [Current PCC 2N] Code section 408 accounts or annuities
[ballot] [Current PCC 2L] Code section 403(b)(1) arrangement
[ballot] [Current PCC 2M] Code section 403(b)(7) arrangement
9a(9) If this is a defined contribution pension plan, check all
the appropriate box(es) to indicate all type(s) of features your
plan has.
[ballot] [Current PCC 2S] Automatic Enrollment
[ballot] [New] Designated ROTH
[ballot] [Current PCC 2A] Age/service weighted or new comparability
or similar plan
[ballot] [New] Financial education for participants
[ballot] [New] Financial advice for participants
[ballot] [New] Other (specify)
9a(10) Is this a participant-directed defined contribution
pension plan? [ballot] Yes [ballot] No
If ``Yes,'' check all that apply:
[ballot] [Current PCC 2F] ERISA section 404(c) plan
[ballot] [Current PCC 2G] Total participant-directed account plan
[ballot] [Current PCC 2H] Partial participant-directed account plan
[ballot] [Current PCC 2R] Participant-directed brokerage accounts.
If you check this box, enter the number of participants using
the participant-directed brokerage account(s)
9a(11) [Current PCC 2T; new breakouts to indicate types of
default accounts] Does the plan have default investment alternatives
that are intended to be qualified default investment alternatives
(QDIA) (see instructions) for participants who fail to direct assets
in their account?
[ballot] Yes [ballot] No
If ``Yes,'' check all applicable boxes to indicate type(s) of
QDIA.
[ballot] Target date/life cycle fund
[ballot] Fixed income
[ballot] Money market or equivalent (under 29 CFR 2550.404c-5(e))
[ballot] Balanced fund
[ballot] Professionally managed account
[ballot] Other (specify)
9a(12) [New] Is this an Eligible Combined Plan under Code
section 414(x)?
[ballot] Yes [ballot] No
9a(13) [New] Check this box if a rollover from a plan (including
an individual retirement plan) was used to start up the business
(ROBS) sponsoring this plan: [ballot]
9a(14) If this is a profit sharing or money purchase plan
combined with an ESOP, or a plan requiring that all or part of
employer contributions be invested and held, at least for a limited
period, in employer securities check all that apply. (You must
attach a Schedule E if the plan is an ESOP or has ESOP features).
[ballot] [Current PCC 2P] Leveraged ESOP
[ballot] [Current PCC 2O] ESOP other than a leveraged ESOP
[ballot] [Current PCC 2Q] ESOP of an S corporation
[ballot] [Current PCC 3I] Other plan requiring that all or part of
employer contributions be invested and held, at least for a limited
period, in employer securities
9a(15) Other Pension Benefit Features (Check all that apply):
[ballot] [Current PCC 3D; 2016 Schedule R Line 17a] IRS Pre-approved
plan.
If you check this box enter:
(1) most recent adoption date
(2) the IRS opinion or advisory letter's serial number.
[ballot] [Current PCC 3B] Plan covering self-employed individuals
[ballot] [Current PCC 3C] Plan not intended to be qualified under
Internal Revenue Code
[ballot] [Current PCC 3D-breakout] Master and prototype (M&P) plan
[ballot] [Current PCC 3D-breakout] Volume submitter plan
[ballot] [New] Plan sponsor(s) received services of leased employees
[ballot] [Current PCC 3J] U.S.-based plan that covers residents of
Puerto Rico and is qualified under both Code section 401 and section
1165 of Puerto Rico Code
[ballot] [New] Electing church plan under Code Section 410(d).
9b [Current Line 8b; now multiple questions instead of plan
characteristic codes entered in a list from instructions; PCC 4T,
and 4U eliminated] If the plan provides welfare benefits, complete
Lines 9b(1)-9b(4). Plans that do not provide any welfare benefits
skip to question 10.
9b(1) [Modification and expansion of current PCC 4A, 4D, 4E]
Does the plan provide health, dental, or vision coverage?
[ballot] Yes [ballot] No
If ``Yes,'' check all that apply:
[ballot] [New Breakout of current PCC 4A] medical/surgical benefits
[ballot] [New Breakout of current PCC 4A] pharmacy or prescription
drug benefits
[ballot] [New Breakout of current PCC 4A] mental health/substance
use disorder benefits
[ballot] [New Breakout of current PCC 4A] wellness program
[ballot] [New Breakout of current PCC 4A] preventive care services
[ballot] [New Breakout of current PCC 4A] emergency services
[ballot] [New Breakout of current PCC 4A] pregnancy benefits
[ballot] [Current PCC 4E] vision
[ballot] [Current PCC 4D] dental
9b(2) Does the plan provide disability benefits?
[ballot] Yes [ballot] No
If ``Yes,'' check all that apply.
[ballot] [Current PCC 4F] Temporary disability (accident and
sickness)
[ballot] [Current PCC 4H] Long-term disability
9b(3) Does the plan provide welfare benefits other than health,
dental, vision, or disability?
[ballot] Yes [ballot] No
If ``Yes,'' check all that apply.
[ballot] [Current PCC 4B] Life insurance
[ballot] [Current PCC 4L] Death benefits (include travel accident
but not life insurance)
[ballot] [New] Long term care insurance
[ballot] [Current PCC 4J] Apprenticeship and training
[ballot] [Current PCC 4C] Supplemental unemployment
[ballot] [Current PCC 4K] Scholarship (funded)
[ballot] [Current PCC 4G] Prepaid legal
[ballot] [Current PCC 4I] Severance pay
[ballot] [Current PCC 4P] Taft-Hartley Financial Assistance for
Employee Housing Expenses
[ballot] [Current PCC 4Q] Other (Enter description.)
9b(4) If the plan is a welfare plan that does not provide health
benefits, check the appropriate box to indicate whether the plan
will stop or stopped filing in an earlier year in reliance on 29 CFR
2520.104-20. (If the plan provided group health benefits, it is not
eligible for the limited exemption in 29 CFR 2520.104-20 and must
file a Form 5500 Annual Return/Report in accordance with the
instructions annually, regardless of plan size.)
[ballot] [Current PCC 4R] Unfunded, fully insured, or combination
unfunded/fully insured welfare plan that does not provide health
benefits that will not file an annual report for next plan year
pursuant to 29 CFR 2520.104-20. (Plans that check this box should
not check ``final return/report'' in Part I, Box B.)
[ballot] [Current PCC 4S] Unfunded, fully insured, or combination
unfunded/fully insured welfare plan that does not provide health
benefits that stopped filing annual reports in an earlier plan year
pursuant to 29 CFR 2520.104-20. (Plans that check this box should
not check ``first return/report'' in Part I, Box B.)
10a [Current Line 9a] Plan funding arrangement (Check all that
apply.)
(1) [ballot] Insurance
(2) [ballot] Code section 412(e)(3) insurance contracts
(3) [ballot] Trust
(4) [ballot] General assets of the sponsor
10b [Current Line 9b] Plan benefit arrangement (Check all that
apply.)
(1) [ballot] Insurance
(2) [ballot] Code section 412(e)(3) insurance contracts
(3) [ballot] Trust
(4) [ballot] General assets of the sponsor
11 [Current Line 10, Except check box added for Schedule E and
Schedule J and Eliminated For Schedule I] Check all applicable boxes
in 11a and 11b to indicate which schedules are attached, and, where
indicated, enter the number attached. (See instructions).
11a Pension Schedules
(1) [ballot] Schedule R (Retirement Plan Information)
(2) [ballot] Schedule E (Employee Stock Ownership Plan
Information)
(3) [ballot] Schedule MB (Multiemployer Defined Benefit Plan and
Certain Money
[[Page 47572]]
Purchase Plan Actuarial Information)--signed by the plan actuary
(4) [ballot] Schedule SB (Single-Employer Defined Benefit Plan
Actuarial Information)--signed by the plan actuary
11b General Schedules
(1) [ballot] Schedule H (Financial Information)
(2) [ballot] Schedule A (Insurance Information) Enter number of
Schedules A attached (See instructions.)
(3) [ballot] Schedule C (Service Provider Information) Enter
number of Schedules C attached (See instructions.)
(4) [ballot] Schedule D (DFE/Participating Plan Information)
(5) [ballot] Schedule G (Financial Transaction Schedules)
(6) [ballot] Schedule J (Group Health Plan Information)
[Current Part III Form M-1 information moved to Schedule J]
[JURAT and SIGNATURE BLOCK to appear on first page, as with
current form]
CAUTION: A penalty for the late or incomplete filing of this
return/report will be assessed unless reasonable cause is
established.
Under penalties of perjury and other penalties set forth in the
instructions, I declare that I have examined this return/report,
including accompanying schedules, statements and attachments, as
well as the electronic version of this return/report, and to the
best of my knowledge and belief, it is true, correct, and complete.
SIGN HERE Signature of plan administrator
Enter Date:
Enter name of individual signing as plan administrator
SIGN HERE Signature of employer/plan sponsor
[ballot] [New] Check here if two signatures for Taft-Hartley
plan
(1) Management trustee signature (2) Labor trustee signature
Enter Date:
Enter name(s) of individual(s) signing as employer or plan
sponsor
SIGN HERE Signature of DFE
Enter Date:
Enter name of individual signing as DFE
Preparer's name (including firm name, if applicable) and
address; include room or suite number.
Preparer's telephone number
Line A(2) Schedule
Complete as many entries as needed to report the required
information for all participating employers.
------------------------------------------------------------------------
------------------------------------------------------------------------
Multiple-Employer Plan Participating Employer Information
(Heading for this chart must include Name of Plan, and EIN/PN as shown
on the Form 5500)
------------------------------------------------------------------------
(a) Name of participating (b) EIN.......... (c) Percent of Total
employer. Contributions.
(a) Name of participating (b) EIN.......... (c) Percent of Total
employer. Contributions.
------------------------------------------------------------------------
Line A(3) Schedule
Complete as many entries as needed to report the required
information for all participating employers.
------------------------------------------------------------------------
------------------------------------------------------------------------
Controlled Group Plan Member Information
(Heading for this chart must include Name of Plan, and EIN/PN as shown
on the Form 5500). Complete elements (a), (b), and (c) to provide the
name, EIN, and percent of total contributions of each controlled group
member.)
------------------------------------------------------------------------
(a) Name of controlled group (b) EIN.......... (c) Percent of Total
member. Contributions.
(a) Name of controlled group (b) EIN.......... (c) Percent of Total
member. Contributions.
------------------------------------------------------------------------
Form 5500-SF (Short Form Annual Return/Report of Small Employee Benefit
Plan)
Part I Annual Report Identification Information [Same As Current Part
I, Except New Box A(3)]
For calendar plan year 20XX or fiscal plan year beginning DD/MM/
20XX and ending DD/MM/20XX+1
A [Current except as shown] This return/report is for:
(1) [ballot] a single-employer plan
(2) [ballot] a multiple-employer plan (not multiemployer)
(Filers checking this box must attach a list of participating
employer information in accordance with the form instructions)
(3) [ballot] [New] a plan of a controlled group of corporations,
group of trades or businesses under common control, or an affiliated
service group (see instructions) (Filers checking this box must
attach a list of controlled group member information in accordance
with the form instructions)
(4) [ballot] a one-participant plan
(5) [ballot] foreign plan
B [Current] This return/report is (check as applicable) (see
instructions):
(1) [ballot] the first return/report
(2) [ballot] the final return/report
(3) [ballot] an amended return/report
(4) [ballot] a short plan year return/report (less than 12
months)
(5) [ballot] [Part of current Line 13b for PBGC-trusteed plans
revised to include date of trusteeship] A plan trusteed by PBGC.
Filers checking this box, enter the date of trusteeship __/__/__.
(If you checked box B(5), you only need to complete only certain
line items. (See Instructions.)
C [Current] Check the applicable box if filing under an
extension or through the DFVC Program:
(1) [ballot] Form 5558
(2) [ballot] automatic extension
(3) [ballot] special extension (enter description)
(4) [ballot] DFVC program
Part II Basic Plan Information--Enter all requested information [Same
As Current Part II (Lines 1-6), except as shown] (You must use the same
plan name, PN, and EIN as in the previous year's annual return/report,
except as provided in Line 5.)
1a Name of Plan
1b Three-digit plan number (PN)
1c Effective date of plan
2a [Current except as shown] Plan sponsor's name (employer, if
for a single-employer plan) and address; include room or suite
number, city or town, state or province, country, and ZIP or foreign
postal code (if foreign, see instructions)
2b(1) Plan sponsor's Employer Identification Number (EIN)
(2) [New] Plan sponsor's legal entity identifier (LEI) if
available (see instructions)
2c Sponsor's telephone number
2d Business code (see instructions)
3 [Current except as shown] Plan administrator's name and
address
[ballot] Check if same as Plan Sponsor Name
[ballot] Check if same as Plan Sponsor Address
3a Plan Administrator's Name and address
3b Administrator's EIN
3c Administrator's telephone number
4a [New] Named Fiduciary's name and address (see instructions).
[ballot] Check if same as Plan Sponsor Name
[ballot] Check if same as Plan Sponsor Address
4b [New] Named Fiduciary's EIN
4c [New] Named Fiduciary's telephone number
5 [Current Line 4 except to add LEI] If the name, EIN, or LEI of
the plan sponsor has changed since the last return/report filed for
this plan, enter the name, EIN, LEI, and the plan number from the
last return/report:
5a Sponsor's Name
5b(1) EIN
(2) [New] LEI (if available)
5c Plan Number
6 [Current Line 5] Total number of participants at the beginning
of the plan year
[[Page 47573]]
7 [Current Line 6] Number of participants (welfare plans
complete only Lines 7a(1), 7a(2), 7b, 7c, and 7d).
7a(1) [Current Line 5d(1)] Total number of active participants
at the beginning of the plan year
(2) [Current Line 5d(2)] Total number of active participants as
of the end of the plan year
7b [New] Retired or separated participants receiving benefits as
of the end of the plan year
7c [New] Other retired or separated participants entitled to
future benefits as of the end of the plan year
7d [New] Subtotal. Add Lines 7a(2), 7b, and 7c
7e [New] Deceased participants whose beneficiaries are receiving
or are entitled to receive benefits as of the end of the plan year
7f [New] Total. Add Lines 7d and 7e
7g If you are filing for defined contribution pension plan, you
must complete Line 7g(1)-(4). Welfare plans complete only Line
7g(3). Defined benefit pension plans skip to Line 7h.
(1) [New] Number of participants with account balances as of the
beginning of the plan year
(2) [Current Line 5c] Number of participants with account
balances as of the end of the plan year
(3) [New] Number of participants that made contributions during
the plan year
(4) [New] Number of participants that terminated employment
during the plan year that had their entire account balance
distributed as of the end of the plan year
7h [Current Line 5e] Number of participants that terminated
employment during the plan year with accrued benefits that were less
than 100% vested
Part III--Form 5500-SF Eligibility Information [New ``Part'' title for
existing eligibility questions]
8a [Current Line 6a] Were all of the plan's assets during the
plan year invested in eligible assets? (See instructions.)
[ballot] Yes [ballot] No
8b [Current Line 6b] Are you claiming a waiver of the annual
examination and report of an independent qualified public accountant
(IQPA) under 29 CFR 2520.104-46? (See instructions on waiver
eligibility and conditions.)
[ballot] Yes [ballot] No
8c [New] Did the plan provide group health benefits?
[ballot] Yes [ballot] No
If you answered ``No'' to Line 8a or 8b, or ``Yes'' to Line 8c,
the plan cannot use Form 5500-SF and must instead file the Form 5500
and any required Schedules and attachments.
Part IV--Financial Information [Current Part III, with new breakouts]
9 [Current Line 7] Plan Assets and Liabilities [Columns for (a)
Beginning of Year (BOY) and (b) End of Year (EOY) Values for 9a-9d]
9a [Current Line 7a] Total plan assets
9b [Current Line 7b] Total plan liabilities
9c [Current Line 7c] Net plan assets (subtract Line 9b from Line
9a)
10 [Current Line 8] Income, Expenses, and Transfers for this
Plan Year
10a [Current Line 8a] Contributions
(1) Received or receivable in cash from:
(A) [Current Line 8a(1)] Employers
(B) [Current Line 8a(2)] Participants
(2) [Current Line 8a(3)] Others (including rollovers from IRAs/
other plans)
10b [Current Line 8b] Other income (loss)
10c [Current Line 8c] Total income (add Lines 10a(1)(A) and (B),
10a(2), 10b and 10c)
10d [Current Line 8d] Benefits paid (including direct rollovers
and insurance premiums to provide benefits)
10e [Current Line 8e] Certain deemed and/or corrective
distributions (see instructions)
10f [Current Line 8f] Administrative service providers
(salaries, fees, commissions)
10g [Current Line 8g] Other expenses
10h [Current Line 8h] Total expenses (add Lines 10e, 10f, 10g,
and 10h)
10i [Current Line 8i] Net income (loss) (subtract Line 10h from
Line 10d)
10j [Current Line 8j] Transfers to (from) the plan (see
instructions)
11 [New] Specific Assets [Columns for (a) Beginning of Year
(BOY) and (b) End of Year (EOY) Values] [New]
11a Cash/cash equivalents
11b [New] Securities, except employer securities, traded on a
public exchange
(1) Stock
(2) Bonds
(3) Other
11c [New breakout] Government securities issued by the United
States or a State
11d [New] Interests in registered investment companies (Mutual
funds, Unit Investment Trusts, Closed End Funds)
11e [New] Interests in insurance company pooled separate
accounts (PSAs)
11f [New] Interests in insurance investment and annuity
contracts (other than PSAs)
11g [New] Interests in bank common collective trusts (CCTs)
11h [New] Interests in bank investment contracts (other than
CCTs)
11i [New] Participant loans
Part V--Plan Characteristics Information [Current Part IV]
12a [Current Line 8a; Now multiple questions instead of Plan
Characteristic Codes (PCC) entered in a list from Instructions]
Check the appropriate box to indicate the type of plan. If the plan
provides pension benefits, answer the applicable 12a questions
below; see the instructions for additional details. (Plans that
provide only welfare benefits check the box for ``Welfare Plan'' and
then skip to question 12b.)
[ballot] Defined benefit pension plan
[ballot] Defined contribution pension plan
[ballot] Welfare plan
12a(1) Check the appropriate box(es) to indicate how the
benefits are calculated (Defined benefit pension plans only.)
[ballot] [Current PCC 1A] Benefits are primarily pay related
[ballot] [Current PCC 1B] Benefits are primarily flat dollar
(includes dollars per year of service)
[ballot] [Current PCC 1C breakout] Cash balance plan
[ballot] [Current PCC 1C breakout] Pension equity plan (PEP)
[ballot] [Current PCC 1C breakout] Other hybrid plan
[ballot] [Current PCC 1D] Floor-offset plan
12a(2) Does your plan have any of the Internal Revenue Code
arrangements listed below? Check all that apply. Defined benefit
pension plans only)
[ballot] [Current PCC 1F] Code Section 414(k) arrangement
12a(3) [Current PCC 1H] Is this a defined benefit pension plan
that was terminated and closed out for PBGC purposes (see
instructions)?
[ballot] Yes [ballot] No
12a(4) [Current Line 6c, revised to add a new sentence at the
end on PBGC premium filings. For 2016, PBGC proposed that the new
sentence be added to Line 5c of the Schedule H] If the plan is a
defined benefit pension plan, is it covered under the PBGC insurance
program (see ERISA section 4021)?
[ballot] Yes [ballot] No [ballot] Not determined
If ``Yes'' is checked, enter the My PAA confirmation number from
the PBGC premium filing for this plan year. (See instructions)
12a(5) [Current PCC 1I expanded to include DC as well as DB
pension plans] Is this a frozen pension benefit plan? (Both defined
benefit and defined contribution pension plans must answer this
question.)
[ballot] Yes [ballot] No
12a(6) [Current PCC 1D and 2D; new requirement to provide
identifying information about sponsor of other plan or arrangement]
Are plan benefits subject to offset for retirement benefits provided
in another plan or arrangement of the employer?
[ballot] Yes [ballot] No
If ``Yes,'' enter name, EIN, and LEI of sponsor and PN of other
plan or arrangement
12a(7) If this is a defined contribution pension plan, indicate
the type(s) of plan (check all that apply):
[ballot] [Current PCC 2E] Profit-sharing plan
[ballot] [Current PCC 2I] Stock bonus plan
[ballot] [Current PCC 2C] Money purchase plan
[ballot] [Current PCC 2B] Target benefit plan
[ballot] [Current PCC 2D] Offset plan
12a(8) If this is a defined contribution pension plan, check the
appropriate box(es) to indicate the type(s) of arrangements under
which the plan operates for purposes of the Code (check all that
apply):
[ballot] [Current PCC 2J] Code section 401(k) arrangement
[ballot] [Current PCC 2K] Code section 401(m) arrangement
[ballot] [New] SIMPLE 401(k) plan under Code sections 401(k)(11) and
401(m)(10)
[ballot] [New] Safe harbor 401(k) plan under Code sections
401(k)(12) and 401(m)(11)
[ballot] [New] Safe harbor 401(k) plan using automatic contribution
arrangements under Code sections 401(k)(13) and 401(m)(12)
[ballot] [Current PCC 2N] Code section 408 accounts or annuities
[ballot] [Current PCC 2L] Code section 403(b)(1) arrangement
[ballot] [Current PCC 2M] Code section 403(b)(7) arrangement
12a(9) If this is a defined contribution pension plan, check the
appropriate box(es)
[[Page 47574]]
to indicate the type(s) of features your plan has:
[ballot] [Current PCC 2S] Automatic Enrollment
[ballot] [New] Designated ROTH
[ballot] [Current PCC 2A] Age/service weighted or new comparability
or similar plan
[ballot] [New] Financial education for participants
[ballot] [New] Financial advice for participants
[ballot] [New] Other (specify)
12a(10) If this a participant-directed defined contribution
pension plan, check all that apply:
[ballot] [Current PCC 2F] ERISA section 404(c) plan
[ballot] [Current PCC 2G] Total participant-directed account plan
[ballot] [Current PCC 2H] Partial participant-directed account plan
[ballot] [Current PCC 2R] Participant-directed brokerage accounts.
If you check this box, enter the number of participants using the
participant-directed brokerage account(s)
12a(11) [New] (A) Does the plan have default investment
alternatives that are intended to be qualified default investment
alternatives (QDIA) (see instructions) for participants who fail to
direct assets in their account?
[ballot] Yes [ballot] No
(B) If ``Yes,'' indicate type(s) of QDIA (Check all that apply)
[ballot] Target date/life cycle fund
[ballot] Fixed income
[ballot] Money market or equivalent (under 2550.404c-5(e))
[ballot] Balanced/target allocation fund
[ballot] Professionally managed account
[ballot] Other (specify)
12a(12) [New] Is this an Eligible Combined Plan under Code
section 414(x)?
[ballot] Yes [ballot] No
12a(13) [New] Check this box if a rollover from a plan
(including an individual retirement plan) was used to start up the
business (ROBS) sponsoring this plan: [ballot]
12a(14) Other Pension Benefit Features (check all that apply):
[ballot] [Current PCC 3D; 2016 Line 17a] IRS Pre-approved plan. If
you check this box enter: (1) most recent adoption date and (2) the
IRS opinion or advisory letter's serial number
[ballot] [Current PCC 3B] Plan covering self-employed individuals
[ballot] [Current PCC 3C] Plan not intended to be qualified under
Internal Revenue Code
[ballot] [Current PCC 3D-breakout] Master and prototype (M&P) plan
[ballot] [Current PCC 3D-breakout] Volume submitter plan
[ballot] [New] Plan sponsor(s) received services of leased employees
[ballot] [Current PCC 3J] U.S.-based plan that covers residents of
Puerto Rico and is qualified under both Code section 401 and section
1165 of Puerto Rico Code
[ballot] [New] Electing church plan under Code Section 410(d)
12b If the plan provides welfare benefits, complete Lines
12b(1)-(3). Plans that do not provide any welfare benefits skip to
question 13.
12b(1) Does the plan provide disability benefits?
[ballot] Yes [ballot] No
If ``Yes,'' check all that apply.
[ballot] [Current PCC 4F] Temporary disability (accident and
sickness)
[ballot] [Current PCC 4H] Long-term disability
12b(2) Does the plan provide welfare benefits other than
disability?
[ballot] Yes [ballot] No
If ``Yes,'' check all that apply.
[ballot] [Current PCC 4B] Life insurance
[ballot] [Current PCC 4L] Death benefits (include travel accident
but not life insurance)
[ballot] [New] Long term care insurance
[ballot] [Current PCC 4J] Apprenticeship and training
[ballot] [Current PCC 4C] Supplemental unemployment
[ballot] [Current PCC 4K] Scholarship (funded)
[ballot] [Current PCC 4G] Prepaid legal
[ballot] [Current PCC 4I] Severance pay
[ballot] [Current PCC 4P] Taft-Hartley Financial Assistance for
Employee Housing Expenses
[ballot] [Current PCC 4Q] Other (Enter description. Caution: If the
plan provides health benefits, you must file the Form 5500.)
12b(3) If the plan is a welfare plan that does not provide
health benefits, check the appropriate box to indicate whether the
plan will stop or stopped filing in an earlier year in reliance on
29 CFR 2520.104-20. (If the plan provided group health benefits, it
is not eligible for the exemption in 29 CFR 2520.104-20 and must
file a return/report annually, regardless of plan size.)
[ballot] [Current PCC 4R] Unfunded, fully insured, or combination
unfunded/fully insured welfare plan that will not file an annual
report for next plan year pursuant to 29 CFR 2520.104-20. (Plans
that check this box should not check ``final return/report'' in Part
I, Box B.)
[ballot] [Current PCC 4S] Unfunded, fully insured, or combination
unfunded/fully insured welfare plan that stopped filing annual
reports in an earlier plan year pursuant to 29 CFR 2520.104-20.
(Plans that check this box should not check ``first return/report''
in Part I, Box B.)
13a [New; taken from current Form 5500 Line 9a] Plan funding
arrangement (check all that apply)
(1) [ballot] Insurance
(2) [ballot] Code section 412(e)(3) insurance contracts
(3) [ballot] Trust
(4) [ballot] General assets of the sponsor
13b [New to Form 5500-SF; current Form 5500 Line 9b] Plan
benefit arrangement (check all that apply)
(1) [ballot] Insurance
(2) [ballot] Code section 412(e)(3) insurance contracts
(3) [ballot] Trust
(4) [ballot] General assets of the sponsor
Part VI--Plan Operations Compliance Questions [Current Part V]
During the plan year:
14a [Current Line 10a revised] Was there a failure to transmit
to the plan any participant contributions or repayments as of the
earliest date on which such contributions can reasonably be
segregated from the employer's general assets as described in 29 CFR
2510.3-102? Continue to answer ``Yes'' for any prior year failures
until fully corrected. (See instructions and DOL's Voluntary
Fiduciary Correction Program.)
[ballot] Yes [ballot] No Amount
14b [Current Line 10b] Were there any nonexempt prohibited
transactions with any party-in-interest? (Do not include
transactions reported on Line 14a.)
[ballot] Yes [ballot] No Amount
14c [Current Line 10c revised] Was this plan covered by one or
more fidelity bonds naming the plan as insured that provide coverage
for losses due to fraud or dishonesty by persons who handle plan
funds or other property?
[ballot] Yes [ballot] No Amount
14d [Current Line 10d] Did the plan have a loss, whether or not
reimbursed by a fidelity bond covering the plan, that was caused by
fraud or dishonesty?
[ballot] Yes [ballot] No Amount
14e [Current Line 10e] Were any fees or commissions paid to any
brokers, agents, or other persons by an insurance carrier, insurance
service, or other organization that provides some or all of the
benefits under the plan?
[ballot] Yes [ballot] No Amount
14f [Current Line 10f] Has the plan failed to provide any
benefit when due under the plan?
[ballot] Yes [ballot] No Amount
14g [Current Line 10h] If this is an individual account plan,
was there a blackout period? (See 29 CFR 2520.101-3.)
[ballot] Yes [ballot] No
14h [Current Line10i] If 14h was answered ``Yes,'' check the box
if you either provided the required notice or one of the exceptions
to providing the notice applied under 29 CFR 2520.101-3:
[ballot] Yes [ballot] No
14i [New] Is this a participant-directed individual account plan
(e.g., a 401(k)-type or 403(b) defined contribution pension plan),
subject to the requirements in 29 CFR 2550.404a-5 to disclose plan
and investment related information to participants and
beneficiaries?
[ballot] Yes [ballot] No
14j [New] If you answered ``Yes'' to Line 14i, did the plan
provide participants and beneficiaries the plan and investment
disclosures required under 29 CFR 2550.404a-5?
[ballot] Yes [ballot] No
If you answered ``Yes,'' you must attach the investment option
comparative chart or charts that were used to satisfy the disclosure
requirement in 29 CFR 2550.404a-5(d)(2).
14k [New] If you answered ``Yes,'' to Line 14i, enter the number
of designated investment alternatives (DIAs) available under the
plan and indicate the number of DIAs that are index funds. Also,
check all that apply to indicate the types of DIAs available under
the plan:
[ballot] Domestic Stock/Equity
[ballot] Bond/income
[ballot] Balanced/target allocation
[[Page 47575]]
[ballot] Money Market
[ballot] Target date/Lifecycle
[ballot] International/Global Stock/Equity
[ballot] Sector/economy segment
[ballot] Other funds (Describe)
14l [New] If you answered ``Yes,'' to Line 14j, did the plan
make available to participants and beneficiaries a designated
investment manager (DIM)?
[ballot] Yes [ballot] No
If ``Yes,'' enter name of DIM.
14m [New] If you answered ``Yes,'' to Line 14j, did the plan
make available to participants and beneficiaries any brokerage
window, self-directed brokerage account or similar plan arrangements
that enabled participants to select investments beyond those
designated by the plan?
[ballot] Yes [ballot] No
If you answered ``Yes'' to Line 14m, enter the number of
participants that utilized the account or arrangement and the total
amount held in such account(s):
14n [New] Did the plan trust incur unrelated business taxable
income (UBTI)?
[ballot] Yes [ballot] No [ballot] NA
If ``Yes'', enter amount.
14o [New] Did any employer or employer organization sponsoring
the plan pay any of the administrative expenses of the plan that
were not reported on Line 10g?
[ballot] Yes [ballot] No
14p [New] Did any person who is disqualified under ERISA Section
411, serve or was permitted to serve the plan in any capacity?
[ballot] Yes [ballot] No
14q [New] Did the plan sponsor or its affiliates provide any
services to the plan in exchange for direct or indirect
compensation?
[ballot] Yes [ballot] No
14r [New] Have any of the plan's service providers been
terminated for a material failure to meet the terms of a service
arrangement or failure to comply with Title I of ERISA, including
the failure to provide required disclosures under 29 CFR 2550.408b-
2?
[ballot] Yes [ballot] No
If ``Yes,'' complete elements (1)-(7) to identify the service
provider.
(1) Name:
(2) EIN:
(3) Enter applicable service code from Line 2c(1) for describe
services provided to plan:
(4) Address:
(5) Telephone:
(6) Explanation of reason for termination:
(7) [ballot] Check if termination was due to failure to provide
required disclosures under 29 CFR 2550.408b-2.
14s [New (based on 1998 Line 8a)] Is the plan's summary plan
description (SPD), including any summary descriptions of
modifications, in compliance with the content requirements in 29 CFR
2520.102-3? (See instructions.)
[ballot] Yes [ballot] No
14t [New] If this is an individual account plan, were there any
checks to participants or beneficiaries that were uncashed as of the
end of the plan year? [ballot] Yes [ballot] No. If ``Yes,'' complete
14t(1)-(4)
(1) Enter number of uncashed checks
(2) Enter total value of uncashed checks
(3) Describe the procedures followed by the plan to verify a
participant's or beneficiary's address before a check was mailed.
(4) Describe the procedures followed by the plan to monitor
uncashed checks, including steps to locate ``missing'' participants.
Part VII--Pension Funding Compliance [Current Part VI Renumbered]
15 [Current Line 11] Is this a defined benefit pension plan
subject to minimum funding requirements? (If ``Yes,'' see
instructions and complete Schedule SB (Form 5500) and line 14a
below)
[ballot] Yes [ballot] No
15a [Current Line 11a] Enter the unpaid minimum required
contribution for all years from Schedule SB (Form 5500) Line 44.
16 [Current Line 12] Is this a defined contribution pension plan
subject to the minimum funding requirements of section 412 of the
Code or section 302 of ERISA?
[ballot] Yes [ballot] No. If ``Yes,'' complete Line 15a or Lines
15b, 15c, 15d, and 15e below, as applicable.16a If a waiver of
the minimum funding standard for a prior year is being amortized in
this plan year, see instructions, and enter the date of the letter
ruling granting the waiver:
If you completed Line 16a, complete Lines 3, 9, and 10 of
Schedule MB (Form 5500), and skip to line 20.
16b Enter the minimum required contribution for this plan year.
16c Enter the amount contributed by the employer to the plan for
this plan year:
16d Subtract the amount in Line 16c from the amount in Line 16b.
Enter the result (enter a minus sign to the left of a negative
amount):
16e Will the minimum funding amount reported on Line 16d be met
by the funding deadline?
[ballot] Yes [ballot] No [ballot] N/A
Part VIII Plan Termination Information--[Current Part VII Revised and
Expanded]
17a [Current Line 13a; Revised to Ask About Any Resolution to
Terminate] Has a resolution to terminate the plan been adopted in
any plan year?
[ballot] Yes [ballot] No If ``Yes,'' complete Line 17a(1)-(3) below:
(1) [New] Effective date of plan termination
(2) [New] Year the plan assets were distributed to plan participants
and beneficiaries
(3) [Current Line 13a] Enter the amount of plan assets that reverted
to the employer this year:
17b [Part of current Line 13b with a new subpart to report the
year.] Were all the plan assets distributed to participants or
beneficiaries?
[ballot] Yes [ballot] No
17c [Current Line 13c] Transfer to other plans. If this plan
transferred assets or liabilities to another plan since the 20XX-1
filing provide the following information with respect to each plan
to which the assets or liabilities were transferred. Complete as
many entries as needed to identify all transfers.
(1) [Current 13c(2)] EIN
(2) [Current 13c(3)] PN
(3) [New] Date of transfer
(4) [Current 13c(1)] Name of Plan:
(5) [New] Type of transfer:
[ballot] Merger
[ballot] Consolidation
[ballot] Spinoff
[ballot] Other (Describe)
(6) [Part of current Line 13b] Were all plan assets transferred
to another plan?
[ballot] Yes [ballot] No
17d [New] Transfers from other plans. If another plan
transferred assets or liabilities to this plan since the 20XX-1
filing, or in the case of a first plan filing, transferred assets or
liabilities in conjunction with the creation of this new plan,
provide the following information with respect to each plan from
which assets or liabilities were transferred:
(1) EIN
(2) PN
(3) Date of transfer
(4) Name of Plan:
(5) Type of transfer: Type of transfer:
[ballot] Merger
[ballot] Consolidation
[ballot] Spinoff
[ballot] Other ([New] Describe)
17e [New] Terminated Defined Contribution Pension Plans:
Transfers to Financial Institution. Did this plan, as part of the
procedures for terminating the plan, transfer plan assets to
interest bearing federally insured bank accounts in the name of
missing participants?
[ballot] Yes [ballot] No
If ``Yes,'' complete elements (1)-(5). List each financial
institution where plan assets were transferred. You must continue
reporting this information until the final return/report is filed
for the plan.
(1) Financial Institution's Name
(2) Financial Institution's EIN
(3) Date of transfer
(4) Number of accounts established
(5) Total amount transferred
Part IX--Trustee Information--[Current Part III But Not Optional; see
IRS Federal Register Notice ``Proposed Collection; Comment Request for
the Annual Return/Report of Employee Benefit Plan'']
18a [Current Line 14a] Name of Trust
18b [Current Line14b] Trust EIN
18c [New] Name of Trustee/Custodian Check [ballot] if custodian
18d [New] Trustee's or custodian's telephone number
[New--intended to be electronic signature] Date and Signature of
Trustee/Custodian
SIGN HERE Signature of plan trustee or custodian:
Enter Date:
Enter name of individual signing as trustee or custodian
Part X IRS Compliance Questions [See IRS Federal Register Notice
``Proposed Collection; Comment Request for the Annual Return/Report of
Employee Benefit Plan'']
19a [2016 Line 15a] Is this plan a 401(k) plan?
[[Page 47576]]
[ballot] Yes [ballot] No
If ``No,'' skip b.
19b [2016 Line 15b] How did the plan satisfy the
nondiscrimination requirements for employee deferrals under section
401(k)(3)? Check all that apply
[ballot] Design-based safe harbor method
[ballot] ``Prior year'' ADP test
[ballot] ``Current year'' ADP test
[ballot] N/A
20a [2016 Line 16a] What testing method was used to satisfy the
coverage requirements under section 410(b) for the plan year. Check
all that apply:
[ballot] Ratio percentage test
[ballot] Average benefit test
[ballot] N/A
20b [2016 Line 16b] Did the plan satisfy the coverage and
nondiscrimination requirements of sections 410(b) and 401(a)(4) for
the plan year by combining this plan with any other plan under the
permissive aggregation rules?
[ballot] Yes [ballot] No
21 [New] If this is a defined benefit pension plan, does the
plan comply with Code section 401(a)(26) participation requirements?
[ballot] Yes [ballot] No
22a [2016 Line 17b] If the plan is a master and prototype plan
(M&P) or volume submitter plan that received a favorable IRS opinion
letter or advisory letter, enter the date of the letter __/__/__ and
the serial number.
22b [2016 Line 17d] If the plan is an individually-designed plan
that received a favorable determination letter from the IRS, enter
the date of the most recent determination letter _/_/__.
23a [2016 Line 19] If this is a section 401(k) plan, were
hardship distributions made during the plan year?
[ballot] Yes [ballot] No
23b [2016 Line 19] If this is a defined benefit plan or a money
purchase pension plan, did the plan make any distributions during
the plan year to employees who have attained age 62 and who were not
separated from service when the distributions were made? [ballot]
Yes [ballot] No
24 [New] Were required minimum distributions made to 5% owners
who have attained age 70\1/2\ (regardless of whether or not retired)
as required under section 401(a)(9)(C)?
[ballot] Yes [ballot] No [ballot] N/A
25 [New] As of the last day of the plan year, has the plan
ceased to permit contributions and prohibit entry by new
participants?
[ballot] Yes [ballot] No
[JURAT and SIGNATURE BLOCK to appear on first page, as with
current form] CAUTION: A penalty for the late or incomplete filing
of this return/report will be assessed unless reasonable cause is
established.
Under penalties of perjury and other penalties set forth in the
instructions, I declare that I have examined this return/report,
including accompanying schedules, statements and attachments, as
well as the electronic version of this return/report, and to the
best of my knowledge and belief, it is true, correct, and complete.
SIGN HERE Signature of plan administrator:
Enter Date:
Enter name of individual signing as plan administrator
SIGN HERE Signature of employer/plan sponsor:
Enter Date:
Enter name(s) of individual(s) signing as employer or plan sponsor
[New] Trustee Signature for Purposes of the Code:
SIGN HERE Signature of plan trustee or custodian:
Enter Date:
Enter name of individual signing as trustee or custodian
Preparer's name (including firm name, if applicable) and
address; include room or suite number.
Preparer's telephone number
Line A(2) Schedule
Complete as many entries as needed to report the required
information for all participating employers.
Multiple-Employer Plan Participating Employer Information
[Insert Name of Plan, and EIN/PN as shown on the Form 5500]
------------------------------------------------------------------------
------------------------------------------------------------------------
(d) Name of participating (e) EIN........... (f) Percent of
employer. Total
Contributions.
(d) Name of participating (e) EIN........... (f) Percent of
employer. Total
Contributions.
------------------------------------------------------------------------
Line A(3) Schedule
Complete as many entries as needed to report the required
information for all participating employers.
Controlled Group Plan Member Information
[Heading for this chart must include Insert Name of Plan, and EIN/PN as
shown on the Form 5500]
[Complete elements (a), (b), and (c) to provide the name, EIN, and
percent of total contributions of each controlled group member]
------------------------------------------------------------------------
------------------------------------------------------------------------
(d) Name of controlled group (e) EIN........... (f) Percent of
member. Total
Contributions.
(a) Name of controlled group (b) EIN........... (c) Percent of
member. Total
Contributions.
------------------------------------------------------------------------
Schedule A--Insurance Information
[Current Identifying Information] For calendar plan year 20XX or
fiscal plan year beginning DD/MM/20XX and ending DD/MM/20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown on Line 2a of Form 5500
D Employer Identification Number of plan sponsor (EIN)
Part I--Information Concerning Insurance Contract Coverage.
Provide information for each contract on a separate Schedule A.
Individual contracts grouped as a unit in Parts II and III can be
reported on a single Schedule A.
1. Coverage and General Information:
a. [Current 1a] Name of insurance carrier:
b. [Current 1b] EIN of insurance carrier:
c. [More Specific Than Current 1c By Requiring ``Company'' Code
Instead of NAIC Code Generally] NAIC Company Code
d. [Current 1d] Contract or policy identification number:
e. [New] Health plan identification number (HPID) (if subject to
the Health Insurance Portability and Accountability Act (HIPAA))
[Current Line 1e moved as breakout by benefit type in new Line
9]
f. [Current 1(f) and (g)] Policy or contract year (1) beginning
___(2) ending ___
2. [New] Was the policy or contract issued by an insurance
company that is wholly owned by the plan or the plan sponsor?
[ballot] Yes [ballot] No
[Current 2 Moved to New Part IV]
Part II--Investment and Annuity Contract Information. [Current
Part II] Where individual contracts are provided, the entire group
of such individual contracts with each carrier may be treated as a
unit for purposes of this report.
3. [Current Line 4] Current value of plan's interest under this
contract in the general account at contract year end.
4. [Current Line 5, with PSAs. ``Other'' and Variable Annuity
Contracts broken out; new to provide information on variable annuity
contract features] Current value of plan's interest under this
contract in separate accounts and variable annuities at contract
year end.
[ballot] Pooled separate accounts
[ballot] Other separate accounts
[ballot] Variable annuities. If you check this box, indicate whether
the variable annuity contact has any of the following (check all
that apply):
(i) Types of subaccounts:
[ballot] Domestic Stock/Equity
[ballot] Bond/income
[ballot] Balanced/target allocation
[ballot] Money Market
[ballot] Target date/Lifecycle
[ballot] International/Global Stock/Equity
[ballot] Sector/economy segment
[ballot] Other subaccounts (Describe)
(ii) Features
[ballot] Death benefit
[ballot] Guaranteed living benefit
[ballot] Other (specify)
5. [Current Line 6] Contracts With Allocated Funds:
a. State the basis of premium rates
b. Premiums paid to carrier
c. Premiums due but unpaid at the end of the year
d. If the carrier, service, or other organization incurred any
specific costs in connection with the acquisition or retention of
the contract or policy:
(i) Enter amount
(ii) Specify the nature of the costs
e. Type of contract:
(i) [ballot] Individual policies
[[Page 47577]]
(ii) [ballot] Group deferred annuity
(iii) [ballot] Other (specify)
f. If contract purchased, in whole or in part, to distribute
benefits from a terminating plan, check here: [ballot]
6. [Current Line 7] Contracts With Unallocated Funds (Do not
include portions of these contracts maintained in separate accounts)
a. Type of contract:
(1) [ballot] Deposit administration
(2) [ballot] Immediate participation guarantee
(3) [ballot] Guaranteed investment
(4) [ballot] Other (specify)
b. Balance at the end of the previous year
c. Additions:
(1) Contributions deposited during the year
(2) Dividends and credits
(3) Interest credited during the year
(4) Transferred from separate account
(5) Other (specify)
(6) Total additions
d. Total of balance and additions (add Lines 8b and 8c(6))
e. Deductions:
(1) Disbursed from fund to pay benefits or purchase annuities
during year
(2) Administration charge made by carrier
(3) Transferred to separate account
(4) Other (specify)
(5) Total deductions
f Balance at the end of the current year (subtract Line 8e(5)
from Line 8d)
Part III Welfare Benefit Contract Information [Current Part III,
Except As Noted By Line] If more than one contract covers the same
group of employees of the same employer(s) or members of the same
employee organizations(s), the information may be combined for
reporting purposes if such contracts are experience-rated as a unit.
Where contracts cover individual employees, the entire group of such
individual contracts with each carrier may be treated as a unit for
purposes of this report.
7. [Current Line 8 Combined With Current Line 1e Broken Out By
Benefit Type; AD&D and Long Term Care Are New Breakouts] Benefit
type. Check all applicable boxes and enter approximate number of
persons covered at end of contract year by benefit type. (See
instructions)
Columns for the following questions for ``Benefit Type'' and for
``Approximate number of persons covered for each benefit listed''
a [ballot] Health (other than dental or vision)
b [ballot] Dental
c [ballot] Vision
d [ballot] Life insurance: [new breakout] [ballot] term [ballot]
other (specify)
e [ballot] Temporary disability (accident and sickness)
f [ballot] Long-term disability
g [ballot] Supplemental unemployment
h [ballot] Prescription drug
i [ballot] [New] Accidental death and disability
j [ballot] [New] Long term care insurance
k [ballot] Other (specify)
8 [Current Line 8i, j, k, l, m] Type of Contract. (Check
applicable box.)
a [ballot] Stop-loss (large deductible)
b [ballot] HMO contract
c [ballot] PPO contract
d [ballot] Indemnity contract
e [ballot] Other (specify)
9 [Current Line 9, Including Subparts] Experience-rated
contracts:
9a Premiums:
(1) Amount received
(2) Increase (decrease) in amount due but unpaid
(3) Increase (decrease) in unearned premium reserve
(4) Earned ((1) + (2)-(3))
9b Benefit charges
(1) Claims paid
(2) Increase (decrease) in claim reserves
(3) Incurred claims (add (1) and (2))
(4) Claims charged
9c Remainder of premium:
(1) Retention charges (on an accrual basis)
(A) Commissions
(B) Administrative service or other fees
(C) Other specific acquisition costs
(D) Other expenses
(E) Taxes
(F) Charges for risks or other contingencies
(G) Other retention charges
(H) Total retention
(2) Dividends or retroactive rate refunds. Check here to
indicate whether these amounts were:
[ballot] Paid in cash, or [ballot] credited.
9d Status of policyholder reserves at end of year:
(1) Amount held to provide benefits after retirement
(2) Claim reserves
(3) Other reserves
9e Dividends or retroactive rate refunds due. (Do not include
amount entered in Line 9c(2).)
10. [Current Line 10, Including Subparts] Nonexperience-rated
contracts:
10a. Total premiums or subscription charges paid to carrier
10b. If the carrier, service, or other organization incurred any
specific costs in connection with the acquisition or retention of
the contract or policy, other than reported in Part IV, Line 13 (Fee
and Commission Information) report amount:
10c [Part of Current Line 10b] Specify nature of costs of amount
reported on line 10b:
11 [New]
a Were there any premium payment delinquencies for premiums due
but unpaid during the year?
[ballot] Yes [ballot] No If ``Yes,'' enter number of times
delinquent and for each delinquency enter the number of days
delinquent.
b If you answered ``Yes'' to line 11a, indicate whether any
premium delinquency resulted in a lapse in coverage. If you answered
``No'' to line 11a, enter ``N/A''
[ballot] Yes [ballot] No [ballot] N/A.
Part IV Fee and Commission Information
12 [Current Line 2] Insurance fee and commission information.
Enter in Line 12 the total fees and total commissions paid in
connection with the insurance carrier and contract entered in Line
1. List the agents, brokers, and other persons in descending order
of the amount paid.
12a Total amount of commissions paid.
12b Total amount of fees paid
13 [Current Line 3] Persons receiving commissions and fees.
(Complete as many entries as needed to report all persons).
13a [Current 3a] Name and address of the agent, broker, or other
person to whom commissions or fees were paid.
13b [New] Relationship to plan, employer, employee organization,
sponsor, fiduciary, or other party-in-interest
13c [Current 3b] Amount of sales and base commissions paid
13d [Current 3c] Amount of fees and other commissions paid
13e [Current 3d] Purpose of fees and other commissions paid
13f [Current 3e] Organization code (see instructions)
Part V Provision of Information [current Part IV]
14a [Current Line 11] Did the insurance company fail to provide
any information necessary to complete Schedule A?
[ballot] Yes [ballot] No
14b [Current Line 12, Except Checkbox Added for ``Fee and
Commission'' and ``Other'' Instead of Just Open Text Field] If the
answer to Line 14a is ``Yes,'' specify the information not provided:
[ballot] Fee and commission information [ballot] Other (specify)
Schedule C (Service Provider Information) [NEW FORMAT WHERE SEPARATE
SCHEDULE C IS FILED FOR EACH SERVICE PROVIDER RATHER THAN SINGLE
SCHEDULE C FILED THAT COVERS MULTIPLE SERVICE PROVIDERS]
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
A Name of plan
B Three-digit plan number [PN]
C Plan sponsor's name as shown on Line 2a of Form 5500
D Employer Identification Number (EIN)
[New (Revision of current indirect compensation reporting
language to harmonize with 29 CFR 2550.408b-2)] You must complete a
separate Schedule C, in accordance with the instructions, for (1)
each covered service provider who received $1,000 or more in total
direct and indirect compensation (i.e., money or anything else of
monetary value) in connection with services rendered to the plan or
the person's position with the plan during the plan year, including
payments from participants' accounts and (2) other persons who
received $5,000 or more in direct compensation in connection with
services rendered to the plan or the person's position with the plan
during the plan year, including payments from participants'
accounts.
A ``covered service provider'' for Schedule C reporting purposes
includes: (1) ERISA fiduciary service providers to the plan or to a
``plan asset'' vehicle in which the plan invests; (2) investment
advisers registered under Federal or State law; (3) persons who
provide recordkeeping or brokerage services to a participant-
directed individual account plan in connection with designated
investment alternatives (e.g., a ``platform provider''); or (4)
providers of one or more of the following services to the plan who
[[Page 47578]]
received compensation from parties other than from the plan or plan
sponsor in connection with such services: accounting, auditing,
actuarial, banking, consulting, custodial, insurance, investment
advisory, legal, recordkeeping, securities or other investment
brokerage, third party administration, or valuation services.
[Deleted--Current Line 1 ``Information on Persons Receiving Only
Eligible Indirect Compensation'']
Part I Service Provider Information
1 [Current Line 2, except as indicated] Information on Service
Providers Receiving Compensation in Connection with Services
Rendered to the Plan or Their Position with the Plan.
1a [Current Line 2a, but adds requirement to give contact
information for service providers that are natural persons] Enter
name, EIN and address for the service provider. For a self-employed
individual that does not have an EIN, you may enter ``None'' instead
of an EIN. If the service provider identified is not an individual,
in addition to the name, EIN and address of the entity, provide the
name of and address for an individual or office that the plan would
contact for information about the service arrangement. (See
instructions.)
(1) Name of Service Provider
(2) EIN
(3) LEI (if available)
(4) Address
(5) Name of Contact
(6) Address of Contact
1b [Current Line 2c, except refers to relationship to plan
rather than employer, plan sponsor or person known to be party-in-
interest, and enumerates types of parties-in-interest instead of
having all but the employer or employee organization to be reported
as ``other'' person known to be a party-in-interest] Indicate
whether the person identified in Line 1a has one of the following
relationships to the plan. Check ``not applicable'' if the service
provider does not have one of the listed relationships:
(1) [ballot] Employer
(2) [ballot] Plan Sponsor
(3) [ballot] Named fiduciary
(4) [ballot] Plan Sponsor Employee
(5) [ballot] Plan Employee
(6) [ballot] Employee Organization
(7) [ballot] Other party-in-interest (describe)
(8) [ballot] Not applicable
1c [Current Line 2b (``Service codes'' only)] Check the
appropriate box(es) to identify all services provided by the person
identified in Line 1a:
(1) [ballot] Plan Administrator
(2) [ballot] Contract Administrator/third party administrator
(3) [ballot] Trustee (discretionary)
(4) [ballot] Trustee (directed)
(5) [ballot] Investment management
(6) [ballot] Recordkeeping and information management
(computing, tabulating, data processing, etc.)
(7) [ballot] Claims Processing
(8) [ballot] Custodial (securities)
(9) [ballot] Custodial (other than securities)
(10) [ballot] Insurance agents and brokers
(11) [ballot] Insurance services
(12) [ballot] Real estate brokerage
(13) [ballot] Securities brokerage
(14) [ballot] Investment advisory (participants)
(15) [ballot] Investment advisory (plan)
(16) [ballot] Consulting (other than investment advice/
management) (Enter description)
(17) [ballot] Valuation (appraisals, etc.)
(18) [ballot] Accounting (including auditing)
(19) [ballot] Actuarial
(20) [ballot] Form 5500 Annual Return/Report preparation
(21) [ballot] Legal
(22) [ballot] Participant loan processing
(23) [ballot] Participant communication
(24) [ballot] Information technology/computer support
(25) [ballot] Copying and duplicating
(26) [ballot] Other services (Describe)
1d [New] Check here [ballot] if the person identified on Line 1a
was a fiduciary within the meaning of section 3(21) of ERISA at any
time during the plan year.
1e [New] Was the person identified in Line 1a also identified on
Schedule A filed for this plan year as having received insurance
fees and commissions?
[ballot] Yes [ballot] No
1f [New] Did the service provider arrangement include use of an
ERISA recapture, ERISA budget, or similar account during the plan
year?
[ballot] Yes [ballot] No
1g(1) [New] Did the service provider arrangement include
recordkeeping services to a pension plan without explicit
compensation for some or all of such recordkeeping services or with
compensation for such recordkeeping offset or rebated in whole or in
part based on other compensation received by the service provider,
or an affiliate or subcontractor? Only pension plans answer line
1g(1) and 1g(2).
[ballot] Yes [ballot] No
1g(2) [New] If you answered ``Yes'' to line 1g(1), using the
same methodology used in the service provider's estimate of the cost
to the plan of recordkeeping services, enter as a dollar figure the
amount of compensation the service provider received for
recordkeeping services.
2 [Current Line 2d] Direct Compensation Paid by or Charged to
Plan. Enter the total amount of direct payments by the plan to the
person identified in Line 1a. If none, enter ``-0-''.
3 [Current Line 2(g) and Line 3 revised] Indirect compensation
received by covered service providers from sources other than the
plan or plan sponsor, including charges against plan investments.
[Current Lines 2f and 2h eliminated]
3a [Current Line 2(g) as revised because ``eligible indirect
compensation'' concept eliminated] Total amount of compensation
received by the covered service provider identified in Line 1a in
connection with services provided to the plan from sources other
than the plan or plan sponsor, including charges against plan
investments. Include compensation received by an affiliate or
subcontractor in connection with the services rendered to the plan.
Do not include here related party compensation paid among the
person, affiliate or subcontractor reported on Line 4. (See
instructions)
3b [Current Line 3] For compensation reported on Line 3a,
identify each source from whom the person identified in Line 1a
received compensation. (See instructions). Complete as many entries
as needed to report the required information for each source.
(1) Enter name
(2) EIN
(3) LEI (if available)
(4) Enter as a dollar figure the amount or estimate of
compensation received from the source identified in Line 3b(1).
(5) Check the appropriate box(es) to identify all type(s) of
fees/compensation received by the provider identified in Line 1a
from the source identified in Line 3b(1).
(A) [ballot] Investment management fees
(B) [ballot] Sales loads (front end and deferred)
(C) [ballot] Account maintenance fees
(D) [ballot] ``Soft dollars'' commissions
(E) [ballot] Securities brokerage commissions and fees
(F) [ballot] Shareholder servicing fees
(G) [ballot] Sub-transfer agency (subaccounting) fees
(H) [ballot] Finders' fees/placement fees
(I) [ballot] Distribution (12b-1) fees
(J) [ballot] Insurance brokerage commissions and fees
(K) [ballot] Insurance mortality and expense charges
(L) [ballot] Insurance wrap fees
(M) [ballot] Termination fees (surrender charges, etc.)
(N) [ballot] Float revenue
(O) [ballot] Non-monetary compensation (Enter description)
(P) [ballot] Commissions other than securities and insurance
(e.g., real estate commissions)
(Q) [ballot] Recordkeeping fees
(R) [ballot] Other fees/compensation (Enter description)
(6) If the amount of compensation reported in Line 3b(4) was an
estimate based on a formula, check here [ballot] and enter a
description of the formula used to determine the service provider's
eligibility for or the amount of the compensation.
4a [New] Did the service arrangement involve any related party
compensation? (See instructions). If the answer to Line 4a is
``Yes,'' complete Line 4b(1)-(4)
4b(1) Describe the services for which the compensation was paid
(2) Enter names of
(A) the payor and
(B) the recipient of the compensation
(3) Identify status as an [ballot] affiliate or [ballot]
subcontractor
(4) Enter the amount of the compensation
Part II Service Providers Who Fail or Refuse to Provide Information
[Current Part II; because a separate Schedule C would be provided for
each service provider, no need to provide the name and EIN of the
service provider who failed or refused to provide information; current
Lines 4a and 4b eliminated]
5a [Current Line 4] Check this box if the service provider
failed or refused to provide the information necessary to complete
this Schedule.
5b [Current Line 4c] Describe the information that the service
provider failed or refused to provide.
[[Page 47579]]
Schedule D
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
A Name of plan
B Three-digit plan number (PN)
C Plan or DFE sponsor's name as shown on Line 2a of Form 5500:
D Employer Identification Number (EIN)
[Current Part I eliminated]
[Current Part II, with added items for dollar value of investing
plan/DFE interest as of end of reporting DFE year and check box
whether DFE had investors other than plans covered by Title I of
ERISA that file the Form 5500 Annual Return/Report].
1 Information on Participating Plans (to be completed by DFEs)
Complete as many entries as needed to report all participating
plans.
1a Plan name (as shown on Line 1a of the plan's most recent Form
5500/Form 5500-SF):
1b Name of plan sponsor (as shown on line 2a of the plan's most
recent Form 5500/Form 5500-SF):
1c(1) EIN of sponsor of investing plan (as shown on Line 2b of
the plan's most recent Form 5500/Form 5500-SF)
1(c)(2) PN of investing plan (as shown on Line 1b of the plan's
most recent Form 5500/Form 5500-SF)
1d [New] Dollar value of investing plan/DFE interest at end of
reporting DFE year:
1e [New] If the DFE had investors other than plans that are
required to file the Form 5500 or Form 5500-SF (see instructions),
check here [ballot].
Schedule E (ESOP Annual Information)
Heading [Change from 2008 to list DOL and IRS/Treasury instead of just
Treasury/IRS]
[Change from 2008 to add Title I Authority to Code Authority]--
This schedule is required to be filed under section 104 of the
Employee Retirement Income Security Act of 1974 (ERISA) and sections
6058(a) and 6047(e) of the Internal Revenue Code (the Code).
[Change from 2008, which specified Schedule E NOT Open to Public
Inspection] Disclosure: This Form is Open to Public Inspection.
[2008 Basic Identifying Information] For calendar plan year 20XX
or fiscal plan year beginning DD/MM/20XX and ending DD/MM/20XX+1
A Name of plan:
B Plan number
C Plan sponsor's name as shown on Line 2a of Form 5500
D EIN
Part I Employer Stock Acquired with a Securities Acquisition
Loan [New]--Complete this Part only if the ESOP had an outstanding
securities acquisition loan within the meaning of Code section
4975(d)(3) and ERISA section 408(b)(3) during the plan year.
Common Stock
1a [New] Enter the number of common shares of employer stock
held in the ESOP at the end of the plan year.
1b [New] Enter percent of issued and outstanding common stock
held in the ESOP at the end of the plan year.
1c [Current Schedule R, Line 12] Are the shares readily tradable
on an established securities market? [ballot] Yes [ballot] No
1d [New] Enter number of allocated common shares at the end of
the plan year.
1e [New] Enter number of unallocated common shares at the end of
the plan year.
1f [2008 Schedule E, Line 5] If common stock was released from a
loan suspense account, indicate the methods used:
[ballot] Principal and interest
[ballot] Principal only
[ballot] Other (Describe method):
Preferred Stock
1g [2008 Schedule E, Line 4] Did the ESOP hold preferred stock
at the end of the plan year?
[ballot] Yes [ballot] No
1h [New breakout] If convertible based on a ratio, enter ratio.
1i [New breakout] If convertible by some other method, describe
the method of conversion.
Part II [New breakout] Employer Stock Acquired Complete this
Part only if the ESOP acquired during the plan year employer
securities not readily tradable on an established securities market.
Complete as many entries as necessary to report each separate
transaction.
2a [New] Enter seller's relationship to plan, employer, or other
party-in-interest (if no relationship, enter ``unrelated third
party'')
2b [New] Is seller a party-in-interest? [ballot] Yes [ballot] No
2c [New] Enter total consideration paid for stock
2d [New] Enter date of transaction
2e [New] Check the applicable box and enter the identifying
information if an independent fiduciary, trustee, or investment
manager approved the transaction
[ballot] Trustee
[ballot] Investment Manager
[ballot] Independent fiduciary
Name
Street Address
City
State
Zip Code
EIN
2f [New] Identify the independent appraiser that valued the
employer securities. (If an independent appraiser did not value the
employer securities, enter ``None.'' CAUTION: See Code section
401(a)(28)(C) if you enter ``None.'')
Name
Street Address
City
State
Zip Code
EIN
2g [New] What valuation approach was used to value the stock
acquired? (Check all that apply.)
[ballot] Asset
[ballot] Income
[ballot] Market
[ballot] Book Value
[ballot] Other (Enter description):
Part III Securities Acquisition Loans [2008 Schedule E, Line 2a,
with new breakouts as indicated]--Complete this Part only if the
ESOP had outstanding securities acquisition loans within the meaning
of Code section 4975(d)(3) and ERISA section 408(b)(3) during the
plan year. Complete as many entries as necessary to report all
outstanding loans.
3a [New breakout] Lender's relationship to plan, employer, or
other party-in-interest (if no relationship, enter ``unrelated third
party'')
3b [New breakout] [ballot] Check box if lender is a party-in-
interest?
3c [New breakout] Is the loan guaranteed by a party-in-interest?
[ballot] Yes [ballot] No
3d [New breakout] Enter original amount of loan
3e [2008 Schedule E, Line 9a] Enter date of loan
3f [New breakout] Enter interest rate (if variable enter terms)
3g [New breakout] Is the loan in default?
[ballot] Yes [ballot] No If ``Yes,'' enter the amount overdue.
3h [New breakout] (1) Was the loan refinanced or amended during
the plan year?
[ballot] Yes [ballot] No
If ``Yes,'' complete Line 3h(2) and (3)
(2) Enter date of amendment or refinancing.
(3) Enter the outstanding balance at date of refinancing or
amendment
Part IV Other General Information
4a [New] Were employee elective deferrals used to satisfy any
securities acquisition loan?
[ballot] Yes [ballot] No
4b [2008 Schedule E, Lines 1a and 1b] If the ESOP is maintained
by an S corporation, are there any disqualified persons as described
in Code section 409(p)(4)?
[ballot] Yes [ballot] No
4c [2008 Schedule E, Line 6] Were unallocated securities or
proceeds from the sale of unallocated securities used to repay any
exempt loan (within the meaning of Code section 4975(d)(3) and ERISA
section 408(b)(3))?
[ballot] Yes [ballot] No
If ``Yes,'' attach a description of the transaction.
4d [2008 Schedule E, Line 2b] Did the employer maintaining the
ESOP pay dividends (deductible under Code section 404(k)) on the
employer's stock held by the ESOP during the employer's tax year in
which the plan year ends?
[ballot] Yes [ballot] No
If ``Yes,'' answer (d)(1)-(3).
(1) What was the amount of the deduction taken?
(2) What was the dividend rate?
(3) Did the employer make payments in redemption of stock held
by an ESOP to ESOP participants and deduct them under Code section
404(k)(1)?
[ballot] Yes [ballot] No
[[Page 47580]]
Schedule G--Financial Transactions
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
[Identification information same as current Schedule G]
A Name of plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown on Line 2a of Form 5500
D Employer Identification Number (EIN)
Part I. [Current Part I] Schedule of Loans or Fixed Income Obligations
in Default or Classified as Uncollectible
1 [Current Line 1] Schedule of Loans in Default or Classified as
Uncollectible. Complete as many entries as needed to report all
loans in default or classified as uncollectible. (See Instructions.)
1a [Current Part I(b)] Identity and address of obligor
Name
Street Address
City
State
Zip Code
1b [New Breakout] Relationship to plan. (Check all boxes that
apply.) Obligor is a:
[ballot] [New breakout] participant
[ballot] [Current Part I(a)] party-in-interest (e.g. employer,
employee organization, employee of the plan, or other party-in-
interest)
Enter description of the relationship (If no relationship
exists, enter ``unrelated third party'')
1c [Part of Current Part I(c)] Check to indicate whether the
loan is:
[ballot] in default
[ballot] uncollectible
1d [Current Part I(d)] Enter original amount of loan
1e [Part of Current Part I(c)] Enter original interest rate. If
variable, describe terms.
1f [Part of Current Part I(c)] Date of loan origination
1g [Part of Current Part I(c)] Maturity date
1h (1) [Part of Current Part I(c)] Was the loan secured by
collateral? [ballot] Yes [ballot] No If ``Yes,'' complete elements
(2) and (3).
(2) [New breakout] Was the security interest perfected? [ballot]
Yes [ballot] No
(3) [Part of Current Part I(c)] Enter a description of
collateral and value of collateral:
Collateral type
Collateral value
1i [Part of Current Part I(c)] Scheduled payment frequency
(e.g., monthly, annually). Enter description
1j [Current Part I(e) and (f)] Amount received during reporting
year:
Principal
Interest
1k [Current Part I(h) and (i)] Amount overdue:
Principal
Interest
1l [Current instructions require an attachment with this
information]. Enter a description of what steps the plan
administrator has taken or will be taking to collect overdue amounts
for each loan listed.
2 Schedule of Fixed Income Obligations in Default or Classified
as Uncollectible. [Breaks out fixed income obligations from loans;
current Schedule G has filers completing same elements for both
loans and fixed income obligations.] Complete as many entries as
needed to report all fixed income obligations in default or
classified as uncollectible. (See Instructions.)
2a [Current Part I(b)] Identity and address of obligor
Name
Street Address
City
State
Zip Code
2b [Current Part I(a)] Check [ballot] if party-in-interest (e.g.
employer, employee organization, employee of the plan, or other
party-in-interest) was involved in the transaction.
[New breakout] Enter description of the relationship. If no
relationship exists, enter ``unrelated third party.''
2c [Part of current Part I(c)] Check to indicate whether the
fixed income obligation is:
[ballot] in default
[ballot] uncollectible
2d [New breakout; part of description in current Part I(c)]
Check applicable boxes to indicate the nature of the fixed income
obligation:
[ballot] Bond
[ballot] Option
[ballot] Swap
[ballot] Future contract
[ballot] Forward contract
[ballot] Other (Enter description)
2e [Part of current Part I(c)] Date of issuance
2f [Part of current Part I(c)] Maturity date
2g [Part of current Part I(c)] Enter coupon yield or interest
rate
2h [Current Part I(e)] Principal amount of fixed income
obligation
2i [Current Part I(h) and (i)] Amount overdue:
Principal
Interest
2j [Current instructions require an attachment with this
information] Enter a description of what steps the plan
administrator has taken or will be taking to collect overdue amounts
for each fixed income obligation listed.
Part II Schedule of Leases in Default or Classified as
Uncollectible. Complete as many repeating entries as needed to
report all leases in default or classified as uncollectible. (See
instructions.)
3a [Current Part II(b)] Identity and address of lessor/lessee:
Name
Street Address
City
State
Zip Code
3b [Current Part II(a) and (c)] Relationship to plan, employer,
employee organization, or other party-in-interest (if no
relationship, enter ``unrelated third party''). Check to indicate
whether lessor/lessee is [ballot] party-in-interest and enter
description of relationship (including whether plan is lessor or
lessee):
3c [Part of current Part II] Overdue Lease Explanation. Check to
indicate whether the lease is in [ballot] default [ballot]
uncollectible.
3d [Part of current Part II(d)] Enter the address of the leased
property:
Street Address
City
State
Zip Code
3e [Part of current Part II(d)] Enter date of lease origination
3f [Current Part II(e)] Original cost of leased property
3g [Current Part II(f)] Current value of leased property at time
of lease
3h [Current Part II(g)] Gross rental receipts during the plan
year
3i [Current Part II(h)] Expenses paid during the plan year
3j [Current Part II(i)] Net receipts
3k [Part of current Part II(d)] Scheduled payment frequency
(e.g., monthly, annually)
3l [Part of current Part II(d)] Lease expiration date
3m [Current Part II(j)] Amount in arrears
3n [Current instructions require an attachment with this
information]. Enter an explanation of what steps the plan
administrator has taken or will be taking to collect overdue amounts
for each lease listed.
Part III Nonexempt Transactions. Complete as many entries as
needed to report all nonexempt transactions.
CAUTION: If a nonexempt prohibited transaction occurred with
respect to a disqualified person, the disqualified person should
generally file a Form 5330 with the IRS to pay the excise tax on the
transaction.
Line 4 [Current Part III(a)]
4a Name and address of party-in-interest (or parties in
interest, if multiple) involved in the nonexempt prohibited
transaction:
Name
Street Address
City
State
Zip Code:
4b [Current Part III(b)] Relationship to plan, employer,
employee organization, plan sponsor, fiduciary, or other party-in-
interest
4c [Revision of Current Part III(c), but current requirement to
provide a description of transaction replaced with checkboxes;
written description only required for ``other''] Type of nonexempt
transaction (Check all that apply):
[ballot] Sale of any property to/from the plan
[ballot] Exchange of any property
[ballot] Lease of any property to/from the plan
[ballot] Lending of money to/from the plan
[ballot] Other extension of credit to/from the plan
[ballot] Furnishing of goods to/from the plan
[ballot] Furnishing of services to/by the plan
[ballot] Furnishing of facilities to/by the plan
[ballot] Other transfer to a party-in-interest, of any income or
assets of the plan
[ballot] Other use by or for the benefit of a party-in-interest, of
any income or assets of the plan
[ballot] Acquisition, on behalf of the plan, of any employer
security or employer real property in violation of ERISA 407(a)
[ballot] Acting in a fiduciary's individual or any other capacity in
any transaction involving the plan on behalf of a party (or
represent a party) whose interests are
[[Page 47581]]
adverse to the interests of the plan or the interests of its
participants and beneficiaries
[ballot] A receipt of any consideration for his or her personal
account by a party-in-interest who is a fiduciary from any party
dealing with the plan in connection with a transaction involving the
income or assets of the plan
[ballot] Other (enter description)
4d [New] Check the appropriate box (see instructions) to
describe nature of transaction:
[ballot] Discrete
[ballot] Ongoing
4e [Part of current Part III (c)] Date of the transaction or, if
ongoing, date of first instance
4f [Part of current Part III (c)] Amount involved in nonexempt
transaction
4g [Current Part III (j)] Net gain (or loss) on the transaction
4h [New] Has the transaction been fully corrected (see
instructions)? [ballot] Yes [ballot] No
If ``Yes'', check the correct box below and complete (i) and
(j):
[ballot] Transaction corrected outside VFCP
[ballot] Transaction corrected through the VFCP
[ballot] Transaction pending correction through VFCP
4i [New] If the transaction was fully corrected, enter the date
the transaction was fully corrected: MM/DD/20YY
4j [New] If the nonexempt transaction was corrected enter a
description of the corrective action (i.e. reversal, disgorgement,
loan repaid, payment to plan, etc.)
4k [New] If the nonexempt transaction occurred with respect to a
disqualified person, and the person was notified, was a Form 5330
filed with the IRS?
[ballot] Yes
[ballot] No
[ballot] Unknown
[ballot] Not required-VFCP
[ballot] Disqualified person was not notified
Schedule H--Financial Information
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown on line 2a of Form 5500
D Employer Identification Number of plan sponsor (EIN)
Part I Asset and Liability Statement
1. [Current Line 1, except reference to ``MTIA'' changed to
``Master Trust;'' changes to individual data elements as indicated]
Current value of plan assets and liabilities at the beginning and
end of the plan year. Combine the value of plan assets held in more
than one trust. Report the value of the plan's interest in a
commingled fund containing the assets of more than one plan on a
line-by-line basis unless the value is reportable on Lines 1b(5)-
1b(8). Do not enter the value of that portion of an insurance
contract which guarantees, during this plan year, to pay a specific
dollar benefit at a future date. Round off amounts to the nearest
dollar. Master trusts, CCTs, PSAs, and 103-12 IEs do not complete
Lines 1a(1), (2) and (3), 1g, 1h, and 1i. CCTs, PSAs, and 103-12 IEs
also do not complete Lines 1(c)(1) and (2) and 1d. (See
instructions.)
Assets [Columns for (a) Beginning of Year (BOY) and (b) End of
Year (EOY) Values]
[Current Line 1a Moved to Line 1b(1)]
1a [Current 1b] Receivables (less allowance for doubtful
accounts):
(1) [Current 1b(1)] Employer contributions
(2) [Current 1b(2)] Participant contributions
(3) [Current 1c(8)] Notes receivable from participants
(participant loans)
(4) [Current 1b(3)] Other
1b [Current 1c; with changes as indicated] General investments--
(1) [Current 1a] Total noninterest-bearing cash
(2) [Current 1c(1) with new breakouts])
(A) Interest-bearing cash
(B) Certificates of deposit
(C) Money market accounts
(3) [New breakouts] Debt interests/obligations (other than
employer securities, participant loans, and foreign investments)
(A) [Current 1c(2)] U.S. Government securities
(B) [New] Other government securities
(C) [Current 1c(3) Corporate debt instruments (other than
employer securities)
(i) Investment grade
(ii) High-yield debt
(D) [New] Exchange Traded Notes
(E) [New] Asset backed securities (other than real estate)
(F) [New and Partial Current 1c(7)] Other debt interests
(4) [Current 1c(4)] Corporate stocks (other than employer
securities and foreign investments):
(A) [New breakout] Publicly traded
(i) Preferred
(ii) Common
(B) [New breakout] Non-publicly traded
(i) Preferred
(ii) Common
(5) [Current 1c(13)] Registered investment companies (Mutual
funds, Unit Investment Trusts, Closed End Funds)
(6) [New breakout] Eligible Pooled Investment Vehicles (other
than registered investment companies)
(A) [Current 1c(10] Total value of interest in pooled separate
accounts (PSA)
(B) [Current 1c(9)] Total value of interest in common collective
trusts (CCT)
(C) [Current 1c(12)] Value of interest in 103-12 investment
entities (103-12 IEs) (See instructions)
(D) [Current 1c(11)] Total value of interest in master trusts
(7) [Current 1c(14)] Value of interest in funds held in
insurance general account (unallocated contracts)
(A) [New breakout] Deposit administration
(B) [New breakout] Immediate participation guarantee
(C) [New breakout] Guaranteed investment contracts
(D) [New breakout] Other unallocated insurance contracts
(Describe)
(8)(A) [Current 1c(5)] Partnership/joint venture interests
(i) [New breakout] Value of interest in limited partnerships
(ii) [New breakout] Value of interest in venture capital
operating companies (VCOC)
(iii) [New breakout] Private equity
(iv) [New breakout] Hedge funds
(v) [New breakout] Other partnership/joint venture interests
(Describe)
(B) [New sub-part question not part of sum on balance sheet]
(i) Total partnership/joint venture interests that do not hold
plan assets under the DOL's plan asset regulation at 29 CFR 2510.3-
101.
(ii) Total partnership/joint venture interests that hold plan
assets under the DOL's plan asset regulation at 29 CFR 2510.3-101.
(9) [Current 1c(6)] Real Estate Investments (other than employer
real property and foreign investments)
(A) [New breakout] Developed real property (other than employer
real property)
(B) [New breakout] Undeveloped real property (other than
employer real property)
(C) [New breakout] Publicly Traded Real Estate Investment Trusts
(REITs)
(D) [New breakout] Non-Publicly Traded Real Estate Investment
Trusts (REITs)
(E) [New breakout] Mortgage-Backed Securities (Including
Collateralized Mortgage Obligations)
(F) [New breakout] Real Estate Operating Company (REOC)
(G) [New breakout] Other real estate related investments
(Describe)
(10) [New breakout] Commodities (direct investments)
(A) [New breakout] Precious metals
(B) [New breakout] Other (Describe)
(11) [New breakout] Derivatives
(A) [New breakout] Futures
(B) [New breakout] Forwards
(C) [New breakout] Options
(D) [New breakout] Swaps
(E) [New breakout] Other (Describe, e.g., collateralized debt
obligations other than real estate)
(12) [Current 3g on Schedule I] Tangible Personal Property
(including collectibles)
(13) [New breakout] Foreign investments (Other than those held
through registered investment companies or eligible pooled
investment vehicles)
(A) Equities
(B) Debt interests
(C) Real estate
(D) Currency
(E) Other (Describe)
(14) [New breakout] Value of assets held in participant-directed
brokerage accounts (See instructions)
(A) Tangible personal property
(B) Loans
(C) Partnership or joint venture interests
(D) Real property
(E) Employer securities
(F) Investments that could result in a loss in excess of the
account balance of the participant or beneficiary who directed the
transaction, including derivatives
(G) Other (including cash/cash equivalents, registered
investment companies, corporate equities, corporate debt
instruments)
1c [Current 1d except breakout for non-publicly traded stock and
debt] Employer-related investments
[[Page 47582]]
(1) Employer securities
(A) Publicly traded stock
(B) Non-publicly traded stock
(C) Publicly traded debt instruments
(D) Non-publicly traded debt
(2) Employer real property
1d [Current 1e] Buildings and other property used in plan
operation
1e [Current 1c(15)] Other ([New] Describe)
1f [Current 1f] Total assets (Add Lines 1a through 1e.)
Liabilities [Columns for (a) BOY (b) EOY Values]
1g [Current 1g] Benefit claims payable
1h [Current 1h] Operating payables
1i [Current 1i] Acquisition indebtedness
1j [Current 1j] Other liabilities
1j(1) [New] Enter description
1k [Current 1k] Total liabilities (add all amounts in Lines 1g
through 1j)
Net Assets
1l [Current] Net assets (subtract Line 1k from Line 1f)
Part II Income and Expense Statement
2 [Current 2] Plan income, expenses, and changes in net assets
for the year. Include all income and expenses of the plan, including
any trust(s) or separately maintained fund(s) and any payments/
receipts to/from insurance carriers. Round off amounts to the
nearest dollar. Master trusts, CCTs, PSAs, and 103-12 IEs do not
complete Lines 2a, 2b, 2e, 2f, and 2g.
2a [Current 2a] Contributions--
(1) Received or receivable in cash from:
(A) Employers
(B) Participants
(C) Others (including rollovers from IRAs/other plans)
(2) Noncash contributions
(3) Total contributions. Add Lines 2a(1)(A), (B), (C), and Line
2a(2).
2b [Current 2b(1)(E) with new breakouts] Interest on notes
receivable from participants (participant loans)
(1) Received in cash
(2) Receivable in cash
(3) Total. Add Lines 2b(1) and 2b(2).
2c [Current 2b with new breakouts] Earnings on investments.
Provide the total of all earnings by asset type including interest,
dividends, gain (loss) on sale of property, unrealized appreciation
(depreciation), net investment gain (loss), as appropriate for asset
type. Report on Lines 2c(1)(A) and 2(c)(2)(A), respectively,
interest and dividends on debt and equity instruments held directly
by the plan.
(1) Interest on debt instruments/obligations
(A) Interest bearing cash (including money market and
certificates of deposit)
(B) U.S. government securities
(C) Other government securities
(D) Corporate debt instruments
(E) Loans (other than to participants)
(F) Other
(G) Total interest. Add Line 2c(1)(A) through (F)
(2) Dividends (other than employer securities)
(A) Preferred stock
(B) Common stock
(C) Registered investment company shares (e.g., mutual funds)
(D) Total dividends. Add Line 2c(2)(A) through (C).
(3) Rents
(4) Net gain (loss) on sale of assets
(A) Aggregate proceeds
(B) Aggregate carrying amount (see instructions)
(C) Subtract Line 2c(4)(B) from Line 2c(4)(A) and enter result
(5) Unrealized appreciation (depreciation) of assets
(A) Real estate
(B) Partnership/joint venture interests that do not hold plan
assets
(C) Commodities (direct investments)
(D) Derivatives
(E) Employer securities
(F) Foreign investments (other than those held through U.S.
registered investment funds)
(G) Employer real property
(H) Other (Describe)
(6) Pooled Investment Vehicles
(A) Net investment gain (loss) from common/collective trusts
(B) Net investment gain (loss) from pooled separate accounts
(C) Net investment gain (loss) from master trusts
(D) Net investment gain (loss) from 103-12 investment entities
(E) Net investment gain (loss) from registered investment
companies (e.g., mutual funds)
2d [Current 2d] Total income. Add all income amounts in column
(b).
Expenses--[Current]
2e [Current 2e] Benefit payment and payments to provide
benefits:
(1) Directly to participants or beneficiaries
(A) [New breakout from current 2d(1)] Direct rollovers
(B) [New] Hardship distributions made from a section 401(k) plan
(C) [Current 2016 Line 4o] Distributions to employees who have
attained age 62 and who were not separated from service when the
distributions were made for a defined benefit plan or a money
purchase pension plan
(D) [Current 2e(1) except rollovers no longer reported in other]
Other
(2) [Current] To insurance carriers for the provision of
benefits
(3) [Current] Other
(4) [Current] Total benefit payments. Add Lines 2e(1) through
(3).
2f [Current] Corrective distributions (See instructions.)
2g [Current] Certain deemed distributions of participant loans
(See instructions.)
2h [Current] Interest expense
2i [Current 2i with new breakouts as indicated] Administrative
expenses:
(1) [New Breakout (1998 Line 32g(1)] Salaries and allowances
(2) [Current 2i(2)] Contract administrator fees
(3) [Current 2i(3)] Investment advisory and management fees
(4) [New Breakout] IQPA Audit fees
(5) [New based on 1998 Line 32g(2)] Recordkeeping and other
accounting fees
(6) [New Breakout] Bank or Trust Company Trustee/Custodial Fees
(7) [New Breakout (1998 Line 32g(3))] Actuarial fees
(8) [New Breakout (1998 Line 32g(6))] Legal fees
(9) [New Breakout (1998 Line 32g(7))] Valuation/appraisal fees
(10) [New Breakout (1998 Line 32g(8))] Trustee fees/expenses
(including travel, seminars, meetings, etc.)
(11) [Current 2i(4)] Other
(12) [12(C) is Current 2i(5); (A) and (B) are new breakouts]
Total administrative expenses
(A) Total paid by the plan, except charges directly against
participant accounts
(B) Total payments charged directly against participant accounts
(i) Transaction-based charges to individual participant accounts
(ii) Plan level expenses apportioned among participant accounts
(iii) Indicate how apportioned:
[ballot] per capita
[ballot] pro rata by account balance
[ballot] other (describe):
(C) Total. (The amount shown in (C) should be the total of
elements (A) and (B). Element (C) should also be the same as the
total of Lines 2i(1) through (11).)
2j [Current 2j] Total expenses. Add all expense amounts in
column (b) (EOY) and enter total.
Net Income and Reconciliation
2k [Current] Net income (loss). Subtract Line 2j from Line 2d.
2l [Current] Transfers of assets--
(1) [Current 2l(1)] Transfers to this plan. Total at EOY
(2) [Current 2l(2)] Transfers from this plan. Total at EOY
Part III Accountant's Opinion.
Subject to certain exceptions, the administrator of an employee
benefit plan who files a Schedule H must engage an Independent
Qualified Public Accountant (IQPA) pursuant to ERISA section
103(a)(3)(A) and 29 CFR 2520.103-1(b). This requirement also applies
to a Form 5500 Annual Return/Report filed for a 103-12 IE and for a
GIA (see 29 CFR 2520.103-12 and 29 CFR 2520.103-2). The IQPA's
report must be attached to the Form 5500 Annual Return/Report when a
Schedule H is attached unless you check Line 3h(1), (2), (3), or (4)
on the Schedule H. An IQPA Report generally consists of an
Accountant's Opinion, Financial Statements, Notes to the Financial
Statements, and Supplemental Schedules.
3 [Current] Complete Lines 3a through 3g if the opinion of an
IQPA is attached to this Form 5500 Annual Return/Report. Complete
Line 3h if an opinion is not attached.
3a [Current] The attached opinion of an IQPA for this plan is
(see instructions):
(1) [ballot] Unqualified
(2) [ballot] Qualified
(3) [ballot] Disclaimer
(4) [ballot] Adverse
3b [Current question; new requirement to attach
certification(s)] Did the IQPA perform a limited scope audit
pursuant to 29 CFR 2520.103-8 and/or 103-12(d)?
[ballot] Yes [ballot] No
If ``Yes'' you must attach a copy of the certification(s).
(Although you must attach a copy of the certification(s), you do not
need to include any attachments to the
[[Page 47583]]
certification itemizing the assets to which the certification(s)
apply.)
3c [Current] Enter the name and EIN of the IQPA (or accounting
firm) below:
(1) Name
(2) EIN
(3) Name of audit engagement partner
3d [New] Identify the state in which the opinion was issued
3e [New] Did you review and discuss the IQPA report with the
accountant?
[ballot] Yes [ballot] No
3f [New] Did the accountant advise you whether the IQPA report,
including the financial statements and/or notes required to be
attached to this return/report or the IQPA's communications with
those charged with governance (SAS 114 and 115), disclosed any of
the following (check all that apply):
(1) [ballot] Errors or irregularities
(2) [ballot] Illegal acts
(3) [ballot] Material internal control weaknesses
(4) [ballot] A loss contingency indicating that assets are
impaired or a liability incurred
(5) [ballot] That the plan sponsor may not be a going concern
(6) [ballot] The existence of plan qualification issues pursuant
to the Internal Revenue Code
(7) [ballot] Any unusual or infrequent events or transactions
occurring subsequent to the plan year end that might significantly
affect the usefulness of the financial statements in assessing the
plan's present or future ability to pay benefits (explain)
3g [New] Did your IQPA have a peer review performed in
accordance with their state's requirements?
[ballot] Yes [ballot] No
If ``Yes,'' complete elements (1) through (5).
(1) Name of peer reviewer
(2) Year of their last peer review
(3) Rating received in their last peer review report
(4) Number of years that the peer reviewer has been the firm's
peer reviewer
(5) Whether the peer review covered employee benefit plans
3h [Current 3d] The opinion of an IQPA is not attached because
(check appropriate box):
(1) [ballot] This form is filed for a CCT, PSA, or master trust.
(2) [ballot] Pursuant to 29 CFR 2520.104-50, the IQPA report
will be attached to the next Form 5500 Annual Return/Report.
(3) [ballot] The IQPA report was not completed in time. If you
check this box, you must explain the reason for the failure to
comply with the IQPA requirement in a timely fashion and indicate
date by which an amended filing will be made with an IQPA report.
(4) [Current 4k on Schedule I] [ballot] The plan is a small plan
and is eligible to claim a small plan audit waiver of the annual
examination and report of an IQPA under the conditions set forth in
29 CFR 2520.104-46. (See instructions). In addition to meeting other
conditions in 29 CFR 2520.104-46, in order to be a small plan for
this purpose, the plan must have fewer than 100 participants as of
the beginning of the plan year as reported on Form 5500 or be
eligible to claim small plan status under 29 CFR 103-1(d) and had
120 or fewer participants as of the beginning of the plan year.
Defined benefit pension plans and welfare plans use the number
reported on Form 5500, Line 6 for this measure. Defined contribution
pension plans use the number reported on Form 5500, Line 7g(1). (See
instructions.)
Part IV Compliance Questions
Employee benefit plans must complete all lines that apply.
Employee benefit plans must complete all lines that apply. Small
employee benefit plans that were eligible for and claimed the small
plan audit waiver by checking Line 3g(4), must complete all elements
in Part IV, except such small plans do not need to attach Schedules
G or the Line 4j Schedule of Reportable Transactions, even if they
answer ``Yes'' to Lines 4b, 4c, 4d, or 4j. CCTs and PSAs complete
only Line 4i(1). Master trusts and 103-12 IEs complete only Lines
4b, 4c, 4d, 4i, 4j, and 4s. GIAs complete only Lines 4b, 4c, 4d, 4i,
4j, and 4k.
During the plan year:
4a [Current; but would require use of specified structured data
format to complete and file Line 4a schedule] Was there a failure to
transmit to the plan any participant contributions or repayments as
of the earliest date on which such contributions can reasonably be
segregated from the employer's general assets as described in 29 CFR
2510.3-102?? (See instructions). Continue to answer ``Yes'' for any
prior year failures until fully corrected. (See instructions and
DOL's Voluntary Fiduciary Correction Program.) If you answered
``Yes,'' you must complete the Line 4a schedule to provide details
about the failure to transmit, including any corrective action
taken.
[ballot] Yes [ballot] No Amount
4b [Current] Were any loans by the plan or fixed income
obligations due the plan in default as of the close of the plan year
or classified during the year as uncollectible? Disregard
participant loans secured by the participant's account balance. If
you answered ``Yes,'' see instructions for requirements to attach
Schedule G (Form 5500) Part I. Small plans that were eligible for
and claimed the small plan audit waiver under 29 CFR 2520.104-46 do
not need to attach Schedule G Part I.
[ballot] Yes [ballot] No Amount
4c [Current] Were any leases to which the plan was a party in
default or classified during the year as uncollectible? If you
answered ``Yes,'' see instructions for requirements to attach
Schedule G (Form 5500) Part II. Small plans that were eligible for
and claimed the small plan audit waiver under 29 CFR 2520.104-46 do
not need to attach Schedule G Part II.
[ballot] Yes [ballot] No Amount
4d [Current] Were there any nonexempt prohibited transactions
with any party-in-interest? (Do not include transactions reported on
Line 4a. If you answered ``Yes,'' see instructions for requirements
to attach Schedule G (Form 5500) Part III. Small plans that were
eligible for and claimed the small plan audit waiver under 29 CFR
2520.104-46 do not need to attach Schedule G Part III.
[ballot] Yes [ballot] No Amount
4e [Current Line 4e revised] Was this plan covered by one or
more fidelity bonds naming the plan as insured that provide coverage
for losses due to fraud or dishonesty by persons who handle plan
funds or other property? (See instructions.)
[ballot] Yes [ballot] No Amount
4f [Current] Did the plan have a loss, whether or not reimbursed
by the plan's fidelity bond, that was caused by fraud or dishonesty?
[ballot] Yes [ballot] No Amount
4g [Current Line 4g revised] Did the plan hold any assets that
either did not have a readily determinable fair value or were not
valued by an independent third party appraiser? (See instructions)
[ballot] Yes [ballot] No Amount
4h [Current] Did the plan receive any noncash contributions
whose value was neither readily determinable on an established
market nor set by an independent third party appraiser?
