Instructions for Form 5500 |
2006 Tax Year |
Section 6: Line-by-Line Instructions for the 2006 Form 5500 and Schedules
This is archived information that pertains only to the 2006 Tax Year. If you are looking for information for the current tax year, go to the Tax Prep Help Area.
Part I - Annual Report Identification Information
File Form 5500 with "2006" printed in the upper right corner for a plan year that began in 2006 or a DFE year that ended in
2006. If the plan or
DFE year is not the 2006 calendar year, enter the dates in Part I. If the 2006 Form 5500 is not available before the filing
due date, use the 2005
Form 5500 and enter the dates the plan or DFE year began and ended in Part I.
One Form 5500 is generally filed for each plan or entity described in the instructions to boxes A(1) through A(4) below. Do not check more
than one box.
A separate Form 5500, with box A(2) checked, must be filed by each employer participating in a plan or program of benefits
in which the funds
attributable to each employer are available to pay benefits only for that employer's employees, even if the plan is maintained
by a controlled group.
A “controlled group” is generally considered one employer for Form 5500 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 section 414(c), or an affiliated
service group
under section 414(m).
Box A(1). 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, and (c) an election under Code section 414(f)(5) and ERISA section 3(37)(E) has not been made.
Participating employers do not file individually for these plans. See 29 CFR 2510.3-37.
Box A(2). 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.
Box A(3). Multiple-Employer Plan.
Check this box if the Form 5500 is being filed for a multiple-employer plan. A multiple-employer plan is a plan that
is maintained by more than one
employer and is not one of the plans already described. Multiple-employer plans 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). Participating employers do not file individually for these plans. Do not check
this box if the employers maintaining the plan are members of the same controlled group.
Box A(4). Direct Filing Entity.
Check this box and enter the correct letter from the following chart to indicate the type of entity in the space provided.
Type of entity
▽
|
Enter the letter
▽
|
Master Trust
Investment account
|
M
|
Common/collective
trust
|
C
|
Pooled separate
account
|
P
|
103-12 Investment
Entity
|
E
|
Group Insurance
Arrangement
|
G
|
|
|
Note.
A separate annual report with a “M” entered on Form 5500, box A(4), must be filed for each MTIA. See definition on page 10.
Box B(1).
Check this box if an annual return/report has not been previously filed for this plan or DFE. For the purpose of completing
box B(1), the Form
5500-EZ is not considered an annual return/report.
Box B(2).
Check this box if this Form 5500 is being submitted as an amended return/report to correct errors and/or omissions
on a previously filed Form 5500
for the 2006 plan year. If you are filing a corrected return/report in response to correspondence from EBSA regarding the
processing of your
return/report, do not check Part I, box B(2) to identify the filing as an amended return/report unless the correspondence includes
instructions that specifically direct you to check box B(2).
Box B(3).
Check this box if this Form 5500 is the last Form 5500 required to be submitted for this plan. (See Final Return/Report on page 6.)
Note.
Do not check box B(3) if “4R” is entered on line 8b for a welfare plan that is not required to file a Form 5500 for the next plan year because
the welfare plan has become eligible for an annual reporting exemption. For example, certain unfunded and insured welfare
plans may be required to
file the 2006 Form 5500 and be exempt from filing a Form 5500 for the plan year 2007 if the number of participants covered
as of the beginning of the
2007 plan year drops below 100. See Who Must File on page 2. Should the number of participants covered by such a plan increase to 100 or
more in a future year, the plan should resume filing Form 5500 and enter "4S" on line 8b on that year's Form 5500. See 29
CFR 2520.104-20.
Box B(4).
Check this box if this Form 5500 is filed for a plan year of less than 12 months.
Box C.
Check box C 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.
Box D.
Check this box if:
-
You filed for an extension of time to file this form with the IRS using a completed Form 5558, Application for Extension of Time
To File Certain Employee Plan Returns (attach a copy of the Form 5558 to the return/report);
-
You are filing using the automatic extension of time to file Form 5500 until the due date of the Federal income tax return
of the employer
(attach a copy of the employer's extension of time to file the income tax return to the return/report);
-
You are filing using a special extension of time to file Form 5500 that has been announced by the IRS, DOL, and PBGC. Attach
a statement
citing the announced authority for the extension. The attachment must be appropriately labeled at the top of the statement
(e.g., "Form 5500, Box
D - DISASTER RELIEF EXTENSION" or "Form 5500, Box D - COMBAT ZONE EXTENSION"). See Other Extensions of Time on page 5, for
more information.
-
You are filing under DOL's Delinquent Filer Voluntary Compliance (DFVC) Program. Attach a statement that the report is submitted
under the
DFVC Program with "Form 5500, Box D - DFVC FILING" prominently displayed at the top of the statement. See Delinquent Filer Voluntary
Compliance (DFVC) Program on page 5, for more information.
Part II - Basic Plan Information
Line 1a.
Enter the formal name of the plan or DFE or enough information to identify the plan or DFE. Abbreviate if necessary.
Line 1b.
Enter the three-digit plan or entity number (PN) 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 or DFEs as illustrated in the table below. Start at 501 for welfare
plans 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. Do not use it for
any other plan or DFE, even if the first plan or DFE is terminated.
For each Form 5500
with the same EIN
(line 2b), when ▽
|
Assign PN
▽
|
Part II, box 8a is checked, or Part I, A(4) is checked and an M, C, P, or E is entered
|
001 to the first plan or DFE. Consecutively number others as 002, 003. . .
|
Part II, box 8b is checked and 8a is not checked, or Part I, A(4) is checked and a G is entered
|
501 to the first plan or GIA. Consecutively number others as 502, 503. . .
|
|
|
Exception.
If Part II, box 8a is checked 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.
Each row of boxes on the hand print forms is designed to contain specific information regarding the plan sponsor.
Please limit your response to
the information required in each row of boxes as specified below:
-
Enter in the first two rows of boxes labeled 1) 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 an MTIA, one of the sponsoring employers). If the plan covers only the employees
of one employer, enter the
employer's name.
The term "plan sponsor"
means:
-
The employer, for an employee benefit plan that a single employer established or maintains;
-
The employee organization in the case of a plan of an employee organization; or
-
The association, committee, joint board of trustees, or other similar group of representatives of the parties who establish
or maintain the
plan, if the plan is established or maintained jointly by one or more employers and one or more employee organizations, or
by two or more
employers.
Note.
In the case of a multiple-employer plan, if an association or similar entity is not the sponsor, enter the name of a participating
employer as
sponsor. A plan of a controlled group of corporations should enter the name of one of the sponsoring members. In either case,
the same name must be
used in all subsequent filings of the Form 5500 for the multiple-employer plan or controlled group (see instructions to line
4 concerning change in
sponsorship).
-
Enter in row 2) any "in care of (C/O)" name.
-
Enter in row 3) the street address. A post office box number may be entered if the Post Office does not deliver mail to the
sponsor's street address.
-
Enter in row 4) the name of the city.
-
Enter in row 5) the two-character abbreviation of the U.S. state or possession and zip code.
-
Enter in row 6) the foreign routing code, if applicable. Leave row 5), U.S. state and zip code, blank if entering
information in rows 6) and 7).
-
Enter in row 7) the foreign country, if applicable.
-
Enter in row 8) the "doing business as (D/B/A)" or trade name of the sponsor if different from the name entered in
1).
-
Enter in the rows of boxes labeled 9) any second address. Use only a street address, not a P.O. box, here. A P.O. box may be
entered only in row 3).
Line 2b.
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 EIN assigned to the CCT, PSA, MTIA, 103-12 IE, or GIA.
Do not use a social security number in lieu of an EIN. The Form 5500 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 on this line
may result in the
rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
A multiple-employer plan or plan of a controlled group of corporations should use the EIN of the sponsor identified
in line 2a. The EIN must be
used in all subsequent filings of the Form 5500 for these plans (see instructions to line 4 concerning change in EIN).
If the plan sponsor is a group of individuals, get a single EIN for the group. When you apply for a number, enter
on line 1 of Form SS-4 the name
of the group, such as "Joint Board of Trustees of the Local 187 Machinists' Retirement Plan." EINs may be obtained by filing
Form SS-4 as explained
above.
Note.
EINs for funds (trusts or custodial accounts) associated with plans (other than DFEs) are generally not required to be furnished
on the Form 5500;
the IRS will issue EINs for such funds for other reporting purposes. EINs may be obtained by filing Form SS-4 as explained
above. Plan sponsors should
use the trust EIN described above when opening a bank account or conducting other transactions for a trust that require an
EIN.
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 60, 61,
and 62. 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.
Each row of boxes on the hand print forms is designed to contain specific information regarding the plan administrator.
Please limit your response
to the information required in each row of boxes as specified below:
-
Enter in the first two rows of boxes labeled 1) the name of the plan administrator unless the administrator is the sponsor
identified in line 2 or the Form 5500 is submitted for a DFE
(Part I, box A(4) should be checked). If this is the case, enter the word "same" on line 3a and leave the remainder of line
3a, and all of lines 3b
and 3c blank.
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.
-
Enter in row 2) any "in care of (C/O)" name.
-
Enter in row 3) the street address. A post office box number may be entered if the Post Office does not deliver mail to the
administrator's street address.
-
Enter in row 4) the name of the city.
-
Enter in row 5) the two-character abbreviation of the U.S. state or possession and zip code.
-
Enter in rows 6) and 7) the foreign routing code and foreign country, if applicable. Leave row 5), U.S.
state and zip code, blank if entering information in rows 6) and 7).
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.
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 4.
If the plan sponsor's or DFE's name and/or EIN have changed since the last return/report was filed for this plan
or DFE, enter the plan sponsor's
or DFE's name, EIN, and the plan number as it appeared on the last return/report filed.
The failure to indicate on Line 4 that a plan was previously identified by a different Employer Identification Number (EIN)
or Plan Number (PN)
could result in correspondence from the Department of Labor (DOL) and the Internal Revenue Service (IRS).
Line 5.
(Optional) You may use this line to designate the person or entity that is principally responsible for the preparation of the annual
return/report.
Line 5a.
Each row of boxes on the hand print forms is designed to contain specific information regarding the preparer. Please
limit your response to the
information required in each row of boxes as specified below:
-
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 may
name the person in the first two rows of boxes labeled 1).
-
Enter in row 2) the street address. If the Post Office does not deliver mail to the street address and the preparer has a P.O.
box, enter the box number.
-
Enter in row 3) the name of the city.
-
Enter in row 4) the two-character abbreviation of the U.S. state or possession and zip code.
-
Enter in rows 5) and 6) the foreign routing code and foreign country, if applicable. Leave row 4), U.S.
state and zip code, blank if entering information in rows 5) and 6).
Lines 6 and 7.
All filers must complete both lines 6 and 7 unless the Form 5500 is filed for a 403(b) Arrangement or IRA Plan eligible for Limited
Pension Plan Reporting as described on page 9 or for a DFE.
The description of "participant" in the instructions below is only for purposes of these lines.
For welfare plans, the number of participants should be determined by reference to 29 CFR 2510.3-3(d), which provides
that an individual becomes a
participant covered under an employee welfare benefit plan on the earlier 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.
Dependents are considered neither participants nor beneficiaries. A child who is an “ alternate recipient” entitled to health benefits under a
qualified medical child support order 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).
For pension benefit
plans, “ alternate payees” entitled to benefits under a qualified domestic relations order are not to be counted as participants for these lines.
Before counting the number of participants in welfare plans, it is important to determine whether the plan sponsor has established
one or more
plans for Form 5500 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 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 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 reporting purposes, you should consult a qualified benefits consultant or legal counsel.
"Participant" means any individual who is included in one of the categories below:
-
Active participants include any individuals who are currently in employment covered by a plan and who are earning or retaining
credited
service under a plan. This category includes any individuals who are eligible to elect to have the employer make payments
to 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
a plan. This category 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.
-
Retired or separated participants receiving benefits are any individuals who are retired or separated from employment covered
by the plan
and who are receiving benefits under the plan. 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. This category 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.
-
Other retired or separated participants entitled to future benefits are 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 category 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.
-
Deceased individuals who had one or more beneficiaries who are receiving or are entitled to receive benefits under the plan.
This category
does not include an individual if 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 the number of participants included on line 7f (total participants at the end of the plan year) who have account
balances. 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 to the
plan for this plan year or any prior plan year. Defined benefit plans should 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 7i.
If a number is entered on line 7i, you must file Schedule SSA (Form 5500) as an attachment to the Form 5500.
Code section 6057(e) provides that the plan administrator must give each participant a statement showing the same information
reported on Schedule
SSA for that participant.
Line 8 - Benefits Provided Under the Plan.
Check 8a and/or 8b, as appropriate. In addition, enter in the boxes provided all applicable plan characteristic codes
from the table on pages 18
and 19 that describe the characteristics of the plan being reported. (See examples on page 20.)
Applicable to plan sponsors of Puerto Rico plans. Enter condition code 3C only in instances where there was no election made
under section
1022(i)(2) of ERISA and, therefore, the plan does not intend to qualify under section 401(a) of the Internal Revenue Code.
If an election was made
under section 1022(i)(2) of ERISA, do not enter condition code 3C.
Line 9 - 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 the purposes of line 9:
"Insurance" means the plan has an account, contract, or policy with an insurance company, insurance service, or other similar
organization (such as Blue Cross, Blue Shield, or a health maintenance organization) during the plan or DFE year. (This includes
investments with
insurance companies such as guaranteed investment contracts (GICs).) Do not check "insurance" if the sole function of the
insurance company was to
provide administrative services.
"Code section 412(i) 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 a Schedule B is not
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.
"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 held all its assets invested in registered investment companies and other non-insurance company investments until
it purchases
annuities to pay out the benefits promised under the plan, box 9a(3) should be checked as the funding arrangement and box
9b(1) should be checked as
the benefit arrangement.
Note.
An employee benefit plan that checks boxes 9a(1), 9a(2), 9b(1), and/or 9b(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 10b(3), if applicable.
Line 10.
Check the boxes on line 10 to indicate the schedules being filed and, where applicable, count the schedules and enter
the number of attached
schedules in the space provided.
2006 Instructions for Schedule A (Form 5500) Insurance Information
Schedule A, Insurance Information, must be attached to the Form 5500 filed for every defined benefit pension plan, defined contribution
pension plan, and welfare benefit plan if any benefits under the plan are provided by an insurance company, insurance service,
or other similar
organization (such as Blue Cross, Blue Shield, or a health maintenance organization). This includes investments with insurance
companies such as
guaranteed investment contracts (GICs).
For example, if Form 5500 line 9a(1), 9a(2), 9b(1), or 9b(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 (Form 5500) 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.
In addition, Schedules A must be attached to a Form 5500 filed for GIAs, MTIAs, and 103-12 IEs for each insurance or annuity
contract held in the
MTIA, or 103-12 IE or by the GIA. See the Form 5500 instructions for specific requirements for GIAs, MTIAs, and 103-12 IEs.
Do not file Schedule A if: (1) the contract is an Administrative Services Only (ASO) contract; (2) the Form 5500 is being
filed for a plan participating in a MTIA or 103-12 IE for which a Form 5500 is being filed that reports the contract on a
Schedule A filed with the
MTIA or 103-12 IE Form 5500; or (3) the Form 5500 is being filed for a plan that covers only: (A) an individual or an individual and his or
her spouse who wholly own a trade or business, whether incorporated or unincorporated; or
(B) partners, or partners and one or more of the partners' spouses in a partnership.
Check the Schedule A box on the Form 5500 (Part II, line 10b(3)), and enter the number attached in the space provided if one
or more Schedules A
are attached to the Form 5500.
Important Reminder.
The insurance company (or similar organization) is required to provide the plan administrator with the information needed
to complete the
return/report, pursuant to ERISA section 103(a)(2). If you do not receive this information in a timely manner, contact the
insurance company (or
similar organization). If information is missing on Schedule A (Form 5500) due to a refusal to provide information, note this
on the Schedule A.
Information entered on Schedule A (Form 5500) 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 2006 Form 5500 should be for the insurance contract year ending on June 30, 2006.
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
(Form 5500) 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, MTIA, or 103-12 IE for which the Form 5500 is being filed.
