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
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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
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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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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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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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47625
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
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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 nati