[ballot] Yes [ballot] No Amount
4i [Current Line 4i; Except would now break out question into
4i(1) and 4i(2) and require use of specified structured data format
to complete and file Schedules of Assets]
(1) Did the plan have assets held for investment at the end of
the year? If ``Yes,'' you must complete the Line 4i(1) Schedule of
Assets Held for Investment at End of Year.
[ballot] Yes [ballot] No
(2) Did the plan have assets held for investment that were sold
or otherwise disposed of during the plan year (see instructions)? If
``Yes,'' you must complete the Line 4i(2) Schedule of Assets
Disposed of During the Plan Year.
[ballot] Yes [ballot] No
4j [Current, but would require use of specified structured data
format to complete and file Line 4j Schedule of Reportable
Transactions] Were any plan transactions or series of transactions
in excess of 5% of the current value of plan assets? If ``Yes,'' you
must complete the Schedule of Reportable Transactions. (See
instructions). Small plans that were eligible for and claimed the
small plan audit waiver do not need to attach the Line 4j Schedule
of Reportable Transactions.
[ballot] Yes [ballot] No
[Part of current Line 4k moved to Form 5500; part moved to Part
V of Schedule H]
4k [Current 4l] Has the plan failed to provide any benefit when
due under the plan?
[ballot] Yes [ballot] No Amount
4l [Current 4m] If this is an individual account plan, was there
a blackout period? (See instructions and 29 CFR 2520.101-3.)
[ballot] Yes [ballot] No Amount
4m [Current 4n] If you answered ``Yes'' to Line 4l, check the
``Yes'' box here if you either provided the required notice or one
of the exceptions to providing the notice applied under 29 CFR
2520.101-3.
[ballot] Yes [ballot] No
4n [New] Is this a participant-directed individual account plan
(e.g., a 401(k)-type or 403(b) defined contribution pension plan),
subject to the requirements in 29 CFR 2550.404a5 to disclose plan
and investment related information to participants and
beneficiaries?
[ballot] Yes [ballot] No
4o [New] If you answered ``Yes'' to Line 4n, did the plan
provide participants and
[[Page 47584]]
beneficiaries the plan and investment disclosures required under 29
CFR 2550.404a-5?
[ballot] Yes [ballot] No
If you answered ``Yes,'' you must attach the investment option
comparative chart or charts that were used to satisfy the disclosure
requirement in 29 CFR 2550.404a-5(d)(2).
4p [New] If you answered ``Yes,'' to Line 4n, enter the number
of designated investment alternatives (DIAs) available under the
plan and indicate the number of DIAs that are index funds. Also,
check all that apply to indicate the types of DIAs available under
the plan:
[ballot] Domestic Stock/Equity
[ballot] Bond/income
[ballot] Balanced/target allocation
[ballot] Money Market
[ballot] Target date/Lifecycle
[ballot] International/Global Stock/Equity
[ballot] Sector/economy segment
[ballot] Other funds (Describe)
4q [New] If you answered ``Yes,'' to Line 4n, did the plan make
available to participants and beneficiaries a designated investment
manager (DIM)?
[ballot] Yes [ballot] No Enter name of DIM.
4r [New] If you answered ``Yes,'' to Line 4n, did the plan make
available to participants and beneficiaries any brokerage window,
self-directed brokerage account or similar plan arrangements that
enabled participants to select investments beyond those designated
by the plan?
[ballot] Yes [ballot] No
If you answered ``Yes'' to Line 4r, enter the number of
participants that utilized the account or arrangement
4s [New] Did the plan trust incur unrelated business taxable
income (UBTI)?
[ballot] Yes [ballot] No [ballot] NA
If ``Yes,'' enter amount,
4t [New] Were all plan assets valued at least annually at fair
market value?
[ballot] Yes [ballot] No
4u [New] Did any employer sponsoring the plan pay any of the
administrative expenses of the plan that were not reported on
Schedule H, Line 2i?
[ballot] Yes [ballot] No
4v [New] Did any person who is disqualified under ERISA Section
411, serve or was permitted to serve the plan in any capacity?
[ballot] Yes [ballot] No
4w [New] Does the plan have investment acquisitions that are
leveraged, including assets subject to collateralized lending
activities (e.g., securities lending arrangements, repurchase
agreements (repos), etc.)?
[ballot] Yes [ballot] No If ``Yes,'' you must complete Lines 4w(1),
(2), and (3).
(1) Check box to indicate type of activity:
[ballot] securities lending, including repurchase agreements or
sell/buy-backs
[ballot] other, e.g., transactions that subjected plan assets to a
mortgage, lien, or other security interest (describe)
(2) (A) amount of cash obligated in connection with
collateralized lending activities at end of year
(B) value of securities obligated in connection with
collateralized lending activities at end of year
(C) other assets obligated in connection with collateralized
lending activities at end of year
(3) approximate ratio of collateralized/leveraged investments to
total plan assets at end of year
4x [New] Did the plan sponsor or its affiliates provide any
services to the plan in exchange for direct or indirect
compensation?
[ballot] Yes [ballot] No
4y [New (based on 1998 Line 8a)] Is the plan's summary plan
description (SPD), including any summary descriptions of
modifications, in compliance with the content requirements in 29 CFR
2520.102-3? (See instructions.)
[ballot] Yes [ballot] No
4z [New] If this is an individual account plan, were there any
checks to participants or beneficiaries that were uncashed as of the
end of the plan year? [ballot] Yes [ballot] No. If ``Yes,'' complete
4z(1)-(4)
(1) Enter number of uncashed checks
(2) Enter total value of uncashed checks
(3) Describe the procedures followed by the plan to verify a
participant's or beneficiary's address before a check was mailed.
(4) Describe the procedures followed by the plan to monitor
uncashed checks, including steps to locate ``missing'' or ``lost''
participants.
Part V Termination Information on Accountants, Enrolled Actuaries and
Other Service Provider
(See Instructions.) (Complete as many entries as needed.)
5 [Current Part III of Schedule C except adds check boxes to
element (c)] Has any accountant or actuary been terminated? [ballot]
Yes [ballot] No If ``Yes, complete elements (a)-(f).
5a Name
5b EIN
5c [Current element (c), but adds check boxes to distinguish
between accountant and actuary] Position and title (See
instructions.)
[ballot] Accountant
[ballot] Actuary
5d Address
5e Telephone
5f Explanation of reason for termination
6 [New] Have any of the plan's service providers, other than an
accountant or actuary who has been identified in Line 5, been
terminated for a material failure to meet the terms of a service
arrangement or failure to comply with Title I of ERISA, including
the failure to provide required disclosures under 29 CFR 2550.408b-
2? [ballot] Yes [ballot] No If ``Yes,'' complete elements (a)-(e) to
identify the service provider.
6a Name
6b EIN
6c Address
6d Telephone
6e Explanation of reason for termination
6f [ballot] Check if termination was due to failure to provide
required disclosures under 29 CFR 2550.408b-2.
Part VI Plan Termination Information
7a [Revised to ask about any resolution to terminate regardless
of when adopted] Has a resolution to terminate the plan been
adopted? You must continue to report a pending resolution until the
plan terminates and is no longer filing the Form 5500 Annual Return/
Report. (See instructions.)?
[ballot] Yes [ballot] No If ``Yes,'' complete Line 7a(1)-(3) below:
(1) [New] Effective date of plan termination:
(2) [New] Year the plan assets were distributed to plan
participants and beneficiaries:
(3) [Current 5a] The amount of plan assets that reverted to the
employer this year
7b [Current 5b] Transfer to other plans. Did this plan transfer
assets or liabilities to another plan since the (20XX-1) filing?
[ballot] Yes [ballot] No If ``Yes,'' complete elements (1)-(5) to
provide the following information with respect to each plan to which
the assets or liabilities were transferred. Complete as many entries
as needed to identify all transfers.
(1) [Current 5b(2)] EIN
(2) [Current 5b(3)] PN
(3) [New] Date of transfer:
(4) [Current 5b(1)] Name of Plan (Use name on transferee plan's
Form 5500 Annual Return/Report filing.):
(5) [New] Type of transfer:
[ballot] Merger
[ballot] Consolidation
[ballot] Spinoff
[ballot] Other (Describe)
(6) [Part of current Line 4k] Were all plan assets transferred
to another plan? [ballot] Yes [ballot] No
[Current 5c moved to Form 5500]
7c [New] Transfers from other plans. Did another plan
transferred assets or liabilities to this plan since the (20XX-1)
filing, or in the case of a first plan filing, transfer assets or
liabilities in conjunction with the creation of this new plan?
[ballot] Yes [ballot] No If ``Yes,'' provide the following
information with respect to each plan from which assets or
liabilities were transferred:
(1) EIN
(2) PN
(3) Date of transfer
(4) Name of Plan (Use name on transferor Plan's Form 5500 Annual
Return/Report filing.):
(5) Type of transfer:
[ballot] Merger
[ballot] Consolidation
[ballot] Spinoff
[ballot] Other (Describe)
7d [New] Terminated Defined Contribution Pension Plans:
Transfers to Financial Institution. Did this plan, as part of the
procedures for terminating the plan, transfer plan assets to
interest bearing federally insured bank accounts in the name of
missing participants? [ballot] Yes [ballot] No If ``Yes,'' complete
elements (1)-(5). List each financial institution where plan assets
were transferred. You must continue reporting this information until
the final return/report is filed for the plan.
[[Page 47585]]
(1) Financial Institution's Name
(2) Financial Institution's EIN
(3) Date of transfer
(4) Number of accounts established
(5) Total amount transferred
7e [Part of current Line 4k with a new subpart to report the
year.] Were all the plan assets distributed to participants or
beneficiaries? [ballot] Yes [ballot] No
Part VI--Trustee Information--[Current Part V but proposed no longer
optional starting 2016 See IRS Federal Register Notice ``Proposed
Collection; Comment Request for the Annual Return/Report of Employee
Benefit Plan'']
8 Complete as many entries as needed to identify all trusts
holding plan assets. Do not include trusts that are part of pooled
investment funds that hold the assets of two or more unrelated
plans.
8a [Current] Name of Trust
8b [Current] Trust EIN
8c [New] Name of Trustee/Custodian
(1) [New] Trustee/Custodian Address
(2) [New] Telephone Number
(3) [New--intended to be electronic signature] Date and
Signature of Trustee/Custodian:
Trustee Signature for Purposes of the Code
SIGN HERE Signature of plan trustee or custodian:
Enter Date:
Enter name of individual signing as trustee or custodian:
Schedule H Line 4a--Schedule of Delinquent Participant Contributions
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(a) Amount remitted late to plan (b) Amount due, (c) Number of (d)(1) Amount (e) Amount pending (f) Amount (g) Check here if (h) For any amount (i)(1) If
during plan year but unremitted contribution corrected in VFCP correction in corrected outside participant loan reported in reporting for a
during the plan cycles involved (2) Amount not VFCP VFCP repayments are Element (d), did multiemployer
year (number of corrected under included: you file your IRS plan, amount, if
payrolls) PTE 2002-51. [ballot] Form 5330 and pay any, determined
applicable excise during the plan
taxes? year to be
[ballot] Yes uncollectible
[ballot] No. (2) Explain what
steps were taken
to collect
overdue amounts
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Line 4i(1) Schedule of Assets Held for Investment at End of Year
(Complete as many entries in each element as needed to identify all
assets held for investment at end of year)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(a) Assets Held directly by the plan (including assets held through an participant-directed brokerage window) For each asset which the plan holds for
investment purposes that is not a type of assets required to be listed in (b) through (e) below, complete elements (i)-(vii).
---------------------------------------------------------------------------------------------------------------------------------------------------------
(vii) Description
of investment,
including, as
applicable, share
class, maturity
date, rate of
interest, par or
(iv) CUSIP, CIK, maturity value,
(i) Check if issuer, borrower, (ii) Name of (iii) Is the asset LEI, NAIC Company (vi) Indicate Sch. including whether
lessor or similar party is party- issuer, borrower, a hard-to-value Code, other (v) Cost H, Line 1b asset asset/investment
in- interest [ballot] lessor, or similar asset? [ballot] Yes registration category. is subject to
party [ballot] No number: surrender charge.
See instructions
for reporting
assets held
through a
participant-
directed brokerage
account.
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
(b) Investments in Master Trust (repeat as many entries as needed to identify holdings in master trusts) For each master trust in which the plan
invested, break out plan's interest in each asset in the master trust(s) in elements (i)-(viii). Do not include master trust holdings in which the plan
has no interest.
---------------------------------------------------------------------------------------------------------------------------------------------------------
(i) Enter name, EIN/PN of sponsor of master trust used on master trust's Form 5500.
---------------------------------------------------------------------------------------------------------------------------------------------------------
(viii) Description
of investment,
including, as
(v) Enter all that applicable, share
(iii) Name of (iv) Is the asset a apply: EIN, CUSIP, class, maturity
(ii) Check if issuer, borrower, issuer, borrower, hard-to-value CIK, LEI, NAIC (vii) Indicate Sch. date, rate of
lessor or similar party is party- lessor, or similar asset? [ballot] Yes Company Code, other (vi) Cost H, Line 1b asset interest, par or
in- interest [ballot] party (See [ballot] No registration category maturity value,
instructions) number: including whether
asset/investment
is subject to
surrender charge.
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 47586]]
--------------------------------------------------------------------------------------------------------------------------------------------------------
(c) Investments in PSAs and CCTs (repeat as many entries as needed to identify holdings in PSAs and CCTs) If the PSA filed a Form 5500, complete
elements (i)-(vii) indicating the value of the plan's shares in the PSA or CCT. For PSAs or CCTs that have not filed a Form 5500, break out plan's
proportionate interest in each asset in the PSA of CCT in elements (i)-(ix) and include the name and identifying numbers for the non-filing CCT or PSA,
as well a description of the asset held through the non-filing CCT or PSA.
---------------------------------------------------------------------------------------------------------------------------------------------------------
(i) Enter name, EIN/PN of sponsor of CCT/PSA. (ii) Check if issuer, borrower, lessor or similar party
------------------------------------------------------------------------------------------------ is party-in-interest [ballot]
--------------------------------------------------------
(ix) Description
of investment,
including, as
(iv) Name of (vi) ) Enter all applicable, share
(iii) Did the PSA or CCT filed a issuer, borrower, (v) Is the asset a that apply: EIN, class, maturity
Form 5500 Yes [ballot] No lessor, or similar hard-to-value CUSIP, CIK, LEI, (viii) Indicate date, rate of
[ballot] party (see asset? [ballot] Yes NAIC Company Code: (vii) Cost Sch. H, Line 1b interest, par or
Instructions) [ballot] No Other registration asset category maturity value,
number: including whether
asset/investment
is subject to
surrender charge.
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
(d) Investments in 102-12 Investment Entities (repeat as many entries as needed to identify holdings in 103-12
IEs). For each 103-12IE in which the plan invested, complete elements (i)-(vii) indicating the value of the
plan's shares in the in each 103-12IE in elements (i)-(viii).
-----------------------------------------------------------------------------------------------------------------
(i)Enter name, EIN of provider of the 103-12 IE. (ii) Check if
------------------------------------------------------------------------------------------------ issuer,
borrower,
lessor or
similar party
is party-in-
interest
[ballot]
----------------
(viii)
(v) Enter all Description of
that apply: investment,
(iv) Is the EIN, CUSIP, including, as
(iii) Name of issuer, asset a hard-to- CIK, LEI, NAIC (vii) Indicate applicable,
borrower, lessor, or similar value asset? Company Code: (vi) Cost Line 1b asset share class,
party (See instructions) [ballot] Yes Other category. maturity date,
[ballot] No registration rate of
number: interest, par
or maturity
value,
including
whether asset/
investment is
subject to
surrender
charge.
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Line 4i(2) Schedule of Assets Disposed of During the Plan Year
[Current elements of Schedule of Assets Acquired and Disposed of
During Plan Year; element (b) currently unlettered] (Complete as
many entries as necessary to identify all assets sold during plan
year
--------------------------------------------------------------------------------------------------------------------------------------------------------
(a) Enter name, EIN of issuer, borrower, lessor, or similar party (b) Check if issuer, borrower, lessor or similar party is party-in-
------------------------------------------------------------------------------------ interest [ballot]
--------------------------------------------------------------------
(j) Description
(d) Enter all of investment,
that apply: EIN, including
(c) Check if asset was CUSIP, CIK, LEI, (e) Sch. H, Line (h) Expenses (i) Net gain maturity date,
acquired during plan year NAIC Company 1b category (f) Cost (g) Selling incurred with (loss) on rate of
[ballot] Code, Other price disposal of transaction interest,
registration asset collateral,
number: par, or
maturity value
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
Schedule H, Line 4j--Schedule of Reportable Transactions
[Current Line 4j Schedule, except (a) is new and remaining elements
are re-lettered in sequence] Complete as many repeating elements as
necessary to identify all reportable transactions.
----------------------------------------------------------------------------------------------------------------
(a) Check here if transaction (b) Identity of (c) Description of asset (include (d) Purchase price
involved a person/entity known party involved interest rate and maturity in case of -------------------
to be party-in-interest [ballot] -------------------- a loan)
--------------------------------- ----------------------------------------
(g) Expense (i) Current value
incurred with of asset on
(e) Selling price (f) Lease rental transaction (h) Cost of asset transaction date
(including all
fees)
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
[New Schedule] Schedule J (Form 5500)--Group Health Plan Information
For calendar plan year 20XX or fiscal plan year beginning DD/MM/
20XX and ending DD/MM/20XX+1
A Name of plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown on Line 2a of Form 5500
D Employer Identification Number (EIN)
Plans that have fewer than 100 participants at the beginning of
the plan year and are fully insured (see instructions) complete only
basic identifying information and Part I, Lines 1-8. GIAs must
complete a separate Schedule J for each participating plan.
Part I--Group Health Plan Characteristics
1 Approximate number of persons (including participants,
beneficiaries and dependents of participants) covered under the plan
at the end of the plan year?
2 The plan offers health coverage to the following (check all
that apply):
[ballot] employees
[[Page 47587]]
[ballot] spouses
[ballot] children
[ballot] retirees
[ballot] retirees only
3 Indicate which of the following types of benefit(s) and design
characteristics are included under the plan. (Check all that apply):
[ballot] medical/surgical benefits
[ballot] mental health/substance use disorder benefits
[ballot] pharmacy or prescription drug benefits
[ballot] wellness program
[ballot] preventive care services
[ballot] emergency services
[ballot] pregnancy benefits
[ballot] vision
[ballot] dental
4 Health funding and benefit arrangement (check all that apply):
4a(1)(a) [ballot] health insurance issuer. If you check this
box, enter name(s), EIN, and National Insurance Product Registry
Number of insurance carriers providing benefits under the plan.
4a(1)(b) If the health funding or benefit arrangement is through
a prototype/off-the-shelf insurance product, enter the
identification number of the prototype/off-the-shelf insurance
product.
4a(1)(c) Please check whether one or both of the following are
used to pay premiums:
[ballot] employer contributions
[ballot] participant contributions
4a(2) [ballot] benefits paid from general assets of the employer
[ballot] employer contributions
[ballot] participant contributions
4a(3) [ballot] trust
[ballot] employer contributions
[ballot] participant contributions
5 Check all that apply to the plan:
[ballot] one or more benefit package options claiming grandfathered
status under the Affordable Care Act
[ballot] high deductible health plan
[ballot] health reimbursement arrangement (HRA) or plan includes an
HRA
[ballot] health flexible spending account (FSA) or plan includes an
FSA
6a How many persons were offered COBRA benefits during the plan
year?
6b Of the persons counted in line 6a, how many persons elected
COBRA benefits?
6c How many persons were receiving coverage under the plan
through COBRA during the plan year?
7a Did the plan or plan sponsor receive any rebates,
reimbursement, or refunds other than those reported on Schedule A
from service providers during the plan year? [ballot] Yes [ballot]
No If ``Yes,'' you must complete Line 7b. If ``No,'' skip to Line 8.
7b(1) If you answered ``Yes'' to Line 7a, enter separately the
amount and date received of each rebate, reimbursement, or refund.
For each rebate, reimbursement, or refund listed, complete elements
7b(2) and 7b(3).
(2) Type of service provider that provided each rebate,
reimbursement, or refund
[ballot] health insurance issuer
[ballot] third-party administrator
[ballot] pharmacy benefit manager
[ballot] other (specify)
(3) How each rebate, reimbursement, or refund was used (Check
all that apply):
[ballot] amount returned to participants
[ballot] premium holiday
[ballot] payment of benefits
[ballot] other
8a If any benefits were provided pursuant to an insurance policy
that was not reported on Schedule A, were there any premium payment
delinquencies for premiums due but unpaid during the year? [ballot]
Yes [ballot] No If ``Yes,'' enter number of times delinquent and for
each delinquency enter the number of days delinquent
8b If you answered ``Yes'' to line 8a, indicate whether any
premium delinquency resulted in a lapse in coverage. If you answered
``No'' to line 8a, enter ``N/A''. [ballot] Yes [ballot] No [ballot]
N/A
Part II--Service Provider and Stop Loss Insurance Information
(Repeat as many line entries as necessary to report all service
providers under each category that have not already been reported on
Schedule A or Schedule C.)
9 Third Party Administrator/Claims Processor, including a health
insurance issuer subject to an ``administrative services only
(ASO)'' or other agreement: [ballot] N/A
a Name, address and telephone number
b EIN
c NAIC NPN
d If third party administrator/claims processing or similar
services are being provided to the plan through a prototype/off-the-
shelf ASO arrangement, enter the identification number of such
insurance product
10 Mental Health Benefits Manager: [ballot] N/A
a Name, address and telephone number
b EIN
c NAIC NPN
11 Substance Use Disorder Benefits Manager: [ballot] N/A
a Name, address and telephone number
b EIN
c NAIC NPN
12 Pharmacy Benefit Manager/Drug Provider: [ballot] N/A
a Name, address and telephone number
b EIN
c NAIC NPN
13 Independent Review Organization: [ballot] N/A
a Name, address and telephone number
b EIN
c NAIC NPN
14 Wellness Program Manager: [ballot] N/A (may be the same
contact information for wellness program required under 29 CFR
2590.702(f)(2)(v)).
a Name, address and telephone number
b EIN
c NAIC NPN
15 Was there a stop loss policy associated with the plan's
obligation to pay health benefits? If so, complete the following
(Include information on all stop loss policies issued in connection
with plan benefits, including policies with the employer/plan
sponsor as the insured).
a Name of insurance carrier
b EIN
c NAIC NPN
d Total premium
e Attachment point of coverage
Individual attachment point of coverage (if applicable)
Aggregate attachment point of coverage (if applicable)
f Claim Limit
Individual claim limit (if applicable)
Aggregate claim limit (if applicable)
g Policy or contract year from ____ to ____.
h Check this box if the employer/plan sponsor is the insured
[ballot]
Part III--Financial Information.
Plans that complete Schedule H skip to Part IV.
16 Contributions received during the plan year or receivable as
of end of plan year:
a Employer contributions received
b Employer contributions receivable
c Participant contributions received
d Participant contributions receivable
e Other contributions received or receivable (including non-
cash)
f Total contributions. Add Lines 16 a-e.
17 Was there a failure to transmit to the plan any participant
contributions or repayments as of the earliest date on which such
contributions can reasonably be segregated from the employer's
general assets as described in 29 CFR 2510.3-102? [ballot] Yes
[ballot] No
Part IV--Health Benefit Claims Processing and Payment.
18a Enter the number of post-service benefit claims submitted
during the plan year.
(1) How many of those claims were approved during the plan year?
(2) How many of those claims were denied during the plan year?
(3) How many of those claims were pending at the end of the plan
year?
18b Enter the number of post-service benefit claim denials
appealed during the plan year.
(1) How many of those appeals were upheld during the plan year
as denials?
(2) How many of those appeals were overturned and approved
during the plan year after appeal?
18c Enter the number of pre-service benefit claims appealed
during the plan year.
(1) How many of those appeals were upheld during the plan year
as denials?
(2) How many of those appeals were approved during the plan year
after appeal?
19 Were there any claims for benefits or appeals of adverse
benefit determinations that were not adjudicated within the required
timeframes? [ballot] Yes [ballot] No. If ``Yes,'' enter
(1) Number of claims
(2) Number of appeals
20 Did the plan fail to pay any claims during the plan year
within one (1) month of being approved for payment? [ballot] Yes
[ballot] No If ``Yes,'' enter the
(1) Number of claims not paid within one (1) month
(2) Total amount not paid within one (1) month
[[Page 47588]]
(3) Number of claims not paid within three (3) months or longer
21 Total dollar amount of benefits paid pursuant to claims
during the plan year.
Part V--Compliance Information. [Current Form 5500 Part III; the move
limits plans required to complete this part to those providing health
benefits] Plans that file the Form M-1, skip questions 24-30.
22a Were all plan assets held in trust, held by an insurance
company qualified to do business in a State, or as insurance
contracts or policies issued by such an insurance company? (See
section 403 of ERISA and 29 CFR 2550.403a-1 and 2550.403b-1)?
[ballot] Yes [ballot] No If you check ``No,'' you must complete Line
22b.
22b Check all that apply and enter an explanation if checking
``Other'':
[ballot] Plan assets not held in trust based on reliance on
Technical Release 92-01
[ballot] Other (explain)
23 Are the plan's summary plan description (SPD), including any
summary descriptions of modifications, and summary of benefits and
coverage (SBC) in compliance with the applicable content
requirements? (See instructions.)
23a Summary Plan Description (SPD): [ballot] Yes [ballot] No
23b Summary of Benefits and Coverage (SBC) [ballot]Yes
[ballot]No
24 Is the coverage provided by the plan in compliance with the
provisions of the Health Insurance Portability and Accountability
Act of 1996, as incorporated in ERISA, and the Department's
regulations thereunder?
[ballot] Yes [ballot] No [ballot] N/A
25 Is the coverage provided by the plan in compliance with the
provisions of Title I of the Genetic Information Nondiscrimination
Act of 2008 as incorporated in ERISA, and the Department's
regulations issued thereunder?
[ballot] Yes [ballot] No [ballot] N/A
26 Is the coverage provided by the plan in compliance with the
Mental Health Parity Act of 1996 and the Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008 and
the Department's regulations issued thereunder?
[ballot] Yes [ballot] No [ballot] N/A
27 Is the coverage provided by the plan in compliance with the
Newborns' and Mothers' Health Protection Act of 1996 and the
Department's regulations issued thereunder?
[ballot] Yes [ballot] No [ballot] N/A
28 Is the coverage provided by the plan in compliance with the
Women's Health and Cancer Rights Act of 1998?
[ballot] Yes [ballot] No [ballot] N/A
29 Is the coverage provided by the plan in compliance with
Michelle's Law?
[ballot] Yes [ballot] No [ballot] N/A
30 Is the coverage provided by the plan in compliance with the
Affordable Care Act and the Department's regulations issued
thereunder?
[ballot] Yes [ballot] No [ballot] N/A
31a Was the plan subject to the Form M-1 filing requirements
during the plan year? (See instructions and 29 CFR 2520.101-2.)
[ballot] Yes [ballot] No If ``Yes'' is checked, complete Lines 31b
and 31c.
31b Is the plan currently in compliance with the Form M-1 filing
requirements? (See instructions and 29 CFR 2520.101-2.) [ballot] Yes
[ballot] No
31c Enter the Receipt Confirmation Code for the 20XX Form M-1
annual report. If the plan was not required to file the 20XX Form M-
1 annual report, enter the Receipt Confirmation Code for the most
recent Form M-1 that was required to be filed under the Form M-1
filing requirements. (Failure to enter a valid Receipt Confirmation
Code will subject the Form 5500 Annual Return/Report filing to
rejection as incomplete.)
Receipt Confirmation Code
Schedule MB--Multiemployer Defined Benefit Plan and Certain Money
Purchase Plan Actuarial Information
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown in Line 2a of the Form 5500 or
5500-SF
D Employer Identification Number (EIN)
E Type of plan: (1) [ballot] Multiemployer Defined Benefit (2)
[ballot] Money Purchase (see instructions)
1 [Current]
1a Enter the valuation date:
1b Assets:
(1) Current value of assets
(2) Actuarial value of assets for funding standard account
1c(1) Accrued liability for plan using immediate gain method
1c(2) Information for plans using spread gain methods:
(a) Unfunded liability for methods with bases
(b) Accrued liability under entry age normal method
(c) Normal cost under entry age normal method
1c(3) Accrued liability under unit credit cost method
1d Information on current liabilities of the plan:
(1) Amount excluded from current liability attributable to pre-
participation service (see instructions)
(2) ``RPA '94'' information:
(a) Current liability
(b) Expected increase in current liability due to benefits
accruing during the plan year
(c) Expected release from ``RPA `94'' current liability for the
plan year
(3) Expected plan disbursements for the plan year
2 [Current] Operational information as of the beginning of this
plan year:
a Current value of assets (see instructions)
----------------------------------------------------------------------------------------------------------------
(1) Number of
participants (2) Current liability
----------------------------------------------------------------------------------------------------------------
b ``RPA `94'' current liability/participant count breakdown
----------------------------------------------------------------------------------------------------------------
(1) For retired participants and beneficiaries receiving
payment
----------------------------------------------------------------------------------------------------------------
(2) For terminated vested participants
----------------------------------------------------------------------------------------------------------------
(3) For active participants
----------------------------------------------------------------------------------------------------------------
(a) Non-vested benefits
(b) Vested benefits
(c) Total active
----------------------------------------------------------------------------------------------------------------
(4) Total
----------------------------------------------------------------------------------------------------------------
c If the percentage resulting from dividing Line 2a by Line
2(b)(4), column (2), is less than 70%, enter such percentage.
3 [Current, except report withdrawal liability payments
separately from employer contributions and there is minor re-wording
of Lines 3(b) and (c).] Contributions made to the plan for the plan
year by employer(s) including withdrawal liability payments and
contributions to the plan made by employees:
[[Page 47589]]
----------------------------------------------------------------------------------------------------------------
3 Contributions made to the plan for the plan year by employer(s) including withdrawal liability payments and
contributions to the plan made by employees:
-----------------------------------------------------------------------------------------------------------------
(b) Contribution amount (c) Withdrawal (d) Contribution amount
(a) Date (MM-DD-YYYY) paid by employers liability payments paid by employees
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Totals:
----------------------------------------------------------------------------------------------------------------
4 Information on plan status:
4a [Current] Funded percentage for monitoring plan's status
(Line 1b(2) divided by Line 1c(3))
4b [Current] Enter code to indicate plan's status (see
instructions for attachment of supporting evidence of plan's
status). If code is ``N,'' go to Line 5.
4c [Current] Is the plan making the scheduled progress under any
applicable funding improvement or rehabilitation plan? [ballot] Yes
[ballot] No
4d [Current] If the plan is in critical status or critical and
declining status, were any benefits reduced (see instructions)?
[ballot] Yes [ballot] No
4e [Current] If Line 4d is ``Yes,'' enter the reduction in
liability resulting from the reduction in benefits (see
instructions), measured as of the valuation date.
4f [Current] If the rehabilitation plan projects emergence from
critical status or critical and declining status, enter the plan
year in which it is projected to emerge.
If the rehabilitation plan is based on forestalling possible
insolvency, check here [ballot] and enter the plan year in which
insolvency is expected.
5 [Current instructions and for 2016 as data element, except
prior Line 5i (Reorganization) is deleted and Lines 5j-n are
renumbered to reflect MPRA 2014 changes] Actuarial cost method used
as the basis for the plan year's funding standard account
computations (check all that apply):
5a [ballot] Attained age normal
5b [ballot] Entry age normal
5c [ballot] Accrued benefit (unit credit)
5d [ballot] Aggregate
5e [ballot] Frozen initial liability
5f [ballot] Individual level premium
5g [ballot] Individual aggregate
5h [ballot] Shortfall
5i [Current Line 5j] [ballot] Other (specify):
5j [Current Line 5k] If box h is checked, enter period of use of
shortfall method
5k [Current Line 5l] Has a change been made in funding method
for this plan year? [ballot] Yes [ballot] No
5l [Current Line 5m] If Line 5k is ``Yes,'' was the change made
pursuant to Revenue Procedure 2000-40 or other automatic approval?
[ballot] Yes [ballot] No
5m [Current Line 5n] If Line 5k is ``Yes,'' and line l is
``No,'' enter the date (MM/DD/YYYY) of the ruling letter (individual
or class) approving the change in the funding method.
6 [Current--except that Lines 6(g)(2) and 6(h)(2) with check
boxes are added to be answered if a statement showing the actuary's
estimate of the rate of return (actuarial or market value) and
calculation of the rate is attached.] Checklist of certain actuarial
assumptions:
[GRAPHIC] [TIFF OMITTED] TP21JY16.000
7 [Current except that information on amortization charges and
credits that was previously reported for Lines 9c and 9h as an
attachment would be reported on Line 7 of the form.]
[[Page 47590]]
----------------------------------------------------------------------------------------------------------------
Amortization Bases (This will have a variable number of repeating rows; but typically fewer than 50)
-----------------------------------------------------------------------------------------------------------------
(4) Years
(2) Outstanding (3) Valuation date remaining in (5) Amortization
(1) Type of base balance of base was amortization amount
remaining payments established period
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Totals:
----------------------------------------------------------------------------------------------------------------
8 Miscellaneous information:
8a [Current] If a waiver of a funding deficiency has been
approved for this plan year, enter the date (MM/DD/YYYY) of the
letter ruling granting the approval.
8b(1)(a) [Current] Is the plan required to provide a projection
of expected benefit payments? [ballot] Yes [ballot] No
8b(1)(b) [Current except moved to the face of the form] If
8b(1)(a) is ``Yes,'' complete the schedule below:
------------------------------------------------------------------------
Schedule of Projection of Expected Annual
Plan Year Benefit Payments
------------------------------------------------------------------------
Current plan year
------------------------------------------------------------------------
Current plan year plus 1
------------------------------------------------------------------------
Etc.
------------------------------------------------------------------------
Current plan year plus 9
------------------------------------------------------------------------
8b(2)(a) [Current] Is the plan required to provide a Schedule of
Active Participant Data ? (see instructions) [ballot] Yes [ballot]
No
8b(2)(b) [Current except moved to the face of the form] If
8b(2)(a) is ``Yes,'' complete the schedule below and items 8b(2)(c)
and 8b(2)(d).
[GRAPHIC] [TIFF OMITTED] TP21JY16.001
8b(2)(c) [New] Average age of active participants as of the
valuation date
8b(2)(d) [New] Average credited service of active participants
as of the valuation date
8b(3)(a) [New] Is the plan required to provide a Schedule of
Retired Participants and Beneficiaries Receiving Payment Data? (See
the instructions) [ballot] Yes [ballot] No
8b(3)(b) [New] If 8b(3)(a) is ``Yes,'' complete the schedule
below and items 8b(3)(c) and 8b(3)(d).
Schedule of Retired Participants and Beneficiaries Receiving Payment
Data
------------------------------------------------------------------------
Average Annual In-
Attained Age Number Pay Benefit Amount
------------------------------------------------------------------------
Under 55
------------------------------------------------------------------------
55 to 59
------------------------------------------------------------------------
Etc.
------------------------------------------------------------------------
90 and up
------------------------------------------------------------------------
8b(3)(c) [New] Average Age for Retired Participants and
Beneficiaries as of the valuation date
8b(3)(d) [New] Average Annual In-Pay Benefit for Retired
Participants and Beneficiaries as of the valuation date
8b(4)(a) [New] Is the plan required to provide a Schedule of
Terminated Vested Participant Data? (See the instructions) [ballot]
Yes [ballot] No
8b(4)(b) [New] If 8b(4)(a) is ``Yes,'' complete the schedule
below and items 8b(4)(c) through 8b(4)(f).
[[Page 47591]]
Schedule of Terminated Vested Participant Data
------------------------------------------------------------------------
Average Annual
Attained Age Number Benefit Amount
------------------------------------------------------------------------
Under 25
------------------------------------------------------------------------
25 to 29
------------------------------------------------------------------------
Etc.
------------------------------------------------------------------------
70 and up
------------------------------------------------------------------------
8b(4)(c) [New] Average age of terminated vested participants as
of the valuation date
8b(4)(d) [New] Average annual benefit of terminated vested
participants as of the valuation date
8b(4)(e) [New] Assumed form of payment shown
8b(4)(f) [New] Assumed age of first payment for benefits shown
8c [Current] Are any of the plan's amortization bases operating
under an extension of time under section 412(e) (as in effect prior
to 2008) or section 431(d) of the Code? [ballot] Yes [ballot] No
8d [Current] If Line 8c is ``Yes,'' provide the following
additional information:
(1) Was an extension granted automatic approval under section
431(d)(1) of the Code? [ballot] Yes [ballot] No
(2) If Line 8d(1) is ``Yes,'' enter the number of years by which
the amortization period was extended.
(3) Was an extension approved by the Internal Revenue Service
under section 412(e) (as in effect prior to 2008) or 431(d)(2) of
the Code? [ballot] Yes [ballot] No
(4) If Line 8d(3) is ``Yes,'' enter the number of years by which
the amortization period was extended (not including the number of
years in Line (2))
(5) If Line 8d(3) is ``Yes,'' enter the date of the ruling
letter approving the extension
(6) If Line 8d(3) is ``Yes,'' is the amortization base eligible
for amortization using interest rates applicable under section
6621(b) of the Code for years beginning after 2007? [ballot] Yes
[ballot] No
8(e) [Current] If box 5h is checked or Line 8c is ``Yes,'' enter
the difference between the minimum required contribution for the
year and the minimum that would have been required without using the
shortfall method or extending the amortization base(s).
Line 9 [Current, except a check box is added to Line 9f to be
answered if an explanation of a prior year credit balance/funding
deficiency discrepancy is attached.]
[[Page 47592]]
[GRAPHIC] [TIFF OMITTED] TP21JY16.002
[[Page 47593]]
10 [Current] Contribution necessary to avoid an accumulated
funding deficiency (see instructions)
11 [Current] Has a change been made in the actuarial assumptions
for the current plan year?
If ``Yes,'' see instructions. [ballot] Yes [ballot] No
Statement by Enrolled Actuary [Current, except that information
previously reported on an attachment per the instructions will be
reported on the Schedule.] To the best of my knowledge, the
information supplied in this schedule and accompanying schedules,
statements, and attachments, if any, is complete and accurate. Each
prescribed assumption was applied in accordance with applicable law
and regulations. In my opinion, each other assumption is reasonable
(taking into account the experience of the plan and reasonable
expectations) and such other assumptions, in combination, offer my
best estimate of anticipated experience under the plan.
Signature of actuary
Date
Type or print name of actuary
Most recent enrollment number
Firm name
Telephone number (including area code)
Address of firm
If the actuary has not fully reflected any regulation or ruling
promulgated under the statute in completing this schedule, provide
the information requested in the instructions in this line and check
here [ballot]
SCHEDULE R (Form 5500) Retirement Plan Information
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
A Name of plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown on line 2a of Form 5500
D Employer Identification Number (EIN)
Part I Distributions.
All references to distributions relate only to payments of
benefits during the plan year.
1 [Current] Total value of distributions paid in property other
than in cash or the forms of property specified in the instructions
2 [Current] Enter the EIN(s) of payor(s) who paid benefits on
behalf of the plan to participants or beneficiaries during the year
(if more than two, enter EINs of the two payors who paid the
greatest dollar amounts of benefits):
EIN(s):
Profit-sharing plans, ESOPs, and stock bonus plans, skip Line 3.
3 [Current Line 3, with new breakout numbers for active,
terminated vested, retired] Number of participants (living or
deceased) whose benefits were distributed in a single sum, during
the plan year
[Columns for (1) number of participants/(2) payment of
annuities/(3) payment of lump sums]
Active
Terminated Vested
Retired
4 [New] Were required minimum distributions made to 5% owners
who have attained age 70 \1/2\ (regardless of whether or not
retired) as required under section 401(a)(9) of the Internal Revenue
Code? [ballot] Yes [ballot] No [ballot] N/A
Part II Funding Information
(If the plan is not subject to the minimum funding requirements
of section of 412 of the Internal Revenue Code or ERISA section 302,
skip this Part)
5 [Current Line 4] Is the plan administrator making an election
under Code section 412(d)(2) or ERISA section 302(d)(2)? [ballot]
Yes [ballot] No [ballot] N/A
If the plan is a defined benefit pension plan, go to Line 9.
6 [Current Line 5] If a waiver of the minimum funding standard
for a prior year is being amortized in this plan year, see
instructions and enter the date of the ruling letter granting the
waiver.
If you completed Line 6, complete Lines 3, 9, and 10 of Schedule
MB and do not complete the remainder of this schedule.
7a [Current Line 6] Enter the minimum required contribution for
this plan year (include any prior year accumulated funding
deficiency not waived).
7b [Current] Enter the amount contributed by the employer to the
plan for this plan year
7c [Current] Subtract the amount in Line 7b from the amount in
Line 7a. Enter the result (enter a minus sign to the left of a
negative amount)
If you completed line 7c, skip Lines 9 and 10.
8 [Current Line 7] Will the minimum funding amount reported on
Line 7c be met by the funding deadline? [ballot] Yes [ballot] No
[ballot] N/A
9 [Current Line 8] If a change in actuarial cost method was made
for this plan year pursuant to a revenue procedure or other
authority providing automatic approval for the change or a class
ruling letter, does the plan sponsor or plan administrator agree
with the change?
[ballot] Yes [ballot] No [ballot] N/A
Part III Determination and Amendment
10 [Current Line 9] If this is a defined benefit pension plan,
were any amendments adopted during this plan year that increased or
decreased the value of benefits? If ``Yes,'' check the appropriate
box. If no, check the ``No'' box'': [ballot] Increase [ballot]
Decrease [ballot] Both [ballot] No
11a [Current 2016 Line 22a] If the plan is a master and
prototype plan (M&P) or volume submitter plan that received a
favorable IRS opinion letter or advisory letter, enter the date of
the letter _/_/_ and the serial number ___
11b [Current 2016 Line 22b] If the plan is an individually-
designed plan that received a favorable determination letter from
the IRS, enter the date of most recent determination letter: _/_/_.
[Current Part IV ESOPs--moved to new Schedule E]
Part IV [current Part V] Additional Information for Multiemployer
Defined Benefit Pension Plans
12 [Current Line 13] Enter the following information for each
employer that contributed more than 5% of total contributions to the
plan during the plan year (measured in dollars). See instructions.
Complete as many entries as needed to report all applicable
employers.
a Name of contributing employer
b EIN
c Dollar amount contributed by employer
d Date collective bargaining agreement expires (If employer
contributes under more than one collective bargaining agreement,
check box [ballot] and see instructions regarding required
attachment. Otherwise, enter the applicable date.)
e Contribution rate information (If more than one rate applies,
check this box [ballot] and see instructions regarding required
attachment. Otherwise, complete Lines 12e(1) and 12e(2).)
(1) Contribution rate (in dollars and cents)
(2) Base unit measure:
[ballot] Hourly
[ballot] Weekly
[ballot] Unit of production
[ballot] Other (specify)
13 [Current Line 14] Enter the number of participants on whose
behalf no contributions were made by an employer as an employer of
the participant for:
a The current year
b The plan year immediately preceding the current plan year
c The second preceding plan year
14. [Current Line 15] Enter the ratio of the number of
participants under the plan on whose behalf no employer had an
obligation to make an employer contribution during the current plan
year to:
a The corresponding number for the plan year immediately
preceding the current plan year
b The corresponding number for the second preceding plan year
15 [Current Line 16] Information with respect to any employers
who withdrew from the plan during the preceding plan year:
a Enter the number of employers who withdrew during the
preceding plan year:
b If Line 15a is greater than 0, enter the aggregate amount of
withdrawal liability assessed or estimated to be assessed against
such withdrawn employers.
16 [Current Line 17] If assets and liabilities from another plan
have been transferred to or merged with this plan during the plan
year, check box and see instructions regarding supplemental
information to be included as an attachment. [ballot]
[[Page 47594]]
Part V [Current Part VI] Additional information for Single-Employer and
Multiemployer Defined Benefit Pension Plans
17 [Current Line 18] If any liabilities to participants or their
beneficiaries under the plan as of the end of the plan year consist
(in whole or in part) of liabilities to such participants and
beneficiaries under two or more pension plans as of immediately
before such plan year, check box and see instructions regarding
supplemental information to be included as an attachment. [ballot]
18 [Current Line 19] If the total number of participants is
1,000 or more, complete Lines (a) through (c)
a Enter the percentage of plan assets held as:
Stock:
Investment-Grade Debt:
High-Yield Debt:
Real Estate:
Other:
b Provide the average duration of the combined investment-grade
and high-yield debt:
[ballot] 0-3 years
[ballot] 3-6 years
[ballot] 6-9 years
[ballot] 9-12 years
[ballot] 12-15 years
[ballot] 15-18 years
[ballot] 18-21 years
[ballot] 21 years or more
c What duration measure was used to calculate Line 18(b)?
[ballot] Effective duration [ballot] Macaulay duration [ballot]
Modified duration [ballot] Other (specify)
Part VI [New Part; all of these questions on IRS List for 2015 changes
and published in draft on the IRS's Form 5500-SUP]
Nondiscrimination and Coverage
19a If this is a section 401(k) plan, check the correct box to
indicate how the plan is intended to satisfy the nondiscrimination
requirements for employee deferrals and employer matching
contributions (as applicable) under section 401(k)(3) and 401(m)(2)?
[ballot] Design-based safe harbor method [ballot] ADP/ACP test
[ballot] Both
b If the ADP test is used, did the plan perform ADP testing for
the plan year using the ``current year testing method'' for
nonhighly compensated employees (Treas. Reg. sections 1.401(k)-
2(a)(2)(ii) [ballot] Yes [ballot] No
20a Check the box to indicate the method used by the plan to
satisfy the coverage requirements under section 410(b): [ballot]
ratio percentage test [ballot] average benefit test [ballot] N/A
b Does the plan satisfy the coverage and nondiscrimination tests
of sections 410(b) and 401(a)(4) by combining this plan with any
other plans under the permissive aggregation rules?
[ballot] Yes [ballot] No
21 If this is a defined benefit pension plan, does the plan
comply with Code section 401(a)(26) participation requirements?
[ballot] Yes [ballot] No
Part VII [New Part/New Questions]
Participation Information in Defined Contribution Pension Plans
(Only defined contribution pension plans need to complete this
Part.)
22a Were employees participating in the plan eligible to receive
employer contributions even if they did not make any elective
deferrals?
[ballot] Yes [ballot] No If ``Yes,'' answer Line 22b.
22b Check the appropriate box to indicate how the employer's
contribution is calculated and enter the percent or dollar amount or
other formula:
[ballot] % of a participant's compensation (provide percentage)
[ballot] $ per participant (provide amount)
[ballot] Other (specify)
23a Does the plan provide for employer matching contributions
contingent on employee elective deferrals? [ballot] Yes [ballot] No
If ``Yes,'' answer Line 23b-d.
23b Check the appropriate box and enter the percentage, amount
or formula to indicate the minimum elective deferrals necessary to
qualify for an employer matching contribution (if there is no
minimum, check ``other'' and enter ``none''):
[ballot] % of a participant's contribution up to a limit (provide
percentage)
[ballot] $ per participant (provide amount)
[ballot] Other (specify)
23c Check the appropriate box and enter the percentage, amount
or other formula to indicate the maximum employer matching
contribution under the terms of the plan.
[ballot] % of a participant's compensation (provide percentage)
[ballot] $ per participant (provide amount)
[ballot] Other (Specify)
23d Enter the number of participants making sufficient elective
deferrals to receive the maximum employer match.
24a Does the plan have automatic enrollment? [ballot] Yes
[ballot] No If ``Yes,'' answer Lines 24b(1)-(3).
24b (1) Enter the default elective deferral as a percentage of a
participant's compensation in the first year after a participant is
automatically enrolled?
(2) Does the plan have automatic escalation, assuming a
participant has made no active elections? [ballot] Yes [ballot] No
If ``Yes,'' enter the maximum elective deferral as a percentage of a
participant's compensation.
(3) Enter the number of participants that have not made any
investment decisions and remain in the plan's default investment
account(s):
25 Enter the number of participants making catch-up
contributions.
Schedule SB--Single-Employer Defined Benefit Plan Actuarial Information
[Current header and identifying information] For calendar plan
year 20XX or fiscal plan year beginning DD/MM/20XX and ending DD/MM/
20XX+1
A Name of Plan
B Three-digit plan number (PN)
C Plan sponsor's name as shown in Line 2a of the Form 5500 or
5500-SF
D Employer Identification Number (EIN)
E Type of plan: [ballot] Single [ballot] Multiple-A [ballot]
Multiple-B
F Prior year plan size: [ballot] 100 or fewer [ballot] 101-500
[ballot] More than 500
Part I Basic Information
1 [Current] Enter the valuation date:
2 [Current] Assets:
a Market value
b Actuarial value
----------------------------------------------------------------------------------------------------------------
3 [Current] Funding target/participant count breakdown
-----------------------------------------------------------------------------------------------------------------
(1) Number of (2) Vested Funding (3) Total Funding
participants Target Target
----------------------------------------------------------------------------------------------------------------
a For retired participants and
beneficiaries receiving payment
----------------------------------------------------------------------------------------------------------------
b For terminated vested participants
----------------------------------------------------------------------------------------------------------------
c For active participants
----------------------------------------------------------------------------------------------------------------
d Total
----------------------------------------------------------------------------------------------------------------
4 Current, except that allocation of total must be completed by
participant groups and formatting (1), (2), etc. changed to conform
to other tables on the form.] If the plan is in at-risk status,
check the box and complete Lines (a) through (d) [ballot]
[[Page 47595]]
------------------------------------------------------------------------
(2) Funding target
reflecting at-risk
assumptions, but
disregarding
(1) Funding target transition rule for
disregarding plans that have been
prescribed at-risk in at-risk status
assumptions for fewer than five
consecutive years
and disregarding
loading factor
------------------------------------------------------------------------
a For retired participants
and beneficiaries receiving
payment
------------------------------------------------------------------------
b For terminated vested
Participants
------------------------------------------------------------------------
c For active participants
------------------------------------------------------------------------
Total
------------------------------------------------------------------------
5 [Current] Effective interest rate __%
6 Target normal cost [Current, except allocation of plan-related
expenses separated from the target normal cost.].
a [New allocation] Target normal cost (without plan expenses)
b [New allocation] Plan-related expenses
c Total [Reflects current Line 6]
Part II Beginning of Year Carryover and Prefunding Balances
[[Page 47596]]
[GRAPHIC] [TIFF OMITTED] TP21JY16.003
14 [Current instructions for Line 7 with minor rewording,
checkbox added] If Line 7 does not equal Line 13 from the prior
year, provide an explanation in this line and check here [ballot]
15 [Current instructions for Line 8 with minor rewording,
checkbox added] If Line 8 reflects a late election to apply the
balances to quarterly installments, provide an explanation in this
line and check here [ballot]
16 [Current instructions for Line 9 with minor rewording,
checkbox added] If Line 9 has been adjusted so that it does not
match the amount for the pre-effective date plan year, provide an
explanation in this line and check here [ballot]
Part III Funding Percentages
17 [Current Line 14] Funding target attainment percentage __%
18 Adjusted funding target attainment
a [Current Line 15] Adjusted funding target attainment
percentage __%
b [Current instructions for Line 15 with minor rewording,
checkbox added] If an attachment is included reconciling differences
between valuation results and amounts used to calculate the AFTAP,
check here [ballot]
19 [Current Line 16] Prior year's funding percentage for
purposes of determining whether carryover/prefunding balances may be
used to reduce current year's funding requirement __%
20 [Current Line 17] If the current value of the assets of the
plan is less than 70 percent of the funding target, enter such
percentage __%
Part IV Contributions and Liquidity Shortfalls
[[Page 47597]]
--------------------------------------------------------------------------------------------------------------------------------------------------------
21 [Current line 18 and line 19 attachment] Contributions made to the plan by employer(s) and employees:
---------------------------------------------------------------------------------------------------------------------------------------------------------
(a) (b) (c) (d) (e) (f) (g) (h)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Discounted/
Plan year to Number of days increased
Amount paid by which Interest rate to to discount employer Allocation to Amount paid by
Date (MM/DD/YYYY) employer(s) contribution adjust employer employer contributions contributions employees
applies contributions contributions at valuation in line 22
date
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
22 [Current Line 19] Discounted employer contributions--see
instructions for small plans with a valuation date after the
beginning of the year:
a Contributions allocated toward unpaid minimum required
contributions for prior years
b Contributions made to avoid restrictions adjusted to valuation
date
c Contributions allocated toward minimum required contribution
for current year adjusted to valuation date
23 [Current Line 20, except new checkbox added to Line 23c.]
Quarterly contributions and liquidity shortfalls:
a Did the plan have a ``funding shortfall'' for the prior year?
[ballot] Yes [ballot] No
b If Line 23a is ``Yes,'' were required quarterly installments
for the current year made in a timely manner? [ballot] Yes [ballot]
No
c [Minor rewording of the question and new check box added] If
Line 23a is ``Yes,'' see instructions. If a liquidity requirement
certification is attached, complete the following table as
applicable and check here [ballot]:
----------------------------------------------------------------------------------------------------------------
Liquidity shortfalls as of the end of quarter of this plan year
-----------------------------------------------------------------------------------------------------------------
(1) 1st (2) 2nd (3) 3rd (4) 4th
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Part V Assumptions Used to Determine Funding Target and Target Normal
Cost --
24 [Current Line 21] Discount rate:
----------------------------------------------------------------------------------------------------------------
a Segment rates:
-----------------------------------------------------------------------------------------------------------------
[ballot] N/A, full
1st segment: % 2nd segment: % 3rd segment: % yield curve used
----------------------------------------------------------------------------------------------------------------
% %...................... %......................
----------------------------------------------------------------------------------------------------------------
b Applicable month (enter code)
25 [Current Line 22] Weighted average retirement age
26 [Current Line 23] Mortality Table(s):
26a Mortality table(s) (see instructions) [ballot] Prescribed--
combined [ballot] Prescribed separate [ballot] Substitute
26b [Attachment to current Line 23, new checkbox added.] If more
than one mortality table was used, provide an explanation in this
line describing the mortality table used for each population and the
size of that population and check here. [ballot]
26c [Attachment to current Line 23, new checkbox added.] If
substitute mortality tables are used, provide in this line of a
summary of plan populations for which substitute mortality tables
are used, plan populations for which the prescribed tables are used,
and the last plan year for which IRS approval of the substitute
mortality tables applies and check here [ballot].
Part VI Miscellaneous Items
27 [Current Line 24] Has a change been made in the non-
prescribed actuarial assumptions for the current plan year? If
``Yes,'' see instructions regarding required attachment [ballot] Yes
[ballot] No.
28 [Current Line 25, minor rewording, new checkbox added.] If a
method change has been made for the current plan year, provide a
description of the change in this line and check here. [ballot]
29 Participant schedules
29a(i) [Current Line 26] Is the plan required to provide a
Schedule of Active Participant Data? (See instructions) [ballot] Yes
[ballot] No
a(ii) [Current Line 26 instructions moved to the face of the
form] If 29a(i) is ``Yes,'' complete the schedule below and items
29a(iii) and (iv). If the plan is hard frozen and average annual
accrued benefit data is entered instead of average compensation
data, check this box [ballot] (see instructions)
[[Page 47598]]
[GRAPHIC] [TIFF OMITTED] TP21JY16.004
a(iii) [New] Average age of active participants as of the
valuation date
a(iv) [New] Average credited service of active participants as
of the valuation date
29b(i) [New] Is the plan required to provide a Schedule of
Retired Participants and Beneficiaries Receiving Payment Data?(See
instructions) [ballot] Yes [ballot] No.
b(ii) [New] If 29b(i) is ``Yes,'' complete the schedule below
and items 29b(iii) and b(iv).
Schedule of Retired Participants and Beneficiaries Receiving Payment
Data
------------------------------------------------------------------------
Average Annual In-
Attained Age Number Pay Benefit Amount
------------------------------------------------------------------------
Under 55
------------------------------------------------------------------------
55 to 59
------------------------------------------------------------------------
Etc.
------------------------------------------------------------------------
90 and up
------------------------------------------------------------------------
b(iii) [New] Average Age for Retired Participants and
Beneficiaries as of the valuation date
b(iv) [New] Average Annual In-Pay Benefit for Retired
Participants and Beneficiaries as of the valuation date
29c(i) [New] Is the plan required to provide a Schedule of
Terminated Vested Participant Data? (See the instructions) [ballot]
Yes [ballot] No
c(ii) [New] If c(i)(a) is ``Yes,'' complete the schedule below
and items c(iii) through c(vi).
Schedule of Terminated Vested Participant Data
------------------------------------------------------------------------
Average Annual In-
Attained Age Number Pay Benefit Amount
------------------------------------------------------------------------
Under 25
------------------------------------------------------------------------
25 to 29
------------------------------------------------------------------------
Etc.
------------------------------------------------------------------------
70 and up
------------------------------------------------------------------------
c(iii) [New] Average age of terminated vested participants as of
the valuation date
c(iv) [New] Average annual benefit of terminated vested
participants as of the valuation date
c(v) [New] Assumed form of payment shown
c(vi) [New] Assumed age of first payment for benefits shown
30a [New] Is the plan required to provide a projection of
expected benefit payments? (see instructions) [ballot] Yes [ballot]
No
b [New] If ``Yes,'' complete the schedule below:
------------------------------------------------------------------------
Schedule of Projection of
Plan Year Expected Annual Benefit
Payments
------------------------------------------------------------------------
Current plan year
------------------------------------------------------------------------
Current plan year plus 1
------------------------------------------------------------------------
Etc.
------------------------------------------------------------------------
Current plan year plus 9 ...............................
------------------------------------------------------------------------
[[Page 47599]]
31 [Current Line 27] If the plan is subject to the alternative
funding rules, enter applicable code and see instructions regarding
attachment
Part VII Reconciliation of Unpaid Minimum Required Contributions For
Prior Years
32 [Current Line 28] Unpaid minimum required contributions for
all prior years
33 [Current Line 29; reference updated] Discounted employer
contributions allocated toward unpaid minimum required contributions
from prior years [Current Line 19a] (Line 22a)
34 [Current Line 30; references updated] Remaining amount of
unpaid minimum required contributions [Current Line 28 minus Line
29] (Line 32 minus Line 33)
Part VIII Minimum Required Contribution For Current Year
35 [Current Line 31] Target normal cost and excess assets (see
instructions):
a [Current Line 6] Target normal cost (Line 6c)
b [Current] Excess assets, if applicable, but not greater than
Line 35a
36 [Current Line 32]
------------------------------------------------------------------------
Amortization Installments Outstanding balance Installment
------------------------------------------------------------------------
a Net shortfall amortization
installment
------------------------------------------------------------------------
b Waiver amortization
installment
------------------------------------------------------------------------
[Current attachment] Schedule of Amortization Bases
----------------------------------------------------------------------------------------------------------------
Amortization installments
-----------------------------------------------------------------------------------------------------------------
(iv) Years
(ii) Present value (iii) Valuation remaining in (v) Current year
(i) Type of base of remaining date base was amortization installment
installments established period
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
Total
----------------------------------------------------------------------------------------------------------------
37 [Current Line 33] If a waiver has been approved for this plan
year, enter the date of the ruling letter granting approval (Month/
Day/Year) and the waived amount
38 [Current Line 34; reflects renumbering of references] Total
funding requirement before reflecting carryover/prefunding balances
[Current Lines 31a-31b + 32a + 32b -33] (Lines 35a-35b + 36a + 36b-
37)
----------------------------------------------------------------------------------------------------------------
Carryover balance Prefunding balance Total balance
----------------------------------------------------------------------------------------------------------------
39 [Current Line 35] Balances elected
for use to offset funding
requirement.
----------------------------------------------------------------------------------------------------------------
40 [Current Line 36; reflects renumbering of references]
Additional cash requirement [Current Line 34 minus Line 25] (Line 38
minus Line 39)
41 [Current Line 37; reflects renumbering of reference]
Contributions allocated toward minimum required contribution for
current year adjusted to valuation date [Current Line 19c] (Line
22c)
42 [Current Line 38; reflects renumbering of references] Present
value of excess contributions for current year (see instructions)
a Total [Current Line 37 over Line 36] (excess, if any, of Line
41 over Line 40)
b Portion included in [Current Line 38a] Line 42a attributable
to use of prefunding and funding standard carryover balances
43 [Current Line 39; reflects renumbering of references] Unpaid
minimum required contribution for current year [Current Line 36 over
Line 37] (excess, if any, of Line 40 over Line 41)
44 [Current Line 40; reflects renumbering of references] Unpaid
minimum required contributions for all years
Part IX Pension Funding Under Pension Relief Act of 2010 (See
Instructions)
45 [Current Line 41; reflects renumbering of references] If an
election was made to use PRA 2010 funding relief for this plan:
a Schedule elected [ballot] 2 plus 7 years [ballot] 15 years
b Eligible plan year(s) for which the election in [Current Line
41a] Line 45a was made [ballot] 2008 [ballot] 2009 [ballot] 2010
[ballot] 2011
46 [Current Line 42] Amount of acceleration adjustment
47 [Current Line 43] Excess installment acceleration amount to
be carried over to future plan years
Statement by Enrolled Actuary--Current--except that information
previously reported on an attachment per the instructions will be
reported on the Schedule.
To the best of my knowledge, the information supplied in this
schedule and accompanying schedules, statements, and attachments, if
any, is complete and accurate. Each prescribed assumption was
applied in accordance with applicable law and regulations. In my
opinion, each other assumption is reasonable (taking into account
the experience of the plan and reasonable expectations) and such
other assumptions, in combination, offer my best estimate of
anticipated experience under the plan.
Signature of actuary
Date
Type or print name of actuary
Most recent enrollment number
Firm name
Telephone number (including area code)
Address of firm
If the actuary has not fully reflected any regulation or ruling
promulgated under the statute in completing this schedule, provide
the information requested in the instructions in this line and check
here [ballot]
APPENDIX B
20XX Instructions for Form 5500 Annual Return/Report of Employee
Benefit Plan
Code section references are to the Internal Revenue Code unless
otherwise noted. ERISA refers to the Employee Retirement Income
Security Act of 1974.
EFAST2 Processing System
Under the computerized ERISA Filing Acceptance System (EFAST2),
you must electronically file your 20XX Form 5500. Your Form 5500
entries will be initially screened electronically. For more
information, see the instructions for Electronic Filing Requirement
and the EFAST2 Web site at www.efast.dol.gov. You cannot file a
paper Form 5500 Annual Return/Report by mail or other delivery
service.
About the Form 5500
The Form 5500, Annual Return/Report of Employee Benefit Plan,
including all required schedules and attachments (Form
[[Page 47600]]
5500 Annual Return/Report), is used to report information concerning
employee benefit plans and Direct Filing Entities (DFEs). Any
administrator or sponsor of an employee benefit plan subject to
ERISA must file information about each benefit plan every year
(pursuant to Code section 6058 and ERISA sections 104 and 4065).
Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 Annual Return/Report
as DFEs. See Who Must File and When To File.
The Internal Revenue Service (IRS), Department of Labor (DOL),
and Pension Benefit Guaranty Corporation (PBGC) have consolidated
certain returns and report forms to reduce the filing burden for
plan administrators and employers. Employers and administrators who
comply with the instructions for the Form 5500 generally will
satisfy the annual reporting requirements for the DOL under Title I
of ERISA and for PBGC under Title IV of ERISA and for the IRS under
Code sections 6057(b), 6058, and 6059.
Defined contribution and defined benefit pension plans may have
to file additional information with the IRS, including Form 5330,
Return of Excise Taxes Related to Employee Benefit Plans, Form 5310-
A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of
Plan Assets or Liabilities; Notice of Qualified Separate Lines of
Business, and Form 8955-SSA, Annual Registration Statement
Identifying Separated Participants with Deferred Vested Benefits.
See www.irs.gov for more information.
Plans covered by the PBGC have special additional requirements,
including premiums and reporting certain transactions directly with
that agency. See PBGC's Web site (www.pbgc.gov/practitioners/) for
information on premium payments and reporting and disclosure.
Each Form 5500 must accurately reflect the characteristics and
operations of the plan or arrangement being reported. The
requirements for completing the Form 5500 will vary according to the
type of plan or arrangement. The section What To File summarizes
what information must be reported for different types of plans and
arrangements. The Quick Reference Charts of Form 5500, Schedules and
Attachments for (1) Pension Plans; (2) Direct Filing Entities (Other
than GIAs); (3) Group Health Plans (and GIAs Providing Group Health
Benefits); and (4) Welfare Plans Other Than Group Health, at the end
of these instructions, give a brief guide to the annual return/
report requirements of the 20XX Form 5500 for the various types of
plans and other entities filing a Form 5500 Annual Return/Report.
See also the ``Troubleshooters Guide to Filing the ERISA Annual
Reports'' available on www.dol.gov/ebsa, which is intended to help
filers comply with the Form 5500 and Form 5500-SF annual reporting
requirements and avoid common reporting errors.
The Form 5500 must be filed electronically as noted above. See
Section 3_Electronic Filing Requirement and the EFAST2 Web site at
www.efast.dol.gov. Your Form 5500 entries will be initially screened
electronically. Your entries must satisfy this screening for your
filing to be received. Once received, your form may be subject to
further detailed review, and your filing may be rejected based upon
this further review.
ERISA and the Code provide for the assessment or imposition of
penalties for not submitting the required information when due. See
Penalties.
Annual reports filed under Title I of ERISA must be made
available by plan administrators to plan participants and
beneficiaries and by the DOL to the public pursuant to ERISA
sections 104 and 106. Pursuant to Section 504 of the Pension
Protection Act of 2006 (PPA) Pub. L. 109-280, this availability for
defined benefit pension plans must include the posting of the Form
5500, Schedule SB or MB, and all of the Schedule SB or MB
attachments on any plan sponsor intranet Web site (or Web site
maintained by the plan administrator on behalf of the plan sponsor)
that is used for the purpose of communicating with employees and not
the public. Section 504 also requires DOL to display such
information on DOL's Web site within 90 days after the filing of the
plan's annual return/report. To see plan year 2009 and later forms,
including actuarial information, see www.dol.gov/ebsa. See
www.dol.gov/ebsa/actuarialsearch.html for plan year 2008 and short
plan year 2009 actuarial information filed under the previous paper-
based system.
Changes to Note
[The instructions for the year in which the revisions are
implemented will include such items in the ``Changes to Note''
section.]
Table of Contents
[The Instructions will continue include a Table of Contents in
substantially the same format as the existing Table of Contents,
updated as required.]
How To Get Assistance
If you need help completing this form or have related questions,
call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278) (toll-
free) or access the EFAST2 or IRS Web sites. The EFAST2 Help Line is
available Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern
Time.
You can access the EFAST2 Web site 24 hours a day, 7 days a week
at www.efast.dol.gov to:
File the Form 5500-SF or Form 5500, and any needed
schedules or attachments.
Check on the status of a filing you submitted.
View filings posted by EFAST2.
Register for electronic credentials to sign or submit
filings.
View forms and related instructions.
Get information regarding EFAST2, including approved
software vendors.
See answers to frequently asked questions about the
Form 5500-SF, the Form 5500 and its schedules, and EFAST2.
Access the main EBSA and DOL Web sites for news,
regulations, and publications.
You can access the IRS Web site 24 hours a day, 7 days a week at
www.irs.gov to:
View forms, instructions, and publications.
See answers to frequently asked tax questions.
Search publications on-line by topic or keyword.
Send comments or request help by email.
Sign up to receive local and national tax news by
email.
You can order other IRS forms and publications at the IRS Web
site at www.irs.gov/orderforms. You can order EBSA publications by
calling 1-866-444-EBSA (3272).
Section 1: Who Must File
A return/report must be filed every year for every pension
benefit plan, welfare benefit plan, and for every entity that files
as a DFE as specified below (pursuant to Code section 6058 and ERISA
sections 104 and 4065). If you are a small plan (generally under 100
participants at the beginning of the plan year), that does not
provide group health benefits, you may be eligible to file the Form
5500-SF instead of the Form 5500. For more information, see the
instructions to the Form 5500-SF.
Pension Benefit Plan
All pension benefit plans covered by ERISA must file an annual
return/report except as provided in this section. The return/report
must be filed whether or not the plan is ``tax-qualified,'' benefits
no longer accrue, contributions were not made this plan year, or
contributions are no longer made. Pension benefit plans required to
file include both defined benefit plans and defined contribution
plans.
The following are among the pension benefit plans for which a
return/report must be filed.
1. Profit-sharing plans, stock bonus plans, money purchase
plans, 401(k) plans, etc.
2. 403(b) plans subject to Title I of ERISA. For more
information regarding filing requirements for these annuity
arrangements under Code section 403(b)(1) and custodial accounts
established under Code section 403(b)(7) for regulated investment
company stock, see Field Assistance Bulletins 2009-02 and 2010-01.
3. Individual retirement accounts (IRAs) established by an
employer under Code section 408(c).
4. Church pension plans electing coverage under Code section
410(d).
5. Pension benefit plans that cover residents of Puerto Rico,
the U.S. Virgin Islands, Guam, Wake Island, or American Samoa. This
includes a plan that elects to have the provisions of section
1022(i)(2) of ERISA apply.
6. Plans that satisfy the Actual Deferral Percentage
requirements of Code section 401(k)(3)(A)(ii) by adopting the
``SIMPLE'' provisions of section 401(k)(11).
See What To File for more information about what must be
completed for pension plans.
Do Not File a Form 5500 Annual Return/Report for a Pension Benefit Plan
That Is Any of the Following:
1. An unfunded excess benefit plan. See ERISA section 4(b)(5).
2. An annuity or custodial account arrangement under Code
sections 403(b)(1) or (7) not established or maintained by an
employer as described in DOL Regulation 29 CFR 2510.3-2(f).
[[Page 47601]]
3. A Savings Incentive Match Plan for Employees of Small
Employers (SIMPLE) that involves SIMPLE IRAs under Code section
408(p).
4. A simplified employee pension (SEP) or a salary reduction SEP
described in Code section 408(k) that conforms to the alternative
method of compliance in 29 CFR 2520.104-48 or 2520.104-49. A SEP is
a pension plan that meets certain minimum qualifications regarding
eligibility and employer contributions.
5. A church pension benefit plan not electing coverage under
Code section 410(d).
6. A pension plan that is maintained outside the United States
primarily for the benefit of persons substantially all of whom are
nonresident aliens. However, certain foreign plans are required to
file the Form 5500-EZ with the IRS or may file the Form 5500-SF
electronically with EFAST2. See the instructions to the Form 5500-EZ
for the filing requirements. For more information, go to
www.irs.gov/ep or call 1-877-829-5500.
7. An unfunded pension plan for a select group of management or
highly compensated employees that meets the requirements of 29 CFR
2520.104-23, including timely filing of a registration statement
with the DOL.
8. An unfunded dues financed pension benefit plan that meets the
alternative method of compliance provided by 29 CFR 2520.104-27.
9. An individual retirement account or annuity not considered a
pension plan under 29 CFR 2510.3-2(d).
10. A governmental plan.
11. A ``one-participant plan,'' as defined below. However,
certain one-participant plans are required to file the Form 5500-EZ,
Annual Return of One-Participant (Owners and Their Spouses)
Retirement Plan with the IRS or, may file the Form 5500-SF, Short
Form Annual Return/Report of Employee Benefit Plan, electronically
with EFAST2. For this purpose, a ``one-participant plan'' is:
a. A pension benefit plan that covers only an individual or an
individual and his or her spouse who wholly own a trade or business,
whether incorporated or unincorporated; or
b. A pension benefit plan for a partnership that covers only the
partners or the partners and the partners' spouses.
See the instructions to the Form 5500-EZ and the Form 5500-SF
for filing requirements. For more information, go to www.irs.gov/ep
or call 1-877-829-5500.
Welfare Benefit Plan
Plans that Provide Health Benefits (Group Health Plans)
All employee benefit plans covered by Title I of ERISA that
provide group health benefits consisting of medical care as defined
in section 733(a)(2) of ERISA are required to file a Form 5500
Annual Return/Report, unless specifically exempt below, regardless
of the plan size or type of funding.
MEWA Reminders: The administrator of a group health plan
required to file a Form M-1, Report for Multiple Employer Welfare
Arrangements (MEWAs) and Certain Entities Claiming Exception (ECEs),
must also file the Form 5500 Annual Return/Report for the group
health plan. The administrator of a group health plan that provides
benefits wholly or partially through a Multiple Employer Welfare
Arrangement (MEWA) as defined in ERISA section 3(40) must file a
Form 5500 Annual Return/Report, unless the plan is part of a Group
Insurance Arrangement (GIA) that files a Form 5500 Annual Return/
Report as a DFE on behalf of all the participating plans.
Welfare Benefit Plans Other Than Group Health Plans
All welfare benefit plans covered by ERISA that do not provide
health benefits consisting of medical care as defined in section
733(a)(2) of ERISA are required to file a Form 5500, except as
provided in this section. Welfare benefits other than group health
include disability, life insurance, apprenticeship and training,
scholarship funds, severance pay, etc. See What To File for more
information.
[CAUTION] If the plan provides both health benefits and other
types of benefits, then it is subject to the filing requirements for
a plan that provides health benefits, including the requirement that
all such plans file the Form 5500 regardless of size.
Do Not File a Form 5500 Annual Return/Report for a Welfare Benefit Plan
That Is Any of the Following:
1. A welfare benefit plan that does not provide health benefits
and that covered fewer than 100 participants as of the beginning of
the plan year and is unfunded, fully insured, or a combination of
insured and unfunded, as specified in 29 CFR 2520.104-20.
Note. To determine whether the plan covers fewer than 100
participants for purposes of this filing exemption for insured,
unfunded and combination insured/unfunded welfare plans that do not
provide health benefits, see instructions for Lines 6 and 7 on
counting participants in a welfare plan. See also 29 CFR 2510.3-
3(d).
a. An unfunded welfare benefit plan has its benefits paid as
needed directly from the general assets of the employer or employee
organization that sponsors the plan. Plans that are NOT unfunded
include those plans that received employee (or former employee)
contributions during the plan year and/or used a trust or separately
maintained fund (including a Code section 501(c)(9) trust) to hold
plan assets or act as a conduit for the transfer of plan assets
during the year. A welfare benefit plan with employee contributions
that is associated with a cafeteria plan under Code section 125 may
be treated for annual reporting purposes as an unfunded welfare plan
if it meets the requirements of DOL Technical Release 92-01, 57 FR
23272 (June 2, 1992) and 58 FR 45359 (Aug. 27, 1993). The mere
receipt of COBRA contributions or other after-tax participant
contributions (e.g., retiree contributions) by a cafeteria plan
would not by itself affect the availability of the relief provided
for cafeteria plans that otherwise meet the requirements of DOL
Technical Release 92-01. See 61 FR 41220, 41222-23 (Aug. 7, 1996).
b. A fully insured welfare benefit plan has its benefits
provided exclusively through insurance contracts or policies, the
premiums of which must be paid directly to the insurance carrier by
the employer or employee organization from its general assets or
partly from its general assets and partly from contributions by its
employees or members (which the employer or employee organization
forwards within three (3) months of receipt). The insurance
contracts or policies discussed above must be issued by an insurance
company or similar organization that is qualified to do business in
any state.
c. A combination unfunded/insured welfare benefit plan has its
benefits provided partially as an unfunded plan and partially as a
fully insured plan. An example of such a plan is a welfare benefit
plan that provides disability benefits as in a above and life
insurance benefits as in b above. See 29 CFR 2520.104-20.
2. A welfare benefit plan maintained outside the United States
primarily for persons substantially all of whom are nonresident
aliens.
3. A governmental plan.
4. An unfunded or insured welfare benefit plan maintained for a
select group of management or highly compensated employees, which
meets the requirements of 29 CFR 2520.104-24.
5. An employee benefit plan maintained only to comply with
workers' compensation, unemployment compensation, or disability
insurance laws.
6. A group health plan or other welfare benefit plan that
participates in a group insurance arrangement (GIA) that files a
Form 5500 Annual Return/Report on behalf of the group health plan or
other welfare benefit plan as specified in 29 CFR 2520.103-2. See 29
CFR 2520.104-43.
7. An apprenticeship or training plan meeting all of the
conditions specified in 29 CFR 2520.104-22.
8. An unfunded dues financed welfare benefit plan that does not
provide health benefits exempted by 29 CFR 2520.104-26.
9. A church plan under ERISA section 3(33).
10. A welfare benefit plan that covers only an individual or an
individual and his or her spouse who wholly own a trade or business,
whether incorporated or unincorporated, or that covers only the
partners or the partners and the partners' spouses. See 29 CFR
2510.3-3(b).
Direct Filing Entity (DFE)
Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 Annual Return/Report
as a DFE in accordance with the Direct Filing Entity (DFE) Filing
Requirements. A Form 5500 Annual Return/Report must be filed for a
master trust. A Form 5500 Annual Return/Report is not required but
may be filed for a common/collective trust (CCT), a pooled separate
account (PSA), an investment entity that hold plan assets permitted
under 29 CFR 2520.103-12(103-12 IE), or a group insurance
arrangement (GIA). Plans that participate in CCTs, PSAs, 103-12 IEs,
or GIAs that file as DFEs, however, generally are eligible for
certain annual reporting relief. For reporting purposes, a CCT, PSA,
103-12
[[Page 47602]]
IE, or GIA is not considered a DFE unless a Form 5500 and all
required attachments are filed for it in accordance with the Direct
Filing Entity (DFE) Filing Requirements.
Note. Special requirements also apply to Schedules D and H
attached to the Form 5500 filed by plans participating in master
trusts, CCTs, PSAs, and 103-12 IEs. See these schedules and their
instructions.
Section 2: When To File
Plans and GIAs. File 20XX returns/reports for plan and GIA years
that began in 20XX. All required forms, schedules, statements, and
attachments must be filed by the last day of the 7th calendar month
after the end of the plan or GIA year (not to exceed 12 months in
length) that began in 20XX. If the plan or GIA year differs from the
20XX calendar year, fill in the fiscal year beginning and ending
dates in the space provided.
Short Years. For a plan year of less than 12 months (short plan
year), file the form and applicable schedules by the last day of the
7th calendar month after the short plan year ends or by the extended
due date, if filing under an authorized extension of time. Fill in
the short plan year beginning and ending dates in the space provided
and check the appropriate box in Part I, Line B, of the Form 5500.
For purposes of this return/report, the short plan year ends on the
date of the change in accounting period or upon the complete
distribution of assets of the plan. Also see the instructions for
Final Return/Report to determine if ``the final return/report'' box
in Line B should be checked.
DFEs other than GIAs. File 20XX returns/reports no later than
9\1/2\ months after the end of the DFE year that ended in 20XX. A
Form 5500 Annual Return/Report filed for a DFE must report
information for the DFE year (not to exceed 12 months in length). If
the DFE year differs from the 20XX calendar year, fill in the fiscal
year beginning and ending dates in the space provided.
Notes. (1) If the filing due date falls on a Saturday, Sunday,
or Federal holiday, the return/report may be filed on the next day
that is not a Saturday, Sunday, or Federal holiday. (2) If the
20XX+1 Form 5500 is not available before the plan or DFE filing is
due, use the 20XX Form 5500 and enter the 20XX+1 fiscal year
beginning and ending dates on the line provided at the top of the
form.
Extension of Time To File
Using Form 5558
A plan or GIA may obtain a one-time extension of time to file a
Form 5500 Annual Return/Report (up to 2\1/2\ months) by filing IRS
Form 5558, Application for Extension of Time To File Certain
Employee Plan Returns, on or before the normal due date (not
including any extensions) of the return/report. You MUST file Form
5558 with the IRS. Approved copies of the Form 5558 will not be
returned to the filer. A copy of the completed extension request
must, however, be retained with the filer's records.
File Form 5558 with the Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201-0045.
Using Extension of Time To File Federal Income Tax Return
An automatic extension of time to file the Form 5500 Annual
Return/Report until the due date of the federal income tax return of
the employer will be granted if all of the following conditions are
met:
(1) the plan year and the employer's tax year are the same;
(2) the employer has been granted an extension of time to file
its federal income tax return to a date later than the normal due
date for filing the Form 5500 Annual Return/Report; and
(3) a copy of the application for extension of time to file the
federal income tax return is maintained with the filer's records. An
extension granted by using this automatic extension procedure CANNOT
be extended further by filing a Form 5558, nor can it be extended
beyond a total of 9\1/2\ months beyond the close of the plan year.
Note. An extension of time to file the Form 5500 Annual Return/
Report does not operate as an extension of time to file a Form 5500
Annual Return/Report filed for a DFE (other than a GIA), to file
PBGC premiums or annual financial and actuarial reports (if required
by section 4010 of ERISA) or to file the Form 8955-SSA (Annual
Registration Statement Identifying Separated Participants with
Deferred Vested Benefits) (required to be filed with the IRS under
Code section 6057(a)).
Other Extensions of Time
The IRS, DOL, and PBGC may announce special extensions of time
under certain circumstances, such as extensions for Presidentially-
declared disasters or for service in, or in support of, the Armed
Forces of the United States in a combat zone. See www.irs.gov,
www.efast.dol.gov, and www.pbgc.gov/practitioners for announcements
regarding such special extensions. If you are relying on one of
these announced special extensions, check the appropriate box on
Form 5500, Part I, Line D, and enter a description of the announced
authority for the extension.
Delinquent Filer Voluntary Compliance (DFVC) Program
The DFVC Program facilitates voluntary compliance by plan
administrators who are delinquent in filing annual reports under
Title I of ERISA by permitting administrators to pay reduced civil
penalties for voluntarily complying with their DOL annual reporting
obligations. If the Form 5500 is being filed under the DFVC Program,
check the appropriate box in Form 5500, Part I, Line D, to indicate
that the Form 5500 is being filed under the DFVC Program. See
www.efast.dol.gov for additional information.
Plan administrators are reminded that they can use the online
calculator available at www.dol.gov/ebsa/calculator/dfvcpmain.html
to compute the penalties due under the program. Payments under the
DFVC Program also may be submitted electronically. For information
on how to pay DFVC Program payments online, go to www.dol.gov/ebsa.
[CAUTION] Filers who wish to participate in the DFVC Program for
plan years prior to 20XX-3 must use the 20XX version of Form 5500
or, if applicable, Form 5500-SF. Use the Form 5500 Version Selection
Tool available at www.efast.dol.gov for further information.
Section 3: Electronic Filing Requirement
Under the computerized ERISA Filing Acceptance System (EFAST2),
you must file your 20XX Form 5500 Annual Return/Report
electronically. You may file online using EFAST2's web-based filing
system or you may file through an EFAST2-approved vendor. Detailed
information on electronic filing is available at www.efast.dol.gov.
For telephone assistance, call the EFAST2 Help Line at 1-866-GO-
EFAST (1-866-463-3278). The EFAST2 Help Line is available Monday
through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time.
[CAUTION] Annual returns/reports filed under Title I of ERISA
must be made available by plan administrators to plan participants
and beneficiaries and by the DOL to the public pursuant to ERISA
sections 104 and 106. Even though the Form 5500 Annual Return/Report
must be filed electronically, the administrator must keep a copy of
the Form 5500, including schedules and attachments, with all
required signatures on file as part of the plan's records and must
make a paper copy available upon request to participants,
beneficiaries, and the DOL as required by section 104 of ERISA and
29 CFR 2520.103-1. Filers may use electronic media for record
maintenance and retention, so long as they meet the applicable
requirements.
Generally, questions on the Form 5500 relate to the plan year
entered at the top of the first page of the form. Therefore, answer
all questions on the 20XX Form 5500 with respect to the 20XX plan
year unless otherwise explicitly stated in the instructions or on
the form itself.
Your entries must be in the proper format in order for the
EFAST2 system to process your filing. For example, if a question
requires you to enter a dollar amount, you cannot enter a word. Your
software will not let you submit your return/report unless all
entries are in the proper format. To reduce the possibility of
correspondence and penalties:
Complete all lines on the Form 5500 unless otherwise
specified. Also complete and attach, as required, applicable
schedules and attachments.
Do not enter ``N/A'' or ``Not Applicable'' on the Form
5500 Annual Return/Report unless specifically permitted. ``Yes'' or
``No'' questions on the forms and schedules cannot be left blank,
unless specifically permitted. Answer either ``Yes'' or ``No,'' but
not both.
All schedules and attachments to the Form 5500 must be properly
identified, and must include the name of the plan or DFE, EIN, and
plan number (PN) as found on the Form 5500, lines, 1a, 2b, and 1b,
respectively. At the top of each attachment, indicate the schedule
and line, if any to which the attachment relates.
Check your return/report for errors before signing or submitting
it to EFAST2. Your filing software or, if you are using it, the
EFAST2 web-based filing system will allow you to check your return/
report for errors. If,
[[Page 47603]]
after reasonable attempts to correct your filing to eliminate any
identified problem or problems, you are unable to address them, or
you believe that you are receiving the message in error, call the
EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278) or contact the
service provider you used to help prepare and file your annual
return/report.
Once you complete the return/report and finish the electronic
signature process, you can electronically submit it to EFAST2. When
you electronically submit your return/report, EFAST2 is designed to
immediately notify you if your submission was received and whether
the return/report is ready to be processed by EFAST2. If EFAST2 does
not notify you that your submission was successfully received and is
ready to be processed, you will need to take steps to correct the
problem or you may be deemed a non-filer subject to penalties from
DOL, IRS, and/or PBGC.
Once EFAST2 receives your return/report, the EFAST2 system
should be able to provide a filing status within 20 minutes. The
person submitting the filing should check back into the EFAST2
system to determine the filing status of your return/report. The
filing status message will include a list of filing errors or
warnings that EFAST2 may have identified in your filing. If EFAST2
did not identify any filing errors or warnings, EFAST2 will show the
filing status of your return/report as ``Filing_Received.'' Persons
other than the submitter can check whether the filing was received
by the system by calling the EFAST2 Help Line at 1-866-GO-EFAST (1-
866-463-3278) and using the automated telephone system.
To reduce the possibility of correspondence and penalties from
the DOL, IRS, and/or PBGC, you should do the following: (1) Before
submitting your return/report to EFAST2, check it for errors, and
(2) after you have submitted it to EFAST2, verify that you have
received a filing status of ``Filing Received'' and attempt to
correct and resolve any errors or warnings listed in the status
report. For more information on whether the filing must be corrected
and resubmitted or corrected as an amended filing, go to the EFAST2
Web site at www.efast.dol.gov, Frequently Asked Questions (FAQs), or
call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278).
Note. Even after being received by the EFAST2 system, your
return/report filing may be subject to further detailed review by
DOL, IRS, and/or PBGC, and your filing may be deemed deficient based
upon this further review. See Penalties on Page X.
[CAUTION] Do not enter social security numbers in response to
questions asking for an employer identification number (EIN).
Because of privacy concerns, the inclusion of a social security
number or any portion thereof on the Form 5500 or on a schedule or
attachment that is open to public inspection may result in the
rejection of the filing. If you discover a filing disclosed on the
EFAST2 Web site that contains a social security number, immediately
call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278).
Employers without an EIN must apply for one as soon as possible.
The EBSA does not issue EINs. To apply for an EIN from the IRS:
Mail or fax Form SS-4, Application for Employer
Identification Number, obtained at the IRS Web site at www.irs.gov.
Call 1-800-829-4933 to receive your EIN by telephone.
Select the Online EIN Application link at www.irs.gov.
The EIN is issued immediately once the application information is
validated. (The online application process is not yet available for
corporations with addresses in foreign countries).
[CAUTION] Do not attach a copy of the annual registration
statement (IRS Form 8955-SSA) identifying separated participants
with deferred vested benefits, or a previous year's Schedule SSA
(Form 5500) to your 20XX Form 5500 Annual Return/Report. The annual
registration statement must be filed directly with the IRS and
cannot be attached to a Form 5500 Annual Return/Report submission
with EFAST2.
Amended Return/Report
File an amended return/report to correct errors and/or omissions
in a previously filed annual return/report for the 20XX plan year.
The amended Form 5500 and any amended schedules and/or attachments
must conform to the requirements in these instructions. See the DOL
Web site at www.efast.dol.gov for information on filing amended
returns/reports for prior years.
[TIP] Check the Line B(2) box for ``an amended return/report''
if you filed a previous 20XX annual return/report that was given a
``Filing_Received,'' ``Filing_Error,'' or ``Filing_Stopped'' status
by EFAST2. Do not check the Line B box for ``an amended return/
report'' if your previous submission attempts were not successfully
received by EFAST2 because of problems with the transmission of your
return/report. For more information, go to the EFAST2 Web site at
www.efast.dol.gov or call the EFAST2 Help Line at 1-866-GO-EFAST (1-
866-463-3278).
Final Return/Report
If all assets under the plan (including insurance/annuity
contracts) have been distributed to the participants and
beneficiaries or legally transferred to the control of another plan,
and when all liabilities for which benefits may be paid under a
welfare benefit plan have been satisfied, check the final return/
report box in Part I, Line B(3) at the top of the Form 5500. Do not
mark the final return/report box if you are reporting participants
and/or assets at the end of the plan year. If a trustee has been
appointed for a terminated defined benefit pension plan pursuant to
ERISA section 4042, the last plan year for which the return/report
must be filed is the year in which the trustee is appointed. If you
are in this situation, you may contact DOL at
PBGCTrusteedPlan@dol.gov. See specific instructions for Part I, Line
B(5) for the simplified filing requirements for plans with 500 or
fewer participants.
Examples:
Mergers/Consolidations
A final return/report should be filed for the plan year (12
months or less) that ends when all plan assets were legally
transferred to the control of another plan.
[TIP] Remember to identify, on Schedule H, Line 5, the plan to
which assets were transferred. The transferee plan must also report
the merger/consolidation on its own Form 5500, Schedule H Line 5.
Pension and Welfare Plans That Terminated Without Distributing All
Assets
If the plan was terminated, but all plan assets were not
distributed, a return/report must be filed for each year the plan
has assets. The return/report must be filed by the plan
administrator, if designated, or by the person or persons who
actually control the plan's assets/property.
Group Health Plans and Other Welfare Plans Still Liable To Pay Benefits
A welfare plan cannot file a final return/report if the plan is
still liable to pay benefits for claims that were incurred prior to
the termination date, but not yet paid. See 29 CFR 2520.104b-
2(g)(2)(ii).
Signature and Date
For purposes of Title I of ERISA, the plan administrator is
required to file the Form 5500. If the plan administrator does not
sign a filing, the filing status will indicate that there is an
error with your filing, and your filing will be subject to further
review, correspondence, rejection, and civil penalties. The plan
administrator must electronically sign the Form 5500 Annual Return/
Report or 5500-SF submitted to EFAST2.
Note. If the plan administrator is an entity, the electronic
signature must be in the name of a person authorized to sign on
behalf of the plan administrator.