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 A is attached.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
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 on this
Schedule A or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
Part I - Information Concerning Insurance Contract Coverage, Fees, and Commissions
Line 1(c).
Enter the code number assigned by the National Association of Insurance Commissioners (NAIC) to the insurance company.
If none has been assigned,
enter zeros (-0-) in the spaces provided.
Line 1(d).
If individual policies with the same carrier are grouped as a unit for purposes of this report, and the group does
not have one identification
number, you may use the contract or identification number of one of the individual contracts provided this number is used
consistently to report these
contracts as a group and the plan administrator maintains the records necessary to disclose all the individual contract numbers
in the group upon
request. Use separate Schedules A to report individual contracts that cannot be grouped as a unit.
Line 1(e).
Since plan coverage may fluctuate during the year, the administrator should estimate the number of persons that were
covered by the contract at the
end of the policy or contract year. Where contracts covering individual employees are grouped, compute entries as of the end
of the plan year.
Lines 1(f) and (g).
Enter the beginning and ending dates of the policy year for the contract identified in 1(d). Enter "N/A" in 1(f) if
separate contracts covering
individual employees are grouped.
Line 2.
Report on line 2 all insurance fees and commissions directly or indirectly attributable to the contract or policy
placed with or retained by the
plan. Identify agents, brokers, and other persons individually in descending order of the amount paid. Additional pages may
be necessary. You can get
additional hand print pages by calling 1-800-TAX-FORM (1-800-829-3676) and requesting additional schedules.
For purposes of line 2, 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 element (b) or (c) as appropriate.
Insurers must provide plan administrators with a proportionate allocation of commissions and fees attributable to
each contract. Any reasonable
method of allocating commissions and fees to policies or contracts is acceptable, provided the method is disclosed to the
plan administrator. A
reasonable allocation method could, in the Department'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.
Schedule A reporting is not required for compensation paid by the insurer to third parties for record keeping and
claims processing services
provided to the insurer as part of the insurer's administration of the insurance policy. 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).
Totals.
Enter the total of all commissions and fees paid to agents, brokers, and other persons listed on line 2.
Complete a separate item (elements (a) through (e)) for each person listed. Enter the name and address of the person
identified in element (a) and complete elements (b) through (e) as specified below.
Element (a).
Enter the name and address of the agents, brokers, or other persons to whom commissions or fees were paid.
Element (b).
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 element (c) as fees.
Element (c).
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.
Element (d).
Enter the purpose(s) for which fees were paid.
Element (e).
Enter the most appropriate organization code for the broker, agent, or other person entered in element (a).
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, MTIAs, and 103-12 IEs required to file Part I of Schedule C, commissions and fees listed on the Schedule
A are also to be reported
on Schedule C (Form 5500), unless the only compensation in relation to the plan or DFE consists of insurance fees and commissions
listed on the
Schedule A.
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), or guaranteed investment contracts (GIC).
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 plan that do not include substantial restrictions to participants'
access to plan
funds.
Line 5a.
The rate information called for here may be furnished by attaching the appropriate schedules of current rates filed
with the appropriate state
insurance department or by providing a statement regarding the basis of the rates. Enter “ see attached” if appropriate.
Lines 6a through 6f.
Report contracts with unallocated funds. Do not include portions of these contracts maintained in separate accounts.
Show deposit fund amounts
rather than experience credit records when both are maintained.
Part III - Welfare Benefit Contract Information
Line 7i.
Report a stop-loss insurance policy that is an asset of the plan.
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.
2006 Instructions for Schedule B (Form 5500) Actuarial Information
The employer or plan administrator of a defined benefit plan that is subject to the minimum funding standards (see Code section
412 and Part 3 of
Title I of ERISA) must complete this schedule as an attachment to the Form 5500.
Note.
The Schedule B does not have to be filed with the Form 5500-EZ (in accordance with the instructions for Form 5500-EZ under
the “What To File”
section); however, the funding standard account for the plan must continue to be maintained, even if the Schedule B is not
filed.
If a money purchase defined contribution 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 B must be completed. The Schedule B must be attached to
Form 5500 but it need not
be signed by an enrolled actuary.
Check the Schedule B box on the Form 5500 (Part II, line 10a(2)) if a Schedule B is attached to the Form 5500.
Lines A through E and G (most recent enrollment number) must be completed for ALL plans. If the Schedule B is attached to a Form 5500,
lines A, B, C, and D should include the same information as reported in Part II of the Form 5500. You may abbreviate the plan
name (if necessary) to
fit in the space provided.
Do not use a social security number in line D in lieu of an EIN. The Schedule B and its attachments are open to public inspection
if filed with a
Form 5500, 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 on this Schedule B or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
Check the box in line F if the plan has 100 or fewer participants in the prior plan year. A plan has 100 or fewer participants
in the prior plan
year only if there were 100 or fewer participants (both active and nonactive) on each day of the preceding plan year, taking
into account participants
in all defined benefit plans maintained by the same employer (or any member of such employer's controlled group) who are also
employees of that
employer or member. For this purpose, participants who are solely members of a multiemployer plan are not counted. Nonactive
participants include
vested terminated and retired employees.
All defined benefit plans, regardless of size or type, must complete and file Part I. Part II must be filed for all plans
other than those specified in 1 and 2 below:
-
Part II should not be filed for multiemployer plans for which box 1 in line E is checked.
-
Part II should not be filed for plans that have 100 or fewer participants in the prior plan year as described above.
In addition, please note that “TRA '97” refers to the Taxpayer Relief Act of 1997 and “RPA '94” refers to the Retirement Protection Act
of 1994.
Note.
(1) For split-funded plans, the costs and contributions reported on Schedule B should 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, 9j, and
12j, as applicable, regarding attachment. (3) 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 B 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 section 4041.31
for a standard
termination) — there is no termination date, and therefore, minimum funding standards continue to apply and a Schedule B continues
to be
required. (4) The Pension Protection Act of 2006 provides funding relief for certain defined benefit plans (other than multiemployer plans)
maintained by a commercial passenger airline or by an employer whose principal business is providing catering services to
a commercial passenger
airline, based on an alternative 17-year funding schedule. For plans utilizing this relief, please see the Special Instructions
on page 31.
Statement by Enrolled Actuary
An enrolled actuary must sign Schedule B. The signature of the enrolled actuary may be qualified to state that it is subject
to attached
qualifications. See Treasury Regulation 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 B, check the box
on the last line of page 1.
If this box is checked, indicate on an attachment 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, and label this attachment “Schedule B - Statement
by Enrolled Actuary.” A stamped or machine produced signature is not acceptable. The most recent enrollment number must be entered in line G.
In addition, the actuary may offer any other comments related to the information contained in Schedule B.
All attachments to the Schedule B must be properly identified, and must include the name of the plan, plan sponsor's EIN,
and plan number. Put
“Schedule B” and the line item to which the schedule relates at the top of each attachment. When assembling the package for filing, you
can place
attachments for a schedule either directly behind that schedule or at the end of the filing.
Do not include attachments that contain a visible social security number. The Schedule B 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 on an attachment may result in the rejection of the filing.
Specific Instructions for Part I
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 ERISA section 103(d) and Code section 412(c)(9).
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 2006 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 1(b)(1) regardless of whether they are reported on the 2006 Schedule H (Form 5500) (line 1l, column (a))
or Schedule I (Form 5500)
(line 1c, column (a)), or, alternatively, the 2006 Form 5500-EZ (line 11a, column (a): total assets at the beginning of the
year). 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).
Line 1b(2). Actuarial Value of Assets.
Enter the value of assets determined in accordance with Code section 412(c)(2) or ERISA section 302(c)(2). Do not
adjust for items such as the
existing credit balance or the outstanding balances of certain amortization bases, and do not include contributions designated
for 2006 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, the full funding limitation is calculated using the entry age normal method (see Rev. Rul.
81-13, 1981-1 C.B. 229).
Line 1d(1). Amount Excluded from Current Liability.
In computing current liability for purposes of Code section 412(l) (but not for purposes of section 412(c)(7)), certain
service is disregarded
under Code section 412(l)(7)(D) and ERISA section 302(d)(7)(D). If the plan has participants to whom those provisions apply,
only a percentage of the
years of service before such individuals became participants in the plan is taken into account. Enter the amount excluded
from “ RPA '94” current
liability. If an employer has made an election under section 412(l)(7)(D)(iv) not to disregard such service, enter zero. Note
that such an election,
once made, cannot be revoked without the consent of the Secretary of the Treasury.
Line 1d(2)(a). “RPA '94” Current Liability.
All plans regardless of the number of participants must provide the information indicated in accordance with these
instructions. The interest rate
used to compute the “ RPA '94” current liability must be in accordance with guidelines issued by the IRS and, pursuant to the Pension Protection
Act of 2006, must not be 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 amounts invested conservatively in long-term investment-grade corporate bonds during the 4-year period ending
on the last day before
the beginning of the 2006 plan year.
The “ RPA '94” current liability must be computed using the 1983 G.A.M. mortality table for non-disabled lives published in Rev. Rul. 95-28,
1995-1 C.B. 74, and may be computed taking into account the mortality tables for disabled lives published in Rev. Rul. 96-7,
1996-1 C.B. 59.
Each other actuarial assumption used in calculating the “ RPA '94” 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, “ RPA '94” 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 in line 1d(2)(b) in these computations.
Line 1d(2)(b). Expected Increase in Current Liability.
Enter the amount by which the “ RPA '94” 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). Current Liability Computed at Highest Allowable Interest Rate.
Enter the current liability computed using the highest allowable interest rate (100% of the weighted average interest
rate on amounts invested
conservatively in long-term investment-grade corporate bonds during the 4-year period ending on the last day before the beginning
of the 2006 plan
year). All other assumptions used should be identical to those used for lines 1d(2)(a) and (b). It is not necessary to complete
line 1d(2)(c) if the
plan is a multiemployer plan or if the plan had 100 or fewer participants in the prior plan year. Whether or not a plan had
100 or fewer participants
in the prior plan year is determined according to the instructions under the Who Must File discussion for Schedule B. This line need not be
completed if the actuarial value of assets (line 1b(2)) divided by the “ RPA '94” current liability (line 1d(2)(a)) is greater than or equal to
90%. However, if this line is not completed, sufficient records should be retained so that the current liability amount that
would otherwise have been
entered on this line can be computed at a later time if required.
Line 1d(2)(d). Expected Release from “RPA '94” Current Liability for the Plan Year.
Do not complete this line if Code section 412(l) does not apply to the plan for this plan year under Code sections
412(l)(1), 412(l)(6), or
412(l)(9). Enter the expected release from “ RPA '94” current liability on account of disbursements (including single 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).
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 2006 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. The
pre-participation service phase-in of Internal Revenue Code section 412(l)(7)(D) and ERISA section 302(d)(7)(D) will apply
in computing the
liabilities shown in line 2b, unless the employer has made an election under Code section 412(l)(7)(D)(iv).
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 2006 Schedule H (Form 5500) (line 1l, column (a)) or Schedule I (Form 5500) (line 1c,
column (a)), or,
alternatively, the 2006 Form 5500-EZ (line 11a, column (a): total assets at the beginning of the year). Note that contributions
designated for the
2006 plan year are not included on those lines.
Line 2b. “RPA '94” Current Liability (beginning of plan year).
Enter the “ RPA '94” 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
“ RPA '94” 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 columns
(2) and (3).
Column (2)—Include only the portion of the current liability attributable to vested benefits.
Column (3)—Include the current liability attributable to all benefits, both vested and nonvested.
Line 2c.
This calculation is required under ERISA section 103(d)(11). Do not complete if line 2a divided by line 2b(4), column
(3), is 70% or greater.
Line 3. Contributions Made to Plan.
Show all employer and employee contributions for the plan year. Include employer contributions made not later than
2½ months (or the
later date allowed under Code section 412(c)(10) and ERISA section 302(c)(10)) after the end of the plan year. Show only contributions
actually made
to the plan by the date Schedule B is signed. Certain employer contributions must be made in quarterly installments. See Code
section 412(m). Note
that contributions made to meet the liquidity requirement of Code section 412(m)(5) should be reported.
Add the amounts in both columns (b) and (c) and enter both results on the total line. All contributions must be credited
toward a particular plan
year.
Line 4a. Quarterly Contributions.
In accordance with “ RPA '94,” only plans that have a funded current liability percentage (as provided in Rev. Rul. 95-31, 1995-1 C.B. 76) for
the preceding plan year of less than 100 percent are subject to the quarterly contribution requirement of Code section 412(m)
and ERISA section
302(e). For 2006, the funded current liability percentage for the preceding plan year is equal to line 1b(2) (actuarial value
of assets) divided by
line 1d(2)(a) (“ RPA '94” current liability), both lines as reported on the 2005 Schedule B (Q&A-3, 4, and 5 of Rev. Rul. 95-31, also provide
guidance on this computation). If line 1d(2)(a) is zero for 2005 or if box B(1) of Part I of Form 5500 is checked, enter 100%.
Note.
Section 101(d)(2) of the Pension Funding Equity Act of 2004 provided a lookback rule for the purpose of applying section 412(m)(1)
of the Internal
Revenue Code of 1986, for plan years beginning after December 31, 2003. If this lookback rule is used, attach a demonstration
of the use of this
lookback rule to the Schedule B and label the attachment “Schedule B, line 4a - 412(m)(1) Lookback Rule.”
Line 4b.
Multiemployer plans, plans with funded current liability percentages (as provided in Code section 412(m)(1)) of 100
percent or more for the
preceding plan year, and plans that on every day of the preceding plan year had 100 or fewer participants (as defined under
the Who Must
File discussion for Schedule B) are not subject to the liquidity requirement of Code section 412(m)(5) and ERISA section 302(e)(5)
and should
not complete this line. See Q&As 7 through 17 of Rev. Rul. 95-31 for guidance on the liquidity requirement. Note that a certification
by the
enrolled actuary must be attached if the special rule for nonrecurring circumstances is used, and label the certification
“Schedule B, line 4b
- Liquidity Requirement Certification” (see Code section 412(m)(5)(E)(ii)(II) and Q&A-13 of Rev. Rul. 95-31).
If the plan has a liquidity shortfall for any quarter of the plan year (see Q&A-10 of Rev. Rul. 95-31), 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
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 the liquidity shortfall by the required due date, unless a waiver of the 10% tax under Code section 4971(f) has been granted.
Line 5. Actuarial Cost Method.
Enter only 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 in
lines 5a through 5g is used, check the box for line 5h 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 5h and describe the cost
method. For the shortfall
method, check the appropriate box for the underlying actuarial cost method used to determine the annual computation charge.
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, check “ Yes” in line 5j. If approval was granted by either an individual
ruling letter or a class ruling letter for this plan, enter the date of the applicable ruling letter in line 5k. Note that
the plan sponsor's
agreement to a change in funding method (made pursuant to Rev. Proc. 2000-40 or a class ruling letter) should be reported
on line 7 of Schedule R
(Form 5500).
Line 6. Actuarial Assumptions.
If gender-based assumptions are used in developing plan costs, enter those rates where appropriate in line 6. Note
that requests for gender-based
cost information do not suggest that gender-based benefits are legal. If unisex tables are used, enter the values in both
“ Male” and
“ Female” lines. Complete all blanks. Check “ N/A” if 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 B, 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), and label the
summary “Schedule B,
line 6 - Summary of Plan Provisions.”
Also, include any other information needed to disclose the actuarial position of the plan fully and fairly.
Line 6a. “RPA '94” Current Liability Interest Rate.
Enter the interest rate used to determine “ RPA '94” current liability. The interest rate used must be in accordance with the guidelines issued
by the IRS and, pursuant to the Pension Protection Act of 2006, must not be 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 amounts invested conservatively in long-term investment-grade
corporate bonds
during the 4-year period ending on the last day before the beginning of the 2006 plan year. Enter the rate to the nearest
.01 percent.
Line 6b. Weighted Average Retirement Age.
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 B, 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 list
“Schedule B, line 6b - Description of Weighted Average Retirement Age.”
Line 6c.
Check “ Yes,” if the rates in the contract were used (e.g., purchase rates at retirement).
Line 6d. Mortality Table.