[CAUTION] After submitting your filing, you must check the
Filing Status. If the filing status is ``Processing Stopped,'' it is
possible your submission was not sent with a valid electronic
signature as required, and depending on the error, may be considered
not to have been filed. By looking closer at the Filing Status, you
can see specific error messages applicable to the transmitted filing
and determine whether it was sent with a valid electronic signature
and what other errors may need to be corrected.
Authorized Service Provider Signatures. If the plan
administrator elects to have a service provider who manages the
filing process for the plan get EFAST2 signing credentials and
submit the electronic Form 5500 Annual Return/Report for the plan:
(1) the service provider must receive specific written
authorization from the plan administrator to submit the plan's
electronic filing;
(2) the plan administrator must manually sign a paper copy of
the electronically completed Form 5500 Annual Return/Report, and the
service provider must include a PDF copy of the manually signed Form
5500 as an attachment to the electronic Form 5500 Annual Return/
Report submitted to EFAST2;
(3) the service provider must communicate to the plan
administrator any inquiries received from EFAST2, DOL, IRS or PBGC
regarding the filing;
(4) the service provider must communicate to the plan
administrator that, by electing to use this option, the image of the
plan administrator's manual signature will be
[[Page 47604]]
included with the rest of the return/report posted by the Labor
Department on the Internet for public disclosure; and
(5) the plan administrator must keep the manually signed copy of
the Form 5500, with all required schedules and attachments, as part
of the plan's records. For more information on the electronic
signature option, see the EFAST2 All-Electronic Filing System FAQs
at www.dol.gov/ebsa/faqs/faq-EFAST2.html.
[CAUTION] Service providers should consider implications of IRS
tax return preparer rules.
Note. The Code permits either the plan sponsor/employer or the
administrator to sign the filing. However, any Form 5500 Annual
Return/Report that is not electronically signed by the plan
administrator will be subject to rejection and civil penalties under
Title I of ERISA.
For DFE filings, a person authorized to sign on behalf of the
DFE must sign for the DFE.
The Form 5500 Annual Return/Report must be filed electronically
and signed. To obtain an electronic signature, go to
www.efast.dol.gov and register in EFAST2 as a signer. You will be
provided with a UserID and PIN. Both the UserID and PIN are needed
to sign the Form 5500. The plan administrator must keep a copy of
the Form 5500, including schedules and attachments with all required
signatures on file as part of the plan's records. See 29 CFR
2520.103-1.
Electronic signatures on annual returns/reports filed under
EFAST2 are governed by the applicable statutory and regulatory
requirements.
Preparer Information
Enter the ``Preparer's name (including firm's name, if
applicable), address, and telephone number'' at the bottom of the
first page of Form 5500. A preparer is any person who prepares an
annual return/report for compensation, or who employs one or more
persons to prepare the annual return/report for compensation. If the
person who prepared the annual return/report is not the employer
named in Line 2a or the plan administrator named in Line 3a, you
must name the person on this line. If there are several people who
prepare Form 5500 and applicable schedules, please name the person
who is primarily responsible for the preparation of the annual
return/report.
Note. You must complete preparer information if you are required
to file at least 250 returns of any type with the IRS during the
calendar year. However, if you are a small filer (files fewer than
250 returns of any type with the IRS during the calendar year), and
you do not enter preparer information on the Form 5500, then you
must file the paper Form 5500-SUP with the IRS. See the Treasury
regulations on ``Employee Retirement Benefit Plan Returns Required
on Magnetic Media'' (See 79 FR 58256 at https://federalregister.gov/a/2014-23161) and Instructions for Form 5500-SUP for more
information.
Change in Plan Year
Generally, only defined benefit pension plans need to get
approval for a change in the plan year. See Code section 412(d)(1).
However, under Rev. Proc. 87-27, 1987-1 C.B. 769, these pension
plans may be eligible for automatic approval of a change in plan
year. If a change in plan year for a pension or welfare benefit plan
creates a short plan year, file the form and applicable schedules by
the last day of the 7th calendar month after the short plan year
ends or by the extended due date, if filing under an authorized
extension of time. Fill in the short plan year beginning and ending
dates in the space provided in Part I and check the appropriate box
in Part I, Line B of the Form 5500. For purposes of this return/
report, the short plan year ends on the date of the change in
accounting period or upon the complete distribution of assets of the
plan. Also, see the instructions for the Final Return/Report to
determine if ``Final Return/Report'' in Line B should be checked.
Penalties
Plan administrators and plan sponsors must provide complete and
accurate information and must otherwise comply fully with the filing
requirements. ERISA and the Code provide for the DOL and the IRS,
respectively, to assess or impose penalties for not giving complete
and accurate information and for not filing complete and accurate
statements and returns/reports. Certain penalties are administrative
(i.e., they may be imposed or assessed by one of the governmental
agencies delegated to administer the collection of the annual
return/report data). Others require a legal conviction.
Administrative Penalties
Listed below are various penalties under ERISA and the Code that
may be assessed or imposed for not meeting the annual return/report
filing requirements. Generally, whether the penalty is under ERISA
or the Code, or both, depends upon the Agency for which the
information is required to be filed. One or more of the following
administrative penalties may be assessed or imposed in the event of
incomplete filings or filings received after the due date unless it
is determined that your failure to file properly is for reasonable
cause:
1. A penalty of up to $1,100 a day (or higher amount if adjusted
pursuant to the Federal Civil Penalties Inflation Adjustment Act of
1990, as amended) for each day a plan administrator fails or refuses
to file a complete and accurate report. See ERISA section 502(c)(2)
and 29 CFR 2560.502c-2.
2. A penalty of $25 a day (up to $15,000) for not filing returns
for certain plans of deferred compensation, trusts and annuities,
and bond purchase plans by the due date(s). See Code section
6652(e).
3. A penalty of $1,000 for each failure to file an actuarial
statement (Schedule MB (Form 5500) or Schedule SB (Form 5500))
required by the applicable instructions. See Code section 6692.
Other Penalties
1. Any individual who willfully violates any provision of Part 1
of Title I of ERISA shall on conviction be fined not more than
$100,000 or imprisoned not more than 10 years, or both. See ERISA
section 501.
2. A penalty up to $10,000, five (5) years imprisonment, or
both, may be imposed for making any false statement or
representation of fact, knowing it to be false, or for knowingly
concealing or not disclosing any fact required by ERISA. See section
1027, Title 18, U.S. Code, as amended by section 111 of ERISA.
Section 4: What To File
The Form 5500 Annual Return/Report reporting requirements vary
depending on whether the Form 5500 is being filed for a ``large
plan,'' a ``small plan,'' and/or a DFE, and on the particular type
of plan (e.g., group health plan, welfare plan other than group
health, defined benefit pension plan, defined contribution pension
plan) or the kind of DFE involved (i.e. common/collective trust
(CCT), pooled separate account (PSA), master trust, 103-12
investment entity (103-12 IE), or group insurance arrangement (GIA).
The instructions below provide detailed information about each of
the Form 5500 schedules and which plans and DFEs are required to
file them.
The schedules are grouped in the instructions by type: (1)
Pension Benefit Schedules; and (2) General Schedules (including the
new Schedule J (Group Health Plan Information). Each schedule is
listed separately with a description of the subject matter covered
by the schedule and the plans and DFEs that are required to file the
schedule.
Filing requirements also are listed by type of filer: (1) Filing
Requirements for Pension Benefit Plan; (2) Filing Requirements for
Plans Providing Group Health Benefits; (3) Filing Requirements for
Welfare Benefit Plan Other Than Group Health; and (4) DFE Filing
Requirements. For each filer type, there is a list of the schedules
that must be filed with the Form 5500 (including where applicable,
separate lists for large plan filers, small plan filers, and
different types of DFEs). The filing requirements also are
summarized at the end of these instructions in a series of ``Quick
Reference Charts of Form 5500, Schedules, and Attachments'' for the
various types of filers.
Generally, a return/report filed for a pension benefit plan or
welfare benefit plan other than a group health plan that covered
fewer than 100 participants as of the beginning of the plan year
should be completed following the requirements below for a ``small
plan,'' and a return/report filed for a plan that covered 100 or
more participants as of the beginning of the plan year should be
completed following the requirements below for a ``large plan.''
Use the number of participants required to be entered in Line 6
of the Form 5500 to determine whether a plan is a ``small plan'' or
``large plan.''
Exceptions:
(1) 80-120 Participant Rule: If the number of participants
reported at the beginning of the year was between 80 and 120
(inclusive), and a Form 5500 Annual Return/Report or Form 5500-SF
was filed for the prior plan year, you may elect to complete the
return/report in the same category (``large plan'' or ``small
plan'') as was filed for the prior
[[Page 47605]]
return/report. Thus, if a Form 5500-SF or a Form 5500 Annual Return/
Report was filed for the 20XX-1 plan year as a small plan, and the
plan either had fewer than 100 participants as of the beginning of
the plan year as reported on Form 5500 Annual Return/Report or the
plan is eligible to claim small plan status under 29 CFR 103-1(d)
and had 120 or fewer participants as of the beginning of the plan
year, you may elect to complete the 20XX Form 5500 and schedules in
accordance with the instructions for a small plan, including for
eligible filers, filing the Form 5500-SF instead of the Form 5500.
Defined benefit pension plans, welfare plans, and defined
contribution pension plans that check the ``first plan'' year box
use the number reported on Form 5500, Line 6 for this measure.
Defined contribution pension plans use the number reported on Form
5500, Line 7g(1)).
(2) Short Plan Year Rule: If the plan had a short plan year of
seven (7) months or less for either the prior plan year or the plan
year being reported on the 20XX Form 5500, an election can be made
to defer filing the accountant's report in accordance with 29 CFR
2520.104-50. If such an election was made for the prior plan year,
the 20XX Form 5500 must be completed following the requirements for
a large plan, including the attachment of the Schedule H and the
accountant's reports, regardless of the number of participants
entered in Part II, Line 6 for defined benefit pension plans,
welfare plans, and defined contribution pension plans that check the
``first plan'' year box, or Line 7g(1) for defined contribution
pension plans.
Form 5500 Schedules
Pension Schedules
Schedule R (Retirement Plan Information) is required for both
tax-qualified and nonqualified pension benefit plan unless otherwise
specified under Limited Pension Plan Reporting. For additional
information, see the Schedule R instructions.
Schedule MB (Multiemployer Defined Benefit Plan and Certain
Money Purchase Plan Actuarial Information) is required for most
multiemployer defined benefit pension plans and for defined
contribution pension plans that currently amortize a waiver of the
minimum funding requirements specified in the instructions for the
Schedule MB. For additional information, see the instructions for
the Schedule MB and the Schedule R.
Schedule SB (Single-Employer Defined Benefit Plan Actuarial
Information) is required for most single-employer defined benefit
pension plans, including multiple-employer defined benefit pension
plans. For additional information, see the instructions for the
Schedule SB.
Schedule E (ESOP Annual Information) is required for all pension
benefit plans with ESOP benefits. For additional information, see
the Schedule E instructions.
General Schedules
Schedule H (Financial Information) is required for pension
benefit plans and welfare benefit plans that are not eligible to
file the Form 5500-SF and for all DFE filings. All plans and DFEs
required to file the Schedule H are also generally required to
attach to the Form 5500 Annual Return/Report a ``Schedule of Assets
Held for Investment At End of Year,'' and, if applicable, a
``Schedule of Assets Disposed of During the Plan Year,'' a
``Schedule of Reportable Transactions,'' and a ``Schedule of
Delinquent Participant Contributions.'' For additional information,
see the Schedule H instructions.
Large employee benefit plans, 103-12 IEs, and GIAs filing the
Schedule H are generally required to engage an independent qualified
public accountant (IQPA) and attach a report of the IQPA pursuant to
ERISA section 103(a)(3)(A).
Small employee benefit plans are not required to attach a report
of the IQPA if they meet the conditions for eligibility for a waiver
of the audit requirements as set forth in 2520.104-46. For these
purposes, defined benefit pension plans, welfare plans, and defined
contribution pension plans that check the ``first plan'' year box
use the participant count on Line 6, and defined contribution
pension plans can use the participant count on Line 7g(1).
Exceptions: Insured, unfunded, or combination unfunded/insured
welfare plans including group health plans, as described in 29 CFR
2520.104-44(b)(1), and certain pension plans and arrangements, as
described in 29 CFR 2520.104-44(b)(2) and in Limited Pension Plan
Reporting, are exempt from completing the Schedule H.
Schedule A (Insurance Information) is required if any benefits
under an employee benefit plan are provided by an insurance company,
insurance service or other similar organization, or through a
managed care organization or a health maintenance organization. This
includes investment contracts with insurance companies, such as
guaranteed investment contracts, pooled separate accounts, and
variable annuities. Schedule A is not required for fully insured
group health plans with fewer than 100 participants. For additional
information, see the Schedule A instructions.
Note. Do not file Schedule A for Administrative Services Only
(ASO) contracts. You do not file Schedule A for a plan if a Schedule
A is filed for the contract as part of the Form 5500 Annual Return/
Report filed directly by a master trust or 103-12 IE in which that
plan invested/participated during the plan year.
Schedule C (Service Provider Information) is generally required
for all pension plans filing the Form 5500, master trusts, 103-12
IEs, and GIAs to report the information required for: (1) each
covered service provider who received $1,000 or more in total direct
and indirect compensation (i.e., money or anything else of monetary
value in connection with services rendered to the plan or the
person's position with the plan during the plan year) and (2) other
persons who received $5,000 or more in direct compensation in
connection with services rendered to the plan or the person's
position with the plan during the plan year. For additional
information, including the definition of a ``covered service
provider,'' see the Schedule C instructions. Schedule C is also
required for welfare benefit plans, including group health plans,
unless the plan is exempt under 29 CFR 2520.104-44 from completing
the accountant's report requirement and completing Schedule H.
Schedule D (DFE/Participating Plan Information) Schedule D is
required when the Form 5500 is filed for a DFE. For additional
information, see the Schedule D instructions.
Schedule G (Financial Transaction Schedules) is required for a
large plan, master trust, 103-12 IE, or GIA when Schedule H
(Financial Information) lines 4b, 4c, and/or 4d are checked ``Yes.''
Part I of the Schedule G reports loans or fixed income obligations
in default or classified as uncollectible. Part II of the Schedule G
reports leases in default or classified as uncollectible. Part III
of the Schedule G reports nonexempt transactions. For additional
information, see the Schedule G instructions.
[CAUTION] An unfunded, fully insured, or combination unfunded/
insured welfare plan with 100 or more participants exempt under 29
CFR 2520.104-44 from completing Schedule H must still complete
Schedule G, Part III, to report nonexempt transactions.
Schedule J (Group Health Plan Information). All plans that
provide group health benefits must complete the Schedule J (Group
Health Plan Information) to report coverage, participation, claims,
benefit, and other group health information. Small, fully insured
plans only need to complete lines 1-8.
Filing Requirements
Pension Benefit Plans
Pension benefit plan filers must complete the Form 5500 Annual
Return/Report, including the signature block and, unless otherwise
specified, attach the following schedules and information:
Small Pension Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached to a
Form 5500 filed for a small pension plan that is neither exempt from
filing nor is filing the Form 5500-SF:
1. Schedule A (as many as needed), to report insurance, annuity,
and investment contracts held by the plan.
2. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds.
3. Schedule H, to report plan financial information, unless
exempt. See Limited Pension Plan Reporting.
4. Schedule MB or SB, to report actuarial information, if
applicable.
5. Schedule R, to report retirement plan information, if
applicable.
[CAUTION] Unless you have checked Schedule H, Line 3h(4) to
indicate that the plan has fewer than 100 participants and is
claiming a small plan audit waiver of the annual examination and
report of an IQPA under 29 CFR 2520.104-46, you must attach the
report of the independent qualified public accountant (IQPA) or
check Schedule H, Line 3h(2) to indicate that the plan is eligible
and elects to defer attaching the
[[Page 47606]]
IQPA's opinion pursuant to 29 CFR 2520.104-50 in connection with a
short plan year of seven months or less.
Large Pension Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached to a
Form 5500 filed for a large pension plan:
1. Schedule A (as many as needed), to report insurance, annuity,
and investment contracts held by the plan.
2. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds.
3. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the plan
year, leases in default or classified as uncollectible, and
nonexempt transactions, i.e., file Schedule G if Schedule H (Form
5500) lines 4b, 4c, and/or 4d are checked ``Yes.''
4. Schedule H, to report financial information, unless exempt.
See Limited Pension Plan Reporting.
5. Schedule MB or SB, to report actuarial information, if
applicable.
6. Schedule R, to report retirement plan information, if
applicable.
Eligible Combined Plans
Section 903 of PPA established rules for a new type of pension
plan, an ``eligible combined plan,'' effective for plan years
beginning after December 31, 2009. See Code section 414(x) and ERISA
section 210(e). An eligible combined plan consists of a defined
benefit pension plan and a defined contribution pension plan that
includes a qualified cash or deferred arrangement under Code section
401(k), with the assets of the two plans held in a single trust, but
clearly identified and allocated between the plans. The eligible
combined plan design is available only to employers that employed an
average of at least two, but not more than 500 employees, on
business days during the calendar year preceding the plan year as of
which the eligible combined plan is established and that employs at
least two employees on the first day of the plan year that the plan
is established. Because an eligible combined plan includes both a
defined benefit pension plan and a defined contribution pension
plan, the Form 5500 filed for the plan must include all the
information, schedules, and attachments that would be required for
either a defined benefit pension plan (such as a Schedule SB) or a
defined contribution pension plan.
Limited Pension Plan Reporting
The pension benefit plans or arrangements described below are
eligible for limited annual reporting:
1. IRA Plans: A pension plan using individual retirement
accounts or annuities (as described in Code section 408) as the sole
funding vehicle for providing pension benefits need complete only
Form 5500, Part I and Part II, lines 1 through 4, and 9a(8) (check
the box for ``Code section 408 accounts and annuities on Form 5500).
2. Fully Insured Pension Plan: A pension benefit plan providing
benefits exclusively through an insurance contract or contracts that
are fully guaranteed and that meet all of the conditions of 29 CFR
2520.104-44(b)(2) during the entire plan year must complete all the
requirements listed under this Pension Benefit Plan Filing
Requirements section, except that such a plan is exempt from
attaching Schedule H, and an independent qualified public
accountant's opinion, and from the requirement to engage an IQPA.
[CAUTION] A pension benefit plan that has insurance contracts of
the type described in 29 CFR 2520.104-44 as well as other assets
must complete all requirements for a pension benefit plan, except
that the value of the plan's allocated contracts (see below) should
not be reported in Part I of Schedule H. All other assets should be
reported on Schedule H and any other required schedules. If Schedule
H is filed, attach an accountant's report in accordance with the
Schedule H instructions.
Note. For purposes of the annual return/report and the
alternative method of compliance set forth in 29 CFR 2520.104-44, a
contract is considered to be ``allocated'' only if the insurance
company or organization that issued the contract unconditionally
guarantees, upon receipt of the required premium or consideration,
to provide a retirement benefit of a specified amount. This amount
must be provided to each participant without adjustment for
fluctuations in the market value of the underlying assets of the
company or organization, and each participant must have a legal
right to such benefits, which is legally enforceable directly
against the insurance company or organization. For example, deposit
administration, immediate participation guarantee, guaranteed
investment contracts, and variable annuities are NOT allocated
contracts for Form 5500 Annual Return/Report purposes.
Welfare Benefit Plans that Provide Group Health Benefits
Large group health plans must follow the filing rules for large
welfare plans and also must file the Schedule J (Group Health Plan
Information).
Small group health plans that are unfunded or a combination of
unfunded and insured file the complete Form 5500 and the complete
Schedule J and Schedule A, if applicable. Small group health plans
that are fully insured need only complete Lines 1-5 of the Form 5500
and Lines 1-8 of the Schedule J (and they do not complete Schedule
A). Small group health plans that are funded with a trust generally
follow the rules for large group health plans funded with a trust
(except small welfare plans are not required to complete Schedule G
or the other separate schedules listed in 29 CFR 2020.104-46(c)).
Other Welfare Benefit Plans
Welfare benefit plans that do not provide group health benefits
must complete the Form 5500 Annual Return/Report, including the
signature block and, unless otherwise specified, attach the
following schedules and information:
Small Welfare Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached to a
Form 5500 filed for a small welfare plan that is neither exempt from
filing the annual return/report nor filing the Form 5500-SF:
1. Schedule A (as many as needed), to report insurance contracts
held by the plan.
2. Schedule H to report plan financial information, unless
exempt.
3. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds, unless exempt.
Large Welfare Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached to a
Form 5500 filed for a large welfare plan:
1. Schedule A (as many as needed), to report insurance and
investment contracts held by the plan.
2. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds, unless exempt.
3. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the plan
year, leases in default or classified as uncollectible, and
nonexempt transactions, i.e., file Schedule G if Schedule H (Form
5500) lines 4b, 4c, and/or 4d are checked ``Yes'' or if a large
welfare plan that is not required to file a Schedule H has nonexempt
transactions.
4. Schedule H, to report financial information, unless exempt.
[TIP] Attach the report of the independent qualified public
accountant (IQPA) identified on Schedule H, Line 3c, unless Line
3e(2) or (3) is checked. Neither Schedule H nor an IQPA's opinion is
required to be attached to a Form 5500 filed for an unfunded, fully
insured or combination unfunded/insured welfare plan that meets the
requirements of 29 CFR 2520.104-44. However, Schedule G, Part III,
must be attached to the Form 5500 to report any nonexempt
transactions for a large welfare plan. A large welfare benefit plan
that uses a ``voluntary employees' beneficiary association'' (VEBA)
under Code section 501(c)(9) is generally not exempt from the
requirement of engaging an IQPA.
Direct Filing Entity (DFE) Filing Requirements
Only one Form 5500 Annual Return/Report should be filed for each
DFE for all plans participating in the DFE; however, the Form 5500
filed for the DFE, including all required schedules and attachments,
must report information for the DFE year (not to exceed 12 months in
length) that ends with or within the participating plan's year.
Any Form 5500 filed for a DFE is an integral part of the annual
return/report of each participating plan, and the plan administrator
may be subject to penalties for failing to file a complete annual
report unless
[[Page 47607]]
both the DFE's Form 5500 and the plan's Form 5500 are properly
filed. The information required for a Form 5500 Annual Return/Report
filed for a DFE varies according to the type of DFE. The following
paragraphs provide specific guidance for the reporting requirements
for each type of DFE.
Master Trust
The administrator filing a Form 5500 Annual Return/Report for an
employee benefit plan is required to file or have a designee file a
Form 5500 for each master trust in which the plan participated at
any time during the plan year. For reporting purposes, a ``master
trust'' is a trust for which a regulated financial institution (as
defined below) serves as trustee or custodian (regardless of whether
such institution exercises discretionary authority or control with
respect to the management of assets held in the trust), and in which
assets of more than one plan sponsored by a single employer or by a
group of employers under common control are held.
``Common control'' is determined on the basis of all relevant
facts and circumstances (whether or not such employers are
incorporated).
A ``regulated financial institution'' means a bank, trust
company, or similar financial institution that is regulated,
supervised, and subject to periodic examination by a state or
federal agency. A securities brokerage firm is not a ``similar
financial institution'' as used here. See DOL Advisory Opinion 93-
21A (available at www.dol.gov/ebsa).
The Form 5500 submitted for the master trust must comply with
the Form 5500 Annual Return/Report instructions for a Large Pension
Plan, unless otherwise specified in the forms and instructions. The
master trust must file:
1. Form 5500, except lines C, D, 1c, 2d, and 6 through 10. Be
certain to check the ``master trust'' box Part I, Line A, as the DFE
type.
2. Schedule A (as many as needed) to report insurance, annuity
and investment contracts held by the master trust.
3. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds.
4. Schedule D, to list all plans that participated in the master
trust during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
master trust year, all leases in default or classified as
uncollectible, and nonexempt transactions.
6. Schedule H, except Lines 1a(1), 1a(2), 1a(3), 1g, 1h, 1i, 2a,
2b, 2e, 2f, 2g, 4a, 4e, 4f, 4g, 4h, 4k, 4l, 4m, and 5, to report
financial information. The opinion of an independent qualified
public accountant (IQPA) is not required for a master trust.
7. Additional information required by the instructions to the
above schedules, including, for example, the Schedules of Assets and
the Schedule of Reportable Transactions. For purposes of the
schedule of reportable transactions, the 5% figure shall be
determined by comparing the current value of the transaction at the
transaction date with the current value of the investment account
assets at the beginning of the applicable fiscal year of the master
trust. All attachments must be properly labeled.
Note. If the plan uses more than one master trust, a separate
annual report for each master trust must be filed.
Common/Collective Trust (CCT) and Pooled Separate Account (PSA)
A Form 5500 Annual Return/Report is not required to be filed for
a CCT or PSA. However, the administrator of a large plan or DFE that
participates in a CCT or PSA that files as specified below is
entitled to reporting relief that is not available to plans or DFEs
participating in a CCT or PSA for which a Form 5500 Annual Return/
Report is not filed.
For reporting purposes, ``common/collective trust'' and ``pooled
separate account'' are, respectively: (1) a trust maintained by a
bank, trust company, or similar institution or (2) an account
maintained by an insurance carrier, which is regulated, supervised,
and subject to periodic examination by a state or federal agency in
the case of a CCT, or by a state agency in the case of a PSA, for
the collective investment and reinvestment of assets contributed
thereto from employee benefit plans maintained by more than one
employer or controlled group of corporations as that term is used in
Code section 1563. See 29 CFR 2520.103-3, 103-4, 103-5, and 103-9.
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR 2510.3-
101(h)(1)(iii) does not constitute a pooled separate account.
The Form 5500 Annual Return/Report submitted for a CCT or PSA
must comply with the Form 5500 Annual Return/Report instructions for
a Large Pension Plan, unless otherwise specified in the forms and
instructions.
The CCT or PSA must file:
1. Form 5500, except lines C, D, 1c, 2d, and 6 through 10. Check
``CCT'' or ``PSA,'' as appropriate, in Part I, Line A, as the DFE
type.
2. Schedule D, to list all plans that participated in the CCT or
PSA during its year.
3. Schedule H, except Lines 1a(1), 1a(2), 1a(3), 1c, 1d, 1g, 1h,
1i, 2a, 2b, 2e, 2f, and 2g, to report financial information. CCTs
and PSAs are not required to attach an IQPA report or complete Part
IV, except Line 4(i)(1). CCTs and PSAs must attach the Line 4i(1)
Schedule of Assets Held for Investment at End of Year.
[CAUTION] Different requirements apply to Schedule H attached to
the Form 5500 filed by plans and DFEs participating in CCTs and
PSAs, depending upon whether a DFE Form 5500 has been filed for the
CCT or PSA. See the instructions for these schedules.
103-12 Investment Entity (103-12 IE)
DOL Regulation 2520.103-12 provides an alternative method of
reporting for plans that invest in an entity (other than a master
trust, CCT, or PSA), whose underlying assets include ``plan assets''
within the meaning of 29 CFR 2510.3-101 of two or more plans that
are not members of a ``related group'' of employee benefit plans.
Such an entity for which a Form 5500 is filed constitutes a ``103-12
IE.'' A Form 5500 is not required to be filed for such entities;
however, filing a Form 5500 as a 103-12 IE provides certain
reporting relief, including the limitation of the examination and
report of the independent qualified public accountant (IQPA)
provided by 29 CFR 2520.103-12(d), to participating plans and DFEs.
For this reporting purpose, a ``related group'' of employee benefit
plans consists of each group of two or more employee benefit plans
(1) each of which receives 10% or more of its aggregate
contributions from the same employer or from a member of the same
controlled group of corporations (as determined under Code section
1563(a), without regard to Code section 1563(a)(4) thereof); or (2)
each of which is either maintained by, or maintained pursuant to a
collective-bargaining agreement negotiated by, the same employee
organization or affiliated employee organizations. For purposes of
this paragraph, an ``affiliate'' of an employee organization means
any person controlling, controlled by, or under common control with
such organization. See 29 CFR 2520.103-12.
The Form 5500 submitted for an entity holding plan assets that
is permitted under 29 CFR 2520.103-12 to file a Form 5500 must
comply with the Form 5500 instructions for a Large Pension Plan,
unless otherwise specified in the forms and instructions.
The 103-12 IE must file:
1. Form 5500, except lines C, D, 1c, 2d, and 6 through 10. Check
103-12 IE in part I, Line A, as the DFE type.
2. Schedule A (as many as needed), to report insurance, annuity
and investment contracts held by the 103-12 IE.
3. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds.
4. Schedule D, to list all plans that participated in the 103-12
IE during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the 103-
12 IE year, leases in default or classified as uncollectible, and
nonexempt transactions.
6. Schedule H, except lines 1a(1), 1a(2), 1a(3), 1c, 1d, 1g, 1h,
1i, 2a, 2b, 2e, 2f, 2g, 4a, 4e, 4f, 4g, 4h, 4j, 4k, 4l, 4m, and 5,
to report financial information.
7. Additional information required by the instructions to the
above schedules, including, for example, the report of the
independent qualified public accountant (IQPA) identified on
Schedule H, Line 3c, the Line 4i(1) Schedule of Assets Held for
Investment at End of Year, and the Line 4i(2) Schedule of Assets
Disposed of During the Plan Year. All attachments must be properly
labeled.
Group Insurance Arrangement (GIA)
Each welfare benefit plan, regardless of whether it provides
group health benefits, that is part of a group insurance arrangement
is exempt from the requirement to file a Form 5500 Annual Return/
Report if a consolidated
[[Page 47608]]
report for all the plans in the arrangement was filed in accordance
with 29 CFR 2520.104-43. For reporting purposes, a ``group insurance
arrangement'' provides benefits to the employees of two or more
unaffiliated employers (not in connection with a multiemployer plan
or a collectively-bargained multiple-employer plan), fully insures
one or more welfare plans of each participating employer, uses a
trust or other entity as the holder of the insurance contracts, and
uses a trust as the conduit for payment of premiums to the insurance
company.
The GIA must file:
1. Form 5500, except lines C and 2d. Check ``GIA'' in Part I,
Line A, as the DFE type.
2. Schedule A (as many as needed), to report insurance, annuity
and investment contracts held by the GIA.
3. Schedule C (as many as needed) to report information on
service providers who received compensation at or above the
applicable $1,000 and $5,000 thresholds.
4. Schedule D, to list all plans that participated in the GIA
during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the GIA
year, leases in default or classified as uncollectible, and
nonexempt transactions.
6. Schedule H, except lines 4a, 4e, 4f, 4g, 4h, 4l, 4m, and 5,
to report financial information.
7. Separate Schedules J for each participating employer, if the
GIA provides group health benefits.
8. Additional information required by the instructions to the
above schedules, including, for example, the report of the
independent qualified public accountant (IQPA) identified on
Schedule H, Line 3c, the Schedules of Assets and the Schedule of
Reportable Transactions. (All attachments must be properly labeled.)
Section 5: Line-by-Line Instructions for the 20XX Form 5500 and
Schedules
Part I--Annual Return/Report Identification Information
File the 20XX Form 5500 Annual Return/Report for a plan year
that began in 20XX or a DFE year that ended in 20XX. Enter the
beginning and ending dates in Part I. The 20XX Form 5500 Annual
Return/Report must be filed electronically.
One Form 5500 is generally filed for each plan or entity
described in the instructions to the boxes in Line A. Do not check
more than one box.
Line A(1)--Box for Single-Employer Plan. Check this box if the
Form 5500 is filed for a single-employer plan. A single-employer
plan for this Form 5500 reporting purpose is an employee benefit
plan maintained by one employer or one employee organization.
Note. Do not check this box even if all of the employers
maintaining the plan are members of the same controlled group or
affiliated service group under Code sections 414(b), (c), or (m).
Check Box A(3).
Line A(2)--Box for Multiple-Employer Plan. Check this box if
Form 5500 is being filed for a multiple-employer plan. A multiple-
employer plan is a plan that is maintained by more than one employer
and is not one of the plans described in A(3) or A(4). A multiple-
employer plan can be collectively bargained and collectively funded,
but if covered by PBGC termination insurance, must have properly
elected before September 27, 1981, not to be treated as a
multiemployer plan under Code section 414(f)(5) or ERISA sections
3(37)(E) and 4001(a)(3), and have not revoked that election or made
an election to be treated as a multiemployer plan under Code section
414(f)(6) or ERISA section 3(37)(G). Participating employers do not
file individually for this type of plan.
Note. Do not check this box if all of the employers maintaining
the plan are members of the same controlled group or affiliated
service group under Code sections 414(b), (c), or (m).
``Multiple-Employer Plan Participating Employer Information.''
If you checked box A(2) for ``Multiple-Employer Plan,'' you must
complete the ``Multiple-Employer Plan Participating Employer
Information'' attachment. Enter the name of the plan, EIN, and plan
number (PN) as found on the plan's Form 5500. Complete as many
entries as needed to report the required information for all
participating employers.
Provide a good faith estimate of each employer's percentage of
the total contributions (including employer and participant
contributions) made by all participating employers during the year.
Any employer who was obligated to make contributions to the plan for
the plan year, made contributions to the plan for the plan year, or
whose employees were covered under the plan is a ``participating
employer'' for this purpose. If a participating employer made no
contributions, enter ``-0-'' in element (c).
Multiple employer welfare plans that are exempt under 29 CFR
2520.104-20 or 29 CFR 2520.104-44 from the obligation to file
financial statements with their annual report are required to
include only a list of participating employers with the
corresponding EIN/PN numbers in elements (a) and (b) of the
``Multiple Employer Plan Participating Employer Information''
attachment included with their Form 5500.
Line A(3)--Box for Controlled Group. Check this box for a
``controlled group'' of corporations that is filing a single Form
5500 for reporting purposes. A ``controlled group'' is a controlled
group of corporations under Code section 414(b), a group of trades
or businesses under common control under Code section 414(c), or an
affiliated service group under Code section 414(m).
``Controlled Group Member Information.'' If you checked box A(3)
for ``Controlled Group Plan,'' you must complete the ``Controlled
Group Member Information'' attachment. Complete as many entries as
needed to report the required information for all employers that are
participating members of the controlled group sponsoring the plan.
Provide a good faith estimate of each employer's percentage of the
total contributions (including employer and participant
contributions) made by all employers made during the year. Any
employer that was a member of the controlled group who was obligated
to make contributions to the plan for the plan year, made
contributions to the plan for the plan year, or whose employees were
covered under the plan is a ``participating employer'' for this
purpose. If a participating employer made no contributions, enter
``-0-'' in element (c).
Line A(4)--Multiemployer Plan. Check this box if the Form 5500
is filed for a multiemployer plan. A plan is a multiemployer plan
if: (a) more than one employer is required to contribute, (b) the
plan is maintained pursuant to one or more collective bargaining
agreements between one or more employee organizations and more than
one employer; (c) an election under Code section 414(f)(5) and ERISA
section 3(37)(E) has not been made; and (d) the plan meets any other
applicable conditions of 29 CFR 2510.3-37. A plan that has made a
proper election under ERISA section 3(37)(G) and Code section
414(f)(6) on or before August 17, 2007, is also a multiemployer
plan. Participating employers do not file individually for these
plans.
Line A(5)--Direct Filing Entity (DFE). If filing as a DFE, check
the box to indicate the correct entity type.
Line B(1)--First Return/Report. Check this box if an annual
return/report has not been previously filed for this plan or DFE.
For the purpose of completing this box, filings made for ``one
participant'' plans for purposes of the Code and not Title I are not
considered an annual return/report.
Line B(2)--Amended Return/Report. Check this box if you have
already filed for the 20XX plan year and are now filing an amended
return/report to correct errors and/or omissions on the previously
filed return/report. See instructions on page xx.
Check the Line B box for an ``amended return/report'' if you
filed a previous 20XX annual return/report that was given a
``Filing_Received,'' ``Filing_Error,'' or ``Filing_Stopped'' status
by EFAST2. Do not check the Line B box for an ``amended return/
report'' if your previous submission attempts were not successfully
received by EFAST2 because of problems with the transmission of your
return/report. For more information, go to the EFAST2 Web site at
www.efast.dol.gov or call the EFAST2 Help Line at 1-866-GO-EFAST (1-
866-463-3278).
Line B(3)--Final Return/Report. Check this box if this Form 5500
is the last annual return/report required to be submitted for this
plan. (See Final Return/Report.)
Note. Do not check box B(3) (Final Return/Report) if in Line
9b(4), you check the box to indicate that the plan is an unfunded,
fully insured, or combination unfunded/fully insured welfare plan
(other than a group health plan) that will not file an annual report
for next plan year pursuant to 29 CFR 2520.104-20. Only check the
box on Line 9b(4) for a welfare plan that is not required to file a
Form 5500 for the next plan year because the welfare plan that does
not provide group health benefits has become eligible for an annual
reporting exemption. For example, certain unfunded and insured life
insurance or disability plans may be required to file the 20XX Form
5500 and be exempt from filing a Form 5500 for the plan
[[Page 47609]]
year 20XX if the number of participants covered as of the beginning
of the 20XX plan year drops below 100. See Who Must File. Should the
number of participants covered by such a plan increase to 100 or
more in a future year, the plan must resume filing Form 5500 and
check the box on Line 9b(4) to indicate on that year's Form 5500
that the filer is an unfunded, fully insured, or combination
unfunded/fully insured welfare plan that stopped filing annual
reports in an earlier plan year pursuant to 29 CFR 2520.104-20. See
29 CFR 2520.104-20.
Line B(4)--Short Plan Year Return/Report. Check this box if this
Form 5500 is being filed for a plan year period of less than 12
months. Provide the dates in Part I, Plan Year Beginning and Ending.
Line B(5)--Plan Trusteed by PBGC. All plans that, as of the due
date of this return, have been trusteed by PBGC under section
4041(c) or 4042 of ERISA, must check this box and enter the date of
trusteeship in the space provided. Plans with 500 or fewer
participants as of the beginning of the plan year (see Part II, Line
6, asking for participant count) only complete all of Part I and
lines 1, 2, 3, 6, 9a(3) and 9a(4) in Part II. Plans with more than
500 participants continue to file in accordance with the
requirements for large defined benefit pension plans.
Line C--Collectively-Bargained Plan. Check this box when the
contributions to the plan and/or the benefits paid by the plan are
subject to the collective bargaining process (even if the plan is
not established and administered by a joint board of trustees and
even if only some of the employees covered by the plan are members
of a collective bargaining unit that negotiates contributions and/or
benefits). The contributions and/or benefits do not have to be
identical for all employees under the plan.
Line D--Extension and DFVC Program. Check the appropriate box
here if:
You filed for an extension of time, using a completed
Form 5558, Application for Extension of Time To File Certain
Employee Plan Returns, and maintain a copy of the Form 5558 with the
filer's records;
You are filing using the automatic extension of time to
file Form 5500 Annual Return/Report until the due date of the
federal income tax return of the employer and maintain a copy of the
employer's extension of time to file the income tax return with the
plan's records;
You are filing using a special extension of time to
file the Form 5500 Annual Return/Report that has been announced by
the IRS, DOL, and PBGC. If you checked that you are using a special
extension of time, enter a description of the extension of time in
the space provided; or
You are filing under DOL's Delinquent Filer Voluntary
Compliance (DFVC) Program.
Part II--Basic Plan Information
Line 1a. Enter the formal name of the plan or DFE. If an annual
return/report has previously been filed on behalf of the plan,
regardless of the type of Form that was filed (Form 5500, Form 5500-
EZ, or Form 5500-SF), use the same name or abbreviation as was used
on the prior filings. Once you use an abbreviation, continue to use
it for that plan on all future annual return/report filings with the
IRS, DOL, and PBGC. Do not use the same name or abbreviation for any
other plan, even if the first plan is terminated.
Line 1b. Enter the three-digit plan or entity number (PN) that
the employer or plan administrator assigned to the plan or DFE. This
three-digit number, in conjunction with the employer identification
number (EIN) entered on Line 2b, is used by the IRS, DOL, and PBGC
as a unique 12-digit number to identify the plan or DFE.
Start at 001 for plans providing pension benefits, plans
providing pension and welfare benefits, or DFEs (master trusts,
CCTs, and PSAs) except GIAs, as illustrated in the table below.
Start at 501 for plans providing only welfare benefits and GIAs.
Do not use 888 or 999.
Once you use a plan or DFE number, continue to use it for that
plan or DFE on all future filings with the IRS, DOL, and PBGC.
Failure to use the same three-digit plan/DFE number may result in
correspondence from DOL or IRS. Do not use this unique three-digit
number for any other plan or DFE, even if the first plan or DFE is
terminated.
You Should Assign a Plan Number (PN) as Described Below for Each Form
5500 (and Form 5500-SF) With the Same EIN of Plan or DFE Sponsor Entered
Into Line 2b
------------------------------------------------------------------------
------------------------------------------------------------------------
Pension benefit plans and Master 001 to the first plan or DFE.
trusts, CCTs, PSAs, and 103-12 IEs. Consecutively number other
plans providing pension
benefits with the same plan
sponsor or other master
trusts, CCTs, PSAs, or 103-12
IEs with the same sponsor as
002, 003 . . .
Welfare benefit plans, including group 501 to the first plan or GIA.
health, and GIAs. Consecutively number others as
502, 503 . . .
------------------------------------------------------------------------
Exception. If Part II, Line 9a is completed and 333 (or a higher
number in a sequence beginning with 333) was previously assigned to
the plan, that number may be entered on Line 1b.
Line 1c. Enter the date the plan first became effective.
Line 2a. Limit your response to the information required in each
row as specified below:
1. Enter the name of the plan sponsor or, in the case of a Form
5500 filed for a DFE, the name of the insurance company, financial
institution, or other sponsor of the DFE (e.g., in the case of a
GIA, the trust or other entity that holds the insurance contract, or
in the case of a master trust, one of the sponsoring employers). If
the plan covers only the employees of one employer, enter the
employer's name.
The term ``plan sponsor'' means:
The employer, for an employee benefit plan that a
single employer established or maintains;
The employee organization in the case of a plan of an
employee organization; or
The association, committee, joint board of trustees, or
other similar group of representatives of the parties who establish
or maintain the plan, if the plan is established or maintained
jointly by one or more employers and one or more employee
organizations, or by two or more employers.
Note. In the case of a multiple-employer plan, file only one
annual return/report for the plan. If an association or other entity
is not the sponsor, enter the name of a participating employer as
sponsor. For a plan of a controlled group of corporations, the name
of one of the sponsoring members should be entered. In either case,
the same name must be used in all subsequent filings of the Form
5500 Annual Return/Report or Form 5500-SF for the multiple-employer
plan or controlled group (see instructions for Line 5 concerning
change in sponsorship).
2. Enter any ``in care of'' (C/O) name.
3. Enter the current street address. A post office box number
may be entered in addition to the street address if the Post Office
does not deliver mail to the sponsor's street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of the U.S. state or
possession and zip code.
6. Enter the foreign routing code, if applicable. Leave U.S.
state and zip code blank if entering a foreign routing code and
country name.
7. Enter the foreign country, if applicable. Do not abbreviate
the country name after ``Enter the foreign country.''
8. Enter the D/B/A (the doing business as) or trade name of the
sponsor if different from the plan sponsor's name.
9. Enter any second address. Use only a street address here, not
a P.O. box.
Note. You can also use the IRS Form 8822-B, Change of Address--
Business, to notify the IRS if the address provided here is a change
in your business mailing address or your business location.
Line 2b(1). Enter the nine-digit employer identification number
(EIN) assigned to the plan sponsor/employer, for example, 00-
1234567. In the case of a DFE, enter the employer identification
number (EIN) assigned to the CCT, PSA, master trust, 103-12 IE, or
GIA.
[CAUTION] Do not use a social security number in lieu of an EIN.
The Form 5500 Annual Return/Report is open to public inspection, and
the contents are public
[[Page 47610]]
information and are subject to publication on the Internet. Because
of privacy concerns, the inclusion of a social security number or
any portion thereof on this line may result in the rejection of the
filing.
Employers without an EIN must apply for one as soon as possible.
The EBSA does not issue EINs. To apply for an EIN from the IRS:
Mail or fax Form SS-4, Application for Employer
Identification Number, obtained at the IRS Web site at www.irs.gov.
Call 1-800-829-4933 to receive your EIN by telephone.
Select the Online EIN Application link at www.irs.gov.
The EIN is issued immediately once the application information is
validated. (The online application process is not yet available for
corporations with addresses in foreign countries or Puerto Rico.)
A multiple-employer plan or plan of a controlled group of
corporations should use the EIN of the sponsor identified in Line
2b(1). The EIN must be used in all subsequent filings of the Form
5500 for these plans (see instructions to Line 5 concerning change
in EIN).
If the plan sponsor is a group of individuals, such as for the
Board of Trustees for a multiemployer plan, get a single EIN for the
group. When you apply for the EIN, provide the name of the group,
such as ``Joint Board of Trustees of the Local 187 Machinists'
Retirement Plan.'' (If filing IRS Form SS-4, enter the group name on
Line 1.)
Note. Except in the case of certain DFEs, the EIN of the plan
sponsor is not the EIN of the fund (trust or custodial account)
associated with plan.
Line 2b(2). If available, enter the global legal entity
identification number (LEI). With respect to any company, the LEI is
the ``legal entity identifier'' assigned by or on behalf of an
internationally recognized standards setting body and required for
reporting purposes by the U.S. Department of the Treasury's Office
of Financial Research or a financial regulator. In the case of a
financial institution, if a ``legal entity identifier'' has not been
assigned, then provide the RSSD ID assigned by the National
Information Center of the Board of Governors of the Federal Reserve
System, if any.
Line 2c. Enter the current telephone number for the plan
sponsor. Use numbers only, including area code, and do not include
any special characters.
Line 2d. Enter the six-digit business code that best describes
the nature of the plan sponsor's business from the list of business
codes on pages XX-XY. If more than one employer or employee
organization is involved, enter the business code for the main
business activity of the employers and/or employee organizations.
Line 3a. Limit your response to the information required in each
row as specified below:
1. Enter the current name and address of the plan administrator
unless the administrator is the sponsor identified in Line 2. If
both the plan administrator name and address are the same as the
plan sponsor name and address, check the ``Same as Plan Sponsor''
box and disregard items 2 through 6 below. If the Form 5500 is
submitted for a DFE, check the appropriate box in Part I, Line A,
and enter the appropriate DFE code.
The term ``plan administrator'' means:
The person or group of persons specified as the
administrator by the instrument under which the plan is operated;
The plan sponsor/employer if an administrator is not so
designated; or
Any other person prescribed by regulations if an
administrator is not designated and a plan sponsor cannot be
identified.
2. Enter any ``in care of'' (C/O) name.
3. Enter the current street address. A post office box number
may be entered, in addition to the street address, if the Post
Office does not deliver mail to the administrator's street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of the U.S. state or
possession and zip code.
6. Enter the foreign routing code and foreign country, if
applicable. Leave U.S. state and zip code blank if entering foreign
routing code and country information.
Line 3b. Enter the plan administrator's nine-digit EIN. A plan
administrator must have an EIN for Form 5500 reporting purposes.
If the plan administrator does not have an EIN, apply for one as
explained in the instructions for Line 2b. One EIN should be entered
for a group of individuals who are, collectively, the plan
administrator.
Do not use a social security number in lieu of an EIN. The Form
5500 and its schedules and attachments are open to public
inspection, and the contents are public information and are subject
to publication on the Internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Form 5500 or any of it schedules or attachments may result in the
rejection of the filing.
Note. Employees of the plan sponsor who perform administrative
functions for the plan are generally not the plan administrator
unless specifically designated in the plan document. If an employee
of the plan sponsor is designated as the plan administrator, that
employee must get an EIN.
Line 3c. Enter the current telephone number for the plan
administrator.
Line 4. A plan must have at least one fiduciary (a person or
entity) named in the written plan document, or through a process
described in the plan, as having control over the plan's operation.
The named fiduciary can be identified by office or by name. For some
plans, it may be an administrative committee or a company's board of
directors.
Enter the name and current address of the ``named fiduciary''
unless the named fiduciary is the plan sponsor identified in Line 2.
If both the fiduciary name and address are the same as the plan
sponsor name and address, check the ``Same as Plan Sponsor'' box. If
the named fiduciary is an entity such as a committee or board,
include the name and contact information for a specific individual,
as well as the name of the entity. If you are unable to determine
who is the ``named fiduciary,'' enter the name and identifying
information of the person who appointed the plan trustee.
Line 5. If the plan sponsor's or DFE's name, EIN, or LEI have
changed since the last return/report was filed for this plan or DFE,
enter the plan sponsor's or DFE's name, EIN, LEI, and the plan
number as it appeared on the last return/report filed.
[CAUTION] The failure to indicate on Line 5 that a plan or plan
sponsor was previously identified by a different name, employer
identification number (EIN), LEI, or plan number could result in
correspondence from the DOL and the IRS.
Line 5a. Enter the plan sponsor's name as it appeared on the
last return/report filed.
Line 5b(1). Enter the plan sponsor's EIN as it appeared on the
last return/report filed.
Line 5b(2). Enter the plan sponsor's LEI (if available) as it
appeared on the last return/report filed.
Line 5c. Enter the plan sponsor's plan number as it appeared on
the last return/report filed.
Lines 6 and 7. All filers must complete both lines 6 and 7
unless the Form 5500 is filed for an IRA Plan described in Limited
Pension Plan Reporting or for a DFE.
The description of ``participant'' in the instructions below is
only for purposes of these lines.
An individual becomes a participant covered under an employee
welfare benefit plan on the earliest of:
the date designated by the plan as the date on which
the individual begins participation in the plan;
the date on which the individual becomes eligible under
the plan for a benefit subject only to occurrence of the contingency
for which the benefit is provided; or
the date on which the individual makes a contribution
to the plan, whether voluntary or mandatory.
See 29 CFR 2510.3-3(d)(1). This includes former employees who
are receiving group health continuation coverage benefits pursuant
to Part 6 of ERISA and who are covered by the employee welfare
benefit plan. Covered dependents are not counted as participants. A
child who is an ``alternate recipient'' entitled to health benefits
under a qualified medical child support order (QMCSO) should not be
counted as a participant for lines 6 and 7. An individual is not a
participant covered under an employee welfare plan on the earliest
date on which the individual (a) is ineligible to receive any
benefit under the plan even if the contingency for which such
benefit is provided should occur, and (b) is not designated by the
plan as a participant. See 29 CFR 2510.3-3(d)(2).
[TIP] Before counting the number of participants, especially in
a welfare benefit plan, it is important to determine whether the
plan sponsor has established one or more plans for Form 5500/Form
5500-SF reporting purposes. As a matter of plan design, plan
sponsors can offer benefits through various structures and
combinations. For example, a plan sponsor could create (i) one plan
providing major medical benefits, dental benefits, and vision
benefits, (ii) two plans with one providing major medical benefits
and the other providing self-insured dental and vision benefits; or
(iii) three separate plans. You must review the governing documents
and actual operations to determine whether welfare benefits are
being
[[Page 47611]]
provided under a single plan or separate plans.
The fact that you have separate insurance policies for each
different welfare benefit does not necessarily mean that you have
separate plans. Some plan sponsors use a ``wrap'' document to
incorporate various benefits and insurance policies into one
comprehensive plan. In addition, whether a benefit arrangement is
deemed to be a single plan may be different for purposes other than
Form 5500/Form 5500-SF reporting. For example, special rules may
apply for purposes of HIPAA, COBRA, and Internal Revenue Code
compliance. If you need help determining whether you have a single
welfare benefit plan for Form 5500/Form 5500-SF reporting purposes,
you should consult a qualified benefits consultant or legal counsel.
For pension benefit plans, ``alternate payees'' entitled to
benefits under a qualified domestic relations order (QDRO) are not
to be counted as participants for this line.
For pension benefit plans, ``participant'' for this line means
any individual who is included in one of the categories below:
1. Active participants (i.e., any individuals who are currently
in employment covered by the plan and who are earning or retaining
credited service under the plan). This includes any individuals who
are eligible to elect to have the employer make payments under a
Code section 401(k) qualified cash or deferred arrangement. Active
participants also include any nonvested individuals who are earning
or retaining credited service under the plan. This does not include
(a) nonvested former employees who have incurred the break in
service period specified in the plan or (b) former employees who
have received a ``cash-out'' distribution or deemed distribution of
their entire nonforfeitable accrued benefit.
2. Retired or separated participants receiving benefits (i.e.,
individuals who are retired or separated from employment covered by
the plan and who are receiving benefits under the plan). This does
not include any individual to whom an insurance company has made an
irrevocable commitment to pay all the benefits to which the
individual is entitled under the plan.
3. Other retired or separated participants entitled to future
benefits (i.e., any individuals who are retired or separated from
employment covered by the plan and who are entitled to begin
receiving benefits under the plan in the future). This does not
include any individual to whom an insurance company has made an
irrevocable commitment to pay all the benefits to which the
individual is entitled under the plan.
4. Deceased individuals who had one or more beneficiaries who
are receiving or are entitled to receive benefits under the plan.
This does not include any individual to whom an insurance company
has made an irrevocable commitment to pay all the benefits to which
the beneficiaries of that individual are entitled under the plan.
Line 7g. Enter in element (1) the number of participants who
have account balances at the beginning of the year. Enter in element
(2) the number of participants included on Line 7f (total
participants at the end of the plan year) who have account balances
at the end of the plan year. For example, for a Code section 401(k)
plan the number entered on Line 7g should be the number of
participants counted on line 7f who have made a contribution, or for
whom a contribution has been made, to the plan for this plan year or
any prior plan year. Enter in element (3) the number of participants
that made contributions to the plan (regardless of whether the
employer made contributions) during the plan year. Both defined
contribution pension plans and welfare plans complete element (3).
Enter in element (4) the number of participants that terminated
employment during the plan year that had their entire account
balance distributed during the plan year. Only defined contribution
pension plans complete element (4).
Welfare plans should leave Line 7g(1), (2), and (4) blank.
Defined benefit pension plans should also leave Line 7g blank.
Line 7h. Include any individual who terminated employment during
this plan year, whether or not he or she (a) incurred a break in
service, (b) received an irrevocable commitment from an insurance
company to pay all the benefits to which he or she is entitled under
the plan, and/or (c) received a cash distribution or deemed cash
distribution of his or her nonforfeitable accrued benefit.
Multiemployer plans and multiple-employer plans that are
collectively bargained do not have to complete Line 7h.
Line 8. Only multiemployer plans should complete Line 8.
Multiemployer plans must enter the total number of employers
obligated to contribute to the plan. For purposes of Line 8 of the
Form 5500, an employer obligated to contribute is defined as an
employer who, during the 20XX plan year, is a party to the
collective bargaining agreement(s) pursuant to which the plan is
maintained or who may otherwise be subject to withdrawal liability
pursuant to ERISA section 4203. Any two or more contributing
entities (e.g., places of business with separate collective
bargaining agreements) that have the same nine-digit employer
identification number (EIN) must be aggregated and counted as one
employer for this purpose.
Line 9. Benefits Provided Under the Plan. Answer all questions
in Line 9a based on the reporting year of the plan or arrangement.
Line 9a(1). Defined Benefit Pension Features; How Benefits Are
Calculated. If benefits are based primarily on pay, check the box
``Benefits are primarily pay related.''
If benefits are primarily flat dollar, including dollars per
year of service, check the box ``Benefits are primarily flat
dollar.''
Check the box for ``Cash balance'' if the plan has a ``cash
balance'' formula under which the accumulated benefit provided under
the formula is expressed as the current balance of a hypothetical
account maintained for the participant. For this purpose, a ``cash
balance'' formula is a lump sum based benefit formula in a defined
benefit pension plan by whatever name (for example, personal account
plan, life cycle plan, cash account plan, etc.)
Check the box for ``Pension equity plan (PEP)'' if the plan has
a ``pension equity plan formula under which the accumulated benefit
provided under the formula is expressed as the current value of an
accumulated percentage of the participant's final average
compensation or is expressed as a current single-sum dollar amount
equal to a percentage of the participant's highest average
compensation (with a permitted lookback period for determining
highest average compensation, such as highest 5 out of the last 10
years).
Check the box for ``Other hybrid plan'' if the plan provides a
lump sum based benefit formula that is different from the cash
balance or pension equity plan formula. Note that a benefit formula
does not constitute a lump sum based benefit formula unless a
distribution of the benefits under that formula in the form of a
single-sum payment equals the accumulated benefit under that formula
(except to the extent the single-sum payment is greater to satisfy
the requirements of Code section 411(d)(6)).
Line 9a(2) Code Section Arrangements for Defined Benefit Pension
Plans. Check the box for ``Code section 401(h) arrangement'' if the
plan contains separate accounts under Code section 401(h) to provide
employee health benefits.
Check the box for ``Code section 414(k) arrangement'' if
benefits are based partly on the balance of the separate account of
the participant (also include appropriate defined contribution
pension feature codes).
Line 9a(3) Terminated Defined Benefit Pension Plan. Check
``yes'' if the plan is covered by PBGC and was terminated and closed
out for PBGC purposes before the end of the plan year (or a prior
plan year), and either (1) the plan terminated in a standard (or
distress) termination and completed the distribution of plan assets
in satisfaction of all benefit liabilities (or all ERISA Title IV
benefits for distress termination); or (2) a trustee was appointed
for a terminated plan pursuant to ERISA section 4042.
Line 9a(4) PBGC Covered Defined Benefit Pension Plan. If you are
uncertain whether the plan is covered under the PBGC termination
insurance program, check the box ``Not determined'' and contact the
PBGC either by phone at 1-800-736-2444, by Email at
standard@pbgc.gov, or in writing to Pension Benefit Guaranty
Corporation, Standard Termination Compliance Division, Suite 930,
Processing and Technical Assistance Branch, 1200 K Street, NW.,
Washington, DC 20005-4026. If you checked the box ``Yes,'' enter the
My PAA generated confirmation number for the premium filing for this
plan year (see filing receipt). If you amended your premium filing
for this plan year, enter the confirmation number for that filing
and not for the previous filing(s). Defined contribution pension
plans and welfare plans need not complete this item.
Line 9a(5) Frozen Plans. Check ``Yes'', if the plan is frozen.
Both defined contribution and defined benefit pension plans must
indicate whether the plan is frozen.
Line 9a(6) Offset Arrangement. Both defined benefit and
contribution plans that are part of an offset arrangement must
answer this question. Check ``Yes'' if plan benefits are subject to
offset for retirement benefits provided in another plan or
arrangement of the employer. If you have checked ``Yes,''
[[Page 47612]]
enter the name, EIN, and if available, LEI of sponsor, and PN of the
other plan or arrangement.
Line 9a(7) Defined Contribution Pension Plan Type(s). If this is
a defined contribution pension plan, check all the type(s) that
apply.
Line 9a(8) Defined Contribution Pension Plan Arrangements. If
this is a defined contribution pension plan, check all the type(s)
of arrangements under which the plan operates.
Line 9a(9) Defined Contribution Pension Plan Features. If this
is a defined contribution pension plan, check all that apply to
indicate features of the plan.
Check automatic enrollment feature if the plan has elective
contributions from payroll and provides for automatic enrollment in
the plan.
A designated Roth account is a feature in new or existing
401(k), 403(b) or governmental 457(b) plans that permit such plans
to accept designated Roth contributions and certain rollovers. If a
plan adopts this feature, employees can designate some or all of
their elective contributions (also referred to as elective
deferrals) as designated Roth contributions (which are included in
gross income), rather than traditional, pre-tax elective
contributions.
Check the box for ``Age/service weighted plan'' if allocations
are based on age, service, or age and service. New comparability or
similar plan: Allocations are based on participant classifications
and a classification(s) consists entirely or predominantly of highly
compensated employees; or the plan provides an additional allocation
rate on compensation above a specified threshold, and the threshold
or additional rate exceeds the maximum threshold or rate allowed
under the permitted disparity rules of Code section 401(l).
Check ``Other'' if the plan has any other particularized
features for defined contribution pension plans that are not listed
above and enter a short description in the space provided.
Line 9a(10) Participant-Directed Defined Contribution Pension
Plan. If you check ``Yes'' to identify that the plan is a
participant-directed defined contribution plan, check the box for
ERISA section 404(c) plan if the plan, or any part of it, is
intended to meet the conditions of 29 CFR 2550.404c-1.
Check the box for total participant-directed account plan if
participants have the opportunity to direct the investment of all
the assets allocated to their individual accounts, regardless of
whether 29 CFR 2550.404c is intended to be met.
Check partial participant-directed account if participants have
the opportunity to direct the investment of a portion of the assets
allocated to their individual accounts, regardless of whether 29 CFR
2550.404c is intended to be met. Do not check both ``total'' and
``partial'' participant-directed account.
Check the box for participant-directed brokerage accounts (also
referred to as ``open brokerage windows'') if the plan provides such
accounts as an investment option under the plan. If you check that
the plan has participant-directed brokerage accounts, enter the
number of participants that invested through such accounts during
the plan year.
Line 9a(11) Qualified Default Investment Alternatives (QDIAs).
Regardless of whether the plan is total or partial participant-
directed, if the plan uses default investment alternatives that are
intended to be QDIA(s) for participants who fail to direct assets in
their account, also check the box to so indicate. If the plan uses a
QDIA for participants who fail to direct assets in their account,
indicate the type of default investment alternative: target date/
life fund; fixed income; money market or equivalent; balanced fund;
professionally managed account; or other. If other, specify the type
of account. If you checked the box for ``Other,'' you may be using
an investment alternative that does not satisfy the QDIA
requirements in the Department of Labor's regulation at 29 CFR
2550.404c-5.
Line 9a(12) Eligible Combined Plan Under Code section 414(x). If
the plan is an eligible combined plan under Code section 414(x),
check ``Yes.''
Note. In the case of an eligible combined plan under Code
section 414(x) and ERISA section 210(e), you must answer all
applicable line items for both the defined benefit pension features
and the defined contribution pension features of the plan.
Line 9a(13). Check this box if a rollover from a plan was used
to start up the business (ROBS) sponsoring this plan.
Line 9a(14). If the plan is an employee stock ownership plan
(ESOP) or has ESOP features, check all applicable boxes. You must
also attach a Schedule E if the plan is an ESOP or has ESOP
features.
Line 9a(15) Other Pension Benefit Features. Check all that
apply.
Notes: (1) If a plan sponsor or an employer adopted a pre-
approved plan that includes a master & prototype plan or a volume
submitter plan, enter the most recent adoption date and the IRS
favorable opinion or advisory letter's serial number. (2) Sponsors
of Puerto Rico plans, check the box to indicate that the plan is not
intended to be qualified under Code sections 401, 403, or 408 only
if:
1. only Puerto Rico residents participate;
2. the trust is exempt from income tax under the laws of Puerto
Rico, and
3. the plan administrator has not made the election under ERISA
section 1022(i)(2), and, therefore, the plan is not intended to
qualify under section 401(a) of the Internal Revenue Code (U.S).
Line 9b Welfare Benefit Plan Characteristics. Plans that provide
welfare benefits must answer all applicable questions in Line 9b.
Plans that provide only pension benefits skip to question 10.
Line 9b(1) Group Health Benefits. If the plan provides health,
dental, or vision coverage, answer ``Yes'' and check all that apply.
If you answered ``Yes'' here, you must attach Schedule J--Group
Health Plan Information. Plans that offer excepted benefits that
consist of limited scope dental or vision benefits must still file a
Schedule J.
Line 9b(2) Disability. If the plan provides disability benefits,
answer ``Yes'' and check all that apply.
Line 9b(3) Other Welfare Benefits. If the plan provides welfare
benefits other than group health or disability, answer ``Yes'' and
check all that apply. If the type of benefits is not listed, check
``other'' and enter a description.
Line 9b(4) Welfare Plans That Do Not Provide Health Benefits
That Relied on or Will Be Relying on 29 CFR 2520.104.20. Welfare
plans that provide health benefits must file the Form 5500 annually
and cannot rely on the exemption from reporting under 29 CFR
2520.104-20.
Line 10 Funding and Benefit Arrangements. Check all boxes that
apply to indicate the funding and benefit arrangements used during
the plan year. The ``funding arrangement'' is the method for the
receipt, holding, investment, and transmittal of plan assets prior
to the time the plan actually provides benefits. The ``benefit
arrangement'' is the method by which the plan provides benefits to
participants. For purposes of Line 10:
``Insurance'' means the plan has an account, contract, or policy
with an insurance company, insurance service, or other similar
organization, or through a managed care organization or a health
maintenance organization during the plan or DFE year. (This includes
investments with insurance companies such as guaranteed investment
contracts (GICs).) An annuity account arrangement under Code section
403(b)(1) that is required to complete the Form 5500 should check
``insurance'' for both the plan funding arrangement and plan benefit
arrangement. Do not check ``insurance'' if the sole function of the
insurance company was to provide administrative services.
``Code section 412(e)(3) insurance contracts'' are contracts
that provide retirement benefits under a plan that are guaranteed by
an insurance carrier. In general, such contracts must provide for
level premium payments over the individual's period of participation
in the plan (to retirement age), premiums must be timely paid as
currently required under the contract, no rights under the contract
may be subject to a security interest, and no policy loans may be
outstanding. If a plan is funded exclusively by the purchase of such
contracts, the otherwise applicable minimum funding requirements of
section 412 of the Code and section 302 of ERISA do not apply for
the year and neither the Schedule MB nor the Schedule SB is required
to be filed.
``Trust'' includes any fund or account that receives, holds,
transmits, or invests plan assets other than an account or policy of
an insurance company. A custodial account arrangement under Code
section 403(b)(7) that is required to complete the Form 5500 should
check ``trust'' for both the plan funding arrangement and the plan
benefit arrangement.
``General assets of the sponsor'' means either the plan had no
assets or some assets were commingled with the general assets of the
plan sponsor prior to the time the plan actually provided the
benefits promised.
Example. If the plan holds all its assets invested in registered
investment companies and other non-insurance company
[[Page 47613]]
investments until it purchases annuities to pay out the benefits
promised under the plan, box 10a(3) should be checked as the funding
arrangement and box 10b(1) should be checked as the benefit
arrangement.
Note. An employee benefit plan that checks boxes on Lines
10a(1), 10a(2), 10b(1), and/or 10b(2) must attach Schedule A (Form
5500), Insurance Information, to provide information concerning each
contract year ending with or within the plan year. See the
instructions to the Schedule A and enter the number of Schedules A
on Line 11b(2), if applicable.JY2.
Line 11. Check the boxes on Line 11 to indicate the schedules
being filed and, where applicable, count the schedules and enter the
number of attached schedules in the space provided.
20XX Instructions for Schedule A (Form 5500) Insurance Information
General Instructions
Who Must File
Schedule A (Form 5500) must be attached to the Form 5500 filed
for every defined benefit pension plan, defined contribution pension
plan, and welfare benefit plan required to file a Form 5500 Annual
Return/Report if any benefits under the plan are provided by an
insurance company, insurance service, or other similar organization,
or through a managed care organization or a health maintenance
organization. This includes investment and annuity contracts with
insurance companies such as guaranteed investment contracts (GICs)
and variable annuities. In addition, Schedules A must be attached to
a Form 5500 filed for GIAs, master trusts, and 103-12 IEs for each
insurance or annuity contract held in the master trust, or by the
103-12 IE or the GIA. Plans with fewer than 100 participants that
provide group health benefits that are fully insured do not complete
Schedule A.
TIP. If Form 5500 Line 10a(1), 10a(2), 10b(1), or 10b(2) is
checked, indicating that either the plan funding arrangement or plan
benefit arrangement includes an account, policy, or contract with an
insurance company (or similar organization), at least one Schedule A
would be required to be attached to the Form 5500 filed for a
pension or welfare plan to provide information concerning the
contract year ending with or within the plan year.
Do not file Schedule A for a contract that is an Administrative
Services Only (ASO) contract, a fidelity bond or policy, or a
fiduciary liability insurance policy. Also, if a Schedule A for a
contract or policy is filed as part of a Form 5500 for a master
trust or 103-12 IE that holds the contract, do not include a
Schedule A for the contract or policy on the Form 5500s filed for
the plans participating in the master trust or 103-12 IE. Schedule A
is not required to be attached by a small, fully insured group
health plan.
Check the Schedule A box on the Form 5500 (Part II, Line
11b(2)), and enter the number attached in the space provided if one
or more Schedules A are attached to the Form 5500.
Specific Instructions
Information entered on Schedule A should pertain to the
insurance contract or policy year ending with or within the plan
year (for reporting purposes, a year cannot exceed 12 months).
Example. If an insurance contract year begins on July 1 and ends
on June 30, and the plan year begins on January 1 and ends on
December 31, the information on the Schedule A attached to the 20XX
Form 5500 should be for the insurance contract year ending on June
30, 20XX.
Exception. If the insurance company maintains records on the
basis of a plan year rather than a policy or contract year, the
information entered on Schedule A may pertain to the plan year
instead of the policy or contract year.
Include only the contracts issued to or held by the plan, GIA,
master trust, or 103-12 IE for which the Form 5500 is being filed.
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule A is
attached.
Do not use a social security number in lieu of an EIN. The
Schedule A and its attachments are open to public inspection, and
the contents are public information and are subject to publication
on the Internet. Because of privacy concerns, the inclusion of a
social security number or any portion thereof on this Schedule A or
any of its attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
General Instructions to Form 5500. The EBSA does not issue EINs.
Part I--Information Concerning Insurance Contract Coverage, Fees, and
Commissions
Line 1a. Enter the name of the insurance carrier. If you are
reporting the same insurance carrier on multiple Schedules A to
report different contracts, use the same name on each Schedule A.
Line 1b. Enter the EIN of the insurance carrier. If you are
reporting the same insurance carrier on multiple Schedules A to
report different contracts, use the same EIN on each Schedule A.
Line 1c. Enter the five-digit ``Company Code'' number assigned
by the National Association of Insurance Commissioners (NAIC) to the
insurance company. Do not use the NAIC ``group code'' or a state-
issued identity number for the insurance company.
Line 1d. If individual policies with the same carrier are
grouped as a unit for purposes of this report, and the group does
not have one identification number, you may use the contract or
identification number of one of the individual contracts, provided
this number is used consistently to report these contracts as a
group and the plan administrator maintains the records necessary to
disclose all the individual contract numbers in the group upon
request. Use separate Schedules A to report individual contracts
that cannot be grouped as a unit.
Line 1e. For contracts or policies providing group health
benefits, enter the health plan identifier (HPID) required under the
Health Insurance Portability and Accountability Act (HIPAA).
Line 1f. Enter the beginning and ending dates of the policy year
for the contract identified in elements (1) and (2). Leave 1(f)
blank if separate contracts covering individual employees are
grouped.
Part II--Investment and Annuity Contract Information
Line 3. Enter the current value of the plan's interest at year
end in the contract reported on Line 6 e.g., deposit administration
(DA), immediate participation guarantee (IPG), guaranteed investment
contracts (GIC), or variable annuity contract.
Exception. Contracts reported on Line 6 need not be included on
Line 3 if: (1) the Schedule A is filed for a defined benefit pension
plan and the contract was entered into before March 20, 1992; or (2)
the Schedule A is filed for a defined contribution pension plan and
the contract is a fully benefit-responsive contract, i.e., it
provides a liquidity guarantee by a financially responsible third
party of principal and previously accrued interest for liquidations,
transfers, loans, or hardship withdrawals initiated by plan
participants exercising their rights to withdraw, borrow, or
transfer funds under the terms of a defined contribution pension
plan that does not include substantial restrictions to participants'
access to plan funds.
Important Reminder. Plans may treat multiple individual annuity
contracts, including Code section 403(b)(1) annuity contracts,
issued by the same insurance company as a single group contract for
reporting purposes on Schedule A.
Line 4. Enter the current value of the plan's interest under
this contract in separate accounts at contract year end. Check
whether the separate account is a pooled separate account (PSA),
other separate account, or variable annuity. If other, enter a
description of the separate account.
Line 5 Contracts with Allocated Funds
Line 5a. Enter a description of the basis of the rates.
Line 5b. Enter the amount of premiums paid to the carrier.
Line 5c. Enter the amount, if any, of premiums due but unpaid at
the end of year.
Line 5d. If the carrier, service, or other organization incurred
any specific costs in connection with the acquisition or retention
of the contract or policy, enter the amount and specify the nature
of the costs.
Line 5e. Check the appropriate box to indicate whether this is
for individual policies, a group deferred annuity or other. If you
check ``Other,'' you must enter a description of the type of
contract.
Line 5f. If the contract being reported here was purchased, in
whole or in part, to distribute benefits from a terminating plan,
you must check the box in Line 5f.
Line 6 Contracts with Unallocated Funds
Lines 6a-f. Report contracts with unallocated funds. Do not
include portions of these contracts maintained in separate
[[Page 47614]]
accounts. Show deposit fund amounts rather than experience credit
records when both are maintained.
Part III--Welfare Benefit Contract Information
Line 7. Since plan coverage may fluctuate during the year, the
administrator should estimate the number of persons that were
covered for each benefit by the contract at the end of the policy or
contract year.
Persons, for purposes of this line, includes participants,
beneficiaries, and dependents of participants that are covered under
the insurance contract (such as with family coverage). Where
contracts covering individual employees are grouped, compute entries
as of the end of the plan year.
Line 8a. Report a stop-loss insurance policy that is an asset of
the plan on Schedule A.
Note. Employers sponsoring welfare plans may purchase a stop-
loss insurance policy with the employer as the insured to help the
employer manage its risk associated with its liabilities under the
plan. These employer contracts with premiums paid exclusively out of
the employer's general assets without any employee contributions
generally are not plan assets and are not reportable on Schedule A,
but may be required to be reported on Schedule J.
Line 11. Indicate whether there were any premium delinquencies
during the reporting year. You must answer ``Yes'' or ``No.'' Do not
leave Line 11a blank. If you answered ``Yes,'' you must indicate
both the number of times delinquent for premiums due but unpaid
during the year, and for each delinquency, the number of days
delinquent. If you answered ``no'' to line 11a, check ``N/A.'' If
any premium payments that were not made within the time required by
the insurance carrier that resulted in a lapse of insurance
coverage, you must answer ``Yes'' to Line 11a even if coverage was
retroactively reinstated.
Part IV--Fee and Commission Information
Lines 12 and 13. Report on Line 12 the total of all insurance
fees and commissions directly or indirectly attributable to the
contract or policy placed with or retained by the plan.
Totals. Enter on Line 12 the total of all such commissions and
fees paid to agents, brokers, and other persons listed on Line 13.
Complete a separate Line 13 item (elements (a) through (f)) for each
person listed.
For purposes of Lines 12 and 13, commissions and fees include
sales and base commissions and all other monetary and non-monetary
forms of compensation where the broker's, agent's, or other person's
eligibility for the payment or the amount of the payment is based,
in whole or in part, on the value (e.g., policy amounts, premiums)
of contracts or policies (or classes thereof) placed with or
retained by an ERISA plan, including, for example, persistency and
profitability bonuses. The amount (or pro rata share of the total)
of such commissions or fees attributable to the contract or policy
placed with or retained by the plan must be reported in Lines 12a
and b and in Lines 13c and d, as appropriate.
Insurers must provide plan administrators with an allocation of
commissions and fees attributable to each contract. Any reasonable
method of allocating commissions and fees to policies or contracts
is acceptable, provided the method is disclosed to the plan
administrator. A reasonable allocation method could, in the
Department of Labor's view, allocate fees and commissions to a
Schedule A based on a calendar year calculation even if the plan
year or policy year was not a calendar year. For additional
information on these Schedule A reporting requirements, see ERISA
Advisory Opinion 2005-02A, available on the Internet at www.dol.gov/ebsa.
Where benefits under a plan are purchased from and guaranteed by
an insurance company, insurance service, or other similar
organization, and the contract or policy is reported on a Schedule
A, payments of reasonable monetary compensation by the insurer out
of its general assets to affiliates or third parties for performing
administrative activities necessary for the insurer to fulfill its
contractual obligation to provide benefits, where there is no direct
or indirect charge to the plan for the administrative services other
than the insurance premium, then the payments for administrative
services by the insurer to the affiliates or third parties do not
need to be reported on lines 12 and 13 of Schedule A. This would
include compensation for services such as recordkeeping and claims
processing services provided by a third party pursuant to a contract
with the insurer to provide those services but would not include
compensation provided by the insurer incidental to the sale or
renewal of a policy, such as finder's fees, insurance brokerage
commissions and fees, or similar fees.
Schedule A reporting also is not required for compensation paid
by the insurer to a ``general agent'' or ``manager'' for that
general agent's or manager's management of an agency or performance
of administrative functions for the insurer. For this purpose, (1) a
``general agent'' or ``manager'' does not include brokers
representing insureds, and (2) payments would not be treated as paid
for managing an agency or performance of administrative functions
where the recipient's eligibility for the payment or the amount of
the payment is dependent or based on the value (e.g., policy
amounts, premiums) of contracts or policies (or classes thereof)
placed with or retained by ERISA plan(s).
Schedule A reporting is not required for occasional non-monetary
gifts or meals of insubstantial value that are tax deductible for
federal income tax purposes by the person providing the gift or meal
and would not be taxable income to the recipient. For this exemption
to be available, the gift or gratuity must be both occasional and
insubstantial. For this exemption to apply, the gift must be valued
at less than $50, the aggregate value of gifts from one source in a
calendar year must be less than $250, but gifts with a value of less
than $10 do not need to be counted toward the $250 annual limit. If
the $250 aggregate value limit is exceeded, then the aggregate value
of all the gifts will be reportable. For this purpose, non-monetary
gifts of less than $10 also do not need to be included in
calculating the aggregate value of all gifts required to be reported
if the $250 limit is exceeded.
Gifts from multiple employees of one service provider should be
treated as originating from a single source when calculating whether
the $50 or $250 thresholds apply. On the other hand, in applying the
threshold to an occasional gift received from one source by multiple
employees of a single service provider, the amount received by each
employee should be separately determined in applying the $50 and
$250 thresholds. For example, if 11 employees of a broker attend a
business conference put on by an insurer designed to educate and
explain the insurer's products for employee benefit plans, and the
insurer provides, at no cost to the attendees, refreshments valued
at $25 per individual, the gratuities would not be reportable on
lines 12 and 13 of the Schedule A even though the total cost of the
refreshments for all the employees would be $275.
These thresholds are for purposes of Schedule A reporting.
Filers are cautioned that the payment or receipt of gifts and
gratuities of any amount by plan fiduciaries may violate ERISA and
give rise to civil liabilities and criminal penalties.
Line 13. Identify agents, brokers, and other persons
individually in descending order of the amount paid. Complete as
many entries as necessary to report all required information.
Complete 13a-f for each person as specified below.
13a. Enter the name and address of the agents, brokers, or other
persons to whom commissions or fees were paid.
13b. Enter any relationship of the person identified in Line 13a
to the plan sponsor, to the participating employer or employee
organization, or to any person known to be a party-in-interest, for
example, employer, plan sponsor, employee of employer, vice-
president of employer, union officer, affiliate of plan
recordkeeper/fiduciary/investment manager, etc.
13c. Report all sales and base commissions here. For purposes of
this element, sales and/or base commissions are monetary amounts
paid by an insurer that are charged directly to the contract or
policy and that are paid to a licensed agent or broker for the sale
or placement of the contract or policy. All other payments should be
reported in Line 13d as fees.
13d. Fees to be reported here represent payments by an insurer
attributable directly or indirectly to a contract or policy to
agents, brokers, and other persons for items other than sales and/or
base commissions (e.g., service fees, consulting fees, finders'
fees, profitability and persistency bonuses, awards, prizes, and
non-monetary forms of compensation). Fees paid to persons other than
agents and brokers should be reported here, not in Parts II and III
on Schedule A as acquisition costs, administrative charges, etc.
13e. Enter the purpose(s) for which fees were paid.
13f. Enter the most appropriate organization code for the
broker, agent, or other person entered in Line 13a.
[[Page 47615]]
Code Type of Organization
1 Banking, Savings & Loan Association, Credit Union, or other
similar financial institution
2 Trust Company
3 Insurance Agent or Broker
4 Agent or Broker other than insurance
5 Third party administrator
6 Investment Company/Mutual Fund
7 Investment Manager/Adviser
8 Labor Union
9 Foreign entity (e.g., an agent or broker, bank, insurance
company, etc., not operating within the jurisdictional boundaries of
the United States)
0 Other
For plans, GIAs, master trusts, and 103-12 IEs required to file
Part I of Schedule C, commissions and fees listed on the Schedule A
are not required to be reported again on Schedule C. The amount of
the compensation that must be reported on Schedule A must, however,
be taken into account in determining whether the agent's, broker's,
or other person's direct or indirect compensation in relation to the
plan or DFE is $1,000 or more indirect compensation or combined
direct and indirect compensation or $5,000 or more in direct
compensation and, thus, requiring the compensation not listed on the
Schedule A to be reported on the Schedule C. See FAQs about the
Schedule C available on the EBSA Web site at www.dol.gov/ebsa/faqs.
Part V--Provision of Information
The insurance company, insurance service, or other similar
organization is required under ERISA section 103(a)(2) to provide
the plan administrator with the information needed to complete this
return/report. If you do not receive this information in a timely
manner, contact the insurance company, insurance service, or other
similar organization.
Line 14. If information is missing on Schedule A due to a
refusal by the insurance company, insurance service, or other
similar organization to provide information, check ``Yes'' on Line
14. If you answer ``Yes'' to Line 14, you must complete Line 14b. If
you received all the information necessary to receive the Schedule
A, check ``No'' and leave Line 14b blank.
TIP. The insurance company, insurance service, or other similar
organization is statutorily required to provide you with all of the
information necessary to complete the Schedule A, but need not
provide the information on a Schedule A itself.
On Line 14b, check the box if the information not provided was
``fee and commission information.'' For all other types of
information, check ``Other,'' and enter a description of the
information not provided.
20XX Instructions for Schedule C (Form 5500) (Service Provider
Information)
General Instructions
Who Must File
Schedule C (Form 5500) must be attached to a Form 5500 filed for
pension or welfare benefit plans, master trusts, 103-12 IEs, or GIAs
required to file the Form 5500 to report certain information
concerning service providers, except as provided below. Remember to
check the Schedule C box on the Form 5500 (Part II, Line 11b(3)) and
enter the number attached in the space provided to indicate the
number of Schedules C attached to the Form 5500.
All plans required to complete a Schedule C must complete a
separate Schedule C, in accordance with the instructions, to report
the information required for: (1) Each ``covered service provider,''
as defined below, who received $1,000 or more in total direct and
indirect compensation (i.e., money or anything else of monetary
value) in connection with services rendered to the plan or the
person's position with the plan during the plan year, including
payments from participants' accounts and (2) other persons who
received $5,000 or more in direct compensation in connection with
services rendered to the plan or the person's position with the plan
during the plan year, including payments from participants'
accounts.
A ``covered service provider'' for Schedule C reporting has the
same meaning as ``covered service provider'' in 29 CFR 2550.408b-
2(c)(1)(iii) and includes: (1) Persons who provide services as an
ERISA fiduciary directly to the plan; (2) persons who provide
services as an ERISA fiduciary to an investment contract, product,
or entity that holds plan assets (as determined pursuant to section
3(42) and 401 of the Act and 29 CFR 2510.3-101) and in which the
plan has a direct equity investment; (3) persons who provide
services to the plan as investment advisers registered under Federal
or State law; (4) persons who provide recordkeeping or brokerage
services to a participant-directed individual account plan in
connection with a designated investment alternative (DIA) (e.g., a
``platform provider''); and (5) persons who provide of one or more
of the following services to the plan who received indirect
compensation from parties other than from the plan or plan sponsor
in connection with such services: Accounting, auditing, actuarial,
banking, consulting, custodial, insurance, investment advisory,
legal, recordkeeping, securities or other investment brokerage,
third party administration, or valuation services.
Welfare plans are not subject to the service provider disclosure
regulation at 29 CFR 2550.408b-2, but all plans, including welfare
plans, that are required to file the Schedule C should use the
provisions and definitions 29 CFR 2550.408b-2 as a guide in
completing the Schedule C.
Exceptions.
1. Employees of the plan whose only compensation in relation to
the plan was less than $25,000 for the plan year. With regard to
reporting plan employees' salaries, total salaries (before taxes and
other deductions) paid to employees should be used to determine
whether an employee has received less than $25,000 during the plan
year. Do not include the employer portion of FICA and FUTA taxes as
part of the total compensation of an employee. Include salary,
bonuses, overtime. Also include indirect compensation from persons
other than the plan received in connection with the person's
position with the plan or services provided to the plan. Include
expenses for travel, educational, conference, meals, etc., whether
paid directly by the plan or reimbursed to the employee, only if
such payments would be reportable as taxable income to the employee.
2. Employees of the plan sponsor or other business entity where
the plan sponsor or business entity is reported on the Schedule C as
a service provider, provided the employee did not separately receive
reportable direct or indirect compensation in relation to the plan;
3. Persons whose only compensation in relation to the plan
consists of insurance fees and commissions listed in a Schedule A
filed for the plan;
4. Payments made directly by the plan sponsor that are not
reimbursed by the plan. In the case of a multiemployer or multiple-
employer plan, where the ``plan sponsor'' would be the joint board
of trustees for the plan, payments by contributing employers,
directly or through an employer association, or by participating
employee organizations, should be treated the same as payments by a
plan sponsor; and
5. Welfare plans, including group health plans, that are
required to file the Form 5500 and that do not have to complete the
Schedule H because they meet the conditions of the DOL's regulation
at 29 CFR 2520.104-44 or Technical Release 92-01, also do not have
to file the Schedule C.
Part II of the Schedule C must be completed to report service
providers who fail or refuse to provide information necessary to
complete Part I of this Schedule.
For plans, GIAs, master trusts, and 103-12 IEs required to file
Part I of Schedule C, commissions and fees listed on the Schedule A
are not required to be reported again on Schedule C. The amount of
the compensation that must be reported on Schedule A must, however,
be taken into account in determining whether the service provider's
direct or indirect compensation in relation to the plan or DFE meets
the Schedule C reporting threshold, thus, requiring the compensation
not listed on the Schedule A to be reported on the Schedule C.
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule C is
attached.
Do not use a social security number in Line D in lieu of an EIN.
The Schedule C and its attachments are open to public inspection,
and the contents are public information subject to publication on
the Internet. Because of privacy concerns, the inclusion of a social
security number or any portion thereof on this Schedule C or any of
its attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
General Instructions to Form 5500. The EBSA does not issue EINs.
Do not list the PBGC or the IRS on Schedule C as service
providers.
Either the cash or accrual basis may be used for the recognition
of transactions
[[Page 47616]]
reported on the Schedule C as long as the filer uses one method
consistently. The basis used by various service providers may be
different from that of the filing plan or DFE, as long as each
service provider is also using one method consistently from year to
year and providing the information to the plan consistently.
If service provider compensation is reported on a Schedule C
filed as a part of a Form 5500 Annual Return/Report filed for a
master trust or a 103-12 IE, do not report the same compensation
again on the Schedule C filed for the plans that participate in the
master trust or 103-12 IE. If a service provider paid or retained by
a master trust performs services only for certain of the
participating plans, the service provider must be reported on the
Schedule C(s) for the plan(s) for which the services were performed;
only compensation received in connection with services provided to
all plans participating in the master trust should be reported at
the master trust level.
Schedule C Reportable Compensation
For Schedule C purposes, reportable compensation includes money
and any other thing of value (for example, gifts, awards, trips)
received by a person, directly or indirectly, from the plan
(including fees charged as a percentage of assets and deducted from
investment returns and payments from parties other than the plan) in
connection with services rendered to the plan or the person's
position with the plan. Amounts are considered to have been received
in connection with services rendered to the plan if the person's
eligibility for a payment is based, in whole or in part, on services
that were rendered to the plan or on a transaction or series of
transactions with the plan. This includes any compensation that the
covered service provider, an affiliate, or a subcontractor received
in connection with termination of the contract or arrangement.
Reportable compensation would not include amounts that would have
been received had the service not been rendered or the transaction
had not taken place and that cannot be reasonably allocated to the
services performed or transaction(s) with the plan. The term
``person'' for this purpose includes individuals, trades and
businesses (whether incorporated or unincorporated). See ERISA
section 3(9).
Since, in most cases, the ``spread'' earned by a broker-dealer
in a principal transaction would not be commission compensation paid
by the covered plan for ``services,'' but instead would be
considered ``profit'' for a non-service transaction, such as a
purchase or sale of securities (i.e., where the broker-dealer acts
as principal, not as an agent), the ``spread'' received would not be
``compensation'' (direct or indirect) for Schedule C purposes. For
this purpose, the Department will rely upon the definition of the
term ``commission'' used by the SEC under Section 28(e) of the
Securities Exchange Act of 1934, as amended, per SEC Release No. 34-
45194.
Similarly, the broker-dealer's sale of IPO securities to the
plan does not occur ``in connection with'' services to the plan, but
occurs as a result of a separate, non-service transaction where the
broker-dealer is acting as a principal (e.g., a dealer who buys and
sells securities from its inventory, as an underwriter or otherwise,
and receives a ``mark-up'' or ``spread'' on the price vis-a-vis its
own separate purchase or sale activities as a dealer). Thus, the
broker-dealer is not a service provider to the plan in its role as a
securities dealer, and its affiliates who may receive fees for
underwriting and/or managing an underwriting syndicate for an IPO
would not be receiving such fees ``in connection with'' services
provided to the covered plan.
The investment of plan assets and payment of premiums for
insurance contracts are not in and of themselves payments for
services rendered to the plan for purposes of Schedule C reporting
and the investment and payment of premiums themselves are not
reportable compensation for purposes of Part I of the Schedule C.
Direct Compensation--Payments Received from the Plan. Direct
compensation for Schedule C purposes has the same meaning as
``direct compensation'' in 29 CFR 2550.408b-2(c)(1)(viii)(B)(1), and
includes payments received directly from the plan by a service
provider in connection with services rendered to the plan, or a
covered service provider, its affiliate or subcontractor in
connection with the services rendered to the plan. Direct
compensation includes, for example, direct payments by the plan out
of a plan account, charges to plan forfeiture accounts and plan fee
recapture trust accounts, charges to a plan's trust account before
allocations are made to individual participant accounts, and direct
charges to plan participant individual accounts. For example, the
plan sponsor may pay for certain plan administrative services by
writing a check from the plan account. Alternatively, a covered
service provider may be paid a fixed per capita fee from
participants' accounts in the covered plan when participants take
out plan loans. Payments made by the plan sponsor, which are not
reimbursed by the plan, are not subject to Schedule C reporting
requirements even if the sponsor is paying for services rendered to
the plan. Payments by made by the plan sponsor that are reimbursed
by the plan are treated as direct payments by the plan.
Indirect Compensation--Amounts Received from Parties Other Than
the Plan or Plan Sponsor. Indirect compensation for Schedule C
purposes has the same meaning as ``indirect compensation'' in 29 CFR
2550.408b-2(c)(1)(viii)(B)(2), and includes compensation received by
the covered service provider, an affiliate or subcontractor in
connection with the services rendered to the plan from any source
other than directly from the plan, plan sponsor, by an affiliate or
subcontractor from the covered service provider, or by the covered
service provider from an affiliate. Compensation received from a
subcontractor is indirect compensation unless it is received in
connection with services performed under the subcontractor's
contract or arrangement with the covered service provider or an
affiliate for performing one or more services provided for by the
contract or arrangement with the plan. Indirect compensation
includes amounts received by the covered service provider, affiliate
or subcontractor that are charged against the investments of the
plan (e.g., mutual funds or other investment funds) and reflected in
the plan's return on investment.
For example, indirect compensation would include payments that
an independent recordkeeper receives from investment issuers to
compensate the recordkeeper for administrative services it performs
for the investment issuer when those payments are received in
connection with investments that such plans make in the issuers'
products. If a covered service provider, affiliate or subcontractor
receives revenue sharing payments from an investment fund (e.g.,
mutual fund), investment provider or other plan service provider or
person in connection with the services the covered service provider,
affiliate or subcontractor rendered to a covered plan, that
compensation would be ``indirect compensation.'' Amounts charged
against the fund for other ordinary operating expenses of the fund,
such as attorneys' fees, accountants' fees, printers' fees, are not
reportable indirect compensation received by the attorneys,
accountants, or printers for Schedule C purposes. Also, brokerage
costs associated with a broker-dealer effecting securities
transactions within the portfolio of a mutual fund or for the
portfolio of an investment fund that holds ``plan assets'' for ERISA
purposes are not reportable compensation paid to the broker as a
plan service provider for Schedule C purposes.
If a service provider charges the plan a fee or commission, but
agrees to offset the fee or commission with any revenue received
from a party other than the plan or plan sponsor, for example, as
part of a commission recapture or other offset arrangement, only the
amount paid directly by the plan after any revenue sharing offset
should be entered as direct compensation in Line 2. If the amount
deposited into the plan's trust account by the record keeper is net
of the record keeper's service fees, however, the amount the record
keeper retains would be reportable indirect compensation for
Schedule C purposes. Amounts paid to persons out of the plan's ERISA
fee recapture trust account for services rendered to the plan are
considered direct compensation to the receiving service provider
reportable in Line 1g. If the record keeper retains the revenue
sharing income but reflects some or all of it on the record keeper's
accounts as a credit to the plan (as opposed to depositing in the
plan's trust account), payments by the record keeper to itself or
other persons for rendering services to the plan that reduce the
plan's credit balance would be reportable indirect compensation to
the persons receiving the payments reportable in Line 3.
Compensation paid among the covered service provider, an
affiliate, or a subcontractor, in connection with the services
provided to the plan is not reportable indirect compensation.
Rather, those payments may be required to be reported as Related
Party Compensation on Line 4.
Special rules for non-monetary compensation of insubstantial
value,
[[Page 47617]]
guaranteed benefit insurance policies, bundled service arrangements,
and allocating compensation among multiple plans:
Excludable Non-Monetary Compensation: You may exclude non-
monetary compensation of insubstantial value (such as gifts or meals
of insubstantial value) that is tax deductible for federal income
tax purposes by the person providing the gift or meal and would not
be taxable income to the recipient. The gift or gratuity must be
valued at less than $50, and the aggregate value of gifts from one
source in a calendar year must be less than $250, but gifts with a
value of less than $10 do not need to be counted toward the $250
limit. If the $250 aggregate value limit is exceeded, then the value
of all the gifts over $10 will be reportable. Gifts received by one
person from multiple employees of one entity must be treated as
originating from a single source when calculating whether the $50 or
$250 threshold applies. On the other hand, gifts received from one
person by multiple employees of one entity can be treated as
separate compensation when calculating the $50 and $250 thresholds.
These thresholds are for purposes of Schedule C reporting only.
Filers are cautioned that gifts and gratuities of any amount paid to
or received by plan fiduciaries may violate ERISA and give rise to
civil liabilities and criminal penalties.
Fully Insured Group Health and Similarly Fully Insured Benefits:
Where benefits under a plan are purchased from and guaranteed by an
insurance company, insurance service, or other similar organization,
and the contract or policy is reported on a Schedule A, payments of
reasonable monetary compensation by the insurer out of its general
assets to persons for performing administrative activities necessary
for the insurer to fulfill its contractual obligation to provide
benefits, where there is no direct or indirect charge to the plan
for the administrative services other than the insurance premium,
would not be treated as indirect compensation for services provided
to the plan for Schedule C reporting purposes. This would include
compensation for services such as recordkeeping and claims
processing provided by a third party pursuant to a contract with the
insurer to provide those services, but would not include
compensation provided by the insurer incidental to the sale or
renewal of a policy, such as finder's fees, insurance brokerage
commissions and fees, or similar fees. Insurance investment
contracts are not eligible for this exception.
[CAUTION] Allocating Compensation Among Multiple Plans: Where
reportable compensation is received by a person in connection with
several plans or DFEs, any reasonable method of allocating the
compensation among the plans or DFEs may be used provided that the
allocation method is disclosed to the plan administrator. If a such
a reasonable method of allocation is used in determining the
compensation attributable to the plan, then in calculating the
$1,000 and $5,000 thresholds for purposes of determining whether a
person must be identified in Part I, the amount of compensation
received by the person that is determined to be attributable to the
plan or DFE filing the Form 5500 should be used, not the aggregate
amount of compensation received in connection with all the plans or
DFEs.
Specific Instructions
Part I--Service Provider Information
Line 1a. As explained above, a separate Schedule C must be
filed, in accordance with the instructions, to report the
information for: (1) Each covered service provider who received
$1,000 or more in total direct and indirect compensation (i.e.,
money or anything else of monetary value in connection with services
rendered to the plan or the person's position with the plan during
the plan year, including payments from participants' accounts and
(2) other persons who received $5,000 or more in direct compensation
in connection with services rendered to the plan or the person's
position with the plan during the plan year, including payments from
participants' accounts.
Enter in Line 1a the covered service provider or other person's
name and complete Lines 1a(1)-(6). If the service provider
identified is not an individual, provide the name and address for an
individual or office at the service provider that the plan could
contact for information about the service arrangement in Lines
1a(5)-(6). If the name of an individual is entered in Line 1a and
the individual does not have an EIN, enter the EIN of the
individual's employer. If the person is self-employed and does not
have an EIN, you may enter the person's address and telephone
number. Do not use a social security number in lieu of an EIN. The
Schedule C and its attachments are open to public inspection and are
subject to publication on the Internet. Because of privacy concerns,
the inclusion of a social security number or any portion thereof on
this Schedule C or any of its attachments may result in the
rejection of the filing. Also enter the service provider's LEI, if
available.
Line 1b. Check the appropriate box to indicate the relationship
of the service provider identified in Line 1a to the plan. Check
Line 1b(7) ``Other'' and enter a description, e.g., vice-president
of employer, union officer, affiliate of the plan sponsor,
recordkeeper, fiduciary, investment manager, etc., if the service
provider has a relationship to the plan other than ``service
provider'' that is not one of relationships listed in Line 1b(1)-
(6). If the service provider has no relationship to the plan other
than the service provider relationship being reported on the
Schedule C, check the box in Line 1b(8) for ``not applicable.''
Line 1c. Types of Services. Check all the appropriate box(es) to
describe the types of services provided. The ``plan administrator''
for purposes of Line 1c is the person who has been designated as the
administrator by the terms of the instrument under which the plan is
operated; or if no plan administrator is designated, the plan
sponsor. See ERISA section 3(16). The plan administrator should be
identified in the plan's summary plan description. For most employee
benefit plans, the plan administrator is the employer, a committee
of employees, a company executive, or in some cases a person or
organization hired to be the plan administration. The plan's ``third
party administrator'' often is not the same as the ``plan
administrator'' for this purpose.
Line 1d. Check the box if the person identified in Line 1a was a
fiduciary within the meaning of section 3(21) of ERISA during the
plan year. Every employee benefit plan must be established and
maintained pursuant to a written instrument. The instrument must
provide for one or more ``named fiduciaries'' who jointly or
severally have authority to control and management the operation and
administration of the plan. Under ERISA section 402(a), ``the term
named fiduciary means a fiduciary who is named in the plan
instrument, or who, under a procedure specified in the plan, is
identified as a fiduciary (a) by a person who is an employer or
employee organization with respect to the plan or (b) by such an
employer and such employee organization acting jointly.'' Other
persons may be functional fiduciaries because they exercise control
over plan assets, have discretionary authority for administration or
management of the plan, or provide investment advice for a fee.
Line 1e. Check ``Yes'' if the person identified in Line 1a also
was identified on Schedule A as having received insurance fees and
commissions.
Line 1f. Check ``Yes,'' if the arrangement with the service
provider included the use of an ERISA recapture, ERISA budget or
similar account during the plan year.
Line 1g. Check ``Yes'' in Line 1g(1) if the arrangement with the
service provider identified in Line 1a included recordkeeping
services to a pension plan without explicit compensation for some or
all of such recordkeeping services or with compensation for such
recordkeeping offset or rebated in whole or in part based on other
compensation received by the service provider, or an affiliate or
subcontractor. If ``Yes,'' use the same methodology to develop a
dollar estimate of the cost to the plan of recordkeeping services
provided in the service provider's 408-b(2) disclosure, enter in
Line 1g(2), as a dollar figure, the amount of compensation the
service provider received for recordkeeping services.
Line 2--Direct Compensation. Report the amount of direct
compensation received by the person or covered service provider
(including its affiliate or subcontractor) identified in Line 1a.
TIP. The total reported in Line 2 generally would be those
payments that would be includable as administrative expenses on
Schedule H, Line 2i. Do not leave Line 2 blank. If no direct
compensation was received, enter ``0''.
Line 3--Indirect Compensation. Complete Line 3 to report
indirect compensation received by the covered service provider,
affiliate or subcontractor from persons other than the plan or plan
sponsor, including charges against the plan's investments.
Note: You must separately report in Line 4 certain related party
compensation paid among the person identified in Line 1a and the
affiliate or subcontractor.
Line 3a. Enter the total amount of indirect compensation plan
from sources other than
[[Page 47618]]
the plan or plan sponsor received by the covered service provider,
affiliate or subcontractor in connection with services provided to
the plan, including charges against the plan's investments. This
should equal the total of the amounts or estimates reported on the
Line 3b(4) entries.
Line 3b. Complete as many entries (Lines 3b(1)-(6)) as necessary
to identify all sources of indirect compensation reported in Line
3a. If the name of an individual is entered in Line 3a and the
individual does not have an EIN, enter the EIN of the individual's
employer. If the person is self-employed and does not have an EIN,
you may enter the person's address and telephone number. Do not use
a social security number in lieu of an EIN. The Schedule C and its
attachments are open to public inspection and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Schedule C or any of its attachments may result in the rejection of
the filing. Also enter the service provider's LEI, if available.
Line 3b(4). Enter as a dollar figure the amount or estimate of
compensation received from the source. If an estimate is reported,
you must complete Line 3b(6).
Line 3b(5). Types of Compensation. Check all the appropriate
box(es) to describe the types of compensation received from the
source.
Line 4--Related Party Compensation. You must report on Line 4 as
related party compensation any compensation that is paid among the
service provider, affiliates and subcontractors in connection with
the services rendered to the plan if the amount was set on a per
transaction basis, (e.g., commissions, soft dollars, finder's fees
or other similar incentive compensation based on business placed or
retained) or is charged directly against the plan's investment and
reflected in the net value of the investment (e.g., Rule 12b-1 fees,
distribution fees, management fees shareholder servicing fees). This
does not include compensation received by an employee from his or
her employer on account of work performed by the employee. Other
revenue sharing payments among the covered service provider,
affiliate or subcontractor in connection with the services rendered
to the plan do not need to be reported as related party
compensation.
Part II--Service Providers Who Fail or Refuse To Provide Information
Line 5. Check the box in Line 5a to identify each covered
service provider who you believe failed or refused to provide any of
the information necessary to complete Part I of this schedule. In
Line 5b describe the information that the service provider failed or
refused to provide.
Important Reminder. Before identifying a service provider as a
person who failed or refused to provide information, you should
contact the service provider to request the necessary information
and tell them that you will list them on the Schedule C as a service
provider who failed or refused to provide information if they do not
provide the necessary information.
On Line 5b, include in the description of the information that
the service failed or refused to provide whether you are relying on
the exemption at 29 CFR 2550.408b-2(c)(1)(ix) with respect to the
failure of any fiduciary or service provider to provide information
required to complete Part I of Schedule C.
[CAUTION]. The failure of certain service providers to provide
information needed to complete the annual return/report, including
Schedule C, may give rise to a prohibited transaction under section
408(b)(2) of ERISA, see 29 CFR 2550.408b-2(c)(1)(vi), that must be
reported on Schedule H, Line 4d and, as applicable, attach a
Schedule G.
20XX Instructions for Schedule D
(Form 5500 DFE/Participating Plan Information)
General Instructions
Who Must File
When the Form 5500 is filed for a Direct Filing Entity (DFE)
that is a master trust (MT), 103-12 Investment Entity (103-12 IEs),
common/collective trust (CCT), pooled separate account (PSA), or
group insurance arrangement (GIA) the Schedule D (Form 5500) is
required to provide information about plans participating in the
DFE. A Form 5500 Annual Return/Report filed for a CCT, PSA, MT, 103-
12 IE, or GIA should be identified as a ``DFE'' on Part I, Line
A(5), of the Form 5500 and the Schedule D box should be checked on
the Form 5500, Part II, Line 11b(4). For more information, see
instructions for Direct Filing Entity (DFE) Filing Requirements.
Specific Instructions
Lines A, B, C, and D. The information must be the same as
reported in Part II of the Form 5500 to which this Schedule D is
attached.
Do not use a social security number in Line D in lieu of an EIN.
The Schedule D and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Schedule D or any of its attachments may result in the rejection of
the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
General Instructions to Form 5500. The EBSA does not issue EINs.
Information on Participating Plans
Complete as many repeating entries as necessary to enter the
information specified below for all plans invested or participated
in the DFE at any time during the DFE year.
[CAUTION] The administrator of each participating plan is
required to provide the CCT, PSA, MT, and 103-12IE with the plan
number, name of the plan sponsor and EIN of the plan sponsor being
reported on the plan's Form 5500 so that the DFE can timely and
accurately complete its Schedule D. Failure to provide that
information to the DFE may result in the plan's Form 5500 Annual
Return/Report being treated as incomplete and subject to rejection.
See 29 CFR 2520.103-9(b).
Complete a separate Line 1 (elements (a) through (e)) for each
plan investing or participating in the DFE.
Line 1a. Enter the name of each plan that invested or
participated in the DFE at any time during the DFE year.
Line 1b. Enter the name of the sponsor of each plan investing or
participating in the DFE.
Line 1c. Enter the nine-digit EIN and three-digit PN for each
plan named in Line 1a. This is the EIN and PN entered on lines 2b
and 1b of the plan's Form 5500 or Form 5500-SF. GIAs should enter
the EIN of the sponsor of the participating plan listed in Line 1(b)
of the Schedule D. Do not use a social security number in lieu of an
EIN. The Schedule D and its attachments are open to public
inspection, and the contents are public information and are subject
to publication on the Internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Schedule D or any of its attachments may result in the rejection of
the filing.
Line 1d. Enter the dollar value of each investing plan's
interest in the DFE as of the end of the DFE year. GIAs do not
complete Line 1d.
1e. If the DFE had investors other than plans that are required
to file the Form 5500 or Form 5500-SF, such as governmental plans,
``one-participant'' plans, or non-plan investors, check the box in
Line 1e.
20XX Instructions for Schedule E (Form 5500) ESOP Annual Information
General instructions
Who Must File
Every employer or plan administrator of a pension benefit plan
that provides ESOP benefits must file a Schedule E (Form 5500).
Specific Instructions
Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule E is
attached. If necessary, you may abbreviate the plan name to fit the
space provided.
Part I Employer Stock Acquired with a Securities Acquisition
Loan. A ``securities acquisition loan'' is an exempt loan to an ESOP
to the extent that the proceeds are used to acquire employer
securities for the plan.
Line 1a. Enter the number of common shares of employer stock
held in the ESOP at the end of the plan year.
Line 1b. Enter the percent of issued and outstanding common
stock held in the ESOP at the end of the plan year.
Line 1c. A security is readily tradable on an established
securities market if it is traded on a national securities exchange
that is registered under section 6 of the Securities Exchange Act of
1934 or if it is traded on a foreign national exchange that is
officially recognized, sanctioned, or supervised by a governmental
authority and the security is deemed by the Securities Exchange
Commission as having a ``ready market''. Treasury Regulations
1.401(a)(35)-1(f)(5)(ii).
Line 1d. Enter the number of shares of common stock that were
allocated at the end of the plan year.
[[Page 47619]]
Line 1e. Enter the number of shares of common stock that were
unallocated at the end of the plan year.
Line 1f. If common stock was released from a loan suspense
account, check the appropriate box(es) to indicate the method(s)
used. If you check ``Other'' you must provide a description of the
method used.
Line 1g. Check ``Yes'' if the ESOP holds preferred stock. Under
section 409(l)(3) of the Code preferred stock is stock convertible
at any time into stock that meets the requirements of sections
409(l)(1) for readily tradable stock or section 409(l)(2) for non-
readily tradable stock. The stock must be convertible at a
conversion price which (as of the date of acquisition) is
reasonable.
If you answered ``Yes'' and the preferred stock was acquired by
the ESOP in a securities acquisition loan, answer Lines 1h-i.
Lines 1h-i. Respond to these questions only if preferred stock
was acquired by the ESOP in a securities acquisition loan.
Line 1i. If, for example, the conversion price is variable or
incorporates the issuance of stock warrants, a description of the
method used must be provided.
Part II Employer Stock Acquired.
Respond to these questions only if during the plan year any non-
readily tradable employer securities were purchased by the ESOP,
including employer securities acquired with the proceeds from a
securities acquisition loan.
Line 2b. For purposes of this form, a party in interest is
deemed to include a disqualified person. See Code section
4975(e)(2). See Instructions for Schedule G for the definition of
party in interest.
Line 2e. Check the appropriate box and enter the applicable
identifying information if a trustee, investment manager, or
independent fiduciary directly or indirectly approved the
transaction.
Line 2f. Section 401(a)(28(C) of the Code provides that, in
order for an ESOP to be a qualified plan under the Code, all
valuations of employer securities which are not readily tradable on
an established securities market with respect to activities carried
on by the plan must be by an independent appraiser.
Line 2g. Check the appropriate box(es) to indicate what
valuation approach(es) were used to set the value of the stock
acquired. If you check ``Other,'' enter a description.
Part III Securities Acquisition Loans.
Complete Part III only if the ESOP had outstanding securities
acquisition loans within the meaning of Code section 4975(d)(3) and
ERISA section 408(b)(3) during the plan year. Complete as many Line
3 (elements (a)-(h)) as needed to identify each such loan.
Part IV Other General Information
Line 4b. As described in Code section 409(p), a disqualified
person, for purposes of this section, is generally, any person whose
deemed-owned shares of the S corporation, as defined in section
409(p)(4)(C), including synthetic equity shares, as defined in
Treasury Regulations section 1.409(p)-1(f)(2) are at least ten
percent of the deemed-owned shares of the S corporation and that
person's synthetic equity shares of the S corporation. In addition,
disqualified persons include a person and each of such person's
family members, as defined in section 409(p)(4)(D), if the aggregate
number of deemed-owned shares of this family group, including
synthetic equity, is at least twenty percent of the deemed owned
shares of the S corporation and the synthetic equity shares of such
persons.
Line 4d(3). Payments in redemption of stock held by an ESOP
include reacquisition payments that are used to make benefit
distributions to participants or beneficiaries.
20XX Instructions for Schedule G (Form 5500) Financial Transaction
Schedules
Who Must File
Large plans, small pension plans that are not exempt from the
annual IQPA audit under 29 CFR 104-46 (see instructions to Schedule
H, Line 3h(4)), master trusts, 103-12 IEs, and GIAs, must attach
Schedule G to their Form 5500 if they are required to file a
Schedule H and they have the following to report:
Loans and/or fixed income obligations in default or
determined to be uncollectible as of the end of the plan year,
Leases in default or classified as uncollectible, and
Nonexempt transactions that occurred or remained
uncorrected during the plan year.
Check the Schedule G box on the Form 5500 (Part II, Line 11b(5))
if you are attaching Schedule G. Complete as many entries as
necessary to report the required information.
[CAUTION] The plans described below, although exempt from
certain other financial reporting requirements, are still required
to file Schedule G, Part III to report nonexempt transactions:
An unfunded, fully insured, or combination unfunded/
insured welfare plan, including group health plans, with 100 or more
participants exempt under 29 CFR 2520.104-44 from completing
Schedule H.
A plan that is required to file a Form M-1, Report for
Multiple Employer Welfare Arrangements (MEWAs) and Certain Entities
Claiming Exception (ECEs).
The Schedule G consists of three parts:
Part I to report any loans or fixed income obligations
in default or determined to be uncollectible as of the end of the
plan year.
Part II to report any leases in default or classified
as uncollectible.
Part III to report nonexempt transactions.
Specific Instructions
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule G is
attached.
Do not use a social security number in Line D in lieu of an EIN.
The Schedule G and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Schedule G or any of its attachments may result in the rejection of
the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
General Instructions to Form 5500. The EBSA does not issue EINs.
Part I--Loans or Fixed Income Obligations in Default or Classified as
Uncollectible
List all loans or fixed income obligations in default or
determined to be uncollectible as of the end of the plan year or the
fiscal year of the GIA, master trust, or 103-12 IE. Include:
Obligations where the required payments have not been
made by the due date;
Fixed income obligations that have matured, but have
not been paid, for which it has been determined that payment will
not be made; and
Loans that were in default even if renegotiated during
the year.
The due date, payment amount, and conditions for determining
default in the case of a note or a loan are usually contained in the
documents establishing the note or loan. A loan is in default when
the borrower is unable to pay the obligation upon maturity.
Obligations that require periodic repayment can default at any time.
Generally loans and fixed income obligations are considered
uncollectible when payment has not been made and there is little
probability that payment will be made. A fixed income obligation has
a fixed maturity date at a specified interest rate.
Line 1. Schedule of Loans in Default or Classified as
Uncollectible Complete as many entries as needed to report all loans
in default or classified as uncollectible.
Do not report on Line 1 participant loans under an individual
account plan with investment experience segregated for each account,
that are made according to 29 CFR 2550.408b-1, and that are secured
solely by a portion of the participant's vested accrued benefit.
Report all other participant loans in default or classified as
uncollectible on Part I, and list each loan individually.
CAUTION: You may not attach an amortization schedule in lieu of
completing as many repeating Line 1 entries as necessary to identify
loans in default or classified as uncollectible.
1a. Identity and address of obligor. Enter the name, street
address, city, state, and zip code for the obligor. A post office
box number may be entered in addition to the street address if the
Post Office does not deliver mail to the obligor's street address.
1b. Relationship of Obligor to Plan. Check the appropriate boxes
to indicate whether the obligor is a party-in-interest or a plan
participant. Also enter a description of the relationship of the
obligor to the plan, such as employer, employee organization, plan
sponsor, fiduciary, service provider, or other party in or other
party-in-interest, (if no relationship, enter ``unrelated third
party'').
1c. Status of Loan. Check to the appropriate box to indicate
whether the loan is in default or has been determined to be
uncollectible. Generally, loans are considered uncollectible when
payment has not been made and there is little probability that
payment will be made. The documents establishing the loan normally
specify its
[[Page 47620]]
terms, due date, payment amount, and conditions for determining
default. A loan is in default when the borrower is unable to pay the
obligation when due. Obligations that require periodic repayment can
default at any time.
1d. Original Principal Amount of Loan. Enter original amount of
loan.
1e. Original Interest Rate of Loan. Enter original interest rate
of the loan. If the original interest rate of the loan was variable,
enter in the space provided, a description of the terms of the
variable interest rate.
1f. Origination Date. Enter the date the loan originated.
1g. Original Maturity Date. Enter the original maturity date of
the loan. If the maturity date was extended to a different date,
include the new maturity date in element (l) in the description of
steps taken to collect the loan.
1h. Loan Collateral. In Line 1h, check the appropriate box to
indicate whether the loan secured by collateral. If you answered
``Yes,'' complete Lines 1h(2) and (3). In Line 1h(2), indicate
whether the security interest in the collateral was perfected. In
Line 1h(3), enter a description of the collateral type and its
value.
1i. Scheduled Payment Frequency. Enter the scheduled payment
frequency (e.g., monthly, annually).
1j. Payments Received. Enter the amount of principal and
interest payments received during the plan year.
1k. Amount Overdue. Enter separately the principal and interest
amounts overdue as of the end of the plan year. Include the amount,
of principal and interest that is overdue from previous plan years.
1l. Steps Taken to Collect. Describe what steps have been taken
or will be taken to collect overdue amounts, including renegotiation
of original terms of the loan.
Line 2--Schedule of Fixed Income Obligations in Default or Classified
as Uncollectible.
Complete as many entries as needed to report all fixed income
obligations in default or classified as uncollectible.
2a. Identity and address of obligor. Enter the name, street
address, city, state, and zip code for the obligor. A post office
box number may be entered in addition to the street address if the
Post Office does not deliver mail to the obligor's street address.
2b. Relationship of Obligor to Plan. Check the box to indicate
whether the obligor is a party-in-interest. Also enter a description
of the relationship of the obligor to the plan, such as employer,
employee organization, plan sponsor, fiduciary, service provider, or
other party in or other party-in-interest (if no relationship, enter
``unrelated third party'').
2c. Status of Fixed Income Obligation. Check the appropriate box
to indicate whether the loan is in default or has been determined to
be uncollectible. Generally, fixed income obligations are considered
uncollectible when payment has not been made and there is little
probability that payment will be made. The documents establishing
the obligation normally specify its terms, due date, payment amount,
and conditions for determining default. A fixed income obligation is
in default when the obligee is unable to pay the obligation when
due. Obligations that require periodic repayment can default at any
time.
2d. Nature of Fixed Income Obligation. Check applicable boxes to
indicate the nature of the fixed income obligation. See Schedule H,
Line 1b instructions for more information on types of fixed income
obligations.
2e. Date of issuance. Enter the date the fixed income obligation
was issued.
2f. Maturity date. Enter the original maturity date of the
obligation. If the maturity date was extended to a different date,
include the new maturity date in the description of steps taken to
collect the obligation in element (l).
2g. Yield/Interest Rate. Enter yield or interest rate for the
obligation provided for in the note or contract establishing the
obligation.
2h. Principal amount of fixed income obligation. Enter the
principal amount of the obligation at the time the plan entered into
the transaction.
2i. Amount Overdue. Enter separately the principal and interest
amounts overdue as of the end of the plan year. Include the amount
of principal and interest that is overdue from previous plan years.
2j. Steps Taken to Collect. Enter a description of what steps
the plan administrator has taken or will be taking to collect
overdue amounts for each loan.
Part II Leases in Default or Classified as Uncollectible.
List any leases in default or classified as uncollectible. A
lease is an agreement conveying the right to use property, plant, or
equipment for a stated period. A lease is in default when the
required payment(s) has not been made. An uncollectible lease is one
where the required payments have not been made and for which there
is little probability that payment will be made.
3a. Identity and address of obligor. Enter the name, street
address, city, state, and zip code for the obligor. A post office
box number may be entered in addition to the street address if the
Post Office does not deliver mail to the obligor's street address.
3b. Relationship of Obligor to Plan. Check the appropriate boxes
to indicate whether the obligor is a party-in-interest or a plan
participant. Also enter a description of the relationship of the
obligor to the plan, such as employer, employee organization, plan
sponsor, fiduciary, service provider, or other party-in-interest (if
no relationship, enter ``unrelated third party'').
3c. Status of Lease. Check to the appropriate box to indicate
whether the lease is in default or has been determined to be
uncollectible. Generally, leases are considered uncollectible when
payment has not been made and there is little probability that
payment will be made. The documents establishing the lease normally
specify its terms, due date, payment amount, and conditions for
determining default. A lease is in default when the lessee is unable
to pay the obligation when due. Obligations that require periodic
repayment can default at any time.
3d. Address of Leased Property. You must enter the name, street
address, city, state, and zip code of the leased property. You may
not use a post office box.
3e. Date of Lease Origination. Enter date of lease origination.
3f. Original Cost of Leased Property. Enter the cost to acquire
the property.
3g. Current Value of Leased Property at Time of Lease. Enter the
value of the leased property at time the plan entered into the
lease.
3h. Annual Lease Payments Due. Enter the gross rental amounts
due during the plan year.
3k. Scheduled Payment Frequency. Indicate the lease payment
schedule, i.e., monthly, annually.
3l. Lease Expiration Date: Enter the lease expiration date.
3m. Amount In Arrears. Enter the amount of payments under the
lease that are in arrears.
3n. Steps Taken to Collect. Enter an explanation of what steps
the plan administrator has taken or will be taking to collect
overdue amounts for each lease listed.
Part III Nonexempt Transactions
You must report all nonexempt party-in-interest transactions,
regardless of whether they are disclosed in the accountant's report,
unless the nonexempt transaction is:
1. Statutorily exempt under Part 4 of Title I of ERISA;
2. Administratively exempt under ERISA section 408(a);
3. Exempt under Code sections 4975(c) or 4975(d);
4. The holding of participant contributions in the employer's
general assets for a welfare plan that meets the conditions of ERISA
Technical Release 92-01;
5. A transaction of a 103-12 IE with parties other than the
plan; or
6. A delinquent participant contribution or a delinquent
participant loan repayment reported on Schedule H, Line 4a.
Nonexempt transactions with a party-in-interest include any
direct or indirect:
A. Sale or exchange, or lease, of any property between the plan
and a party-in-interest.
B. Lending of money or other extension of credit between the
plan and a party-in-interest.
C. Furnishing of goods, services, or facilities between the plan
and a party-in-interest.
D. Transfer to, or use by or for the benefit of, a party-in-
interest, of any income or assets of the plan.
E. Acquisition, on behalf of the plan, of any employer security
or employer real property in violation of ERISA section 407(a).
F. Dealing with the assets of the plan for a fiduciary's own
interest or own account
G. Acting in a fiduciary's individual or any other capacity in
any transaction involving the plan on behalf of a party (or
represent a party) whose interests are adverse to the interests of
the plan or the interests of its participants or beneficiaries.
H. A receipt of any consideration for his or her own personal
account by a party-in-interest who is a fiduciary from any party
dealing with the plan in connection with a transaction involving the
income or assets of the plan.
[[Page 47621]]
For purposes of this form, party-in-interest is deemed to
include a disqualified person. See Code Section 4975(e)(2). The term
``party-in-interest'' means, as to an employee benefit plan:
A. Any fiduciary (including, but not limited to, any
administrator, officer, trustee or custodian), counsel, or employee
of the plan;
B. A person providing services to the plan;
C. An employer, any of whose employees are covered by the plan;
D. An employee organization, any of whose members are covered by
the plan;
E. An owner, direct or indirect, of 50% or more of:
(1) the combined voting power of all classes of stock entitled
to vote or the total value of shares of all classes of stock of a
corporation,
(2) the capital interest or the profits interest of a
partnership, or
(3) the beneficial interest of a trust or unincorporated
enterprise that is an employer or an employee organization described
in C or D;
F. A relative of any individual described in A, B, C, or E;
G. A corporation, partnership, or trust or estate of which (or
in which) 50% or more of:
(1) the combined voting power of all classes of stock entitled
to vote or the total value of shares of all classes of stock of such
corporation,
(2) the capital interest or profits interest of such
partnership, or
(3) the beneficial interest of such trust or estate is owned
directly or indirectly, or held by, persons described in A, B, C, D,
or E;
H. An employee, officer, director (or individual having powers
or responsibilities similar to those of officers or directors), or a
10% or more shareholder, directly or indirectly, of a person
described in B, C, D, E, or G, or of the employee benefit plan; or
I. A 10% or more (directly or indirectly in capital or profits)
partner or joint venture of a person described in B, C, D, E, or G.
If you are unsure whether a transaction is exempt or not, you
should consult with either the plan's independent qualified public
accountant or legal counsel or both.
You may indicate that an application for an administrative
exemption is pending.
If the plan is a qualified pension plan and a nonexempt
prohibited transaction occurred with respect to a disqualified
person, the disqualified person must file an IRS Form 5330, Return
of Excise Taxes Related to Employee Benefit Plans, to pay the excise
tax on the transaction.
4a. Identity and Address of Party Involved in Non-exempt
Transaction. Enter the name, street address, city, state, and zip
code for the obligor. A post office box number may be entered in
addition to the street address if the post office does not deliver
mail to the obligor's street address.
4b. Relationship to Plan. Enter a description of the
relationship of the party involved in the transaction to the plan,
such as employer, employee organization, plan sponsor, fiduciary,
service provider, or other party-in-interest.
4c. Type of Nonexempt Transaction. Check all of the boxes that
apply to the nonexempt transaction.
4d. Nature of Transaction. Check the appropriate box to indicate
the nature of the transaction. A transaction is a discrete
transaction if it was a single occurrence that did not continue in
time, for example, the sale of property between a plan and a party-
in-interest is a discrete transaction. An ongoing transaction is one
that is continuous over a period of time, such as a lease or other
obligation that requires regular payments for a continuing time
period.
4e. Date of Transaction. Enter the date the transaction occurred
or was entered into. If ongoing, enter the date of the commencement
or first instance.
4f. Principal Amount Of Nonexempt Transaction. Enter the
principal amount of the transaction.
4g. Net Gain (Or Loss) On the Transaction. Enter the net gain
(or loss) on the transaction.
4h-j. Correction of Transaction. Check the appropriate box to
indicate whether the transaction has been corrected, and if so, when
and how the transaction was corrected. The DOL Voluntary Fiduciary
Correction Program (VFCP) describes how to apply the specific
transactions covered (for example, delinquent participation
contributions to pension and welfare plans) and acceptable methods
for correcting violations. In addition, applicants that satisfy both
the VFCP requirements and the conditions of Prohibited Transaction
Exemption (PTE) 2002-51 are eligible for immediate relief from
payment of certain prohibited excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 FR 20261 (Apr.
19, 2006) and 71 FR 20135 (Apr. 19, 2006). If conditions of PTE
2002-51 are satisfied, corrected transactions should be treated as
exempt under Code section 4975(c) when answering Schedule G, Part
III. Information about the VFCP is also available on the internet at
www.dol.gov/ebsa.
4k. Filing of Form 5330 and Payment of Excise Taxes. Check the
appropriate box to indicate whether a Form 5330 with payment of
excise taxes to the IRS was required and if so, whether the Form
5330 was in fact filed.
20XX Instructions for Schedule H (Form 5500) (Financial Information)
General Instructions
Who Must File
Schedule H (Form 5500) must be attached to a Form 5500 filed for
any pension or welfare benefit plan required to file the Form 5500,
unless subject to one of the exceptions listed below or permitted to
file the Form 5500-SF. Master trusts, CCTs, PSAs, 103-12 IEs, and
GIAs also must complete as part of their Form 5500 Annual Return/
Report filing some or all of the Schedule H, depending on type of
entity filing. See the instructions to the Form 5500 in Section 4:
Direct Filing Entity (DFE) Filing Requirements.
Exceptions: (1) Fully insured, unfunded, or a combination of
unfunded/insured welfare plans, including plans that provide health
benefits, and fully insured pension plans that meet the requirements
of 29 CFR 2520.104-44, are exempt from completing the Schedule H.
(2) Plans that are eligible to file and in fact file a Form
5500-SF for the 20XX plan year are not required to file a Schedule H
for that year. See What To File. and Instructions for Form 5500-SF.
Check the Schedule H box on the Form 5500 (Part II, Line 11b(1))
if a Schedule H is attached to the Form 5500.
Specific Instructions
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule H is
attached.
Do not use a social security number in Line D in lieu of an EIN.
The Schedule H and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Schedule H or any of its attachments may result in the rejection of
the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
General Instructions to Form 5500. The EBSA does not issue EINs.
Part I--Asset and Liability Statement
Note. The cash, modified cash, or accrual basis may be used for
recognition of transactions in Parts I and II, as long as you use
one method consistently. Round off all amounts reported on the
Schedule H to the nearest dollar. Any other amounts are subject to
rejection. Check all subtotals and totals carefully.
If the assets of two or more plans are maintained in a fund or
account that is not reported on lines 1b(6) through 1b(8), complete
Parts I and II of the Schedule H by entering the plan's allocable
part of each line item.
If assets of one plan are maintained in two or more trust funds,
report the combined financial information in Parts I and II.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith under
the terms of the plan by a trustee or a named fiduciary, assuming an
orderly liquidation at time of the determination. See ERISA section
3(26).
Note. Amounts reported in column (a) must be the same as
reported for the end of the plan year for corresponding line items
of the return/report for the preceding plan year. Do not include
contributions designated for the 20XX plan year in column (a).
1a(1). Employer contributions. Noncash basis filers must include
contributions due the plan by the employer but not yet paid. Do not
include other amounts due from the employer such as the
reimbursement of an expense or the repayment of a loan.
1a(2). Participant contributions. Noncash basis filers must
include contributions withheld by the employer from participants
[[Page 47622]]
and amounts due directly from participants that have not yet been
received by the plan. Do not include the repayment of participant
loans.
1a(3). Notes receivable from participants (participant loans).
Enter the current value of all loans to participants, including
residential mortgage loans that are subject to Code section 72(p).
Include the sum of the value of the unpaid principal balances, plus
accrued but unpaid interest, if any, for participant loans made
under an individual account plan with investment experience
segregated for each account, which are made in accordance with 29
CFR 2550.408b-1 and secured solely by a portion of the participant's
vested accrued benefit. When applicable, combine this amount with
the current value of any other participant loans. Do not include in
column (b) a participant loan that has been deemed distributed
during the plan year under the provisions of Code section 72(p) and
Treasury Regulations section 1.72(p)-1, if both of the following
circumstances apply:
1. Under the plan, the participant loan is treated as a directed
investment solely of the participant's individual account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
If both of these circumstances apply, report the loan as a
deemed distribution on Line 2g. However, if either of these
circumstances does not apply, the current value of the participant
loan (including interest accruing thereon after the deemed
distribution) must be included in column (b) without regard to the
occurrence of a deemed distribution.
Note. After a participant loan that has been deemed distributed
is reported on Line 2g, it is no longer to be reported as an asset
on Schedule H unless, in a later year, the participant resumes
repayment under the loan. However, such a loan (including interest
accruing thereon after the deemed distribution) that has not been
repaid is still considered outstanding for purposes of applying Code
section 72(p)(2)(A) to determine the maximum amount of subsequent
loans. Also, the deemed distribution is not treated as an actual
distribution for other purposes, such as the qualification
requirements of Code section 401, including, for example, the
determination of top-heavy status under Code section 416 and the
vesting requirements of Treasury Regulations section 1.411(a)-
7(d)(5). See Q&As 12 and 19 of Treasury Regulations section 1.72(p)-
1.
The entry on Line 1a(3), column (b), of Schedule H (participant
loans--end of year) must include the current value of any
participant loan that was reported as a deemed distribution on Line
2h for any earlier year if the participant resumes repayment under
the loan during the plan year. In addition, the amount to be entered
on Line 2h must be reduced by the amount of the participant loan
that was reported as a deemed distribution on Line 2h for the
earlier year.
Line 1a(4). Other Receivables. Noncash basis filers must include
amounts due to the plan that are not includable in Lines 1a(1),
1a(2), and 1a(3). These amounts may include investment income earned
but not yet received by the plan and other amounts due to the plan
such as amounts due from the employer or another plan for expense
reimbursement or from a participant for the repayment of an
overpayment of benefits.
Line 1b(1). Total noninterest-bearing cash. Total noninterest
bearing cash includes, among other things, cash on hand or cash in a
noninterest bearing checking account.
1b(2). Interest-bearing cash and cash equivalents. Include all
assets that earn interest in a financial institution account, such
as interest bearing checking accounts, passbook savings accounts in
Line 1b(2)(A). Report certificates of deposit on Line 1b(2)(B).
Report money market accounts on Line 1b(2)(C).
Line 1b(3). Debt Interests/Obligations. Enter in the appropriate
categories any debt interests/obligations held directly by the plan.
Line 1b(3)(A). U.S. Government securities. Include securities
issued or guaranteed by the U.S. Government or its designated
agencies such as U.S. Savings Bonds, Treasury Bonds, Treasury Bills,
Federal National Mortgage Association (FNMA), and Government
National Mortgage Association (GNMA).
Line 1b(3)(B). Other government securities. Include here state
and municipal bonds. Report bonds issued by foreign governments in
Line 1b(13).
Line 1b(3)(C). Corporate debt instruments (other than employer
securities). Include investment securities (other than employer
securities defined below in Line 1c(1)) issued by a corporate entity
at a stated interest rate repayable on a particular future date such
as most bonds, debentures, convertible debentures, commercial paper
and zero coupon bonds. Do not include debt securities of
governmental units that should be reported on Line 1b(3)(A). For
purposes of the breakouts on Line 1b(3)(C)(i) and (ii), investment-
grade debt-instruments are those with an S&P rating of BBB--or
higher, a Moody's rating of Baa3 or higher, or an equivalent rating
from another rating agency. High-yield debt instruments are those
that have ratings below these rating levels. If the debt does not
have a rating, it should be included in the ``high-yield'' category
if it does not have the backing of a government entity. Unrated debt
with the backing of a government entity would generally be included
in the ``investment-grade'' category unless it is generally accepted
that the debt should be considered as ``high-yield.'' Use the
ratings in effect as of the beginning of the plan year. See the
instructions for Schedule R, Line 18.
Line 1b(3)(D). Exchange Traded Notes. Report here unsecured,
unsubordinated debt securities that are traded on an exchange and
that are not registered investment companies under the Investment
Company Act of 1940.
Line 1b(3)(E). Asset backed securities (other than real estate).
An asset-backed security generally is one that is collateralized by
a discrete pool of assets (such as loans or receivables) and that
makes payments based primarily on the performance of those assets.
Do not include here securities backed by real estate or real estate-
related loans.
Line 1b(3)(F). Other debt instruments. Include here, debt
instruments not otherwise includable in Lines 1a(3) (participant
loans), 1b(3)(A)-(E), 1b(9)(E) (mortgage-backed securities) or
1b(9)(G) (e.g., construction and mortgage loans).
Line 1b(4). Corporate Stocks (Other than Employer Securities,
Private Equity, and Foreign Investments). Include here publicly
traded and non-publicly traded domestic equities owned directly by
the plan. Do not include employer securities, foreign stocks, or
private equity here.
Line 1b(4)(A). Publicly Traded Corporate Stocks. Enter in
element (i) the total value of all ``preferred'' corporate stock
that is publicly traded. Include stock issued by corporations (other
than employer securities defined in Line 1c(1) below) that is
accompanied by preferential rights such as the right to share in
distributions of earnings at a higher rate or which has general
priority over the common stock of the same entity. Include the value
of warrants convertible into preferred stock. Enter in element (ii)
the total value of all ``common'' corporate stock that is publicly
traded. This includes any stock (other than employer securities
defined in Line 1c(1)) that represents regular ownership of the
corporation and is not accompanied by preferential rights. Include
the value of warrants convertible into common stock.
Line 1b(4)(B). Corporate Stocks That Are Not Publicly Traded.
Enter in element (i) the total value of nonpublicly traded preferred
stock and in element (ii) the total value of nonpublicly traded
common stock. See instructions for Line 1b(4)(A) for a description
of ``preferred'' and ``common'' stock.
Line 1b(5). Registered Investment Companies (Mutual funds, Unit
Investment Trusts, Closed End Funds). A registered investment
company is an investment company registered under the Investment
Company Act of 1940. These are mutual funds (legally known as open-
end companies), closed-end funds (legally known as closed-end
companies), and unit investment trusts (UITs) (legally known as unit
investment trusts).
Lines 1b(6)(A) and (B). Interests in CCTs and PSAs. Enter
information, in the appropriate elements as of the beginning and end
of the filing plan or DFE year, about interests in PSAs and CCTs,
regardless of whether the CCT or PSA has filed its own Form 5500
Annual Return/Report.
CAUTION: The plan's or DFE's interest in common/collective
trusts (CCTs) and pooled separate accounts (PSAs) must be allocated
and reported in the appropriate categories on an investment by
investment basis on the Line 4i Schedules, with the box checked to
identify that the investment was held through a CCT or PSA, unless
the CCT or PSA has filed its own Form 5500, including Schedule H,
and the Line 4i(1) Schedule of Assets Held for Investment at End of
Year. See instructions for Line 4i(1) Schedule of Assets Held for
Investment at End of Year, element (a).
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR 2510.3-
101(h)(1)(iii) does not constitute a PSA.
[[Page 47623]]
Line 1b(6)(C). Interests in 103-12 investment entities (103-12
IEs). Enter the total value of the plan's interest in all 103-12 IEs
on Line 1b(6)(C)(1)(a).
Line 1b(6)(D). Master Trust. Enter the total value of the plan's
interest in all master trusts on Line 1b(6)(D)(1)(a).
CAUTION. If the plan participated in a master trust, it must
separately list on the Line 4i(1) Schedule of Assets Held for
Investment at End of Year all of the master trust assets in which
the plan had a proportionate interest, indicating that the asset was
held through the master trust. See instructions for Line 4i(1)
Schedule of Assets Held for Investment at End of Year, element (a).
Line 1b(7). Value of Interest in Funds Held in Insurance General
Account (Unallocated Contracts). Use the same method for determining
the value of the insurance contracts reported here as you used for
Line 3 of Schedule A, or, if Line 3 is not required, Line 6 of
Schedule A.
Line 1b(8). Partnership and Joint Venture Interests. Enter in
the appropriate element information about partnership and joint
venture interests.
Line 1b(8)(A)(1). Value of Interest in Limited Partnerships.
Include the value of the plan's participation in a partnership or
joint venture regardless of whether the underlying assets of the
partnership or joint venture are considered to be plan assets under
29 CFR 2510.3-101. Do not include here the value of a plan's
interest in a partnership or joint venture that satisfies all of the
requirements for being a 103-12 Investment Entity (103-12 IE),
including the requirement that such an entity timely files its own
Form 5500 Annual Return/Report and associated schedules and
attachments. Report the value of a 103-12 IE on Line 1b(6)(C).
Partnerships and joint ventures should be reported in one of the
partnership/joint venture categories where it fits best, or in
another category where it fits better. For example, a real estate
partnership that does not fit into one of the other real estate
reporting categories would be reported on proposed Line 1c(9)(G) and
a joint venture that invests in foreign investments would be
reported in the appropriate subcategory in Line 1b(13).
Line 1b(8)(A)(2). Value of Interest in Venture Capital Operating
Companies (VCOC). A ``venture capital operating company'' is an
operating company that meets the conditions of 29 CFR 2510.3-101(d).
Line 1b(8)(A)(3). Private Equity. Include on this line private
equity stakes and interests in private equity funds. ``Private
equity fund'' is commonly used to describe privately managed pools
of capital that invest in companies that typically are not listed on
a stock exchange. Report stock ownership of non-publicly traded
corporate stocks that are not private equity investments on Line
1b(4)(B).
Line 1b(8)(A)(4). Hedge Funds. The term ``hedge fund'' is
commonly used to describe pooled investment vehicles that are
privately organized and administered by professional managers who
engage in active trading of various types of securities, commodity
futures, options contracts, and other investment vehicles, including
relatively illiquid and hard-to-value investments.
Line 1b(8)(A)(5). Other Partnership/Joint Venture Interests.
Report here any other partnership or joint venture interests in
which the plan has invested that are not reported on lines 1b(8)(A)-
(D).
Line 1b(8)(B). Plan Asset Status Under DOL Regulation 29 CFR
2510.3-101. Enter into Line 1b(8)(B)(i) the total of all
partnerships/joint venture interests reported in Line 1b(8)(A) that
do not hold plan assets under the DOL's plan asset regulation at 29
CFR 2510.3-101. In Line 1b8(B)(2) enter the total partnership/joint
venture interests that hold plan assets under the DOL's plan asset
regulation at 29 CFR 2510.3-101. To avoid double-counting, do not
include amounts reported on Line 1b(8)(B)(1) and (2) in the total
assets reported on Line 1f.
Line 1b(9). Real Estate Investments (Other Than Employer Real
Property). Enter information about real estate and real estate based
interests in the appropriate element.
Line 1b(9)(A)-(B). Real property (Other Than Employer Real
Property). Report here direct ownership interest of the plan in real
property other than employer real property in the appropriate
category.
Line 1b(9)(C)-(D). Real Estate Investment Trusts (REITs). Report
here entities that invest in real estate that are REITs as set forth
in Code Sec. 856.
Line 1b(9)(E). Mortgage-Backed Securities (Including
Collateralized Mortgage Obligations). Report here all types of
mortgage-backed securities, which generally are debt obligations
that represent claims to the cash flows from pools of mortgage
loans, most commonly on residential property. Collateralized
mortgage obligations (CMOs) are one type of mortgage-backed
security.
Line 1b(8)(F). Real Estate Operating Company (REOC). Report here
investments in ``real estate operating companies'' (REOCs). A REOC
is an operating company that meets the conditions of 29 CFR 2510.3-
101(e).
Line 1b(9)(G). Other real estate related investments. Include
here any residential mortgages that are not covered under IRC 72(p),
commercial mortgages, construction loans, and any other real estate-
related investments not includable on lines 1b(9)(A)-(F) that are
not employer real property reportable on Line 1c(2) or buildings or
other property used in plan operations reportable on Line 1d.
Line 1b(10). Commodities (Direct investments). Enter direct
investments in commodities on Line 1b(10). Enter total value of
precious metals in Line 1b(10)(A) and the total value of all other
commodities in Line 1b(10)(B).
Line 1b(11). Derivatives. Enter information about direct
investments in derivatives in the appropriate element in Line
1b(11). Derivatives include futures, forwards, options, and swaps.
Enter a description for any derivatives reported in Line 1b(11)(E)
``Other.''
Line 1b(12). Tangible personal property (including
collectibles). Enter the total value of any collectibles or other
personal property owned by the plan. Include all property that has
concrete existence and is capable of being processed, such as goods,
wares, merchandise, furniture, machines, equipment, animals,
automobiles, etc. This includes collectibles, such as works of art,
rugs, antiques, metals, gems, stamps, coins, alcoholic beverages,
musical instruments, and historical objects (documents, clothes,
etc.). Do not include any intangible property, such as patents,
copyrights, goodwill, franchises, notes, mortgages, stocks, claims,
interests, or other property that embodies intellectual or legal
rights.
Line 1b(13). Foreign investments (Other than through U.S.-
registered investment funds). Enter information about foreign
investments in the appropriate element. Do not include the value of
U.S.-based pooled investment vehicles that are designed to invest in
foreign securities. Instead, report such pooled investment vehicles
in the appropriate categories on Line 1b(5)-(7).
Line 1b(14). Participant-directed brokerage accounts. Report
assets held through participant-directed brokerage accounts in the
appropriate sub-elements on Line 1b(14). Report in the aggregate all
other investments through participant-directed brokerage accounts,
that are not reportable in the separate categories in Lines
1b(14)(A)-(F), including stocks, bonds, registered investment funds,
etc., on Line 1b(14)(G).
Line 1c(1). Employer securities. An employer security is any
security issued by an employer (including affiliates) of employees
covered by the plan. These may include common stocks, preferred
stocks, bonds, zero coupon bonds, debentures, convertible
debentures, notes, and commercial paper. Report in the appropriate
category any types of employer securities held by the plan.
Line 1c(2). Employer real property. The term ``employer real
property'' means real property (and related personal property) that
is leased to an employer of employees covered by the plan, or to an
affiliate of such employer. For purposes of determining the time at
which a plan acquires employer real property for purposes of this
line, such property shall be deemed to be acquired by the plan on
the date on which the plan acquires the property or on the date on
which the lease to the employer (or affiliate) is entered into,
whichever is later.
Line 1d. Buildings and other property used in plan operation.
Include the current (not book) value of the buildings and other
property used in the operation of the plan. Report in 1c(9) and
1c(2), as applicable, rather than Line 1d, buildings or other
property held as plan investments that are not used in the operation
of the plan.
Line 1e. Other. Include all other investments not includable in
lines 1b through 1d and enter a description.
Line 1f. Total assets. Add all amounts in lines 1a through 1e.
Note. Do not include the value of future pension payments on
lines 1g, h, i, j, or k.
Line 1g. Benefit claims payable. Noncash basis plans must
include the total amount of benefit claims that have been processed
and approved for payment by the plan. Include welfare plan
``incurred but not reported'' (IBNR) benefit claims on this line.
[[Page 47624]]
Line 1h. Operating payables. Noncash basis plans must include
the total amount of obligations owed by the plan which were incurred
in the normal operations of the plan and have been approved for
payment by the plan but have not been paid.
Line 1i. Acquisition indebtedness. ``Acquisition indebtedness,''
for debt-financed property other than real property, means the
outstanding amount of the principal debt incurred:
1. By the organization in acquiring or improving the property;
2. Before the acquisition or improvement of the property if the
debt was incurred only to acquire or improve the property; or
3. After the acquisition or improvement of the property if the
debt was incurred only to acquire or improve the property and was
reasonably foreseeable at the time of such acquisition or
improvement. For further explanation, see Code section 514(c).
Line 1j. Other liabilities. Noncash basis plans must include
amounts owed for any liabilities that would not be classified as
benefit claims payable, operating payables, or acquisition
indebtedness and enter a description of such liabilities.
Line 1k. Total liabilities. Add all amounts in lines 1g through
1k.
Net Assets
Line 1l. Net assets. Enter the net assets as of the beginning
and end of the plan year. (Subtract Line 1k from Line 1f.) The entry
in column (b) must equal the sum of the entry in column (a) plus
Lines 2k and 2l(1), minus 2l(2).
Part II Income and Expense Statement
Line 2. Plan income, expenses, and changes in net assets for the
year. Include all income and expenses of the plan, including any
trust(s) or separately maintained fund(s) and any payments/receipts
to/from insurance carriers. Round off amounts to the nearest dollar.
Master trusts, CCTs, PSAs, and 103-12 IEs do not complete lines 2a,
2b, 2e, 2f, and 2g.
Line 2a. Contributions. Include the total cash contributions
received and/or (for accrual basis plans) due to be received.
Note. Plans using the accrual basis of accounting should not
include contributions designated for years before the 20XX plan year
on Line 2a.
Line 2a (1). Contributions Received or receivable. Enter
contributions received, or for accrual basis filers receivable, from
employers in element (A), from participants in element (B). In
element (C) enter all other contributions received or receivable,
including rollovers from other qualified retirement plans.
Line 2a(1)(B). For welfare plans, report all employee
contributions, including all elective contributions under a
cafeteria plan (Code section 125). For pension benefit plans,
participant contributions, for purposes of this item, also include
elective contributions under a qualified cash or deferred entities
arrangement. (Code section 401(k)).
Line 2a(2). Noncash contributions. Use the current value, at
date contributed, of securities or other noncash property.
Line 2a(3). Total contributions. Add Lines 2a(1)(A), (B), (C),
and Line 2a(2).
Line 2b. Interest Income on Notes Receivable from Participants
(Participant Loans). Enter interest income on participant loans.
Also include here interest income on residential mortgage loans to
participants under Code Sec. 72(p).
Line 2c. Earnings on Investments. Report in Line 2c(1)(A)-(E)
the total interest paid directly to the plan by the issuer . Report
the total of all other earnings on debt interests or obligations in
Line 2c(1)(F).
Report in Line 2c(2)(A) the total dividends on corporate stocks
(other than employer securities) paid directly to the plan by the
issuer of any corporate stocks. Report the total of all other
earnings on corporate stocks in Line 2c(2)(B).
In Line 2c(1)-(6), report the total of all earnings by asset
type, including interest, dividends, gain (loss) on sale of
property, unrealized appreciation (depreciation), and, if the asset
has been sold during the plan year, the net investment gain (loss),
as appropriate for asset type.
Interest includes interest earned on interest-bearing cash,
including earnings from sweep accounts, STIF accounts, money market
accounts, certificates of deposit, government securities etc.
For accrual basis plans, include any dividends declared for
stock held on the date of record, but not yet received as of the end
of the plan year.
Generally, rents represent the income earned on the real
property. Include ``rent'' reporting as part of earnings as a
``Net'' figure. Net rents are determined by taking the total rent
received and subtracting all expenses directly associated with the
property. If the real property is jointly used as income producing
property and for the operation of the plan, net that portion of the
expenses attributable to the income producing portion of the
property against the total rents received.
Net gain (loss) on sale of assets equals the sum of the net
realized gain (or loss) on each asset held at the beginning of the
plan year which was sold or exchanged during the plan year, and on
each asset that was both acquired and disposed of within the plan
year.
Note. As current value reporting is required for the Form 5500
Annual Return/Report, assets are revalued to current value at the
end of the plan year. For purposes of this form, the increase or
decrease in the value of assets since the beginning of the plan year
(if held on the first day of the plan year) or their acquisition
date (if purchased during the plan year) is included as part of
total earnings for particular assets.
The sum of the realized gain (or loss) of assets sold or
exchanged during the plan year is to be calculated as follows:
1. Include for each category of asset in Line 2c, where
applicable, the sum of the amount received for these former assets;
2. Include for each category of asset in Line 2c, the sum of the
current value of these former assets as of the beginning of the plan
year and the purchase price for assets both acquired and disposed of
during the plan year.
If entering a negative number, enter a minus sign ``-'' to the
left of the number.
Note. Bond write-offs should be reported as realized losses.
To calculate total unrealized appreciation of assets in each
category subtract the current value of assets at the beginning of
the year plus the cost of any assets acquired during the plan year
from the current value of assets at the end of the year to obtain
this figure. If entering a negative number, enter a minus sign ``-''
to the left of the number.
Line 2d. Total income. Add all income amounts (c) and enter
total in the space provided.
Line 2e(1). Include the current value of all cash, securities,
or other property at the date of distribution. Include all eligible
rollover distributions as defined in Code section 401(a)(31)(D) paid
at the participant's election to an eligible retirement plan
(including an IRA within the meaning of section 401(a)(31)(E)).
2e(2). Include payments to insurance companies and similar
organizations, managed care organizations, and health maintenance
organizations for the provision of plan benefits (e.g., paid-up
annuities, accident insurance, health insurance, vision care, dental
coverage, stop-loss insurance whose claims are paid to the plan (or
which is otherwise an asset of the plan)), etc.
2e(3). Include all payments made to other organizations or
individuals providing benefits. Generally, these are individual
providers of welfare benefits such as legal services, day care
services, training, and apprenticeship services.
Line 2f. Corrective Distributions. Include on this line all
distributions paid during the plan year of excess deferrals under
Code section 402(g)(2)(A)(ii), excess contributions under Code
section 401(k)(8), and excess aggregate contributions under Code
section 401(m)(6). Include allocable income distributed. Also
include on this line any elective deferrals and employee
contributions distributed or returned to employees during the plan
year, as well as any attributable income that was also distributed.
Line 2g. Certain Deemed Distributions of Participant Loans.
Report on Line 2g a participant loan that has been deemed
distributed during the plan year under the provisions of Code
section 72(p) and Treasury Regulations section 1.72(p)-1 only if
both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a directed
investment solely of the participant's individual account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
If either of these circumstances does not apply, a deemed
distribution of a participant loan should not be reported on Line
2g. Instead, the current value of the participant loan (including
interest accruing thereon after the deemed distribution) must be
included on Line 1a(3), column (b) (participant loans--end of year),
without regard to the occurrence of a deemed distribution.
Note. The amount to be reported on Line 2g of Schedule H must be
reduced if, during the plan year, a participant resumes
[[Page 47625]]
repayment under a participant loan reported as a deemed distribution
on Line 2g for any earlier year. The amount of the required
reduction is the amount of the participant loan reported as a deemed
distribution on Line 2g for the earlier year. If entering a negative
number, enter a minus sign ``-'' to the left of the number. The
current value of the participant loan must then be included in Line
1a(3), column (b), of Schedule H (Notes receivable from
participants)
Although certain participant loans deemed distributed are to be
reported on Line 2g of the Schedule H and are not to be reported on
the Schedule H as an asset thereafter (unless the participant
resumes repayment under the loan in a later year), they are still
considered outstanding loans and are not treated as actual
distributions for certain purposes. See Q&As 12 and 19 of Treasury
Regulations section 1.72(p)-1.
Lines 2h-2j Expenses. Report expenses on the appropriate line
items below.
CAUTION. Master trust expenses that are not allocable to all
plans investing in the master trust must be reported at the
individual plan level. Only master trust expenses that are
reasonably equally attributable to each participating plan may be
reported at the master trust level. This includes administrative
expenses associated with investments in which not all plans in the
master trust have an interest.
Line 2h. Interest Expense. Interest expense is a monetary charge
for the use of money borrowed by the plan. This amount should
include the total of interest paid or to be paid (for accrual basis
plans) during the plan year.
Line 2i. Administrative Expenses. Report all administrative
expenses (by specified category) paid by or charged to the plan,
including those that were not subtracted from the gross income of
CCTs, PSAs, master trusts, and 103-12 IEs in determining their net
investment gain(s) or loss(es). Expenses incurred in the general
operations of the plan are classified as administrative expenses.
Include, in the appropriate categories in lines 2i(1)-(11), the
total fees paid (or in the case of accrual basis plans, costs
incurred during the plan year but not paid as of the end of the plan
year) by the plan for plan salaries and allowances, outside contract
administrator, investment advisory and management fees, IQPA audit
fees, recordkeeping and other accounting fees, bank or trust company
trustee/custodial fees, actuarial fees, legal fees, and valuation/
appraisal services.
Line 2i(1). Salaries and Allowances. Report total salaries and
expenses for plan employees in Line 2i(1).
Line 2i(2). Contract administrator fees. Enter the total fees
paid (or in the case of accrual basis plans, costs incurred during
the plan year but not paid as of the end of the plan year) to a
contract administrator for performing administrative services for
the plan. For purposes of the return/report, a contract
administrator is any individual, partnership, or corporation,
responsible for managing the clerical operations (e.g., handling
membership rosters, claims payments, maintaining books and records)
of the plan on a contractual basis. Do not include salaried staff or
employees of the plan or banks or insurance carriers.
Line 2i(3). Investment Advisory and Management Fees. Enter the
total fees paid (or in the case of accrual basis plans, costs
incurred during the plan year but not paid as of the end of the plan
year) to an individual, partnership or corporation (or other person)
for advice to the plan relating to its investment portfolio. These
may include fees paid to manage the plan's investments, fees for
specific advice on a particular investment, and fees for the
evaluation for the plan's investment performance.
Line 2i(4). IQPA Audit Fees. Enter in Line 2j(4) fees for the
annual audit of the plan by an independent qualified public
accountant (IQPA); for payroll audits, and any other audit fees paid
by the plan.
Line 2i(5). Recordkeeping and Other Accounting Fees. Include
fees for accounting/bookkeeping services other than amounts paid for
audit fees reportable in Line 2i(4).
Line 2i(6). Bank or Trust Company Trustee/Custodial Fees. Report
here bank or trust company trustee/custodial fees.
Line 2i(7). Actuarial Fees. Include fees for actuarial services
rendered to the plan, including preparation of Schedules MB or SB,
as applicable.
Line 2i(8). Legal Fees. Include payments to a lawyer for
rendering legal opinions, litigation, and advice (but not for
providing legal services as a benefit to plan participants).
Line 2i(9). Valuation/appraisal Fees. Include the fee(s) for
valuations or appraisals to determine the cost, quality, or value of
an item such as real property, personal property (gemstones, coins,
etc.), and for valuations of closely held securities for which there
is no ready market.
Line 2i(10). Trustee Fees and Expenses. Include the total fees
and expenses paid to or on behalf of plan trustees (or in the case
of accrual basis plans, costs incurred during the plan year but not
paid as of the end of the plan year). Include direct payment by the
plan or reimbursement by the plan to trustees of expenses associated
with trustees such as lost time, seminars, travel, meetings,
educational conferences, etc. Do not include in Line 2i(10) amounts
paid to plan employees to perform bookkeeping/accounting functions
that should be included in Line 2i(5).
Line 2i(11). Other Expenses. Other expenses are those that
cannot be included in Lines 2-(1) through 2-(10). These may include
plan expenditures such as salaries and other compensation and
allowances, expenses for office supplies and equipment, cars,
telephone, postage, rent, expenses associated with the ownership of
a building used in the operation of the plan, and all miscellaneous
expenses. Include premium payments to the PBGC when paid from plan
assets.
Line 2i(12)(C). Total Administrative Expenses. Add all
administrative expense amounts in column (b) in lines 2i(1) through
(11) and enter total (b).
Line 2j. Total expenses. Add all expense amounts in column (b)
and enter total (b).
Line 2l. Include in these reconciliation figures the value of
all transfers of assets or liabilities into or out of the plan
resulting from, among other things, mergers and consolidations. A
transfer of assets or liabilities occurs when there is a reduction
of assets or liabilities with respect to one plan and the receipt of
these assets or the assumption of these liabilities by another plan.
A transfer is not a shifting of one plan's assets or liabilities
from one investment to another. A transfer is not a distribution of
all or part of an individual participant's account balance that is
reportable on IRS Form 1099-R, Distributions From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance
Contracts, etc. (See the instructions for Line 2f). Transfers out at
the end of the year should be reported as occurring during the plan
year.
Note. If this Schedule H is filed for a CCT, PSA, master trust,
or 103-12 IE, report the value of all asset transfers to the CCT,
PSA, master trust, or 103-12 IE, including those resulting from
contributions to participating plans on Line 2l(1), and report the
total value of all assets transferred out of the CCT, PSA, master
trust, or 103-12 IE, including assets withdrawn for disbursement as
benefit payments by participating plans, on Line 2l(2).
Contributions and benefit payments are considered to be made to/by
the plan (not to/by a CCT, PSA, master trust, or 103-12 IE).
Part III--Accountant's Opinion
Line 3. The administrator of an employee benefit plan who files
a Schedule H generally must engage an Independent Qualified Public
Accountant (IQPA) pursuant to ERISA section 103(a)(3)(A) and 29 CFR
2520.103-1(b). This requirement also applies to a Form 5500 Annual
Return/Report filed for a 103-12 IE and for a GIA (see 29 CFR
2520.103-12 and 29 CFR 2520.103-2). The IQPA's report must be
attached to the Form 5500 when a Schedule H is attached unless you
checked Schedule H, Line 3h(1), (2), or (3) or (4).
[CAUTION] If you checked Schedule H, Line 3h(3) to indicate that
the required IQPA's report is not attached to the Form 5500, the
filing is subject to rejection as incomplete and penalties may be
assessed.
Notes. (1) An IQPA Report generally consists of an Accountant's
Opinion, Financial Statements, Notes to the Financial Statements,
and Supplemental Schedules. 29 CFR 2520.103-1(b) requires that any
separate financial statements prepared in order for the IQPA to form
the opinion and notes to these financial statements must be attached
to the Form 5500. Any separate statements must include the
information required to be disclosed in Parts I and II of the
Schedule H; however, they may be aggregated into categories in a
manner other than that used on the Schedule H. The separate
statements must consist of reproductions of Parts I and II or
statements incorporating by reference Parts I and II. See ERISA
section 103(a)(3)(A), and the DOL regulations 29 CFR 2520.103-
1(a)(2) and (b), 2520.103-2, and 2520.104-50.
(2) Delinquent participant contributions reported on Line 4a
must be treated as part of the separate schedules referenced in
ERISA section 103(a)(3)(A) and 29 CFR 2520.103-1(b) and 2520.103-
2(b) for purposes of preparing the IQPA's opinion described on Line
3 even though they are not
[[Page 47626]]
required to be listed on Part III of the Schedule G. If the
information contained on Line 4a is not presented in accordance with
regulatory requirements, i.e., when the IQPA concludes that the
scheduled information required by Line 4a does not contain all the
required information or contains information that is inaccurate or
is inconsistent with the plan's financial statements, the IQPA
report must make the appropriate disclosures in accordance with
generally accepted auditing standards. Delinquent participant
contributions that are exempt because they satisfy the DOL Voluntary
Fiduciary Correction Program (VFCP) requirements and the conditions
of prohibited transaction exemption (PTE) 2002-51 do not need to be
treated as part of the schedule of nonexempt party-in-interest
transactions.
Lines 3a(1) through 3a(4). These boxes identify the type of
opinion offered by the IQPA.
Line 3a(1). Check if an unqualified opinion was issued.
Generally, an unqualified opinion is issued when the IQPA concludes
that the plan's financial statements present fairly, in all material
respects, the financial status of the plan as of the end of the
period audited and the changes in its financial status for the
period under audit in conformity with generally accepted accounting
principles (GAAP) or another comprehensive basis of accounting
(OCBOA), e.g., cash basis.
Line 3a(2). Check if a qualified opinion was issued. Generally,
a qualified opinion is issued by an IQPA when the plan's financial
statements present fairly, in all material respects, the financial
status of the plan as of the end of the audit period and the changes
in its financial status for the period under audit in conformity
with GAAP or OCBOA, except for the effects of one or more matters
described in the opinion.
Line 3a(3). Check if a disclaimer of opinion was issued. A
disclaimer of opinion is issued when the IQPA does not express an
opinion on the financial statements because he or she has not
performed an audit sufficient in scope to enable him or her to form
an opinion on the financial statements.
Line 3a(4). Check if the plan received an adverse accountant's
opinion. Generally, an adverse opinion is issued by an IQPA when the
plan's financial statements do not present fairly, in all material
respects, the financial status of the plan as of the end of the
audit period and the changes in its financial status for the period
under audit in conformity with GAAP or OCBOA.
Line 3b. Limited Scope Audit and Certification of Assets. Check
``Yes'' if a box is checked on Line 3a, and the only limitation on
the scope of the plan's audit was pursuant to DOL regulations 29 CFR
2520.103-8 and 2520.103-12(d) because the examination and report of
an IQPA did not extend to: (1) statements or information regarding
assets held by a bank, similar institution, or insurance carrier
that is regulated and supervised and subject to periodic examination
by a state or federal agency provided that the statements or
information are prepared by and certified to by the bank or similar
institution or an insurance carrier, or (2) information included
with the Form 5500 filed for a 103-12 IE. The term ``similar
institution'' as used here does not extend to securities brokerage
firms (see DOL Advisory Opinion 93-21A). See 29 CFR 2520.103-8 and
2520.103-12(d).
[CAUTION] Check ``No'' if the scope of the plan's audit was
limited for any reason in addition to that pursuant to DOL
regulations 29 CFR 2520.103-8 and 2520.103-12.
You must attach a copy of the certification(s) if the audit
opinion was limited in scope pursuant to DOL regulations 29 CFR
2520.103-8 and 2520.103-12(d) (regardless of whether you checked
``yes'' for Line 3b). Although you must attach a copy of the
certification(s), you do not need to include any attachments to the
certification itemizing the assets to which the certification(s)
apply.
Note. These regulations do not exempt the plan administrator
from engaging an IQPA or from attaching the IQPA's report to the
Form 5500. If you check Line 3b, you must also check the appropriate
box on Line 3a to identify the type of opinion offered by the IQPA.
Line 3c. Enter the name and EIN of the accountant (or accounting
firm) in the space provided on Line 3c. Do not use a social security
number or any portion thereof in lieu of an EIN. The Schedule H is
open to public inspection, and the contents are public information
and are subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number or any portion
thereof on this Schedule H may result in the rejection of the
filing. If the name of an accounting firm is entered in Line 3c(1),
enter the name of the audit engagement partner in Line 1c(3).
Line 3d. Enter the state in which the accountant's opinion was
issued.
Line 3e. Check ``Yes'' if you reviewed and discussed the IQPA
report with the accountant preparing the report?
Line 3f. If you answered ``Yes,'' to Line 3e, check all that
apply.
Line 3h(1). Check this box only if the Schedule H is being filed
for a CCT, PSA, or master trust.
Line 3h(2). Check this box if the plan has elected to defer
attaching the IQPA's opinion for the first of two (2) consecutive
plan years, one of which is a short plan year of seven (7) months or
fewer. The Form 5500 for the first of the two (2) years must be
complete and accurate, with all required attachments, except for the
IQPA's report, including an attachment explaining why one of the two
(2) plan years is of seven (7) or fewer months duration and stating
that the annual report for the immediately following plan year will
include a report of an IQPA with respect to the financial statements
and accompanying schedules for both of the two (2) plan years. The
Form 5500 for the second year must include: (a) financial schedules
and statements for both plan years; (2) a report of an IQPA with
respect to the financial schedules and statements for each of the
two (2) plan years (regardless of the number of participants covered
at the beginning of each plan year); and (3) a statement identifying
any material differences between the unaudited financial information
submitted with the first Form 5500 and the audited financial
information submitted with the second Form 5500. See 29 CFR
2520.104-50.
Note. Do not check the box on Line 3h(2) if the Form 5500 is
filed for a 103-12 IE or a GIA. A deferral of the IQPA's opinion is
not permitted for a 103-12 IE or a GIA. If the box for 103-12 IE or
GIA is checked on Form 5500, Part I, Line A(5), an IQPA's opinion
must be attached to the Form 5500 and the type of opinion must be
reported on Schedule H, Line 3a.
Line 3h(4). Small Plan Audit Waiver. Check ``Yes'' if you are a
small plan claiming a waiver of the annual examination and report of
an independent qualified public accountant (IQPA) under 29 CFR
2520.104-46. Large plans are not eligible for the audit waiver under
29 CFR 2520.104-46. You are eligible to claim the waiver if this
filing is for:
1. A small welfare plan, or
2. A small pension plan for a plan year that began on or after
April 18, 2001, that complies with the conditions of 29 CFR
2520.104-46 summarized below.
Note. For plans that check ``No,'' the IQPA report must make the
appropriate disclosures in accordance with generally accepted
auditing standards if the information reported on Line 4a is not
presented in accordance with regulatory requirements.
The following summarizes the conditions of 29 CFR 2520.104-46
that must be met for a small pension plan with a plan year beginning
on or after April 18, 2001, to be eligible for the waiver. For more
information regarding these requirements, see the EBSA's Frequently
Asked Questions on the Small Pension Plan Audit Waiver Regulation
and 29 CFR 2520.104-46, which are available at www.dol.gov/ebsa, or
call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278) (toll-
free).
Condition 1: At least 95 percent of plan assets are ``qualifying
plan assets'' as of the end of the preceding plan year, or any
person who handles assets of the plan that do not constitute
qualifying plan assets is bonded in accordance with the requirements
of ERISA section 412 (see the instructions for Line 4e), except that
the amount of the bond shall not be less than the value of such non-
qualifying assets. The determination of the ``percent of plan
assets'' as of the end of the preceding plan year and the amount of
any required bond must be made at the beginning of the plan's
reporting year for which the waiver is being claimed. For purposes
of this line, you will have satisfied the requirement to make these
determinations at the beginning of the plan reporting year for which
the waiver is being claimed if they are made as soon after the date
when such year begins as the necessary information from the
preceding reporting year can practically be ascertained. See 29 CFR
2580.412-11, 14 and 19 for additional guidance on these
determinations, and 29 CFR 2580.412-15 for procedures to be used for
estimating these amounts if there is no preceding plan year.
The term ``qualifying plan assets,'' for purposes of this line
means:
1. Any assets held by any of the following regulated financial
institutions:
a. A bank or similar financial institution as defined in 29 CFR
2550.408b-4(c);
[[Page 47627]]
b. An insurance company qualified to do business under the laws
of a state;
c. An organization registered as a broker-dealer under the
Securities Exchange Act of 1934; or
d. Any other organization authorized to act as a trustee for
individual retirement accounts under Code section 408.
2. Shares issued by an investment company registered under the
Investment Company Act of 1940 (e.g., mutual funds);
3. Investment and annuity contracts issued by any insurance
company qualified to do business under the laws of a state;
4. In the case of an individual account plan, any assets in the
individual account of a participant or beneficiary over which the
participant or beneficiary has the opportunity to exercise control
and with respect to which the participant or beneficiary is
furnished, at least annually, a statement from a regulated financial
institution referred to above describing the assets held or issued
by the institution and the amount of such assets;
5. Qualifying employer securities, as defined in ERISA section
407(d)(5); and
6. Participant loans meeting the requirements of ERISA section
408(b)(1).
Condition 2: The administrator must disclose the following
information in the summary annual report (SAR) furnished to
participants and beneficiaries, in accordance with 29 CFR 2520.104b-
10. For defined benefit pension plans that are required pursuant to
section 101(f) of ERISA to furnish an Annual Funding Notice (AFN),
the administrator must instead either provide the information to
participants and beneficiaries with the AFN or as a stand-alone
notification at the time a SAR would have been due and in accordance
with the rules for furnishing an SAR, although such plans do not
have to furnish a SAR.
1. The name of each regulated financial institution holding or
issuing qualifying plan assets and the amount of such assets
reported by the institution as of the end of the plan year (this SAR
disclosure requirement does not apply to qualifying employer
securities, participant loans and individual account assets
described in paragraphs 4,5 and 6 above);
2. The name of the surety company issuing the fidelity bond, if
the plan has more than 5% of its assets in non-qualifying plan
assets;
3. A notice that participants and beneficiaries may, upon
request and without charge, examine or receive from the plan
evidence of the required bond and copies of statements from the
regulated financial institutions describing the qualifying plan
assets; and
4. A notice that participants and beneficiaries should contact
the EBSA Regional Office if they are unable to examine or obtain
copies of the regulated financial institution statements or evidence
of the required bond, if applicable.
A Model Notice that plans can use to satisfy the enhanced SAR
(or Annual Funding Notice) disclosure requirements to be eligible
for the audit waiver is available as an Appendix to 29 CFR 2520.104-
46.
Condition 3: In addition, in response to a request from any
participant or beneficiary, the administrator, without charge to the
participant or beneficiary, must make available for examination, or
upon request furnish copies of, each regulated financial institution
statement and evidence of any required bond.
Examples. Plan A, which has a plan year that began on or after
April 18, 2001, had total assets of $600,000 as of the end of the
20XX-1 plan year that included: investments in various bank,
insurance company and mutual fund products of $520,000; investments
in qualifying employer securities of $40,000; participant loans
(meeting the requirements of ERISA section 408(b)(1)), totaling
$20,000; and a $20,000 investment in a real estate limited
partnership. Because the only asset of the plan that did not
constitute a ``qualifying plan asset'' is the $20,000 real estate
limited partnership investment and that investment represents less
than 5% of the plan's total assets, no fidelity bond is required as
a condition for the plan to be eligible for the waiver for the 20XX
plan year.
Plan B is identical to Plan A except that of Plan B's total
assets of $600,000 as of the end of the 20XX-1 plan year, $558,000
constitutes ``qualifying plan assets'' and $42,000 constitutes non-
qualifying plan assets. Because 7%--more than 5%--of Plan B's assets
do not constitute ``qualifying plan assets,'' Plan B, as a condition
to be eligible for the waiver for the 20XX plan year, must ensure
that it has a fidelity bond in an amount equal to at least $42,000
covering persons handling its non-qualifying plan assets. Inasmuch
as compliance with ERISA section 412 generally requires the amount
of the bond be not less than 10% of the amount of all the plan's
funds or other property handled, the bond acquired for ERISA section
412 purposes may be adequate to cover the non-qualifying plan assets
without an increase (i.e., if the amount of the bond determined to
be needed for the relevant persons for ERISA section 412 purposes is
at least $42,000). As demonstrated by the foregoing example, where a
plan has more than 5% of its assets in non-qualifying plan assets,
the required bond is for the total amount of the non-qualifying plan
assets, not just the amount in excess of 5%.
If you need further information regarding these requirements,
see 29 CFR 2520.104-46 which is available at www.dol.gov/ebsa or
call the EFAST2 Help Line at 1-866-GO EFAST (1-866-463-3278) (toll-
free).
Part IV--Compliance Questions
Lines 4a through 4z. Plans completing Schedule H must answer all
these lines with either ``Yes'' or ``No.'' Do not leave any answer
blank, unless otherwise directed. For Lines 4a through 4h and Line
4l, if the answer is ``Yes,'' an amount must be entered.
Report investments in CCTs, PSAs, master trusts, and 103-12 IEs,
but not the investments made by these entities. Plans with all of
their funds held in a master trust should check ``No'' on Line 4b
and 4c. CCTs and PSAs complete only Line 4i(1). Master trusts and
103-12 IEs complete only Lines 4b, 4c, 4d, 4i(1) and (2), 4j, and
4s. GIAs complete only Lines 4b, 4c, 4d, 4i(1) and (2), 4j, and 4k.
Except as otherwise provided, all plans and DFEs that have not
checked on Form 5500 that this is the ``final'' return/report and
have indicated that they have no assets (``-0-'') must check ``Yes''
on Line 4i(1) and complete the Line 4i(1) Schedule of Assets Held
for Investment at End of Year. Where applicable, they must also
check ``Yes'' on Line 4i(2) and complete the Line 4i(2) Schedule of
Assets Disposed of During the Plan Year.
Small welfare plans that are required to complete the Schedule
H, do not have to complete the attachments to Line 4(a), Line 4i(1)
and (2), and Line 4j, even if the answer to any of those questions
is ``Yes.''
Line 4a. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the plan
are participant contributions that become plan assets as of the
earliest date on which such contributions can reasonably be
segregated from the employer's general assets (see 29 CFR 2510.3-
102). Plans that check ``Yes'' must enter the aggregate amount of
all late contributions for the year. The total amount of the
delinquent contributions should be included on Line 4a of the
Schedule H for the year in which the contributions were delinquent
and should be carried over and reported again on Line 4a of the
Schedule H, for each subsequent year until the year after the
violation has been fully corrected, which correction includes
payment of the late contributions and reimbursement of the plan for
lost earnings or profits. If no participant contributions were
received or withheld by the employer during the plan year, answer
``No.''
An employer holding these assets after that date commingled with
its general assets will have engaged in a prohibited use of plan
assets (see ERISA section 406). If such a nonexempt prohibited
transaction occurred with respect to a disqualified person (see Code
section 4975(e)(2)), file IRS Form 5330, Return of Excise Taxes
Related to Employee Benefit Plans, with the IRS to pay any
applicable excise tax on the transaction.
Participant loan repayments paid to and/or withheld by an
employer for purposes of transmittal to the plan that were not
transmitted to the plan in a timely fashion must be reported either
on Line 4a in accordance with the reporting requirements that apply
to delinquent participant contributions or on Line 4d. See Advisory
Opinion 2002-02A, available at www.dol.gov/ebsa.
[CAUTION] Delinquent participant contributions reported on Line
4a should be treated as part of the separate schedules referenced in
ERISA section 103(a)(3)(A) and 29 CFR 2520.103-1(b) and 2520.103-
2(b) for purposes of preparing the IQPA's opinion described on Line
3 even though they are not required to be listed on Part III of the
Schedule G. If the information contained on Line 4a is not presented
in accordance with regulatory requirements, i.e., when the IQPA
concludes that the scheduled information required by Line 4a does
not contain all the required information or contains information
that is inaccurate or is inconsistent with the plan's financial
statements, the IQPA report must make the appropriate disclosures in
accordance with generally accepted auditing standards. For more
information, see EBSA's Frequently Asked Questions About Reporting
[[Page 47628]]
Delinquent Contributions on the Form 5500, available on the Internet
at www.dol.gov/ebsa. These Frequently Asked Questions clarify that
plans have an obligation to include delinquent participant
contributions on their financial statements and supplemental
schedules and that the IQPA's report covers such delinquent
contributions even though they are not required to be included on
Part III of the Schedule G. Although all delinquent participant
contributions must be reported on Line 4a, delinquent contributions
for which the DOL VFCP requirements and the conditions of PTE 2002-
51 have been satisfied do not need to be treated as nonexempt party-
in-interest transactions.
[TIP] The VFCP describes how to apply, the specific transactions
covered (which transactions include delinquent participant
contributions to pension and welfare plans), and acceptable methods
for correcting violations. In addition, applicants that satisfy both
the VFCP requirements and the conditions of PTE 2002-51 are eligible
for immediate relief from payment of certain prohibited transaction
excise taxes for certain corrected transactions, and are also
relieved from the obligation to file the IRS Form 5330 with the IRS.
For more information, see 71 FR 20261 (Apr. 19, 2006) and 71 FR
20135 (Apr. 19, 2006). Information about the VFCP is also available
on the Internet at www.dol.gov/ebsa.
All participant contributions that were delinquent during the
plan year must be reported on Line 4a even if violations have been
corrected.
Line 4a Schedule of Delinquent Participant Contributions.
Complete the ``Line 4a Schedule of Delinquent Participant
Contributions'' if you entered ``Yes.''
Element (a). Enter the total amount of delinquent contributions
from this and previous years that were remitted during the plan
year. Include contributions due in previous years that were remitted
during this plan year. If you include participant loan repayments on
Line 4a, you must apply the same supplemental schedule and IQPA
disclosure requirements to the loan repayments as applied to
delinquent transmittals of participant contributions. If you include
participant loan repayments, check the box in element (g).
Element (b). Enter the total amount of delinquent contributions
due, but unremitted during the plan year. You must carry these over
and report them for each subsequent year until they are fully
correct. Include contributions due in previous plan years, but still
unremitted.
Element (c). Enter the number of payrolls for which the
contributions were delinquent and uncorrected.
Element (d). Enter in element d(1) the total amount of
delinquent contributions that were corrected under VFCP. See 71 FR
20261 (Apr. 19, 2006). Information about the VFCP is also available
on the Internet at www.dol.gov/ebsa. Enter in element d(2) any
amount that were corrected under the VFCP, but not under PTE 2002-
51. See 71 FR 20135 (Apr. 19, 2006). For all amount reported in
element (d), complete element (h) to indicate whether you filed Form
5330 with the IRS and paid any applicable excise taxes.
Element (e). Enter the amount of delinquent contributions
pending correction in VFCP as of the date of the Form 5500 Annual
Return/Report filing.
Element (f). Enter the total amount of delinquent contributions
for which the contributions were paid and the plan reimbursed fully
for lost earnings or profits outside of the VFCP. See the VFCP for
more information on how to fully correct delinquent participant
contributions.
Element (g). Check the box in element (g) if you included
delinquent participant loan repayments on Line 4a and in element
(a).
Element (h). Check ``Yes'' for any amount reported in element
(h) if you filed your Form 5330 with the IRS and paid all applicable
excise taxes associated with the delinquent contributions and/or
delinquent participant loan repayments. For more information on Form
5330, see https://www.irs.gov/Retirement-Plans/Form-5330-Corner.
Element (i). Only multiemployer plans complete this item. In
element (i)(1), enter the amount of participant contributions from
participating employers in the multiemployer plan that has been
determined during the plan year to be uncollectible (including
contributions due in previous plan years but still unremitted). In
element (i)(2), explain what steps were taken to collect overdue
amounts (including whether claims were submitted on performance
bonds) before determining the amount that is uncollectible.
Line 4b. Plans that check ``Yes'' must enter the amount and
complete Part I of Schedule G. The due date, payment amount and
conditions for determining default of a note or loan are usually
contained in the documents establishing the note or loan. A loan by
the plan is in default when the borrower is unable to pay the
obligation upon maturity. Obligations that require periodic
repayment can default at any time. Generally, loans and fixed income
obligations are considered uncollectible when payment has not been
made and there is little probability that payment will be made. A
fixed income obligation has a fixed maturity date at a specified
interest rate. Do not include participant loans made under an
individual account plan with investment experience segregated for
each account that were made in accordance with 29 CFR 2550.408b-1
and secured solely by a portion of the participant's vested accrued
benefit. Small plans that were eligible for and claimed the small
plan audit waiver do not need to attach Schedule G.
Line 4c. Plans that check ``Yes'' must enter the amount and
complete Part II of Schedule G. A lease is an agreement conveying
the right to use property, plant, or equipment for a stated period.
A lease is in default when the required payment(s) has not been
made. An uncollectible lease is one where the required payments have
not been made and for which there is little probability that payment
will be made. Small plans that were eligible for and claimed the
small plan audit waiver do not need to attach Schedule G.
Line 4d. Plans that check ``Yes'' must enter the amount and
complete Part III of Schedule G. Small plans that were eligible for
and claimed the small plan audit waiver do not need to attach
Schedule G. Check ``Yes'' if any nonexempt transaction with a party-
in-interest occurred regardless of whether the transaction is
disclosed in the IQPA's report. Do not check ``Yes'' or complete
Schedule G, Part III, with respect to transactions that are:
(1) Statutorily exempt under Part 4 of Title I of ERISA;
(2) Administratively exempt under ERISA section 408(a);
(3) Exempt under Code sections 4975(c) or 4975(d);
(4) The holding of participant contributions in the employer's
general assets for a welfare plan that meets the conditions of ERISA
Technical Release 92-01;
(5) A transaction of a 103-12 IE with parties other than the
plan; or
(6) Delinquent participant contributions or delinquent
participant loan repayments reported on Line 4a.
Note. See the instructions for Part III of the Schedule G (Form
5500) concerning nonexempt transactions and party-in-interest.
You may indicate that an application for an administrative
exemption is pending. If you are unsure as to whether a transaction
is exempt or not, you should consult with either the plan's IQPA or
legal counsel or both.
[TIP] Applicants that satisfy the VFCP requirements and the
conditions of PTE 2002-51 (see the instructions for Line 4a) are
eligible for immediate relief from payment of certain prohibited
transaction excise taxes for certain corrected transactions, and are
also relieved from the obligation to file the IRS Form 5330 with the
IRS. For more information, see 71 FR 20261 (Apr. 19, 2006) and 71 FR
20135 (Apr. 19, 2006). When the conditions of PTE 2002-51 have been
satisfied, the corrected transactions should be treated as exempt
under Code section 4975(c) for the purposes of answering Line 4d.
Line 4e. Plans that check ``Yes'' must enter the aggregate
amount of fidelity bond coverage for all claims. Check ``Yes'' only
if the plan itself (as opposed to the plan sponsor or administrator)
is a named insured under a fidelity bond from an approved surety
covering plan officials and that protects the plan from losses due
to fraud or dishonesty as described in 29 CFR part 2580. Generally,
every plan official of an employee benefit plan who ``handles''
funds or other property of such plan must be bonded. Generally, a
person shall be deemed to be ``handling'' funds or other property of
a plan, so as to require bonding, whenever his or her duties or
activities with respect to given funds are such that there is a risk
that such funds could be lost in the event of fraud or dishonesty on
the part of such person, acting either alone or in collusion with
others. Section 412 of ERISA and 29 CFR part 2580 describe the
bonding requirements, including the definition of ``handling'' (29
CFR 2580.412-6), the permissible forms of bonds (29 CFR 2580.412-
10), the amount of the bond (29 CFR part 2580, subpart C), and
certain exemptions such as the exemption for unfunded plans, certain
banks and insurance companies (ERISA section 412), and the exemption
allowing plan officials to purchase bonds from surety companies
[[Page 47629]]
authorized by the Secretary of the Treasury as acceptable reinsurers
on federal bonds (29 CFR 2580.412-23).