The 1983 G.A.M. mortality table published in Rev. Rul. 95-28 must be used in the calculation of “ RPA '94” current liability for non-disabled
lives. The mortality tables published in Rev. Rul. 96-7 may be used in the calculation of “ RPA '94” current liability for disabled lives. Enter
the mortality table code for non-disabled lives used for valuation purposes as follows:
Code 6 includes all sex-distinct versions of the 1983 G.A.M. table other than the table published in Rev. Rul. 95-28.
Thus, for example, Code 6
also would include the 1983 G.A.M. male-only table used for males, where the 1983 G.A.M. male-only table with a 6-year setback
is used for females.
Code 9 includes mortality tables other than those listed in Codes 1 through 8, 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 “ 9” with no further notation. If the valuation assumes a maturity value to provide the post-retirement income without
separately identifying the mortality, interest and expense elements, under “ post-retirement,” enter on line 6d the value of $1.00 of monthly
pension beginning at the age shown on line 6b, assuming the normal form of annuity for an unmarried person; in this case check
“ N/A” on lines 6e
and 6f.
Line 6e. 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
and liabilities determined under the alternative funding standard account (see instructions for line 8b). 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 6f. Expense Loading.
If there is no expense loading, enter -0-. For instance, there would be no expense loading attributable to investments
if the rate of investment
return on assets is adjusted to take investment expenses into account. If there is a single expense loading not separately
identified as
pre-retirement or post-retirement, enter it under pre-retirement and check “ N/A” under post-retirement. Where expenses are assumed other than as
a percentage of plan costs or liabilities, enter the assumed pre-retirement expense as a percentage of the plan's normal cost,
and enter the
post-retirement expense as a percentage of plan liabilities. If the normal cost of the plan is zero, enter the assumed pre-retirement
expense as a
percentage of the sum of the lines 9c(1) and 9c(2), minus line 9j. Enter rates to the nearest .1 percent.
Line 6g. Annual Withdrawal Rates.
Enter rates to the nearest .01 percent. Enter the rate assumed for a new entrant to the plan at the age shown. Enter
“ S” before the rate if
that rate is different for participants with the same age but longer service. Enter “ U” before the rate if all participants of that age are
assumed to experience the same withdrawal rates, regardless of service. Enter “ C” before the rate if criteria other than service apply to the
rates used.
Line 6h. 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 “ N/A.”
Line 6i. Estimated Investment Return - Actuarial Value.
Enter 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 B, line 6i - Estimated Rate
of Investment Return (Actuarial Value).”
Line 6j. Estimated Investment Return - Current (Market) Value.
Enter 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 1(b)(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 B, line 6j - Estimated Rate
of Investment Return (Current Value).”
Line 7. New Amortization Bases Established.
List all new amortization bases established in the current plan year (before the combining of bases, if bases were
combined). 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 9l(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 |
Switchback from alternative funding standard account
|
|
8 |
Initial unfunded liability (for new plan)
|
Line 8a. Funding Waivers or Extensions.
If a funding waiver or extension request is approved after the Schedule B is filed, an amended Schedule B should be
filed with Form 5500 to report
the waiver or extension approval (also see instructions for line 9m(1)).
Line 8b. Alternative Methods or Rules.
Enter the appropriate code from the table below if one or more of the alternative methods or rules were used for this
plan year.
Code
|
Method or Rule
|
|
1 |
Shortfall method
|
|
2 |
Alternative funding standard account (AFSA)
|
|
3 |
Shortfall method used with AFSA
|
|
4 |
Plan is in reorganization status
|
|
5 |
Shortfall method used when in reorganization status
|
|
6 |
Alternative 17-Year Funding Schedule for Airlines
|
Note.
For Code 6, see Special Instructions for Plans Utilizing Alternative 17-Year Funding Schedule for Airlines on page 31.
Shortfall Method:
Only certain collectively bargained plans may elect the shortfall funding method (see regulations under Code section
412). 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. However, 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.
Alternative Minimum Funding Standard Account:
A worksheet must be attached if the alternative minimum funding standard account is used and be labeled “Schedule B, line 8b -
Alternative Minimum Funding Standard Account.” The worksheet should show:
-
The prior year alternate funding deficiency (if any).
-
Normal cost.
-
Excess, if any, of the value of accrued benefits over the market value of assets.
-
Interest on 1, 2, and 3 above.
-
Employer contributions (total from columns (b) of line 3 of Schedule B).
-
Interest on 5 above.
-
Funding deficiency: if the sum of 1 through 4 above is greater than the sum of 5 and 6 above,
enter the difference.
If the entry age normal cost method was not used as the valuation method, the plan may not switch to the alternative
minimum funding standard
account for this year. Additionally, in line 3 of the worksheet, the value of accrued benefits should exclude benefits accrued for the
current plan year. The market value of assets should be reduced by the amount of any contributions for the current plan year.
Reorganization Status:
Attach an explanation of the basis for the determination that the plan is in reorganization for this plan year and
label the explanation
“Schedule B, line 8b - Reorganization Status Explanation.” Also, attach a worksheet showing for this plan year:
-
The amounts considered contributed by employers,
-
Any amount waived by the IRS,
-
The development of the minimum contribution requirement (taking into account the applicable overburden credit, cash-flow amount,
contribution bases and limitation on required increases on the rate of employer contributions), and
-
The resulting accumulated funding deficiency, if any, which is to be reported on line 9p.
Label the worksheet “Schedule B, line 8b - Reorganization Status Worksheet.”
Line 8c.
All multiemployer plans check “ No.” Plans other than multiemployer plans check “ Yes” only if (a) the plan is covered by Title IV of ERISA
and (b) the plan has active participants.
If line 8c is “ Yes,” attach a schedule of the active plan participant data used in the valuation for this plan year. Use the same size paper
as the Schedule B and the format shown below and label the schedule “Schedule B, line 8c - Schedule of Active Participant Data.”
Expand this schedule by adding columns after the “ 5 to 9” column and before the “ 40 & up” column for active participants with total
years of credited service in the following ranges: 10 to 14; 15 to 19; 20 to 24; 25 to 29; 30 to 34; and 35 to 39. 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) 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 plans using characteristic code 1C on line 8a of Form 5500), reporting 1,000 or more active
participants on line 2b(3)
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:
-
the number of active participants in the age/service bin,
-
the average compensation of the active participants in the age/service bin, and
-
the average cash balance account of the active participant in the age/service bin, using $0 for anyone who has no cash balance
account-based
benefit.
If the accrued benefit is the greater of a cash balance benefit or some other benefit, average in only the cash balance account.
If the accrued
benefit is the sum of a cash balance account benefit and some other benefit, average in only the cash balance account. For
both the average
compensation and the average cash balance account, do not enter an amount for age/service bins with fewer than 20 active participants.
In lieu of the above, two alternatives are provided for showing compensation and cash balance accounts. Each alternative
provides for two
age/service scatters (one showing compensation and one showing cash balance accounts) as follows:
Alternative A:
-
Scatter 1 — Provide participant count and average compensation for all active participants, whether or not participants
have account-based benefits.
-
Scatter 2 — Provide participant count and average cash balance account for all active participants, whether or not
participants have account-based benefits.
Alternative B:
-
Scatter 1 — Provide participant count and average compensation for all active participants, whether or not participants
have account-based benefits (i.e., identical to Scatter 1 in Alternative A).
-
Scatter 2 — Provide participant count and average cash balance account for only those active participants with account-based
benefits. If the number of participants with account-based benefits in a bin is fewer than 20, the average account should not be shown
even if
there are more than 20 active participants in this bin on Scatter 1.
In general, information should be determined as of the valuation date. Average cash balance accounts may be determined
as of either:
-
the valuation date or
-
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 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-participant data in a manner consistent
with the computations for
the funding requirements reported on line 9. See the specific instructions for Lines 9a through 9q. For example, if the funding
requirements are computed as if each participating employer maintained a separate plan, attach a separate schedule for each
participating employer in
the multiple-employer plan.
Line 9. Shortfall Method.
Under the shortfall method of funding, the normal cost in the funding standard account is the charge 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.
Lines 9a through 9q. Multiple-Employer Plans.
If the plan is a multiple-employer plan subject to the rules of Code section 413(c)(4)(A) for which minimum funding
requirements are to be computed
as if each employer were maintaining a separate plan, complete one Schedule B for the plan. Also submit an attachment completed
in the same format as
lines 9a through 9q showing, for this plan year, for each individual employer maintaining the plan, the development of the
minimum contribution
requirement (taking into account the applicable normal cost, amortization charges and credits, and all other applicable charges
or credits to the
funding standard account that would apply if the employer were maintaining a separate plan), and label the attachment “Schedule B, lines 9a
through 9q - Development of Minimum Contribution Requirement for Each Individual Employer.” Compute the entries on Schedule B, except
for the entries on lines 9a, 9h, 9o, and 9p, as the sum of the appropriate individual amounts computed for each employer.
Compute the entry on line 9a
as the sum of the prior year's funding deficiency, if any, for each individual employer and the entry on line 9p as the sum
of the separately computed
funding deficiency, if any, for the current year for each employer. Credit balance amounts on lines 9h and line 9o are separately
computed in the same
manner. (Note that it is possible for the Schedule B to show both a funding deficiency and a credit balance for section 413(c)
plans. This could not
appear for other plans.)
Lines 9c and 9j. Amortization Charges and Credits.
If there are any amortization charges or credits, attach a maintenance schedule of funding standard account bases
and label the schedule
“Schedule B, lines 9c and 9j - Schedule of Funding Standard Account Bases.” The attachment should clearly indicate the type of
base (i.e., original unfunded liability, amendments, actuarial losses, etc.), the outstanding balance of each base, the number
of years remaining in
the amortization period, and the amortization amount. If bases were combined in the current year, the attachment should show
information on bases both
prior to and after the combining of bases.
The outstanding balance and amortization charges and credits must be calculated as of the valuation date for the plan
year.
Note.
If an election was made under Code section 412(b)(7)(F) to defer a portion of an amount otherwise determined under section
412(b)(2)(B)(iv),
include an attachment describing this calculation and label the schedule “Schedule B, line 9c - Deferral of Charge for Portion of Net
Experience Loss.”
Line 9c(2).
Amortization for funding waivers must be based on the interest rate provided in Section 412(d) (“ mandated rate”).
Line 9d. Interest as Applicable.
Interest as applicable should be charged to the last day of the plan year. The mandated rates must be used when calculating
interest on any
amortization charges for funding waivers.
Line 9e.
If the funded current liability percentage for the preceding year reported in line 4a is at least 100%, quarterly
contributions are not required
for the current plan year.
Interest is charged for the entire period of underpayment. Refer to IRS Notice 89-52, 1989-1 C.B. 692, for a description
of how this amount is
calculated.
Note.
Notice 89-52 was issued prior to the amendment of section 412(m)(1) by the Revenue Reconciliation Act of 1989. Rather than
using the rate in the
Notice, the applicable interest rate for this purpose is the greater of:
-
175% of the Federal mid-term rate at the beginning of the plan year,
-
The rate used to determine the “RPA '94” current liability, or
-
The valuation rate.
All other descriptions of the additional interest charge contained in Notice 89-52 still apply.
Line 9f.
Enter the required additional funding charge from line 12q. Check “ N/A” if line 12 is not applicable.
Note.
If an election was made under Code section 412(l)(12) to reduce the amount of contributions required under Code section 412(l)(1)
(determined
without regard to Code section 412(l)(12), include an attachment describing this calculation and label the schedule “Schedule B, line 9f
- Alternative Deficit Reduction Contribution.”
Line 9h.
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, attach an explanation and label the attachment
“Schedule B, line 9h - 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.
Line 9l(1). ERISA Full Funding Limitation.
Instructions for this line are reserved pending published guidance.
Line 9l(2). “RPA '94” Override.
Instructions for this line are reserved pending published guidance.
Line 9l(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 9l(1) or 9l(2).
Line 9m(1). Waived Funding Deficiency Credit.
Enter a credit for a waived funding deficiency for the current plan year (Code section 412(b)(3)(C)). If a waiver
of a funding deficiency is
pending, report a funding deficiency. If the waiver is granted after Form 5500 is filed, file an amended Form 5500 with an
amended Schedule B to
report the funding waiver (see page 6 of the Instructions for Form 5500).
Line 9m(2). Other Credits.
Enter a credit in the case of a plan for which the accumulated funding deficiency is determined under the funding
standard account if such plan
year follows a plan year for which such deficiency was determined under the alternative minimum funding standard.
Line 9q. Reconciliation Account.
The reconciliation account is made up of those components that upset the balance equation of Treasury Regulation section
1.412(c)(3)-1(b).
Valuation assets should not be adjusted by the reconciliation account balance when computing the required minimum funding.
Line 9q(1).
The accumulation of additional funding charges for prior plan years must be included. Enter the sum of line 9q(1)
(increased with interest at the
valuation rate to the first day of the current plan year) and line 9f, both from the prior year's Schedule B (Form 5500).
Line 9q(2).
The accumulation of additional interest charges due to late or unpaid quarterly installments for prior plan years
must be included. Enter the sum
of line 9q(2) (increased with interest at the valuation rate to the first day of the current plan year) and line 9e, both
from the prior year's
Schedule B (Form 5500).
Line 9q(3)(a).
If a waived funding deficiency is being amortized at an interest rate that differs from the valuation rate, enter
the prior year's
“ reconciliation waiver outstanding balance” increased with interest at the valuation rate to the current valuation date and decreased by the year
end amortization amount based on the mandated interest rate. Enter the amounts as of the valuation date. Also, include in
this line reconciliation
amounts due to extensions of amortization periods that have been approved by the IRS.
Line 9q(4).
Enter the sum of lines 9q(1), 9q(2), and 9q(3)(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 9q(4) (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 9p. However, if the alternative funding standard account is elected and the accumulated
funding deficiency under that
method is smaller than line 9p, enter such amount (also see instructions for line 8b). For multiemployer plans in reorganization,
see the instructions
for line 8b. File Form 5330 with the IRS to pay the 10% excise tax (5% in the case of a multiemployer plan) on the funding
deficiency.
Note.
See Special Instructions for Plans Utilizing Alternative 17-Year Funding Schedule for Airlines on page 31.
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 B, line 11 - Justification for Change in Actuarial Assumptions.” The preceding sentence applies for all
plans.
The following instructions are applicable only to changes in current liability assumptions for plans (other than multiemployer
plans) subject to
Title IV of ERISA that resulted in a decrease in the unfunded current liability (UCL). If the current liability assumptions
(other than a change in
the assumptions required under Code section 412(l)(7)(C)) were changed for the current plan year and such change resulted
in a decrease in UCL,
approval for such a change may be required. However, if one of the following three conditions is satisfied with respect to
a change in assumptions for
a plan year, then the plan sponsor is not required to obtain approval from the IRS for such change(s):
Condition 1: Aggregate Unfunded Vested Benefits
The aggregate unfunded vested benefits as of the close of the plan year preceding the year in which assumptions were
changed (as determined under
section 4006(a)(3)(E)(iii) of ERISA) for the plan, and all other plans maintained by contributing sponsors (as defined in
section 4001(a)(13) of
ERISA) and members of such sponsor's controlled group (as defined in section 4001(a)(14) of ERISA) which are covered by Title
IV of ERISA
(disregarding plans with no unfunded vested benefits) is less than or equal to $50 million.
Condition 2: Amount of Decrease in UCL
The change in assumptions (other than a change required under Code section 412(l)(7)(C)) resulted in a decrease in
the UCL of the plan for the plan
year in which the assumptions were changed of less than or equal to $5 million.
Condition 3: Amount of Decrease in UCL, and CL Before Change in Assumptions
Although the change in assumptions (other than a change required under Code section 412(l)(7)(C)) resulted in a decrease
in the UCL of the plan for
the plan year in which the assumptions were changed which was greater than $5 million and less than or equal to $50 million,
the decrease was less
than five percent of the current liability of the plan before such change.
If the current liability assumptions for the plan have been changed, and such change requires approval of the Service,
enter on an attachment the
date(s) of the ruling letter(s) granting approval and label the attachment “Schedule B, line 11 - Change in Current Liability Assumptions
Approval Date.”
If the current liability assumptions for the plan have been changed, and such change would have required approval
in the absence of satisfaction of
one of the conditions outlined above, enter on an attachment the number of the applicable condition and the plan year for
which it applies, and label
the attachment “Schedule B, line 11 - Change in Current Liability Applicable Condition.” If condition 1 or 2 applies, also enter
the amount of the decrease in UCL. Note that only one of the conditions needs to be entered.
Specific Instructions for Part II
Line 12. Additional Required Funding Charge.
There is no additional funding charge for multiemployer plans that checked box 1 on line E or plans that have 100
or fewer participants in the
prior plan year (as defined under the Who Must File discussion for Schedule B). Do not complete Part II for such plans.
Line 12a.
A plan's “ Gateway %” is equal to the actuarial value of assets (line 1b(2), unreduced by any credit balance) divided by the current liability
computed with the highest allowable interest rate (line 1d(2)(c)). If line 1d(2)(c) is not completed in accordance with instructions
for that line,
use “ RPA '94” current liability reported on line 1d(2)(a). There is no additional funding charge for plan years beginning in 2006 if the
“ Gateway %” is at least 90%. In such cases, enter -0- on line 12q. There is no additional funding charge for plan years beginning in
2006 if
(a) the “ Gateway %” (for 2006) is at least 80% but less than 90%, and (b) the “ Gateway %” for the plan years
beginning in 2005 and 2004 were at least 90%, or, the “ Gateway %” for the plan years beginning in 2004 and 2003 were at least 90% (in such case,
enter -0- on line 12q).
Note.
Section 1508 of TRA '97 provided transition rules for certain plans sponsored by companies engaged primarily in the interurban
or interstate
passenger bus service that have “Gateway” percentages that are greater than certain prescribed minimum percentages. These transition rules are
effective for such plans for any plan years beginning after 1996 and before 2010. If one of these transition rules is used,
line 12a should be
completed, and, if appropriate, a zero should be entered in line 12q. Attach a demonstration of the use of this transition
rule to the Schedule B and
label the attachment “Schedule B, line 12a - TRA '97 Transition Rule.”
Note.
Section 101(d)(2) of the Pension Funding Equity Act of 2004 provided a lookback rule for the purpose of applying section 412(l)(9)(B)(ii)
of the
Internal Revenue Code of 1986, for plan years beginning after December 31, 2003. If this lookback rule is used, attach a demonstration
of the use of
this lookback rule to the Schedule B and label the attachment “Schedule B, line 12a - Volatility Lookback Rule.”
Line 12c.
Enter the actuarial value of assets (line 1b(2)), reduced by the prior year's credit balance (line 9h). If line 9h
was determined at a date other
than the valuation date, adjust the credit balance for interest at the valuation rate to the current valuation date before
subtracting. Do not add a
prior year's funding deficiency to the assets.
Line 12d. Funded Current Liability Percentage.
Enter the actuarial value of the assets expressed as a percentage of “ RPA '94” current liability. Enter the result to the nearest .01% (e.g.,
28.72%).
Line 12f.
Enter the liability for any unpredictable contingent event (other than events that occurred before the first plan
year beginning after 1988) that
was included in line 12b, whether or not such unpredictable contingent event has occurred.
Line 12g.
Enter the outstanding balance of the unfunded old liability as of the valuation date. This is line 12(g) of the 2005
Schedule B reduced by the
prior year's amortization amount, and adjusted for interest at the prior year's current liability interest rate from the prior
year's valuation date
to the current valuation date. The unfunded old liability (and therefore all its components) will be considered fully amortized
in accordance with
Q&A-7 of Rev. Rul. 96-20, 1996-1 C.B. 62.
Note.
In the case of a collectively bargained plan, this amount must be increased by the unamortized portion of any “unfunded existing benefit increase
liability” in accordance with Code section 412(l)(3)(C).
Line 12h.
This amount is the unfunded new liability. It is recomputed each year. If a negative result is obtained, enter zero.
Line 12i.
If the unfunded new liability is zero, enter zero for the unfunded new liability amount. If the unfunded new liability
is greater than zero, first
calculate the amortization percentage as follows:
-
If the funded current liability percentage (line 12d) is less than or equal to 60%, the amortization percentage is 30%.
-
If the current liability percentage exceeds 60%, the amortization percentage is determined by reducing 30% by the product
of 40% and the
amount of such excess. Enter the resulting amortization percentage to the nearest 0.01 percent.
The unfunded new liability amount is equal to the above-calculated percentage of the unfunded new liability.
Line 12j.
Enter the amortization amount for line 12g based on the “ RPA '94” current liability interest rate (line 6a) in effect for the plan year and
the following amortization period:
In general:
For the 2006 plan year, the remaining amortization period is 1 year.
Special rule:
In the case of a collectively bargained plan, the amortization amount must be increased by the amortization of any
“ unfunded existing benefit
increase liability” in accordance with Code section 412(l)(3)(C)(ii). For any such amortization, the amortization period is equal to the remainder
of the original 18-year period that applied when the amortization began.
Base maintenance:
On a separate attachment, show the initial amount of each DRC amortization base (as defined in Rev. Rul. 96-20) being
amortized under the general
or special rule, the outstanding balance of each DRC amortization base, the number of years remaining in the amortization
period, and the amortization
amount (with the valuation date as the due date of the amortization amount), and label the schedule “Schedule B, line 12j - Schedule of
DRC Bases.” It is not necessary to list separately the unfunded old liability base and the additional unfunded old liability base.
Line 12l.
Enter the result determined by subtracting the amortization credits (line 9j) from the sum of the normal cost and
the amortization charges (lines
9b, 9c(1), and 9c(2)). Use the valuation date as the due date for the amortization amounts. If entering a negative number,
enter a minus sign
“ -” to the left of the number.
Line 12m. Unpredictable Contingent Event Amount.
Line 12m does not apply to the unpredictable contingent event benefits (and related liabilities) for an event that
occurred before the first plan
year beginning after December 31, 1988.
Line 12m(1).
Enter the total of all benefits paid during the plan year that were paid solely because an unpredictable event occurred.
Line 12m(4). Amortization of All Unpredictable Contingent Event Liabilities.
Amortization should be based on the “ RPA '94” current liability interest rate (line 6a), using the valuation date as the due date. The initial
amortization period for each base established in a plan year is generally 7 years; however, see Code section 412(l)(5) for
special rules.
Note.
An alternative calculation of an unpredictable contingent amount is available for the first year of amortization. Refer to
Code section
412(l)(5)(D) for a description. If this alternative calculation is used, include an attachment describing the calculation
and label the schedule
“Schedule B, line 12m(4) - Alternative UCEB Calculation.”
Line 12m(5). “RPA '94” Additional Amount.
Subtract line 12g from line 12e. If the result is zero or less than zero, enter -0-. If the result is a positive number,
multiply the result by the
percentage used to calculate line 12i. Enter the excess, if any, of this amount over the amount on line 12i.
Line 12n. Preliminary charge.
Adjust with interest using the “ RPA '94” current liability interest rate.
Line 12o. Contributions needed to increase current liability percentage to 100%.
This amount is equal to the excess, if any, of the “ adjusted current liability” over the “ adjusted assets.” The adjusted current
liability is equal to the excess of (1) the sum of lines 1d(2)(a) and 1d(2)(b), over (2) line 1d(2)(d), each adjusted to the
end of the plan year
using the “ RPA '94” current liability interest rate.
The adjusted assets are equal to the actuarial value of assets for the plan year adjusted by (1) subtracting any credit
balance (or adding any
debit balance) in the plan's funding standard account as of the end of the prior plan year, adjusted with interest to the
valuation date at the
valuation interest rate, (2) subtracting the disbursements from the plan (including single sum distributions) expected to
be paid after the valuation
date but prior to the end of the plan year, (3) adding the charges to the funding standard account as maintained under Code
section 412(b) for the
plan year (other than the additional funding charge under Code section 412(I)), and (4) subtracting the credits to the funding
standard account as
maintained under Code section 412(b) for the plan year (other than credits under Code sections 412(b)(3)(A) and 412(b)(3)(C)).
The actuarial value of
assets and the adjustments described above are determined as of the valuation date, and each is appropriately adjusted with
interest to the end of the
plan year at the valuation interest rate. The result of the calculation of adjusted assets may be a negative number.
Line 12q.
If the plan had 150 or more participants on each day of the preceding plan year, enter 100%. If the plan had less
than 150 participants but more
than 100 participants on each day of the preceding plan year, enter the applicable percentage. The same participant aggregation
rule described in the
instructions for line 12 applies. The applicable percentage is calculated as follows: (1) Determine the greatest number of participants on
any day during the preceding plan year in excess of 100. (2) The applicable percentage is 2% times the number of such participants in
excess of 100. The percentage should not exceed 100%. The amount on line 12q is also the amount entered on line 9f.
Special Instructions for Plans Utilizing Alternative 17-Year Funding Schedule for Airlines
Section 402(e) of the Pension Protection Act (PPA) of 2006 provides funding relief for certain defined benefit 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. If an employer has made an election to apply the alternative funding schedule for 2006 in accordance with
IRS Announcement 2006-70,
2006-40 I.R.B. 629, complete all items on this Schedule B (including item 9) as if the alternative funding schedule had not been elected,
except as indicated below:
Line 8b. Alternative Methods or Rules.
Enter code 6 to indicate that the plan is using the alternative 17-year funding schedule for airlines.
Also, attach a worksheet showing the information below, determined in accordance with section 402(e) of the Pension
Protection Act of 2006. Label
this worksheet “Schedule B, line 8b - Alternative 17-Year Funding Schedule for Airlines.”
-
Date as of which plan benefits were frozen as required under section 402(b)(2) of the PPA.
-
Date on which the first applicable plan year begins.
-
If the plan sponsor elected to change the plan year as provided in section 402(d)(1)(C) of the PPA, the beginning and ending
dates of the
plan year immediately preceding the first applicable plan year.
-
Unit credit accrued liability calculated as of the first day of the plan year, using an interest rate of 8.85% and other assumptions
as
reported in lines 6b-6g of the Schedule B and related attachments.
-
Fair market value of assets as of the first day of the plan year.
-
Unfunded liability used to calculate the 17-year amortization charge.
-
Alternative funding schedule:
-
Charge necessary to amortize the unfunded liability over 17 years, assuming payments at the end of the plan year and using
an interest rate
of 8.85%;
-
Employer contributions for the plan year which were made before the end of the plan year, as reported in line 3, column (b),
increased for
interest to the end of the plan year using a rate of 8.85%;
-
Employer contributions for the plan year which were made after the end of the plan year, as reported in line 3, column (b),
discounted for
interest to the end of the plan year using a rate of 8.85%; and
-
Contribution shortfall, if any ((1)-(2)-(3), but not less than zero).
Note.
If a portion of the plan was the result of a spin-off during the plan year as described in section 402(e)(5) of the Pension
Protection Act of 2006,
provide the above information for the plan as a whole (disregarding the spin-off) as well as the allocation of the minimum
funding requirements
between (or among) the affected plans.
Line 10. Contribution Necessary to Avoid Deficiency.
Enter zero if the contributions to the plan for the plan year are not less than the minimum required contribution
determined under such alternative
schedule (i.e., if the contribution shortfall in line 4 of the alternative funding schedule is zero; see special instructions
for line 8b above).
Additional information will be provided later in the case where there is a contribution shortfall in the alternative funding
schedule.
2006 Instructions for Schedule C (Form 5500) Service Provider Information
Schedule C (Form 5500) must be attached to a Form 5500 filed for a large pension or welfare benefit plan and to a Form 5500
filed for a MTIA,
103-12 IE, or GIA to report information concerning service providers. See the instructions to the Form 5500 for Form 5500 Schedules and
Direct Filing Entity (DFE).
Check the Schedule C box on the Form 5500 (Part II, line 10b(4)) if a Schedule C is attached to the Form 5500. Multiple Schedule
C pages must be
attached to the Form 5500 if necessary to report the required information.
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 C is attached.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
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 and are subject to publication on the Internet. Because of privacy concerns, the inclusion of a social
security number on this
Schedule C or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
Line 1 of Part I.
Line 1 must be completed if line 2 of Part I is required to be completed as specified below.
Line 2 of Part I.
Line 2 of Part I must be completed to report contract administrators and persons receiving, directly or indirectly,
$5,000 or more in compensation
for all services rendered to the plan or DFE during the plan or DFE year except:
-
Employees of the plan whose only compensation in relation to the plan was less than $1,000 for each month of employment during
the plan
year;
-
Employees of the plan sponsor who did not receive direct or indirect compensation from the plan;
-
Employees of a business entity (e.g., corporation, partnership, etc.), other than the plan sponsor, who provided services
to the plan;
or
-
Persons whose only compensation in relation to the plan consists of insurance fees and commissions listed in a Schedule A
attached to the
Form 5500 filed for this plan.
Generally, indirect compensation would not include compensation that would have been received had the service not
been rendered and that cannot be
reasonably allocated to the services performed. Indirect compensation includes, among other things, payment of "finder's fees"
or other fees and
commissions by a service provider to an independent agent or employee for a transaction or service involving the plan.
Notes.
-
Either the cash or accrual basis may be used for the recognition of transactions reported on the Schedule C as long as you
use one
method consistently.
-
The compensation listed should only reflect the amount of compensation received by the service provider from the plan or DFE
filing the
Form 5500, not the aggregate amount received for providing services to several plans or DFEs.
-
The term "persons" on the Schedule C instructions includes individuals, trades and businesses (whether incorporated or unincorporated).
See ERISA section 3(9).
Part I - Service Provider Information Line 1.
Enter the total dollar amount of compensation received by all persons who provided services to the plan who are not
listed in line 2 (except for
those persons described in 2, 3, or 4 in the General Instructions).
Example.
A plan had service providers, A, B, C, and D, who received $12,000, $6,000, $4,500, and $430, respectively, from the
plan. Service providers A and
B must be identified separately in line 2 by name, EIN, official plan position, etc. As service providers C and D each received
less than $5,000, the
amount they received must be combined and $4,930 entered in line 1.
Line 2.
List up to 40 service providers, including the contract administrator, as specified below.
First, list the contract administrator, if any, on the first item (complete elements (a) through (g)) on line 2 where
indicated. A contract administrator is any individual, trade or business (whether incorporated or unincorporated) responsible
for managing the
clerical operations of the plan on a contractual basis (e.g., handling membership rosters, claims payment, maintaining books
and records), except for
salaried staff or employees of the plan or banks or insurance carriers. If you do not have a contract administrator, leave
the first item blank and
skip to the next item. DO NOT cross out the preprinted words “ Contract administrator.”
Next, complete a separate item for each person required to be reported in line 2 in the order of compensation received.
Start with the most highly
compensated and end with the lowest compensated. Enter in element (a) the person's name and complete elements (b) through
(g) as specified below. Additional pages may be necessary to list all service providers. If you are using the official hand print
forms,
you can get additional hand print pages by calling 1-800-TAX-FORM (1-800-829-3676) and requesting additional schedules.
Element (b).
An EIN must be entered. If the name of an individual is entered in element (a), the EIN to be entered in element (b) should
be the EIN of the individual's employer. 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 on this Schedule C or any of its attachments may result in the rejection of the filing.
Element (c).
Enter, for example, employee, trustee, accountant, attorney, etc.
Element (d).
Enter, for example, employee, vice-president, union president, etc.
Elements (e) and (f).Plan Filers.
Include the plan's share of compensation for services paid during the year to a MTIA or 103-12 IE trustee and to persons
providing services to the
MTIA or 103-12 IE, if such compensation is not subtracted from the total income in determining the net income (loss) reported on the MTIA
or 103-12 IE's Schedule H, line 2k.
Include brokerage commissions or fees only if the broker is granted some discretion (see 29 CFR 2510.3-21 paragraph
(d), regarding "discretion").
Include all other commissions and fees on investments, whether or not they are capitalized as investment costs.
MTIA and 103-12 IEs.
Include compensation for services paid by the MTIA or 103-12 IE during its fiscal year to persons providing services
to the MTIA or 103-12 IE if
such compensation is subtracted from the total income in determining the net income (loss) reported by the MTIA or 103-12
IE on Schedule H, line 2k.
Element (g).
Select and enter all codes that describe the nature of services provided from the list below. If more than one service
was provided, list the code
for the primary service first. If necessary, use a properly identified attachment to list all applicable service codes.
Note.
Do not list PBGC or IRS as a service provider on Part I of Schedule C.