Information concerning the list of approved sureties and
reinsures is available on the Internet at www.fms.treas.gov/c570.
For more information on the fidelity bonding requirements, see Field
Assistance Bulletin 2008-04, available on the Internet at
www.dol.gov/ebsa.
Note. Plans are permitted under certain conditions to purchase
fiduciary liability insurance. These fiduciary liability insurance
policies are not written specifically to protect the plan from
losses due to dishonest acts and cannot be reported as fidelity
bonds on Line 4e.
Line 4f. Check ``Yes,'' if the plan suffered or discovered any
loss as a result of any dishonest or fraudulent act(s) even if the
loss was reimbursed by the plan's fidelity bond or from any other
source. If the plan suffered such a loss, enter the full amount of
the loss. If the full amount of the loss has not yet been
determined, provide an estimate and disclose that the figure is an
estimate as determined in good faith by a plan fiduciary. You must
keep, in accordance with ERISA section 107, records showing how the
estimate was determined.
CAUTION: Willful failure to report is a criminal offense. See
ERISA section 501.
Line 4g. Check ``Yes'' if the plan had assets of which the
current value was neither readily determinable on an established
market nor set by an independent third party appraiser. Enter in the
amount column the fair market value of the assets referred to on
Line 4g whose value was not readily determinable on an established
market and which were not valued by an independent third-party
appraiser in the plan year. Generally, as it relates to these
questions, an appraisal by an independent third party is an
evaluation of the value of an asset prepared by an individual or
firm who knows how to judge the value of such assets and does not
have an ongoing relationship with the plan or plan fiduciaries
except for preparing the appraisals.
TIP: Do not check ``Yes'' on Line 4g for mutual fund shares or
insurance company investment contracts for which the plan receives
valuation information at least annually. Also, do not check ``Yes''
on Line 4g if the plan is a defined contribution pension plan and
the only assets the plan holds, that do not have a readily
determinable value on an established market, are: (1) participant
loans not in default, or (2) assets over which the participant
exercises control within the meaning of section 404(c) of ERISA.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith under
the terms of the plan by a trustee or a named fiduciary, assuming an
orderly liquidation at the time of the determination. See ERISA
section 3(26). An accurate assessment of fair market value is
essential to a pension plan's ability to comply with the
requirements set forth in the Code (e.g., the exclusive benefit rule
of Code section 401(a)(2), the limitations on benefits and
contributions under Code section 415, and the minimum funding
requirements under Code section 412) and must be determined
annually.
Examples of assets that may not have a readily determinable
value on an established market (e.g., NYSE, AMEX, over the counter,
etc.) include real estate, nonpublicly traded securities, shares in
a limited partnership, derivatives, notes and stock not traded on an
exchange, private equity, and collectibles.
Although the current value of plan assets must be determined
each year, there is no requirement that the assets (other than
certain nonpublicly traded employer securities held in ESOPs) be
valued every year by independent third-party appraisers.
Line 4h. Check ``Yes'' if the plan received during the plan year
noncash contributions of which the current value was neither readily
determinable on an established market nor set by an independent
third party appraiser. Enter in the amount column the fair market
value of the assets referred to on Line 4g whose value was not
readily determinable on an established market and which were not
valued by an independent third-party appraiser in the plan year. See
instructions for Line 4g.
Line 4i. Schedules of Assets. Check ``Yes'' in elements (1) and/
or (2) and complete, as appropriate, the ``Line 4i(1) Schedule of
Assets Held for Investment at End of Year'' and the ``Line 4i(2)
Schedule of Assets Disposed of During the Plan Year.'' You may not
create your own schedules of assets in the form of an attachment or
otherwise. You must complete the schedule through IFile or using
EFAST-approved third-party software. If the plan both disposed of
assets during the plan year and held assets for investment at end of
year, you must complete both the Line 4i(1) and 4i(2) schedules.
Generally, all plans that are ongoing must answer ``Yes'' to Line
4i(1) and complete the ``Line 4i(1) Schedule of Assets Held for
Investment at End of Year.''
Notes: (1) Participant loans under an individual account plan
with investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and that are secured
solely by a portion of the participant's vested accrued benefit, may
be aggregated for reporting purposes in Line 4i. Under identity of
borrower enter ``Participant loans,'' under rate of interest enter
the lowest rate and the highest rate charged during the plan year
(e.g., 8%-10%), under the cost and proceeds columns enter zero, and
under current value enter the total amount of these loans. (2)
Column (d) cost information for the Line 4i(1) Schedule of Assets
Held for Investment at End of Year and the column (c) cost of
acquisitions information for the Line 4i(2) Schedule of Assets
Disposed of During the Plan Year may be omitted when reporting
investments of an individual account plan that a participant or
beneficiary directed with respect to assets allocated to his or her
account (including a negative election authorized under the terms of
the plan). Likewise, cost information for investments in Code
sections 403(b)(1) annuity contracts and 403(b)(7) custodial
accounts may also be omitted. (3) Investments in Code section
403(b)(1) annuity contracts and Code section 403(b)(7) custodial
accounts generally may also be treated as one asset held for
investment for purposes on the Line 4i schedules. For 403(b)(7)
accounts, show the corresponding Line 1b(5)(A) categories to show
the types of investment accounts.
Line 4i(1). Schedule of Assets Held for Investment at End of
Year. Assets held for investment purposes for purposes of the Line
4i(1) Schedule of Assets Held for Investment at End of Year includes
all investment assets held by the plan on the last day of the plan
year other than cash and cash equivalents reported on Line 1b(1) and
(2) that are held at end of year. You must complete the Schedule of
Assets Held for Investment at End of Year if you answered ``Yes'' to
Line 4(i)(1).
Line 4i(1) Schedule of Assets Held for Investment at End of Year
(Complete as many entries in each element as needed to identify all
assets held for investment at end of year)
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
(a) Assets Held directly by the plan (including assets held through an participant-directed brokerage window) For each asset which the plan holds for
investment purposes that is not a type of assets required to be listed in (b) through (e) below, complete elements (i)-(vii).
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(i) Check if issuer, borrower, (ii) Name of (iii) Check if (iv) CUSIP, CIK, (v) Cost (vi) Indicate (vii) Description of
lessor or similar party is issuer, borrower, asset is hard-to- LEI, NAIC Sch. H, Line 1b investment,
party-in- interest [ballot] lessor, or value asset Company Code, asset category including, as
similar party other applicable share
registration class, maturity date,
number: rate of interest, par
or maturity value,
including whether
asset/investment is
subject to surrender
charge. See
instructions for
reporting assets held
through a participant-
directed brokerage
account.
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[[Page 47630]]
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(b) Investments in Master Trust (repeat as many entries as needed to identify holdings in master trusts) For each master trust in which the plan
invested, break out plan's proportionate interest in each asset in the master trust(s) in elements (i)-(viii). Do not include master trust holdings in
which the plan has no interest.
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(i) Enter name, EIN/PN of sponsor of master trust used on master trust's Form 5500......................................................................
--------------------------------------------------------------------------------------------------------------------------------------------------------
(ii) Check if issuer, borrower, (iii) Name of (iv) Check if (v) Enter all (vi) Cost (vii) Indicate (viii) Description of
lessor or similar party is issuer, borrower, asset is hard-to- that apply: EIN, Sch. H, Line 1b investment,
party-in- interest [ballot] lessor, or value asset CUSIP, CIK, LEI, asset category including, as
similar party [ballot] NAIC Company applicable share
(See Code, other class, maturity date,
instructions) registration rate of interest, par
number: or maturity value,
including whether
asset/investment is
subject to surrender
charge.
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
(c) Investments in PSAs and CCTs (repeat as many entries as needed to identify holdings in PSAs and CCTs) If the PSA filed a Form 5500, complete
elements (i)-(vii) indicating the value of the plan's shares in the PSA or CCT. For PSAs or CCTs that have not filed a Form 5500, break out plan's
proportionate interest in each asset in the PSA of CCT in elements (i)-(ix) and include the name and identifying numbers for the non-filing CCT or PSA,
as well a description of the asset held through the non-filing CCT or PSA.
--------------------------------------------------------------------------------------------------------------------------------------------------------
(i) Enter name, EIN/PN of sponsor of CCT/PSA............................................................................................................
--------------------------------------------------------------------------------------------------------------------------------------------------------
(ii) Check if issuer, (iii) Check here (iv) Name of (v) Check if (vi) Enter all (vii) Cost (viii) Indicate (ix)
borrower, lessor or similar if PSA or CCT issuer, asset is hard- that apply: Sch. H, Line Description of
party is party-in- interest filed a Form borrower, to-value asset EIN, CUSIP, 1b asset investment,
[ballot] 5500 [ballot] lessor, or [ballot] CIK, LEI, NAIC category including, as
similar party Company Code: applicable
(see Other share class,
Instructions). registration maturity date,
number: rate of
interest, par
or maturity
value, and
whether asset/
investment is
subject to
surrender
charge.
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
(d) Investments in 102-12 Investment Entities (repeat as many entries as needed to identify holdings in 103-12 IEs)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(i) Enter name, EIN of provider of the 103-12 IE........................................................................................................
--------------------------------------------------------------------------------------------------------------------------------------------------------
(ii) Check if issuer, borrower, (iii) Name of (iv) Check if (v) Enter all that (vi) Cost (vii) Indicate (viii) Description
lessor or similar party is issuer, borrower, asset is hard-to- apply: EIN, Line 1b asset of investment,
party-in- interest [ballot] lessor, or value asset CUSIP, CIK, LEI, category including, as
similar party [ballot] NAIC Company applicable share
(See Code: Other class, maturity
instructions) registration date, rate of
number: interest, par or
maturity value,
including whether
asset/investment
is subject to
surrender charge.
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Element (a). Assets Held Directly By the Plan. Investments held
by the plan are all assets held by the plan except interests in
master trusts; interests in pooled separate accounts (PSAs) and
common collective trusts (CCTs), regardless of whether the PSA or
CCT files a Form 5500; and interests in 103-12 Investment Entities
(103-12 IEs). For each asset held directly by the plan, complete
elements (i)-(vii).
Participant-directed brokerage account assets reported in the
aggregate on Line 1b(14) generally may be treated as one asset held
for investment for purposes here, except investments in tangible
personal property, loans, partnership or joint venture interests,
real property, employer securities, and investments that could
result in a loss in excess of the account balance of the participant
or beneficiary who directed the transaction must be reported as
separate aggregations of assets on Line 4i(1)(a), with an indication
of which of the Line 1b(14) breakouts that the asset was reported as
being held through a participant-directed brokerage account.
Element a(ii). Check the box in element a(i) if the issuer of
the investment is a person known to be a party-in-interest to the
plan. This includes when the seller, issuer, lender, or similar
party is the employer, employee organization, a service provider to
the plan, or other party interest, including a subcontractor or
affiliate.
Element a(iii). Enter the name of the seller, issuer, lender, or
similar party. If the person is a plan sponsor, service provider, or
direct filing entity also identified on the Form 5500, Schedule C or
any other of the Schedule H Line 4 schedules, or is a DFE that files
its own Form 5500, use the same name in all places.
Element a(iv). Check here if the asset is a ``hard-to-value''
asset. Assets that are not listed on any national exchanges or over-
the-counter markets, or for which quoted market prices are not
available from sources such as financial publications, the
exchanges, or the National Association of Securities Dealers
Automated Quotations System (NASDAQ), are required to be identified
as hard-to-value assets on the Schedule of Assets Held for
Investment at End of Year. Bank collective investment funds or
insurance company
[[Page 47631]]
pooled separate accounts that are primarily invested in assets that
are listed on national exchanges or over-the-counter markets and are
valued at least annually need not be identified as hard-to-value
assets. CCTs or PSAs invested primarily in hard-to-value assets must
also be identified as a hard-to-value asset. A non-exhaustive list
of examples of assets that would be required to be identified as
hard-to-value on the proposed schedules of assets is: non-publicly
traded securities, real estate, private equity funds; hedge funds;
and real estate investment trusts (REITs).
Element a(v). If the person is a plan sponsor, service provider,
or direct filing entity also identified on the Form 5500, Schedule
C, or Schedule D, or any other of the Schedule H Line 4 schedules,
or is a DFE that files its own Form 5500, use the same
identification numbers in all places. If the person identified in
element (c), has a CUSIP, CIK number, LEI, NAIC Company Code, or
other government or market exchange registration or identity number,
you must include all that apply here.
Element a(vi). Enter the acquisition cost of the asset.
Element a(vii). Enter in element a(vii) in which category the
asset was part of the total on Line 1b.
Element a(viii). Enter a description of the investment,
including, as applicable maturity date, rate of interest, par, or
maturity value, including whether asset/investment is subject to
surrender charge. Include any restriction on transferability of
corporate securities. (Include lending of securities permitted under
Prohibited Transactions Exemption 81-6.)
Element (b)--Investments in Master Trusts. For each master trust
in which the plan invested, complete elements (b)(ii)-(vi) for each
asset in which the plan had an interest. Do not include assets held
by the master trust in which the plan does not hold an interest.
Example. A master trust in which Plan A, Plan B, and Plan C
invest, has various assets, including a parcel of real estate. Only
Plan A and Plan B are invested in the parcel of real estate. The
remaining assets of the master trust are held proportionately by all
three plans. Plans A and B should report information on their
holding in all of the assets of the plan, including the parcel of
real estate. Plan C should report only its proportionate interest in
the assets other than the parcel of real estate.
Element (c)--Investments in PSAs and CCTs. For all investments
in PSAs and CCTs, enter the name, EIN/PN of the sponsor of the PSA
or CCT, regardless of whether the PSA or CCT filed a Form 5500 in
element (c)(i).
Check the box in element (c)(iii) to indicate whether the CCT or
PSA filed a Form 5500. If the CCT or PSA did not file a Form 5500,
leave element (c)(iii) blank.
If the CCT or PSA filed a Form 5500, make sure to report in
element (c)(i) the same name, EIN/PN as reported on the CCT or PSA's
Form 5500. If the CCT or PSA filed a Form 5500, enter ``same name''
in element (c)(iv).
If the CCT or PSA did not file a Form 5500, you must provide the
name of the issuer, borrower, lessor, or similar party of each
individual asset in the CCT or PSA in element c(iv). Complete as
many entries in elements (c)(ii)-(ix) as needed to identify the
assets held by each CCT or PSA that did not file a Form 5500.
For an investment in a CCT or PSA that filed a Form 5500, check
the box in element c(v) to indicate if the CCT or PSA is primarily
invested in hard-to-value assets.
Element (d). Investments in 103-12 Investment Entities. Complete
as many entries as need to identify holdings in 103-12 IEs. Do not
report in element (d) investments in any entities other than in an
entity that filed a Form 5500 for itself as a 103-12 IE.
Line 4i(2) Assets Disposed of During Plan Year.
You must identify on the Line 4i(2) Schedule each investment
asset sold during the plan year except:
1. Debt obligations of the U.S. or any U.S. agency.
2. Interests issued by a company registered under the Investment
Company Act of 1940 (e.g., a mutual fund).
3. Bank certificates of deposit with a maturity of one year or
less.
4. Commercial paper with a maturity of 9 months or less if it is
valued in the highest rating category by at least two nationally
recognized statistical rating services and is issued by a company
required to file reports with the Securities and Exchange Commission
under section 13 of the Securities Exchange Act of 1934.
5. Participations in a bank common or collective trust.
6. Participations in an insurance company pooled separate
account.
7. Securities purchased from a broker-dealer registered under
the Securities Exchange Act of 1934 and either: (1) listed on a
national securities exchange and registered under section 6 of the
Securities Exchange Act of 1934 or (2) quoted on NASDAQ.
Assets disposed of during the plan year shall not include any
investment that was not held by the plan on the last day of the plan
year if that investment is reported in the annual report for that
plan year in any of the following:
1. The schedule of loans or fixed income obligations in default
required by Schedule G, Part I;
2. The schedule of leases in default or classified as
uncollectible required by Schedule G, Part II;
3. The schedule of nonexempt transactions required by Schedule
G, Part III; or
4. The schedule of reportable transactions required by Schedule
H, Line 4j.
Line 4i(2). Schedule of Assets Disposed of During the Plan Year.
You must complete the ``Schedule of Assets Disposed of During the
Plan Year'' if you answered ``Yes'' to Line 4(i)(2).
Element (a). Enter the name of the seller, issuer, lender, or
similar party. If the person is a plan sponsor, service provider, or
direct filing entity also identified on the Form 5500, Schedule C,
or Schedule D, or any other of the Schedule H Line 4 schedules, use
the same name in all places. If the asset was held through a master
trust, 103-12 IE, CCT, or PSA provide the name, EIN and PN of the
entity. For DFEs use the same identifying information used on the
entity's own Form 5500. For CCTs and PSAs, check the appropriate box
to indicate whether or not the CCT or PSA filed a Form 5500.
Element (b). Indicate in element (b) whether the seller, issuer,
lender, or similar party is the employer, employee organization, or
other party interest, including a subcontractor or affiliate.
Element (c). Check if the asset was acquired during the plan
year.
Element (d). In element (e) enter the employer identification
number (EIN) of issuer, borrower, lessor, similar party. If the
person is a plan sponsor, service provider, or direct filing entity
also identified on the Form 5500, Schedule C, or Schedule D, or any
other of the Schedule H, Line 4 schedules, use the same name in all
places.
Element (e). Enter in element (c) in which category the asset
was part of the total on Line 1(b).
Element (a).
Element (f). Enter the acquisition cost here.
Element (g). Enter the sale price.
Element (h). Enter the total expenses incurred with disposal of
asset, including any termination or surrender charges.
Element (i). Enter the net gain (loss) on the asset.
Element (j). Enter a description of the investment, including
maturity date, rate of interest, collateral, par, or maturity value.
Line 4j. Check ``Yes'' and attach to the Form 5500 the following
schedule if the plan had any reportable transactions (see 29 CFR
2520.103-6 and the examples provided in the regulation). You may not
create your own schedules of assets, but must complete the schedules
through IFile or using EFAST-approved third-party software.
A reportable transaction includes:
1. A single transaction within the plan year in excess of 5% of
the current value of the plan assets;
2. Any series of transactions with or in conjunction with the
same person, involving property other than securities, which amount
in the aggregate within the plan year (regardless of the category of
asset and the gain or loss on any transaction) to more than 5% of
the current value of plan assets;
3. Any transaction within the plan year involving securities of
the same issue if within the plan year any series of transactions
with respect to such securities amount in the aggregate to more than
5% of the current value of the plan assets; and
4. Any transaction within the plan year with respect to
securities with, or in conjunction with, a person if any prior or
subsequent single transaction within the plan year with such person,
with respect to securities, exceeds 5% of the current value of plan
assets.
The 5% figure is determined by comparing the current value of
the transaction at the transaction date with the current value of
the plan assets at the beginning of the plan year. If this is the
initial plan year, you may use the current value of the plan assets
at the end of the plan year to determine the 5% figure.
If the assets of two or more plans are maintained in one trust,
except as provided
[[Page 47632]]
below, the plan's allocable portion of the transactions of the trust
shall be combined with the other transactions of the plan, if any,
to determine which transactions (or series of transactions) are
reportable (5%) transactions.
For investments in common/collective trusts (CCTs), pooled
separate accounts (PSAs), 103-12 IEs, and registered investment
companies determine the 5% figure by comparing the transaction date
value of the acquisition and/or disposition of units of
participation or shares in the entity with the current value of the
plan assets at the beginning of the plan year. If the Schedule H is
attached to a Form 5500 filed for a plan with all plan funds held in
a master trust, check ``No'' on Line 4j. Plans with assets in a
master trust that have other transactions should determine the 5%
figure by subtracting the current value of plan assets held in the
master trust from the current value of all plan assets at the
beginning of the plan year and check ``Yes'' or ``No,'' as
appropriate. Do not include individual transactions of CCTs, PSAs,
master trusts, 103-12 IEs, and registered investment companies in
which this plan or DFE invests.
In the case of a purchase or sale of a security on the market,
do not identify the person from whom purchased or to whom sold.
Special rule for certain participant-directed transactions.
Transactions under an individual account plan that a participant or
beneficiary directed with respect to assets allocated to his or her
account (including a negative election authorized under the terms of
the plan) should not be treated for purposes of Line 4j as
reportable transactions. The current value of all assets of the
plan, including these participant-directed transactions, should be
included in determining the 5% figure for all other transactions.
Line 4j. Schedule of Reportable Transactions. You must complete
the ``Schedule of Reportable Transactions'' if you answered ``Yes''
to Line 4(j).
Element (a). Check the box in element (a) if the seller, issuer,
lender, or similar party is the employer, employee organization,
service provider, or other party interest, including a subcontractor
or affiliate.
Element (b). Enter the name and EIN of the seller, issuer,
lender, or similar party. If the person is a plan sponsor, service
provider, or direct filing entity also identified on the Form 5500,
Schedule C, or Schedule D, or any other of the Schedule H Line 4
schedules, use the same name in all places.
Element (c). Enter a description of the asset, including
interest rate and maturity date in the case of the loan.
Element (d). Enter the purchase price, regardless of whether the
transaction being reported here is the acquisition or disposal of an
asset.
Element (e). If the transaction was the disposal of an asset,
enter the sale price.
Element (f). If the transaction involved a lease, enter a
description of the lease terms including annual rental and duration
of lease.
Element (g). Enter the total expenses incurred in connection
with the transaction, including fees and commissions.
Element (h). Enter the cost of the asset.
Element (i). Enter the current value of the asset on transaction
date.
Line 4k. You must check ``Yes'' if any benefits due under the
plan were not timely paid or not paid in full. This would include
minimum required distributions to 5% owners who have attained 70\1/
2\ whether or not retired and/or non-5% owners who have attained
70\1/2\ and have retired or separated from service, see section
401(a)(9) of the Code. Include in this amount the total of any
outstanding amounts that were not paid when due in previous years
that have continued to remain unpaid.
Do not enter ``Yes'' if the only benefits not paid are those
owed to ``missing'' or ``lost'' participants, and the plan
fiduciaries have acted in compliance with the Department of Labor's
Field Assistance Bulletin 2014-01 to attempt to locate the
participants.
Line 4l ``Blackout Period.'' Check ``Yes'' if there was a
``blackout period.'' A blackout period is a temporary suspension of
more than three (3) consecutive business days during which
participants or beneficiaries of a 401(k) or other individual
account pension plan were unable to, or were limited or restricted
in their ability to, direct or diversify assets credited to their
accounts, obtain loans from the plan, or obtain distributions from
the plan. A ``blackout period'' generally does not include a
temporary suspension of the right of participants and beneficiaries
to direct or diversity assets credited to their accounts, obtain
loans from the plan, or obtain distributions from the plan if the
temporary suspension is: (1) part of the regularly scheduled
operations of the plan that has been disclosed to participants and
beneficiaries; (2) due to a qualified domestic relations order
(QDRO) or because of a pending determination as to whether a
domestic relations order is a QDRO; (3) due to an action or a
failure to take action by an individual participant or because of an
action or claim by someone other than the plan regarding a
participant's individual account; or (4) by application of federal
securities laws. For more information, see 29 CFR 2520.101-3
(available at www.dol.gov/ebsa).
Line 4m. If there was a blackout period, did you provide the
required notice not less than 30 days nor more than 60 days in
advance of restricting the rights of participants and beneficiaries
to change their plan investments, obtain loans from the plan, or
obtain distributions from the plan? If so, check ``Yes.'' See 29 CFR
2520.101-3 for specific notice requirements and for exceptions from
the notice requirement. Also, answer ``Yes'' if one of the
exceptions to the notice requirement under 29 CFR 2520.101-3
applies.
Line 4n. Disclosures for Participant-Directed Accounts. All
individual account plans that provide for participant-direction must
provide specified disclosures under 29 CFR 2550.404a-5 with respect
to each participant or beneficiary that, pursuant to the terms of
the plan, has the right to direct the investment of assets held in,
or contributed to, his or her individual account. Included in the
required disclosures is a comparison chart.
4o. If you answered ``Yes'' to Line 4n, check the box to
indicate whether the plan provided participants and beneficiaries
the plan and investment disclosures required under 29 CFR 2550.404a-
5(d)(2). If you answered ``Yes,'' attach the comparison chart(s)
provided to participants and beneficiaries.
4p. If you answered ``Yes,'' to Line 4n, enter the number of
designated investment alternatives (DIAs) available under the plan,
indicate the number of DIAs that are index funds, and check the
appropriate box(es) to indicate the types of DIAs available.
4q. If you answered ``Yes,'' to Line 4n, check the appropriate
box to indicate whether the plan made available to participants and
beneficiaries a designated investment manager (DIM). If you answered
``Yes,'' enter the name of the DIM.
4r. Check ``Yes,'' if the plan made available to participants
and beneficiaries any brokerage window, self-directed brokerage
account or similar plan arrangements that enabled participants to
select investments beyond those designated by the plan. If you
answered ``Yes'' to Line 4r, enter the number of participants that
utilized the account or arrangement.
Line 4s. Unrelated business taxable income generally means the
gross income derived from any unrelated trade or business (as
defined in Code section 513) regularly conducted and not
substantially related to the plan's exempt purpose under Code
section 512, less the deductions directly connected with carrying on
the trade or business. See IRS Publication 598 for more information.
Check ``N/A'' if this plan does not have a trust, such as 412(e)(3)
fully insured plans or certain 403(b) annuity plans.
Plans that check ``Yes'' must enter any amount of unrelated
business taxable income. Form 990-T, Exempt Organization Business
Income Tax Return, is required for any gross income of $1000 or more
generated by an employer's trust by the 15th day of the 4th month
following the end of the trust's tax year. See Instructions to Form
990-T for more details.
Note. You are required to complete Line 4s if you are required
to file at least 250 returns of any type with the IRS during the
calendar year. However, if you are a small filer (file fewer than
250 returns of any type with the IRS during the calendar year), and
you do not voluntarily complete this Line 4s, then you must file the
Form 5500-SUP with the IRS on paper.
Line 4t. Under the Code, all defined contribution pension plans
must provide for a valuation of investments held by the trust at
least once a year in a manner consistently followed and uniformly
applied. Fair market value on the valuation date specified in the
plan is to be used for this purpose and the respective accounts of
participants are to be adjusted accordingly. See Rev. Rul. 80-155.
Plans that check ``No'' may result in disqualification of the plan
under Treasury Regulations section 1.401-1(a)(2).
Line 4u. Check ``Yes'' if the employer sponsoring the plan paid
any of the
[[Page 47633]]
administrative expenses of the plan that were not reimbursed by the
plan.
Line 4v. Check ``Yes'' if any person who is disqualified under
ERISA Section 411, served or was permitted to serve the plan in any
capacity. Section 411 of ERISA establishes a bar against certain
persons serving as employee benefit plan fiduciaries or service
providers because they have been convicted of any of a broad range
of specified crimes. Prohibited positions and activities include
consultants and advisers to plans and any entity whose activities
are in whole or substantial part devoted to providing goods or
services to employee benefit plans. As amended by the Comprehensive
Crime Control Act of 1984, section 411 of ERISA prohibits such
persons from serving plans for a period of thirteen years after such
judgment or the end of imprisonment resulting from a disqualifying
conviction, whichever is later, unless the sentencing court, under
appropriate circumstances, has reduced the period of prohibition to
not less than three years or has determined that service in any of
the prohibited capacities would not be contrary to the purposes of
ERISA. The prohibition takes effect upon the date of conviction (the
date of entry of judgment by the trial court) or the end of
imprisonment, whichever is later.
Line 4w. If the plan has investment acquisitions that are
leveraged, including assets subject to collateralized lending
activities (e.g., securities lending arrangements, repurchase
agreements (repos), etc.), check ``Yes.'' If you check ``Yes,''
check the appropriate box to indicate whether securities lending,
including repurchase agreements or sell/buy-backs or ``Other,''
including transactions that subjected plan assets to a mortgage,
lien, or other security interest. If you check ``Other,'' enter a
description. Then separately enter in Line 4w(2) the total amount of
cash obligated, the total value of securities obligated, and the
total value of other assets obligated in connection with
collateralized lending activities at the end of the plan year. In
Line 4w(3) enter the approximate ratio of collateralized/leveraged
investments (including cash that is obligated) to total plan assets
at the end of the year list total amount and approximate ratio of
leveraged investments to total plan assets.
Line 4x. Check ``Yes'' if the plan sponsor or its affiliates
provide any services to the plan in exchange for direct or indirect
compensation.
Line 4y. See 29 CFR 2520.102-2 and 2520.102-3 for style, format,
and content requirements for summary plan descriptions. For
distribution requirements see 29 CFR 2520.104b.
Line 4z. Defined contribution pension plans must complete Line
4z. For purposes of Line 4z, an uncashed check is one that is no
longer negotiable or is subject to limited payability. Check
``Yes,'' if there were any uncashed checks as of the end of the plan
year. If ``Yes,'' indicate the number of checks that were uncashed
at the end of the plan year and the total value of the checks.
Briefly describe the procedures followed by the plan to verify a
participant's or beneficiary's address before a check was mailed.
Plans must ensure that they use measures reasonably calculated to
ensure actual receipt of materials by plan participants and
beneficiaries, which would include procedures to keep track of
participants' and beneficiaries' current mailing addresses so that
information is less likely to be mailed to a bad address. See CFR
2520.104b-1(b). Also, briefly describe the procedures followed by
the plan to address the uncashed checks, including steps to locate
``missing participants.''
Plans should have procedures to keep track of uncashed checks.
The procedures for ongoing plans should include procedures for
locating ``missing'' participants. Plans may use the steps described
in FAB 2014-01 to search for lost participants or beneficiaries,
which may be helpful in particular where a check was returned as
``undeliverable.'' The procedures should also include a method by
which plan fiduciaries keep track or are made aware of the number of
uncashed checks and the amount involved. Such procedures could
include contractually requiring any third party administrators to
keep the plan administrator regularly informed of uncashed checks.
For missing participant and beneficiary searches and distributions
from terminating defined contribution pension plans, see 29 CFR
2550.404a-3; DOL Field Assistance Bulletin 2014-01 (Aug. 14, 2014).
Part V--Termination Information on Service Providers
Complete Part V if there was a termination in the appointment of
an accountant or enrolled actuary during the 20XX plan year
regardless of the reason or to identify any service providers, other
than accountants or actuaries identified above, that have been
terminated for a material failure to meet the terms of a service
arrangement or failure to comply with Title I of ERISA, including
the failure to provide required disclosures under 29 CFR 2550.408b-
2.
Line 5. Termination Information on Accountants and Actuaries.
Information on the termination of an accountant or actuary must be
provided on the Form 5500 Annual Return/Report for the plan year
during which the termination occurred. For example, if an accountant
was terminated in the 20XX plan year after completing work on an
audit for the 20XX-1 plan year, the termination should be reported
on the Schedule H filed with the 20XX plan year Form 5500 Annual
Return/Report. If the accountant is a firm (such as a corporation,
partnership, etc.), report when the service provider (not an
individual within the firm) was terminated.
An enrolled actuary is by definition an individual and not a
firm, and you must report when the individual is terminated.
Provide an explanation of the reasons for the termination of an
accountant or enrolled actuary. Include a description of any
material disputes or matters of disagreement concerning the
termination, even if resolved prior to the termination. If an
individual is listed, and the individual does not have an EIN, the
EIN to be entered should be the EIN of the individual's employer.
[TIP] If the only reason for change of appointment was a
temporary leave of absence due to non-work circumstances of the
enrolled actuary, so indicate in the ``explanation'' field.
Do not use a social security number in lieu of an EIN. The
Schedule C and its attachments are open to public inspection, and
the contents are public information and are subject to publication
on the Internet. Because of privacy concerns, the inclusion of a
social security number or any portion thereof on this Schedule C or
any of its attachments may result in the rejection of the filing.
The plan administrator must also provide the terminated
accountant or enrolled actuary with a copy of the explanation for
the termination provided in Line 5f, along with a completed copy of
the notice below.
Notice to Terminated Accountant or Enrolled Actuary
I, as plan administrator, verify that the explanation that is
reproduced below or attached to this notice is the explanation
concerning your termination reported on the Schedule C (Form 5500)
attached to the 20XX Form 5500, Annual Return/Report of Employee
Benefit Plan, for the ________ (enter name of plan).
This Form 5500 is identified in Line 2b by the nine-digit EIN__-
__(enter sponsor's EIN), and in Line 1b by the three-digit PN___
(enter plan number).
You have the opportunity to comment to the Department of Labor
concerning any aspect of this explanation. Comments should include
the name, EIN, and PN of the plan and be submitted to: Office of
Enforcement, Employee Benefits Security Administration, U.S.
Department of Labor, 200 Constitution Avenue, NW., Washington, DC
20210. [INSERT EMAIL ADDRESS]
Signed
Dated
Line 6. Information on Service Providers Terminated for Material
Failure. Provide information for any service providers, other than
accountants or actuaries identified above, that have been terminated
for a material failure to meet the terms of a service arrangement or
failure to comply with Title I of ERISA, including the failure to
provide required disclosures under 29 CFR 2550.408b-2.
Lines 6a-d. Provide identifying information in the appropriate
lines.
Lines 6e-f. If the reason for termination was the failure to
provide required disclosures under 29 CFR 2550.408b-2, in addition
to providing an explanation in Line 6e, check the box in Line 6f.
Part VI--Plan Termination Information
Line 7a. Check ``Yes'' if a resolution to terminate the plan was
adopted during this or any prior plan year, unless the termination
was revoked and no assets reverted to the employer. If ``Yes'' is
checked, enter in Line 7a(1) the effective date of plan termination,
enter in Line 7a(2) the plan year in which assets were distributed
to participants and beneficiaries (including insurance/annuity
contracts) and enter in Line 7a(3) the amount of plan assets that
reverted to the employer during the plan year in connection with the
implementation of such termination. Enter
[[Page 47634]]
``0'' if no reversion occurred during the current plan year.
Line 7b. Transfer to other plans. If the plan transferred assets
or liabilities to another plan since the date of the most recent
filing, report the EIN and PN of the plan to which the assets and
liabilities were transferred (i.e., the ``transferee plan''). In
addition, report the date of the transfer and check the box that
best describes the type of transfer (see Definitions below). Do not
use a social security number in lieu of an EIN or include an
attachment that contains visible social security numbers. The
Schedule H is open to public inspection, and the contents are public
information and are subject to publication on the Internet. Because
of privacy concerns, the inclusion of a social security number or
any portion thereof on this Schedule H or the inclusion of a visible
social security number or any portion thereof on an attachment may
result in the rejection of the filing.
Note. A distribution of all or part of an individual
participant's account balance that is reportable on Form 1099-R
should not be included on Line 7b. Do not submit Form 1099-R with
the Form 5500 Annual Return/Report.
IRS Form 5310-A, Notice of Plan Merger or Consolidation,
Spinoff, or Transfer of Plan Assets or Liabilities; Notice of
Qualified Separate Lines of Business, may be required to be filed at
least 30 days before any plan merger or consolidation or any
transfer of plan assets or liabilities to another plan. There is a
penalty for not filing IRS Form 5310-A on time. In addition, a
transfer of benefit liabilities involving a plan covered by PBGC
insurance may be reportable to the PBGC. See PBGC Form 10, Post-
Event Notice of Reportable Events, and PBGC Form 10-Advance, Advance
Notice of Reportable Events.
Line 7c. Transfers from other plans. If another plan transferred
assets or liabilities to this plan since the date of the most recent
filing, report the EIN and PN of the plan from which the assets and
liabilities were transferred (i.e., the ``transferor plan''), the
date of the transfer, and the box that best describes the type of
transfer.
``Consolidation'' means a transaction in which two or more plans
transfer all of their assets and liabilities to a new plan and, as a
result, cease to exist (because the transferor plans become part of
the new transferee plan). It differs from a Merger because in a
Merger, the transferee plan existed before the transaction. In a
consolidation, the transferee plan is a new plan that is created in
the Consolidation. Thus, the plan that exists after the
Consolidation follows the PBGC premium filing rules for new plans.
``Merger'' means a transaction in which one or more plans
transfer all of their assets and liabilities to an existing plan
and, as a result, cease to exist (because the transferor plan(s)
become part of the transferee plan). It differs from a Consolidation
because in a Consolidation, the transferee plan did not exist before
the transaction. In a Merger, the transferee plan is an existing
plan and follows the rules for a preexisting, ongoing plan.
``Spinoff'' means a transaction in which the transferor plan
transfers only part of its assets and/or liabilities to the
transferee plan. The transferee plan may be a new plan that is
created in the Spinoff, or it may be a preexisting plan that simply
receives part of the assets or liabilities of the transferor plan.
Note: If Final Return/Report is checked on the Form 5500 of Form
5500-SF, information should be entered an at least one of lines 7a
or 7b. Participant-directed transfers do not need to be reported on
Line 7c. If you reported transfers of assets and liabilities to this
plan on Line 2l(1), information should be entered in Line 7c.
Line 7d. Terminated Defined Contribution Pension Plans:
Transfers to Financial Institutions. If the filer is a defined
contribution pension plan, indicate whether, as part of the
procedures for terminating the plan, transferred plan assets to a
financial institution(s), establishing interest bearing federally
insured bank accounts in the name of missing participants in
connection with terminating the plan. If ``Yes,'' complete elements
(1)-(5). List each financial institution where plan assets were
transferred and continue reporting until the plan terminates and the
final return/report is filed. For more information on making
provisions for lost or missing participants, see DOL Field
Assistance Bulletin 2014-01.
Part VII--Trust Information
Line 8a. Enter the ``Name of trust.'' If a plan uses more than
one trust or custodial account for its fund, you should enter the
primary trust or custodial account in which the greatest dollar
amount or largest percentage of the plan assets as of the end of the
plan year is held on this Line. For example, if a plan uses three
different trusts, X, Y, Z, with the percentages of plan assets, 35%,
45%, and 20%, respectively, trust Y that held the 45% of plan assets
would be entered in Line 6a.
Line 8b. You may use this line to enter the ``Trust's Employer
Identification Number (EIN)'' assigned to the employee benefit trust
or custodial account, if one has been issued to you. The trust EIN
should be used for transactions conducted for the trust. If you do
not have a trust EIN, enter the EIN you would use on Form 1099-R,
Distributions From Pensions, Annuities, Retirement or Profit-Sharing
Plans, IRAs, Insurance Contracts, etc., to report distributions from
employee benefit plans and on Form 945, Annual Return of Withheld
Federal Income Tax, to report withheld amounts of income tax from
those payments.
Do not use a social security number in lieu of an EIN. Form 5500
and its attachments are open to public inspection, and the contents
are public information and are subject to publication on the
Internet. Because of privacy concerns, the inclusion of a social
security number or any portion thereof may result in the rejection
of the filing.
Trust EIN can be obtained from the IRS by applying for one on
Form SS-4, Application for Employer Identification Number. See
Instructions to Line 2b (Form 5500) for applying for an EIN. Also
see the online IRS EIN application page at https://federal-ein-online.com/ for further information.
Line 8c. Enter the name and other identifying information of the
plan trustee or custodian. Enter the telephone number for the plan
trustee or custodian.
Note. You must enter trust information from Lines 8a through 8c
if you are required to file at least 250 returns of any type with
the IRS during the calendar year. However, if you are a small filer
(files fewer than 250 returns of any type with the IRS during the
calendar year), and you do not enter trust information here, then
you must file the paper Form 5500-SUP with the IRS. See the Treasury
regulations on ``Employee Retirement Benefit Plan Returns Required
on Magnetic Media.'' (See 79 FR 58256 at https://federalregister.gov/a/2014-23161) and Instructions for Form 5500-SUP for more
information.
Trustee/Custodian Signature
The plan trustee or custodian may electronically sign this
schedule or attach to the Form 5500 an electronic reproduction of
the Schedule H signed by the plan's trustee. This electronic
reproduction must be labeled ``Trustee Signature'' and must be
included as a Portable Document Format (PDF) attachment or any
alternative electronic attachment allowable under EFAST2 if this is
not electronically signed. If there is more than one trustee or
custodian, the trustee or custodian authorized by the others may
sign. If the plan trustee or custodian is an entity, the signature
must be the name of a person authorized to sign on behalf of the
plan trustee or custodian.
Note. Trust information reported in this Schedule is for the
purpose of satisfying the requirements under Code section 6033(a)
for an annual information return from every section 401(a)
organization exempt from tax under section 501(a). The statute of
limitations under Code section 6501(a) for any trust described in
section 401(a), which is exempt from tax under section 501(a), will
not start to run until you timely file with the appropriate trust
information on this Schedule.
Schedule J (Form 5500) Group Health Plan Information
General Instructions
Who Must File
Schedule J (Form 5500) must be attached to a Form 5500 filed for
group health plans, except as provided below. The term ``group
health plan'' means an employee welfare benefit plan to the extent
that the plan provides medical care (as defined in ERISA Sec.
733(a)(2) and including items and services paid for as medical care)
to employees or their dependents (as defined under the terms of the
plan) directly or through insurance, reimbursement, or otherwise.
This includes group health plans that are funded through a trust,
unfunded, fully-insured, or a combination of more than one of these
funding arrangements. This also includes plans that claim
``grandfathered'' status under 29 CFR 2950.715-1251, and plans that
are exempt from certain market reform requirements under ERISA Sec.
732(a) (exemption for certain small group health plans that have
less than two participants who are current employees) or ERISA Sec.
733(c) (group health plans consisting solely
[[Page 47635]]
of excepted benefits). See the Form 5500 Annual Return/Report
Instructions ``Who Must File'' section for more information. It also
includes retirement plans that provide retiree health benefits and
welfare plans that provide a variety of benefits, including medical
benefits.
Small (fewer than 100 participants at the beginning of the plan
year), fully-insured group health plans only need to complete Part
I, Lines 1-8 of Schedule J, except they must complete the entire
Schedule J where the only policy is a ``stop loss'' policy,
including stop loss policies with the employer/plan sponsor as the
insured.
If a plan provides multiple types of benefits such as group
health, life, and disability, only report information about group
health benefit participation, claims, benefit types, compliance,
etc., on Schedule J.
Plans must complete one Schedule J for all the health benefit
coverages they provide. GIAs must complete a separate Schedule J for
each participating plan.
Check the Schedule J box on the Form 5500 (Part II, Line 11b(6))
if a Schedule J is attached to the Form 5500.
Part I of the Schedule J must be completed to report certain
characteristics of the group health plan.
Part II of the Schedule J must be completed to report service
providers providing services to the group health plan. You must
include information on third party administrators and claims
processors; mental health benefits managers, substance use disorder
benefits managers, pharmacy benefit managers (PBM), independent
review organizations (IRO), and wellness program managers. Multiple
entries for each may be entered. Service providers that render
services in relation to the group health plan that are reported on
the Schedule C or the Schedule A do not need to be reported on
Schedule J.
Part III of the Schedule J must be completed by plans that do
not file Schedule H to report financial information.
Part IV of the Schedule J must be completed to report claims
processing and payment information.
Part V of the Schedule J must be completed to report compliance
information for plans that do not file the Form M-1. Plans that file
the Form M-1, skip questions 24-30.
For more information and guidance for group health plans, visit
EBSA's Web site at www.dol.gov/ebsa. For information on state
regulation of health insurance, contact your State Insurance
Department. For information on HHS regulation of health insurance,
go to the Web site of the Center for Consumer Information and
Insurance Oversight at https://www.cms.gov/cciio/.
Specific Instructions
Part I--Group Health Plan Characteristics
You must enter information related to certain characteristics of
the group health plan.
Line 1. Report the number of persons covered by the plan at the
end of the plan year. Persons, for purposes of this line, include
participants, beneficiaries, and dependents of participants covered
under the plan.
Line 2. Check all that apply to indicate who is eligible for
coverage under the plan.
Line 3. Check all that apply to indicate the type of benefits
and design characteristics included under the plan.
Line 4. Check all that apply to indicate the funding and benefit
arrangement(s) for the plan. If the plan offers benefit package
options that are fully insured (i.e. benefits are provided under a
group policy purchased from a health insurance issuer to fund the
benefits), in Line 4a(1)(a), check ``Health Insurance Issuer'' and
enter the name(s), EIN and National Insurance Product Registry
Number of insurance carriers providing benefits under the plan. If
the health funding or benefit arrangement is through a health
insurance issuer, and the product is an ``off-the-shelf'' or
``prototype'' policy, product, or arrangement, enter in Line
4a(1)(b) any unique identification information for the product or
policy (e.g., a state assigned product identification number). Check
all that apply under 4a(1)(c).
If the plan offers benefit package options that are self-insured
(i.e., provide benefits from the general assets of the employer or
through a trust), check all that apply under 4a(2) and/or 4a(3).
A Health Insurance Issuer means an insurance company, insurance
service, or insurance organization (including a health maintenance
organization, as defined in ERISA Sec. 733(b)(3)), that is licensed
to engage in the business of insurance in a State and that is
subject to State laws regulating insurance (within the meaning of
ERISA Sec. 514(b)(2)).
Line 5. Check all characteristics that apply to the plan. With
regard to plans that claim grandfathered status, certain changes may
cause the plan to relinquish its grandfathered status such as
elimination of benefits, certain increases in cost-sharing
requirements, and certain decreases in contribution rates by
employers or employee organizations. For more information about
grandfathered group health plans, see 29 CFR 2590.715-1251.
In general, a health flexible spending account (FSA) is a
benefit designed to reimburse employees for medical care expenses
(as defined in Code section 213(d), other than premiums) incurred by
the employee, or the employee's spouse, dependents, and any children
who, as of the end of the taxable year, have not attained age 27.
See Code section 106(c)(2) and 26 CFR 1.125-5. A health
reimbursement arrangement (HRA) typically consists of a promise by
an employer to reimburse medical expenses, including insurance
premiums, for the year up to a certain amount, with unused amounts
available to reimburse medical expenses in future years. See IRS
Notice 2002-45. A high deductible health plan (HDHP) is a group
health plan subject to specific cost-sharing requirements as defined
in section 223(c)(2) of the Code.
Line 6a. Indicate the total number of persons offered COBRA
continuation coverage under the plan during the plan year.
Line 6b. From the universe of persons listed in line 6a,
indicate the number of persons who subsequently elected COBRA
coverage. Include any persons who elected coverage after the end of
the plan year.
Line 6c. Indicate the number of persons covered under the plan
through COBRA continuation coverage at any time during the plan
year.
Line 7. Indicate on Line 7a whether the plan received a rebate,
reimbursement, or refund from a service provider such as a health
insurance issuer, third-party administrator, or pharmacy benefit
manager. Include multiple entries if necessary. Include all
distributions from service providers including refunds, dividends,
demutualization payments, rebates, and excess surplus distributions.
Any medical loss ratio (MLR) rebates received pursuant to Section
2718 of the Public Health Service Act must be reported here. Also,
include refunds returned to the plan based on low claims experience
or termination of a service contract. Do not include dividends or
retroactive rate refunds reported on Schedule A, Line 9. If you
answer ``Yes'' to Line 7a, you must complete Line 7b. Complete a
separate entry for Lines 7b(1)-(3) for each rebate, reimbursement,
or refund, entering in Line 7b(1) the amount(s) and date(s) the
rebate(s), reimbursement(s), or refund(s) were received. Check the
appropriate box in b(2) to indicate the source and the appropriate
box in b(3) to specify how the funds were used or allocated.
Line 8. Indicate whether there were any premium delinquencies
during the reporting year. You must answer ``Yes'' or ``No.'' Do not
leave Line 8a blank. If you answered ``Yes,'' you must indicate both
the number of times delinquent for premiums due but unpaid during
the year, and for each delinquency, the number of days delinquent.
If you answered ``No'' to line 8a, check ``N/A'' on line 8b. If any
premium payments that were not made within the time required by the
insurance carrier resulted in a lapse of health insurance coverage,
you must answer ``Yes'' to Line 8b even if coverage was
retroactively reinstated.
Part II--Service Provider and Stop Loss Insurance Information
Lines 9-13. Enter identifying information for third party
administrator/claims processor, including insurance issuers subject
to an ``administrative services only'' (ASO) contract or other
agreement that are not reported on Schedule A or Schedule C, mental
health benefits managers, substance use disorder benefits managers,
pharmacy benefit manager/drug providers, and independent review
organizations on the appropriate line. Repeat as many line entries
as necessary to report all service providers under each category.
Element (c). If applicable, enter the National Producer Number
(NPN) of the service provider in element (c) for each type of
service provider. The NPN is a unique NAIC identifier assigned
through the licensing application process or the NAIC reporting
systems to individuals and business entities (including, but not
limited to producers, adjusters, and navigators) engaged in
insurance related activities regulated by a state insurance
department. The NPN is used to track those individuals and business
entities on a national basis.
Line 14. Wellness Program Manager. If there was a wellness
program associated with
[[Page 47636]]
the plan, enter the contact information for the wellness program
manager. A ``wellness program'' is defined in 29 CFR 2590.702(f) to
include ``any program designed to promote health or prevent
disease'' and includes programs that condition benefits (including
cost-sharing mechanisms) or the premium or employer contribution
amounts on an individual satisfying a standard that is related to a
health factor as well as those programs that do not include
conditions for obtaining a reward that are based on an individual
satisfying a standard that is related to a health factor.
Line 15. ``Stop Loss'' Insurance. If there was stop loss
insurance associated with the plan, enter the name and identifying
information for the insurance carrier providing the coverage in
elements (a)-(c). This includes policies entered into by the plan
sponsor for obligations of the plan sponsor to pay benefits under
the plan.
Line 15d. Enter the total premium paid to the stop loss
provider.
Line 15e. Enter the applicable attachment points for individual
claims and aggregate claims. For this purpose, attachment points are
the threshold dollar amounts which, when reached, the stop loss
coverage begins to pay benefit claims.
Line 15f. Enter any applicable individual and aggregate claim
limits at which the stop loss ceases coverage. For example, stop
loss coverage may only cover individual claims up to a certain
dollar amount or cease paying claims after an aggregate dollar
amount is met.
Line 15g. Enter the policy or contract year beginning and end
dates for the policy ending with or within the plan year.
Line 15h. Check the box if the employer or plan sponsor is the
insured party under the stop-loss policy.
Part III--Financial Information
Note: Form 5500 filers that file Schedule H can skip this
section and proceed to Part IV Claims Processing and Payment.
Line 16a. Report the total cash contributions received from
employer(s). In the absence of a trust (e.g., where a cafeteria plan
elects not to establish a trust in reliance on Technical Release No.
92-01), include employer contributions applied directly to the
payment of benefits or expenses attendant to the provision of health
benefits.
Line 16b. For accrual basis plans, report the total cash
contributions receivable from employer(s).
Line 16c. Report the total cash contributions received from
employees, including all elective contributions under a cafeteria
plan (Code section 125 arrangement) attendant to the provision of
health benefits.
Line 16d. For accrual basis plans, report the total cash
contributions receivable from employees, including all receivable
elective contributions under a cafeteria plan (Code section 125
arrangement) attendant to the provision of health benefits.
Line 16e. Report other contributions received or receivable,
including non-cash contributions, which should be reported at the
current value at the date contributed.
Line 16f. Enter the total contributions. Add lines 16a-e.
Line 17. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the plan
are participant contributions that become plan assets as of the
earliest date on which such contributions can reasonably be
segregated from the employer's general assets (see 29 CFR 2510.3-
102). For Schedule J purposes, participant contributions include all
elective contributions under a cafeteria plan (Code section 125
arrangement). Indicate whether there was a failure to timely
transmit participant contributions to the plan during the filing
period. Continue to answer ``Yes'' for any prior year failures until
fully corrected.
Part IV--Health Benefit Claims Processing and Payment
Every employee benefit plan shall establish and maintain
reasonable procedures governing the filing of benefit claims,
notification of benefit determinations, and appeal of adverse
benefit determinations. See 29 CFR 2560.503-1 and 2590.715-2719(a).
These questions ask you to quantify the number of benefit claims
processed during the year. Unless otherwise instructed, do not
provide dollar amounts instead of number of benefit claims
processed.
A pre-service benefit claim means any claim for a benefit under
a group health plan with respect to which the terms of the plan
condition receipt of the benefit, in whole or in part, on approval
of the benefit in advance of obtaining medical care and includes
urgent care and concurrent care claims.
A post-service benefit claim means any claim for a benefit under
a group health plan that is not a pre-service claim and is typically
a request for payment that you or your health care provider submits
to your health insurer when you get items or services you think are
covered.
``Claims Adjudication'' is a term used in the insurance industry
to refer to the process of paying claims submitted or denying them
after comparing claims to the benefit or coverage requirements.
Line 18a(1)-(3). Enter the number of post-service benefit claims
submitted during the plan year regardless of whether the claim was
approved or denied. Do not include duplicate claims, i.e., claims
denied as previously considered. Enter the number of post-service
benefit claims paid during the plan year. Enter the number of post-
service benefit claims denied during the plan year. Do not include
duplicate claims, i.e., denied as previously considered.
Line 18b(1)-(2). Enter the number of post-service benefit claims
appealed during the plan year. Then, enter the number of post-
service claim denials upheld upon appeal and the number that were
payable after appeal.
Line 18c(1)-(2). Enter the number of pre-service benefit claims
appealed. Then, enter the number of pre-service claim denials upheld
upon appeal and the number that were payable after appeal.
Line 19. Indicate whether there were any pre-service or post-
service benefit claims that were not adjudicated within the required
time frames. In accordance with 29 CFR 2560.503-1(f)(2)(iii)(A), the
plan administrator shall notify the claimant of the plan's benefit
determination (whether adverse or not) within a reasonable period of
time appropriate to the medical circumstances, but not later than 15
days after the receipt of the claim. In accordance with 29 CFR
2560.503-1(f)(2)(iii)(B) the plan administrator shall notify the
claimant of the plan's adverse benefit determination on a post-
service claim within a reasonable period of time, but not later than
30 days after receipt of the claim. This period may be extended one
time for up to 15 days in circumstances where the delay is beyond
the plan's control and the plan notifies the claimant of the
extension prior to the expiration of the initial review period of
why the extension is needed and the date by which the plan expects
to render a decision.
Line 20. Indicate whether, at any time during the year, the
group health plan failed to pay benefit claims within one month of
being approved for payment. If you answer ``Yes,'' indicate the
number of claims the plan failed to pay, total dollar amount of
claims not paid within one (1) month, and the number of claims not
paid within three (3) months or longer.
Example. A plan sponsor of an unfunded plan experienced
financial difficulty in February and was unable to pay health
benefit claims until May. In May, the plan sponsor's revenues
increased and claims were paid. The plan must report the number of
claims the plan was unable to pay from February to May even though
the claims were subsequently paid in May.
Line 21. Enter the total dollar amount of health benefit claims
paid during the year. Do not include administrative expenses in the
amount of claims paid.
Part V--Compliance Information
Line 22. Trust compliance. Indicate whether all plan assets are
maintained consistent with ERISA Sec. 403 and 29 CFR 2550.403a-1
and 2550.403b-1. Pursuant to Technical Release 92-01, the DOL has
opted to take a non-enforcement policy with respect to violations
resulting solely because of a failure to hold participant
contributions in trust in the case of a cafeteria plan described in
section 125 of the Internal Revenue Code.
Line 23. General Disclosure Compliance. Indicate whether the
following disclosure documents are in compliance with the applicable
content requirements:
Summary plan description (SPD)--See 29 CFR 2520.104b-2.
Summary of Benefits and Coverage (SBC)--See 29 CFR
2590.715-2715.
Summary of material modification (SMM)--See 29 CFR
2520.104b-3.
Summary annual reports (SAR)--See 29 CFR 2520.104b-
10(d).
A Reporting and Disclosure Guide for Employee Benefit Plans
describing basic reporting and disclosure requirements under ERISA
can be found at https://www.dol.gov/ebsa/pdf/rdguide.pdf.
Health Benefit Compliance
Plans that file the Form M-1, skip questions 24-30. Guidance
material and additional compliance assistance information
[[Page 47637]]
that may be helpful in understanding the requirements listed below
is available in publications, fact sheets, and frequently asked
questions available on EBSA's Web site at www.dol.gov/ebsa.
Interested persons may also call and speak to a benefits advisor
about these laws, by calling the EBSA toll-free hotline at 1-866-
444-3272. A self-auditing tool to determine compliance with Part 7
of Title I of ERISA is available at https://www.dol.gov/ebsa/pdf/cagappa.pdf.
Line 24. HIPAA Compliance. The Health Insurance Portability and
Accountability Act of 1996 (Pub. L. 104-191) (HIPAA) amended ERISA
to provide for, among other things, improved portability and
continuity of health insurance coverage.
Line 25. GINA Compliance. The Genetic Information
Nondiscrimination Act of 2008 (Pub. L. 110-233) (GINA) amended ERISA
to prohibit the use of genetic information to adjust group premiums
or contributions, prohibit the collection of genetic information,
and prohibit requesting individuals to undergo genetic testing.
Line 26. Mental Health Parity Compliance. The Mental Health
Parity Act of 1996 (Pub. L. 104-204, as amended by Pub. L. 107-116
and Pub. L. 107-147) (MHPA) amended ERISA to provide parity in the
application of aggregate lifetime and annual dollar limits for
certain mental health benefits with such dollar limits on medical
and surgical benefits. The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008 (Pub. L. 110-343)
(MHPAEA) amended ERISA by expanding the MHPA rules to cover benefits
for substance use disorders, and adding new rules for parity in
financial requirements and treatment limitations.
Line 27. Newborns' and Mothers' Health Protection Compliance.
The Newborns' and Mothers' Health Protection Act of 1996 (Pub. L.
104-204) (Newborns' Act) amended ERISA to provide new protections
for mothers and their newborn children with regard to group health
plan coverage of the length of hospital stays in connection with
childbirth.
Line 28. Women's Health and Cancer Rights Compliance. The
Women's Health and Cancer Rights Act of 1998 (Pub. L. 105-277)
(WHCRA) amended ERISA to provide new rights under group health plans
for coverage of reconstructive surgery in connection with a
mastectomy.
Line 29. Michelle's Law Compliance. Michelle's Law (Pub. L. 110-
381) amended ERISA to provide dependent children with protections
against termination of group health plan coverage while on a
medically necessary leave of absence from a postsecondary
educational institution.
Line 30. Affordable Care Act Compliance. The Affordable Care Act
amended ERISA to provide a wide range of protections for
participants of group health plans. For more information on the
Affordable Care Act, see www.dol.gov/ebsa/healthreform.
Form M-1 Compliance Information.
Line 31a. You must answer either ``Yes'' or ``No'' to Line 31a.
Do not leave the answer blank. If the plan is a multiple employer
welfare arrangement or an Entity Claiming Exception (ECE) subject to
the Form M-1, Report for Multiple Employer Welfare Arrangements
(MEWAs) and Certain Entities Claiming Exception (ECEs) filing
requirements, check ``Yes'' and complete elements 31b and 31c. If
the answer is ``No,'' skip elements 31b and 31c.
Generally, a Form M-1 must be filed each year by March 1st
following the calendar year in which a plan operates subject to the
Form M-1 filing requirement. (For example, a plan MEWA that was
operating in 20XX must file the 20XX Form M-1 annual report by March
1, 20XX+1.) In addition, Form M-1 filings are necessary in the case
of certain registration, origination, or special events. See the
instructions for Form M-1 at https://www.askebsa.dol.gov/mewa, and 29
CFR 2520.101-2 for more information regarding the Form M-1 filing
requirements for plan MEWAs and ECEs.
Line 31b. All plans that answered ``Yes'' in Line 31a must
complete Line 31b by answering either ``Yes'' or ``No.'' Do not
leave the answer blank if you answered ``Yes'' in Line 31a.
Line 31c. All plans that answered ``Yes'' in Line 31a must enter
a Receipt Confirmation Code for the 20XX Form M-1 annual report that
was required to be filed with the Department of Labor under the Form
M-1 filing requirements. The Receipt Confirmation Code is a unique
code generated by the Form M-1 electronic filing system. You can
find this code under the ``completed filings'' area when you log
into your Form M-1 electronic filing system at https://www.askebsa.dol.gov/mewa. If a plan was not required to file a 20XX
Form M-1 annual report, enter the Receipt Confirmation Code for the
most recent Form M-1 that was required to be filed under the Form M-
1 filing requirements on or before the date of filing the 20XX Form
5500. (For example, if a plan was not required to file a 20XX Form
M-1 annual report by March 1, 20XX+1 for the 20XX calendar year
because it experienced a registration event between October 1 and
December 31, 20XX, and made a timely Form M-1 registration filing,
the plan must enter on Line 31c of the 20XX Form 5500 the Receipt
Confirmation Code issued for the Form M-1 registration filing.)
If a plan that is subject to the Form M-1 filing requirements
was not required to file a 20XX Form M-1 annual report, enter the
Receipt Confirmation Code for the most recent Form M-1 that was
required to be filed under the Form M-1 filing requirements on or
before the date of filing the 20XX Form 5500. (For example, if a
plan was not required to file a 20XX Form M-1 annual report by March
1, 20XX for the 20XX calendar year because it experienced a
registration event between October 1 and December 31, 20XX, and made
a timely Form M-1 registration filing, the plan must provide the
Receipt Confirmation Code for the Form M-1 registration filing.)
The failure of a plan required to complete Schedule J to answer
Line 31a, and if applicable, lines 31b and 31c, or enter a valid
Receipt Confirmation Code in Line 31c, will subject the Form 5500
filing to rejection as incomplete and civil penalties may be
assessed pursuant to ERISA Section 502(c)(2) and 29 CFR 2560.502c-2.
20XX Instructions for Schedule MB (Form 5500)--Multiemployer Defined
Benefit Plan and Certain Money Purchase Plan Actuarial Information
General Instructions
Who Must File
As the first step, the plan administrator of any multiemployer
defined benefit pension plan that is subject to the minimum funding
standards (see Code sections 412 and 431 and Part 3 of Title I of
ERISA) must obtain a completed Schedule MB (Form 5500) that is
prepared and signed by the plan's enrolled actuary as discussed
below in the Statement by Enrolled Actuary section. The plan
administrator must retain with the plan records the Schedule MB that
is prepared and electronically signed by the plan's actuary. The
electronic-signature by the plan actuary is acceptable. The plan
actuary can access the EFAST2 Web site at www.efast.dol.gov to
register for electronic credentials to sign.
The plan administrator of a multiemployer defined benefit
pension plan must ensure that the information from the actuary's
Schedule MB is entered electronically into the annual return/report
being submitted. When entering the information, whether using
EFAST2-approved software or EFAST2's web-based filing system, all
the fields required for the type of plan must be completed (see
instructions for fields that need to be completed).
Further, if a plan actuary chooses not to sign electronically,
then the actuary must manually sign the Schedule MB and an
electronic reproduction must be filed with the Form 5500. The plan
administrator of a multiemployer defined benefit pension plan must
attach to the Form 5500 an electronic reproduction of the Schedule
MB prepared and signed by the plan's enrolled actuary. This
electronic reproduction must be labeled ``MB Actuary Signature'' and
must be included as a Portable Document Format (PDF) attachment or
any alternative electronic attachment allowable under EFAST2.
If a money purchase defined contribution pension plan (including
a target benefit plan) has received a waiver of the minimum funding
standard, and the waiver is currently being amortized, lines 3, 9,
and 10 of Schedule MB must be completed but it need not be signed by
an enrolled actuary. In such a case, the Form 5500 or the Form 5500-
SF that is submitted under EFAST2 must include the Schedule MB with
lines 3, 9, and 10 completed, but is not required to include a
signed Schedule MB.
Note. Schedule MB does not have to be filed with the Form 5500-
EZ, but, if required, it must be retained (in accordance with the
instructions for Form 5500-EZ under the What to File section).
Similarly, if a plan is a one-participant plan that meets the
requirements for filing a Form 5500-EZ, but a Form 5500-SF is
instead filed for the plan, the Schedule MB, if required, does not
have to be filed with the Form 5500-SF, but it must be retained (in
accordance with the instructions for the Form 5500-SF under Schedule
MB in the Specific Instructions Only for ``One-Participant Plans and
Certain
[[Page 47638]]
Foreign Plans'' section). Also, the funding standard account for the
plan must continue to be maintained, even if the Schedule MB is not
filed.
Check the Schedule MB box on the Form 5500 (Part II, Line
10a(2)) if a Schedule MB is attached to the Form 5500.
Lines A through E must be completed for ALL plans. If the
Schedule MB is attached to a Form 5500 or Form 5500-SF, Lines A, B,
C, and D should include the same information as reported in Part II
of the Form 5500 or Form 5500-SF. You may abbreviate the plan name.
Do not use a social security number in Line D in lieu of an EIN.
The Schedule MB and its attachments are open to public inspection if
filed with a Form 5500 or Form 5500-SF, and the contents are public
information and are subject to publication on the Internet. Because
of privacy concerns, the inclusion of a social security number or
any portion thereof on this Schedule MB or any of its attachments
may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
the General Instructions to Form 5500 and How to File--Electronic
Filing Requirement under the General Instructions to Form 5500-SF.
The EBSA does not issue EINs.
Note. (1) For split-funded plans, the costs and contributions
reported on Schedule MB must include those relating to both trust
funds and insurance carriers. (2) For plans with funding standard
account amortization charges and credits, see the instructions for
lines 9c and 9h. (3) For terminating multiemployer plans, Code
section 412(e)(4) and ERISA section 301(c) provide that minimum
funding standards apply until the last day of the plan year in which
the plan terminates within the meaning of section 4041A(a)(2) of
ERISA. Accordingly, the Schedule MB is not required to be filed for
any later plan year.
Statement by Enrolled Actuary
An enrolled actuary must sign Schedule MB with either an
electronic signature or a handwritten signature unless, as described
above, the plan is a money purchase defined contribution pension
plan that has received a waiver of the minimum funding standard. The
signature of the enrolled actuary may be qualified to state that it
is subject to attached qualifications. See Treasury Regulations
section 301.6059-1(d) for permitted qualifications. Except as
otherwise provided in these instructions, a stamped or machine
produced signature is not acceptable. If the actuary has not fully
reflected any final or temporary regulation, revenue ruling, or
notice promulgated under the statute in completing the Schedule MB,
check the box on the last line of page 1. If this box is checked,
indicate on this line whether an accumulated funding deficiency or a
contribution that is not wholly deductible would result if the
actuary had fully reflected such regulation, revenue ruling, or
notice. In addition, the actuary may offer any other comments
related to the information contained in Schedule MB.
The actuary must provide the completed and signed Schedule MB
and transmit it to the plan administrator to be retained with the
plan records and included (in accordance with these instructions)
with the Form 5500 Annual Return/Report that is submitted under
EFAST2. The plan's actuary is permitted to electronically sign the
Schedule MB or sign on page one using the actuary's signature or by
inserting the actuary's typed name in the signature line followed by
the actuary's handwritten initials. The actuary's most recent
enrollment number must be entered on the Schedule MB that is
prepared and signed by the plan's actuary.
Attachments
All attachments to the Schedule MB must be properly identified,
and must include the name of the plan, the plan sponsor's EIN, and
the plan number. Put ``Schedule MB'' and the line number to which
the attachment relates at the top of each attachment. Do not include
attachments that contain a visible social security number. The
Schedule MB and its attachments are open to public inspection, and
the contents are public information and are subject to publication
on the Internet. Because of privacy concerns, the inclusion of a
visible social security number or any portion thereof on an
attachment may result in the rejection of the filing.
Specific Instructions
Line 1. All entries must be reported as of the valuation date.
Line 1a. Actuarial Valuation Date. The valuation for a plan year
may be as of any date in the plan year, including the first or last
day of the plan year. Valuations must be performed within the period
specified by Code section 431(c)(7) and ERISA section 304(c)(7).
Line 1b(1). Current Value of Assets. Enter the current value of
assets as of the valuation date. The current value is the same as
the fair market value. Do not adjust for items such as the existing
credit balance or the outstanding balances of certain amortization
bases. Contributions designated for 20XX should not be included in
this amount. Note that this entry may be different from the entry in
Line 2a. Such a difference may result, for example, if the valuation
date is not the first day of the plan year, or if insurance
contracts are excluded from assets reported on Line 1b(1) but not on
Line 2a.
Rollover amounts or other assets held in individual accounts
that are not available to provide defined benefits under the plan
should not be included on Line 1b(1), regardless of whether they are
reported on the 20XX Schedule H (Form 5500) (Line 1I, column (a)).
Additionally, asset and liability amounts must be determined in a
consistent manner. Therefore, if the value of any insurance
contracts have been excluded from the amount reported on Line 1b(1),
liabilities satisfied by such contracts should also be excluded from
the liability values reported on Lines 1c(1), 1c(2), and 1d(2) of
the Schedule MB.
Line 1b(2). Actuarial Value of Assets. Enter the value of assets
determined in accordance with Code section 431(c)(2) and ERISA
section 304(c)(2). Do not adjust for items such as the existing
credit balance or the outstanding balances of certain amortization
bases, and do not include contributions designated for 20XX in this
amount.
Line 1c(1). Accrued Liability for Immediate Gain Methods.
Complete this line only if you use an immediate gain method (see
Rev. Rul. 81-213, 1981-2 C.B. 101, for a definition of immediate
gain method).
Lines 1c(2)(a), (b), and (c). Information for Plans Using Spread
Gain Methods. Complete these lines only if you use a spread gain
method (see Rev. Rul. 81-213 for a definition of spread gain
method).
Line 1c(2)(a). Unfunded Liability for Methods with Bases.
Complete this line only if you use the frozen initial liability or
attained age normal cost method.
Lines 1c(2)(b) and (c). Entry Age Normal Accrued Liability and
Normal Cost. For spread gain methods, these calculations are used
for purposes of the full funding limitation (see Rev. Rul. 81-13,
1981-1 C.B. 229).
Line 1d(1). Amount Excluded from Current Liability. Leave Line
1(d)(1) blank.
Line 1d(2)(a). Current Liability. All multiemployer plans,
regardless of the number of participants, must provide the
information indicated in accordance with these instructions. The
interest rate used to compute the current liability must be in
accordance with guidelines issued by the IRS and, pursuant to the
Pension Protection Act of 2006 (PPA), must not be more than 5
percent above and must not be more than 10 percent below the
weighted average of the rates of interest, as set forth by the
Treasury Department, on 30-year Treasury securities during the 4-
year period ending on the last day before the beginning of the 20XX
plan year.
The current liability must be computed using the mortality
tables referenced in section 1.431(c)(6)-1 of the Treasury
Regulations.
Each other actuarial assumption used in calculating the current
liability must be the same assumption used for calculating other
costs for the funding standard account. See Notice 90-11, 1990-1
C.B. 319. The actuary must take into account rates of early
retirement and the plan's early retirement and turnover provisions
as they relate to benefits, where these would significantly affect
the results. Regardless of the valuation date, current liability is
computed taking into account only credited service through the end
of the prior plan year. No salary scale projections should be used
in these computations. Do not include the expected increase in
current liability due to benefits accruing during the plan year
reported on Line 1d(2)(b) in these computations.
Line 1d(2)(b). Expected Increase in Current Liability. Enter the
amount by which the current liability is expected to increase due to
benefits accruing during the plan year on account of credited
service and/or salary changes for the current year. One year's
salary scale may be reflected.
Line 1d(2)(c). Expected Release From Current Liability for the
Plan Year. Enter the expected release from current liability on
account of disbursements (including single-
[[Page 47639]]
sum distributions) from the plan expected to be paid after the
valuation date but prior to the end of the plan year (see also Q&A-7
of Rev. Rul. 96-21, 1996-1 C.B. 64).
Line 1d(3). Expected Plan Disbursements. Enter the amount of
plan disbursements expected to be paid for the plan year.
Line 2. All entries must be reported as of the beginning of the
20XX plan year. Lines 2a and 2b should include all assets and
liabilities under the plan except for assets and liabilities
attributable to: (1) rollover amounts or other amounts in individual
accounts that are not available to provide defined benefits, or (2)
benefits for which an insurer has made an irrevocable commitment as
defined in 29 CFR 4001.2.
Line 2a. Current Value of Assets. Enter the current value of net
assets as of the first day of the plan year. Except for plans with
excluded assets as described above, this entry should be the same as
reported on the 20XX Schedule H (Form 5500) (line 1l, column (a)).
Note that contributions designated for the 20XX plan year are not
included on those lines.
Line 2b. Current Liability (beginning of plan year). Enter the
current liability as of the first day of the plan year. Do not
include the expected increase in current liability due to benefits
accruing during the plan year. See the instructions for Line
1d(2)(a) for actuarial assumptions used in determining current
liability.
Column (1)--Enter the number of participants and beneficiaries
as of the beginning of the plan year. If the current liability
figures are derived from a valuation that follows the first day of
the plan year, the participant and beneficiary count entries should
be derived from the counts used in that valuation in a manner
consistent with the derivation of the current liability reported in
column (2).
Column (2)--Include the current liability attributable to all
benefits, with subtotals for vested and nonvested benefits in the
case of active participants.
Line 2c. This calculation is required under ERISA section
103(d)(11). Do not complete if Line 2a divided by Line 2b(4), column
(2), is 70% or greater.
Line 3. Contributions Made to Plan. Show all employer
contribution amounts (column b), withdrawal liability payments
(column c) and employee contribution amounts (column d) for the plan
year. Employer contribution amounts should not include withdrawal
liability payments which should be reported separately. Include
employer contribution amounts and withdrawal liability payments made
not later than 2\1/2\ months (or the later date allowed under Code
section 431(c)(8) and ERISA section 304(c)(8)) after the end of the
plan year. Show only contribution amounts and withdrawal liability
payments actually made to the plan by the date this Schedule MB is
signed.
Add the amounts in columns (b), (c) and (d) and enter the
results on the total line. All contribution amounts and withdrawal
liability payments must be credited toward a particular plan year.
Line 4. Information on Plan Status. All multiemployer plans
regardless of the number of participants must provide the
information indicated in accordance with these instructions.
Line 4a. All plans enter the funded percentage for monitoring
the plan's status. This is Line 1b(2) divided by Line 1c(3).
Line 4b. Enter the code for the status of the multiemployer plan
for the plan year, as certified by the plan actuary (or as elected
by the plan sponsor in accordance with Code section 432(b)(4)(A) and
ERISA section 305(b)(4)(A)), using one of the following codes:
Code Plan Status
E Endangered Status
S Seriously Endangered Status
C Critical Status
D Critical and Declining Status
N Not in Endangered or Critical Status
If the plan is certified to be in endangered status, seriously
endangered status, critical status, or critical and declining
status, attach a copy of the actuarial certification of such status
to this Schedule MB. Also attach an illustration showing the details
(including year-by-year cash flow projections demonstrating the
solvency of the plan over the relevant period if the plan is
certified as being in critical and declining status) providing
support for the actuarial certification of status and label the
illustration ``Schedule MB, Line 4b--Illustration Supporting
Actuarial Certification of Status.'' For example, if a plan is
certified as being in critical status based on Code section
432(b)(2)(B), show the funded percentage (if applicable) and the
projection of the funding standard account for the year in which the
accumulated funding deficiency occurs. All supporting documentation
should include descriptions of the assumptions used.
Line 4c. If, in the plan year in which the Schedule MB is filed,
a certification was required to be made under Code section
432(b)(3)(A)(ii) and ERISA section 305(b)(3)(A)(ii) with respect to
scheduled progress during the plan year for which the Schedule MB is
filed, check ``Yes'' or ``No'' to reflect the certification. Attach
documentation comparing the current status of the plan to the
scheduled progress under the applicable funding improvement or
rehabilitation plan to this Schedule MB. Label the documentation
``Schedule MB, Line 4c--Documentation Regarding Progress Under
Funding Improvement or Rehabilitation Plan.''
Lines 4d and 4e. If Code C (Critical Status) or Code D (Critical
and Declining Status) was entered on Line 4b, an entry on line 4d is
required. For purposes of Lines 4d and 4e, in determining whether
benefits have been reduced, only adjustable benefits that would
otherwise be protected under Code section 411(d)(6) and ERISA
section 204(g) are taken into account if the plan is certified as in
critical status. Plans that are certified as being in critical and
declining status should determine whether benefits have been
reduced, including all benefits that were adjusted (only adjustable
benefits that would otherwise be protected under Code section
411(d)(6) and ERISA section 204(g) are taken into account), any
benefits that have been suspended under Code section 432(e)(9), and
any benefit reductions due to partition under ERISA section 4233.
For a plan that has benefits suspended under Code section 432(e)(9)
and/or partitioned under ERISA section 4233, attach a full
description of the transaction and label the attachment ``Schedule
MB, Lines 4d and 4e--Description of Benefit Reductions Due to
Suspension or Partition.'' In addition, only benefit reductions that
are first reflected in Line 1c(3) for the current year's Schedule MB
should be reported, and this amount should not include any amounts
previously reported on any prior year's Schedule MB.
Line 4f. If Code C (Critical Status) or Code D (Critical and
Declining Status) was entered on Line 4b you must complete Line 4f.
If the rehabilitation plan projects emergence from critical status
or critical and declining status, enter the plan year in which the
plan is projected to emerge. If the rehabilitation plan is based on
forestalling possible insolvency, check the box provided and enter
the plan year in which the insolvency is expected.
Line 5. Actuarial Cost Method. Enter the primary method used. If
the plan uses one actuarial cost method in one year as the basis of
establishing an accrued liability for use under the frozen initial
liability method in subsequent years, answer as if the frozen
initial liability method was used in all years. The projected unit
credit method is included in the ``Accrued benefit (unit credit)''
category of Line 5c. If a method other than a method listed on Lines
5a through 5g is used, check the box for Line 5i and specify the
method. For example, if a modified individual level premium method
for which actuarial gains and losses are spread as a part of future
normal cost is used, check the box for 5i and describe the cost
method.
Check the appropriate box for the underlying actuarial cost
method used as the basis for this plan year's funding standard
account computation. If box 5h is checked, enter the period of use
of the shortfall method in Line 5j. For this purpose, enter the
calendar year (YY) which includes the first day of the plan year in
which the shortfall method was first used.
Changes in funding methods include changes in actuarial cost
method, changes in asset valuation method, and changes in the
valuation date of plan costs and liabilities or of plan assets.
Changes in the funding method of a plan include not only changes to
the overall funding method used by the plan, but also changes to
each specific method of computation used in applying the overall
method. Generally, these changes require IRS approval. If the change
was made pursuant to Rev. Proc. 2000-40, 2000-2 C.B. 357, or
pursuant to other automatic approval (such as the Preservation of
Access to Care for Medicare Beneficiaries and Pension Relief Act of
2010 (PRA 2010), Pub. L. 111-192), check ``Yes'' for Line 5l. If
approval was granted for this plan by either an individual ruling
letter or a class ruling letter, enter the date of the applicable
ruling letter in Line 5m. Note that the plan sponsor's agreement to
certain changes in funding methods should be reported on Line 9 of
Schedule R (Form 5500).
Shortfall Method: Only certain plans may elect the shortfall
funding method (see
[[Page 47640]]
Treasury Regulations section 1.412(c)(1)-2). Advance approval from
the IRS for the election of the shortfall method of funding is NOT
required if it is first adopted for the first plan year to which
Code section 412 applies. In addition, pursuant to PPA section
201(b), a plan does NOT need advance approval from the IRS to adopt
or cease using the shortfall method if the plan (1) has not adopted
or ceased using the shortfall method during the 5-year period ending
on the day before the date the plan is to use the method, and (2) is
not operating under an amortization period extension and did not
operate under such an extension during such 5-year period. In such a
case, check ``Yes'' for Line 5l. If a plan utilizes this automatic
approval to apply the shortfall method, the benefit increase
limitations of Code section 412(c)(7) apply.
If a plan is not eligible for automatic approval as set forth in
the preceding paragraph, advance approval from the IRS is required
if the shortfall funding method is adopted at a later time, if a
specific computation method is changed, or if the shortfall method
is discontinued. In such a case there is no automatic limitation on
benefit increases.
Line 6. Actuarial Assumptions. If gender-based assumptions are
used in developing plan costs, enter those rates where appropriate
in Line 6. Note that requests for gender-based cost information do
not suggest that gender-based benefits are legal. If unisex tables
are used, enter the values in both ``Male'' and ``Female'' lines.
Check ``N/A'' for Line 6b if the question is not applicable.
Attach a statement of actuarial assumptions (if not fully
described by Line 6) and actuarial methods used to calculate the
figures shown in Lines 1 and 9 (if not fully described by Line 5),
and label the statement ``Schedule MB, Line 6--Statement of
Actuarial Assumptions/Methods.'' The statement must describe all
actuarial assumptions used to determine the liabilities. For
example, the statement for non-traditional plans (e.g., cash balance
plans) must include the assumptions used to convert balances to
annuities.
Also attach a summary of the principal eligibility and benefit
provisions on which the valuation was based, including the status of
the plan (e.g., eligibility frozen, service/pay frozen, benefits
frozen), optional forms of benefits, special plan provisions,
including those that apply only to a subgroup of employees (e.g.,
those with imputed service), supplemental benefits, an
identification of benefits not included in the valuation (e.g.,
shutdown benefits), a description of any significant events that
occurred during the year, a summary of any changes in principal
eligibility or benefit provisions since the last valuation, a
description (or reasonably representative sample) of plan early
retirement factors, and any change in actuarial assumptions or cost
methods and justifications for any such change (see section 103(d)
of ERISA). Label the summary ``Schedule MB, Line 6--Summary of Plan
Provisions.''
Line 6a. Current Liability Interest Rate. Enter the interest
rate used to determine current liability. The interest rate used
must be in accordance with the guidelines issued by the IRS and,
pursuant to PPA, must not be more than 5 percent above and must not
be more than 10 percent below the weighted average of the rates of
interest, as set forth by the Treasury Department, on 30-year
Treasury securities during the 4-year period ending on the last day
before the beginning of the 20XX plan year. Enter the rate to the
nearest .01 percent.
Line 6b. Check ``Yes,'' if the rates in the contract were used
(e.g., purchase rates at retirement).
Line 6c. Mortality Table. The mortality table published in
section 1.431(c)(6)-1 of the Treasury Regulations must be used in
the calculation of current liability for non-disabled lives. Enter
the mortality table code for non-disabled lives used for valuation
purposes as follows:
------------------------------------------------------------------------
Mortality Table Code
------------------------------------------------------------------------
1951 Group Annuity.............................................. 1
1971 Group Annuity Mortality (G.A.M.)........................... 2
1971 Individual Annuity Mortality (I.A.M.)...................... 3
UP-1984......................................................... 4
1983 I.A.M...................................................... 5
1983 G.A.M...................................................... 6
1983 G.A.M. (solely per Rev. Rul. 95-28)........................ 7
UP-1994......................................................... 8
Mortality table applicable to current plan year under section 9
1.431(c)(6)-1 of the Income Tax Regulations....................
RP-2000......................................................... 10
RP-2000 (with Blue Collar Adjustment)........................... 11
Other........................................................... A
None............................................................ 0
------------------------------------------------------------------------
Code 6 includes all sex-distinct versions of the 1983 G.A.M.
table other than the table published in Rev. Rul. 95-28, 1995-1 C.B.
74. Thus, for example, Code 6 also would include the 1983 G.A.M.
male-only table used for males, where the 1983 G.A.M. male-only
table with a 6-year setback is used for females. Code A includes
mortality tables other than those listed in Codes 1 through 9,
including any unisex version of the 1983 G.A.M. table.
Where an indicated table consists of separate tables for males
and females, add F to the female table (e.g., 1F). When a projection
is used with a table, follow the code with ``P'' and the year of
projection (omit the year if the projection is unrelated to a single
calendar year); the identity of the projection scale should be
omitted. When an age setback or set forward is used, indicate with
``-'' or ``+'' and the number of years. For example, if for females
the 1951 Group Annuity Table with Projection C to 1971 is used with
a 5-year setback, enter ``1P71-5.'' If the table is not one of those
listed, enter ``A'' with no further notation. If the valuation
assumes a maturity value to provide the post-retirement income
without separately identifying the mortality, interest and expense
elements, enter on Line 6c, under ``Post-retirement,'' the value of
$1.00 of monthly pension beginning at the plan's weighted average
retirement age, assuming the normal form of annuity for an unmarried
person. In such a case, leave Lines 6d and 6e blank.
Line 6d. Valuation Liability Interest Rate. Enter the assumption
as to the expected interest rate (investment return) used to
determine all the calculated values except for current liability. If
the assumed rate varies with the year, enter the weighted average of
the assumed rate for 20 years following the valuation date. Enter
rates to the nearest .01 percent.
Line 6e. Expense Loading. If there is no expense loading, check
the ``N/A'' boxes under ``Pre-retirement'' and ``Post-retirement''.
For instance, there would be no expense loading attributable to
investments if the rate of investment return on assets is adjusted
to take investment expenses into account. If there is a single
expense loading not separately identified as pre-retirement or post-
retirement, enter it under ``Pre-retirement'' and check the ``N/A''
box under ``Post-Retirement.'' Where expenses are assumed other than
as a percentage of plan costs or liabilities, enter the assumed pre-
retirement expense as a percentage of the plan's normal cost, and
enter the post-retirement expense as a percentage of plan
liabilities. If the normal cost of the plan is zero, enter the
assumed pre-retirement expense as a percentage of the sum of Lines
9c(1), 9c(2), and 9c(3), minus Line 9h. Enter rates to the nearest
.1 percent.
Line 6f. Salary Scale. If a uniform level annual rate of salary
increase is used, enter that annual rate. Otherwise, enter the level
annual rate of salary increase that is equivalent to the rate(s) of
salary increase used. Enter the annual rate as a percentage to the
nearest .01 percent, used for a participant from age 25 to assumed
retirement age. If the plan's benefit formula is not related to
compensation, check the ``N/A'' box.
Line 6g. Estimated Investment Return--Actuarial Value. Enter on
Line 6g(1) the estimated rate of return on the actuarial value of
plan assets for the 1-year period ending on the valuation date. For
this purpose, the rate of return is determined by using the formula
2I/(A + B-I), where I is the dollar amount of the investment return
under the asset valuation method used for the plan, A is the
actuarial value of the assets one year ago, and B is the actuarial
value of the assets on the current valuation date. Enter rates to
the nearest .1 percent. If entering a negative number, enter a minus
sign (``-'') to the left of the number.
Note. Use the above formula even if the actuary feels that the
result of using the formula does not represent the true estimated
rate of return on the actuarial value of plan assets for the 1-year
period ending on the valuation date. The actuary may attach a
statement showing both the actuary's estimate of the rate of return
and the actuary's calculations of that rate, and label the statement
``Schedule MB, Line 6g--Estimated Rate of Investment Return
(Actuarial Value).'' Check the box on Line 6g(2) if a statement is
attached.
Line 6h. Estimated Investment Return--Current (Market) Value.
Enter on Line 6h(1)
[[Page 47641]]
the estimated rate of return on the current value of plan assets for
the 1-year period ending on the valuation date. (The current value
is the same as the fair market value--see Line 1b(1) instructions.)
For this purpose, the rate of return is determined by using the
formula 2I/(A + B-I), where I is the dollar amount of the investment
return, A is the current value of the assets one year ago, and B is
the current value of the assets on the current valuation date. Enter
rates to the nearest .1 percent. If entering a negative number,
enter a minus sign (``-'') to the left of the number.
Note. Use the above formula even if the actuary feels that the
result of using the formula does not represent the true estimated
rate of return on the current value of plan assets for the 1-year
period ending on the valuation date. The actuary may attach a
statement showing both the actuary's estimate of the rate of return
and the actuary's calculations of that rate, and label the statement
``Schedule MB, Line 6h--Estimated Rate of Investment Return (Current
Value).'' Check the box on Line 6h(2) if a statement is attached.
Line 7. Schedule of Amortization Bases Established. List all
amortization bases established in the current or prior plan years
that have an outstanding balance as of the valuation date for the
current plan year. Use the following table to indicate the type of
base established and enter the appropriate code under ``Type of
base.'' List amortization bases and charges and/or credits as of the
valuation date. Bases that are considered fully amortized because
there is a credit for the plan year on Line 9j(3) should be listed.
If entering a negative number, enter a minus sign (``-'') to the
left of the number.
Code Type of Amortization Base
1 Experience gain or loss
2 Shortfall gain or loss
3 Change in unfunded liability due to plan amendment
4 Change in unfunded liability due to change in actuarial
assumptions
5 Change in unfunded liability due to change in actuarial cost
method
6 Waiver of the minimum funding standard
7 Initial unfunded liability (for new plan)
Line 8a and 8d. Funding Waivers or Extensions. If a funding
waiver or extension request is approved after the Schedule MB is
filed, an amended Schedule MB must be filed with Form 5500 to report
the waiver or extension approval (also see instructions for Line
9k(1)).
Line 8b(1)(a). Schedule of Projection of Expected Benefit
Payments. Check ``Yes'' only if this is a multiemployer plan covered
by Title IV of ERISA that has 500 or more total participants as of
the valuation date.
Line 8b(1)(b). If Line 8b(1)(a) is ``Yes,'' on Line 8b(1)(b),
provide a projection of benefits expected to be paid for the entire
plan (not to include expected expenses) in each of the next ten
years starting with the current plan year of this filing assuming
(1) no additional accruals, (2) experience (e.g., termination,
mortality, and retirement) are in line with valuation assumptions,
and (3) no new entrants are covered by the plan.
Line 8b(2)(a). Schedule of Active Participant Data. Check
``Yes'' on Line 8b(2)(a) only if this is a multiemployer plan
covered by Title IV of ERISA that has active participants. If Line
8(2)(a) is ``Yes,'' complete the schedule in Line 8b(2)(b) with the
active plan participant data used in the valuation for this plan
year and enter the average age and average credited service of the
active participants as of the valuation date on Lines 8b(2)(c) and
8b(2)(d), respectively.
Include all active participants in the averages, even ones that
are not required to be shown in the schedule under the instructions
below.
For each column, enter the number of active participants with
the specified number of years of credited service divided according
to age group. For participants with partial years of credited
service, round the total number of years of credited service to the
next lower whole number. Years of credited service are the years
credited under the plan's benefit formula.
Plans reporting 1,000 or more active participants on Line
2b(3)(c), column (1), and using compensation to determine benefits,
must also provide average compensation data. For each grouping,
enter the average compensation of the active participants in that
group. For this purpose, compensation is the compensation taken into
account for each participant under the plan's benefit formula,
limited to the amount defined under section 401(a)(17) of the Code.
Do not enter the average compensation in any grouping that contains
fewer than 20 participants.
Cash balance plans (or any similar plans) reporting 1,000 or
more active participants on Line 2b(3)(c), column (1), must also
provide average cash balance account data, regardless of whether all
active participants have cash balance accounts. For each age/service
bin, enter the average cash balance account of the active
participants in that bin. Do not enter the average cash balance
account in any age/service bin that contains fewer than 20 active
participants.