Code
|
Service
|
|
10 |
Accounting (including auditing)
|
|
11 |
Actuarial
|
|
12 |
Contract Administrator
|
|
13 |
Administration
|
|
14 |
Brokerage (real estate)
|
|
15 |
Brokerage (stocks, bonds, commodities)
|
|
16 |
Computing, tabulating, ADP, etc.
|
|
17 |
Consulting (general)
|
|
18 |
Custodial (securities)
|
|
19 |
Insurance agents and brokers
|
|
20 |
Investment advisory
|
|
21 |
Investment management
|
|
22 |
Legal
|
|
23 |
Printing and duplicating
|
|
24 |
Recordkeeping
|
|
25 |
Trustee (individual)
|
|
26 |
Trustee (corporate)
|
|
27 |
Pension insurance advisor
|
|
28 |
Valuation services (appraisals, asset valuations, etc.)
|
|
29 |
Investment evaluations
|
|
30 |
Medical
|
|
31 |
Legal services to participants
|
|
99 |
Other (specify)
|
Part II - Termination Information on Accountants and Enrolled Actuaries
Complete Part II if there was a termination in the appointment of an accountant or enrolled actuary. In case the service provider
is not an
individual (i.e., when the accountant is a legal entity such as a corporation, partnership, etc.), report when the service
provider (not the
individual) has been 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,
the EIN to be entered
should be the EIN of the individual's employer.
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 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 Part II of the Schedule C, 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 2006 Annual Return/Report Form 5500 for
the
(enter name of plan). This Form 5500 is identified in line 2b by the nine-digit EIN
-
(enter sponsor's EIN), and in line 1b by the three-digit PN
(enter plan number).
|
|
|
You have the opportunity to comment to the Department of Labor concerning any aspect of this explanation.
Comments should include the name, EIN, and PN of the plan and be submitted to: Office of Enforcement, Employee Benefits Security
Administration,
U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210.
|
|
|
Signed
Dated
|
|
|
|
|
2006 Instructions for Schedule D (Form 5500) DFE/Participating Plan Information
When the Form 5500 is filed for a plan or DFE that invested or participated in any MTIAs, 103-12 IEs, CCTs and/or PSAs, Part
I provides information
about these entities. When the Form 5500 is filed for a DFE, Part II provides information about plans participating in the
DFE.
Employee Benefit Plans:
Schedule D must be attached to a Form 5500 filed for an employee benefit plan that participated or invested in one
or more common/collective trusts
(CCTs), pooled separate accounts (PSAs), master trust investment accounts (MTIAs), or 103-12 Investment Entities (103-12 IEs)
at anytime during the
plan year.
Direct Filing Entities:
Schedule D must be attached to a Form 5500 filed for a CCT, PSA, MTIA, 103-12 IE or Group Insurance Arrangement (GIA),
as a Direct Filing Entity
(i.e., when Form 5500 Part I, line A(4) is checked). For more information, see instructions for Direct Filing Entity (DFE) on pages 4 and
10 of the instructions for the Form 5500.
Check the Schedule D box on the Form 5500 (Part II, line 10b(5)) if a Schedule D is attached to the Form 5500. Multiple
Schedule D pages must be
attached to the Form 5500 if necessary to report the required information. You can get additional hand print pages by calling
1-800-TAX-FORM (1-800-829-3676) to request additional schedules.
Lines A, B, C, and D.
The information should be the same as reported in Part II of the Form 5500 to which this Schedule D is attached. You
may abbreviate the plan name
(if necessary) to fit in the space provided. 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 on this Schedule D or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
Part I - Information on Interests in MTIAs, CCTs, PSAs, and 103-12 IEs (To Be Completed by Plans and DFEs)
Use as many Schedule D, Part I pages as necessary to enter the information specified below for all MTIAs, CCTs, PSAs, and
103-12 IEs in which the
plan or DFE filing the Form 5500 participated at anytime during the plan or DFE year.
Complete a separate item (elements (a) through (e)) for each MTIA, CCT, PSA, or 103-12 IE.
Element (a).
Enter the name of the MTIA, CCT, PSA, or 103-12 IE in which the plan or DFE filing the Form 5500 participated at any
time during the plan or DFE
year.
Element (b).
Enter the name of the sponsor of the MTIA, CCT, PSA, or 103-12 IE named in (a).
Element (c).
Enter the nine-digit employer identification number (EIN) and three-digit plan/entity number (PN) for each MTIA, CCT,
PSA, or 103-12 IE named in
(a). This must be the same DFE EIN/PN as reported on lines 2b and 1b of the Form 5500 filed for the DFE. If a Form 5500 was
not filed for a CCT or PSA named in element (a), enter the EIN for the CCT or PSA and enter 000 for the PN. 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 on this Schedule
D or any of its
attachments may result in the rejection of the filing.
Element (d).
Enter an M, C, P, or E, as appropriate, (see table below) to identify the type of entity (MTIA, CCT, PSA, or 103-12
IE).
Type of entity
▼
|
Enter in (d)
▼
|
MTIA
|
M
|
CCT
|
C
|
PSA
|
P
|
103-12 IE
|
E
|
Element (e).
Enter the dollar value of the plan's or DFE's interest as of the end of the year. If the plan or DFE for which this
Schedule D is filed had no
interest in the MTIA, CCT, PSA, or 103-12 IE listed at the end of the year, enter "0".
Example for Part I:
If a plan participates in a MTIA, the MTIA is named in element (a); the MTIA's sponsor is named in element (b); the MTIA's
EIN and PN is entered in element (c) (such as: 12-3456789-001); an "M" is entered in element (d); and the dollar value of the
plan's interest in the MTIA as of the end of the plan year is entered in element (e).
If the plan also participates in a CCT for which a Form 5500 was not filed, the CCT is named in another element (a); the name
of the CCT sponsor is entered in element (b); the EIN for the CCT, followed by 000 is entered in element (c) (such as:
99-8765432-000); a "C" is entered in element (d); and the dollar value of the plan's interest in the CCT is entered in element
(e).
If the plan also participates in a PSA for which a Form 5500 was filed, the PSA is named in a third element (a); the name of
the PSA sponsor is entered in element (b); the PSA's EIN and PN is entered in element (c) (such as: 98-7655555-001); a "P" is
entered in element (d); and the dollar value of the plan's interest in the PSA is entered in element (e).
Part II - Information on Participating Plans (To Be Completed Only by DFEs)
Use as many Schedule D, Part II pages as necessary to enter the information specified below for all plans that invested or
participated in the DFE
at any time during the DFE year.
Complete a separate item (elements (a) through (c)) for each plan.
Element (a).
Enter the name of each plan that invested or participated in the DFE at any time during the DFE year. GIAs need not
complete element
(a).
Element (b).
Enter the sponsor of each investing or participating plan.
Element (c).
Enter the nine-digit EIN and three-digit PN for each plan named in element (a). This is the EIN and PN entered on lines 2b and 1b of
the plan's Form 5500. GIAs should enter the EIN of the sponsor listed in element (b). 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 on this Schedule D or any of its attachments
may result in the
rejection of the filing.
2006 Instructions for Schedule E (Form 5500) ESOP Annual Information
Use this schedule to satisfy the requirements under Code section 6047(e) for an annual information return for an employee
stock ownership plan
(ESOP).
Every employer or plan administrator of a pension benefit plan that contains ESOP benefits must file a Schedule E (Form 5500).
File Schedule E (Form 5500) annually as an attachment to Form 5500 or 5500-EZ. If more than one securities acquisition loan
(see specific
instructions for lines 7 through 12) is outstanding, you must file one Schedule E (Form 5500) and an attachment for each additional
securities
acquisition loan and label the attachment “Schedule E, lines 7 through 12 - Additional Securities Acquisition Loans.” Each
attachment must provide answers to questions 7 through 12, be in a similar format to, and on the same size paper as, the Schedule
E.
Check the Schedule E box on the Form 5500 (Part II, line 10a(3)) if a Schedule E is attached to the Form 5500.
Note.
The Small Business Job Protection Act of 1996 repealed the partial interest exclusion of Code section 133 effective, in general,
with respect to
loans made after August 20, 1996. However, Schedule E (Form 5500) must be filed for securities acquisition loans made to ESOPs
before August 21, 1996,
loans made pursuant to a written binding contract in effect before June 10, 1996, and at all times thereafter before the loan
was made, and certain
loans made after August 20, 1996, to refinance a securities acquisition loan originally made on or before August 20, 1996.
If the employer maintaining the ESOP is an S corporation and Schedule E is attached to a Form 5500, enter 2Q and other applicable
codes on Form
5500, Part II, line 8.
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.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
Line 1b.
Code section 409(p) precludes an ESOP from making allocations in a nonallocation year (as defined in Code section
409(p)(3)) to any disqualified
person (within the meaning of Code section 409(p)(4)). If an ESOP fails Code section 409(p), allocations are taxed to the
disqualified person (see
Code section 409(p)(2)) and an excise tax is imposed on the S corporation under Code section 4979A. (See section 1.409(p)-1T
of the Temporary
Regulations.)
Line 4.
If the schedule does not provide enough space, enter “ ATTACHED” and provide the required formula(s) as an attachment to Schedule E.
Lines 7 through 12.
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 7.
A "back to back loan" is a securities acquisition loan from a lender to an employer corporation followed by a loan
from the corporation to the ESOP
maintained by the employer corporation. A "back to back loan" constitutes a "securities acquisition loan" under Code section
133 if the following
requirements are satisfied:
-
The loan from the employer corporation to the ESOP qualifies as an exempt loan under Treasury Regulation sections 54.4975-7
and
54.4975-11;
-
The repayment terms of the loan from the corporation to the ESOP are "substantially similar" (as defined in Temporary Income
Tax Regulations
section 1.133-1T) to the repayment terms of the loan from the corporation to the lender; and
-
If the loan from the corporation to the ESOP provides for more rapid repayment of principal and interest, the allocations
under the ESOP
attributable to such repayments do not discriminate in favor of highly compensated employees (within the meaning of Code section
414(q)).
Line 8.
An immediate allocation loan is any loan to an employer corporation to the extent that, within 30 days, employer securities
are transferred to the
ESOP maintained by the corporation in an amount equal to the proceeds of the loan and the securities are allocable to the
accounts of plan
participants within one year of the date of the loan. (See Code section 133(b)(1)(B).)
Line 9c.
The transition rules of Act section 7301(f)(2) through (6) of the Omnibus Budget Reconciliation Act of 1989 (OBRA),
P.L. 101-239, provide that the
amendments made to Code section 133 by OBRA will not apply to certain loans that satisfy the requirements of those paragraphs.
In general, the
amendments made by OBRA will not apply to:
-
Loans made pursuant to a binding written commitment in effect on June 6, 1989, and at all times thereafter before the loan
was made, or
pursuant to a written binding contract (or tender offer registered with the Securities and Exchange Commission (SEC)) in effect
on June 6, 1989, and
at all times thereafter before such securities were acquired.
-
If subparagraph 1 does not apply, loans made pursuant to a binding written commitment in effect on July 10, 1989, and at all
times
thereafter before the loan was made, but only to the extent that the proceeds were used to acquire employer securities pursuant
to a certain binding
written contract (or tender offer registered with the SEC) in effect on July 10, 1989, and at all times thereafter before
the securities are
acquired.
-
Any loan made on or before July 10, 1992, pursuant to a written agreement entered into before July 10, 1989, if the agreement
evidences the
intent of the borrower to enter, on a periodic basis, into securities acquisition loans described in Code section 133(b)(1)(B)
(as in effect before
December 19, 1989). This rule applies only if one or more securities acquisition loans were made to the borrower on or before
July 10,
1989.
See Act section 7301(f)(2) to determine the specific requirements of the transition rules described above. See Act
section 7301(f)(3) through (6)
for additional transition rules on refinancings, collective-bargaining agreements, filings with the United States, and the
30% test for certain loans.
Line 10.
If the loan is a back to back loan or an immediate allocation loan, enter the amount of interest paid by the employer
corporation to the lender(s)
during the plan year.
Line 12b.
The repeal of Code section 133 by Act section 1602 of SBJPA 1996 does not apply to a refinancing of an ESOP securities
acquisition loan made after
August 20, 1996, or pursuant to a binding contract in effect before June 10, 1996, if:
-
The refinancing loan meets the requirements of Code section 133 in effect on August 20, 1996,
-
The outstanding principal amount of the loan is not increased, and
-
The term of the original loan is not extended.
Line 18.
If there are more than three classes of stock, include an attachment with the information required for elements (a) through
(f) for each additional class of stock and label the attachment “Schedule E, line 18 - Additional Classes of Stock.”
Line 18(d).
In determining the dividend rate for a class of common stock, use the percentage of the average dividends paid on
the class of common stock during
the plan year over the average value of the class of common stock during the plan year.
In determining the dividend rate for a class of preferred stock, use the dividend rate stated in the terms of the
stock, or if a dividend rate is
not stated, use the percentage of the average dividends paid on the class of preferred stock during the plan year over the
par value of the class of
preferred stock.
2006 Instructions for Schedule G (Form 5500) Financial Transaction Schedules
Schedule G (Form 5500) must be attached to a Form 5500 filed for a plan, MTIA, 103-12 IE, or GIA 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. See Schedule H (Form 5500) lines 4b, 4c, and/or 4d.
Check the Schedule G box on the Form 5500 (Part II, line 10b(6)) if a Schedule G is attached to the Form 5500. Multiple Schedule
G pages must be
attached to the Form 5500 if necessary to report the required information. You can get additional hand print pages by calling
1-800-TAX-FORM (1-800-829-3676) and requesting additional schedules.
The Schedule G consists of three parts. Part I of the Schedule G reports any loans or fixed income obligations in default
or determined to be
uncollectible as of the end of the plan year. Part II of the Schedule G reports any leases in default or classified as uncollectible.
Part III of the
Schedule G reports nonexempt transactions.
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 G is attached.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
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 on this
Schedule G or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. 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, MTIA, 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 later during the year.
Note.
Identify in element (a) each obligator known to be a party-in-interest to the plan.
Provide, on a separate attachment, an explanation of what steps have been taken or will be taken to collect overdue amounts
for each loan listed
and label the attachment “Schedule G, Part I - Overdue Loan Explanation.”
The due date, payment amount, and conditions for determining default in the case of a note or 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.
Do not report in Part I 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.
Report all other participant
loans in default or classified as uncollectible on Part I, and list each such loan individually.
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. Provide, on a separate attachment, an explanation
of what steps
have been taken or will be taken to collect overdue amounts for each lease listed and label the attachment “Schedule G, Part II - Overdue
Lease Explanation.”
Part III - Nonexempt Transactions
All nonexempt party-in-interest transactions must be reported, regardless of whether disclosed in the accountant's report,
unless the nonexempt
transaction is:
-
Statutorily exempt under Part 4 of Title I of ERISA;
-
Administratively exempt under ERISA section 408(a);
-
Exempt under Code sections 4975(c) or 4975(d);
-
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;
-
A transaction of a 103-12 IE with parties other than the plan; or
-
A delinquent participant contribution reported on Schedule H, line 4a.
Nonexempt transactions with a party-in-interest include any direct or indirect:
A. Sale or exchange, or lease, of any property between the plan and a party-in-interest.
|
B. Lending of money or other extension of credit between the plan and a party-in-interest.
|
C. Furnishing of goods, services, or facilities between the plan and a party-in-interest.
|
D. Transfer to, or use by or for the benefit of, a party-in-interest, of any income or assets of the plan.
|
E. Acquisition, on behalf of the plan, of any employer security or employer real property in violation of Code section
407(a).
|
F. Dealing with the assets of the plan for a fiduciary's own interest or own account.
|
G. Acting in a fiduciary's individual or any other capacity in any transaction involving the plan on behalf of a party (or
represent a party) whose interests are adverse to the interests of the plan or the interests of its participants or beneficiaries.
|
H. Receipt of any consideration for his or her own personal account by a party-in-interest who is a fiduciary from any party
dealing with the plan in connection with a transaction involving the income or assets of the plan.
|
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.
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,
a Form
5330, Return of Excise Taxes Related to Employee Benefit Plans, should be filed with the IRS to pay the excise tax on the transaction.