General Rule. In general, data to be shown in each age/service
bin includes:
1. the number of active participants in the age/service bin,
2. the average compensation of the active participants in the
age/service bin, and
3. the average cash balance account of the active participants
in the age/service bin, using $0 for anyone who has no cash balance
account-based benefit.
If the accrued benefit is the greater of a cash balance benefit
or some other benefit, average in only the cash balance account. If
the accrued benefit is the sum of a cash balance account benefit and
some other benefit, average in only the cash balance account. For
both the average compensation and the average cash balance account,
do not enter an amount for age/service bins with fewer than 20
active participants.
In lieu of the above, two alternatives are provided for showing
compensation and cash balance accounts. Each alternative provides
for two age/service scatters (one showing compensation and one
showing cash balance accounts) as follows:
Alternative A:
Scatter 1--Provide participant count and average
compensation for all active participants, whether or not
participants have account-based benefits.
Scatter 2--Provide participant count and average cash
balance account for all active participants, whether or not
participants have account-based benefits.
Alternative B:
Scatter 1--Provide participant count and average
compensation for all active participants, whether or not
participants have account-based benefits (i.e., identical to Scatter
1 in Alternative A).
Scatter 2--Provide participant count and average cash
balance account for only those active participants with account
based benefits. If the number of participants with account-based
benefits in a bin is fewer than 20, the average account should not
be shown even if there are more than 20 active participants in this
bin on Scatter 1.
In general, information should be determined as of the valuation
date. Average cash balance accounts may be determined as of either:
1. the valuation date or
2. the day immediately preceding the valuation date.
Average cash balance accounts that are offset by amounts from
another plan may be reported either as amounts prior to taking into
account the offset or as amounts after taking into account the
offset. Do not report the offset amount. For this or any other
unusual or unique situation, the attachment should include an
explanation of what is being provided.
Line 8b(3)(a). Schedule of Retired Participants and
Beneficiaries Receiving Payment Data. Check ``Yes'' only if this is
a multiemployer plan covered by Title IV of ERISA that has retired
participants and beneficiaries. If Line 8b(3)(a) is ``Yes,''
complete the schedule in Line 8b(3)(b) with the retired plan
participant and beneficiaries receiving payment data used in the
valuation for this plan year and enter the average age and average
in-pay annual benefit as of the valuation date of the retired
participants and beneficiaries on Lines 8b(3)(c) and 8b(3)(d),
respectively. Do not report average annual in-pay benefit
information for age brackets where there are 10 or less retired
participants and beneficiaries receiving payment in the average.
Line 8b(4)(a). Schedule of Terminated Vested Participant Data.
Check ``Yes'' only if this is a multiemployer plan covered by Title
IV of ERISA that has terminated vested participants. If Line
8b(4)(a) is ``Yes,'' complete the schedule in Line 8b(4)(b) with the
terminated vested participant data used in the valuation for this
plan year and enter the average age and average annual benefit as of
the valuation date of the terminated vested participants in Line
8b(4)(c) and 8b(4)(d), respectively. Do not report average annual
benefit information for age brackets where there are 10 or less
terminated vested participants in the average. Include the assumed
form of payment and the assumed first age of payment in Lines
8b(4)(e) and 8b(4)(f), respectively, for the benefit amounts shown
in the schedule.
Line 9. Shortfall Method. Under the shortfall method of funding,
the normal cost in the funding standard account is the charge
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per unit of production (or per unit of service) multiplied by the
actual number of units of production (or units of service) that
occurred during the plan year. Each amortization installment in the
funding standard account is similarly calculated.
Line 9c. Amortization Charges. The outstanding balance and
amortization charges and credits must be calculated as of the
valuation date for the plan year. Line 9c(3) should only include
information related to the amortization bases extended and amortized
using the interest rate under section 6621(b) of the Code.
Line 9d. Interest as Applicable. Interest as applicable should
be charged to the last day of the plan year.
Line 9f. Note that the credit balance or funding deficiency at
the end of ``Year X'' should be equal to the credit balance or
funding deficiency at the beginning of ``Year X+1.'' If such credit
balances or funding deficiencies are not equal, check the box on
Line 9f(2), attach an explanation and label the attachment
``Schedule MB, Line 9f--Explanation of Prior Year Credit Balance/
Funding Deficiency Discrepancy.'' For example, if the difference is
because contributions for a prior year that were not previously
reported are received this plan year, attach a listing of the
amounts and dates of such contributions. As another example, if the
difference is due to the application of funding relief under the
Preservation of Access to Care for Medicare Beneficiaries and
Pension Relief Act of 2010 (PRA 2010), Pub. L. 111-192, the
attachment should show how the information on the Schedule MB filed
for any previous plan year would have differed if it had reflected
application of the special funding relief in accordance with
published guidance (to the extent that the plan sponsor has applied
the special funding relief).
Line 9h. Amortization Credits. The outstanding balance and
amortization credits must be calculated as of the valuation date.
Line 9j(1). ERISA Full Funding Limitation. Instructions for this
line are reserved pending published guidance.
Line 9j(2). ``RPA '94'' Override. Instructions for this line are
reserved pending published guidance.
Line 9j(3). Full Funding Credit. Enter the excess of (1) the
accumulated funding deficiency, disregarding the credit balance and
contributions for the current year, if any, over (2) the greater of
Lines 9j(1) or 9j(2).
Line 9k(1). Waived Funding Deficiency Credit. Enter a credit for
a waived funding deficiency for the current plan year (Code section
431(b)(3)(C)). If a waiver of a funding deficiency is pending,
report a funding deficiency. If the waiver is granted after Form
5500 or Form 5500-SF is filed, file an amended Form 5500 or Form
5500-SF, as applicable, with an amended Schedule MB to report the
funding waiver (see Amended Return/Report in the instructions for
Form 5500 or Line B--Box for Amended Return/Report in the
instructions for Form 5500-SF, as applicable).
Line 9k(2). Other Credits. Enter a credit in the case of a plan
for which the accumulated funding deficiency is determined under the
funding standard account if such plan year follows a plan year for
which such deficiency was determined under the alternative minimum
funding standard.
Line 9o. Reconciliation Account. The reconciliation account is
made up of those components that upset the balance equation of
Treasury Regulations section 1.412(c)(3)-1(b). Valuation assets must
not be adjusted by the reconciliation account balance when computing
the required minimum funding.
Line 9o(1). This amount is equal to the prior year's accumulated
reconciliation amount due to prior waived funding deficiencies,
increased with interest at the valuation rate to the current
valuation date.
Line 9o(2)(a). If an amortization extension is being amortized
at an interest rate that differs from the valuation rate, enter the
prior year's ``reconciliation amortization extension outstanding
balance,'' increased with interest at the valuation interest rate to
the current valuation date, and decreased by the year end
amortization amount based on the amortization interest rate from the
prior plan year.
Line 9o(3). Enter the sum of Lines 9o(1) and 9o(2)(b) (each
adjusted with interest at the valuation rate to the current
valuation date, if necessary).
Note. The net outstanding balance of amortization charges and
credits minus the prior year's credit balance minus the amount on
Line 9o(3) (each adjusted with interest at the valuation rate, if
necessary) must equal the unfunded liability.
Line 10. Contribution Necessary to Avoid Deficiency. Enter the
amount from Line 9n. If applicable, file IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit Plans, with the IRS to pay
the excise tax on the funding deficiency. There is a penalty for not
filing the Form 5330 on time.
Line 11. In accordance with ERISA section 103(d)(3), attach a
justification for any change in actuarial assumptions for the
current plan year and label the attachment--``Schedule MB, Line 11--
Justification for Change in Actuarial Assumptions.''
20XX Instructions for Schedule R (Form 5500) (Retirement Plan
Information)
General Instructions
Purpose of Schedule
Schedule R (Form 5500) reports certain information on retirement
plan distributions, funding, nondiscrimination, coverage, and the
adoption of amendments, as well as certain information on single-
employer and multiemployer defined benefit pension plans.
Electronic Attachments. All attachments to Schedule R must be
properly identified, must include the name of the plan, plan
sponsor's EIN, and plan number. Place ``Schedule R'' and the
Schedule R line number at the top of each attachment to identify the
information to which the attachment relates. Do not include
attachments that contain a visible social security number. The
Schedule R and its attachments are open to public inspection, and
the contents are subject to publication on the Internet. Because of
privacy concerns, the inclusion of a visible social security number
or any portion thereof on an attachment may result in the rejection
of the filing.
Who Must File
Schedule R must be attached to a Form 5500 filed for both tax-
qualified and nonqualified pension benefit plans. The parts of
Schedule R that must be completed depend on whether the plan is
subject to the minimum funding standards of Code section 412 or
ERISA section 302 and the type of plan. See line item requirements
under Specific Instructions for more details.
Exceptions: Schedule R should not be completed when the Form
5500 Annual Return/Report is filed for a pension plan that uses, as
the sole funding vehicle for providing benefits, individual
retirement accounts or annuities (as described in Code section 408).
See the Form 5500 Annual Return/Report instructions for Limited
Pension Plan Reporting for more information.
Check the Schedule R box on the Form 5500 (Part II, Line 10a(1))
if a Schedule R is attached to the Form 5500.
Specific Instructions
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule R is
attached.
Do not use a social security number in Line D instead of an EIN.
Schedule R and its attachments are open to public inspection, and
the contents are public information and are subject to publication
on the Internet. Because of privacy concerns, the inclusion of a
social security number or any portion thereof on Schedule R or any
of its attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement. The
EBSA does not issue EINs.
``Participant'' for purposes of Schedule R, means any present or
former employee who at any time during the plan year had an accrued
benefit in the plan (account balance in a defined contribution
pension plan).
Part I--Distributions
``Distribution'' includes only payments of benefits during the
plan year, in cash, in kind, by purchase for the distributee of an
annuity contract from an insurance company, or by distribution of
life insurance contracts. It does not include:
1. Corrective distributions of excess deferrals, excess
contributions, or excess aggregate contributions, or the income
allocable to any of these amounts;
2. Distributions of automatic contributions pursuant to Code
section 414(w);
3. The distribution of elective deferrals or the return of
employee contributions to correct excess annual additions under Code
section 415, or the gains attributable to these amounts; and
4. A loan deemed as a distribution under Code section 72(p).
Note. It does, however, include a distribution of a plan loan
offset amount as defined in Treasury Regulations section 1.402(c)-2,
Q&A 9(b).
Line 1. Enter the total value of all distributions made during
the year
[[Page 47643]]
(regardless of when the distribution began) in any form other than
cash, annuity contracts issued by an insurance company, distribution
of life insurance contracts, marketable securities within the
meaning of Code section 731(c)(2), or plan loan offset amounts. Do
not include eligible rollover distributions paid directly to
eligible retirement plans in a direct rollover under Code section
401(a)(31) unless such direct rollovers include property other than
that enumerated in the preceding sentence.
Line 2. Enter the EIN(s) of any payor(s) (other than the plan
sponsor or plan administrator on Line 2b or 3b of the Form 5500) who
paid benefits reportable on IRS Form 1099-R on behalf of the plan to
participants or beneficiaries during the plan year. This is the EIN
that appears on the IRS Forms 1099-R that are issued to report the
payments. Include the EIN of the trust if different than that of the
sponsor or plan administrator. If more than two payors made such
payments during the year, enter the EINs of the two payors who paid
the greatest dollar amounts during the year. For purposes of this
Line 2, take into account all payments made during the plan year, in
cash or in kind, that are reportable on IRS Form 1099-R, regardless
of when the payments began, but take into account payments from an
insurance company under an annuity only in the year the contract was
purchased.
Line 3. Enter in the appropriate location, broken out by active,
terminated vested, and retired, the number of living or deceased
participants whose benefits under the plan were distributed during
the plan year in the form of a single-sum distribution, either as an
annuity or a lump sum. For this purpose, a distribution of a
participant's benefits will not fail to be a single-sum distribution
merely because, after the date of the distribution, the plan makes a
supplemental distribution as a result of earnings or other
adjustments made after the date of the single-sum distribution. Also
include any participants whose benefits were distributed in the form
of a direct rollover to the trustee or custodian of a qualified plan
or individual retirement account. Profit-sharing plans, ESOPs, and
stock bonus plans skip Line 3.
Line 4. Check ``Yes'' if the required minimum distributions were
made to 5% owners who attained age 70\1/2\ and older. Required
Minimum Distributions (RMDs) generally are minimum amounts that a
retirement plan account owner must withdraw annually starting with
the year that he or she reaches 70\1/2\ years of age or, if later,
the year in which he or she retires. However, if the account owner
is a 5% owner of the business sponsoring the retirement plan, the
RMDs must begin once the account holder is age 70\1/2\, regardless
of whether he or she is retired.
Note. You must complete Line 4 if you are required to file at
least 250 returns of any type with the IRS during the calendar year.
However, if you are a small filer (files fewer than 250 returns of
any type with the IRS including information returns (for example,
Forms W-2 and Forms 1099), income tax returns, employment tax
returns, and excise tax returns during the calendar year), and you
do not complete this line, then you must file the paper Form 5500-
SUP with the IRS. See Instructions for Form 5500-SUP for more
information.
Part II--Funding Information
Complete Part II only if the plan is subject to the minimum
funding requirements of Code section 412 or ERISA section 302.
All qualified defined benefit and defined contribution pension
plans are subject to the minimum funding requirements of Code
section 412 unless they are described in the exceptions listed under
Code section 412(e)(2). These exceptions include profit- sharing or
stock bonus plans, insurance contract plans described in Code
section 412(e)(3), and certain plans to which no employer
contributions are made.
Nonqualified employee pension benefit plans are subject to the
minimum funding requirements of ERISA section 302 unless
specifically exempted under ERISA sections 4(a) or 301(a). The
employer or plan administrator of a single-employer or multiple-
employer defined benefit pension plan that is subject to the minimum
funding requirements must file Schedule SB as an attachment to Form
5500. Schedule MB is filed for multiemployer defined benefit pension
plans and certain money purchase defined contribution pension plans
(whether they are single-employer or multiemployer plans). However,
Schedule MB is not required to be filed for a money purchase defined
contribution pension plan that is subject to the minimum funding
requirements unless the plan is currently amortizing a waiver of the
minimum funding requirements.
Line 5. Check ``Yes'' if, for purposes of computing the minimum
funding requirements for the plan year, the plan administrator is
making an election intended to satisfy the requirements of Code
section 412(d)(2) or ERISA section 302(d)(2). Under Code section
412(d)(2) and ERISA section 302(d)(2), a plan administrator may
elect to have any amendment, adopted after the close of the plan
year for which it applies, treated as having been made on the first
day of the plan year if all of the following requirements are met:
1. The amendment is adopted no later than two and one-half
months (two years for a multiemployer plan) after the close of such
plan year;
2. The amendment does not reduce the accrued benefit of any
participant determined as of the beginning of such plan year; and
3. The amendment does not reduce the accrued benefit of any
participant determined as of the adoption of the amendment unless
the plan administrator notified the Secretary of the Treasury of the
amendment and the Secretary either approved the amendment or failed
to disapprove the amendment within 90 days after the date the notice
was filed. See Treasury Temporary Regulations section 11.412(c)-7(b)
for details on when and how to make the election and what
information to include on the statement of election, which must be
filed with the Form 5500 Annual Return/Report.
Line 6. If a money purchase defined contribution pension plan
(including a target benefit plan) has received a waiver of the
minimum funding standard, and the waiver is currently being
amortized, complete Lines 3, 9, and 10 of Schedule MB. See
instructions for Schedule MB. Attach Schedule MB to Form 5500. The
Schedule MB for a money purchase defined contribution pension plan
does not need to be signed by an enrolled actuary.
Line 7a. The minimum required contribution for a money purchase
defined contribution pension plan (including a target benefit plan)
for a plan year is the amount required to be contributed for the
year under the formula set forth in the plan document. If there is
an accumulated funding deficiency for a prior year that has not been
waived, that amount should also be included as part of the
contribution required for the current year.
Line 7b. Include all contributions for the plan year made not
later than 8\1/2\ months after the end of the plan year. Show only
contributions actually made to the plan by the date the form is
filed. For example, do not include receivable contributions for this
purpose.
Line 7c. If the minimum required contribution exceeds the
contributions for the plan year made not later than 8\1/2\ months
after the end of the plan year, the excess is an accumulated funding
deficiency for the plan year. File IRS Form 5330, Return of Excise
Taxes Related to Employee Benefit Plans, with the IRS to pay the
excise tax on the deficiency. There is a penalty for not filing IRS
Form 5330 on time.
Line 8. Check ``Yes'' if the minimum required contribution
remaining in Line 7c will be made not later than 8\1/2\ months after
the end of the plan year. If ``Yes,'' and contributions are actually
made by this date, then there will be no reportable deficiency and
IRS Form 5330 will not need to be filed.
Line 9. Revenue Procedure 2000-40, 2000-2 C.B. 357, providing
for automatic approval for a change in funding method for a plan
year, generally does not apply unless the plan administrator or an
authorized representative of the plan sponsor explicitly agrees to
the change. If a change in funding method made pursuant to such a
revenue procedure (or a class ruling letter) is to be applicable for
the current plan year, this line generally must be checked ``Yes.''
In certain situations, however, the requirement that the plan
administrator or an authorized representative of the plan sponsor
agree to the change in funding method will be satisfied if the plan
administrator or an authorized representative of the plan sponsor is
made aware of the change.
In these situations, this line must be checked ``N/A.'' See
section 6.01(2) of Rev. Proc. 2000-40. If the plan's change in
funding method is not made pursuant to a revenue procedure or other
authority providing automatic approval which requires plan sponsor
agreement, or to a class ruling letter (e.g., it is pursuant to a
regulation or the Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act of 2010 (PRA 2010), Pub. L.
111-192), then this line should be checked ``N/A.''
Part III--Determination and Amendments
Line 10. If this is a defined benefit pension plan, indicate as
follows whether there were
[[Page 47644]]
any amendments adopted during this plan year that increased or
decreased the value of benefits:
Check ``No'' if no amendments were adopted during this
plan year that increased or decreased the value of benefits.
Check ``Increase'' if an amendment was adopted during
the plan year that increased the value of benefits in any way. This
includes an amendment providing for an increase in the amount of
benefits or rate of accrual, more generous lump sum factors, COLAs,
more rapid vesting, additional payment forms, or earlier eligibility
for some benefits.
Check ``Decrease'' if an amendment was adopted during
the plan year that decreased the value of benefits in any way. This
includes a decrease in future accruals, closure of the plan to new
employees, or accruals being frozen for some or all participants.
If the amendments that were adopted increased the value
of some benefits but decreased the value of others, check ``Both.''
Line 11a. If a plan sponsor or an employer adopted a pre-
approved plan that includes a master & prototype plan (a
standardized or nonstandardized M&P) or a volume submitter plan,
enter the date of the most recent favorable opinion or advisory
letter issued by the IRS and the serial number listed on that
favorable letter.
Line 11b. If it is an individually-designed plan and received a
favorable determination letter from the IRS, enter the date of the
most recent determination letter. Leave it blank if this individual-
designed plan has never received a favorable determination letter.
Part IV--Additional Employer Information for Multiemployer Defined
Benefit Pension Plans
If this is not a multiemployer plan, skip this Part.
Required attachments. Multiemployer defined benefit pension
plans that are in Endangered Status or Critical Status must attach a
summary of their Funding Improvement Plan or Rehabilitation Plan (as
updated, if applicable) and also any update to a Funding Improvement
Plan or Rehabilitation Plan.
The summary of any Funding Improvement Plan or Rehabilitation
Plan must reflect such plan in effect at the end of the plan year
(whether the original Funding Improvement Plan or Rehabilitation
Plan or as updated) and must include a description of the various
contribution and benefit schedules that are being provided to the
bargaining parties and any other actions taken in connection with
the Funding Improvement Plan or Rehabilitation Plan, such as use of
the shortfall funding method or extension of an amortization period.
The summary must also identify the first year and the last year of
the Funding Improvement Period or the Rehabilitation Period. If an
extended Funding Improvement Period (of 13 or 18 years) or
Rehabilitation Period (of 13 years) applies because of an election
under section 205 of the Worker, Retiree, and Employer Recovery Act
of 2008 (``WRERA''), the summary must include a statement to that
effect and the date that the election was filed with the IRS.
The summary must also include a schedule of the expected annual
progress for the funded percentage or other relevant factors under
the Funding Improvement Plan or Rehabilitation Plan. If the sponsor
of a multiemployer plan in Critical Status has determined that,
based on reasonable actuarial assumptions and upon exhaustion of all
reasonable measures, the plan cannot emerge from Critical Status by
the end of the Rehabilitation Period as described in Code section
432(e)(3)(A)(ii), the summary must include an explanation of the
alternatives considered, why the plan is not reasonably expected to
emerge from Critical Status by the end of the Rehabilitation Period,
and when, if ever, it is expected to emerge from Critical Status
under the Rehabilitation Plan.
The plan sponsor is required to annually update a Funding
Improvement Plan or Rehabilitation Plan that was adopted in a prior
year. The update must be filed as an attachment to the Schedule R.
The update attachment must identify the modifications made to the
Funding Improvement Plan or Rehabilitation Plan during the plan
year, including contribution increases, benefit reductions, or other
actions.
The attachment described above must be labeled ``Schedule R,
Summary of Funding Improvement Plan,'' or ``Schedule R, Summary of
Rehabilitation Plan'' as appropriate, and if applicable, ``Schedule
R, Update of Funding Improvement Plan or Rehabilitation Plan.'' Each
attachment must also include the plan name, the plan sponsor's name
and EIN, and the plan number.
Line 12. This line should be completed only by multiemployer
defined benefit pension plans that are subject to the minimum
funding standards (see Code section 412 and Part 3 of Title I of
ERISA). Enter the information on Lines 13a through 13e for any
employer that contributed more than five (5) percent of the plan's
total contributions for the 20XX plan year. List employers in
descending order according to the dollar amount of their
contributions to the plan. Complete as many entries as are necessary
to list all employers that contributed more than five (5) percent of
the plan's contributions.
Line 12a. Enter the name of the employer contributing to the
plan.
Line 12b. Enter the EIN of the employer contributing to the
plan. Do not enter a social security number in lieu of an EIN;
therefore, ensure that you have the employer's EIN and not a social
security number. The Form 5500 Annual Return/Report is open to
public inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy concerns,
the inclusion of a social security number or any portion thereof on
this line may result in the rejection of the filing.
EINs can be obtained from the IRS online, by telephone, by fax,
or by mail depending on when you need to use the EIN. For more
information, see Section 3: Electronic Filing Requirement. The EBSA
does not issue EINs.
Line 12c. Dollar Amount Contributed. Enter the total dollar
amount contributed to the plan by the employer for all covered
workers in all locations for the plan year. Do not include the
portion of an aggregated contribution that is for another plan, such
as a welfare benefit plan, a defined contribution pension plan or
another defined benefit pension plan.
Line 12d. Collective Bargaining Agreement Expiration Date. Enter
the date on which the employer's collective bargaining agreement
expires. If the employer has more than one collective bargaining
agreement requiring contributions to the plan, check the box and
include, as an attachment, the expiration date of each collective
bargaining agreement (regardless of the amount of contributions
arising from such agreement). Label the attachment: ``Schedule R,
line 12d--Collective Bargaining Agreement Expiration Date.'' Include
the plan name and the sponsor's name and EIN.
Line 12e. Contribution Rate Information. Enter the contribution
rate (in dollars and cents) per contribution base unit in Line
12e(1) and the base unit measure in Line 12e(2). Indicate whether
the base unit is measured on an hourly, weekly, unit-of-production,
or other basis. If ``Other,'' specify the base unit measure used. If
the contribution rate changed during the plan year, enter the last
contribution rate in effect for the plan year.
If the employer has different contribution rates for different
classifications of employees or different places of business, check
the box in the first line of Line 12e and list in an attachment each
contribution rate and corresponding base unit measure under which
the employer made contributions (regardless of the amount of
contributions resulting from each rate). Label the attachment:
``Schedule R, Line 12e--Information on Contribution Rates and Base
Units.'' Include the plan name and the sponsor's name and EIN.
Line 13. Enter the number of participants on whose behalf no
contributions were made by an employer as an employer of the
participant. For purposes of Line 13, count only those participants
whose last contributing employer had withdrawn from the plan by the
beginning of the relevant plan year. Disregard any participants
whose employers had not withdrawn from the plan, even if, in the
relevant year, no contributions were made by the employer on behalf
of those participants. Thus, for the limited purposes of Line 13 and
notwithstanding any contrary definition of such participants
applicable elsewhere, the deferred vested and retired participants
of employers who have not withdrawn from the plan should not be
included in these numbers.
Note. Withdrawal liability payments are not to be treated as
contributions for the purpose of determining the number of
participants for Line 13.
Line 13a. Enter the number of participants for the 20XX plan
year described in the Line 13 instructions.
Line 13b. Enter the number of participants for the 20XX-1 plan
year described in the Line 13 instructions.
Line 13c. Enter the number of participants for the 20XX-2 plan
year described in the Line 13 instructions.
Line 14. Enter the ratio of number of participants on whose
behalf no employer
[[Page 47645]]
had an obligation to make a contribution for the 20XX plan year to
the corresponding number for each of the two preceding plan years.
For the purpose of these ratios, count all participants whose
employers have withdrawn from the plan as well as all deferred
vested and retired participants of employers still active in the
plan (unless the collective bargaining agreement specifically
requires the employer to make contributions for such participants).
Line 14a. Enter the ratio of the number of participants as
described in the Line 14 instructions for the 20XX plan year to the
number for the 20XX-1 plan year.
Line 14b. Enter the ratio of the number of participants as
described on the Line 14 instructions for the 20XX plan year to the
number for the 20XX-2 plan year.
Note. Withdrawal liability payments are not to be treated as
contributions for determining the number of participants on Line 14.
Line 15a. Enter the number of employers that withdrew from the
plan during the 20XX-1 plan year.
Line 15b. If Line 15a is greater than zero, enter the aggregate
amount of withdrawal liability assessed against these employers. If
the withdrawal liability for one or more withdrawing employers has
not yet been determined, include the amounts estimated to be
assessed against them in the aggregate amount.
The definitions of withdrawal are those contained in Section
4203 of ERISA. If the plan is in the building and construction,
entertainment, or another industry that has special withdrawal
rules, withdrawing employers should only be counted if the
withdrawal adheres to the special rules applying to its specific
industry.
Line 16. If assets and liabilities from another plan were
transferred to or merged with the assets and liabilities of this
plan during the 20XX plan year, check the box and provide the
following information as an attachment. The attachment should
include the names and employer identification numbers of all plans
that transferred assets and liabilities to, or merged with, this
plan. For each plan, including this plan, the attachment should also
include the actuarial valuation of the total assets and total
liabilities for the year preceding the transfer or merger, based on
the most recent data available as of the day before the first day of
the 20XX plan year. Label the attachment ``Schedule R, Line 16--
Information on Assets and Liabilities Transferred to or Merged with
This Plan'' and include the plan name and the plan sponsor's name
and EIN.
Part V--Additional Information for Single-Employer and Multiemployer
Defined Benefit Pension Plans
Line 17. If any liabilities to participants or their
beneficiaries under the plan at the end of the plan year consist of
liabilities under two (2) or more plans as of the last day of the
plan year immediately before the 20XX plan year, check the box and
provide the following information as an attachment. The attachment
should include the names, employer identification numbers, and plan
numbers of all plans, including the current plan, that provided a
portion of liabilities of the participants and beneficiaries in
question. The attachment should also include the funding percentage
of each plan as of the last day of the 20XX-1 plan year. For single-
employer plans, the funding percentage is the funding target
attainment percentage, where the numerator is the value of plan
assets reduced by the sum of the amount of the prefunding balance
and the funding standard carryover balance, and the denominator is
the funding target for the plan (for this purpose, if the plan is in
at risk status, then the funding target is determined as if the plan
were not in at risk status). For multiemployer plans, the funding
percentage is the ratio where the numerator is the actuarial value
of the plan's assets and the denominator is the accrued liability of
the plan. For a terminated plan for which the funding percentage is
required to be reported, write ``Terminated'' in the space where the
plan's funding percentage would otherwise have been reported. Label
the attachment ``Schedule R, Line 17--Funded Percentage of Plans
Contributing to the Liabilities of Plan Participants'' and include
the plan name and the plan sponsor's name and EIN.
Line 18. This line must be completed for all defined benefit
pension plans (except DFEs) with 1,000 or more participants at the
beginning of the plan year. To determine if the plan has 1,000 or
more participants, use the participant count shown on Line 3d(1) of
the Schedule SB for single-employer plans or on Line 2b(4)(1) of the
Schedule MB for multiemployer plans.
Line 18a. Show the beginning-of-year distribution of assets for
the categories shown. Use the market value of assets and do not
include the value of any receivables. These percentages, expressed
to the nearest whole percent, should reflect the total assets held
in stocks, investment-grade debt instruments, high-yield debt
instruments, real estate, or other asset classes, regardless of how
they are listed on the Schedule H. The percentages in the five
categories should sum to 100 percent. Assets held in trusts,
accounts, mutual funds, and other investment arrangements should be
disaggregated and properly distributed among the five asset
components. The assets in these trusts, accounts, mutual funds, and
investment arrangements should not be included in the ``Other''
component unless these investments contain no stocks, bonds, or real
estate holdings. The same methodology should be used in
disaggregating trust assets as is used when disclosing the
allocation of plan assets on the sponsor's 10-K filings to the
Securities and Exchange Commission. Real estate investment trusts
(REITs) should be listed with stocks, while real estate limited
partnerships should be included in the Real Estate category.
Investment-grade debt-instruments are those with an S&P rating
of BBB--or higher, a Moody's rating of Baa3 or higher, or an
equivalent rating from another rating agency. High-yield debt
instruments are those that have ratings below these rating levels.
If the debt does not have a rating, it should be included in the
``high-yield'' category if it does not have the backing of a
government entity. Unrated debt with the backing of a government
entity would generally be included in the ``investment-grade''
category unless it is generally accepted that the debt should be
considered as ``high-yield.'' Use the ratings in effect as of the
beginning of the plan year.
Line 18b. Check the box that shows the average duration of the
plan's combined investment-grade and high-yield debt portfolio. If
the average duration falls exactly on the boundary of two boxes,
check the box with the lower duration. To determine the average
duration, use the ``effective duration'' or any other generally
accepted measure of duration. Report the duration measure used in
Line 19c. If debt instruments are held in multiple debt portfolios,
report the weighted average of the average durations of the various
portfolios where the weights are the dollar values of the individual
portfolio.
Part VI Nondiscrimination and Coverage
Note. You must complete this part from Lines 19 through 21 if
you are required to file at least 250 returns of any type with the
IRS, including information returns (for example, Forms W-2 and Forms
1099), income tax returns, employment tax returns, and excise tax
returns, during the calendar year. However, if you are a small filer
(files fewer than 250 returns of any type with the IRS during the
calendar year), and you do not complete these lines, you must file
Form 5500-SUP with the IRS on paper. See the Treasury regulations on
``Employee Retirement Benefit Plan Returns Required on Magnetic
Media'' (See 79 FR 58256 at https://federalregister.gov/a/2014-23161)
and Instructions for Form 5500-SUP for more information.
19a. Check ``Yes'' if the plan includes a cash or deferred
arrangement (CODA), under which a covered employee may elect to have
the employer either contribute an amount to the plan's trust on
behalf of the employee or to pay the employee directly in cash or
some other taxable benefit. The contributions go into an individual
account, with the employee often choosing the investments based on
options provided under the plan. In some plans, the employer also
makes contributions, such as contributions that match the employee's
contributions up to a certain percentage.
Line 19b. If Line 19a is ``Yes,'' check the applicable method
used to satisfy the nondiscrimination requirements of Code section
401(k). A safe harbor 401(k) plan is similar to a traditional 401(k)
plan but, among other things, it must provide for employer
contributions. These contributions may be employer matching
contributions, limited to employees who defer, or employer
contributions made on behalf of all eligible employees, regardless
of whether they make elective deferrals. The safe harbor 401(k) plan
is not subject to the complex annual nondiscrimination tests that
apply to traditional 401(k) plans. Check ``Design-based safe harbor
method'' if this is a safe harbor 401(k) plan that is a SIMPLE
401(k) plan under Code section 401(k)(11), a safe harbor 401(k) plan
under Code section 401(k)(12), or a qualified automatic
[[Page 47646]]
contribution arrangement under Code section 401(k)(13).
If the plan, by its terms, does not satisfy the safe harbor
method, it generally must satisfy the regular nondiscrimination
test, known as the actual deferral percentage (ADP) test. Check the
appropriate box to indicate if the plan uses the ``current year''
ADP test or the ``prior year'' ADP test. Check ``current year'' ADP
test if the plan uses the current year testing method under which
the ADP test is performed by comparing the current plan year's ADP
for HCEs with the current plan year's (rather than the prior plan
year's) ADP for NHCEs. Check all boxes that apply for a plan that
tests different groups of employees on a disaggregated basis. Check
``N/A'' if the plan is not required to test for nondiscrimination
under Code section 401(k)(3), such as a plan in which no HCE is
benefiting.
Line 20a. Check the applicable testing method used to satisfy
the minimum coverage requirements under Code section 410(b). Check
``N/A'' if the plan is deemed to satisfy section 410(b)
automatically, such as a plan in which no HCE is benefitting. Check
all boxes that apply for a plan that tests different groups of
employees on a disaggregated basis.
Line 20b. Check ``Yes'' if this plan was permissively aggregated
with another plan to satisfy requirements under Code sections 410(b)
and 401(a)(4). Generally, each single plan must separately satisfy
the coverage and nondiscrimination requirements. However, an
employer may designate two or more separate plans as a single plan
for purposes of applying the ratio percentage test of Treasury
Regulations section 1.410(b)-2(b)(2) or the nondiscretionary
classification test of Treasury Regulations section 1.401(b)-4. Two
or more plans that are permissively aggregated and treated as a
single plan for purposes of the minimum coverage test of Code
section 410(b) must also be treated as a single plan for purpose of
the nondiscrimination test under Code section 401(a)(4). See
Treasury Regulations sections 1.410(b)-7 and 1.401(a)(4)-(9) for
more information.
Line 21. Check ``Yes'' if the plan does not satisfy any
exceptions under Treasury Regulation section 1.401(a)26)-1(b) if it
benefitted at least the lesser of: 50 employees of the employer, or
the greater of: 40 percent of all employees of the employer, or 2
employees (or if there is only 1 employee, such employer). The
definition of employer includes all related employers under Code
sections 414(b), (c) or (m). In performing the participation tests,
the employees who are excludable are generally the same as those who
are excludable for purposes of performing coverage tests under Code
section 410(b), see Treasury Regulation section 1.401(a)(26)-6. In
addition, for most plans the definition of who is benefiting under
the plan for the purposes of the participation tests is the same as
the definition of benefiting employees for purposes of coverage
tests under Code section 410(b), see Treasury Regulation section
1.401(a)(26)-5.
Part VII Participation Information in Defined Contribution Pension
Plans
Line 22. Employer Contributions. Check ``Yes'' in Line 22a if
the employer provided contributions to the participant's defined
contribution pension account regardless of whether the participant
made any contributions. If ``Yes'' is checked in Line 22a, enter in
Line 22b the appropriate line the formula describing how the amount
of such employer contributions was determined. See formula examples
below.
Example 1: The employer provided 1.5% of compensation for each
participant. Check the ``% of a participant's compensation'' formula
and enter ``1.5'' in the corresponding amount line.
Example 2: The employer provided one flat dollar amount ($500)
to each participant. Check the ``$ per participant'' formula and
enter ``500'' in the corresponding amount line.
Example 3: The employer used a different kind of formula or
method. Check ``Other'' and enter a description in the text field.
Line 23. Employer Matching Contributions. If the plan offers
employer matching contributions, check ``Yes'' in Line 23a. If you
checked ``Yes'' in Line 23a, check the appropriate box in Line 23b
to identify the formula used to determine the amount of the employer
matching contribution for each participant. If the employer matches
participant contributions at a certain rate up to a limit, check ``%
of a participant's contribution up to a limit'' and enter the
percentage. In Line 23c, enter the maximum employer contribution by
checking the applicable box and providing either the percentage of a
participant's compensation or the dollar amount that corresponds to
the maximum. If the plan uses a different type of formula, check
``Other'' and describe the formula in the open text field. See
formula examples below.
Example 1: The employer provides a 50% match on participant
contributions of up to 6% of the participant's compensation. When
the participant is contributing at or above the maximum, the
employer contributes 3% of the participant's compensation. Check the
``% of a participant's contribution up to a limit'' formula and
enter ``50''. The maximum match that the employer will contribute is
``3''.
Example 2: The employer provides a 50% match on a participant's
contributions up to $3,000 contribution by the employee. At that
maximum level the employer would be contributing $1,500. Check the
``$ per participant'' formula and enter ``1500'' in the
corresponding amount line.
Example 3: The employer provides 100% match up to the first 3%
of employee's salary deferrals and 50% for the next 2%. Check the
``Other'' box and describe the formula in the open text field.
Line 24. Automatic Enrollment. Answer ``Yes'' in Line 24a if the
plan has automatic enrollment. If you answer ``Yes,'' enter the
default elective deferral as a percentage of a participant's
compensation in the first year after a participant is automatically
enrolled. In Line 24b, indicate whether the plan has automatic
escalation, assuming a participant has made no active elections. If
the plan has automatic escalation, indicate the maximum elective
deferral as a percentage of a participant's compensation. In Line
24c enter the number of participants that remain in the plan's
default investment account(s) and have not directed any assets into
other plan investments.
Line 25. Catch-up Contributions. Enter the number of
participants making catch-up contributions.
20XX Instructions for Schedule SB (Form 5500)--Single-Employer Defined
Benefit Plan Actuarial Information
General Instructions
Note. Final regulations under certain portions of Code section
430 (sections 430(d), 430(f), 430(g), 430(h), and 430(i)) and Code
section 436 (and the corresponding provisions of ERISA (sections
206(g) and 303)) were published in the Federal Register July 31,
2008, and October 15, 2009, and apply for plan years beginning on or
after January 1, 2010. Proposed regulations providing additional
rules under Code sections 430(a), 430(j) and 4971 (and the
corresponding provisions of ERISA (section 303)) were published in
the Federal Register on April 15, 2008. The final regulations that
relate to those proposed regulations have a later effective date
than the final regulations published October 15, 2009. With respect
to provisions for which the final regulations do not apply to a plan
for the plan year, plan sponsors must follow a reasonable
interpretation of the statute, taking into account the provisions of
the Worker, Retiree, and Employer Recovery Act of 2008 (``WRERA''),
Public Law 110-458, the Preservation of Access to Care for Medicare
Beneficiaries and Pension Relief Act of 2010 (``PRA 2010''), Public
Law 111-192, Moving Ahead for Progress in the 21st Century Act
(``MAP-21''), Public Law 112-141, and any other amendments to the
funding rules that are enacted. For this purpose, plan sponsors may
rely on the provisions of the proposed regulations or the final
regulations, as applicable, but must take into account the
provisions of WRERA, PRA 2010, MAP-21, any other amendments to the
funding rules that are enacted, and any applicable published
guidance.
Who Must File
As the first step, the plan administrator of any single-employer
defined benefit pension plan (including a multiple-employer defined
benefit pension plan) that is subject to the minimum funding
standards (see Code section 412 and Part 3 of Title I of ERISA) must
obtain a completed Schedule SB (including attachments) that is
prepared and signed by the plan's enrolled actuary as discussed
below in the Statement by Enrolled Actuary section. The plan
administrator must retain with the plan records the Schedule SB that
is prepared and signed by the plan's actuary. The electronic-
signature by the plan actuary is acceptable. The plan actuary can
access the EFAST2 Web site at www.efast.dol.gov to register for
electronic credentials to sign.
The plan administrator must ensure that the information from the
actuary's Schedule SB is entered electronically into the annual
[[Page 47647]]
return/report being submitted. When entering the information,
whether using EFAST2-approved software or EFAST2's web-based filing
system, all the fields required for the type of plan must be
completed (see instructions for fields that need to be completed).
Further, if a plan actuary chooses not to sign electronically,
then the actuary must manually sign the Schedule SB and an
electronic reproduction must be filed with the Form 5500. The plan
administrator of a single-employer defined benefit pension plan must
attach to the Form 5500 or Form 5500-SF an electronic reproduction
of the Schedule SB (including attachments) prepared and signed by
the plan's enrolled actuary. This electronic reproduction must be
labeled ``SB Actuary Signature'' and must be included as a Portable
Document Format (PDF) attachment or any alternative electronic
attachment allowable under EFAST2.
Note. The Schedule SB (Form 5500) does not have to be filed with
the Form 5500-EZ, but it must be retained (in accordance with the
Instructions for Form 5500-EZ under the What To File section).
Similarly, the Schedule SB does not have to be filed with the Form
5500-SF for a one-participant plan (as defined in the Form 5500-EZ
instructions) that is eligible for the Form 5500-SF and elects to
file such form instead of the Form 5500-EZ. However, the Schedule SB
must be retained in accordance with the Instructions for Form 5500-
SF under the section headed Specific Instructions Only for ``One-
Participant Plans.'' The enrolled actuary must complete and sign the
Schedule SB and forward it to the person responsible for filing the
Form 5500-EZ or Form 5500-SF, even if the Schedule SB is not filed.
Check the Schedule SB box on the Form 5500 (Part II, Line
10a(3)) if a Schedule SB is attached to Form 5500. Check ``Yes'' on
Line 11 in Part VI of the Form 5500-SF if a Schedule SB is required
to be prepared for the plan, even if Schedule SB is not required to
be attached to Form 5500-SF (see instructions in the Note above,
pertaining to ``one-participant plans'').
Note. This schedule is not filed for a multiemployer plan nor
for a money purchase defined contribution pension plan (including a
target benefit plan) for which a waiver of the minimum funding
requirements is currently being amortized. Information for these
plans must be filed using Schedule MB (Form 5500).
Specific Instructions
Lines A through F. Identifying Information. Lines A-F must be
completed for all plans. Lines A through D should include the same
information as reported in corresponding lines in Part II of the
Form 5500, Form 5500-SF, or Form 5500-EZ filed for the plan. You may
abbreviate the plan name (if necessary) to fit in the space
provided.
Do not use a social security number in line D instead of an EIN.
The Schedule SB and its attachments are open to public inspection if
filed with a Form 5500 or Form 5500-SF, and the contents are public
information and are generally subject to publication on the
Internet. Because of privacy concerns, the inclusion of a social
security number or any portion thereof on the Schedule SB or any of
its attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone, by
fax, or by mail depending on how soon you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement under
General Instructions to Form 5500. The EBSA does not issue EINs.
Line E. Type of Plan. Check the applicable box to indicate the
type of plan. A single-employer plan for this reporting purpose is
an employee benefit plan maintained by one employer or one employee
organization. A multiple-employer plan is a plan that is maintained
by more than one employer, but is not a multiemployer plan. (See the
Instructions for Form 5500, box A for additional information on the
definition of a multiemployer plan.)
1. Check ``Single'' if the Form 5500, Form 5500-SF, or Form
5500-EZ is filed for a single-employer plan (including a plan
maintained by more than one member of the same controlled group).
2. Check ``Multiple-A'' if the Form 5500 or Form 5500-SF is
being filed for a multiple-employer plan and the plan is subject to
the rules of Code section 413(c)(4)(A) (i.e., it is funded as if
each employer were maintaining a separate plan). This includes plans
established before January 1, 1989, for which an election was made
to fund in accordance with Code section 413(c)(4)(A).
3. Check ``Multiple-B'' if the Form 5500 or Form 5500-SF is
being filed for a multiple-employer plan and the plan is subject to
the rules of Code section 413(c)(4)(B) (i.e., it is funded as if all
participants were employed by a single employer).
If ``Multiple-A'' is checked, with the exception of Part III,
the data entered on Schedule SB should be the sum of the individual
amounts computed for each employer. The percentages reported in Part
III should be calculated based on the reported aggregate numbers
rather than by summing up the individual percentages. The Schedule
SB data for each employer's portion of the plan must be submitted as
an attachment. This is accomplished by completing and attaching a
Schedule SB for each employer or by attaching a document containing
that information (e.g., a table showing a row for each Schedule SB
data item and a column for each employer). Label the attachment
``Schedule SB--Information for Each Individual Employer.''
Line F. Prior Year Plan Size. Check the applicable box based on
the highest number of participants (both active and inactive) on any
day of the preceding plan year, taking into account participants in
all defined benefit pension plans maintained by the same employer
(or any member of such employer's controlled group) who are or were
also employees of that employer or member. For this purpose,
participants whose only defined benefit pension plan is a
multiemployer plan (as defined in Code section 414(f)) are not
counted, and participants who are covered in more than one of the
defined benefit pension plans described above are counted only once.
Inactive participants include vested terminated and retired
employees as well as beneficiaries of deceased participants. If this
is the first plan year that a plan described in this paragraph
exists, complete this line based on the highest number of
participants that the plan was reasonably expected to have on any
day during the first plan year.
General Instructions, Parts I through IX, Statement by Enrolled
Actuary, and Attachments
Except as noted below, Parts I through VIII must be completed
for all single and multiple-employer defined benefit pension plans,
regardless of size or type. See instructions for Line 31 for
additional information to be provided for certain plans with special
circumstances. Part IX is completed only for those plans for which
an alternative amortization schedule was elected under section
430(c)(2)(D) of the Code or section 303(c)(2)(D) of ERISA, as
amended by PRA 2010, and for those plans for which funding relief
was elected under section 107 of Pension Protection Act of 2006, as
added by PRA 2010.
The Pension Protection Act of 2006, as amended (PPA), provides
delayed effective dates for the funding rules under Code section 430
for plans meeting certain criteria (certain multiple-employer plans
maintained by eligible cooperative plans, and eligible charity
plans, as described in PPA section 104). Eligible plans to which
these delayed effective dates apply do not need to complete the
entire Schedule SB, but will have to file information relating to
pre-PPA calculations in an attachment using the 2007 Schedule B
form. See the instructions for Line 31 for more information about
which lines of Schedule SB need to be completed and what additional
attachments are required.
PPA provides funding relief for certain defined benefit pension
plans (other than multiemployer plans) maintained by a commercial
passenger airline or by an employer whose principal business is
providing catering services to a commercial passenger airline, based
on an alternative 17-year funding schedule. Plans using this funding
relief do not need to complete the entire Schedule SB, but are
required to provide supplemental information as an attachment to
Schedule SB. Alternatively, these plans can elect to apply the
funding rules generally applicable to single-employer defined
benefit pension plans, but amortize the funding shortfall over 10
years instead of the standard 7-year period and use a special
interest rate to determine the funding target. Plans using this 10-
year funding option must complete the entire Schedule SB and provide
additional information. See the instructions for Line 31 for more
information about which lines of Schedule SB need to be completed
and what additional attachments are required.
MAP-21 amended Code section 430(h)(2)(C) and ERISA section
302(h)(2)(C) to provide that, for certain purposes, each of the
three segment rates described in those sections is adjusted as
necessary to fall within a specified range that is determined based
on an average of the corresponding
[[Page 47648]]
segment rates for the 25-year period ending on September 30 of the
calendar year preceding the first day of the plan year. Accordingly,
if the funding target and target normal cost for a plan are
determined using these segment rates, the segment rates used to
determine the minimum required contribution and the adjusted funding
target attainment percentage (``AFTAP'') used to apply funding-based
benefit restrictions under Code section 436 and ERISA section 206(g)
may be different from those used for other purposes (such as the
segment rates used to determine the deductible limit under Code
section 404(o)). In such cases, report all information on Schedule
SB reflecting the assumptions used to determine the minimum required
contribution and the AFTAP used to apply funding-based benefit
restrictions.
Note. (1) For a plan funded with insurance (other than a plan
described in Code section 412(e)(3) or ERISA section 301(b)), refer
to section 1.430(d)-1(c)(2) of the Income Tax Regulations regarding
whether to include the liabilities for benefits covered under
insurance contracts held by the plan and whether to include the
value of the insurance contracts in plan assets. (2) For terminating
plans, Rev. Rul. 79-237, 1979-2 C.B. 190, provides that minimum
funding standards apply until the end of the plan year that includes
the termination date. Accordingly, the Schedule SB is not required
to be filed for any later plan year. However, if a termination fails
to occur--whether because assets remain in the plan's related trust
(see Rev. Rul. 89-87, 1989-2 C.B. 81) or for any other reason (e.g.,
the PBGC issues a notice of noncompliance pursuant to 29 CFR 4041.31
for a standard termination)--there is no termination date, and
therefore, minimum funding standards continue to apply and a
Schedule SB continues to be required.
Statement by Enrolled Actuary
An enrolled actuary must sign Schedule SB with either an
electronic signature or a handwritten signature. The electronic
signature of the enrolled actuary may be qualified to state that it
is subject to attached qualifications. See Treasury Regulations
section 301.6059-1(d) for permitted qualifications. If the actuary
has not fully reflected any final or temporary regulation, revenue
ruling, or notice promulgated under the statute in completing the
Schedule SB, check the box on the last line of page 1. If this box
is checked, indicate on this line whether any unpaid required
contribution or a contribution that is not wholly deductible would
result if the actuary had fully reflected such regulation, revenue
ruling, or notice. In addition, the actuary may offer any other
comments related to the information contained in Schedule SB. Except
as otherwise provided in these instructions, a stamped or machine
produced signature is not acceptable.
The actuary must provide the completed and signed Schedule SB to
the plan administrator to be retained with the plan records and
included (in accordance with these instructions) with the Form 5500
or Form 5500-SF that is submitted under EFAST2. The plan's actuary
is permitted to electronically sign the Schedule SB, or sign on page
one using the actuary's signature or by inserting the actuary's
typed name in the signature line followed by the actuary's
handwritten initials. The actuary's most recent enrollment number
must be entered on the Schedule SB that is prepared and signed by
the plan's actuary.
Attachments
All attachments to the Schedule SB must be properly identified
as attachments to the Schedule SB, and must include the name of the
plan, plan sponsor's EIN, plan number, and line number to which the
schedule relates.
Do not include attachments that contain a visible social
security number. Except for certain one-participant plans, the
Schedule SB and its attachments are open to public inspection, and
the contents are public information and are subject to publication
on the Internet. Because of privacy concerns, the inclusion of a
visible social security number or any portion thereof on an
attachment may result in the rejection of the filing.
Part I--Basic Information
Note. All entries in Part I must be reported as of the valuation
date, reflecting the assumptions and amounts generally used to
determine the minimum required contribution. In the case of a plan
described in section 104 of PPA, the information should be reported
as if PPA provisions were effective for all plan years beginning
after December 31, 2007.
Line 1. Valuation Date. The valuation date for a plan year must
be the first day of the plan year unless the plan meets the small-
plan exception of Code section 430(g)(2)(B) and ERISA section
303(g)(2)(B). For plans that qualify for the exception, the
valuation date may be any date in the plan year, including the first
or last day of the plan year. A plan qualifies for this small-plan
exception if there were 100 or fewer participants on each day of the
prior plan year. For the definition of participant as it applies in
this case, see the instructions for Line F.
Line 2a. Market Value of Assets. Enter the fair market value of
assets as of the valuation date. Include contributions designated
for any previous plan year that are made after the valuation date
(but within the 8\1/2\-month period after the end of the immediately
preceding plan year), adjusted for interest for the period between
the date of payment and the valuation date as provided in the
applicable regulations.
Contributions made for the current plan year must be excluded
from the amount reported in Line 2a. If these contributions were
made prior to the valuation date (which can only occur for small
plans with a valuation date other than the first day of the plan
year), the asset value must be adjusted to exclude not only the
contribution amounts, but interest on the contributions from the
date of payment to the valuation date, using the current-year
effective interest rate.
Do not adjust for items such as the funding standard carryover
balance, prefunding balance, any unpaid minimum required
contributions, or the present value of remaining shortfall or waiver
amortization installments. Rollover amounts or other assets held in
individual accounts that are not available to provide defined
benefits under the plan should not be included on Line 2a regardless
of whether they are reported on the Schedule H (Form 5500) (line 1l,
column (a)) or Form 5500-SF (Line 7c, column (a)). Additionally,
asset and liability amounts must be determined in a consistent
manner. Therefore, if the value of any insurance contracts has been
excluded from the amount reported in Line 2a, liabilities satisfied
by such contracts should also be excluded from the funding target
values reported in Lines 3 and 4.
Line 2b. Actuarial Value of Assets. Do not adjust the actuarial
value of assets for items such as the funding standard carryover
balance, the prefunding balance, any unpaid minimum required
contributions, or the present value of any remaining shortfall or
waiver amortization installments. Treat contributions designated for
a current or prior plan year, rollover amounts, insurance contracts,
and other items in the same manner as for Line 2a. If an averaging
method is used to value plan assets (as permitted under Code section
430(g)(3)(B) and ERISA section 303(g)(3)(B), as amended by WRERA),
enter the value as of the valuation date taking into account the
requirement that such value must be within 90% to 110% of the fair
market value of assets.
Note. Under Code section 430(g)(3)(B), the use of averaging
methods in determining the value of plan assets is permitted only in
accordance with methods prescribed in Treasury regulations.
Accordingly, taxpayers cannot use asset valuation methods other than
fair market value (as described in Code section 430(g)(3)(A)),
except as provided under Notice 2009-22, 2009-14 I.R.B. 741, or
Treasury regulations.
Line 3. Funding Target/Participant Count Breakdown. All amounts
should be reported as of the valuation date.
Column (1)--Enter the number of participants, including
beneficiaries of deceased participants, who are or who will be
entitled to benefits under the plan.
Column (2)--Enter the portion of the funding target
attributable to vested benefits. For this purpose benefits
considered to be vested for PBGC premium purposes must be included.
Column (3)--Enter the funding target attributable to
all benefits, both vested and nonvested.
For columns (2) and (3), the funding target must be calculated
using the methods and assumptions provided in Code sections 430(h)
and (i), ERISA sections 303(h) and (i), and other related guidance.
Unless the plan sponsor has received approval to use substitute
mortality tables in accordance with Code section 430(h)(3)(C) and
ERISA section 303(h)(3)(C), the funding target must be computed
using the mortality tables for non-disabled lives, as described in
section 1.430(h)(3)-1 of the regulations. If substitute mortality
tables have been approved (or deemed to have been approved) by the
IRS, such tables must be used instead of the mortality tables
described in the previous sentence, subject to the rules of
[[Page 47649]]
Code section 430(h)(3) and ERISA section 303(h)(3). The funding
target may be computed taking into account the mortality tables for
disabled lives published in Rev. Rul. 96-7, 1996-1 C.B. 59, and as
provided in Notice 2008-29, 2008-12 I.R.B. 637.
Special rules for plans that are in at-risk status. If a plan is
in at-risk status, report the amount reflecting the additional
assumptions required in Code section 430(i)(1)(B) and ERISA section
303(i)(1)(B).
If the plan has been in at-risk status for any two or more of
the preceding four plan years, also include the loading factor
required in Code section 430(i)(1)(C) and ERISA section
303(i)(1)(C). If the plan is in at-risk status and has been in at-
risk status for fewer than five consecutive years, report the
funding target amounts after reflecting the transition rule provided
in Code section 430(i)(5) and ERISA section 303(i)(5). For example,
the funding target for a plan that is in at-risk status for 20XX and
was in at-risk status for the 20XX-3, 20XX-2 and 20XX-1 plan years
(but not the 20XX-4 plan year) will reflect 80% of the funding
target using the special at-risk assumptions and 20% of the funding
target determined without regard to the at-risk assumptions.
Determining whether a plan is in at-risk status. Refer to Code
section 430(i)(4) and ERISA section 303(i)(4) to determine whether
the plan is in at-risk status. Generally, a plan is in at-risk
status for a plan year if it had more than 500 participants on any
day during the preceding plan year (see instructions for Line F for
the definition of participants) and the plan's funding target
attainment percentage (``FTAP'') for the preceding plan year fell
below specified thresholds.
A plan with over 500 participants is in at-risk status for 20XX
if both:
1. the FTAP for 20XX-1 (Line 17 of the for 20XX-1 Schedule SB)
is less than 80%, and
2. the at-risk funding target attainment percentage for 20XX-1
is less than 70%.
In general, the at-risk funding target attainment percentage is
determined in the same manner as the FTAP (as described in the
instructions for Line 17), except that the funding target is
determined using the additional assumptions for plans in at-risk
status. For this purpose, the at-risk funding target is determined
by disregarding the transition rule of Code section 430(i)(5) and
ERISA section 303(i)(5) for plans that have been in at-risk status
for fewer than five consecutive years, and disregarding the loading
factor in Code section 430(i)(1)(C) and ERISA section 303(i)(1)(C).
For plans that were in at-risk status for the 20XX-1 plan year, the
at-risk funding target used to determine whether the plan is in at-
risk status for the 20XX plan year is the amount reported in Line 4b
of the 20XX-1 Schedule SB.
Refer to the regulations under section 430(i) of the Code for
rules pertaining to new plans and other special situations.
Line 4. Additional Information for Plans in At-Risk Status. If
the plan is in at-risk status as provided under Code section
430(i)(4) and ERISA section 303(i)(4), check the box, complete Lines
4a through 4d, and include as an attachment the information
described below. Do not complete Line 4 if the plan is not in at-
risk status for the current plan year for purposes of determining
the minimum required contribution.
Column 1--Enter the amount of the funding target
determined as if the plan were not in at-risk status.
Column 2--Report the funding target disregarding the
transition rule of Code section 430(i)(5) and ERISA section
303(i)(5), and disregarding the loading factor in Code section
430(i)(1)(C) and ERISA section 303(i)(1)(C).
If the plan is in at-risk status for the current plan year,
include a description of the at-risk assumptions for the assumed
form of payment (e.g., specify the optional form resulting in the
highest present value) in the attachment for Part V regarding the
actuarial assumptions. Label this information in the attachment
``Schedule SB, Line 4--Additional Information for Plans in At-Risk
Status.''
Line 5. Effective Interest Rate. Enter the single rate of
interest which, if used instead of the interest rate(s) reported in
Line 24 to determine the present value of the benefits that are
taken into account in determining the plan's funding target for a
plan year, would result in an amount equal to the plan's funding
target determined for the plan year, without regard to calculations
for plans in at-risk status. (This is the funding target reported in
Line 3d, column (3) for plans not in at-risk status, or in Line 4a
for plans in at-risk status.) However, if the funding target for the
plan year is zero, the effective interest rate is determined as the
single rate that would result in an amount equal to the plan's
target normal cost determined for the plan year, without regard to
calculations for plans in at-risk status. See the provisions of Code
section 430(h)(2)(A), ERISA section 303(h)(2)(A), and the applicable
regulations. Enter rate to the nearest .01% (e.g., 5.26%).
Line 6a. Target Normal Cost. (Without Plan-Related Expenses).
Report the present value of all benefits which have been accrued or
have been earned (or that are expected to accrue or to be earned)
under the plan during the plan year . Include any increase in
benefits during the plan year that is a result of any actual or
projected increase in compensation during the current plan year,
even if that increase in benefits is with respect to benefits
attributable to services performed in a preceding plan year. This
amount must be calculated as of the valuation date and must
generally be based on the same assumptions used to determine the
funding target reported in Line 3c, column (3), reflecting the
special assumptions and the loading factor for at-risk plans, if
applicable. If the plan is in at-risk status for the current plan
year and has been in at-risk status for fewer than five consecutive
years, report the target normal cost after reflecting the transition
rule provided in Code section 430(i)(5) and ERISA section 303(i)(5).
Do not increase the amount by plan expenses and do not reduce the
amount by mandatory employee contributions.
Line 6b. Plan-Related Expenses. Report any plan-related expenses
expected to be paid from plan assets during the plan year.
Line 6c. Total Target Normal Cost. Report the total target
normal cost (sum of Lines 6a and 6b minus mandatory employee
contributions expected to be made during the plan year, but not less
than zero).
Special rule for airlines using 10-year amortization period
under section 402(a)(2) of PPA. Section 402(a)(2) of PPA (as amended
by section 6615 of the U.S. Troop Readiness, Veterans' Care, Katrina
Recovery, and Iraq Accountability Appropriations Act, 2007, Pub. L.
110-28 (121 Stat.112)) states that for plans electing the 10-year
amortization period, the funding target during that period is
determined using an interest rate of 8.25% rather than the interest
rates or segment rates calculated on the basis of the corporate bond
yield curve. However, this special 8.25% interest rate does not
apply for other purposes, including the calculation of target normal
cost or the amortization of the funding shortfall. Report the target
normal cost using the interest rates or segment rates otherwise
applicable under 430(h)(2) and ERISA section 303(h)(2).
Part II--Beginning of Year Carryover Prefunding Balances
Line 7. Balance at Beginning of Prior Plan Year After Applicable
Adjustments. In general, report the amount in the corresponding
columns of Line 13 of the prior-year Schedule SB. See instructions
for Line 14 if the balance from the prior year has been adjusted so
that it does not match the corresponding amount in Line 13 of the
prior-year Schedule SB. Note that elections to add excess
contributions or reduce balances have specific deadlines, and
generally cannot be changed once they have been made.
If this is the first year for which the plan is subject to the
minimum funding rules of Code section 430 or ERISA section 303,
leave both columns blank.
Line 8. Portion Elected for Use To Offset Prior Year's Funding
Requirement. Report the amount for each column from the
corresponding column of Line 39 of the prior-year Schedule SB. If
the valuation date is not the first day of the plan year, report the
amounts from Line 39 of the prior-year Schedule SB, discounted to
the beginning of the prior plan year using the effective interest
rate for the prior plan year.
Reflect the full amount reported in Line 39 of the prior-year
Schedule SB even if the amount is larger than the minimum required
contribution reported for that year on Line 38 of the prior-year
Schedule SB. This can occur under the special rule for elections to
use balances in excess of the minimum required contribution under
section 1.430(f)-1(f)(1)(ii) of the regulations, if no timely
election is made to revoke the excess amount.
If this is the first year for which the plan is subject to the
minimum funding rules of Code section 430 or ERISA section 303,
leave both columns blank.
Special rule for late election to apply balances to quarterly
installments. If an election was made to use the funding standard
carryover balance or the prefunding balance to offset the amount of
a required quarterly installment, but the election was made after
the due date of the installment, the amount reported on Line 8 may
not be
[[Page 47650]]
the same as the amount reported on Line 39 for the prior year. Refer
to the regulations under section 430 of the Code for additional
information. See instructions for Line 15 if a late election to
apply the balances to quarterly installments was made.
Line 9. Amount Remaining. Enter the amount equal to Line 7 minus
Line 8 in each column. If this is the first year that the plan is
subject to the minimum funding requirements of Code section 430 or
ERISA section 303, enter the amount of any credit balance at the end
of the prior year (the ``pre-effective plan year'') on Line 9,
column (a) and leave Line 9, column (b) blank. The amount entered on
Line 9, column (a) is generally the amount reported for the pre-
effective plan year on Line 9o of the 2007 version of the Schedule B
form that was submitted as an attachment to the Schedule SB for that
pre-effective plan year. See instructions for Line 16 if there has
been any adjustment to this amount so that it does not match the
amount so reported for the pre-effective plan year.
Line 10. Interest on Line 9. Enter the actual rate of return on
plan assets during the preceding plan year in the space provided.
Enter the rate to the nearest .01% (e.g., 6.53%). If entering a
negative number, enter a minus sign (``-'') to the left of the
number. In each column, enter the product of this interest rate and
the amount reported in the corresponding column of Line 9. If this
is the first year for which the plan is subject to the minimum
funding rules of Code section 430 or ERISA section 303, leave both
columns blank.
Line 11. Prior Year's Excess Contributions to be Added to
Prefunding Balance.
Line 11a. Enter the amount reported in Line 42a on the Schedule
SB for the prior plan year.
Line 11b(1). Enter the effective interest rate for the prior
plan year, as reported on Line 5 of the Schedule SB for the prior
plan year, in the space provided. Enter the rate to the nearest .01%
(e.g., 6.35%).
In column (b), enter the product of the prior year's effective
interest rate in Line 11b(1) and the excess (if any) of the amount
reported on Line 42a for the prior year over the amount reported on
Line 42b for the prior year.
However, if the valuation date for the prior plan year was not
the first day of the plan year (permitted for small plans only),
enter the result of the following calculation:
Step 1: Determine the excess (if any) of the amount reported on
Line 42a for the prior year over the amount reported on Line 42b for
the prior year,
Step 2: Adjust the result in Step 1 to the first day of the
prior year using the effective interest rate for the prior year,
Step 3: Multiply the result in Step 2 by the prior year's
effective interest rate in Line 11(b)(1), and
Step 4: Reduce the result in Step 3 by interest on the result in
Step 2 of this paragraph for the period between the first day of the
prior plan year and the prior-year valuation date using the
effective interest rate for the prior year.
The amount reported in Line 11(b)(1) is zero if the prior year's
valuation date was the last day of the prior plan year.
Line 11(b)(2). In column (b), enter the product of the prior
year's actual rate of return (from Line 10) and the present value of
excess contributions reported on Line 42b for the prior year.
However, if the valuation date for the prior plan year was not the
first day of the plan year (permitted for small plans only), enter
the result of the following calculation:
Step 1: Adjust the prior-year amount reported in Line 42b to the
first day of the prior year, using the effective interest rate for
the prior year,
Step 2: Multiply the result in Step 1 by the prior year's actual
rate of return (from Line 10), and
Step 3: Reduce the result in Step 2 by interest on the result in
Step 1 for the period between the first day of the prior plan year
and the prior-year valuation date using the effective interest rate
for the prior year.
Line 11c. Enter the sum of Lines 11a, 11b(1) and 11(b)(2).
Line 11d. Enter the amount of the excess contributions for the
prior year (with interest) that the plan sponsor elected to use to
increase the prefunding balance. This amount cannot be greater than
the amount reported on Line 11c. If this is the first year for which
the plan is subject to the minimum funding rules of Code section 430
or ERISA section 303, leave Lines 11a-d blank.
Line 12. Other Reductions in Balances Due to Elections or Deemed
Elections. In each column, enter the amount by which the employer
elects to reduce (or is deemed to elect to reduce, per Code section
436(f)(3) and ERISA section 206(g)(5)(C)) the funding standard
carryover balance or prefunding balance, as applicable, under Code
section 430(f) and ERISA section 303(f), other than any amount
reported in Line 8 that is treated as a reduction in these balances
under the special rule in section 1.430(f)-1(f)(3)(ii) (relating to
amounts elected for use to offset the minimum required contribution
that exceed the minimum required contribution for the plan for the
plan year, and which are not revoked by the plan sponsor). This
amount cannot be greater than the sum of the amounts reported in the
corresponding column of Lines 9, 10 and, if applicable, 11d. Note
that an election (or deemed election) cannot be made to reduce the
prefunding balance in column (b) until the funding standard
carryover balance in column (a) has been reduced to zero.
If the valuation date is not the first day of the plan year,
adjust the amounts reported in Line 12 to the first day of the plan
year, using the effective interest rate for the current plan year.
If the plan did not exist in the prior year and is not a successor
plan, leave both columns blank. If this is the first year for which
the plan is subject to the minimum funding rules of Code section 430
or ERISA section 303, leave column (b) blank.
Line 13. Balance at Beginning of Current Year.
Column (a)--Enter the sum of the amounts reported on Lines 9 and
10 of column (a), minus the amount reported on Line 12 of column
(a).
Column (b)--Enter the sum of the amounts reported on Lines 9, 10
and 11d of column (b), minus the amount reported on Line 12 of
column (b).
If this is the first year for which the plan is subject to the
minimum funding rules of Code section 430 or ERISA section 303,
leave column (b) blank.
Line 14. Discrepancy in Prior Year Funding Standard Carryover
Balance or Prefunding Balance. If the funding standard carryover
balance or prefunding balance from the prior year reported on Line 7
has been adjusted so that it does not match the corresponding amount
in Line 13 of the prior-year Schedule SB, check the box in Line 14
and provide an explanation. Note that elections to add excess
contributions or reduce balances have specific deadlines, and
generally cannot be changed once they have been made.
Line 15. Late Election to Apply the Funding Standard Carryover
Balance or Prefunding Balance to Quarterly Installments. If an
election was made to use the funding standard carryover balance or
the prefunding balance to offset the amount of a required quarterly
installment, and the election was made after the due date of the
installment, so that the amount reported on Line 8 is not the same
as the amount reported on Line 39 for the prior year, check the box
on Line 15 and provide an explanation.
Line 16. Credit Balance Discrepancy. If there has been any
adjustment to the credit balance amount reported in Line 9 so that
it does not match the amount so reported for the pre-effective plan
year, check the box on Line 16 and provide an explanation.
Part III--Funding Percentages
Enter all percentages in this section by truncating at .01%
(e.g., report 82.649% as 82.64%).
Line 17. Funding Target Attainment Percentage. Enter the funding
target attainment percentage (FTAP) determined in accordance with
Code section 430(d)(2) and ERISA section 303(d)(2). The FTAP is the
ratio (expressed as a percentage) which the actuarial value of plan
assets (reduced by the funding standard carryover balance and
prefunding balance) bears to the funding target determined without
regard to the additional rules for plans in at-risk status. This
percentage is determined by subtracting the sum of the amounts
reported in Line 13 from Line 2b and dividing the result by the
funding target. The funding target used for this purpose is the
number reported in Line 3d, column (3) for plans that are not in at-
risk status and Line 4a for plans that are in at-risk status. If the
plan's valuation date is not the first day of the plan year,
subtract the sum of the amounts reported in Line 13, adjusted for
interest between the beginning of the plan year and the valuation
date using the effective interest rate for the current plan year,
from the amount reported in Line 2b; and divide by the funding
target.
Line 18. Adjusted Funding Target Attainment Percentage. Enter
the adjusted funding target attainment percentage (AFTAP) determined
in accordance with Code section 436(j)(2) and ERISA section
206(g)(9)(B). The AFTAP is calculated in the same manner as the FTAP
reported in Line 17, except that both the assets and the funding
target used to calculate the AFTAP are increased by the aggregate
amount of
[[Page 47651]]
purchases of annuities for employees other than highly compensated
employees (as defined in Code section 414(q)) which were made by the
plan during the preceding two plan years.
See Code section 436(j)(3) and ERISA section 206(g)(9)(C) for
rules regarding circumstances in which the actuarial value of plan
assets is not reduced by the funding standard carryover balance and
prefunding balance for certain fully-funded plans when determining
the AFTAP. Note that this special rule applies only to the
calculation of the AFTAP and not to the FTAP reported in Line 17.
Report the final certified AFTAP for the plan year, even if it
does not correspond to the valuation results reported on this
Schedule SB (for instance, if any adjustments pertaining to the plan
year were made subsequent to the valuation or the AFTAP). If no
AFTAP was certified for the plan year, check the box and attach an
explanation and (1) report 100%, if the plan's adjusted funding
target for the plan year is zero, as described in section 1.436-
1(j)(1)(iv) of the Treasury regulations, or (2) leave Line 18 blank
if the plan's adjusted funding target for the plan year is not equal
to zero. Label the attachment, ``Line 18, Reconciliation of
differences between valuation results and amounts used to calculate
AFTAP.'' For plans with valuation dates other than the first day of
the plan year, report the AFTAP that is the final certified AFTAP
based on the valuation results for the current plan year at the time
that the Schedule SB is filed (reflecting contributions for the
current plan year and reflecting other adjustments as described in
applicable guidance), even if that AFTAP is not used to apply the
restrictions under Code section 436 and ERISA section 206(g) until
the following plan year.
If the AFTAP reported on Line 18 does not correspond to the
valuation results reported on this Schedule SB (for instance, if any
adjustments pertaining to the plan year were made subsequent to the
valuation), check the box and attach a schedule showing each AFTAP
that was certified or recertified for the plan year, the date of the
certification (or recertification), and a description and the amount
of each adjustment to the funding target, actuarial value of assets,
funding standard carryover balance and prefunding balance used to
determine the corresponding AFTAP. Label the attachment, ``Line 18,
Reconciliation of differences between valuation results and amounts
used to calculate AFTAP.'' It is not necessary to include any
information pertaining to a range certification in this attachment.
Special rules for airlines using 10-year amortization period
under section 402(a)(2) of PPA. Section 402(a)(2) of PPA (as
amended) states that for plans electing the 10-year funding
amortization period, the funding target during that period is
determined using an interest rate of 8.25% rather than the interest
rates or segment rates calculated on the basis of the corporate bond
yield curve. Report the AFTAP for these plans based on the funding
target determined using the special 8.25% interest rate.
Line 19. Prior Year's Funding Percentage for Purposes of
Determining Whether Carryover/Prefunding Balances May Be Used To
Offset Current Year's Funding Requirement. Under Code section
430(f)(3) and ERISA section 303(f)(3), the funding standard
carryover balance and prefunding balance may not be applied toward
minimum contribution requirements unless the ratio of plan assets
for the preceding plan year to the funding target for the preceding
plan year (as described in Code section 430(f)(3)(C) and ERISA
section 303(f)(3)(C)) is 80% or more.
Enter the applicable percentage as described below, truncated at
.01% (e.g., report 81.239% as 81.23%). In general, the percentage is
the ratio that the prior-year actuarial value of plan assets
(reduced by the amount of any prefunding balance, but not the
funding standard carryover balance) bears to the prior-year funding
target determined without regard to the additional rules for plans
in at-risk status. This percentage is determined as follows, with
all amounts taken from the prior year's Schedule SB:
1. For plans that are not in at-risk status, subtract the amount
reported on Line 13, column (b) (adjusted for interest as described
below, if the valuation date is not the first day of the plan year)
from the amount reported on Line 2b, and divide the result by the
funding target reported on Line 3d, column (3).
2. For plans that are in at-risk status, subtract the amount
reported on Line 13, column (b) (adjusted for interest as described
below, if the valuation date is not the first day of the plan year)
from the amount reported on Line 2b, and divide the result by the
funding target reported on Line 4a.
If the valuation date for the prior plan year was not the first
day of that plan year, the amount subtracted from the assets for the
purpose of the above calculations is the amount reported on Line 13,
column(b), adjusted for interest between the beginning of the prior
plan year and the prior year's valuation date, using the effective
interest rate for the prior plan year.
Line 20. Ratio of Current Value of Assets to Funding Target if
Below 70%. This calculation is required under ERISA section
103(d)(11). If Line 2a divided by the funding target reported in
Line 3d, column (3), is less than 70%, enter such percentage.
Otherwise, leave this line blank.
Part IV--Contributions and Liquidity Shortfalls
Line 21. Contributions Made to the Plan. Show all employer and
employee contributions either designated for this plan year or those
allocated to unpaid minimum required contributions for a prior plan
year. Do not adjust contributions to reflect interest in column (b).
Show only employer contributions actually made to the plan within
8\1/2\ months after the end of the plan year for which this Schedule
SB is filed (or actually made before the Schedule SB is signed, if
earlier).
Certain employer contributions must be made in quarterly
installments. See Code section 430(j) and ERISA section 303(j).
Contributions made to meet the liquidity requirement of Code section
430(j)(4) and ERISA section 303(j)(4) should be reported. Include
contributions made to avoid benefit restrictions under Code section
436 and ERISA section 206(g).
Add the amounts in both columns 21(b) and 21(h) separately and
enter each result in the corresponding column on the total line. All
contributions except those made to avoid benefit restrictions under
Code section 436 and ERISA section 206(g) must be credited toward
minimum funding requirements for a particular plan year.
Employer contributions reported in Line 21 that were made on a
date other than the valuation date must be adjusted to reflect
interest for the time period between the valuation date for the plan
year to which the contribution is allocated and the date the
contribution was made. In general, adjust each contribution using
the effective interest rate reported on Line 5 for the plan year to
which the contribution is allocated.
Show the dates and amounts of individual contributions, the year
to which the contributions (or the portion of individual
contributions) are applied, the interest rate(s) used to adjust the
contributions (i.e., the effective interest rate for timely
contributions and the applicable effective interest rate plus 5% for
late quarterly installments) and the periods during which each rate
applies, and the interest-adjusted contribution. In Line 21(g),
allocate the interest-adjusted employer contributions to Lines 22a,
22b, and 22c to report the purpose for which they were made (as
described below).
Special note for small plans with valuation dates after the
beginning of the plan year. If the valuation date is after the
beginning of the plan year and contributions for the current year
were made during the plan year but before the valuation date, such
contributions are increased with interest to the valuation date
using the effective interest rate for the current plan year. These
contributions and the interest calculated as described in the
preceding sentence are excluded from the value of assets reported in
Lines 2a and 2b.
Interest adjustment for contributions representing late required
quarterly installments--installments due after the valuation date.
If the full amount of a required installment due after the valuation
date for the current plan year is not paid by the due date for that
installment, increase the effective interest rate used to discount
the contribution by 5 percentage points for the period between the
due date for the required installment and the date on which the
payment is made. If all or a portion of the late required quarterly
installment is due to a liquidity shortfall, the increased interest
rate is used for a period of time corresponding to the period
between the due date for the installment and the end of that
quarter, regardless of when the contribution is actually paid.
Interest adjustment for contributions representing late required
quarterly installments--small plans with valuation dates after the
beginning of the plan year--installments due prior to the valuation
date. See the regulations under section 430 for rules regarding
interest adjustments for late quarterly contributions for quarterly
contributions due before the valuation date.
[[Page 47652]]
Line 22. Discounted Employer Contributions.
Line 22a. Contributions Allocated Toward Unpaid Minimum Required
Contributions from Prior Plan Years. Code section 4971(c)(4)(B)
provides that any payment to or under a plan for any plan year shall
be allocated first to unpaid minimum required contributions for all
preceding plan years on a first-in, first-out basis and then to the
minimum required contribution for the current plan year. Report any
contributions from Line 21 that are allocated toward unpaid minimum
required contributions from prior plan years, discounted for
interest from the date the contribution was made to the valuation
date for the plan year for which the contribution was originally
required as described above. Increase the effective interest rate
for the applicable plan year by 5 percentage points for any portion
of the unpaid minimum required contribution that represents a late
quarterly installment, for the period between the due date for the
installment and the date of payment. Reflect the increased interest
rate for any portion of the unpaid minimum required contribution
that represents a late liquidity shortfall installment, for the
period corresponding to the time between the date the installment
was due and the end of the quarter during which it was due. The
amount reported in Line 22a cannot be larger than the amount
reported in Line 32.
For the purpose of allocating contribution amounts to unpaid
minimum required contributions, any unpaid minimum required
contribution attributable to an accumulated funding deficiency at
the end of the last plan year before Code section 430 or ERISA
section 303 applied to the plan (the ``pre-effective plan year'') is
treated as a single contribution due on the last day of the pre-
effective plan year (without separately identifying any portion of
the accumulated funding deficiency attributable to late quarterly
installments or late liquidity shortfall installments), and the
associated effective interest rate is deemed to be the valuation
interest rate for the pre-effective plan year.
Line 22b. Contributions Made To Avoid Benefit Restrictions.
Include in this category current year contributions made to avoid or
terminate benefit restrictions under Code section 436 and ERISA
section 206(g). Adjust each contribution for interest from the date
the contribution was made to the valuation date as described above.
Line 22c. Contributions Allocated Toward Minimum Required
Contribution for Current Year. Include in this category
contributions (including any contributions made in excess of the
minimum required contribution) that are not included in Line 22a or
22b. Adjust each contribution for interest from the date the
contribution was made to the valuation date as described above.
Line 23. Quarterly Contributions and Liquidity Shortfalls.
Line 23a. Did the Plan Have a Funding Shortfall for the Prior
Plan Year? In accordance with Code section 430(j)(3) and ERISA
section 303(j)(3), only plans that have a funding shortfall for the
preceding plan year are subject to an accelerated quarterly
contribution schedule. For this purpose, a plan is considered to
have a funding shortfall for the prior year if the funding target
reported on Line 3d, column (3) is greater than the actuarial value
of assets reported on Line 2b, reduced by the sum of the funding
standard carryover balance and prefunding balance reported on Line
13, columns (a) and (b), with all figures taken from the prior
year's Schedule SB.
If the valuation date for the prior plan year was not the first
day of that plan year, the amount subtracted from the actuarial
value of assets for the above calculation is the sum of the amounts
reported on Line 13, columns (a) and (b) of the prior-year Schedule
SB, but adjusted for interest between the beginning of the prior
plan year and the prior year's valuation date using the effective
interest rate for the plan for the prior plan year.
However, see Code section 430(f)(4)(B)(ii) and ERISA section
303(f)(4)(B)(ii) for special rules in the case of a binding
agreement with the PBGC providing that all or a portion of the
funding standard carryover balance and/or prefunding balance is not
available to offset the minimum required contribution for the prior
plan year.
Please note that a plan may be considered to have a funding
shortfall for this purpose even if it is exempt from establishing a
shortfall amortization base under the provisions of Code section
430(c)(5) and ERISA section 303(c)(5).
Line 23b. If Line 23a is ``No'' (i.e., if the plan did not have
a funding shortfall in the prior plan year), the plan is not subject
to the quarterly contribution rules, and this line should not be
completed. If Line 23a is ``Yes,'' check the ``Yes'' box on Line 23b
if required installments for the current plan year were made in a
timely manner; otherwise, check ``No.''
Line 23c. If Line 23a is ``No,'' or the plan had 100 or fewer
participants on every day of the preceding plan year (as defined for
line F), the plan is not subject to the liquidity requirement of
Code section 430(j)(4) and ERISA section 303(j)(4) and this line
should not be completed. Check the box and attach a certification by
the enrolled actuary if the special rule for nonrecurring
circumstances is used, and label the certification ``Schedule SB,
Line 23c--Liquidity Requirement Certification.'' See Code section
430(j)(4)(E)(ii)(II) and ERISA section 303(j)(4)(E)(ii)(II).
If the plan is subject to the liquidity requirement and has a
liquidity shortfall for any quarter of the plan year (see Code
section 430(j)(4)(E) and ERISA section 303(j)(4)(E)), enter the
amount of the liquidity shortfall for each such quarter. If the plan
was subject to the liquidity requirement but did not have a
liquidity shortfall, enter zero. File IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit Plans, with the IRS to pay
the 10% excise tax(es) if there is a failure to pay any liquidity
shortfall by the required due date, unless a waiver of the 10% tax
has been granted under Code section 4971(f)(4).
Part V--Assumptions Used To Determine Funding Target and Target Normal
Cost
Attach a statement of actuarial assumptions and funding methods
used to calculate the Schedule SB entries and label the statement
``Schedule SB, Part V--Statement of Actuarial Assumptions/Methods.''
The statement must describe all non-prescribed actuarial assumptions
(e.g., retirement, withdrawal rates) used to determine the funding
target and target normal cost, including the assumption as to the
frequency with which participants are assumed to elect each optional
form of benefit (including lump sum distributions), whether
mortality tables are applied on a static or generational basis,
whether combined mortality tables are used instead of separate
annuitant and nonannuitant mortality tables (for plans with 500 or
fewer participants as of the valuation date), and (for target normal
cost) expected plan-related expenses and increases in compensation.
For applicable defined benefit pension plans under Code section
411(a)(13)(C) and ERISA section 203(f)(3) (e.g., cash balance plans)
the statement must include the assumptions used to convert balances
to annuities. In addition, the statement must describe the method
for determining the actuarial value of assets and any other aspects
of the funding method for determining the Schedule SB entries that
are not prescribed by law.
Also attach a summary of the principal eligibility and benefit
provisions on which the valuation was based, including the status of
the plan (e.g., frozen eligibility, service/pay, or benefits),
optional forms of benefits, special plan provisions, including those
that apply only to a subgroup of employees (e.g., those with imputed
service), supplemental benefits, and identification of benefits not
included in the valuation, a description of any significant events
that occurred during the year, a summary of any changes in principal
eligibility or benefit provisions since the last valuation, and a
description (or reasonably representative sample) of plan early
retirement reduction factors and optional form conversion factors.
Label the summary ``Schedule SB, Part V--Summary of Plan
Provisions.''
Also, include any other information needed to disclose the
actuarial position of the plan fully and fairly.
Line 24. Discount Rate. All discount rates are to be reported
and used as published by the IRS, and are to be applied as annual
rates without adjustment.
Line 24a. Enter the three segment rates used to calculate the
funding target and target normal cost as provided under Code section
430(h)(2)(C) and ERISA section 303(h)(2)(C) and as published by the
IRS, unless the plan sponsor has elected to use the full yield
curve. If the sponsor has elected to use the full yield curve, check
the ``N/A, full yield curve used'' box. Special rules for airlines
using 10-year amortization period under section 402(a)(2) of PPA (as
amended). Enter the information described above to reflect the
discount rates used to determine the target normal cost in
accordance with Code section 430(h)(2) and ERISA section 303(h)(2).
Do not enter the special 8.25% interest rate used to determine the
funding target under section 402(a)(2) of PPA.
Line 24b. Code section 430(h)(2)(E) and ERISA section
303(h)(2)(E) provide that the segment rate(s) used to measure the
funding
[[Page 47653]]
target and target normal cost are those published by Treasury for
the month that includes the valuation date (based on the average of
the monthly corporate bond yield curves for the 24-month period
ending with the month preceding that month). Alternatively, at the
election of the plan sponsor, the segment rate(s) used to measure
the funding target and target normal cost may be those published by
Treasury for any of the four months that precede the month that
includes the valuation date.
Enter the applicable month to indicate which segment rates were
used to determine the funding target and target normal cost. Enter
``0'' if the rates used to determine the funding target and target
normal cost were published for the month that includes the valuation
date. Enter ``1'' if the rates were published for the month
immediately preceding the month that includes the valuation date,
``2'' for the second preceding month, and ``3'' or ``4,''
respectively, for the third or fourth preceding months. For example,
if the valuation date is January 1 and the funding target and target
normal cost were determined based on rates published for November,
enter ``2.''
Note. The plan sponsor's interest rate election under Code
section 430(h)(2) or ERISA section 303(h)(2) (an election to use the
yield curve or an election to use an applicable month other than the
default month) generally may not be changed unless the plan sponsor
obtains approval from the IRS. However, see the regulations under
section 430(h)(2) for circumstances in which a change in interest
rate may be made without obtaining approval from the IRS.
Line 25. Weighted Average Retirement Age. Enter the weighted
average retirement age for active participants. If the plan is in
at-risk status, enter the weighted average retirement age as if the
plan were not in at-risk status. If each participant is assumed to
retire at his/her normal retirement age, enter the age specified in
the plan as normal retirement age. If the normal retirement age
differs for individual participants, enter the age that is the
weighted average normal retirement age; do not enter ``NRA.''
Otherwise, enter the assumed retirement age. If the valuation uses
rates of retirement at various ages, enter the nearest whole age
that is the weighted average retirement age.
On an attachment to Schedule SB, list the rate of retirement at
each age and describe the methodology used to compute the weighted
average retirement age, including a description of the weight
applied at each potential retirement age, and label the attachment
``Schedule SB, Line 25--Description of Weighted Average Retirement
Age.''
Line 26. Mortality Tables. Mortality tables described in Code
section 430(h)(3), ERISA section 303(h)(3), and section 1.430(h)(3)-
1 of the regulations as published by the IRS must be used to
determine the funding target and target normal cost for non-disabled
participants and may be used to determine the funding target and
target normal cost for disabled participants, unless the IRS has
approved (or was deemed to have approved) the use of a substitute
mortality table for the plan. Standard mortality tables must be
either applied on a generational basis, or the tables must be
updated to reflect the static tables published for the year in which
the valuation date occurs. Substitute mortality tables must be
applied in accordance with the terms of the IRS ruling letter.
Separate standard mortality tables were published by the IRS for
annuitants (rates applying for periods when a participant is assumed
to receive a benefit under the plan) and nonannuitants (rates
applying to periods before a participant is assumed to receive a
benefit under the plan). If a plan has 500 or fewer participants as
of the valuation date for the current plan year as reported in Line
3d, column (1), the plan sponsor can elect to use the combined
mortality tables published by the IRS, which reflect combined rates
for both annuitants and nonannuitants.
Line 26a. Mortality Tables Used. Check the applicable box to
indicate which mortality table was used to determine the funding
target and target normal cost. If one mortality table was used for
certain populations within the plan and a different mortality table
was used for other populations, check the box for the table that
applied to the largest population.
1. Check ``Prescribed--combined'' if the funding target and
target normal cost are based on the prescribed tables with combined
annuitant/nonannuitant mortality rates.
2. Check ``Prescribed--separate'' if the funding target and
target normal cost are based on the prescribed tables with separate
mortality rates for nonannuitants and annuitants.
3. Check ``Substitute'' if the funding target and target normal
cost are based on substitute mortality tables.
Line 26b. Use of More Than One Mortality Table. If more than one
mortality table was used, check the box and provide an explanation
describing the mortality table used for each population and the size
of that population.
Line 26c. Substitute Mortality Tables. If substitute mortality
tables are used, check the box and provide a summary of plan
populations for which substitute mortality tables are used, plan
populations for which the prescribed tables are used, and the last
plan year for which the IRS approval of the substitute mortality
tables applies.
Part VI--Miscellaneous Items
Line 27. Change in Non-Prescribed Actuarial Assumptions. Check
the box if a change has been made in the non-prescribed actuarial
assumptions for the current plan year. Provide a description of any
change in non-prescribed actuarial assumptions and justifications
for any such change. If the only assumption changes are statutorily
required changes in the discount or mortality rates, or changes
required for plans in at-risk status, do not check the box and do
not provide a description of the changes. (See section 103(d) of
ERISA.) If the non-prescribed assumptions have been changed in a way
that decreases the funding shortfall for the current plan year,
approval for such a change may be required.
Line 28. Change in Method. Check the box if a change in the
method has been made for the current plan year. For this purpose, a
change in funding method refers to not only a change in the overall
method used by the plan, but also each specific method of
computation used in applying the overall method. Accordingly,
funding method changes include modifications such as a change in the
method for calculating the actuarial value of assets or a change in
the valuation date (not an exclusive list). Also check the box if
there has been a change in the method for determining the discount
rates reported in Line 24. In general, any changes in a plan's
method must be approved by the IRS. However, see the regulations
under Code section 430 and Announcement 2010-3, 2010-4 I.R.B. 333,
for circumstances in which a change in method may be made without
obtaining approval from the IRS. Provide a description of the
change.
Note. The plan sponsor's agreement to certain changes in funding
method should be reported on Line 9 of Schedule R (Form 5500).
Line 29a. Schedule of Active Participant Data. Check ``Yes'' on
Line 29a(i) only if (a) the plan is covered by Title IV of ERISA and
(b) the plan has active participants. If Line 29a(i) is ``Yes,''
complete the schedule in Line 29a(ii) with the active plan
participant data used in the valuation for this plan year and enter
the average age and average credited service of the active
participants on Lines 29a(iii) and 29a(iv), respectively. Include
all active participants in the averages, even ones that are not
required to be shown in the schedule under the instructions below.
For each column, enter the number of active participants with the
specified number of years of credited service divided according to
age group. For participants with partial years of credited service,
round the total number of years of credited service to the next
lower whole number. Years of credited service are the years credited
under the plan's benefit formula.