The DOL Voluntary Fiduciary Correction Program (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 Prohibited Transaction Exemption (PTE) 2002-51 are eligible for immediate
relief from payment
of certain prohibited transaction excise taxes for certain corrected transactions, and are also relieved from the obligation
to file the Form 5330
with the IRS. For more information, see 71 Fed. Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19, 2006). If the
conditions of PTE 2002-51
are satisfied, corrected transactions should be treated as exempt under Code section 4975(c) for the purposes of answering
Schedule G, Part III.
Information about the VFCP is also available on the Internet at
www.dol.gov/ebsa.
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 an individual having powers or responsibilities similar to those of officers or directors),
or a 10% or more shareholder, directly or indirectly, of a person described in B, C, D, E, or G, or of the employee benefit
plan; or
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I. A 10% or more (directly or indirectly in capital or profits) partner or joint venturer of a person described in B, C, D,
E, or
G.
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2006 Instructions for Schedule H (Form 5500) Financial Information
Schedule H (Form 5500) must be attached to a Form 5500 filed for a pension benefit plan or a welfare benefit plan that covered
100 or more
participants as of the beginning of the plan year and a Form 5500 filed for a MTIA, CCT, PSA, 103-12 IE, or GIA. See the instructions
to the Form 5500
for Direct Filing Entity (DFE) Filing Requirements.
Exceptions:
(1) Insured, unfunded, or a combination of unfunded/insured welfare plans and fully insured pension plans that meet the requirements
of
29 CFR 2520.104-44 are exempt from completing the Schedule H. (2) If a Schedule I was filed for the plan for the 2005 plan year and the
plan covered fewer than 121 participants as of the beginning of the 2006 plan year, the Schedule I may be completed instead
of a Schedule H. See
What To File on page 7.
Check the Schedule H box on the Form 5500 (Part II, line 10b(1)) if a Schedule H is attached to the Form 5500. Do
not attach both a Schedule H and
a Schedule I to the same Form 5500.
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 H is attached.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
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 on this
Schedule H or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
Note.
Do not mark through the printed line descriptions on the Schedule H and insert your own description as this may cause correspondence
due to a
computerized review of the Schedule H.
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 a DFE, a registered investment
company, or the general account
of an insurance company under an unallocated contract (see the instructions for lines 1c(9) through 1c(14)), complete Parts
I and II of the Schedule H
by entering the plan's allocable part of each line item.
Exception.
When completing Part II of the Schedule H for a plan or DFE that participates in a CCT or PSA for which a Form 5500
has not been filed, do not
allocate the income of the CCT or PSA and expenses that were subtracted from the gross income of the CCT or PSA in determining
their net investment
gain (loss). Instead, enter the CCT or PSA net gain (loss) on line 2b(6) or (7) in accordance with the instructions for these
lines.
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.
For the 2006 plan year, plans that provide participant-directed brokerage accounts as an investment alternative (and have
entered pension feature
code "2R" on line 8a of the Form 5500) may report investments in assets made through participant-directed brokerage accounts
either:
-
As individual investments on the applicable asset and liability categories in Part I and the income and expense categories
in Part II,
or
-
By including on line 1c(15) the total aggregate value of the assets and on line 2c 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 that could
result in a loss in excess of the account balance of the participant or beneficiary who directed the transaction. Expenses
charged to the accounts
must be reported on the applicable expense line items. Participant-directed brokerage account assets reported in the aggregate
on line 1c(15) should
be treated as one asset held for investment for purposes of the line 4i schedules, except that investments in tangible personal
property must continue
to be reported as separate assets on the line 4i schedules.
In the event that investments made through a participant-directed brokerage account are loans, partnership or joint venture
interests, real
property, employer securities, or investments that could result in a loss in excess of the account balance of the participant
or beneficiary who
directed the transaction, such assets must be broken out and treated as separate assets on the applicable asset and liability
categories in Part I,
income and expense categories in Part II, and on the line 4i schedules. The remaining assets in the participant-directed brokerage
account may be
reported in the aggregate as set forth in paragraph 2 above. The agencies will be evaluating whether, and to what extent, the aggregate
method of reporting is appropriate for future plan years.
Columns (a) and (b).
Enter the current value on each line as of the beginning and end of the plan year.
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 2006 plan year in column (a).
Line 1a.
Total noninterest bearing cash includes, among other things, cash on hand or cash in a noninterest bearing checking
account.
Line 1b(1).
Noncash basis filers should 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.
Line 1b(2).
Noncash basis filers should include contributions withheld by the employer from participants and amounts due directly
from participants that have
not yet been received by the plan. Do not include the repayment of participant loans.
Line 1b(3).
Noncash basis filers should include amounts due to the plan that are not includable in lines 1b(1) or 1b(2). These
amounts may include investment
income earned but not yet received by the plan and other amounts due to the plan such as amounts due from the employer or
another plan for expense
reimbursement or from a participant for the repayment of an overpayment of benefits.
Line 1c(1).
Include all assets that earn interest in a financial institution account such as interest bearing checking accounts,
passbook savings accounts, or
in money market accounts.
Line 1c(2).
Include securities issued or guaranteed by the U.S. Government or its designated agencies such as U.S. Savings Bonds,
Treasury bonds, Treasury
bills, FNMA, and GNMA.
Line 1c(3).
Include investment securities (other than employer securities defined below in 1d(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 1c(2) or 1c(15).
"Preferred" means any of the above securities that are publicly traded on a recognized securities exchange and the
securities have a rating of "A"
or above. If the securities are not "Preferred," they are listed as "Other."
Line 1c(4)(A).
Include stock issued by corporations (other than employer securities defined in 1d(1) below) which 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.
Line 1c(4)(B).
Include any stock (other than employer securities defined in 1d(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 1c(5).
Include the value of the plan's participation in a partnership or joint venture if the underlying assets of the partnership
or joint venture are
not considered to be plan assets under 29 CFR 2510.3-101. Do not include the value of a plan's interest in a partnership or
joint venture that is a
103-12 IE. Include the value of a 103-12 IE in 1c(12).
Line 1c(6).
Include the current value of both income and non-income producing real property owned by the plan. Do not include
the value of property that is
employer real property or property used in plan operations that should be reported on lines 1d and 1e, respectively.
Line 1c(7).
Enter the current value of all loans made by the plan, except participant loans reportable on line 1c(8). Include
the sum of the value of loans
for construction, securities loans, commercial and/or residential mortgage loans that are not subject to Code section 72(p)
(either by making or
participating in the loans directly or by purchasing loans originated by a third party), and other miscellaneous loans.
Line 1c(8).
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, that 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
Regulation section 1.72(p)-1, if both of the following circumstances apply:
-
Under the plan, the participant loan is treated as a directed investment solely of the participant's individual account; and
-
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) should
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 or
Schedule I 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 Regulation section 1.411(a)-7(d)(5). See Q&As 12 and 19 of Treasury Regulation section 1.72(p)-1.
The entry on line 1c(8), column (b), of Schedule H (participant loans - end of year) or on line 1a, column (b), of Schedule
I (plan assets - end of
year) must include the current value of any participant loan that was reported as a deemed distribution on line 2g 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 2g must be
reduced by the amount of
the participant loan that was reported as a deemed distribution on line 2g for the earlier year.
Lines 1c(9), (10), (11), and (12).
Enter the total current value of the plan's or DFE's interest in DFEs on the appropriate lines as of the beginning
and end of the plan or DFE
year. The value of the plan's or DFE's interest in each DFE at the end of the plan or DFE year must be reported on the Schedule
D (Form 5500).
The plan's or DFE's interest in CCTs and PSAs for which a DFE Form 5500 has not been filed may not be included on lines 1c(9) or 1c(10).
The plan's or DFE's interest in the underlying assets of such CCTs and PSAs must be allocated and reported in the appropriate categories on
a line-by-line basis on Part I of the Schedule H.
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.
Line 1c(14).
Use the same method for determining the value of the insurance contracts reported here as you used for line 3 of
Schedule A (Form 5500), or, if
line 3 is not required, line 6 of Schedule A (Form 5500).
Line 1c(15).
Include all other investments not includable in lines 1c(1) through (14), such as options, index futures, repurchase
agreements, state and
municipal securities, collectibles, and other personal property.
Line 1d(1).
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.
Line 1d(2).
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 1e.
Include the current (not book) value of the buildings and other property used in the operation of the plan. Buildings
or other property held as
plan investments should be reported in 1c(6) and 1d(2).
Do not include the value of future pension payments on lines 1g, h, i, j, or k.
Line 1g.
Noncash basis plans should include the total amount of benefit claims that have been processed and approved for payment
by the plan. Welfare plans
should also include "incurred but not reported" benefit claims.
Line 1h.
Noncash basis plans should 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", for debt-financed property other than real property, means the outstanding amount of
the principal debt incurred:
-
By the organization in acquiring or improving the property;
-
Before the acquisition or improvement of the property if the debt was incurred only to acquire or improve the property; or
-
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.
Noncash basis plans should include amounts owed for any liabilities that would not be classified as benefit claims
payable, operating payables, or
acquisition indebtedness.
Line 1l.
The entry in column (b) must equal the sum of the entry in column (a) plus lines 2k, 2l(1), and 2l(2).
Line 2a.
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 2006 plan year
on line 2a.
Line 2a(1)(B).
For welfare plans, report all employee contributions, including all elective contributions under a cafeteria plan
(Code section 125). For pension
plans, participant contributions, for purposes of this item, also include elective contributions under a qualified cash or
deferred arrangement (Code
section 401(k)).
Line 2a(2).
Use the current value, at date contributed, of securities or other noncash property.
Line 2b(1)(A).
Enter interest earned on interest-bearing cash, including earnings from sweep accounts, STIF accounts, money market
accounts, certificates of
deposit, etc. This is the interest earned on the investments reported on line 1c(1).
Line 2b(1)(B).
Enter interest earned on U.S. Government Securities. This is the interest earned on the investments reported on line
1c(2).
Line 2b(1)(C).
Generally, this is the interest earned on securities that are reported on lines 1(c)(3)(A) and (B) and 1d(1).
Line 2b(2).
Generally, the dividends are for investments reported on line 1c(4)(A) and (B) and 1d(1). 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.
Line 2b(3).
Generally, rents represent the income earned on the real property that is reported in items 1c(6) and 1d(2). Rents
should be entered 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, that portion of the expenses attributable
to the income
producing portion of the property should be netted against the total rents received.
Line 2b(4).
Enter in column (b), the total of net gain (loss) on sale of assets. This 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, 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 reported in line 2b(5) below, with two exceptions: (1) the realized gain (or loss)
on each asset that was disposed of during the plan year is reported in 2b(4) (NOT on line 2b(5)), and (2) the net investment gain (or loss)
from CCTs, PSAs, MTIAs, 103-12 IEs, and registered investment companies is reported in lines 2b(6) through (10).
The sum of the realized gain (or loss) of assets sold or exchanged during the plan year is to be calculated as follows:
-
Enter in 2b(4)(A), column (a), the sum of the amount received for these former assets;
-
Enter in 2b(4)(B), column (a), 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; and
-
Enter in 2b(4)(C), column (b), the result obtained when 2b(4)(B) is subtracted from 2b(4)(A). 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.
Line 2b(5).
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. Do
not include the value of assets reportable in lines 2b(4) and 2b(6) through 2b(10).
Lines 2b(6), (7), (8), and (9).
Report all earnings, expenses, gains or losses, and unrealized appreciation or depreciation included in computing
the net investment gain (or
loss) from all CCTs, PSAs, MTIAs, and 103-12 IEs here. If some plan funds are held in any of these entities and other plan
funds are held in other
funding media, complete all applicable subitems of line 2 to report plan earnings and expenses relating to the other funding
media. The net investment
gain (or loss) allocated to the plan for the plan year from the plan's investment in these entities is equal to:
-
The sum of the current value of the plan's interest in each entity at the end of the plan year,
-
Minus the current value of the plan's interest in each entity at the beginning of the plan year,
-
Plus any amounts transferred out of each entity by the plan during the plan year, and
-
Minus any amounts transferred into each entity by the plan during the plan year.
Enter the net gain as a positive number or the net loss as a negative number.
Note.
Enter the combined net investment gain or loss from all CCTs and PSAs, regardless of whether a DFE Form 5500 was filed for
the CCTs and PSAs.
Line 2b(10).
Enter net investment gain (loss) from registered investment companies here. Compute in the same manner as discussed
above for lines 2b(6) through
(9).
Line 2c.
Include all other plan income earned that is not included in 2a or 2b. Do not include transfers from other plans
that should be reported in line
2l.
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)(C) paid at the participant's election to an eligible retirement plan (including an IRA
within the meaning of
section 401(a)(31)(D)).
Line 2e(2).
Include payments to insurance companies and similar organizations such as Blue Cross, Blue Shield, 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.
Line 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.
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 section 401(k)(8), and excess aggregate contributions under 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 in accordance
with Treasury Regulation
section 1.415-6(b)(6)(iv), as well as any attributable gains that were also distributed.
Line 2g.
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
Regulation section 1.72(p)-1 only if both of the following circumstances apply:
-
Under the plan, the participant loan is treated as a directed investment solely of the participant's individual account; and
-
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) should be included
on line 1c(8), 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 or Schedule I must be reduced if, during the plan year, a participant resumes
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 1c(8), column (b), of Schedule
H (participant loans
- end of year) or in line 1a, column (b), of Schedule I (plan assets - end of year).
Although certain participant loans that are deemed distributed are to be reported on line 2g of the Schedule H or Schedule
I, and are not to be
reported on the Schedule H or Schedule I 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 Regulation
section 1.72(p)-1.
Line 2h.
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.
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, MTIAs, 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.
Line 2i(1).
Include 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 outside accounting, actuarial, legal, and valuation/appraisal services. Include fees for the annual
audit of the plan by an
independent qualified public accountant; for payroll audits; for accounting/bookkeeping services; for actuarial services rendered
to the plan, and to
a lawyer for rendering legal opinions, litigation, and advice (but not for providing legal services as a benefit to plan participants).
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. Do not include amounts paid to plan
employees to perform
bookkeeping/accounting functions that should be included in 2i(4).
Line 2i(2).
Enter the total fees paid (or in the case of accrual basis plans, costs incurred during the plan year but not paid
as of the end of the plan year)
to a contract administrator for performing administrative services for the plan. For purposes of the return/report, a contract
administrator is any
individual, partnership or corporation, responsible for managing the clerical operations (e.g., handling membership rosters,
claims payments,
maintaining books and records) of the plan on a contractual basis. Do not include salaried staff or employees of the plan
or banks or insurance
carriers.
Line 2i(3).
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 of
the plan's investment
performance.
Line 2i(4).
Other expenses are those that cannot be included in 2i(1) through 2i(3). These may include plan expenditures such
as salaries and other
compensation and allowances (e.g., payment of premiums to provide health insurance benefits to plan employees), 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, all miscellaneous
expenses and trustees' fees and reimbursement of expenses associated with trustees such as lost time, seminars, travel, meetings,
etc.
Line 2l.
Include in these reconciliation figures the value of all transfers of assets or liabilities into or out of the plan
resulting from, among other
things, mergers and consolidations. A transfer of assets or liabilities occurs when there is a reduction of assets or liabilities
with respect to one
plan and the receipt of these assets or the assumption of these liabilities by another plan. A transfer is not a shifting
of one plan's assets or
liabilities from one investment to another. A transfer is not a distribution of all or part of an individual participant's
account balance that is
reportable on Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.,
(see the instructions for line 2e). 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 DFE, report the value of all asset transfers to the DFE, including those resulting from
contributions to
participating plans on line 2l(1), and report the total value of all assets transferred out of the DFE, 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 DFE).
Line 3.
The administrator of an employee benefit plan who files a Schedule H (Form 5500) 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 filed
for a 103-12 IE and for a
GIA (see 29 CFR 2520.103-12 and 29 CFR 2520.103-2). The accountant's report must be attached to the Form 5500 when a Schedule
H (Form 5500) is
attached unless line 3d(1) or 3d(2) on the Schedule H is checked.
29 CFR 2520.103-1(b) requires that any separate financial statements prepared in order for the independent qualified
public accountant 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 should be either typewritten or printed and consist of reproductions of Parts I and II or statements incorporating
by references
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.
Note.
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 accountant's opinion described on line
3 even though they are no
longer 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, 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.
If the required accountant's report is not attached to the Form 5500, the filing is subject to rejection as incomplete
and penalties may be
assessed.
Lines 3a(1) through 3a(4).
These boxes identify the type of opinion offered by the accountant.
Line 3a(1).
Check if an unqualified opinion was issued. Generally, an unqualified opinion is issued when the independent qualified
public accountant 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 an other
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 independent qualified public
accountant 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 independent qualified public
accountant 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 independent
qualified public accountant
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.
Check “ Yes” if a box is checked on line 3a and the scope of the plan's audit was limited pursuant to DOL regulations 29 CFR 2520.103-8
and
2520.103-12(d) because the examination and report of an independent qualified accountant did not extend to: (a) 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 (b) information included with the Form 5500 filed for a 103-12 IE. The term "similar institution" as used here does
not extend to securities brokerage firms (see DOL Advisory Opinion 93-21A). See 29 CFR 2520.103-8 and 2520.103-12(d).
Note.
These regulations do not exempt the plan administrator from engaging an accountant or from attaching the accountant'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 accountant.
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 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 on this Schedule H may result in the rejection of the filing.
Line 3d(1).
Check this box only if the Schedule H is being filed for a CCT, PSA, or MTIA.
Line 3d(2).
Check this box if the plan has elected to defer attaching the accountant's opinion for the first of 2 consecutive
plan years, one of which is a
short plan year of 7 months or less. The Form 5500 for the first of the 2 years must be complete and accurate, with all required
attachments, except
for the accountant's report, including an attachment explaining why one of the 2 plan years is of 7 or fewer months duration
and stating that the
annual report for the immediately following plan year will include a report of an independent qualified public accountant
with respect to the
financial statements and accompanying schedules for both of the 2 plan years. The Form 5500 for the second year must include:
(a) financial
schedules and statements for both plan years; (b) a report of an independent qualified public accountant with respect to the financial
schedules and statements for each of the 2 plan years (regardless of the number of participants covered at the beginning of
each plan year); and
(c) a statement identifying any material differences between the unaudited financial information submitted with the first Form
5500 and the
audited financial information submitted with the second Form 5500. See 29 CFR 2520.104-50.
Note.
Do not check the box on line 3d(2) if the Form 5500 is filed for a 103-12 IE or a GIA. A deferral of the accountant's opinion
is not permitted for
a 103-12 IE or a GIA. If an E or G is entered on Form 5500, Part I, line A(4), an accountant's opinion must be attached to
the Form 5500 and the type
of opinion must be reported on Schedule H, line 3a.
Lines 4a through 4k.
Plans completing Schedule H must answer all these lines either "Yes" or "No." If lines 4a through 4h are "Yes," an
amount must be entered where
indicated. Report investments in CCTs, PSAs, MTIAs, 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, 4c, 4i, and 4j. CCTs and PSAs do not complete Part IV. MTIAs, 103-12 IEs,
and GIAs do not complete
lines 4a, 4e, 4f, 4g, 4h, or 4k. 103-12 IEs also do not complete line 4j.
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). 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 Form 5330, Return of Excise Taxes Related to Employee Benefit Plans, with the IRS to pay any applicable excise
tax on the transaction.
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 or I, as applicable, for the year in which the contributions
were delinquent and should
be carried over and reported again on line 4a of the Schedule H or I, as applicable, 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."
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 accountant's opinion described on line
3 even though they are no
longer 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, 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 Delinquent Contributions, available on the Internet at
www.dol.gov/ebsa. Although all delinquent participant contributions must be reported on line 4a, delinquent
contributions for which the DOL Voluntary Fiduciary Correction Program (VFCP) requirements and the conditions of Prohibited
Transaction Exemption
(PTE) 2002-51 have been satisfied do not need to be treated as nonexempt party-in-interest transactions.
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 Form 5330 with the IRS. For more information, see 71 Fed. Reg. 20261 (Apr.
19, 2006) and 71 Fed.
Reg. 20135 (Apr. 19, 2006). Information about the VFCP is also available on the Internet at
www.dol.gov/ebsa.
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.
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.
Line 4d.
Plans that check "Yes" must enter the amount and complete Part III of Schedule G. Check "Yes" if any nonexempt transaction
with a
party-in-interest occurred regardless of whether the transaction is disclosed in the accountant'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 reported on line
4a.
Note.
See the instructions for Part III of the Schedule G (Form 5500) concerning non-exempt 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 independent qualified public accountant or legal counsel or both.
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 Form 5330 with the IRS. For more information, see 71 Fed. Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 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 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 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 other
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 DOL regulations 29 CFR
2580 provide 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 2580, subpart C), and certain exemptions such as the exemption for unfunded plans, certain banks and insurance companies
(ERISA section 412),
and the exemption allowing plan officials to purchase bonds from surety companies authorized by the Secretary of the Treasury
as acceptable reinsurers
on Federal bonds (29 CFR 2580.412-23). Information concerning the list of approved sureties and reinsurers is available on
the Internet at
www.fms.treas.gov/c570.
Note.
Plans are permitted under certain conditions to purchase fiduciary liability insurance. These policies do not protect the
plan from dishonest acts
and are not bonds that should be reported in line 4e.
Line 4f.
Check "Yes," if the plan had suffered or discovered any loss as a result of any dishonest or fraudulent act(s) even
if the loss was reimbursed by
the plan's fidelity bond or from any other source. If "Yes" is checked enter the full amount of the loss. If the full amount
of the loss has not yet
been determined, provide an estimate and disclose that the figure is an estimate, such as “ @1000.”
Willful failure to report is a criminal offense. See ERISA section 501.
Lines 4g and 4h.
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, and collectibles. Do not check "Yes" on line 4g if
the plan is a defined
contribution 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.
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.
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.
Line 4i.
Check "Yes" if the plan had any assets held for investment purposes, and attach a schedule of assets held for investment
purposes at end of year,
a schedule of assets held for investment purposes that were both acquired and disposed of within the plan year, or both, as
applicable. The schedules
must use the format set forth below or a similar format and the same size paper as the Form 5500. See 29 CFR 2520.103-11.
Assets held for investment purposes shall include:
Assets held for investment purposes 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:
-
The schedule of loans or fixed income obligations in default required by Schedule G, Part I;
-
The schedule of leases in default or classified as uncollectible required by Schedule G, Part II;
-
The schedule of non-exempt transactions required by Schedule G, Part III; and
-
The schedule of reportable transactions required by Schedule H, line 4j.
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). The schedule must use the format set forth below or a similar format and the same size paper
as the Form 5500. See 29 CFR
2520.103-11.
A reportable transaction
includes:
-
A single transaction within the plan year in excess of 5% of the current value of the plan assets;
-
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;
-
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
-
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 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 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, pooled separate accounts, 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 common/collective trusts, pooled separate accounts, master
trust investment accounts,
103-12 IEs, and registered investment companies in which this plan or DFE invests.
In the case of a purchase or sale of a security on the market, do not identify the person from whom purchased or to
whom sold.
Special rule for certain participant-directed transactions.
Transactions under an individual account plan that a participant
or beneficiary directed with respect to assets allocated to his or her account (including a negative election authorized under
the terms of the plan)
should not be treated for purposes of line 4j as reportable transactions. The current value of all assets of the plan, including
these
participant-directed transactions, should be included in determining the 5% figure for all other transactions.
Line 4k.
Check "Yes" if all the plan assets (including insurance/annuity contracts) were distributed to the participants and
beneficiaries, legally
transferred to the control of another plan, or brought under the control of the PBGC.
Check "No" for a welfare benefit plan that is still liable to pay benefits for claims incurred before the termination
date, but not yet paid. See
29 CFR 2520.104b-2(g)(2)(ii).
Note.
If "Yes" was checked on line 4k because all plan assets were distributed to participants and/or beneficiaries, you are encouraged
to complete
Schedule SSA (Form 5500), listing each participant reported on a previous Schedule SSA (Form 5500) who has received all of
his/her plan benefits, and,
therefore, is no longer entitled to receive deferred vested benefits. This will ensure that SSA's records are correct, and
help eliminate confusion
for participants and plan administrators in the future. See the instructions to the Schedule SSA (Form 5500) for greater detail.
Line 5a.
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 the amount of plan assets that reverted to the employer during the plan
year in connection with
the implementation of such termination. Enter "-0-" if no reversion occurred during the current plan year.
A Form 5500 must be filed for each year the plan has assets, and, for a welfare benefit plan, if the plan is still liable
to pay benefits for
claims incurred before the termination date, but not yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line 5b.
Enter information concerning assets and/or liabilities transferred from this plan to another plan(s) (including spin-offs)
during the plan year. 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. Enter the name, PN, and EIN of the transferee plan(s) involved on
lines 5b(1), (2), and (3).
If there are more than four plans, include an attachment with the information required for 5b(1), (2), and (3) for each additional
plan and label the
attachment, "Schedule H, line 5b - Additional Plans."
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 on this Schedule H or the inclusion of a visible social security number 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 5b. Do not submit Form 1099-R with the Form 5500.
Form 5310-A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities; Notice of Qualified Separate
Lines of Business, must 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 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 and Form 10-Advance).
2006 Instructions for Schedule I (Form 5500) Financial Information - Small Plan
Schedule I (Form 5500) must be attached to a Form 5500 filed for pension benefit plans and welfare benefit plans that covered
fewer than 100
participants as of the beginning of the plan year.
Exception.
If a Schedule I was filed for the plan for the 2005 plan year and the plan covered fewer than 121 participants as of the beginning of
the 2006 plan year, the Schedule I may be completed instead of a Schedule H.
Note.
Certain insured, unfunded or combination unfunded/insured welfare plans are exempt from filing the Form 5500 and the Schedule
I. In addition,
certain fully insured pension plans are exempt from completing the Schedule I. See the Form 5500 instructions for Who Must File on page 2
and Limited Pension Plan Reporting on page 9 for more information.
Check the Schedule I box on the Form 5500 (Part II, line 10b(2)) if a Schedule I is attached to the Form 5500. Do not attach
both a Schedule I and
a Schedule H to the same Form 5500.
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 I is attached.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
Do not use a social security number in line D in lieu of an EIN. The Schedule I 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 on this
Schedule I or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
Note.
Do not mark through the printed line descriptions on the Schedule I and insert your own description as this may cause additional
correspondence due
to a computerized review of the Schedule I.
Use either the cash, modified cash, or accrual basis for recognition of transactions, as long as you use one method
consistently. Round off all
amounts reported on the Schedule I 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 one fund, such as when an employer has two plans funded through
a single trust (except a DFE),
complete Parts I and II 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 Part
I.
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).
Part I - Small Plan Financial Information
Amounts reported on lines 1a, 1b, and 1c for the beginning of the plan year must be the same as reported for the end of the
plan year for
corresponding lines on the return/report for the preceding plan year.
Do not include contributions designated for the 2006 plan year in column (a).
Line 1a.
A plan with assets held in common/collective trusts, pooled separate accounts, master trust investment accounts,
and/or 103-12 IEs must also
attach Schedule D (Form 5500).
Use the same method for determining the value of the plan's interest in an insurance company general account (unallocated
contracts) that you used
for line 3 of Schedule A (Form 5500), or, if line 3 is not required, line 6 of Schedule A (Form 5500).
Note.
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 Regulation section 1.72(p)-1, if both of the following circumstances apply:
-
Under the plan, the participant loan is treated as a direct investment solely of the participant's individual account; and
-
As of the end of the plan year, the participant is not continuing repayment under the loan.
If the deemed distributed participant loan is included in column (a) and both of these circumstances apply, 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) should be included in column (b) without regard to the occurrence of a deemed distribution.
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 or
Schedule I 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 Regulation section 1.411(a)-7(d)(5). See Q&As 12 and 19 of Treasury Regulation section 1.72(p)-1.
The entry on line 1a, column (b), of Schedule I (plan assets - end of year) or on line 1c(8), column (b), of Schedule H (participant
loans - end of
year) must include the current value of any participant loan reported as a deemed distribution on line 2g for any earlier
year if, during the plan
year, the participant resumes repayment under the loan. In addition, the amount to be entered on line 2g must be reduced by
the amount of the
participant loan reported as a deemed distribution on line 2g for the earlier year.
Line 1b.
Enter the total liabilities at the beginning and end of the plan year. Liabilities to be entered here do not include
the value of future pension
payments to plan participants. However, the amount to be entered in line 1b for accrual basis filers includes, among other
things:
-
Benefit claims that have been processed and approved for payment by the plan but have not been paid (including all incurred
but not reported
welfare benefit claims);
-
Accounts payable obligations owed by the plan that were incurred in the normal operations of the plan but have not been paid;
and
-
Other liabilities such as acquisition indebtedness and any other amount owed by the plan.
Line 1c.
Enter the net assets as of the beginning and end of the plan year. (Subtract line 1b from 1a.) Line 1c, column (b)
must equal the sum of line 1c,
column (a) plus lines 2j and 2k.
Line 2a.
Include the total cash contributions received and/or (for accrual basis plans) due to be received.
Line 2a(1).
Plans using the accrual basis of accounting should not include contributions designated for years before the 2006
plan year on line 2a(1).
Line 2a(2).
For welfare plans, report all employee contributions, including all elective contributions under a cafeteria plan
(Code section 125). For pension
plans, participant contributions, for purposes of this item, also include elective contributions under a qualified cash or
deferred arrangement (Code
section 401(k)).
Line 2b.
Use the current value, at date contributed, of securities or other noncash property.
Line 2c.
Enter all other plan income for the plan year. Do not include transfers from other plans that should be reported on
line 2k. Other income received
and/or receivable would include:
-
Interest on investments (including money market accounts, sweep accounts, STIF accounts, etc.).
-
Dividends. (Accrual basis plans should include dividends declared for all stock held by the plan even if the dividends have
not been
received as of the end of the plan year.)
-
Rents from income-producing property owned by the plan.
-
Royalities.
-
Net gain or loss from the sale of assets.
-
Other income, such as unrealized appreciation (depreciation) in plan assets. To compute this amount subtract the current value
of all assets
at the beginning of the year plus the cost of any assets acquired during the plan year from the current value of all assets
at the end of the year
minus assets disposed of during the plan year.
Line 2d.
Enter the total of all cash contributions (line 2a(1) through (3)), noncash contributions (line 2b), and other plan
income (line 2c) during the
plan year. If entering a negative number, enter a minus sign “ -” to the left of the number.
Line 2e.
Include: (1) payments made (and for accrual basis filers payments due) to or on behalf of participants or beneficiaries in cash,
securities, or other property (including rollovers of an individual's accrued benefit or account balance). Include all eligible
rollover distributions
as defined in Code section 401(a)(31)(D) paid at the participant's election to an eligible retirement plan (including an IRA
within the meaning of
section 401(a)(31)(E)); (2) payments to insurance companies and similar organizations such as Blue Cross, Blue Shield, and health
maintenance organizations for the provision of plan benefits (e.g., paid-up annuities, accident insurance, health insurance,
vision care, dental
coverage, etc.); and (3) payments made to other organizations or individuals providing benefits. Generally, these payments discussed in (3)
are made to individual providers of welfare benefits such as legal services, day care services, and training and apprenticeship
services. If
securities or other property are distributed to plan participants or beneficiaries, include the current value on the date
of distribution.
Line 2f.
Include all distributions paid during the plan year of excess deferrals under Code section 402(g)(2)(A)(ii), excess
contributions under section
401(k)(8), and excess aggregate contributions under section 401(m)(6), allocable income distributed, and any elective deferrals
and employee
contributions distributed or returned to employees during the plan year in accordance with Treasury Regulation section 1.415-6(b)(6)(iv),
as well as
any attributable gains that were also distributed.
Line 2g.
Report on line 2g a participant loan included in line 1a, column (a) (participant loans - beginning of year) and that
has been deemed distributed
during the plan year under the provisions of Code section 72(p) and Treasury Regulation section 1.72(p)-1 only if both of
the following circumstances
apply:
-
Under the plan, the participant loan is treated as a directed investment solely of the participant's individual account; and
-
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) should be included
on line 1a, column (b)
(plan assets - end of year), without regard to the occurrence of a deemed distribution.
Note.