Plans reporting 1,000 or more active participants on Line 3d,
column (1), must also provide average compensation data. For each
grouping, enter the average compensation of the active participants
in that group. For this purpose, compensation is the compensation
taken into account for each participant under the plan's benefit
formula, limited to the amount defined under section 401(a)(17) of
the Code. Do not enter the average compensation in any grouping that
contains fewer than 20 participants.
In the case of a plan under which benefits are primarily pay-
related and under which no future accruals are granted (i.e., a
``frozen'' plan as defined in the instructions for Line 9a(4) of the
Form 5500), check the box and report the average annual accrued
benefit in lieu of average compensation.
Cash balance plans (or any similar plans that check the box on
Line 9a(1) of Form 5500) reporting 1,000 or more active participants
on Line 3d, column (1), must also provide average cash balance
account data, regardless of whether all active participants have
cash balance accounts. For each age/service bin, enter the average
cash balance account of the active participants in that bin. Do not
enter the average cash
[[Page 47654]]
balance account in any age/service bin that contains fewer than 20
active participants.
General Rule. When all active participants in the plan have a
cash balance account, data to be shown in each age/service bin
includes:
1. The number of active participants in the age/service bin,
2. The average compensation of the active participants in the
age/service bin, and
3. The average cash balance account of the active participants
in the age/service bin.
If the accrued benefit is the greater of a cash balance benefit
or some other benefit, average in only the cash balance account. If
the accrued benefit is the sum of a cash balance account benefit and
some other benefit, average in only the cash balance account. For
both the average compensation and the average cash balance account,
do not enter an amount for age/service bins with fewer than 20
active participants.
When some active participants do not have cash balance accounts,
an alternative is provided for showing compensation and cash balance
accounts, requiring two age/service scatters as follows:
Scatter 1--Provide participant count and average
compensation for all active participants, without account-based
benefits.
Scatter 2--Provide participant count and average cash
balance account for only those active participants with account-
based benefits. If the number of participants with account-based
benefits in a bin is fewer than 20, the average account should not
be shown even if there are 20 or more active participants in this
bin on Scatter 1.
In general, information should be determined as of the valuation
date. Average cash balance accounts may be determined as of either:
1. The valuation date or
2. The day immediately preceding the valuation date.
Average cash balance accounts that are offset by amounts from
another plan may be reported either as amounts prior to taking into
account the offset or as amounts after taking into account the
offset. Do not report the offset amount. For this or any other
unusual or unique situation, the attachment should include an
explanation of what is being provided.
If the plan is a multiple-employer plan, complete one or more
schedules of active participants in a manner consistent with the
computations for the funding requirements reported in Part VIII. For
example, if the funding requirements are computed as if each
participating employer maintained a separate plan, complete a
separate Schedule of Active Participant Data for each participating
employer in the multiple-employer plan on the separate Schedule SB
attached in accordance with the instructions for Line E.
Line 29b. Schedule of Retired Participants and Beneficiaries
Receiving Payment Data. Check ``Yes'' on Line 29b(i) only if (a) the
plan is covered by Title IV of ERISA and (b) the plan has retired
participants and beneficiaries receiving payment at the valuation
date. If Line 29b(i) is ``Yes,'' complete the schedule in Line
29b(ii) with the retired participant and beneficiary data used in
the valuation for this plan year and enter the average age and
average in-pay annual benefit of the retired participants and
beneficiaries on Lines 29b(iii) and 29b(iv), respectively. Do not
report average annual benefit information for age bins where there
are 10 or less retired participants and beneficiaries receiving
payment in the average.
If the plan is a multiple-employer plan, complete one or more
schedules of retired participant and beneficiary data in a manner
consistent with the computations for the funding requirements
reported in Part VIII. For example, if the funding requirements are
computed as if each participating employer maintained a separate
plan, complete a separate Schedule of Retired Participants and
Beneficiaries Receiving Payment Data for each participating employer
in the multiple-employer plan on the separate Schedule SB attached
in accordance with the instructions for Line E.
Line 29c. Schedule of Terminated Vested Participant Data. Check
``Yes'' on Line 29c(i) only if (a) the plan is covered by Title IV
of ERISA and (b) the plan has terminated vested participants at the
valuation date. If Line 29c(i) is ``Yes,'' complete the schedule in
Line 29c(ii) with the terminated vested participant data used in the
valuation for this plan year and enter the average age and average
annual benefit of the terminated vested participants on Lines
29c(iii) and 29c(iv), respectively. Do not report average annual
benefit information for age bins where there are 10 or less
terminated vested participants in the average. Include the assumed
form of payment and the assumed first age of payment in Lines 29c(v)
and 29c(vi), respectively, for the benefit amounts shown in the
schedule.
If the plan is a multiple-employer plan, complete one or more
schedules of terminated vested participant data in a manner
consistent with the computations for the funding requirements
reported in Part VIII. For example, if the funding requirements are
computed as if each participating employer maintained a separate
plan, complete a separate Schedule of Terminated Vested Participant
Data for each participating employer in the multiple-employer plan
on the separate Schedule SB attached in accordance with the
instructions for Line E.
Line 30. Projection of Expected Benefit Payments. Check ``Yes''
on Line 30a if this is a single-employer plan covered by Title IV of
ERISA and is required to provide a projection of expected benefit
payments. Do not report information if the plan has less than 500
participants as of the valuation date.
If Line 30a is ``Yes,'' in Line 30b provide a projection of
benefits expected to be paid (not to include expected expenses) in
each of the next ten years starting with the current plan year of
this filing assuming (1) no additional accruals, (2) experience
(e.g., termination, mortality, and retirement) are in line with
valuation assumptions, and (3) no new entrants are covered by the
plan.
Line 31. Alternative Funding Rules. If one of the alternative
funding rules was used for this plan year, enter the appropriate
code from the table below and follow the special instructions
applicable to that code, including completion of any required
attachments.
Code Alternative Funding Rule
1 A CSEC Act plan that is described in Code section 414(v). This
includes certain multiple-employer plans maintained by rural
cooperatives and other specified cooperative organizations and
certain plans maintained by more than 1 employer (determined after
application of Code section 414(b) and (c)), all of which are
described in Code section 501(c (3). Do not use Code 1 for a plan
that satisfies the definition of CSEC plan that has made the
election not to be treated as a CSEC plan.
2 This code, formerly used by certain plans maintained by PBGC
settlements as described in section 105 of PPA, is no longer
applicable and should not be used.
3 Reserved.
4 Plans with binding agreements with PBGC to maintain prefunding
and/or funding standard carryover balances described in Code section
430(f)(4)(B)(ii) and ERISA section 303(f)(4)(B)(ii).
5 Airlines using 10-year amortization period for initial post-
PPA shortfall amortization base under section 402(a)(2) of PPA (as
amended).
6 Airlines with frozen plans using alternative 17-year funding
schedule under section 402(a)(1) of PPA.
7 Interstate transit company described in section 115 of PPA.
8 A plan subject to 104 of PPA as amended that is not a CSEC
plan. This includes plans that fit into the definition of a CSEC
plan that elect out of CSEC plan status and become subject to
section 104 of PPA as amended, and certain plans maintained by more
than 1 employer (determined without regard to section 414(c)) where
all of the employers are described in section 501(c)(3). Do not use
Code 8 for a PPA section 104 plan that has made an election to not
be treated as an eligible charity plan.
Special Instructions for Codes 1 through 8
CSEC Plans, as described in Code section 414(y) and subject to
Code section 433 (code 1).
Reserved
Plans with binding agreements with the PBGC to maintain
prefunding and/or carryover balances (code 4). Complete entire
Schedule SB and attachments as outlined in these instructions. In
addition, report on an attachment the amount subject to the binding
agreement with the PBGC, reported separately for the funding
standard carryover balance and prefunding balance. Label the
attachment ``Schedule SB, Line 31--Balances Subject to Binding
Agreement with PBGC.''
Airlines using 10-year amortization period for initial post-PPA
shortfall amortization base (code 5). Complete the entire Schedule
SB and attachments as outlined in these instructions. Under section
402(a)(2) of PPA (as amended), the funding target for plans funded
using this alternative is determined using an interest rate of 8.25%
for each of the 10 years during the amortization period instead of
the interest
[[Page 47655]]
rates otherwise required under Code section 430(h)(2) and ERISA
section 303(h)(2). However, this special 8.25% interest rate does
not apply for other purposes, including the calculation of target
normal cost or the amortization of the funding shortfall.
Airlines with frozen plans using alternative 17-year funding
schedule (code 6). Complete the following lines on Schedule SB and
provide associated attachments:
Lines A through F.
Part I (including signature of enrolled actuary)--
complete all lines.
Parts III through VII--complete all lines.
For this purpose, disregard the special funding rules under
section 402(e) of PPA except for the information reported on the
following lines:
Lines 21 and 22--Discount contributions to the
applicable valuation date using the 8.85% discount rate provided
under section 402(e)(4)(B) of PPA.
Line 23--Reflect required quarterly installments based
on the minimum required contribution determined under section 402(e)
of PPA to the extent applicable (i.e., for purposes of calculating
the required annual payment under Code section 430(j)(3)(D)(ii)(l)
and ERISA section 303(j)(3)(D)(ii)(l)).
Line 33--Reflect the minimum required contribution
determined under section 402(e) of PPA when determining the unpaid
minimum required contribution.
Also, attach a worksheet showing the information below,
determined in accordance with section 402(e) of PPA. Label this
worksheet ``Schedule SB, Line 31--Alternative 17-Year Funding
Schedule for Airlines.''
Date as of which plan benefits were frozen as required
under section 402(b)(2) of PPA.
Date on which the first applicable plan year began.
Accrued liability under the unit credit method
calculated as of the first day of the plan year, using an interest
rate of 8.85%.
A summary of all other assumptions used to calculate
the unit credit accrued liability.
Fair market value of assets as of the first day of the
plan year.
Unfunded liability under section 402(e)(3)(A) of PPA.
Alternative funding schedule:
1. Contribution necessary to amortize the unfunded liability
over the remaining number of years, assuming payments at the
valuation date for each plan year and using an interest rate of
8.85%;
2. Employer contributions for the plan year, discounted for
interest to the valuation date for the plan year, and using a rate
of 8.85%; and
3. Contribution shortfall, if any ((1)-(2) but not less than
zero).
Interstate transit company (code 7). Complete the entire
Schedule SB, reflecting the modifications to the otherwise-required
funding rules under section 115(b) of PPA, and disregarding the
attachment required for plans reporting the use of the substitute
mortality table in Line 26.
Plans entitled to delayed effective dates for PPA funding rules
(code 8).
For plan years before Code section 430 and ERISA section 303
apply to the plan, complete only the following lines on Schedule SB:
Lines A through F.
1. Part I (including signature of enrolled actuary), determined
as if PPA provisions were effective for all plan years beginning
after December 31, 2007.
2. Part III, Line 17, determined as if PPA provisions were
effective for all plan years beginning after December 31, 2007.
3. Part V, determined as if PPA provisions were effective for
all plan years beginning after December 31, 2007.
4. If the minimum required contribution for any year was
determined using pension funding relief under section 107 of PPA
'06, as added by PRA 2010, complete Part IX, Lines 45a and 45b.
Also, report other information for the current plan year using a
2007 Schedule B (Form 5500). Label this attachment ``20XX Schedule
SB, Line 31--Actuarial Information Based on Pre-PPA Funding Rules.''
Complete all items, and attach the form and all applicable
attachments to the Schedule SB. Note that under PPA, the third
segment rate determined under Code section 430(h)(2)(C)(iii) and
ERISA section 303(h)(2)(C)(iii) is substituted for the current
liability interest rate under Code section 412(b)(5)(B) and ERISA
section 302(b)(5)(B) (as in effect before PPA).
Part VII--Reconciliation of Unpaid Minimum Required Contributions for
Prior Years
Line 32. Unpaid Minimum Required Contributions for Prior Years.
Enter the total amount of any unpaid minimum required contributions
for all years from Line 44 of the Schedule SB for the prior plan
year.
If this is the first year that the plan is subject to the
minimum funding requirements of Code section 430 or ERISA section
303, enter the amount of any accumulated funding deficiency at the
end of the prior year (the pre-effective plan year). This is the
amount reported on Line 9p of the 2007 Schedule B form that was
submitted as an attachment to the Schedule SB for the pre-effective
plan year.
Line 33. Discounted Employer Contributions Allocated Toward
Unpaid Minimum Required Contributions from Prior Years. Enter the
total amount of discounted contributions made for the current plan
year allocated toward unpaid minimum required contributions from
prior years as reported in Line 22a.
Line 34. Remaining Unpaid Minimum Required Contributions. Enter
the amount in Line 32 minus the amount in Line 33.
Part VIII--Minimum Required Contribution for Current Year
Line 35. Target Normal Cost and Excess Assets.
Line 35a. Target Normal Cost (Line 6c). Enter the target normal
cost as reported in Line 6c.
Line 35b. Excess Assets. Enter the excess, if any, of the value
of assets reported on Line 2b reduced by any funding standard
carryover balance and prefunding balance on Line 13, columns (a) and
(b), over the funding target reported on Line 3d, column (3). If the
valuation date is not the first day of the plan year, excess assets
are determined as the value of assets reported on Line 2b reduced by
any funding standard carryover balance and prefunding balance
reported on Line 13, columns (a) and (b), adjusted for interest at
the effective interest rate for the period between the beginning of
the plan year and the valuation date, minus the funding target
reported on Line 3d, column (3) (but not less than zero). Limit the
amount reported in Line 35b so that it is not greater than the
target normal cost reported in Line 35a.
Line 36. Amortization Installments.
Line 36a. Shortfall Amortization Bases and Amortization
Installments.
Outstanding balance. If the plan's funding shortfall (determined
under Code section 430(c)(4) and ERISA section 303(c)(4)) is zero,
all amortization bases and related installments are considered fully
amortized. In this case, enter zero. Otherwise, enter the sum (but
not less than zero) of the outstanding balances of all shortfall
amortization bases (including any new shortfall amortization base
established for the current plan year). The outstanding balance for
each amortization base established in past years is equal to the
present value as of the valuation date of any remaining amortization
installments for each base (including the amortization installment
for the current plan year), using the interest rates reported on
Line 24.
A plan is generally exempt from the requirement to establish a
new shortfall amortization base for the current plan year if the
funding target reported on Line 3d, column (3), is less than or
equal to the reduced value of assets as described below.
For the purpose of determining whether a plan is exempt from the
requirement to establish a new shortfall amortization base for the
current plan year, the reduced value of assets is the amount
reported on Line 2b, reduced by the full value of the prefunding
balance reported on Line 13, column (b), adjusted for interest for
the period between the beginning of the plan year and the valuation
date using the effective interest rate for the current plan year, if
the valuation date is not the first day of the plan year. However,
the assets are reduced by the prefunding balance if and only if the
plan sponsor has elected to use any portion of the prefunding
balance to offset the minimum required contribution for the current
plan year, as reported on Line 39. The assets are not reduced by the
amount of any funding standard carryover balance for this
calculation regardless of whether any portion of the funding
standard carryover balance is used to offset the minimum required
contribution for the plan year.
If the plan is not exempt from the requirement to establish a
new shortfall amortization base for the current plan year, the
amount of that base is generally equal to the difference between the
funding shortfall as of the valuation date (determined under Code
section 430(c)(4) and ERISA section 303(c)(4)) and the sum of any
outstanding balances of any previously established
[[Page 47656]]
shortfall and waiver amortization bases. The new shortfall
amortization base may be either greater than or less than zero.
For the purpose of determining the amount of any new shortfall
amortization base, the funding shortfall is equal to the amount of
the funding target reported on Line 3d, column (3), minus the
reduced value of assets, but not less than zero.
If the plan's valuation date is the first day of the plan year,
then the reduced value of assets for the purpose of determining the
amount of any new shortfall amortization base is the amount reported
on Line 2b, reduced by the sum of the funding standard carryover
balance and the prefunding balance reported on Line 13, columns (a)
and (b). However, if the plan's valuation date is not the first day
of the plan year, then the reduced value of assets for the purpose
of determining the amount of any new shortfall amortization base is
the amount reported on Line 2b, reduced by the sum of the funding
standard carryover balance and the prefunding balance reported on
Line 13, columns (a) and (b), adjusted for interest for the period
between the beginning of the plan year and the valuation date (using
the effective interest rate for the current plan year). See Code
section 430(f)(4)(B)(ii) and ERISA section 303(f)(4)(B)(ii) for
special rules in the case of a binding agreement with the PBGC
providing that all or a portion of the funding standard carryover
balance and/or prefunding balance is not available to offset the
minimum required contribution for the plan year.
Shortfall amortization installment--Enter the sum (but not less
than zero) of:
1. Any shortfall amortization installments that were established
to amortize shortfall amortization bases established in prior years,
excluding amortization installments for bases that have been or are
deemed to be fully amortized, and
2. The shortfall amortization installment that corresponds to
any new shortfall amortization base established for the current plan
year. This amount is the level amortization payment that will
amortize the new shortfall amortization base over 7 annual payments,
using the interest rates reported in Line 21 for the current plan
year.
Note. (1) Shortfall amortization installments for a given
shortfall amortization base are not re-determined from year to year
regardless of any changes in interest rates or valuation dates. (2)
If an election was made to use an alternative shortfall amortization
schedule under Code section 430(c)(2)(D) and ERISA section
303(c)(2)(D) added by PRA 2010, the shortfall amortization
installment is the amount determined in accordance with the
shortfall amortization schedule chosen and guidance issued by
Treasury and the IRS. Include any increase to the shortfall
amortization installment for this year due to the installment
acceleration amount, as provided in Code section 430(c)(7) and ERISA
section 303(c)(7).
Line 36b. Waiver Amortization Bases and Amortization
Installments.
Outstanding balance--If the plan's funding shortfall (determined
under Code section 430(c)(4) and ERISA section 303(c)(4)) is zero,
all waiver amortization bases and related installments are
considered fully amortized. In this case, enter zero. Otherwise,
enter the present value as of the valuation date of all remaining
waiver amortization installments (including any installment for the
current plan year), using the interest rates reported on Line 24. Do
not include any new waiver amortization base established for a
waiver of minimum funding requirements for the current plan year.
Waiver amortization installments--Enter the sum of any remaining
waiver amortization installments that were established to amortize
any waiver amortization bases for prior plan years, unless such
bases have been or are deemed to be fully amortized. Do not include
an amortization installment for any new waiver amortization base
established for a waiver of minimum funding requirements for the
current plan year.
Note. If a waiver of minimum funding requirements has been
granted for the current plan year, a waiver amortization base is
established as of the valuation date for the current plan year equal
to the amount of the funding waiver reported in Line 37. The waiver
amortization installment that corresponds to any waiver amortization
base established for the current year is the level amortization
payment that will amortize the new waiver amortization base over 5
annual payments, using the same segment interest rates or rates from
the full yield curve reported on Line 24 for the current plan year,
but with the first payment due on the valuation date for the
following plan year. The amount of the waiver amortization base and
the waiver amortization installments for this base are not reported
in Line 36b for the year in which they are established. Rather,
these are included in the entries for Line 36b on the Schedule SB
for the following plan year.
Note. Waiver amortization installments (including the waiver
amortization installments of any waiver amortization base
established for the prior plan year) are not re-determined from year
to year regardless of any changes in interest rates or valuation
dates.
Required Schedule of Amortization Bases. If there are any
shortfall or waiver amortization bases, complete the schedule
listing all bases (other than a base established for a funding
waiver for the current plan year) showing for each base:
1. The type of base (shortfall or waiver),
2. The present value of any remaining installments (including
the installment for the current plan year),
3. The valuation date as of which the base was established,
4. The number of years remaining in the amortization period, and
5. The amortization installment.
If a base is negative (i.e., a ``gain base''), show amounts in
parentheses or with a negative sign in front of them. All amounts
must be calculated as of the valuation date for the plan year.
If any of the shortfall amortization bases shown on this
schedule are being amortized using an alternative amortization
schedule in accordance with Code section 430(c)(2)(D) or ERISA
section 303(c)(2)(D), identify the amortization schedule being used
and show separately the amount of any installment acceleration
amount added to the shortfall amortization installment for the
current plan year under Code section 430(c)(7) or ERISA section
303(c)(7).
Line 37. Funding Waiver. If a waiver of minimum funding
requirements has been approved for the current plan year, enter the
date of the ruling letter granting the approval and the waived
amount (reported as of the valuation date) in the spaces provided.
If a waiver is pending, do not complete this line. If a pending
waiver is granted after Form 5500 Annual Return/Report is filed,
file an amended Form 5500 with an amended Schedule SB.
Line 38. Total Funding Requirement Before Reflecting Carryover/
Prefunding Balances. Enter the target normal cost in Line 35a, minus
the excess assets in Line 35b, plus the amortization installments
reported in Lines 36a and 36b, reduced by any waived amounts
reported in Line 37.
Line 39. Balances Elected for Use to Offset Funding Requirement.
If the percentage reported on Line 19 is at least 80%, and the plan
has a funding standard carryover balance and/or prefunding balance
(as reported on Line 13, columns (a) and (b)), the plan sponsor may
elect to credit all or a portion of such balances against the
minimum required contribution. Enter the amount of any balance
elected for use for this purpose in the applicable column of Line
39, and enter the total in the column headed ``Total Balance.'' No
portion of the prefunding balance can be used for this purpose
unless the full amount of any remaining funding standard carryover
balance (Line 13, column (a)) is used. The amounts entered on Line
39 cannot be larger than the corresponding amounts on Line 13
(unless the plan's valuation date is not the first day of the plan
year, as discussed below).
If the plan's valuation date is not the first day of the plan
year, adjust the portion of the funding standard carryover balance
and prefunding balance used to offset the minimum required
contribution for interest between the beginning of the plan year and
the valuation date using the effective interest rate for the current
plan year.
Special rule for late election to apply balances to quarterly
installments. If an election was made to use the funding standard
carryover balance or the prefunding balance to offset the amount of
a required quarterly installment, but the election was made after
the due date of the installment, the amount reported on Line 39 may
not be the same amount that is subtracted from the plan's balances
in the following plan year (to be reported in Line 8 of Schedule SB
for the following plan year). Refer to the regulations under Section
430 of the Code for additional information.
Special rule for elections to use balances in excess of the
minimum required contribution. Section 1.430(f)-1(f)(3)(ii) of the
regulations provides an exception to the general rule requiring that
any elections to use the funding standard carryover balance and/or
prefunding balance to offset the minimum required contribution
[[Page 47657]]
are irrevocable. Under this exception, such an election may be
revoked to the extent that the amount of the election exceeds the
minimum required contribution for the plan year as reported in Line
38. If a timely election is made to revoke the excess amount, report
only the amount of the election used to offset the minimum required
contribution on Line 39. If the excess amount is not revoked by
means of a timely election, report the full amount of the election
on Line 39 even if it exceeds the minimum required contribution
reported on Line 38.
Line 40. Additional Cash Requirement. Enter the amount in Line
38 minus the amount in the ``Total Balance'' column in Line 39. (The
result cannot be less than zero.) This represents the contribution
needed to satisfy the minimum funding requirement for the current
year, adjusted for interest to the valuation date.
Line 41. Contributions Allocated Toward Minimum Required
Contribution for Current Year, Adjusted to Valuation Date. Enter the
amount reported in Line 22c.
Line 42. Present Value of Excess Contributions for Current Year.
Line 42a. If Line 41 is greater than Line 40, enter the amount
by which Line 41 exceeds line 40. Otherwise, enter ``0.'' This
amount (plus interest, if applicable) is the maximum amount by which
the plan sponsor may elect to increase the prefunding balance.
Line 42b. Enter the amount of any portion of the amount shown on
Line 42a that results solely from the use of the funding standard
carryover balance and/or prefunding balance to offset the minimum
required contribution.
Line 43. Unpaid Minimum Required Contribution for Current Year.
If Line 41 is less than Line 40, enter the amount by which Line 40
exceeds Line 41. Otherwise, enter ``0''.
Line 44. Unpaid Minimum Required Contributions for All Years.
Enter the sum of the remaining unpaid minimum required contributions
from Line 34 and the unpaid minimum required contribution for the
current year from Line 43. If this amount is greater than zero, file
Form 5330, Return of Excise Taxes Related to Employee Benefit Plans
and pay the 10% excise tax on the unpaid minimum required
contributions.
Part IX--Election to Use Pension Funding Relief under PRA 2010
Note. This section is completed only if:
(1) an election was made to use an alternative shortfall
amortization schedule for any election year under Code section
430(c)(2)(D) or ERISA section 303(c)(2)(D), or
(2) in the case of a plan subject to a delayed effective date
for PPA funding rules under section 104 of PPA, an election was made
to determine the minimum required contribution for any election year
using the extended amortization periods under section 107 of PPA
'06, as added by PRA 2010 (complete Lines 45a and 45b only).
Line 45a. Schedule elected. Check the applicable box to indicate
which alternative shortfall amortization schedule is being used, the
2 plus 7-year schedule or the 15-year being used, the 2 plus 7-year
schedule or the 15-year schedule.
Line 45b. Eligible plan year(s) for which the election in Line
45a was made. Check the box(es) to indicate the eligible plan years
for which the election was made to use an alternative amortization
schedule under Code section 430(c)(2)(D) or ERISA section
303(c)(2)(D) or the relief under section 107 of PPA '06 as added by
PRA 2010. Note that an election to use an alternative amortization
schedule may only be made with respect to one or two eligible plan
years. Refer to Code section 430(c)(2)(D)(v) or ERISA section
303(c)(2)(D)(v) for the definition of eligible plan years.
Line 46. Amount of acceleration adjustment. Enter the total
amount included in the shortfall amortization installments reported
for the current year on Line 36a as a result of increases due to any
installment acceleration amount under Code section 430(c)(7) or
ERISA section 303(c)(7), taking into account any amounts carried
over from previous years and the annual limitation in Code section
430(c)(7)(C)(ii) or ERISA section 303(c)(7)(C)(ii).
Line 47. Excess installment acceleration amount to be carried
over to future plan years. Enter the amount of any excess
installment acceleration amount for the current year (including any
amounts carried to the current year from prior years) that will be
carried over to future plan years in accordance with Code section
430(c)(7)(C)(iii) or ERISA section 303(c)(7)(C)(iii).
Quick Reference Charts
Note. The following series of quick reference charts set forth a
general summary of filing requirements for pension plans, welfare
plans that provide group health benefits, welfare plans other than
group health, and direct filing entities. Not all rules and
requirements are reflected for the various types of filers.
CAUTION: Refer to specific Form 5500 Annual Return/Report
instructions for complete information on filing requirements (e.g.,
Who Must File and What To File). These charts do not include filing
requirements for small plans eligible to file the Form 5500-SF or
the new registration alternative for small fully insured group
health plans.
Make sure you are reading the right chart for your type of plan
or filing entity:
1. Pension Plans Required to File the Form 5500
2. Direct Filing Entities Other Than Group Insurance
Arrangements (GIAs)
3. Welfare Plans and GIAs That Provide Group Health Benefits
4. Welfare Plans Other Than Group Health
Pension Plans Required to File the Form 5500
(Does not include filing requirements for small plans eligible
to file the Form 5500-SF). This chart provides only general
guidance. Not all rules and requirements are reflected. Refer to
specific Form 5500 Annual Return/Report instructions for complete
information on filing requirements (e.g., Who Must File and What To
File).
------------------------------------------------------------------------
Large Pension Plan Small Pension Plan
------------------------------------------------------------------------
Form 5500................... Must complete....... Must complete unless
eligible to File
Form 5500-SF.
Pension plans and
welfare plans with
fewer than 100
participants at the
beginning of the
plan year that are
not exempt from
filing an annual
return/report may
be eligible to file
the Form 5500-SF, a
simplified report.
In addition to the
limitation on the
number of
participants, a
Form 5500-SF may
only be filed for a
plan that is exempt
from the
requirement that
the plan's books
and records be
audited by an
independent
qualified public
accountant (but not
by reason of
enhanced bonding),
has 100 percent of
its assets invested
in certain secure
investments with a
readily
determinable fair
market value, holds
no employer
securities, and is
not a multiemployer
plan. See Who Must
File. Defined
contribution
pension plans
(other than those
that check the
``first plan year''
box, which use Line
6) that otherwise
meet the conditions
for filing the Form
5500-SF use the
count on Line
7g(1)--number of
participants with
account balances at
the beginning of
the year--to
determine whether
they are a small
plan.
Schedule A (Insurance Must complete if Must complete if
Information). plan has insurance plan has insurance
contracts. contracts.
[[Page 47658]]
Schedule C (Service Provider Must complete Part I Must complete Part I
Information). if (1) each covered if (1) each covered
service provider service provider
who received $1,000 who received $1,000
or more in total or more in total
direct and indirect direct and indirect
compensation (i.e., compensation (i.e.,
money or anything money or anything
else of monetary else of monetary
value in connection value in connection
with services with services
rendered to the rendered to the
plan or the plan or the
person's position person's position
with the plan with the plan
during the plan during the plan
year, including year, including
payments from payments from
participants' participants'
accounts and (2) accounts and (2)
other persons who other persons who
received $5,000 or received $5,000 or
more in direct more in direct
compensation in compensation in
connection with connection with
services rendered services rendered
to the plan or the to the plan or the
person's position person's position
with the plan with the plan
during the plan during the plan
year, including year, including
payments from payments from
participants' participants'
accounts; and Part accounts; and Part
II if a service II if a service
provider failed to provider failed to
provide information provide information
necessary for the necessary for the
completion of Part completion of Part
I. I.
Schedule D (DFE/ Not required........ Not required
Participating Plan
Information).
Schedule G (Financial Must complete if Must complete if
Schedules). Schedule H, Lines Schedule H, Lines
4b, 4c, or 4d are 4b, 4c, or 4d are
answered ``Yes.''. answered ``Yes''
and plan is not
eligible for the
audit waiver under
29 CFR 2520.104-46.
Schedule H (Financial Must complete....... Must complete
Information).
Line 4a Schedule of Must check ``yes'' Must check ``yes''
Delinquent Participant to Schedule H, Line to Schedule H, Line
Contributions. 4a and complete if 4a and complete if
plan had delinquent plan had delinquent
contributions (see contributions (see
instructions). instructions).
Line 4i(1) Schedule of Must check ``yes'' Must check ``yes''
Assets Held for Investment to Schedule H, Line to Schedule H, Line
at EOY. 4i(1) and complete 4i(1) and complete
if plan held assets if plan held assets
at end of year (all at end of year (all
plans except those plans except those
that are filing that are filing
final return/report final return/report
with -0- assets at with -0- assets at
year end)). If year end)). If
invested in a CCT invested in a CCT
or PSA that has not or PSA that has not
filed a Form 5500, filed a Form 5500,
must break out the must break out the
underlying underlying
investments of the investments of the
CCT and PSA, CCT and PSA,
indicating assets indicating assets
held through a CCT held through a CCT
or PSA. If invested or PSA. If invested
in a CCT or PSA in a CCT or PSA
that has filed the that has filed the
Form 5500, may Form 5500, may
report individual report individual
CCTs and PSAs at CCTs and PSAs at
the CCT/PSA level, the CCT/PSA level,
indicating the Line indicating the Line
1b category for 1b category for
type of CCT/PSA type of CCT/PSA
investment. investment.
Line 4i(2) Schedule of Must check ``yes'' Must check ``yes''
Assets Disposed of During to Schedule H, Line to Schedule H, Line
the Plan Year. 4i(2) and complete 4i(2) and complete
if plan disposed of if plan disposed of
assets during the assets during the
plan year. Certain plan year. Certain
readily tradable readily tradable
assets not required assets not required
to be reported (see to be reported (see
instructions). instructions).
Line 4j Schedule of Must check ``yes'' Must check ``yes''
Reportable Transactions. to Schedule H, Line to Schedule H, Line
4j and complete if 4j and complete if
plan had plan had
transactions transactions
involving 5% or involving 5% or
more of plan assets. more of plan
assets.
Schedule J.................. Pension plans do NOT Pension plans do NOT
need to complete need to complete
unless providing unless providing
retiree health retiree health
benefits or benefits or
otherwise providing otherwise providing
``group health ``group health
benefits''. benefits''.
Schedule MB (Actuarial Must complete if Must complete if
Information). multiemployer multiemployer
defined benefit defined benefit
pension plan or pension plan or
money purchase plan money purchase plan
subject to minimum subject to minimum
funding standards. funding standards.
Schedule R (Pension Plan Must complete....... Must complete.
Information). Money purchase Money purchase
defined defined
contribution contribution
pension plans that pension plans that
are amortizing a are amortizing a
funding waiver are funding waiver are
required to required to
complete Lines 3, complete Lines 3,
9, and 10 of the 9, and 10 of the
Schedule MB in Schedule MB in
accordance with the accordance with the
instructions. Also instructions. Also
see instructions see instructions
for Line 6 and 7a for Line 6 and 7a
of Schedule R. of Schedule R.
Schedule R should Schedule R should
not be completed not be completed
when the Form 5500 when the Form 5500
Annual Return/ Annual Return/
Report is filed for Report is filed for
a pension plan that a pension plan that
uses, as the sole uses, as the sole
funding vehicle for funding vehicle for
providing benefits, providing benefits,
individual individual
retirement accounts retirement accounts
or annuities (as or annuities (as
described in Code described in Code
section 408). See section 408). See
the Form 5500 the Form 5500
instructions for instructions for
Limited Pension Limited Pension
Plan Reporting for Plan Reporting for
more information. more information.
Schedule SB (Actuarial Must complete if Must complete if
Information). single-employer or single-employer or
multiple-employer multiple-employer
defined benefit defined benefit
pension plan, pension plan,
including an including an
eligible combined eligible combined
plan and subject to plan and subject to
minimum funding minimum funding
standards. standards.
Accountant's Opinion (IQPA Must attach......... Required unless
Report). Schedule H, Line
3h(4) is checked to
indicate that the
plan is a small
plan that meets the
requirements of 29
CFR 2520.104-46.
------------------------------------------------------------------------
Direct Filing Entities Other Than Group Insurance Arrangements
(GIAs)). This chart provides only general guidance. Not all rules
and requirements are reflected. Refer to specific Form 5500 Annual
Return/Report instructions for complete information on filing
requirements (e.g., Who Must File and What To File).
[[Page 47659]]
----------------------------------------------------------------------------------------------------------------
Master Trusts CCTs/PSAs 103-12 IEs
----------------------------------------------------------------------------------------------------------------
Form 5500............................ Must complete.......... CCTs and PSAs are not Certain collective
required to file a investment vehicles
Form 5500, but filing that hold plan assets
by the CCT/PSA are permitted to elect
relieves investing to file a Form 5500,
plans of certain which filing relieves
reporting obligations. investing plans of
certain reporting
obligations.
Schedule of Participating Employers.. Not required........... Not required........... Not required
Schedule A (Insurance Information)... Must complete if plan Not required........... Must complete if plan
has insurance has insurance
contracts. contracts.
Schedule C (Service Provider Must complete Part I if Not required........... Must complete Part I if
Information). (1) each covered (1) each covered
service provider who service provider who
received $1,000 or received $1,000 or
more in total direct more in total direct
and indirect and indirect
compensation (i.e., compensation (i.e.,
money or anything else money or anything else
of monetary value in of monetary value in
connection with connection with
services rendered to services rendered to
the plan or the the plan or the
person's position with person's position with
the plan during the the plan during the
plan year, including plan year, including
payments from payments from
participants' accounts participants' accounts
and (2) other persons and (2) other persons
who received $5,000 or who received $5,000 or
more in direct more in direct
compensation in compensation in
connection with connection with
services rendered to services rendered to
the plan or the the plan or the
person's position with person's position with
the plan during the the plan during the
plan year, including plan year , including
payments from payments from
participants' participants'
accounts; and Part II accounts; and Part II
if a service provider if a service provider
failed to provide failed to provide
information necessary information necessary
for the completion of for the completion of
Part I. Part I.
Schedule D (DFE/Participating Plan Must complete.......... Must complete.......... Must complete
Information).
Schedule G (Financial Schedules)..... Must complete if Not required........... Must complete if
Schedule H, Lines 4b, Schedule H, Lines 4b,
4c, or 4d are answered 4c, or 4d are answered
``Yes.''. ``Yes.''.
Schedule H (Financial Information)... Must complete.......... Must complete.......... Must complete
Line 4a Schedule of Delinquent Not required........... Not required........... Not required
Participant Contributions.
Line 4i(1) Schedule of Assets Held Must check ``yes'' to Must check ``yes'' to Must check ``yes'' to
for Investment at EOY. Schedule H, Line 4i(1) Schedule H, Line 4i(1) Schedule H, Line 4i(1)
and complete if master and complete if plan and complete if 103-12
trust held assets at held assets at end of IE held assets at end
end of year (all plans year (all plans except of year (all plans
except those that are those that are filing except those that are
filing final return/ final return/report filing final return/
report with -0- assets with -0- assets at report with -0- assets
at year end). year end). at year end)
Line 4i(2) Schedule of Assets Must check ``yes'' to Not required........... Must check ``yes'' to
Disposed of During the Plan Year. Schedule H, Line 4i(2) Schedule H, Line 4i(2)
and complete if master and complete if 103-12
trust disposed of IE disposed of assets
assets during the plan during the plan year.
year. Certain readily Certain readily
tradable assets not tradable assets not
required to be required to be
reported (see reported (see
instructions). instructions)
Line 4j Schedule of Reportable Must check ``yes'' to Not required........... Not required
Transactions. Schedule H, Line 4j
and complete if master
trust had transactions
involving 5% or more
of assets.
Schedule J........................... Not required........... Not required........... Not required
Schedule MB (Actuarial Information).. Not required........... Not required........... Not required
Schedule R (Pension Plan Information) Not required........... Not required........... Not required
Schedule SB (Actuarial Information).. Not required........... Not required........... Not required
Accountant's Opinion (IQPA Report)... Not required........... Not required........... Must attach
----------------------------------------------------------------------------------------------------------------
Welfare Plans and Group Insurance Arrangements (GIAs) That
Provide Health Benefits \44\ This chart provides only general
guidance. Not all rules and requirements are reflected. Refer to
specific Form 5500 Annual Return/Report instructions for complete
information on filing requirements (e.g., Who Must File and What To
File).
[[Page 47660]]
----------------------------------------------------------------------------------------------------------------
Group insurance
Large welfare plans Small welfare plans arrangements that
providing health benefits providing health provide health benefits
benefits (GIAs)
----------------------------------------------------------------------------------------------------------------
Form 5500........................ Must complete............ Must complete. Must complete.
Exception: Small fully
insured group health
plans complete only
certain questions.
Schedule of Participating Multiple employer plans Multiple employer plans Must complete
Employers. and plans covering and plans covering
members of a controlled members of a controlled
group must complete. group must complete.
Schedule A (Insurance Must complete if plan has Must complete if plan Must complete
Information). insurance contracts. has insurance
contracts. Exception:
Small fully insured
group health plans do
not complete.
Schedule C (Service Provider Must complete Part I for Must complete Part I for Must complete Part I for
Information). (1) each covered service (1) each covered (1) each covered
provider who received service provider who service provider who
$1,000 or more in total received $1,000 or more received $1,000 or more
direct and indirect in total direct and in total direct and
compensation (i.e., indirect compensation indirect compensation
money or anything else (i.e., money or (i.e., money or
of monetary value in anything else of anything else of
connection with services monetary value in monetary value in
rendered to the plan or connection with connection with
the person's position services rendered to services rendered to
with the plan during the the plan or the the plan or the
plan year, including person's position with person's position with
payments from the plan during the the plan during the
participants' accounts) plan year, including plan year, including
and (2) other persons payments from payments from
who received $5,000 or participants' accounts) participants' accounts
more in direct and (2) other persons and (2) other persons
compensation in who received $5,000 or who received $5,000 or
connection with services more in direct more in direct
rendered to the plan or compensation in compensation in
the person's position connection with connection with
with the plan during the services rendered to services rendered to
plan year, including the plan or the the plan or the
payments from person's position with person's position with
participants' accounts; the plan during the the plan during the
and Part II if a service plan year, including plan year, including
provider failed to payments from payments from
provide information participants' accounts; participants' accounts;
necessary for the and Part II if a and Part II if a
completion of Part I. service provider failed service provider failed
Exception: Unfunded, to provide information to provide information
fully insured, or necessary for the necessary for the
combination unfunded/ completion of Part I. completion of Part I.
fully insured group Exception: Unfunded,
health plans are exempt fully insured, or
under 29 CFR 2520.104-44 combination unfunded/
from completing Schedule fully insured group
C. health plans are exempt
under 29 CFR 2520.104-
44 from completing
Schedule C.
Schedule D (DFE/Participating Not required for plans... Not required for plans.. Must complete to report
Plan Information). participating plans.
Schedule G (Financial Schedules). Must complete if Schedule Not required............ Must complete if
H, Lines 4b, 4c, or 4d Schedule H, Lines 4b,
are answered ``Yes.''. 4c, or 4d for a GIA,
Unfunded, fully insured, are answered ``Yes.''
or combination unfunded/ Unfunded, fully insured,
fully insured welfare or combination unfunded/
plans are exempt under fully insured welfare
29 CFR 2520.104-44 from plans are exempt under
completing Parts I and 29 CFR 2520.104-44 from
II but must still completing Parts I and
complete Schedule G, II but GIA's must still
Part III to report complete Schedule G,
nonexempt transactions. Part III to report
nonexempt transactions
for participating
plans.
Schedule H (Financial Must complete if plan is Must complete if plan is Must complete
Information). partly or fully funded partly or fully funded
with a trust (including with a trust (including
a VEBA). Unfunded, fully a VEBA). Unfunded,
insured, or combination fully insured, or
unfunded/fully insured combination unfunded/
group health plans are fully insured group
exempt under 29 CFR health plans are exempt
2520.104-44 from under 29 CFR 2520.104-
completing Schedule H. 44 from completing
Schedule H.
Line 4a Schedule of Delinquent Must complete if required Not required............ Not required
Participant Contributions. to complete Schedule H.
Line 4i(1) Schedule of Assets If required to complete Not required............ Must complete
Held for Investment at EOY. Schedule H, must check
``yes'' to Schedule H,
Line 4i(1) and complete
if plan held assets at
end of year (all plans
except those that are
filing final return/
report with -0- assets
at year end).
Line 4i(2) Schedule of Assets If required to complete Not required............ Must complete
Disposed of During the Plan Year. Schedule H, must check
``yes'' to Schedule H,
Line 4i(2) and complete
if plan disposed of
assets during the plan
year. Certain readily
tradable assets not
required to be reported
(see instructions).
[[Page 47661]]
Line 4j Schedule of Reportable If required to complete Not required............ Must complete
Transactions. Schedule H, must check
``yes'' to Schedule H,
Line 4j and complete if
plan had transactions
involving 5% or more of
plan assets.
Schedule J....................... Must complete............ Must complete entire Must complete a separate
Schedule J if not fully Schedule J for each
insured. If fully participating employer.
insured, must complete
Lines 1-8.
Schedule MB (Actuarial Not required............. Not required............ Not required
Information).
Schedule R (Pension Plan Not required............. Not required............ Not required
Information).
Schedule SB (Actuarial Not required............. Not required............ Not required
Information).
Accountant's Opinion (IQPA Must complete if plan is Not required............ Must attach.
Report). partly or fully funded
with a trust (including
a VEBA). Unfunded, fully
insured, or combination
unfunded/fully insured
group health plans are
exempt under 29 CFR
2520.104-44 from the
IQPA report.
----------------------------------------------------------------------------------------------------------------
Welfare Plans Other Than Group Health This chart provides only
general guidance. Not all rules and requirements are reflected.
Refer to specific Form 5500 Annual Return/Report instructions for
complete information on filing requirements (e.g., Who Must File and
What To File).
---------------------------------------------------------------------------
\44\ Pension plans that also provide health benefits must follow
the rules for pension plan filings and must also attach a Schedule J
to report on health benefits.
----------------------------------------------------------------------------------------------------------------
Group insurance
Large welfare plans NOT Small welfare plans NOT arrangements (GIAs) NOT
providing health plan providing health plan providing health
benefits benefits benefits
----------------------------------------------------------------------------------------------------------------
Form 5500........................ Must complete............ Must complete, except Must complete
(1) unfunded, fully
insured, or combination
unfunded/fully insured
welfare plans covering
fewer than 100
participants at the
beginning of the plan
year that meet the
requirements of 29 CFR
2520.104-20 are exempt
from filing an annual
report.
(2) Welfare plans with
fewer than 100
participants at the
beginning of the plan
year that are not
exempt from filing an
annual return/report
may be eligible to file
the Form 5500-SF, a
simplified report.
Note: If plan provides
group health benefits,
follow the filing
instructions for group
health plans.
Schedule of Participating Multiple employer plans Multiple employer plans Must complete
Employers. and plans covering and plans covering
members of a controlled members of a controlled
group must complete. group must complete.
Schedule A (Insurance Must complete if plan has Must complete if plan Must complete
Information). insurance contracts. has insurance contracts.
[[Page 47662]]
Schedule C (Service Provider Must complete Part I for Must complete Part I for Must complete Part I for
Information). (1) each covered service (1) each covered (1) each covered
provider who received service provider who service provider who
$1,000 or more in total received $1,000 or more received $1,000 or more
direct and indirect in total direct and in total direct and
compensation (i.e., indirect compensation indirect compensation
money or anything else (i.e., money or (i.e., money or
of monetary value in anything else of anything else of
connection with services monetary value in monetary value in
rendered to the plan or connection with connection with
the person's position services rendered to services rendered to
with the plan during the the plan or the the plan or the
plan year, including person's position with person's position with
payments from the plan during the the plan during the
participants' accounts) plan year, including plan year, including
and (2) other persons payments from payments from
who received $5,000 or participants' accounts) participants' accounts
more in direct and (2) other persons and (2) other persons
compensation in who received $5,000 or who received $5,000 or
connection with services more in direct more in direct
rendered to the plan or compensation in compensation in
the person's position connection with connection with
with the plan during the services rendered to services rendered to
plan year, including the plan or the the plan or the
payments from person's position with person's position with
participants' accounts; the plan during the the plan during the
and Part II if a service plan year, including plan year, including
provider failed to payments from payments from
provide information participants' accounts; participants' accounts;
necessary for the and Part II if a and Part II if a
completion of Part I. service provider failed service provider failed
Unfunded, fully insured, to provide information to provide information
or combination unfunded/ necessary for the necessary for the
fully insured welfare completion of Part I. completion of Part I.
plans are exempt under Exception: Unfunded,
29 CFR 2520.104-44 from fully insured, or
completing Schedule C. combination unfunded/
fully insured welfare
benefit plans are
exempt under 29 CFR
2520.104-44 from
completing Schedule C.
Schedule D (DFE/Participating Not required............. Not required............ Must complete to report
Plan Information). participating plans.
Schedule G (Financial Schedules). Must complete if Schedule Not required............ Must complete if
H, Lines 4b, 4c, or 4d Schedule H, Lines 4b,
are ``Yes.'' Unfunded, 4c, or 4d are answered
fully insured, or ``Yes.''
combination unfunded/
fully insured welfare
plans are exempt under
29 CFR 2520.104-44 from
completing Parts I and
II but must still
complete Schedule G,
Part III to report
nonexempt transactions.
Schedule H (Financial Must complete if plan is Not required............ Must complete
Information). partly or fully funded
with a trust (including
a VEBA). Unfunded, fully
insured, or combination
unfunded/fully insured
welfare plans are exempt
under 29 CFR 2520.104-44
from completing Schedule
H.
Line 4a Schedule of Delinquent Must complete if required Not required............ Not required
Participant Contributions to complete Schedule H.
Line 4i(1) Schedule of Assets Must check ``Yes'' to Not required............ Must complete
Held for Investment at EOY Schedule H, Line 4i(1)
and complete if plan
held assets at end of
year (all plans except
those that are filing
final return/report with
-0- assets at year end).
Line 4i(2) Schedule of Assets Must check ``Yes'' to Not required............ Must complete
Disposed of During the Plan Year Schedule H, Line 4i(2)
and complete if plan
disposed of assets
during the plan year.
Certain readily tradable
assets not required to
be reported (see
instructions).
Line 4j Schedule of Reportable Must check ``Yes'' to Not required............ Must complete
Transactions Schedule H, Line 4j and
complete if plan had
transactions involving
5% or more of plan
assets.
Schedule J....................... Not required............. Not required............ Not required
Schedule MB (Actuarial Not required............. Not required............ Not required
Information).
Schedule R (Pension Plan Not required............. Not required............ Not required
Information).
Schedule SB (Actuarial Not required............. Not required............ Not required
Information).
[[Page 47663]]
Accountant's Opinion (IQPA Large welfare plans must Not required............ Must attach.
Report). complete if plan is
partly or fully funded
with a trust (including
a VEBA). Unfunded, fully
insured, or combination
unfunded/fully insured
welfare plans are exempt
under 29 CFR 2520.104-44
from the IQPA report.
----------------------------------------------------------------------------------------------------------------
ERISA Compliance Quick Checklist
Compliance with the Employee Retirement Income Security Act
(ERISA) begins with knowing the rules. Plan administrators and other
plan officials can use this checklist as a quick diagnostic tool for
assessing a plan's compliance with certain important ERISA rules; it
is not a complete description of all ERISA's rules and it is not a
substitute for a comprehensive compliance review. Use of this
checklist is voluntary. Do not file it with your Form 5500.
If you answer ``No'' to any of the questions below, you should
review your plan's operations because you may not be in full
compliance with ERISA's requirements.
1. Have you provided plan participants with a summary plan
description, summaries of any material modifications of the plan,
and annual summary financial reports or annual pension funding
reports?
2. Do you maintain copies of plan documents at the principal
office of the plan administrator for examination by participants and
beneficiaries?
3. Do you respond to written participant inquires for copies of
plan documents and information within 30 days?
4. Does your plan include written procedures for making benefit
claims and appealing denied claims, and are you complying with those
procedures?
5. Is your plan covered by fidelity bonds protecting the plan
against losses due to fraud or dishonesty by persons who handle plan
funds or other property?
6. Are the plan's investments diversified so as to minimize the
risk of large losses?
7. If the plan permits participants to select the investments in
their plan accounts, has the plan provided them with enough
information to make informed decisions?
8. Has a plan official determined that the investments are
prudent and solely in the interest of the plan's participants and
beneficiaries, and evaluated the risks associated with plan
investments before making the investments?
9. Did the employer or other plan sponsor send participant
contributions to the plan on a timely basis?
10. Did the plan pay participant benefits on time and in the
correct amounts?
11. Did the plan give participants and beneficiaries 30 days
advance notice before imposing a ``blackout period'' of at least
three consecutive business days during which participants or
beneficiaries of a 401(k) or other individual account pension plan
were unable to change their plan investments, obtain loans from the
plan, or obtain distributions from the plan?
If you answer ``Yes'' to any of the questions below, you should
review your plan's operations because you may not be in full
compliance with ERISA's requirements.
1. Has the plan engaged in any financial transactions with
persons related to the plan or any plan official? (For example, has
the plan made a loan to or participated in an investment with the
employer?)
2. Has the plan official used the assets of the plan for his/her
own interest?
3. Have plan assets been used to pay expenses that were not
authorized in the plan document, were not necessary to the proper
administration of the plan, or were more than reasonable in amount?
If you need help answering these questions or want additional
guidance about ERISA requirements, a plan official should contact
the U.S. Department of Labor Employee Benefits Security
Administration office in your region or consult with the plan's
legal counsel or professional employee benefit advisor.
APPENDIX C
Form 5500-SF Instructions
20XX Instructions for Form 5500-SF (Short Form Annual Return/Report of
Small Employee Benefit Plan)
Code section references are to the Internal Revenue Code unless
otherwise noted. ERISA refers to the Employee Retirement Income
Security Act of 1974.
Changes to Note [The instructions for the year in which the
revisions are implemented will include such items in the ``Changes
to Note'' section.]
Table of Contents [The final version of the Instructions for
20XX will include a Table of Contents in substantially the same
format as the existing Table of Contents]
EFAST2 Processing System
Under the computerized ERISA Filing Acceptance System (EFAST),
you must electronically file your 20XX Form 5500-SF, Short Form
Annual Return/Report of Small Employee Benefit Plan. You may file
your 20XX Form 5500-SF online using EFAST2's web-based filing system
or you may file through an EFAST2-approved vendor. You cannot file a
paper Form 5500-SF by mail or other delivery service. For more
information, see the instructions for How To File--Electronic Filing
Requirement on page xx and the EFAST2 Web site at www.efast.dol.gov.
How To Get Assistance
If you need help completing this form, or have other questions,
call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278) (toll
free) or access the EFAST2 or IRS Web sites. The EFAST2 Help Line is
available Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern
Time.
You can access the EFAST2 Web site 24 hours a day, 7 days a week
at www.efast.dol.gov to:
File the Form 5500-SF or 5500 and any needed schedules
or attachments.
Check on the status of a filing you submitted.
View filings posted by EFAST2.
Register for electronic credentials to sign or submit
filings.
View forms and related instructions.
Get information regarding EFAST2, including approved
software vendors.
See answers to frequently asked questions about the
Form 5500-SF, the Form 5500 and its schedules, and EFAST2.
Access the main Employee Benefits Security
Administration (EBSA) and DOL Web sites for news, regulations, and
publications.
You can access the IRS Web site 24 hours a day, 7 days a week at
www.irs.gov to:
View forms, instructions, and publications.
See answers to frequently asked tax questions.
Search publications online by topic or keyword.
Send comments or request help by email.
Sign up to receive local and national tax news by
email.
You can order other IRS forms and publications at the IRS Web
site at www.irs.gov/orderforms. You can order EBSA publications by
calling 1-866-444-EBSA (3272).
General Instructions
The Form 5500-SF, Short Form Annual Return/Report of Small
Employee Benefit Plan, is a simplified annual reporting form for use
by certain small pension and welfare benefit plans. To be eligible
to use the Form 5500-SF, the plan must:
Be a small plan (i.e., generally have fewer than 100
participants at the beginning of the plan year);
Meet the conditions for being exempt from the
requirement that the plan's books and records be audited by an
independent qualified public accountant (IQPA);
Have 100% of its assets invested in certain secure
investments with a readily determinable fair value;
Hold no employer securities;
Not be a multiemployer plan; and
Not provide health benefits.
Plans required to file an annual return/report that are not
eligible to file the Form 5500-SF, must file a Form 5500, Annual
Return/Report of Employee Benefit Plan, with all required schedules
and attachments
[[Page 47664]]
(Form 5500), or Form 5500-EZ, Annual Return of One-Participant
(Owners and Their Spouses) Retirement Plan.
To reduce the possibility of correspondence and penalties, we
remind filers that the Internal Revenue Service (IRS), Department of
Labor (DOL), and Pension Benefit Guaranty Corporation (PBGC) have
consolidated their annual return/report forms to minimize the filing
burden for employee benefit plans. Administrators and sponsors of
employee benefit plans generally will satisfy their IRS and DOL
annual reporting requirements for the plan under ERISA sections 104
and 4065 and Code sections 6058 and 6059 by filing either the Form
5500, Form 5500-SF, or Form 5500-EZ. Defined contribution and
defined benefit pension plans may have to file additional
information with the IRS including: Form 8955-SSA, Annual
Registration Statement Identifying Separated Participants with
Deferred Vested Benefits.; Form 5330, Return of Excise Taxes Related
to Employee Benefit Plans; Form 5310-A, Notice of Plan Merger or
Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities;
Notice of Qualified Separate Lines of Business. See www.irs.gov for
more information. Defined benefit pension plans covered by the PBGC
have special additional requirements, including filing premiums and
reporting certain transactions directly with that agency. See the
PBGC's Web site at www.pbgc.gov/practitioners for information on
premium filings and reporting and disclosure requirements.
Note. The Form 5500-EZ generally is used by ``one-participant
plans or certain foreign plans'' (as defined under Specific
Instructions Only for ``One-Participant Plans and certain foreign
plans'') that are not subject to the requirements of section 104(a)
of ERISA to satisfy certain annual reporting and filing obligations
imposed by the Code. A ``one-participant plan and certain foreign
plan'' may also be eligible to file Form 5500-SF. See Specific
Instructions Only for ``One-Participant Plans and certain foreign
plans.'' A ``one-participant plan or certain foreign plan'' that is
eligible to file Form 5500-SF may elect to file Form 5500-SF
electronically with EFAST2 rather than filing a Form 5500-EZ on
paper with the IRS. A ``one-participant plan or certain foreign
plan'' that is not eligible to file Form 5500-SF must file Form
5500-EZ on paper with the IRS. For more information on filing with
the IRS, go to www.irs.gov or call 1-877-829-5500.
[CAUTION] Abbreviated filing requirements apply for one-
participant plan filers who are eligible to file Form 5500-SF. See
Specific Instructions Only for ``One-Participant Plans'' on page XX.
The Form 5500-SF must be filed electronically. See How To File--
Electronic Filing Requirement instructions and the EFAST2 Web site
at www.efast.dol.gov. Your Form 5500-SF entries will be initially
screened electronically. Your entries must satisfy this screening
for your filing to be received. Once received, your form may be
subject to further detailed review, and your filing may be rejected
based upon this further review.
ERISA and the Code provide for the assessment or imposition of
penalties for not submitting the required information when due. See
Penalties.
Annual returns/reports filed under Title I of ERISA must be made
available by plan administrators to plan participants and
beneficiaries and by the DOL to the public pursuant to ERISA
sections 104 and 106. Pursuant to Section 504 of the Pension
Protection Act of 2006 (PPA), this availability for defined benefit
pension plans must include the posting of identification and basic
plan information and actuarial information (Form 5500-SF, Schedule
SB or MB, and all of the Schedule SB or MB attachments) on any plan
sponsor intranet Web site (or Web site maintained by the plan
administrator on behalf of the plan sponsor) that is used for the
purpose of communicating with employees and not the public. Section
504 also requires DOL to display such information on DOL's Web site
within 90 days after the filing of the plan's annual return/report.
To see 2009 and later Forms 5500-SF, including actuarial
information, see www.dol.gov/ebsa. See www.dol.gov/ebsa/actuarialsearch.html for 2008 and short plan year 2009 actuarial
information filed under the previous paper-based system.
Pension and Welfare Plans Required To File Annual Return/Report
All pension benefit plans and welfare benefit plans covered by
ERISA must file a Form 5500 or Form 5500-SF for a plan year unless
they are eligible for a filing exemption. (See Code sections 6058
and 6059 and ERISA sections 104 and 4065). An annual return/report
must be filed even if the plan is not ``tax qualified,'' benefits no
longer accrue, contributions were not made during this plan year, or
contributions are no longer made. Pension benefit plans required to
file include both defined benefit pension plans and defined
contribution pension plans. Profit-sharing plans, stock bonus plans,
money purchase plans, 401(k) plans, Code section 403(b) plans
covered by Title I of ERISA, and IRA plans established by an
employer are among the pension benefit plans for which an annual
return/report must be filed. Welfare benefit plans provide benefits
such as medical, dental, life insurance, apprenticeship and
training, scholarship funds, severance pay, disability, etc. Plans
that cover residents of Puerto Rico, the U.S. Virgin Islands, Guam,
Wake Island, or American Samoa also must file unless they are
eligible for a filing exemption. This includes a plan that elects to
have the provisions of section 1022(i)(2) of ERISA apply.
For more information about annual return/report filings for Code
section 403(b) plans covered by Title I of ERISA, see Field
Assistance Bulletins 2009-02 and 2010-01, available on the DOL Web
site at www.dol.gov.
Plans Exempt From Filing
Under regulations and applicable guidance, some pension benefit
plans and many welfare benefit plans with fewer than 100
participants are exempt from filing an annual return/report. Do not
file a Form 5500-SF for an employee benefit plan that is any of the
following:
1. An unfunded excess benefit plan. See ERISA section 4(b)(5).
2. A pension benefit plan maintained outside the United States
primarily for the benefit of persons substantially all of whom are
nonresident aliens. However, certain foreign plans are required to
file the Form 5500-EZ with the IRS. See the instructions to the Form
5500-EZ for the filing requirements. For more information, go to
www.irs.gov/ep or call 1-877-829-5500.
3. An annuity or custodial account arrangement under Code
section 403(b)(1) or (7) not established or maintained by an
employer as described in DOL Regulations 29 CFR 2510.3-2(f).
4. A simplified employee pension (SEP) described in Code section
408(k) that conforms to the alternative method of compliance
described in 29 CFR 2520.104-48 or 29 CFR 104-49. A SEP is a pension
plan that meets certain minimum qualifications regarding eligibility
and employer contributions.
5. A Savings Incentive Match Plan for Employees of Small
Employers (SIMPLE) that involves SIMPLE IRAs under Code section
408(p).
6. A church pension benefit plan not electing coverage under
Code section 410(d).
7. An unfunded dues financed pension benefit plan that meets the
alternative method of compliance provided by 29 CFR 2520.104-27.
8. An individual retirement account or annuity not considered a
pension plan under 29 CFR 2510.3-2(d).
9. A ``one-participant plan,'' as defined on page 7. However,
certain one-participant plans are required to file the Form 5500-EZ,
Annual Return of One-Participant (Owners and Their Spouses)
Retirement Plan, with the IRS or, if eligible, may file the Form
5500-SF, Short Form Annual Return/Report of Employee Benefit Plan,
electronically with EFAST2. See page 7.
10. A governmental plan.
11. An unfunded pension benefit plan or an unfunded or insured
welfare benefit plan: (a) whose benefits go only to a select group
of management or highly compensated employees, and (b) which meets
the terms of 29 CFR 2520.104-23 (including the requirement that a
registration statement be timely filed with DOL) or 29 CFR 2520.104-
24.
12. A welfare benefit plan that covers fewer than 100
participants as of the beginning of the plan year and is unfunded,
fully insured, or a combination of insured and unfunded, and does
not provide group health benefits. Plans that provide group health
benefits, regardless of size or funding method must file the Form
5500 and the Schedule J (Group Health Plan Information) and other
schedules as applicable and cannot file the Form 5500-SF. See Form
5500 Annual Return/Report Instructions. For this purpose:
a. An unfunded welfare benefit plan has its benefits paid as
needed directly from the general assets of the employer or the
employee organization that sponsors the plan.
Note. Plans that are NOT unfunded include those plans that
received employee (or former employee) contributions during the
[[Page 47665]]
plan year and/or used a trust or separately maintained fund
(including a Code section 501(c)(9) trust) to hold plan assets or
act as a conduit for the transfer of plan assets during the plan
year. A welfare benefit plan with employee contributions that is
associated with a cafeteria plan under Code section 125 may be
treated for annual reporting purposes as an unfunded welfare benefit
plan if it meets the requirements of DOL Technical Release 92-01, 57
FR 23272 (June 2, 1992) and 58 FR 45359 (Aug. 27, 1993). The mere
receipt of COBRA contributions or other after-tax participant
contributions (e.g., retiree contributions) by a cafeteria plan
would not by itself affect the availability of the relief provided
for cafeteria plans that otherwise meet the requirements of DOL
Technical Release 92-01. See 61 FR 41220, 41222-23 (Aug. 7, 1996).
b. A fully insured welfare benefit plan has its benefits
provided exclusively through insurance contracts or policies, the
premiums of which must be paid directly to the insurance carrier by
the employer or employee organization from its general assets or
partly from its general assets and partly from contributions by its
employees or members (which the employer or employee organization
forwards within 3 months of receipt). The insurance contracts or
policies discussed above must be issued by an insurance company or
similar organization that is qualified to do business in any state.
c. A combination unfunded/insured welfare benefit plan has its
benefits provided partially as an unfunded plan and partially as a
fully insured plan. An example of such a plan is a welfare benefit
plan that provides medical benefits as in ``a'' above and life
insurance benefits as in ``b'' above. See 29 CFR 2520.104-20.
Note. A voluntary employees' beneficiary association, as used in
Code section 501(c)(9) (VEBA), should not be confused with the
employer or employee organization that sponsors the plan. See ERISA
section 3(4).
13. Plans maintained only to comply with workers' compensation,
unemployment compensation, or disability insurance laws.
14. A welfare benefit plan maintained outside the United States
primarily for persons substantially all of whom are nonresident
aliens.
15. A church welfare benefit plan under ERISA section 3(33).
16. An unfunded dues financed welfare benefit plan that meets
the alternative method of compliance provided by 29 CFR 2520.104-26.
17. A welfare benefit plan that participates in a group
insurance arrangement that files a return/report on its behalf under
29 CFR 2520.104-43. A group insurance arrangement generally is an
arrangement that provides benefits to the employees of two or more
unaffiliated employers (not in connection with a multiemployer plan
or a collectively bargained multiple-employer plan), fully insures
one or more welfare benefit plans of each participating employer,
uses a trust (or other entity such as a trade association) as the
holder of the insurance contracts, and uses a trust as the conduit
for payment of premiums to the insurance company.
18. An apprenticeship or training plan meeting all of the
conditions specified in 29 CFR 2520.104-22.
For more information on plans that are exempt from filing an
annual return/report, call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278). For one-participant plan filers, see the
Instructions for Form 5500-EZ or call the IRS Help Line at 1-877-
829-5500.
Who May File Form 5500-SF
If your plan is required to file an annual return/report, you
may file the Form 5500-SF instead of the Form 5500 only if you meet
all of the eligibility conditions listed below.
1. The plan (a) covered fewer than 100 participants at the
beginning of the plan year 20XX, or (b) under 29 CFR 2520.103-1(d)
was eligible to and filed as a small plan for plan year 20XX-1 and
did not cover more than 120 participants at the beginning of plan
year 20XX. (See instructions for Lines 6 and 7, on counting the
number of participants.);
2. The plan did not hold any employer securities at any time
during the plan year;
3. At all times during the plan year, the plan was 100% invested
in certain secure, easy to value assets that meet the definition of
``eligible plan assets'' (see the instructions for Line 8a), such as
mutual fund shares, investment contracts with insurance companies
and banks valued at least annually, publicly traded securities held
by a registered broker dealer, cash and cash equivalents, and plan
loans to participants;
4. The plan is eligible for the waiver of the annual examination
and report of an independent qualified public accountant (IQPA)
under 29 CFR 2520.104-46 (but not by reason of enhanced bonding),
which requirement includes, among others, giving certain disclosures
and supporting documents to participants and beneficiaries regarding
the plan's investments (see instructions for Line 8b);
5. The plan is not a multiemployer plan; and
6. The plan does not provide group health benefits.
Notes. (1) Employee Stock Ownership Plans (ESOPs) and Direct
Filing Entities (DFEs) may not file the Form 5500-SF. (2) One-
participant plans and certain foreign plans should follow the
Specific Instructions Only for ``One-Participant Plans and Certain
Foreign Plans'' in place of the instructions 1-5 above to see if
Form 5500-SF may be filed instead of Form 5500-EZ.
What To File
Plans required to file an annual return/report that meet all of
the conditions for filing the Form 5500-SF may complete and file the
Form 5500-SF in accordance with its instructions. Single-employer
defined benefit pension plans using the Form 5500-SF must also file
the Schedule SB (Form 5500), Single-Employer Defined Benefit Plan
Actuarial Information, and its required attachments. Money purchase
plans amortizing a funding waiver using the Form 5500-SF must also
file the Schedule MB (Form 5500), Multiemployer Defined Benefit Plan
and Certain Money Purchase Plan Actuarial Information, and its
required attachments. For information about Schedule SB and Schedule
MB, see the 20XX Instructions for Form 5500, Annual Return/Report of
Employee Benefit Plan. One-participant plans see Specific
Instructions Only for ``One-Participant Plans and Certain Foreign
Plans.''
Eligible Combined Plans. The Pension Protection Act of 2006
(PPA) established rules for a new type of pension plan, an
``eligible combined plan,'' effective for plan years beginning after
December 31, 2009. See Code section 414(x) and ERISA section 210(e).
An eligible combined plan consists of a defined benefit pension plan
and a defined contribution pension plan that includes a qualified
cash or deferred arrangement under Code section 401(k), with the
assets of the two plans held in a single trust, but clearly
identified and allocated between the plans. The eligible combined
plan design is available only to employers that employed an average
of at least two, but not more than 500 employees, on business days
during the calendar year preceding the plan year as of which the
eligible combined plan is established and that employs at least two
employees on the first day of the plan year that the plan is
established. Because an eligible combined plan includes both a
defined benefit pension plan and a defined contribution pension
plan, the Form 5500-SF filed for the plan must include all the
information, schedules, and attachments that would be required for
either a defined benefit pension plan (such as a Schedule SB) or a
defined contribution pension plan.
When to File
File the 20XX Form 5500-SF for plan years that began in 20XX.
The form, and any required schedules and attachments, must be filed
by the last day of the 7th calendar month after the end of the plan
year (not to exceed 12 months in length) that began in 20XX.
Short Years. For a plan year of less than 12 months (short plan
year), file the form and applicable schedules by the last day of the
7th calendar month after the short plan year ends or by the extended
due date, if filing under an authorized extension of time. Fill in
the short plan year beginning and ending dates in the space provided
and check the appropriate box in Part I, Line B, of the Form 5500-
SF. For purposes of this return/report, a short plan year ends on
the date of the change in accounting period or upon the complete
distribution of assets of the plan. Also see the instructions for
Final Return/Report to determine if ``the final return/report'' box
in Line B should be checked.
Extension of Time To File
Using Form 5558
If filing under an extension of time based on the filing of an
IRS Form 5558, Application for Extension of Time To File Certain
Employee Plan Returns, check the appropriate box on the Form 5500-
SF, Part I, Line C. A one-time extension of time to file the Form
5500-SF (up to 2\1/2\ months) may be obtained by filing Form 5558 on
or before the normal due date (not including any extensions) of the
return/report. [The language on how to file the Form 5558 will
[[Page 47666]]
be changed if filers will be able, as proposed, to file the Form
5558 through EFAST2]. You must file the Form 5558 with the
Department of Treasury, Internal Revenue Service Center, Ogden, UT
84201-0045. Approved copies of the Form 5558 will not be returned to
the filer. A copy of the completed extension request must be
retained with the plan's records.
Using Extension of Time To File Federal Income Tax Return
An automatic extension of time to file Form 5500-SF until the
due date of the federal income tax return of the employer will be
granted if all of the following conditions are met: (1) the plan
year and the employer's tax year are the same; (2) the employer has
been granted an extension of time to file its federal income tax
return to a date later than the normal due date for filing the Form
5500-SF; and (3) a copy of the application for extension of time to
file the federal income tax return is maintained with the filer's
records. An extension of time granted by using this automatic
extension procedure CANNOT be extended further by filing an IRS Form
5558, nor can it be extended beyond a total of 9 \1/2\ months beyond
the close of the plan year.
Notes. (1) If the filing due date falls on a Saturday, Sunday,
or Federal holiday, the return/report may be filed on the next day
that is not a Saturday, Sunday, or Federal holiday. (2) If the 20XX
Form 5500 is not available before the plan filing, use the 20XX-1
Form 5500 and enter the 20XX fiscal year beginning and ending dates
on the line provided at the top of the form.
Other Extensions of Time
The IRS, DOL, and PBGC may announce special extensions of time
under certain circumstances, such as extensions for Presidentially-
declared disasters or for service in, or in support of, the Armed
Forces of the United States in a combat zone. See www.irs.gov,
www.efast.dol.gov, and www.pbgc.gov/practitioners for announcements
regarding such special extensions. If you are relying on one of
these announced special extensions, check the appropriate box on the
Form 5500-SF, Part I, line C, and enter a description of the
announced authority for the extension.
Delinquent Filer Voluntary Compliance (DFVC) Program
The DFVC Program facilitates voluntary compliance by plan
administrators who are delinquent in filing annual return/report
forms under Title I of ERISA by permitting administrators to pay
reduced civil penalties for voluntarily complying with their DOL
annual reporting obligations. If the Form 5500-SF is being filed
under the DFVC Program, check the appropriate box on Form 5500-SF,
Part I, line C to indicate that the Form 5500-SF is being filed
under the DFVC Program. See www.efast.dol.gov for additional
information.
Plan administrators are reminded that they can use the online
calculator available at www.dol.gov/ebsa/calculator/dfvcpmain.html
to compute the penalties due under the program. Payments under the
DFVC Program also may be submitted electronically. For information
on how to pay DFVC Program payments online, go to www.dol.gov/ebsa.
Change in Plan Year
Generally, only defined benefit pension plans need to get
approval for a change in plan year. See Code section 412(d)(1).
However, under Rev. Proc. 87-27, 1987-1 C.B. 769, these pension
plans may be eligible for automatic approval of a change in plan
year.
If a change in plan year for a pension or a welfare benefit plan
creates a short plan year, file the form and applicable schedules by
the last day of the 7th calendar month after the short plan year
ends or by the extended due date, if filing under an authorized
extension of time. Fill in the short plan year beginning and ending
dates in the space provided in Part I and check the appropriate box
in Part I, line B of the Form 5500-SF. For purposes of this return/
report, the short plan year ends on the date of the change in
accounting period or upon the complete distribution of assets of the
plan. Also, see the instructions for Final Return/Report to
determine if ``final return/report'' in line B should be checked.
Penalties
Plan administrators and plan sponsors must provide complete and
accurate information and must otherwise comply fully with the filing
requirements. ERISA and the Code provide for the DOL and the IRS,
respectively, to assess or impose penalties for not giving complete
and accurate information and for not filing complete and accurate
statements and returns/reports. Certain penalties are administrative
(that is, they may be imposed or assessed in an administrative
proceeding by one of the governmental agencies delegated to
administer the collection of the Form 5500-SF data). Others require
a legal conviction.
Administrative Penalties
Listed below are various penalties under ERISA and the Code that
may be assessed or imposed for not meeting the annual return/report
filing requirements. Generally, whether the penalty is under ERISA
or the Code, or both, depends upon the agency for which the
information is required to be filed. One or more of the following
administrative penalties may be assessed or imposed in the event of
incomplete filings or filings received after the due date unless it
is determined that your failure to file properly is for reasonable
cause.
1. A penalty of up to $1,100 a day (or higher amount if adjusted
pursuant to the Federal Civil Penalties Inflation Adjustment Act of
1990, as amended) for each day a plan administrator fails or refuses
to file a complete and accurate annual return/report. See ERISA
section 502(c)(2) and 29 CFR 2560.502c-2.
2. A penalty of $25 a day (up to $15,000) for not filing the
annual return/report for certain plans of deferred compensation,
trusts and annuities, and bond purchase plans by the due date(s).
See Code section 6652(e).
3. A penalty of $1,000 for not filing an actuarial statement
(Schedule MB (Form 5500) or Schedule SB (Form 5500)) required by the
applicable instructions. See Code section 6692.
Other Penalties
1. Any individual who willfully violates any provision of Part 1
of Title I of ERISA shall on conviction be fined not more than
$100,000 or imprisoned not more than 10 years, or both. See ERISA
section 501.
2. A penalty up to $10,000, five (5) years imprisonment, or
both, may be imposed for making any false statement or
representation of fact, knowing it to be false, or for knowingly
concealing or not disclosing any fact required by ERISA. See section
1027, Title 18, U.S. Code, as amended by section 111 of ERISA.
How to File--Electronic Filing Requirement
Under the computerized ERISA Filing Acceptance System (EFAST2),
you must file your 20XX Form 5500-SF electronically. You may file
your 20XX Form 5500-SF online using EFAST2's web-based filing system
or you may file through an EFAST2-approved vendor. Detailed
information on electronic filing is available at www.efast.dol.gov.
For telephone assistance, call the EFAST2 Help Line at 1-866-GO-
EFAST (1-866-463-3278). The EFAST2 Help Line is available Monday
through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time.
[CAUTION] Annual returns/reports filed under Title I of ERISA,
including those filed using the Form 5500-SF, must be made available
by the plan administrators to plan participants and beneficiaries
and by the DOL to the public pursuant to ERISA sections 104 and 106.
Even though the Form 5500-SF must be filed electronically, the plan
administrator must keep a copy of the Form 5500-SF, including
schedules and attachments, with all required signatures on file as
part of the plan's records, and must make a paper copy available on
request to participants, beneficiaries, and the DOL as required by
section 104 of ERISA and 29 CFR 2520.103-1. Filers may use
electronic media for record maintenance and retention, so long as
they meet the applicable requirements.
Generally, questions on the Form 5500-SF relate to the plan year
entered at the top of the first page of the form. Therefore, answer
all questions on the 20XX Form 5500-SF with respect to the 20XX plan
year unless otherwise explicitly stated in the instructions or on
the form itself.
Your entries must be in the proper format in order for the
EFAST2 system to process your filing. For example, if a question
requires you to enter a dollar amount, you cannot enter a word. Your
software will not let you submit your return/report unless all
entries are in the proper format. To reduce the possibility of
correspondence and penalties:
Complete all lines on the Form 5500-SF unless otherwise
specified. Also complete and electronically attach, as required, any
applicable schedules and attachments.
Do not enter ``N/A'' or ``Not Applicable'' on the Form
5500-SF or Schedules SB (Form 5500) and MB (Form 5500) unless
specifically permitted. ``Yes'' or ``No''
[[Page 47667]]
questions on the form and schedules cannot be left blank, unless
specifically permitted. Answer ``Yes'' or ``No,'' but not both.
Use the correct employer identification number (EIN)
and plan number (PN) for the plan.
You should check your return/report for errors before signing or
submitting it to EFAST2. Your filing software or, if you are using
it, the EFAST2 web-based filing system will allow you to check your
return/report for errors. If, after reasonable attempts to correct
your filing to eliminate any identified problem or problems, you are
unable to address them, or you believe that you are receiving the
message in error, call the EFAST2 Help Line at 1-866-GO-EFAST (1-
866-463-3278) or contact the service provider you used to help
prepare and file your annual return/report.
Once you complete the return/report and finish the electronic
signature process, you can electronically submit it to EFAST2. When
you electronically submit your return/report, EFAST2 is designed to
immediately notify you if your submission was received and whether
the return/report is ready to be processed by EFAST2. If EFAST2 does
not notify you that your submission was successfully received and is
ready to be processed, you will need to take steps to correct the
problem or you may be deemed a non-filer subject to penalties from
DOL, IRS, and/or PBGC.
Once EFAST2 receives your return/report, the EFAST2 system
should be able to provide a filing status within 20 minutes. Check
back into the EFAST2 system to determine the filing status of your
return/report. The filing status message will include a list of any
filing errors or warnings that EFAST2 may have identified in your
filing. If EFAST2 did not identify any filing errors or warnings,
EFAST2 will show the filing status of your return/report as
``Filing_Received.'' Persons other than the submitter can check
whether the filing was received by the system by calling the EFAST2
Help Line at 1-866-GO-EFAST (1-866-463-3278) and using the automated
telephone system.
To reduce the possibility of correspondence and penalties from
the DOL, IRS, and/or PBGC, you should do the following: (1) Before
submitting your return/report to EFAST2, check it for errors, and
(2) after you have submitted it to EFAST2, verify that you have
received a filing status of ``Filing_Received'' and attempt to
correct and resolve any errors or warnings listed in the status
report.
Note. Even after being received by the EFAST2 system, your
return/report filing may be subject to further detailed review by
DOL, IRS, and/or PBGC, and your filing may be deemed deficient based
upon this further review. See Penalties on page 5.
The Form 5500-SF, Schedules SB (Form 5500) and MB (Form 5500),
and any attachments that are filed under ERISA are open to public
inspection, and the contents are public information subject to
publication on the Internet.
[CAUTION] Do not enter social security numbers in response to
questions asking for an employer identification number (EIN).
Because of privacy concerns, the inclusion of a social security
number or any portion thereof on the Form 5500-SF or on a schedule
or attachment that is open to public inspection may result in the
rejection of the filing. If you discover a filing disclosed on the
EFAST2 Web site that contains a social security number, immediately
call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278).
Do not attach a copy of the annual registration statement
identifying separated participants with deferred vested benefits or
a previous year's Schedule SSA (Form 5500) to your 20XX Form 5500-SF
annual return/report. The annual registration statement must be
filed directly with the IRS and cannot be attached to a Form 5500-SF
submission with EFAST2.
Employers without an employer identification number (EIN) must
apply to the IRS for one as soon as possible. The EBSA does not
issue EINs. To apply for an EIN from the IRS:
Mail or fax Form SS-4, Application for Employer
Identification Number, obtained at the IRS Web site at www.irs.gov.
Call 1-800-829-4933 to receive your EIN by telephone.
Select the Online EIN Application link at www.irs.gov.
The EIN is issued immediately once the application information
is validated. (The online application process is not yet available
for corporations with addresses in foreign countries or Puerto
Rico.)
Signature and Date
For purposes of Title I of ERISA, the plan administrator is
required to file the Form 5500 or 5500-SF. The plan administrator
must electronically sign the Form 5500 or 5500-SF submitted to
EFAST2.
[CAUTION] After submitting your filing, you must check the
Filing Status. If the filing status is ``Processing Stopped'', it is
possible your submission was not sent with a valid electronic
signature as required, and depending on the error, may be considered
not to have been filed. By looking closer at the Filing Status, you
can see specific error messages applicable to the transmitted filing
and determine whether it was sent with a valid electronic signature
and what other errors may need to be corrected.
Note. If the plan administrator is an entity, the electronic
signature must be in the name of a person authorized to sign on
behalf of the plan administrator.
If the plan administrator does not sign a filing, the filing
status will indicate that there is an error with your filing, and
your filing will be subject to further review, correspondence,
rejection, and civil penalties.
Authorized Service Provider Signatures. If the plan
administrator elects to have a service provider who manages the
filing process for the plan get EFAST2 signing credentials and
submit the electronic Form 5500-SF for the plan:
(1) the service provider must receive specific written
authorization from the plan administrator to submit the plan's
electronic filing;
(2) the plan administrator must manually sign a paper copy of
the electronically completed Form 5500-SF, and the service provider
must include a PDF copy of the entire three-page Form 5500-SF,
excluding any attachments and associated schedules, submitted to
EFAST2;
(3) the service provider must communicate to the plan
administrator any inquiries received from EFAST2, DOL, IRS or PBGC
regarding the filing;
(4) the service provider must communicate to the plan
administrator that, by electing to use this option, the image of the
plan administrator's manual signature will be included with the rest
of the return/report posted by the Labor Department on the Internet
for public disclosure; and
(5) the plan administrator must keep the manually signed copy of
the Form 5500-SF, with all required schedules, as part of the plan's
records. For more information on the electronic signature option,
see EFAST2 All-Electronic Filing System FAQs at www.dol.gov/ebsa/faqs/faq-EFAST2.html.
[CAUTION] Service providers should consider implications of IRS
tax return preparer rules.
Note. The Code permits either the plan sponsor/employer or the
administrator to sign the filing. Therefore, in the case of a Form
5500-SF filed for a ``one-participant plan'' not subject to Title I
of ERISA that is filing a Form 5500-SF with EFAST2 in lieu of filing
a Form 5500-EZ on paper with the IRS (see Specific Instructions Only
for ``One-Participant Plans and certain foreign plans''), either may
sign. However, any other Form 5500-SF that is not electronically
signed by the plan administrator will be subject to rejection and
civil penalties under Title I of ERISA.
The Form 5500-SF annual return/report must be filed
electronically and signed. To obtain an electronic signature, go to
www.efast.dol.gov and register in EFAST2 as a signer. You will be
provided with a UserID and a PIN. Both the UserID and PIN are needed
to sign the Form 5500-SF. The plan administrator must keep a copy of
the Form 5500-SF, including schedules and attachments, with all
required signatures on file as part of the plan's records. See 29
CFR 2520.103-1. Electronic signatures on annual returns/reports
filed under EFAST2 are governed by the applicable statutory and
regulatory requirements.
Trustee/Custodian Signature
The plan trustee or custodian may electronically sign this
schedule or attach to the Form 5500 an electronic reproduction of
the Schedule H signed by the plan's trustee. This electronic
reproduction must be labeled ``Trustee Signature'' and must be
included as a Portable Document Format (PDF) attachment or any
alternative electronic attachment allowable under EFAST2 if this is
not electronically signed. If there is more than one trustee or
custodian, the trustee or custodian authorized by the others may
sign. If the plan trustee or custodian is an entity, the signature
must be the name of a person authorized to sign on behalf of the
plan trustee or custodian.
Note. Trust information reported in this Form is for purpose of
satisfying the requirements under Code section 6033(a) for
[[Page 47668]]
an annual information return from every section 401(a) organization
exempt from tax under section 501(a). The statute of limitations
under Code section 6501(a) for any trust described in section
401(a), which is exempt from tax under section 501(a), will not
start to run until you timely file with the appropriate trust
information on this Form.
Preparer Information
Enter the ``Preparer's name (including firm's name, if
applicable), address, and telephone number'' at the bottom of the
first page of Form 5500-SF. A preparer is any person who prepares an
annual return/report for compensation, or who employs one or more
persons to prepare for compensation. If the person who prepared the
annual return/report is not the employer named in line 2a or the
plan administrator named in line 3a, you must name the person on
this line. If there are several people who prepare Form 5500-SF and
applicable schedules, please name the person who is primarily
responsible for the preparation of the annual return/report.
Note. You must complete preparer information if you are required
to file at least 250 returns of any type with the IRS during the
calendar year. However, if you are a small filer (files fewer than
250 returns of any type with the IRS during the calendar year), and
you do not enter preparer information on the Form 5500, then you
must file the paper Form 5500-SUP with the IRS. See the Treasury
regulations on ``Employee Retirement Benefit Plan Returns Required
on Magnetic Media'' (See 79 FR 58256 at https://federalregister.gov/a/2014-23161) and Instructions for Form 5500-SUP for more
information.
Specific Instructions Only for ``One-Participant Plans and Certain
Foreign Plans''
A ``one-participant plan'' is: (1) A pension benefit plan that
covers only an individual or an individual and his or her spouse who
wholly own a trade or business, whether incorporated or
unincorporated; or (2) a pension benefit plan for a partnership that
covers only the partners or the partners and the partners' spouses.
Thus, a ``one-participant plan'' can cover more than one
participant. On the other hand, merely covering only one participant
does not make you eligible to file as a ``one-participant plan''
unless you are one of the types of plans described above.
A foreign plan is maintained outside the United States primarily
for nonresident aliens, if (1) a plan is maintained by a domestic
employer; or (2) a plan is maintained by a foreign employer with
income derived from sources within the United States (including
foreign subsidiaries of domestic employers) if contributions to the
plan are deducted on its U.S. income tax return.
The Form 5500-EZ generally is used by one-participant plans and
certain foreign plans that are not subject to the requirements of
section 104(a) of ERISA to satisfy certain annual reporting and
filing obligations imposed by the Code. One-participant plans and
certain foreign plans may file the Form 5500-SF electronically in
place of a Form 5500-EZ (on paper) to satisfy the filing obligations
under the Code. One-participant plans and foreign plans that file
the Form 5500-SF electronically complete only certain questions on
the Form 5500-SF. These are the questions that would be completed if
the filer filed Form 5500-EZ on paper. For more information on
filing with the IRS, go to www.irs.gov or call 1-877-829-5500.
Notes. (1) A Form 5500-SF may be filed for one-participant plans
and certain foreign plans that are either defined contribution
pension plans (which include profit-sharing and money purchase
pension plans, but not an ESOP or stock bonus plan) or defined
benefit pension plans. (2) The filer of a one-participant plan or a
foreign plan that is required by the Code or regulations to file at
least 250 returns of any type, including information returns (for
example, Forms W-2 and Forms 1099), income tax returns, employment
tax returns, and excise tax returns, with the IRS during the
calendar year, must use the Form 5500-SF to file the information
required on the Form 5500-EZ, but will not be required to attach to
the filing a Schedules SB or MB. For more information, see IRS
regulations on ``Employee Retirement Benefit Plan Returns Required
on Magnetic Media'' (See T.D. 9695, 79 FR 58256 at https://federalregister.gov/a/2014-23161). (3) Information filed on Form
5500-EZ is required to be made available to the public. Form 5500-SF
is open to public inspection and the contents are public information
subject to publication on the Internet. However, the information on
Form 5500-SF will not be subject to publication on the internet for
a ``one-participant plan or a foreign plan'' that is electronically
filed using a Form 5500-SF with EFAST2 in lieu of filing a Form
5500-EZ on paper with the IRS.
Eligible one-participant plans and certain foreign plans need
complete only the following questions on the Form 5500-SF:
1. Part I, Lines A, B, and C;
2. Part II, Lines 1a-5b; 5d(1), 5d(2), and 5(e);
3. Part III, Lines 7a-c, and 8a;
4. Part IV, Line 9a;
5. Part V, Lines 10g; and 10l
6. Part VI, Lines 11-12e.
7. Part VIII, Lines 14a-14d; and
8. Part IX, Lines 18 a, b, c, d, Line 19, and Line 20.
Note. For Lines 7a through 7c, an eligible one-participant plan
or certain foreign plan need complete only for total plan assets,
total plan liabilities, and net plan assets for beginning of year
and end of year, and is not required to complete Line 7a(1) through
7a(8).
Schedule MB (Form 5500). If a money purchase defined
contribution pension plan (including a target benefit plan) has
received a waiver of the minimum funding standard, and the waiver is
currently being amortized, complete Lines 3, 9, and 10 of Schedule
MB (Form 5500). See the Instructions for Schedule MB in the
Instructions for Form 5500 Annual Return/Report. One-participant
plans and foreign plans, however, do not attach Schedule MB to the
Form 5500-SF. Instead, these plans must keep the completed Schedule
MB in accordance with the applicable records retention requirements.
Schedule SB (Form 5500). One-participant plans and foreign plans
do not attach Schedule SB (Form 5500) to the Form 5500-SF. Instead,
these plans must keep the completed Schedule SB that is signed by
the plan actuary in accordance with the applicable records retention
requirements. Actuaries of one-participant plans and foreign plans
that are defined benefit pension plans subject to the minimum
funding standards for this plan year, must complete Schedule SB
(Form 5500) and forward the completed and signed Schedule SB to the
plan administrator no later than the filing due date. See the
Instructions for Schedule SB in the Instructions for Form 5500.
Filing Form 5500-EZ with the IRS. If you are filing a paper
form, you must file the Form 5500-EZ with the IRS using the
following address: Department of the Treasury, Internal Revenue
Service Center, Ogden, UT 84201-0027. You may order the paper Form
5500-EZ and its instructions by visiting the IRS Web site at
www.irs.gov/formspubs/.
Filing an amendment. If you are filing an amendment for a ``one-
participant plan'' or a ``foreign plan'' that filed a Form 5500-SF
electronically, you may submit the amendment either electronically
using the Form 5500-SF with EFAST2 or on paper using the Form 5500-
EZ with the IRS. If you are filing an amendment for a ``one-
participant plan'' that previously filed on a paper Form 5500-EZ,
you must submit the amendment using the paper Form 5500-EZ with the
IRS. However, if you are filing an amendment for a one-participant
plan or a foreign plan that is required by the Treasury regulations
(See T.D. 9695, 79 FR 58256 at https://federalregister.gov/a/2014-23161 to file electronically using the Form 5500-SF, you must submit
the amendment electronically using the Form 5500-SF with EFAST2.
Specific Line-by-Line Instructions (Form 5500-SF)
Part I--Annual Report Identification Information
File the 20XX Form 5500-SF annual report for a plan year that
began in 20XX. Enter the beginning and ending dates in Part I. The
20 XX Form 5500-SF annual report must be filed electronically.
Check only one of the Line A box choices.
Line A(1)--Box for Single-Employer Plan. Check this box if the
Form 5500-SF is filed for a single-employer plan. A single-employer
plan for purposes of the Form 5500-SF is an employee benefit plan
maintained by one employer or one employee organization.
Note. Do not check this box even if all of the employers
maintaining the plan are members of the same controlled group or
affiliated service group under Code sections 414(b), (c), or (m).
Check Box A(3).
Line A(2)--Box for Multiple-Employer Plan. Check this box if the
Form 5500-SF is being filed for a multiple-employer plan. A
multiple-employer plan is a plan that is maintained by more than one
employer and is not the type of plan described in A(3). For purposes
of the Form 5500-SF, a multiple-employer plan is a plan that is
maintained by
[[Page 47669]]
more than one employer and is not a single-employer plan or a
multiemployer plan. Multiple-employer plans can be collectively
bargained and collectively funded, but if covered by PBGC
termination insurance, they must have properly elected before
September 27, 1981, not to be treated as a multiemployer plan under
Code section 414(f)(5) or ERISA sections 3(37)(E) and 4001(a)(3),
and have not revoked that election or made an election to be treated
as a multiemployer plan under Code section 414(f)(6) or ERISA
section 3(37)(G). Participating employers do not file individually
for multiple-employer plans.
Note. Do not check this box if all of the employers maintaining
the plan are members of the same controlled group or affiliated
service group under Code sections 414(b), (c), or (m).
Except as provided below, multiple-employer pension plans
required to file a Form 5500-SF must include an attachment using the
format below that (1) lists each participating employer in the plan
during the plan year, identified by name and employer identification
number (EIN), and (2) includes a good faith estimate of each
employer's percentage of the total contributions (including employer
and participant contributions) made by all participating employers
during the year. Any employer who was obligated to make
contributions to the plan for the plan year, made contributions to
the plan for the plan year, or whose employees were covered under
the plan is a ``participating employer'' for this purpose. If a
participating employer made no contributions, enter ``-0-'' in
element (c).
The attachment must be properly identified at the top with the
label ``Multiple-employer Plan Participating Employer Information,''
and the name of the plan, EIN, and plan number (PN) as found on the
plan's Form 5500-SF.
Complete as many entries as needed to report the required
information for all participating employers.
------------------------------------------------------------------------
------------------------------------------------------------------------
Multiple-Employer Plan Participating Employer Information
(Insert Name of Plan, and EIN/
PN as shown on the Form 5500-
SF)
------------------------------------------------------------------------
(a) Name of participating (b) EIN (c) Percent of Total
employer Contributions
------------------------------------------------------------------------
[CAUTION]Multiemployer plans cannot use the Form 5500-SF to
satisfy their annual reporting obligations. They must file the Form
5500. For these purposes, a plan is a multiemployer plan if: (a)
More than one employer is required to contribute; (b) the plan is
maintained pursuant to one or more collective bargaining agreements
between one or more employee organizations and more than one
employer; (c) an election under Code section 414(f)(5) and ERISA
section 3(37)(E) has not been made; and (d) the plan meets any other
applicable conditions of 29 CFR 2510.3-37. A plan that made a proper
election under ERISA section 3(37)(G) and Code section 414(f)(6) on
or before Aug. 17, 2007, is also a multiemployer plan.
Line A(3)--Box for Controlled Group. Check this box for a
``controlled group'' of corporations that is filing a single Form
5500-SF for reporting purposes. A ``controlled group'' is a
controlled group of corporations under Code section 414(b), a group
of trades or businesses under common control under Code section
414(c), or an affiliated service group under Code section 414(m).
Plans sponsored by controlled groups required to file a Form
5500-SF must include an attachment using the format below that (1)
lists each controlled group member in the plan during the plan year,
identified by name and employer identification number (EIN), and (2)
includes a good faith estimate of each employer's percentage of the
total contributions (including employer and participant
contributions) made by all members during the year. Any employer who
was obligated to make contributions to the plan for the plan year,
made contributions to the plan for the plan year, or whose employees
were covered under the plan is a ``controlled group member'' for
this purpose. If a controlled group member made no contributions,
enter ``-0-'' in element (c).
``Controlled Group Plan Member Information'' Attachment. If you
checked box A(3) for ``Controlled Group Plan,'' you must complete
the ``Controlled Group Member Information'' attachment. Enter the
name of the plan, EIN, and plan number (PN) as found on the plan's
Form 5500-SF. Complete as many entries as needed to report the
required information for all participating employers.
------------------------------------------------------------------------
------------------------------------------------------------------------
Controlled Group Member Information
(Heading for this chart must
include Insert Name of Plan,
and EIN/PN as shown on the
Form 5500-SF)(Complete
elements (a), (b), and (c) to
provide the name, EIN, and
percent of total contributions
of each controlled group
member.)
------------------------------------------------------------------------
(a) Name of controlled group (b) EIN (c) Percent of Total
member Contributions
------------------------------------------------------------------------
Line A(4)--Box for One-Participant Plan. Check this box if the
Form 5500-SF is being filed for a plan that is a ``one-participant
plan'' (see page 7). Check the one-participant plan box only for
those plans that are submitting the Form 5500-SF in place of a Form
5500-EZ (on paper) to satisfy the annual return/report filing
obligations under the Code. Plans checking the box for one-
participant plan should not check either the box for single-employer
plan or the box for multiple-employer plan. See Specific
Instructions Only for ``One-Participant Plans and Certain Foreign
Plans.''
Line A(5)--Box for Foreign Plans. Check this box if the Form
5500-SF is being filed for a plan that is a ``foreign plan''(see
page XX). Check the foreign plan box only for those plans that are
submitting the Form 5500-SF in place of a Form 5500-EZ (on paper) to
satisfy the annual return/report filing obligations under the Code.
Plans checking the box for foreign plan should not check either the
box for single-employer plan or the box for multiple-employer plan.
See Specific Instructions Only for ``One-Participant Plans and
Certain Foreign Plans.''
Line B(1)--Box for First Return/Report. Check this box if an
annual return/report has not been previously filed for this plan.
For the purpose of completing this box, the Form 5500-EZ is not
considered an annual return/report.
Line B(2)--Box for Final Return/Report. Check this box if this
is the final report for the plan. Only check this box if all assets
under the plan (including insurance/annuity contracts) have been
distributed to the participants and beneficiaries or legally
transferred to the control of another plan, and when all liabilities
for which benefits may be paid under a welfare benefit plan have
been satisfied. Do not mark the final return/report box if you are
reporting participants and/or assets at the end of the plan year. If
a trustee is appointed for a terminated defined benefit pension plan
pursuant to ERISA section 4042, the last plan year for which a
return/report must be filed is the year in which the trustee is
appointed. See Box B(5) for the simplified filing requirements for
PBGC-trusteed plans.
Examples:
Mergers/Consolidations. A final return/report should be filed
for the plan year (12 months or less) that ends when all plan assets
were legally transferred to the control of another plan.
Pension and Welfare Plans That Terminated Without Distributing
All Assets. If the plan was terminated but all plan assets
[[Page 47670]]
were not distributed, a return/report must be filed for each year
the plan has assets. The return/report must be filed by the plan
administrator, if designated, or by the person or persons who
actually control the plan's assets/property.
Welfare Plans Still Liable To Pay Benefits. A welfare plan
cannot file a final return/report if the plan is still liable to pay
benefits for claims that were incurred prior to the termination
date, but not yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line B(3)--Box for Amended Return/Report. Check this box if you
have already filed for the 20XX plan year and are now filing an
amended return/report to correct errors and/or omissions on the
previously filed return/report.
[TIP] Check the Line B box for an ``amended return/report'' if
you filed a previous 20XX annual return/report that was given a
``Filing_Received,'' ``Filing_Error,'' or ``Filing_Stopped'' status
by EFAST2. Do not check the Line B box for an ``amended return/
report'' if your previous submission attempts were not successfully
received by EFAST2 because of problems with the transmission of your
return/report. For more information, go to the EFAST2 Web site at
www.efast.dol.gov or call the EFAST2 Help line at 1-866-GO-EFAST (1-
866-463-3278).
If you need to file an amended return/report to correct errors
and/or omissions in a previously filed annual return/report for the
20XX plan year AND you are eligible to file the Form 5500-SF, you
may use the Form 5500-SF even if the original filing was a Form
5500. If you filed a Form 5500-SF, but determine that you were not
eligible to file the Form 5500-SF, you must use the Form 5500 or
Form 5500-EZ to amend your return/report.
Line B(4)--Box for Short Plan Year Return/Report. Check this box
if this Form 5500-SF is being filed for a plan year period of less
than 12 months. Provide the dates in Part I, Plan Year Beginning and
Ending.
Line B(5)--Box for Plan Trusteed by PBGC. Plans that, as of the
due date of this return, have been trusteed by PBGC under section
4041(c) or 4042 of ERISA, must check this box and enter the date of
trusteeship in the space provided. Plans that check this box must
complete all of Part I, Lines 1, 2, 3, 5 of Part II, and Lines
11a(3) and 11a(4) of Part IV.
Line C--Box for Extensions and DFVC Program. Check the
appropriate box here if:
1. You filed for an extension of time to file this form with the
IRS using Form 5558, Application for Extension of Time To File
Certain Employee Plan Returns, and maintain a copy of the Form 5558
with the filer's records;
2. You are filing using the automatic extension of time to file
the Form 5500-SF return/report until the due date of the federal
income tax return of the employer and maintain a copy of the
employer's extension of time to file the income tax return with the
plan's records;
3. You are filing using a special extension of time to file the
Form 5500-SF annual return/report that has been announced by the
IRS, DOL, or PBGC. If you checked that you are using a special
extension of time, enter a description of the extension of time in
the space provided.; or
4. You are filing under the DFVC Program.
Part II--Basic Plan Information
Line 1a. Enter the formal name of the plan or enough information
to identify the plan. Abbreviate if necessary. If an annual return/
report has previously been filed on behalf of the plan, regardless
of the type of Form that was filed (Form 5500, Form 5500-EZ, or Form
5500-SF), use the same name or abbreviations that were used on the
prior filings. Once you use an abbreviation, continue to use it for
that plan on all future annual return/report filings with the IRS,
DOL, and PBGC. Do not use the same name or abbreviation for any
other plan, even if the first plan is terminated.
Line 1b. Enter the three-digit plan or entity number (PN) that
the employer or plan administrator assigned to the plan. This three-
digit number, in conjunction with the employer identification number
(EIN) entered on Line 2b, is used by the IRS, DOL, and PBGC as a
unique 12-digit number to identify the plan.
Start at 001 for plans providing pension benefits. Start at 501
for welfare plans. Do not use 888 or 999.
Once you use a plan number, continue to use it for that plan on
all future filings with the IRS, DOL, and PBGC. Failure to use the
same three-digit plan/DFE number may result in correspondence from
DOL or IRS. Do not use this unique three-digit number for any other
plan, even if the first plan is terminated.
------------------------------------------------------------------------
------------------------------------------------------------------------
You should assign a plan number (PN) as described below for each Form
5500 (and Form 5500-SF) with the same EIN of plan or DFE sponsor entered
into Line 2b
------------------------------------------------------------------------
Pension benefit plans........ 001 to the first plan. Consecutively
number other plans providing pension
benefits with the same plan sponsor as
002, 003 . . .
Welfare benefit plans........ 501 to the first plan or GIA.
Consecutively number others as 502, 503
. . .
------------------------------------------------------------------------
Exception. If Part II, elements of Line 11a are completed and
333 (or a higher number in a sequence beginning with 333) was
previously assigned to the plan, that number may be entered on Line
1b.
Line 1c. Enter the date the plan first became effective.
Line 2a. Limit your response to the information required in each
row as specified below:
1. Enter the plan sponsor's (employer, if for a single-employer
plan) name, current postal address (only use a P.O. Box number if
the Post Office does not deliver mail to the employer's street
address), foreign routing code where applicable, and ``D/B/A''
(doing business as) or trade name of the employer if different from
the employer's name.
2. Enter any ``in care of'' (C/O) name.
3. Enter the current street address. A post office box number
may be entered, in addition to the street address, if the Post
Office does not deliver mail to the sponsor's street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of the U.S. state or
possession and zip code.
6. Enter the foreign routing code, if applicable. Leave U.S.
state and zip code blank if entering a foreign routing code and
country name.
7. Enter the foreign country, if applicable. Do not abbreviate
the country name after ``Enter foreign country.''
8. Enter the D/B/A (the doing business as) or trade name of the
sponsor if different from the plan sponsor's name.
9. Enter any second address. Use only a street address here, not
a P.O. box.
Notes. (1) In the case of a multiple-employer plan, file only
one annual return/report for the plan. If an association or other
entity is not the sponsor, enter the name of a participating
employer as sponsor. For a plan of a controlled group of
corporations, the name of one of the sponsoring members should be
entered. In either case, the same name must be used in all
subsequent filings of the Form 5500 return/report or Form 5500-SF
for the multiple-employer plan or controlled group. (See
instructions for Line 5 concerning change in sponsorship). (2) You
can also use the IRS Form 8822-B to notify the IRS if the address
provided here is a change in your business mailing address or your
business location.
Line 2b. Enter the employer's nine-digit employer identification
number (EIN).
[CAUTION] Do not use a social security number in lieu of an EIN.
The Form 5500-SF is open to public inspection, and the contents are
public information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number or any portion thereof on this line may result in the
rejection of the filing.
Employers without an EIN number must apply to the IRS for one as
soon as possible. The EBSA does not issue EINs. To apply for an EIN
from the IRS:
Mail or fax Form SS-4, Application for Employer
Identification Number, obtained at the IRS Web site at www.irs.gov.
Call 1-800-829-4933 to receive your EIN by telephone.
Select the Online EIN Application link at www.irs.gov.
The EIN is issued immediately once the application information
is validated. (The online application process is not yet
[[Page 47671]]
available for corporations with addresses in foreign countries).
A multiple-employer plan or plan of a controlled group of
corporations should use the EIN number of the sponsor identified in
Line 2b(1). The EIN must be used in all subsequent filings of the
Form 5500-SF (or any subsequent Form 5500 or Form 5500-EZ in a year
where the plan is not eligible to file the Form 5500-SF) for these
plans. (See instructions to Line 4 concerning change in EIN).
Note. EINs for funds (trusts or custodial accounts) associated
with plans are generally not required to be furnished on the Form
5500-SF. The IRS, however, will issue EINs for such funds for other
reporting purposes. EINs may be obtained as explained above. Plan
sponsors should use the trust EIN described above when opening a
bank account or conducting other transactions for a trust that
requires an EIN.
Line 2b(2). If available, enter the global legal entity
identification number (LEI). With respect to any company, the LEI is
the ``legal entity identifier'' assigned by or on behalf of an
internationally recognized standards setting body and required for
reporting purposes by the U.S. Department of the Treasury's Office
of Financial Research or a financial regulator. In the case of a
financial institution, if a ``legal entity identifier'' has not been
assigned, then provide the RSSD ID assigned by the National
Information Center of the Board of Governors of the Federal Reserve
System, if any.
Line 2c. Enter the telephone number for the plan sponsor. Use
numbers only, including area code, and do not include any special
characters.
Line 2d. Enter the six-digit business code that best describes
the nature of the plan sponsor's business from the list of business
codes on pages XX-XY. If more than one employer or employee
organization is involved, enter the business code for the main
business activity of the employers and/or employee organizations.
Line 3a. Limit your response to the information required in each
row as specified below:
1. Enter the name and address of the plan administrator unless
the administrator is the sponsor identified in Line 2. If both the
plan administrator name and address are the same as the plan sponsor
name and address, check the ``Same as Plan Sponsor'' box and
disregard items 2 through 6 below.
2. Enter any ``in care of'' (C/O) name.
3. Enter the current street address. A post office box number
may be entered, in addition to the street address, if the Post
Office does not deliver mail to the administrator's street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of the U.S. state or
possession and zip code.
6. Enter the foreign routing code and foreign country, if
applicable. Leave U.S. state and zip code blank if entering foreign
routing code and country information.
Plan administrator for this purpose means:
The person or group of persons specified as the
administrator by the instrument under which the plan is operated;
The plan sponsor/employer if an administrator is not so
designated; or
Any other person prescribed by applicable regulations
if an administrator is not designated and a plan sponsor cannot be
identified.
Line 3b. Enter the plan administrator's nine-digit EIN. A plan
administrator must have an EIN for Form 5500-SF reporting. If the
plan administrator does not have an EIN, it must apply to the IRS
for one as explained in the instructions for Line 2b. One EIN should
be entered for a group of individuals who are, collectively, the
plan administrator.
Note. Employees of the plan sponsor who perform administrative
functions for the plan are generally not the plan administrator
unless specifically designated in the plan document. If an employee
of the plan sponsor is designated as the plan administrator, that
employee must obtain an EIN.
Do not use a social security number in lieu of an EIN. The Form
5500-SF and its schedules and attachments are open to public
inspection, and the contents are public information and are subject
to publication on the Internet. Because of privacy concerns, the
inclusion of a social security number or any portion thereof on this
Form 5500-SF or any of it schedules or attachments may result in the
rejection of the filing.
Line 3c. Enter the telephone number for the plan administrator.
Line 4. Enter the name and identifying information of the
``named fiduciary.'' A plan must have at least one fiduciary (a
person or entity) named in the written plan, or through a process
described in the plan, as having control over the plan's operation.
The named fiduciary can be identified by office or by name. For some
plans, it may be an administrative committee or a company's board of
directors. If the named fiduciary is an entity such as a committee
or board, include the name and contact information for a specific
individual, as well as the name of the entity. If you are unable to
determine who is the ``named fiduciary,'' enter the name and
identifying information of the person who appointed the plan
trustee.
Line 5. If the plan sponsor's name, EIN, or LEI have changed
since the last annual return/report was filed for this plan, enter
the plan sponsor's name, EIN, LEI, and the plan number as it
appeared on the last annual return/report filed.
[CAUTION] Failure to indicate on Line 5 that a plan or plan
sponsor was previously identified by a different name, employer
identification number (EIN), LEI, or plan number could result in
correspondence from the DOL and the IRS.
Line 5a. Enter the plan sponsor's name as it appeared on the
last return/report filed.
Line 5b(1). Enter the plan sponsor's EIN as it appeared on the
last return/report filed.
Line 5b(2). Enter the plan sponsor's LEI (if available) as it
appeared on the last return/report filed.
Line 5c. Enter the plan sponsor's plan number as it appeared on
the last return/report filed.
Line 6. Enter in element (a) the total number of participants at
the beginning of the plan year. Enter in element (b) the total
number of participants at the end of the plan year.
Line 7. Enter in element (a) the total number of participants
with account balances as of the end of the plan year. Welfare
benefit plans and defined benefit pension plans do not complete
element (c). Enter in element (a)(1) the total number of active
participants at the beginning of the plan year. Enter in element
(a)(2) the total number of active participants at the end of the
plan year.
The description of ``participant'' in the following instructions
is only for purposes of these lines.
An individual becomes a participant covered under an employee
welfare benefit plan on the earliest of:
The date designated by the plan as the date on which
the individual begins participation in the plan;
The date on which the individual becomes eligible under
the plan for a benefit subject only to occurrence of the contingency
for which the benefit is provided; or
The date on which the individual makes a contribution
to the plan, whether voluntary or mandatory.
See 29 CFR 2510.3-3(d)(1). Covered dependents are not counted as
participants. A child who is an ``alternate recipient'' entitled to
health benefits under a qualified medical child support order
(QMCSO) should not be counted as a participant for Line 6. An
individual is not a participant covered under an employee welfare
plan on the earliest date on which the individual (a) is ineligible
to receive any benefit under the plan even if the contingency for
which such benefit is provided should occur, and (b) is not
designated by the plan as a participant. See 29 CFR 2510.3-3(d)(2).
[TIP] Before counting the number of participants, especially in
a welfare benefit plan, it is important to determine whether the
plan sponsor has established one or more plans for Form 5500/Form
5500-SF reporting purposes. As a matter of plan design, plan
sponsors can offer benefits through various structures or
combinations.
The fact that you have separate insurance policies for each
different welfare benefit does not necessarily mean that you have
separate plans. Some plan sponsors use a ``wrap'' document to
incorporate various benefits and insurance policies into one
comprehensive plan. In addition, whether a benefit arrangement is
deemed to be a single plan may be different for purposes other than
Form 5500/Form 5500-SF reporting. For example, special rules may
apply for purposes of Internal Revenue Code compliance. If you need
help determining whether you have a single welfare benefit plan for
Form 5500/Form 5500-SF reporting purposes, you should consult a
qualified benefits consultant or legal counsel.
[CAUTION] Plans that provide health benefits cannot file the
Form 5500-SF regardless of size and must file the Form 5500.
For pension benefit plans, ``alternate payees'' entitled to
benefits under a qualified domestic relations order (QDRO) are not
to be counted as participants for this line.
For pension benefit plans, ``participant'' for this line means
any individual who is included in one of the categories below.
1. Active participants (i.e., any individuals who are currently
in employment covered by
[[Page 47672]]
the plan and who are earning or retaining credited service under the
plan). This includes any individuals who are eligible to elect to
have the employer make payments under a Code section 401(k)
qualified cash or deferred arrangement. Active participants also
include any nonvested individuals who are earning or retaining
credited service under the plan. This does not include (a) nonvested
former employees who have incurred the break in service period
specified in the plan or (b) former employees who have received a
``cash-out'' distribution or deemed distribution of their entire
nonforfeitable accrued benefit.
2. Retired or separated participants receiving benefits (i.e.,
individuals who are retired or separated from employment covered by
the plan and who are receiving benefits under the plan). This does
not include any individual to whom an insurance company has made an
irrevocable commitment to pay all the benefits to which the
individual is entitled under the plan.
3. Other retired or separated participants entitled to future
benefits (i.e., any individuals who are retired or separated from
employment covered by the plan and who are entitled to begin
receiving benefits under the plan in the future). This does not
include any individual to whom an insurance company has made an
irrevocable commitment to pay all the benefits to which the
individual is entitled under the plan.
4. Deceased individuals who had one or more beneficiaries who
are receiving or are entitled to receive benefits under the plan.
This does not include any individual to whom an insurance company
has made an irrevocable commitment to pay all the benefits to which
the beneficiaries of that individual are entitled under the plan.
Line 7g. Enter in element (1) the number of participants who
have an account balances at the beginning of the year. Enter in
element (2) the number of participants included on Line 7f (total
participants at the end of the plan year) who have account balances
at the end of the plan year. For example, for a Code section 401(k)
plan the number entered on Line 7g should be the number of
participants counted on Line 7f who have made a contribution, or for
whom a contribution has been made, to the plan for this plan year or
any prior plan year. Enter in element (3) the number of participants
that made contributions to the plan (regardless of whether the
employer made contributions) during the plan year. Both defined
contribution pension plans and welfare plans complete element (3).
Enter in element (4) the number of participants that terminated
employment during the plan year that had their entire account
balance distributed as of the end of the plan year. Only defined
contribution pension plans complete element (4).
Defined contribution plans must complete all of Lines 7g(1)-(4).
Welfare plans must complete Line 7g(3) and should leave Line 7g(1),
(2), and (4) blank. Defined benefit pension plans should skip Line
7g and should leave it blank.
Line 7h. Include any individual who terminated employment during
this plan year, whether or not he or she (a) incurred a break in
service, (b) received an irrevocable commitment from an insurance
company to pay all the benefits to which he or she is entitled under
the plan, and/or (c) received a cash distribution or deemed cash
distribution of his or her nonforfeitable accrued benefit.
Part III--Form 5500-SF Eligibility Information.
If your plan is required to file an annual return/report, you
may file the Form 5500-SF instead of the Form 5500 only if you meet
all of the eligibility conditions listed below.
1. The plan (a) covered fewer than 100 participants at the
beginning of the plan year 20XX, or (b) under 29 CFR 2520.103-1(d)
was eligible to and filed as a small plan for plan year 20XX-1and
covered 120 or fewer participants at the beginning of plan year 20XX
(see instructions; defined benefit pension plans, welfare plans, and
defined contribution pension plans that check the ``first plan
year'' box use the number on Line 6; defined contribution pension
plans use the number on Line 7g(1);
2. The plan did not hold any employer securities at any time
during the plan year;
3. At all times during the plan year, the plan was 100% invested
in certain secure, easy to value assets such as mutual fund shares,
investment contracts with insurance companies and banks valued at
least annually and that are not invested in ``hard-to-value''
assets, publicly traded securities held by a registered broker
dealer, cash and cash equivalents, and plan loans to participants
that meet the definition of ``eligible plan assets'' (see the
instructions for Line 8a);
4. The plan is eligible for the waiver of the annual examination
and report of an independent qualified public accountant (IQPA)
under 29 CFR 2520.104-46 (but not by reason of enhanced bonding),
which requirement includes, among others, giving certain disclosures
and supporting documents to participants and beneficiaries regarding
the plan's investments (see instructions for Line 8b);
5. The plan is not a multiemployer plan; and
6. The plan did not provide group health benefits.
Special conditions for filing the Form 5500-SF apply to ``one-
participant plans.'' See Specific Instructions for ``One-Participant
Plans'' on page 7.
Line 8a. Eligible Plan Assets. To be eligible to file the Form
5500-SF, all of the plan's assets must be ``eligible plan assets.''
Answer Line 8a ``Yes'' or ``No.'' Do not leave this question blank.
If the answer to Line 8a is ``No'' you CANNOT file the Form 5500-SF
and must file the Form 5500. See discussion under Who May File Form
5500-SF.
For the purposes of this line, ``eligible plan assets'' are
assets that have a readily determinable fair market value for
purposes of this annual reporting requirement as described in 29 CFR
2520.103-1(c)(2)(ii)(C), are not employer securities, and are held
or issued by one of the following regulated financial institutions:
a bank or similar financial institution as defined in 29 CFR
2550.408b-4(c) (for example, banks, trust companies, savings and
loan associations, domestic building and loan associations, and
credit unions); an insurance company qualified to do business under
the laws of a state; organizations registered as broker-dealers
under the Securities Exchange Act of 1934; investment companies
registered under the Investment Company Act of 1940; or any other
organization authorized to act as a trustee for individual
retirement accounts under Code section 408. Examples of assets that
would qualify as eligible plan assets for this annual reporting
purpose are mutual fund shares, investment contracts with insurance
companies or banks that provide the plan with valuation information
at least annually, publicly traded stock held by a registered broker
dealer, cash and cash equivalents held by a bank. Participant loans
meeting the requirements of ERISA section 408(b)(1) are also
``eligible plan assets'' for this purpose whether or not they have
been deemed distributed. ``Eligible plan assets'' do not include
leveraged investments. Small plans that have such investments must
file the Form 5500.
Line 8b. In addition to all of the plan's assets being eligible
plan assets as defined in Line 8a, to be eligible to file the Form
5500-SF the plan also must meet the conditions for the exemption
from the requirement to be audited annually by an independent
qualified public accountant (IQPA) in 29 CFR 2520.104-46 and covered
fewer than 100 participants as of the beginning of 20XX or, under 29
CFR 2520.103-1(d), was eligible to and filed as a small plan for
plan year 20XX-1 and did not cover more than 120 participants at the
beginning of plan year 20XX. For these purposes, defined benefit
pension plans, welfare plans, and defined contribution pension plans
that check the ``first plan'' year box use the participant count on
Line 6, and defined contribution pension plans can use the
participant count on Line 7g(1).
To be able to file the Form 5500-SF, the filer must meet the
following three requirements for the audit waiver under 29 CFR
2520.104-46:
(1) as the last day of the preceding plan year, at least 95% of
a small pension plan's assets were ``qualifying plan assets;''
(2) the plan includes the required audit waiver disclosure in
the Summary Annual Report (SAR) furnished to participants and
beneficiaries, in accordance with 29 CFR 2520.104b-10. For defined
benefit pension plans that are required pursuant to section 101(f)
of ERISA to furnish an Annual Funding Notice (AFN), the
administrator must instead either provide the information to
participants and beneficiaries with the AFN or as a stand-alone
notification at the time an SAR would have been due and in
accordance with the rules for furnishing an SAR, although such plans
do not have to furnish an SAR; and
(3) in response to a request from any participant or
beneficiary, the plan administrator must furnish without charge
copies of statements from the regulated financial institutions
holding or issuing the plan's ``qualifying plan assets.''
[CAUTION] In order to be eligible to file the Form 5500-SF, a
small pension plan
[[Page 47673]]
must meet the audit waiver conditions by virtue of having 95% or
more of its assets as ``qualifying plan assets'' in accordance with
29 CFR 2520.104-46(b)(1)(i)(A)(1). If the small plan satisfies the
conditions of the audit waiver by virtue of having an enhanced
fidelity bond under 29 CFR 2520.104-46(b)(1)(i)(A)(2), the plan does
not satisfy the conditions for filing the Form 5500-SF and must file
the Form 5500, along with the appropriate schedules and attachments.
Also, although many ``qualifying plan assets'' for audit waiver
purposes will also be ``eligible plan assets'' as described in the
instructions for Line 6a, the definitions are not the same. If, as
of the last day of the preceding plan year, the plan was 100%
invested in ``eligible plan assets,'' the plan would satisfy the
``qualifying plan asset'' prong of the audit waiver conditions.
Holding all the plan's investments in ``qualifying plan assets,''
however, would not necessarily satisfy the conditions for filing the
Form 5500-SF. For example, real estate held by a bank as trustee for
a plan could be a qualifying plan asset for purposes of the small
pension plan audit waiver conditions but it would not be an
``eligible plan asset'' for purposes of the plan being eligible to
file the Form 5500-SF because real estate would not have a readily
determinable fair market value as described in 29 CFR 2520.103-
1(c)(2)(ii)(C).
Line 8c. If you answer ``yes'' because the plan provided health
benefits, whether through insurance or otherwise, you must file the
Form 5500 and cannot file the Form 5500-SF regardless of plan size
or, if any, investment type.
Part IV--Financial Information
Note. The cash, modified cash, or accrual basis may be used for
recognition of transactions in Parts I and II, as long as you use
one method consistently. Round off all amounts reported on the Form
5500-SF to the nearest dollar. Any other amounts are subject to
rejection. Check all subtotals and totals carefully.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith under
the terms of the plan by a trustee or named fiduciary, assuming an
orderly liquidation at the time of the determination. See ERISA
section 3(26).
Line 9. Plan Assets and Liabilities. Amounts reported on the
Form 5500-SF for the beginning of the plan year must be the same as
reported for the end of the plan year for the corresponding lines on
the return/report for the preceding plan year.
Line 9a. Enter the total amount of plan assets at the beginning
of the plan year in column (a). Do not include contributions
designated for the 20XX plan year in column (a).
Enter the total amount of plan assets at the end of the plan
year in column (b). Do not include in column (b) a participant loan
that has been deemed distributed during the plan year under the
provisions of Code section 72(p) and Treasury Regulations section
1.72(p)-1 if both the following circumstances apply: (1) Under the
plan, the participant loan is treated as a directed investment
solely of the participant's individual account; and (2) As of the
end of the plan year, the participant is not continuing repayment
under the loan.
If the deemed distributed participant loan is included in column
(a) and both of these circumstances apply, include the value of the
loan as a deemed distribution on Line 8e. However, if either of
these two circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) should be included in column (b) without regard
to the occurrence of a deemed distribution.
After a participant loan that has been deemed distributed it is
included in the amount reported on Line 10e, it is no longer to be
reported as an asset on Line 9a unless, in a later year, the
participant resumes repayment under the loan. However, such a loan
(including interest accruing thereon after the deemed distribution)
that has not been repaid is still considered outstanding for
purposes of applying Code section 72(p)(2)(A) to determine the
maximum amount of subsequent loans. Also, the deemed distribution is
not treated as an actual distribution for other purposes, such as
the qualification requirements of Code section 401, including, for
example, the determination of top-heavy status under Code section
416 and the vesting requirements of Treasury Regulations section
1.411(a)-7(d)(5). See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
The entry on Line 9a, column (b) (plan assets at end of year)
must include the current value of any participant loan included as a
deemed distribution in the amount reported for any earlier year if,
during the plan year, the participant resumes repayment under the
loan. In addition, the amount to be entered on Line 10e must be
reduced by the amount of the participant loan reported as a deemed
distribution for the earlier year.
Line 9b. Enter the total liabilities at the beginning and end of
the plan year. Liabilities to be entered here do not include the
value of future pension payments to participants. The amount to be
entered in Line 9b for accrual basis filers includes, among other
things:
1. Benefit claims that have been processed and approved for
payment by the plan but have not been paid (including all incurred
but not reported (IBNR) welfare benefit claims);
2. Accounts payable obligations owed by the plan that were
incurred in the normal operations of the plan but have not been
paid; and
3. Other liabilities such as acquisition indebtedness and any
other amount owed by the plan.
Line 9c. Enter the net assets as of the beginning and end of the
plan year. (Subtract Line 9b from Line 9a). Line 9c, column (b),
must equal the sum of Line 9c, column (a), plus Line 10j (net income
(loss)) and Line 10k (transfers to (from) the plan).
Line 10--Income, Expenses, and Transfers for this Plan Year.
Line 10a. Receivables. Include the total cash contributions
received and/or (for accrual basis plans) due to be received.
Line 10a(1). Contributions--Employer and Employee. Plans using
the accrual basis of accounting must not include contributions
designated for years before the 20XX plan year on Line 10a(1). For
welfare plans, report all employee contributions, including all
elective contributions under a cafeteria plan (Code section 125).
For pension plans, participant contributions, for purposes of this
line item, also include elective contributions under a qualified
cash or deferred arrangement (Code section 401(k)).
Line 10a(2). Enter the current value, at date contributed, of
all other contributions, including rollovers from other plans.
Line 10b. Enter all other plan income for the plan year. Do not
include transfers from other plans that are reported on Line 10k.
Examples of other income received and/or receivable include:
1. Interest on investments (including money market accounts,
sweep accounts, etc.)
2. Dividends. (Accrual basis plans should include dividends
declared for all stock held by the plan even if the dividends have
not been received as of the end of the plan year.)
3. Net gain or loss from the sale of assets.
4. Other income such as unrealized appreciation (depreciation)
in plan assets.
To compute this amount, subtract the current value of all assets
at the beginning of the year plus the cost of any assets acquired
during the plan year from the current value of all assets at the end
of the year minus assets disposed of during the plan year.
Line 10c. Enter the total of all cash contributions (Line 10a(1)
through Line 10a(3)) and other plan income (Line 10b) during the
plan year. If entering a negative number, enter a minus sign (``-'')
to the left of the number.
Line 10d. Include: (1) payments made (and, for accrual basis
filers, payments due) to or on behalf of participants or
beneficiaries in cash, securities, or other property (including
rollovers of an individual's accrued benefit or account balance).
Include all eligible rollover distributions as defined in Code
section 401(a)(31)(D) paid at the participant's election to an
eligible retirement plan (including an IRA within the meaning of
Code section 401(a)(31)(E)); (2) payments to insurance companies and
similar organizations for the provision of plan benefits (e.g.,
paid-up annuities, accident insurance, etc.); and (3) payments made
to other organizations or individuals providing benefits. Generally,
these payments discussed in (3) are made to individual providers of
welfare benefits such as legal services, day care services, and
training and apprenticeship services. If securities or other
property are distributed to plan participants or beneficiaries,
include the current value as of the date of distribution.
Line 10e. Include on this line all distributions paid during the
plan year of excess deferrals under Code section 402(g)(2)(A)(ii),
excess contributions under Code section 401(k)(8), and excess
aggregate contributions under Code section 401(m)(6). Include
allocable income distributed. Also include on this line any elective
deferrals and employee contributions distributed or returned to
employees during the plan year
[[Page 47674]]
as well as any attributable income that was also distributed.
For Line 10e, also include in the total amount a participant
loan included in Line 10b, column (a) that has been deemed
distributed during the plan year under the provisions of Code
section 72(p) and Treasury Regulations section 1.72(p)-1 only if
both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a directed
investment solely of the participant's individual account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
If either of these circumstances does not apply, a deemed
distribution of a participant loan should not be included in the
total on Line 10e. Instead, the current value of the participant
loan (including interest accruing thereon after the deemed
distribution) should be included on Lines 9a, column (b) (plan
assets--end of year), and 10b (participant loans--end of year),
without regard to the occurrence of a deemed distribution.
Note. The amount to be reported on Line 10d must be reduced if,
during the plan year, a participant resumes repayment under a
participant loan reported as a deemed distribution on Line 2g of
Schedule H of a prior Form 5500 Annual Return/Report or Line 10e of
a prior Form 5500-SF for any earlier year. The amount of the
required reduction is the amount of the participant loan that was
reported as a deemed distribution on such line for any earlier year.
If entering a negative number, enter a minus sign (``-'') to the
left of the number. The current value of the participant loan must
then be included on line 9a, column (b) (plan assets--end of year).
Although certain participant loans deemed distributed are to be
reported on Line 10e, and are not to be reported on the Form 5500-SF
or on the Schedule H of the Form 5500 Annual Return/Report as an
asset thereafter (unless the participant resumes repayment under the
loan in a later year), they are still considered outstanding loans
and are not treated as actual distributions for certain purposes.
See Q&As 12 and 19 of Treasury Regulations section 1.72(p)-1.
Line 10f. The amount to be reported for expenses involving
administrative service providers (salaries, fees, and commissions)
includes the total fees paid (or in the case of accrual basis plans,
costs incurred during the plan year but not paid as of the end of
the plan year) by the plan for, among others:
1. Salaries to employees of the plan;
2. Fees and expenses for accounting, actuarial, legal,
investment management, investment advice, and securities brokerage
services;
3. Contract administrator fees; and
4. Fees and expenses for individual plan trustees, including
reimbursement for travel, seminars, and meeting expenses.
Line 10g. Other expenses (paid and/or payable) include other
administrative and miscellaneous expenses paid by or charged to the
plan, including among others office supplies and equipment,
telephone, and postage.
Line 10h. Enter the total of all benefits paid or due reported
on Lines 10d and 10e and all other plan expenses reported on Lines
10f and 10g during the year.
Line 10i. Subtract Line 10i from Line 10b.
Line 10j. Enter the net value of all assets transferred to and
from the plan during the plan year including those resulting from
mergers and spinoffs. A transfer of assets or liabilities occurs
when there is a reduction of assets or liabilities with respect to
one plan and the receipt of these assets or the assumption of these
liabilities by another plan. Transfers out at the end of the year
should be reported as occurring during the plan year.
Note. A distribution of all or part of an individual
participant's account balance that is reportable on Form 1099-R,
Distributions From Pensions, Annuities, Retirement or Profit-Sharing
Plans, IRAs, Insurance Contracts, etc., should not be included on
Line 8j but must be included in benefit payments reported on Line
10d. Do not submit IRS Form 1099-R with the Form 5500-SF.
Lines 11(a)-(i). Enter the totals for the various categories as
appropriate.
[CAUTION] Filers that have assets that do not fit into any of
these breakout categories must file the Form 5500. If, the plan is
invested in any assets other than eligible plan assets, which
includes the requirement of being readily marketable, you must file
the Form 5500 and required schedules. For example, if the plan holds
real estate, nonpublicly traded securities, shares in a limited
partnership, derivatives, notes and stock not traded on an exchange,
private equity, and collectibles, or other alternative or hard-to-
value assets, then the plan is required to file a Form 5500.
For reporting purposes, ``common/collective trust'' and ``pooled
separate account'' are, respectively: (1) a trust maintained by a
bank, trust company, or similar institution; or (2) an account
maintained by an insurance carrier, which is regulated, supervised,
and subject to periodic examination by a state or federal agency in
the case of a CCT, or by a state agency in the case of a PSA, for
the collective investment and reinvestment of assets contributed
thereto from employee benefit plans maintained by more than one
employer or controlled group of corporations as that term is used in
Code section 1563. See 29 CFR 2520.103-3, 103-4, 103-5, and 103-9.
To be eligible plan assets for Form 5500-SF reporting purposes, a
bank or insurance company contract, including a CCT or PSA must not
only be valued at least annually, but must itself be invested
primarily in readily marketable assets.
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR 2510.3-
101(h)(1)(iii) does not constitute a pooled separate account.
Part IV--Plan Characteristics
Line 12. Benefits Provided Under the Plan. Pension plans must
answer all applicable questions in Line 11a that applied during the
reporting year of the plan or arrangement. Defined benefit pension
plans must complete Lines 12(1)-(3), 12a(4) and 12a(9)-(11). Defined
contribution pension plans must complete Lines 12a(4)-12a(11).
Welfare benefit plans must complete Lines 11b(1)-(3).
Line 12a(1). Defined Benefit Pension Plans; How Benefits Are
Calculated. If benefits are based primarily on pay, check the box
``Benefits are primarily pay related.'' If benefits are primarily
flat dollar, including dollars per year of service, check the box
``Benefits are primarily flat dollar.''
Check the box for ``Cash balance plan'' if the plan has a ``cash
balance'' formula under which the accumulated benefit provided under
the formula is expressed as the current balance of a hypothetical
account maintained for the participant. For this purpose, a ``cash
balance'' formula is a lump sum based benefit formula in a defined
benefit pension plan by whatever name (for example, personal account
plan, life cycle plan, cash account plan, etc.).
Check the box for ``Pension equity plan (PEP)'' if the plan has
a ``pension equity plan formula under which the accumulated benefit
provided under the formula is expressed as the current value of an
accumulated percentage of the participant's final average
compensation or is expressed as a current single-sum dollar amount
equal to a percentage of the participant's highest average
compensation (with a permitted lookback period for determining
highest average compensation, such as highest 5 out of the last 10
years).
Check the box for ``Other hybrid plan'' if the plan provides a
lump sum based benefit formula that is different from the cash
balance or pension equity plan formula.
Note that a benefit formula does not constitute a lump sum based
benefit formula unless a distribution of the benefits under that
formula in the form of a single-sum payment equals the accumulated
benefit under that formula (except to the extent the single-sum
payment is greater to satisfy the requirements of Code section
411(d)(6)).
Line 12a(2). Code Section Arrangements for Defined Benefit
Pension Plans. Check the box for ``Code section 414(k) arrangement''
if benefits are based partly on the balance of the separate account
of the participant (also include appropriate defined contribution
pension feature codes).
Line 12a(3). Terminated Defined Benefit Pension Plan. Check
``Yes'' if the plan is covered by PBGC and was terminated and closed
out for PBGC purposes before the end of the plan year (or a prior
plan year), and either (1) the plan terminated in a standard (or
distress) termination and completed the distribution of plan assets
in satisfaction of all benefit liabilities (or all ERISA Title IV
benefits for distress termination); or (2) a trustee was appointed
for a terminated plan pursuant to ERISA section 4042.
Line 12a(4). PBGC Covered Defined Benefit Pension Plan. If you
are uncertain whether the plan is covered under the PBGC termination
insurance program, check the box ``Not determined'' and contact the
PBGC either by phone at 1-800-736-2444, by Email at
standard@pbgc.gov, or in writing to Pension Benefit Guaranty
Corporation, Standard Termination Compliance Division, Suite 930,
Processing and Technical Assistance Branch, 1200 K Street, NW.,
Washington, DC 20005-4026. If you checked
[[Page 47675]]
the box ``Yes,'' enter the My PAA generated confirmation number for
the premium filing for this plan year (see filing receipt). If you
amended your premium filing for this plan year, enter the
confirmation number for that filing and not for the previous
filing(s). Defined contribution pension plans and welfare plans do
not need to complete this item.
Line 12a(5). Frozen Plans. Check ``Yes'' if the plan is frozen.
Line 12a(6). Offset Arrangement. Both defined benefit and
contribution plans that are part of an offset arrangement must
answer this question. Check ``Yes'' if plan benefits are subject to
offset for retirement benefits provided in another plan or
arrangement of the employer. If you have checked ``Yes,'' enter the
name, EIN of sponsor, and PN of the other plan or arrangement.
Line 12a(7). Defined Contribution Pension Plan Type(s). Defined
contribution pension plans only complete this line. Check all
type(s) that apply.
Line 12a(8). Defined Contribution Pension Plan Arrangements. If
this is a defined contribution pension plan, check the type(s) of
arrangements under which the plan operates. (Check all that apply.)
Line 12a(9). Defined Contribution Pension Plan Features. If this
is a defined contribution pension plan, check all that apply to
indicate features of the plan.
Check automatic enrollment feature if the plan has elective
contributions from payroll and provides for automatic enrollment in
the plan.
A designated Roth account is a feature in new or existing
401(k), 403(b), or governmental 457(b) plans that permit such plans
to accept designated Roth contributions and certain rollovers. If a
plan adopts this feature, employees can designate some or all of
their elective contributions (also referred to as elective
deferrals) as designated Roth contributions (which are included in
gross income), rather than traditional, pre-tax elective
contributions.
Check the box for ``Age/service weighted plan'' if allocations
are based on age, service, or age and service.
New comparability or similar plan: Allocations are based on
participant classifications and a classification(s) consists
entirely or predominantly of highly compensated employees; or the
plan provides an additional allocation rate on compensation above a
specified threshold, and the threshold or additional rate exceeds
the maximum threshold or rate allowed under the permitted disparity
rules of Code section 401(l).
Check ``other'' if the plan has any other particularized
features for defined contribution pension plans that are not listed
above and enter a short description in the space provided.
Line 12a(10). Participant-Directed Defined Contribution Pension
Plan. Check the box for ERISA section 404(c) plan if the plan, or
any part of it, is intended to meet the conditions of 29 CFR
2550.404c-1.
Check the box for total participant-directed account plan if
participants have the opportunity to direct the investment of all
the assets allocated to their individual accounts, regardless of
whether 29 CFR is intended to be met.
Check partial participant-directed account if participants have
the opportunity to direct the investment of a portion of the assets
allocated to their individual accounts, regardless of whether 29 CFR
is intended to be met. Do not check both ``total'' and ``partial''
participant-directed account.
Check the box for participant-directed brokerage accounts if the
plan provides such accounts as an investment option under the plan.
If you check this box, enter the number of participants using the
participant-directed brokerage account(s).
Line 12a(11). Qualified Default Investment Alternatives (QDIAs).
Regardless of whether the plan is total or partial participant-
directed, if the plan uses default investment alternative(s) (DIA)
that are intended to be QDIA(s) for participants who fail to direct
assets in their account, also check the box to so indicate. If the
plan uses a QDIA for participants who fail to direct assets in their
account, indicate type of default investment alternative: target
date/life fund; fixed income; money market or equivalent; balanced
fund; professionally managed account; or other. If other, specify
the type of account. If you checked the box for ``Other,'' you may
be using an investment alternative that does not satisfy the QDIA
requirements in the Department of Labor's regulation at 29 CFR
2550.404c-5.
Line 12a(12) Eligible Combined Plan Under Code section 414(x).
If the plan is an eligible combined plan under Code section 414(x),
check ``Yes.''
Note. In the case of an eligible combined plan under Code
section 414(x) and ERISA section 210(e), you must answer all
applicable for both the defined benefit pension features and the
defined contribution pension features of the plan.
Line 12a(13). Check this box if a rollover from a plan was used
to start up the business (ROBS) sponsoring this plan.
Line 12a(14). Other Pension Benefit Features. Check all that
apply.
Notes: (1) If a plan sponsor or an employer adopted a pre-
approved plan that includes a master & prototype plan or a volume
submitter plan, enter the most recent adoption date and the IRS
favorable opinion or advisory letter's serial number. (2) Sponsors
of Puerto Rico plans, check the box to indicate that the plan is not
intended to be qualified under Code sections 401, 403, or 408 only
if:
i. only Puerto Rico residents participate,
ii. the trust is exempt from income tax under the laws of Puerto
Rico, and
iii. the plan administrator has not made the election under
ERISA section 1022(i)(2), and, therefore, the plan is not intended
to qualify under section 401(a) of the Internal Revenue Code (U.S).
Line. 12b Welfare Benefit Plan Characteristics. Welfare plans
must answer all applicable questions in Line 12b. Plans that provide
group health benefits cannot file the Form 5500-SF; they must file
the Form 5500. Pension plans skip to Line 13.
Line 12b(1). Disability Benefits. If the plan provides
disability benefits, answer ``Yes'' and check all that apply.
Line 12b(2). Other Welfare Benefits. If the plan provides
welfare benefits other than disability, answer ``Yes'' and check all
that apply. If the type of benefits is not listed, check ``other''
and enter a description.
Line 13. Funding and Benefit Arrangements. Check all boxes that
apply to indicate the funding and benefit arrangements used during
the plan year. The ``funding arrangement'' is the method for the
receipt, holding, investment, and transmittal of plan assets prior
to the time the plan actually provides benefits. ``The benefit
arrangement'' is the method by which the plan provides benefits to
participants. For purposes of Line 13:
``Insurance'' means the plan has an account, contract, or policy
with an insurance company, insurance service, or other similar
organization during the plan or DFE year. (This includes investments
with insurance companies such as guaranteed investment contracts
(GICs).) An annuity account arrangement under Code section 403(b)(1)
that is required to complete the Form 5500 should mark ``insurance''
for both the plan funding arrangement and plan benefit arrangement.
Do not check ``insurance'' if the sole function of the insurance
company was to provide administrative services.
``Code section 412(e)(3) insurance contract'' are contracts that
provide retirement benefits under a plan that are guaranteed by an
insurance carrier. In general, such contracts must provide for level
premium payments over the individual's period of participation in
the plan (to retirement age), premiums must be timely paid as
currently required under the contract, no rights under the contract
may be subject to a security interest, and no policy loans may be
outstanding. If a plan is funded exclusively by the purchase of such
contracts, the otherwise applicable minimum funding requirements of
section 412 of the Code and section 302 of ERISA do not apply for
the year and neither the Schedule MB nor the Schedule SB is required
to be filed.
``Trust'' includes any fund or account that receives, holds,
transmits, or invests plan assets other than an account or policy of
an insurance company. A custodial account arrangement under Code
section 403(b)(7) that is required to complete the Form 5500 should
mark ``trust'' for both the plan funding arrangement and the plan
benefit arrangement.
``General assets of the sponsor'' means either the plan had no
assets or some assets were commingled with the general assets of the
plan sponsor prior to the time the plan actually provided the
benefits promised.
Example. If the plan holds all its assets invested in registered
investment companies and other non-insurance company investments
until it purchases annuities to pay out the benefits promised under
the plan, box 13a(3) should be checked as the funding arrangement
and box 12b(1) should be checked as the benefit arrangement.
Note. An employee benefit plan that checks boxes 13a(1), 13a(2),
13b(1), and/or 13b(2) must answer line 14e to report insurance fee
and commission information.
[[Page 47676]]
Part VI--Plan Operations Compliance Questions
Line 14. Answer all lines either ``Yes'' or ``No.'' Do not leave
any answer blank unless otherwise directed. For Lines 14a, b, c, d,
e, f, and n, if the answer is ``Yes,'' an amount must be entered.
Note. ``One-participant plans'' should complete only Line 14g.
Line 14a. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the plan
are participant contributions that become plan assets as of the
earliest date on which such contributions can reasonably be
segregated from the employer's general assets. See 29 CFR 2510.3-
102. In the case of a plan with fewer than 100 participants at the
beginning of the plan year, any amount deposited with such plan not
later than the 7th business day following the day on which such
amount is received by the employer (in the case of amounts that a
participant or beneficiary pays to an employer), or the 7th business
day following the day on which such amount would otherwise have been
payable to the participant in cash (in the case of amounts withheld
by an employer from a participant's wages), shall be deemed to be
contributed or repaid to such plan on the earliest date on which
such contributions or participant loan repayments can reasonably be
segregated from the employer's general assets. See 29 CFR 2510.3-
102(a)(2). Plans that check ``Yes,'' must enter the aggregate amount
of all late contributions for the year. The total amount of the
delinquent contributions must be included on Line 14a for the year
in which the contributions were delinquent and must be carried over
and reported again on Line 14a for each subsequent year (or on Line
4a of Schedule H of the Form 5500 if not eligible to file the Form
5500-SF in the subsequent year) until the year after the violation
has been fully corrected by payment of the late contributions and
reimbursement of the plan for lost earnings or profits. If no
participant contributions were received or withheld by the employer
during the plan year, answer ``No.''
An employer holding participant contributions commingled with
its general assets after the earliest date on which such
contributions can reasonably be segregated from the employer's
general assets will have engaged in a prohibited use of plan assets
(see ERISA section 406). If such a nonexempt prohibited transaction
occurred with respect to a disqualified person (see Code section
4975(e)(2)), file IRS Form 5330, Return of Excise Taxes Related to
Employee Benefit Plans, with the IRS to pay any applicable excise
tax on the transaction.
Participant loan repayments paid to and/or withheld by an
employer for purposes of transmittal to the plan that were not
transmitted to the plan in a timely fashion must be reported either
on Line 14a in accordance with the reporting requirements that apply
to delinquent participant contributions or on Line 14b. See Advisory
Opinion 2002-02A, available at www.dol.gov/ebsa.
Applicants that satisfy both the DOL Voluntary Fiduciary
Correction Program (VFCP) and the conditions of Prohibited
Transaction Exemption (PTE) 2002-51 are eligible for immediate
relief from payment of certain prohibited transaction excise taxes
for certain corrected transactions, and are also relieved from the
requirement to file the IRS Form 5330 with the IRS. For more
information on how to apply under the VFCP, the specific
transactions covered (which transactions include delinquent
participant contributions to pension and welfare plans), and
acceptable methods for correcting violations. See 71 FR 20261 (Apr.
19, 2006) and 71 FR 20135 (Apr. 19, 2006). All delinquent
participant contributions must be reported on Line 14a at least for
the year in which they were delinquent even if violations have been
fully corrected by the close of the plan year. Information about the
VFCP is also available on the Internet at www.dol.gov/ebsa.
Line 14b. Plans that check ``Yes'' must enter the amount. Check
``Yes'' if any nonexempt transaction with a party-in-interest
occurred. Do not check ``Yes'' with respect to transactions that
are: (1) statutorily exempt under Part 4 of Title I of ERISA; (2)
administratively exempt under ERISA section 408(a); (3) exempt under
Code sections 4975(c) or 4975(d); (4) the holding of participant
contributions in the employer's general assets for a welfare plan
that meets the conditions of ERISA Technical Release 92-01; or (5)
delinquent participant contributions or delinquent loan repayments
reported on Line 14a. You may indicate that an application for an
administrative exemption is pending. If you are unsure whether a
transaction is exempt or not, you should consult either with a
qualified public accountant, legal counsel, or both. If the plan is
a qualified pension plan and a nonexempt prohibited transaction
occurred with respect to a disqualified person, an IRS Form 5330 is
required to be filed with the IRS to pay the excise tax on the
transaction.
Nonexempt transactions. Nonexempt transactions with a party-in-
interest include any direct or indirect:
A. Sale or exchange, or lease, of any property between the plan
and a party-in-interest.
B. Lending of money or other extension of credit between the
plan and a party-in-interest.
C. Furnishing of goods, services, or facilities between the plan
and a party-in-interest.
D. Transfer to, or use by or for the benefit of, a party-in-
interest, of any income or assets of the plan.
E. Acquisition, on behalf of the plan, of any employer security
or employer real property in violation of ERISA section 407(a).
F. Dealing with the assets of the plan for a fiduciary's own
interest or own account.
G. Acting in a fiduciary's individual or any other capacity in
any transaction involving the plan on behalf of a party (or
represent a party) whose interests are adverse to the interests of
the plan or the interests of its participants or beneficiaries.
H. Receipt of any consideration for his or her own personal
account by a party-in-interest who is a fiduciary from any party
dealing with the plan in connection with a transaction involving the
income or assets of the plan.
Party-in-Interest. For purposes of this form, party-in-interest
is deemed to include a disqualified person. See Code section
4975(e)(2). The term ``party-in-interest'' means, as to an employee
benefit plan:
A. Any fiduciary (including, but not limited to, any
administrator, officer, trustee, or custodian), counsel, or employee
of the plan;
B. A person providing services to the plan;
C. An employer, any of whose employees are covered by the plan;
D. An employee organization, any of whose members are covered by
the plan;
E. An owner, direct or indirect, of 50% or more of:
1. the combined voting power of all classes of stock entitled to
vote or the total value of shares of all classes of stock of a
corporation;
2. the capital interest or the profits interest of a
partnership; or
3. the beneficial interest of a trust or unincorporated
enterprise which is an employer or an employee organization
described in C or D;
F. A relative of any individual described in A, B, C, or E;
G. A corporation, partnership, or trust or estate of which (or
in which) 50% or more of:
1. the combined voting power of all classes of stock entitled to
vote or the total value of shares of all classes of stock of such
corporation,
2. the capital interest or profits interest of such partnership,
or
3. the beneficial interest of such trust or estate, is owned
directly or indirectly, or held by persons described in A, B, C, D,
or E;
H. An employee, officer, director (or an individual having
powers or responsibilities similar to those of officers or
directors), or a 10% or more shareholder directly or indirectly, of
a person described in B, C, D, E, or G, or of the employee benefit
plan; or
I. A 10% or more (directly or indirectly in capital or profits)
partner or joint venturer of a person described in B, C, D, E, or G.
[TIP] Applicants that satisfy the VFCP requirements and the
conditions of PTE 2002-51 (see the instructions for Line 12a) are
eligible for immediate relief from payment of certain prohibited
transaction excise taxes for certain corrected transactions and the
requirement to file the Form 5330 with the IRS. For more
information, see 71 FR 20261 (Apr. 19, 2006) and 71 FR 20135 (Apr.
19, 2006). When the conditions of PTE 2002-51 have been satisfied,
the corrected transactions should be treated as exempt under Code
section 4975(c) for the purposes of answering Line 14b.
Line 14c. Plans that check ``Yes'' must enter the aggregate
amount of fidelity bond coverage for all claims. Check ``Yes'' only
if the plan itself (as opposed to the plan sponsor or administrator)
is a named insured under a fidelity bond that is from an approved
surety covering plan officials and that protects the plan from
losses due to fraud or dishonesty as described in 29 CFR part 2580.
Generally, every plan official of an employee benefit plan who
``handles'' funds or other property of such plan must be
[[Page 47677]]
bonded. Generally, a person shall be deemed to be ``handling'' funds
or other property of a plan, so as to require bonding, whenever his
or her duties or activities with respect to given funds are such
that there is a risk that such funds could be lost in the event of
fraud or dishonesty on the part of such person, acting either alone
or in collusion with others. Section 412 of ERISA and 29 CFR part
2580 describe the bonding requirements, including the definition of
``handling'' (29 CFR 2580.412-6), the permissible forms of bonds (29
CFR 2580.412-10), the amount of the bond (29 CFR part 2580, subpart
C), and certain exemptions such as the exemption for unfunded plans,
certain banks and insurance companies (ERISA section 412), and the
exemption allowing plan officials to purchase bonds from surety
companies authorized by the Secretary of the Treasury as acceptable
reinsurers on federal bonds (29 CFR 2580.412-23). Information
concerning the list of approved sureties and reinsurers is available
on the Internet at www.fms.treas.gov/c570. For more information on
the fidelity bonding requirements, see Field Assistance Bulletin
2008-04, available at www.dol.gov/ebsa.
Note. Plans are permitted under certain conditions to purchase
fiduciary liability insurance. These fiduciary liability insurance
policies are not written specifically to protect the plan from
losses due to dishonest acts and cannot be reported as fidelity
bonds on Line 13c.
Line 14d. Check ``Yes'' if the plan had suffered or discovered
any loss as a result of any dishonest or fraudulent act(s) even if
the loss was reimbursed by the plan's fidelity bond or from any
other source. If ``Yes'' is checked enter the full amount of the
loss. If the full amount of the loss has not yet been determined,
provide an estimate as determined in good faith by a plan fiduciary.
You must keep, in accordance with ERISA section 107, records showing
how the estimate was determined.
[CAUTION] Willful failure to report is a criminal offense. See
ERISA section 501.
Line 14e. If any benefits under the plan are provided by an
insurance company, insurance service, or other similar organization
or if the plan has investments with insurance companies such as
guaranteed investment contracts (GICs), report the total of all
insurance fees and commissions paid to agents, brokers and/or other
persons directly or indirectly attributable to the contract(s)
placed with or retained by the plan.
For purposes of Line 14e, commissions and fees include sales or
base commissions and all other monetary and non-monetary forms of
compensation where the broker's, agent's, or other person's
eligibility for the payment or the amount of the payment is based,
in whole or in part, on the value (e.g., policy amounts, premiums)
of contracts or policies (or classes thereof) placed with or
retained by an ERISA plan, including, for example, persistency and
profitability bonuses. The amount (or pro rata share of the total)
of such commissions or fees attributable to the contract or policy
placed with or retained by the plan must be reported. Insurers must
provide plan administrators with a proportionate allocation of
commissions and fees attributable to each contract. Any reasonable
method of allocating commissions and fees to policies or contracts
is acceptable, provided the method is disclosed to the plan
administrator. A reasonable allocation method could allocate fees
and commissions based on a calendar year calculation even if the
plan year or policy year was not a calendar year. For additional
information on these reporting requirements, see ERISA Advisory
opinion 2005-02A, available on the Internet at www.dol.gov/ebsa.
Where benefits under a plan are purchased from and guaranteed by
an insurance company, insurance service, or other similar
organization, and the total fees and commissions are reported on the
Form 5500-SF, payments of reasonable monetary compensation by the
insurer out of its general assets to affiliates or third parties for
performing administrative activities necessary for the insurer to
fulfill its contractual obligation to provide benefits, where there
is no direct or indirect charge to the plan for administrative
services other than the insurance premium, then the payments for
administrative services by the insurer to the affiliates or third
parties do not need to be reported on Line 14e. This would include
compensation for services such as recordkeeping and claims
processing services provided by a third party pursuant to a contract
with the insurer to provide those services but would not include
compensation provided by the insurer incidental to the sale or
renewal of a policy, such as finders' fees, insurance brokerage
commissions and fees, or similar fees.
Reporting also is not required for compensation paid by the
insurer to a ``general agent'' or ``manager'' for that general
agent's or manager's management of an agency or performance of
administrative functions for the insurer. For this purpose, (1) a
``general agent'' or ``manager'' does not include brokers
representing insureds, and (2) payments would not be treated as paid
for managing an agency or performance of administrative functions
where the recipient's eligibility for the payment or the amount of
the payment is dependent or based on the value (e.g., policy
amounts, premiums) of contracts or policies (or classes thereof)
placed with or retained by ERISA plan(s).
Reporting is not required for occasional gifts or meals of
insubstantial value which are tax deductible for federal income tax
purposes by the person providing the gift or meal and would not be
taxable income to the recipient. For this exemption to be available,
the gift or gratuity must be both occasional and insubstantial. For
this exemption to apply, the gift must be valued at less than $50,
the aggregate value of gifts from one source in a calendar year must
be less than $250, but gifts with a value of less than $10 do not
need to be counted toward the $250 annual limit. If the $250
aggregate value limit is exceeded, then the aggregate value of all
the gifts will be reportable. For this purpose, non-monetary gifts
of less than $10 also do not need to be included in calculating the
aggregate value of all gifts required to be reported if the $250
limit is exceeded.
Gifts from multiple employees of one service provider should be
treated as originating from a single source when calculating whether
the $50 or $250 thresholds apply. On the other hand, in applying the
threshold to an occasional gift received from one source by multiple
employees of a single service provider, the amount received by each
employee should be separately determined in applying the $50 and
$250 thresholds. For example, if 11 employees of a broker attend a
business conference put on by an insurer designed to educate and
explain the insurer's products for employee benefit plans, and the
insurer provides, at no cost to the attendees, refreshments valued
at $25 per individual, the gratuities would not be reportable on
this line even though the total cost of the refreshments for all the
employees would be $275.
These thresholds are for purposes of Line 13e reporting. Filers
are cautioned that the payment or receipt of gifts and gratuities of
any amount by plan fiduciaries may violate ERISA and give rise to
civil liabilities and criminal penalties.
Important Reminder. The insurance company, insurance service, or
other similar organization is required under ERISA section 103(a)(2)
to provide the plan administrator with the information needed to
complete this return/report. Your insurance company must provide you
with the information you need to answer this question. If your
insurance company, insurance service, or other similar organization
does not automatically send you this information, you should make a
written request for the information. If you have difficulty getting
the information from your insurance company, contact the nearest
office of the DOL's Employee Benefits Security Administration.
Line 14f. You must check ``Yes'' if any benefits due under the
plan were not timely paid or not paid in full. Include in this
amount the total of any outstanding amounts that were not paid when
due in previous years that have continued to remain unpaid.
Line 14g. Code section 401(k) and other individual account
pension plans must complete Line 10h. Other filers should leave Line
10h blank. Check ``Yes'' if there was a ``blackout period.'' A
blackout period is a temporary suspension of more than three
consecutive business days during which participants or beneficiaries
of a 401(k) or other individual account pension plan were unable, or
were limited or restricted in their ability, to direct or diversify
assets credited to their accounts, obtain loans from the plan, or
obtain distributions from the plan. A ``blackout period'' generally
does not include a temporary suspension of the right of participants
and beneficiaries to direct or diversify assets credited to their
accounts, obtain loans from the plan, or obtain distributions from
the plan if the temporary suspension is: (1) part of the regularly
scheduled operations of the plan that has been disclosed to
participants and beneficiaries; (2) due to a qualified domestic
relations order (QDRO) or because of a pending determination as to
whether a domestic relations order is a QDRO; (3) due to an action
or a failure to take action by an
[[Page 47678]]
individual participant or because of an action or claim by someone
other than the plan regarding a participant's individual account; or
(4) by application of federal securities laws. For more information,
see the DOL's regulation at 29 CFR 2520.101-3 (available at
www.dol.gov/ebsa).
Line 14h. Code section 401(k) and other individual account
pension plans who answered ``Yes'' to Line 14h must complete Line
14i. Other filers should leave Line 14i blank. If there was a
blackout period, did you provide the required notice not less than
30 days nor more than 60 days in advance of restricting the rights
of participants and beneficiaries to change their plan investments,
obtain loans from the plan, or obtain distributions from the plan?
If so, check ``Yes.'' See 29 CFR 2520.101-3 for specific notice
requirements and for exceptions from the notice requirement. Also,
answer ``Yes'' if one of the exceptions to the notice requirement
under 29 CFR 2520.101-3 applies.
Line 14i. Disclosures for Participant-Directed Accounts. All
individual account plans that provide for participant-direction must
provide specified disclosures under 29 CFR 2550.404a-5 with respect
to each participant or beneficiary that, pursuant to the terms of
the plan, has the right to direct the investment of assets held in,
or contributed to, his or her individual account. Included in the
required disclosures is a comparison chart. If subject to the
disclosure requirements under 29 CFR 2550.404a-5, answer ``Yes'' and
attach to your Form 5500-SF, a copy of the comparison chart for the
plan year.
Line 14j. If you answered ``Yes'' to Line 14j, check the box to
indicate whether the plan provide participants and beneficiaries the
plan and investment disclosures required under 29 CFR 2550.404a-
5(d)(2) and, if you answered ``Yes,'' attach the comparison chart(s)
provided to participants and beneficiaries.
Line 14k. If you answered ``Yes,'' to Line 14j, enter the number
of designated investment alternatives (DIAs) available under the
plan and indicate the number of DIAs that are index funds.
Line 14l. If you answered ``Yes,'' to Line 14j, check the
appropriate box to indicate whether the plan made available to
participants and beneficiaries a designated investment manager
(DIM). If you answered ``Yes,'' enter name of DIM.
Line 14m. Check ``Yes,'' if the plan make available to
participants and beneficiaries any brokerage window, self-directed
brokerage account or similar plan arrangements that enabled
participants to select investments beyond those designated by the
plan. If you answered ``Yes'' to Line 14n, enter the number of
participants that utilized the account or arrangement.
Line 14n. Unrelated Business Taxable Income. Unrelated business
taxable income generally means the gross income derived from any
unrelated trade or business (as defined in Code section 513)
regularly conducted and not substantially related to the plan's
exempt purpose under Code section 512, less the deductions directly
connected with carrying on the trade or business. See IRS
Publication 598 for more information. Check ``N/A'' if this plan
does not have a trust, such as 412(e)(3) fully insured plans or
certain 403(b) annuity plans.
Plans that check ``Yes'' must enter any amount of unrelated
business taxable income. Form 990-T, Exempt Organization Business
Income Tax Return, is required to be filed for any gross income of
$1000 or more generated by an employer's trust by the 15th day of
the 4th month following the end of the trust's tax year. See
Instructions to Form 990-T for more details.
Line 14o. Check ``Yes'' if an employer sponsoring the plan pays
any of the administrative expenses of the plan that were not
reported on Line 10g.
Line 14p. Check ``Yes'' if any person who is disqualified under
ERISA Section 411, served or was permitted to serve the plan in any
capacity. Section 411 of ERISA establishes a bar against certain
persons serving as employee benefit plan fiduciaries or service
providers because they have been convicted of any of a broad range
of specified crimes. Prohibited positions and activities include
consultants and advisers to plans and any entity whose activities
are in whole or substantial part devoted to providing goods or
services to employee benefit plans. As amended by the Comprehensive
Crime Control Act of 1984, section 411 of ERISA prohibits such
persons from serving plans for a period of thirteen years after such
judgment or the end of imprisonment resulting from a disqualifying
conviction, whichever is later, unless the sentencing court, under
appropriate circumstances, has reduced the period of prohibition to
not less than three years or has determined that service in any of
the prohibited capacities would not be contrary to the purposes of
ERISA. The prohibition takes effect upon the date of conviction (the
date of entry of judgment by the trial court) or the end of
imprisonment, whichever is later.
Line 14q. Check ``Yes'' if the plan sponsor or its affiliates
provide any services to the plan in exchange for direct or indirect
compensation.
Line 14r. Termination of Service Providers. Identify any service
providers that have been terminated for a material failure to meet
the terms of a service arrangement or failure to comply with Title I
of ERISA, including the failure to provide required disclosures
under 29 CFR 2550.408b-2. If the reason for termination was the
failure to provide required disclosures under 29 CFR 2550.408b-2, in
addition to providing an explanation in (6), check the box in
element (7).
Line 14s. See 29 CFR 2520.102-2 and 2520.102-3 for style,
format, and content requirements for summary plan descriptions. For
distribution requirements see 29 CFR 2520.104b.
Line 14t. Defined contribution pension plans must complete Line
14t. For purposes of Line 14t, an uncashed check is one that is no
longer negotiable or is subject to limited payability. Check
``Yes,'' if there were any uncashed checks as of the end of the plan
year. If ``Yes,'' indicate the number of checks that were uncashed
at the end of the plan year and the total value of the checks.
Briefly describe the procedures followed by the plan to verify a
participant's or beneficiary's address before a check was mailed.
Plans must ensure that they use measures reasonably calculated to
ensure actual receipt of materials by plan participants and
beneficiaries, which would include procedures to keep track of
participants' and beneficiaries' current mailing addresses so that
information is less likely to be mailed to a bad address. See CFR
2520.104b-1(b). Also, briefly describe the procedures followed by
the plan to address the uncashed checks, including steps to locate
``lost participants.''
Plans should have procedures to keep track of uncashed checks.
The procedures for ongoing plans should include procedures for
locating ``missing'' participants. Plans may use the steps described
in FAB 2014-01 to search for missing participants or beneficiaries,
which may be helpful in particular where a check was returned as
``undeliverable.'' The procedures should also include a method by
which plan fiduciaries keep track or are made aware of the number of
uncashed checks and the amount involved. Such procedures could
include contractually requiring any third party administrators to
keep the plan administrator regularly informed of uncashed checks.
For missing participant and beneficiary searches and distributions
from terminating defined contribution pension plans, see 29 CFR
2550.404a-3; DOL Field Assistance Bulletin 2014-01 (Aug. 14, 2014).
Part VI--Pension Funding Compliance
Complete Part VI only if the plan is subject to the minimum
funding requirements of Code section 412 or ERISA section 302.
All qualified defined benefit and defined contribution pension
plans are subject to the minimum funding requirements of Code
section 412 unless they are described in the exceptions listed under
Code section 412(e)(2). These exceptions include profit-sharing or
stock bonus plans, insurance contract plans described in Code
section 412(e)(3), and certain plans to which no employer
contributions are made.
Nonqualified employee pension benefit plans are subject to the
minimum funding requirements of ERISA section 302 unless
specifically exempted under ERISA sections 4(a) or 301(a).
The employer or plan administrator of a single-employer or
multiple-employer defined benefit pension plan that is subject to
the minimum funding requirements must file the Schedule SB (Form
5500) as an attachment to the Form 5500-SF. The employer or plan
administrator of a money purchase plan that is currently amortizing
a waiver of the minimum funding requirements must complete Lines 3,
9, and 10 of the Schedule MB (Form 5500) and file it as an
attachment to the Form 5500-SF.
Line 15. If ``Yes'' is checked, attach a completed and signed
Schedule SB (Form 5500), and complete Line 15a. See the instructions
for the Schedule SB in the Instructions for Form 5500. If this is a
defined contribution pension plan, leave blank.
Line 15a. Enter the amount from Line 40 of Schedule SB (Form
5500).
[[Page 47679]]
Line 16. Check the ``Yes'' box if the plan is a defined
contribution pension plan subject to the minimum funding
requirements of Code section 412 and ERISA section 302. Those money
purchase plans (including target benefit plans) that are amortizing
a waiver of the minimum funding standard for a prior year should
fill out Line 16a and then skip to Line 17. Those defined
contribution pension plans answering ``Yes'' to the Line 15 question
that do not fill out Line 16a should fill out Lines 16b-16e.
Line 16a. If a money purchase defined contribution pension plan
(including a target benefit plan) has received a waiver of the
minimum funding standard, and the waiver is currently being
amortized, complete Lines 3, 9, and 10 of Schedule MB (Form 5500).
See instructions for Schedule MB in the Instructions for Form 5500
Annual Return/Report. The Schedule MB for a money purchase defined
contribution pension plan does not need to be signed by an enrolled
actuary.
Line 16b. The minimum required contribution for a money purchase
defined contribution pension plan (including a target benefit plan)
for a plan year is the amount required to be contributed for the
year under the formula set forth in the plan document. If there is
an accumulated funding deficiency for a prior year that has not been
waived, that amount should also be included as part of the
contribution required for the current year.
Line 16c. Include all contributions for the plan year made not
later than 8\1/2\ months after the end of the plan year. Show only
contributions actually made to the plan by the date the form is
filed. For example, do not include receivable contributions for this
purpose
Line 16d. If the minimum required contribution exceeds the
contributions for the plan year made not later than 8\1/2\ months
after the end of the plan year, the excess is an accumulated funding
deficiency for the plan year. File IRS Form 5330, Return of Excise
Taxes Related to Employee Benefit Plans, with the IRS to pay the
excise tax on the deficiency. There is a penalty for not filing Form
5330 on time.
Line 16e. Check ``Yes'' if the minimum required contribution
remaining in Line 15d will be made not later than 8\1/2\ months
after the end of the plan year. If ``Yes,'' and contributions are
actually made by this date, then there will be no reportable
deficiency and IRS Form 5330 will not need to be filed.
Part VII--Plan Terminations and Transfers of Assets
Line 17a. Check ``Yes'' if a resolution to terminate the plan
was adopted during this or any prior plan year, unless the
termination was revoked and no assets reverted to the employer. If
``Yes'' is checked, enter in Line 17a(1) the effective date of plan
termination, enter in Line 18a(2) the plan year in which assets were
distributed to participants and beneficiaries (including insurance/
annuity contracts) and enter in Line 17a(3) the amount of plan
assets that reverted to the employer during the plan year in
connection with the implementation of such termination. Enter ``0''
if no reversion occurred during the current plan year.
Line 17b. Transfer to other plans. If the plan transferred
assets or liabilities to another plan since the date of the most
recent filing, report the EIN and PN of the plan to which the assets
and liabilities were transferred (i.e., the ``transferee plan''). In
addition, report the date of the transfer and check the box that
best describes the type of transfer (see Definitions below). Do not
use a social security number in lieu of an EIN or include an
attachment that contains visible social security numbers. The Form
5500-SF is open to public inspection, and the contents are public
information and are subject to publication on the Internet. Because
of privacy concerns, the inclusion of a social security number or
any portion thereof on this Schedule H or the inclusion of a visible
social security number or any portion thereof on an attachment may
result in the rejection of the filing.
Note. A distribution of all or part of an individual
participant's account balance that is reportable on Form 1099-R
should not be included on Line 17b. Do not submit Form 1099-R with
the Form 5500 Annual Return/Report.
IRS Form 5310-A, Notice of Plan Merger or Consolidation,
Spinoff, or Transfer of Plan Assets or Liabilities; Notice of
Qualified Separate Lines of Business, may be required to be filed at
least 30 days before any plan merger or consolidation or any
transfer of plan assets or liabilities to another plan. There is a
penalty for not filing IRS Form 5310-A on time. In addition, a
transfer of benefit liabilities involving a plan covered by PBGC
insurance may be reportable to the PBGC. See PBGC Form 10, Post-
Event Notice of Reportable Events, and PBGC Form 10-Advance, Advance
Notice of Reportable Events.
Line 17c. Transfer from other plans. If another plan transferred
assets or liabilities to this plan since the date of the most recent
filing, report the EIN and PN of sponsor of the plan from which the
assets and liabilities were transferred (i.e., the ``transferor
plan''), the date of the transfer, and the box that best describes
tot type of transfer.
``Consolidation'' means a transaction in which two or more plans
transfer all of their assets and liabilities to a new plan and, as a
result, cease to exist (because the transferor plans become part of
the new transferee plan). It differs from a Merger because in a
Merger, the transferee plan existed before the transaction. In a
consolidation, the transferee plan is a new plan that is created in
the Consolidation. Thus, the plan that exists after the
Consolidation follows the PBGC premium filing rules for new plans.
``Merger'' means a transaction I which one or more plans
transfer all of their assets and liabilities to an existing plan
and, as a result, cease to exist (because the transferor plan(s)
become part of the transferee plan). It differs from a Consolidation
because in a Consolidation, the transferee plan did not exist before
the transaction. In a Merger, the transferee plan is an existing
plan and follows the rules for a preexisting, ongoing plan.
``Spinoff'' means a transaction in which the transferor plan
transfers only part of its assets and/or liabilities to the
transferee plan. The transferee plan may be a new plan that is
created in the Spinoff, or it may be a preexisting plan that simply
receives part of the assets or liabilities of the transferor plan.
Note: If Final Return/Report is checked on the Form 5500 or Form
5500-SF, information should be entered an at least one of Lines 17a,
17b, or 17c. Participant-directed transfers do not need to be
reported on Line 17c. If you reported transfers of assets and
liabilities to this plan on Line 10k, information should be entered
in Line 17d.
Line 17d. Defined Contribution Pension Plan--Transfers to
financial institution. If the filer is a defined contribution
pension plan, indicate whether, as part of the procedures for
terminating the plan, transferred plan assets to a financial
institution(s), establishing interest bearing federally insured bank
accounts in the name of missing participants in connection with
terminating the plan. If ``Yes,'' complete elements (1)-(5). List
each financial institution where plan assets were transferred and
continue reporting until the plan terminates and the final return/
report is filed. For more information on making provisions for lost
or missing participants, see DOL Field Assistance Bulletin 2014-01.
Part VIII--Trust Information
Line 18a. Enter the ``Name of trust.'' If a plan uses more than
one trust or custodial account for its fund, you should enter the
primary trust or custodial account in which the greatest dollar
amount or largest percentage of the plan assets as of the end of the
plan year is held on this line. For example, if a plan uses three
different trusts, X, Y, Z, with the percentages of plan assets, 35%,
45%, and 20%, respectively, trust Y that held the 45% of plan assets
would be entered in Line 18a.
Line 18b. Enter the ``Trust's Employer Identification Number
(EIN)'' assigned to the employee benefit trust or custodial account,
if one has been issued to you. The trust EIN should be used for
transactions conducted for the trust. If you do not have a trust
EIN, enter the EIN you would use on Form 1099-R, Distributions From
Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc., to report distributions from employee
benefit plans and on Form 945, Annual Return of Withheld Federal
Income Tax, to report withheld amounts of income tax from those
payments.
Do not use a social security number in lieu of an EIN. Form 5500
and its attachments are open to public inspection, and the contents
are public information and are subject to publication on the
Internet. Because of privacy concerns, the inclusion of a social
security number or any portion thereof may result in the rejection
of the filing.
Trust EINs can be obtained from the IRS by applying for one on
Form SS-4, Application for Employer Identification Number. See
Instructions to Line 2b (Form 5500) for applying for an EIN. Also
see IRS EIN application link page for further information.
Line 18c. Enter the name of the plan trustee or custodian.
Line 18d. Enter the telephone number for the plan trustee or
custodian.
[[Page 47680]]
Part IX--IRS Compliance Questions [New]
Note. If you are required to file an annual return of employee
benefit plans under Code section 6058, you must complete this part
from Lines 18 through 24, unless you are required to file fewer than
250 returns of any type with the IRS, including information returns
(for example, Forms W-2 and Forms 1099), income tax returns,
employment tax returns, and excise tax returns during the calendar
year, then you can alternatively file Form 5500-SUP with the IRS on
paper. See the Treasury regulations on ``Employee Retirement Benefit
Plan Returns Required on Magnetic Media'' (See T.D. 9695, 79 FR
58256 at https://federalregister.gov/a/2014-23161) and Instructions
for Form 5500-SUP for more information.
Line 19a. Check ``Yes'' if the plan includes a cash or deferred
arrangement (CODA), under which a covered employee may elect to have
the employer either contribute an amount to the plan's trust on
behalf of the employee or to pay the employee directly in cash or
some other taxable benefit. The contributions go into an individual
account, with the employee often choosing the investments based on
options provided under the plan. In some plans, the employer also
makes contributions, such as contributions that match the employee's
contributions up to a certain percentage.
Line 19b.
If Line 19a is ``Yes,'' check the applicable method used to
satisfy the nondiscrimination requirements of Code section 401(k). A
safe harbor 401(k) plan is similar to a traditional 401(k) plan but,
among other things, it must provide for employer contributions.
These contributions may be employer matching contributions, limited
to employees who defer, or employer contributions made on behalf of
all eligible employees, regardless of whether they make elective
deferrals. The safe harbor 401(k) plan is not subject to the complex
annual nondiscrimination tests that apply to traditional 401(k)
plans. Check ``Design-based safe harbor method'' if this is a safe
harbor 401(k) plan that is a SIMPLE 401(k) plan under Code section
401(k)(11), a safe harbor 401(k) plan under Code section 401(k)(12),
or a qualified automatic contribution arrangement under Code section
401(k)(13).
If the plan, by its terms, does not satisfy the safe harbor
method, it generally must satisfy the regular nondiscrimination
test, known as the actual deferral percentage (ADP) test. Check the
appropriate box to indicate if the plan uses the ``current year''
ADP test or the ``prior year'' ADP test. Check ``current year'' ADP
test if the plan uses the current year testing method under which
the ADP test is performed by comparing the current plan year's ADP
for HCEs with the current plan year's (rather than the prior plan
year's) ADP for NHCEs. Check all boxes that apply for a plan that
tests different groups of employees on a disaggregated basis. Check
``N/A'' if the plan is not required to test for nondiscrimination
under Code section 401(k)(3), such as a plan in which no HCE is
benefitting.
Line 20a. Check the applicable testing method used to satisfy
the minimum coverage requirements under Code section 410(b). Check
``N/A'' if the plan is deemed to satisfy section 410(b)
automatically, such as a plan in which no HCE is benefitting. Check
all boxes that apply for a plan that tests different groups of
employees on a disaggregated basis.
Line 20b. Check ``Yes'' if this plan was permissively aggregated
with another plan to satisfy requirements under Code sections 410(b)
and 401(a)(4). Generally, each single plan must separately satisfy
the coverage and nondiscrimination requirements. However, an
employer may designate two or more separate plans as a single plan
for purposes of applying the ratio percentage test of Treasury
Regulations section 1.410(b)-2(b)(2) or the nondiscretionary
classification test of Treasury Regulations section 1.401(b)-4. Two
or more plans that are permissively aggregated and treated as a
single plan for purposes of the minimum coverage test of Code
section 410(b) must also be treated as a single plan for purpose of
the nondiscrimination test under Code section 401(a)(4). See
Treasury Regulations sections 1.410(b)-7 and 1.401(a)(4)-(9) for
more information.
Line 21. Check ``Yes'' if the plan does not satisfy any
exceptions under Treasury Regulation section 1.401(a)26)-1(b) if it
benefitted at least the lesser of: 50 employees of the employer, or
the greater of: 40 percent of all employees of the employer, or 2
employees (or if there is only 1 employee, such employer). The
definition of employer includes all related employers under Code
sections 414(b), (c) or (m). In performing the participation tests,
the employees who are excludable are generally the same as those who
are excludable for purposes of performing coverage tests under Code
section 410(b), see Treasury Regulation section 1.401(a)(26)-6. In
addition, for most plans the definition of who is benefiting under
the plan for the purposes of the participation tests is the same as
the definition of benefiting employees for purposes of coverage
tests under Code section 410(b), see Treasury Regulation section
1.401(a)(26)-5.
Line 22a. If a plan sponsor or an employer adopted a pre-
approved plan that includes a master & prototype plan (a
standardized or nonstandardized M&P) or a volume submitter plan,
enter the date of the most recent favorable opinion or advisory
letter issued by the IRS and the serial number listed on that
favorable letter.
Line 22b. If it is an individually-designed plan and received a
favorable determination letter from the IRS, enter the date of the
most recent determination letter. Leave it blank if this
individually-designed plan has never received a favorable
determination letter.
Line 23a. A section 401(k) plan may (in accordance with the plan
document) allow participants to receive hardship distributions under
Code section 401(k)(2)(B)(i)(IV). A distribution from a
participant's elective deferral account can only be made if the
distribution is because of an immediate and heavy financial need,
and the amount should be limited to what is necessary to satisfy
that financial need. Hardship withdrawals are subject to income
taxes and a 10% additional tax on distributions before age 59\1/
2\''. Employees who take a hardship distribution cannot repay it to
the plan.
Line 23b. This is for a defined benefit plan or a money purchase
pension plan only. Check ``Yes'' if the plan made any distributions
during the plan year to employees who have attained age 62 and who
were not separated from service when the distributions were made, as
permitted under Code section 401(a)(36).
Note. Any distribution above made prior to age 59\1/2\ would be
subject to an additional 10% tax under Code section 72(t).
Line 24. Check ``Yes'' if required minimum distributions were
made to 5% owners who attained age 70\1/2\ and older. Required
Minimum Distributions (RMDs) generally are minimum amounts that a
retirement plan account owner must withdraw annually starting with
the year that he or she reaches 70\1/2\ years of age or, if later,
the year in which he or she retires. However, if the account owner
is a 5% owner of the business sponsoring the retirement plan, the
RMDs must begin once the account holder is age 70\1/2\, regardless
of whether he or she is retired.
Line 25. Check ``Yes'' if the plan has ceased employer and/or
employee contributions and prohibited entry by new participants.
ERISA Compliance Quick Checklist
Compliance with the Employee Retirement Income Security Act
(ERISA) begins with knowing the rules. Plan administrators and other
plan officials can use this checklist as a quick diagnostic tool for
assessing a plan's compliance with certain important ERISA rules; it
is not a complete description of all ERISA's rules and it is not a
substitute for a comprehensive compliance review. Use of this
checklist is voluntary, and it is not be filed with your Form 5500-
SF.
If you answer ``No'' to any of the questions below, you should
review your plan's operations because you may not be in full
compliance with ERISA's requirements.
1. Have you provided plan participants with a summary plan
description, summaries of any material modifications of the plan,
and annual summary financial reports or annual pension funding
reports?
2. Do you maintain copies of plan documents at the principal
office of the plan administrator for examination by participants and
beneficiaries?
3. Do you respond to written participant inquires for copies of
plan documents and information within 30 days?
4. Does your plan include written procedures for making benefit
claims and appealing denied claims, and are you complying with those
procedures?
5. Is your plan covered by fidelity bonds protecting the plan
against losses due to fraud or dishonesty by persons who handle plan
funds or other property?
6. Are the plan's investments diversified so as to minimize the
risk of large losses?
7. I f the plan permits participants to select the investments
in their plan accounts, has the plan provided them with enough
information to make informed decisions?
8. Has a plan official determined that the investments are
prudent and solely in the interest of the plan's participants and
beneficiaries, and evaluated the risks
[[Page 47681]]
associated with plan investments before making the investments?
9. Did the employer or other plan sponsor send participant
contributions to the plan on a timely basis?
10. Did the plan pay participant benefits on time and in the
correct amounts?
11. Did the plan give participants and beneficiaries 30 days
advance notice before imposing a ``blackout period'' of at least
three consecutive business days during which participants or
beneficiaries of a 401(k) or other individual account pension plan
were unable to change their plan investments, obtain loans from the
plan, or obtain distributions from the plan?
If you answer ``Yes'' to any of the questions below, you should
review your plan's operations because you may not be in full
compliance with ERISA's requirements.
1. Has the plan engaged in any financial transactions with
persons related to the plan or any plan official? (For example, has
the plan made a loan to or participated in an investment with the
employer?)
2. Has the plan official used the assets of the plan for his/her
own interest?
3. Have plan assets been used to pay expenses that were not
authorized in the plan document, were not necessary to the proper
administration of the plan, or were more than reasonable in amount?
If you need help answering these questions or want additional
guidance about ERISA requirements, a plan official should contact
the U.S. Department of Labor Employee Benefits Security
Administration office in your region or consult with the plan's
legal counsel or professional employee benefit advisor.
Statutory Authority
Accordingly, pursuant to the authority in sections 101, 103,
104, 109, 110 and 4065 of ERISA and sections 6058 and 6059 of the
Code, the Form 5500 Annual Return/Report and the instructions
thereto are proposed to be amended as set forth herein.
Signed at Washington, DC, this 20th day of June 2016.
Phyllis C. Borzi,
Assistant Secretary, Employee Benefits Security Administration, U.S.
Department of Labor.
Signed at Washington, DC, this 20th day of June 2016.
Robert S. Choi, Director,
Employee Plans, Tax Exempt and Government Entities Division, Internal
Revenue Service.
Signed at Washington, DC, this 20th day of June 2016.
W. Thomas Reeder,
Director, Pension Benefit Guaranty Corporation.
[FR Doc. 2016-14893 Filed 7-11-16; 4:15 pm]
BILLING CODE 4510-29-P