The amount to be reported on line 2g of Schedule H or Schedule I must be reduced if, during the plan year, a participant resumes
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 that was 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 1c(8), column (b), of
Schedule H
(participant loans - end of year) or in line 1a, column (b), of Schedule I (plan assets - end of year).
Although certain participant loans deemed distributed are to be reported on line 2g of the Schedule H or Schedule I, and are
not to be reported on
the Schedule H or Schedule I 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
Regulation section
1.72(p)-1.
Line 2h.
Other expenses (paid and/or payable) may include, among others:
-
Salaries to employees of the plan;
-
Expenses for accounting, actuarial, legal, and investment services;
-
Fees and expenses for trustees including reimbursement for travel, seminars, and meeting expenses;
-
Fees paid for valuations and appraisals; and
-
Other administrative and miscellaneous expenses paid by or charged to the plan, including those that were not subtracted from
the gross
income of master trust investment accounts and 103-12 IEs in determining their net investment gain(s) or loss(es).
Line 2i.
Enter the total of all benefits paid or due as reported on lines 2e, 2f, and 2g and all other plan expenses (line
2h) during the year.
Line 2k.
Enter the net value of all assets transferred to and from the plan during the plan year including those resulting
from mergers and spin-offs. A
transfer of assets or liabilities occurs when there is a reduction of assets or liabilities with respect to one plan and the
receipt of these assets
or the assumption of these liabilities by another plan. Transfers out at the end of the year should be reported as occurring
during the plan year.
Note.
A distribution of all or part of an individual participant's account balance that is reportable on Form 1099-R, Distributions
From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., should not be included on line 2k but must
be included in benefit
payments reported on line 2e. Do not submit Form 1099-R with Form 5500.
Lines 3a through 3g.
You must check either “ Yes” or “ No” on each line to report whether the plan held any assets in the listed categories at any time during
the plan year. If “ Yes” is checked on any line, enter in the amount column for that line the current value of the assets held at the end of the
plan year or “ 0” if no assets remain in the category at the end of the plan year. You should allocate the value of the plan's interest in
a
commingled trust containing the assets of more than one plan on a line-by-line basis, except do not include on lines 3a through
3g the value of the
plan's interest in any CCT, PSA, MTIA, or 103-12 IE (see page 4 for definitions of CCT, PSA, MTIA, and 103-12 IE).
Line 3a.
Enter the value of the plan's participation in a partnership or joint venture, unless the partnership or joint venture
is a 103-12 IE.
Line 3b.
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 3d.
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.
Line 3e.
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, that 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 any
amount of a participant loan deemed distributed during the plan year under the provisions of Code section 72(p) and Treasury
Regulation section
1.72(p)-1, if both of the following circumstances apply:
-
Under the plan, the participant loan is treated as a directed investment solely of the participant's individual account; and
-
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) should
be included on line 3e
without regard to the occurrence of a deemed distribution.
Note.
After participant loans have been deemed distributed and reported on line 2g of the Schedule I or H, they are no longer required
to be reported as
assets on the Schedule I or H. However, such loans (including interest accruing thereon after the deemed distribution) that
have not been repaid are
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 Regulation
section 1.411(a)-7(d)(5).
See Q&As 12 and 19 of Treasury Regulation section 1.72(p)-1.
Line 3f.
Enter the current value of all loans made by the plan, except participant loans reportable on line 3e. Include the
sum of the value of loans for
construction, securities loans, commercial and/or residential mortgage loans that are not subject to Code section 72(p) (either
by making or
participating in the loans directly or by purchasing loans originated by a third party), and other miscellaneous loans.
Line 3g.
Include all property that has concrete existence and is capable of being processed, such as goods, wares, merchandise,
furniture, machines,
equipment, animals, automobiles, etc. This includes collectibles, such as works of art, rugs, antiques, metals, gems, stamps,
coins, alcoholic
beverages, musical instruments, and historical objects (documents, clothes, etc.). Do not include the value of a plan's interest
in property reported
on lines 3a through 3f, or intangible property, such as patents, copyrights, goodwill, franchises, notes, mortgages, stocks,
claims, interests, or
other property that embodies intellectual or legal rights.
Part II - Transactions During Plan Year
Answer all lines either "Yes" or "No," and if lines 4a through 4i are "Yes," an amount must be entered. If you check "No"
on line 4k you must
attach the report of an independent qualified public accountant or a statement that the plan is eligible and elects to defer
attaching the IQPA's
opinion pursuant to 29 CFR 2520.104-50 in connection with a short plan year of seven months or less. Plans with all of their
funds held in a master
trust should check “No” on Schedule I, lines 4b, c, and i.
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). 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 Form 5330, Return of Excise Taxes Related to Employee Benefit Plans, with the IRS to pay any applicable excise
tax on the transaction.
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 or I, as applicable, for the year in which the contributions
were delinquent and should
be carried over and reported again on line 4a of the Schedule H or I, as applicable, 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."
The DOL Voluntary Fiduciary Correction Program (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 Prohibited Transaction Exemption (PTE) 2002-51 are eligible for immediate
relief from payment
of certain prohibited transaction excise taxes for certain corrected transactions, and are also relieved from the obligation
to file the Form 5330
with the IRS. For more information, see 71 Fed. Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19, 2006). All delinquent
participant
contributions must be reported on line 4a even if violations have been corrected. Information about the VFCP is also available
on the Internet at
www.dol.gov/ebsa.
Line 4b.
Plans that check "Yes" must enter the amount. 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.
Line 4c.
Plans that check "Yes" must enter the amount. 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.
Line 4d.
Plans that check "Yes" must enter the amount. Check "Yes" if any nonexempt transaction with a party-in-interest occurred
regardless of whether the
transaction is disclosed in the accountant's report. Do not check “ Yes” with respect to transactions that are: (1) statutorily exempt
under Part 4 of Title I of ERISA; (2) administratively exempt under ERISA section 408(a); (3) exempt under Code sections 4975(c)
or 4975(d); (4) the holding of participant contributions in the employer's general assets for a welfare plan that meets the conditions of
ERISA Technical Release 92-01; (5) a transaction of a 103-12 IE with parties other than the plan; or (6) delinquent participant
contributions reported on line 4a. You may indicate that an application for an administrative exemption is pending. If you
are unsure whether a
transaction is exempt or not, you should consult with either a qualified public accountant, legal counsel or both. If the
plan is a qualified pension
plan and a nonexempt prohibited transaction occurred with respect to a disqualified person, a Form 5330 should be filed with
the IRS to pay the excise
tax on the transaction.
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 Form 5330 with the IRS. For more information, see 71 Fed. Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 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.
Party-in-Interest.
For purposes of this form, party-in-interest is deemed to include a disqualified person. See Code section 4975(e)(2).
The term "party-in-interest"
means, as to an employee benefit plan:
A. Any fiduciary (including, but not limited to, any administrator, officer, trustee or custodian), counsel, or employee of
the
plan;
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B. A person providing services to the plan;
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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;
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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;
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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;
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H. An employee, officer, director (or an individual having powers or responsibilities similar to those of officers or directors),
or a 10% or more shareholder, directly or indirectly, of a person described in B, C, D, E, or G, or of the employee benefit
plan; or
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I. A 10% or more (directly or indirectly in capital or profits) partner or joint venturer of a person described in B, C, D,
E, or
G.
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Nonexempt transactions
with a party-in-interest include any direct or indirect:
A. Sale or exchange, or lease, of any property between the plan and a party-in-interest.
|
B. Lending of money or other extension of credit between the plan and a party-in-interest.
|
C. Furnishing of goods, services, or facilities between the plan and a party-in-interest.
|
D. Transfer to, or use by or for the benefit of, a party-in-interest, of any income or assets of the plan.
|
E. Acquisition, on behalf of the plan, of any employer security or employer real property in violation of Code section
407(a).
|
F. Dealing with the assets of the plan for a fiduciary's own interest or own account.
|
G. Acting in a fiduciary's individual or any other capacity in any transaction involving the plan on behalf of a party (or
represent a party) whose interests are adverse to the interests of the plan or the interests of its participants or beneficiaries.
|
H. Receipt of any consideration for his or her own personal account by a party-in-interest who is a fiduciary from any party
dealing with the plan in connection with a transaction involving the income or assets of the plan.
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Line 4e.
Plans that check "Yes" must enter the aggregate amount of 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 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 other
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 DOL regulations 29 CFR
2580 provide 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 2580, subpart C), and certain exemptions such as the exemption for unfunded plans, certain banks and insurance companies
(ERISA section 412),
and the exemption allowing plan officials to purchase bonds from surety companies authorized by the Secretary of the Treasury
as acceptable reinsurers
on Federal bonds (29 CFR 2580.412-23). Information concerning the list of approved sureties and reinsurers is available on
the Internet at
www.fms.treas.gov/c570.
Note.
Plans are permitted under certain conditions to purchase fiduciary liability insurance. These policies do not protect the
plan from dishonest acts
and are not bonds that should be reported in line 4e.
Line 4f.
Check "Yes," if the plan had suffered or discovered any loss as a result of any dishonest or fraudulent act(s) even
if the loss was reimbursed by
the plan's fidelity bond or from any other source. If "Yes" is checked enter the full amount of the loss. If the full amount
of the loss has not yet
been determined, provide an estimate and disclose that the figure is an estimate, such as “ @1000.”
Willful failure to report is a criminal offense. See ERISA section 501.
Lines 4g and 4h.
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).
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, and collectibles. Do not check "Yes" on line 4g if
the plan is a defined
contribution 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.
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.
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.
Line 4i.
Include as a single security all securities of the same issue. An example of a single issue is a certificate of deposit
issued by the XYZ Bank on
July 1, 2005, which matures on June 30, 2006, and yields 5.5%. For the purposes of line 4i, do not check "Yes" for securities
issued by the U.S.
Government or its agencies. Also, do not check “ Yes” for securities held as a result of participant-directed transactions.
Line 4j.
Check "Yes" if all the plan assets (including insurance/annuity contracts) were distributed to the participants and
beneficiaries, legally
transferred to the control of another plan, or brought under the control of the PBGC.
Check "No" for a welfare benefit plan that is still liable to pay benefits for claims that were incurred before the
termination date, but not yet
paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Note.
If "Yes" was checked on line 4j because all plan assets were distributed to participants and/or beneficiaries, you are encouraged
to complete
Schedule SSA (Form 5500), listing each participant reported on a previous Schedule SSA (Form 5500) who has received all of
his/her plan benefits, and
therefore, is no longer entitled to receive deferred vested benefits. This will ensure that SSA's records are correct, and
help eliminate confusion
for participants and plan administrators in the future. See the instructions to the Schedule SSA (Form 5500) for greater detail.
Line 4k.
Check "Yes" if you are claiming a waiver of the annual examination and report of an independent qualified public accountant
(IQPA) under 29 CFR
2520.104-46. You are eligible to claim the waiver if the Schedule I is being filed for:
-
A small welfare plan, or
-
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.
Check "No" and attach the report of the IQPA meeting the requirements of 29 CFR 2520.103-1(b) if you are not claiming
the waiver. Also check "No,"
and attach the required IQPA reports or the required explanatory statement if you are relying on 29 CFR 2520.104-50 in connection
with a short plan
year of seven months or less. At the top of any attached 2520.104-50 statement, enter “ 2520.104-50 Statement, Schedule I, Line 4k.” For more
information on the requirements for deferring an IQPA report pursuant to 29 CFR 2520.104-50 in connection with a short plan
year of seven months or
less and the contents of the required explanatory statement, see the instructions for Schedule H, line 3b(2) or call the EFAST
Help Line at
1-866-463-3278.
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
Audit Waiver Requirement for Small Pension Plans and 29 CFR 2520.104-46, which are available at
www.dol.gov/ebsa, or call the EFAST Help Line at 1-866-463-3278.
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:
-
Any assets held by any of the following regulated financial institutions:
-
A bank or similar financial institution as defined in 29 CFR 2550.408b-4(c);
-
An insurance company qualified to do business under the laws of a state;
-
An organization registered as a broker-dealer under the Securities Exchange Act of 1934; or
-
Any other organization authorized to act as a trustee for individual retirement accounts under Code section 408.
-
Shares issued by an investment company registered under the Investment Company Act of 1940 (e.g., mutual funds);
-
Investment and annuity contracts issued by any insurance company qualified to do business under the laws of a state;
-
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;
-
Qualifying employer securities, as defined in ERISA section 407(d)(5); and
-
Participant loans meeting the requirements of ERISA section 408(b)(1).
Condition 2: The administrator must include in the summary annual report (SAR) furnished to participants and beneficiaries in
accordance with 29 CFR 2520.104b-10:
-
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);
-
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;
-
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
-
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.
Condition 3: In addition, in response to a request from any participant or beneficiary, the administrator, without charge to the
participant or beneficiary, must make available for examination, or upon request furnish copies of, each regulated financial
institution statement and
evidence of any required bond.
Examples.
Plan A, which has a plan year that began on or after April 18, 2001, had total assets of $600,000 as of the end of the 2000
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 2001 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 2000 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 2001 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
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 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 EFAST Help Line at 1-866-463-3278.
Line 5a.
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 the amount of plan assets that reverted to the employer during the plan
year in connection with
the implementation of such termination. Enter "-0-" if no reversion occurred during the current plan year.
A Form 5500 must be filed for each year the plan has assets, and, in the case of a welfare benefit plan, if the plan is still
liable to pay
benefits for claims that were incurred before the termination date, but not yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line 5b.
Enter information concerning assets and/or liabilities transferred from this plan to another plan(s) (including spin-offs)
during the plan year. 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. Enter the name, PN, and EIN of the transferee plan(s) involved on
lines 5b(1), b(2) and b(3).
If there are more than three plans, include an attachment with the information required for 5b(1), b(2) and b(3) for each
additional plan and label
the attachment, "Schedule I, line 5b - Additional Plans."
Do not use a social security number in lieu of an EIN or include an attachment that contains visible social security
numbers. The Schedule I 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 on this Schedule I or the inclusion of a visible social security
number 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 5b. Do not submit Form 1099-R with the Form 5500.
Form 5310-A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities; Notice of Qualified Separate
Lines of Business, must 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 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 and Form 10-Advance).
2006 Instructions for Schedule R (Form 5500) Retirement Plan Information
Schedule R reports certain information on plan distributions, and funding, and the adoption of amendments increasing the value
of benefits in a
defined benefit pension plan.
Schedule R (Form 5500) must be attached to a Form 5500 filed for both tax qualified and nonqualified pension benefit plans.
The parts of the
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
minimum coverage requirement of Code section 410(b).
Exceptions:
(1) Schedule R should not be completed when the Form 5500 is filed for a pension plan that uses, as the sole funding vehicle
for
providing benefits, a tax deferred annuity arrangement under Code section 403(b)(1), a custodial account for regulated investment
company stock under
Code section 403(b)(7), and/or individual retirement accounts or annuities (as described in Code section 408). See the Form
5500 instructions for
Limited Pension Plan Reporting on page 9 for more information.
(2) Schedule R also should not be completed if each of the following conditions is met:
-
The plan is not a defined benefit plan or otherwise subject to the minimum funding standards of Code section 412 or ERISA
section
302.
-
No plan benefits that would be reportable on line 1 of Part I of this Schedule R were distributed during the plan year. See
the instructions
for Part I, line 1, below.
-
No benefits, as described in the instructions for Part I, line 2, below, were paid during the plan year other than by the
plan sponsor or
plan administrator. (This condition is not met if benefits were paid by the trust or any other payor(s) which are reportable
on Form
1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., using an EIN
other than
that of the plan sponsor or plan administrator reported on line 2b or 3b of Form 5500.)
-
Unless the plan is a profit-sharing, ESOP or stock bonus plan, no plan benefits of living or deceased participants were distributed
during
the plan year in the form of a single sum distribution. See the instructions for Part I, line 3, below.
Note.
Schedule R should not be filed if lines 1 through 8 are left blank or checked “N/A”.
Check the Schedule R box on the Form 5500 (Part II, line 10a(1)) if a Schedule R is attached to the Form 5500.
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 R is attached.
You may abbreviate the plan name
(if necessary) to fit in the space provided.
Do not use a social security number in line D in lieu of an EIN. The 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 on this
Schedule R or any of its attachments may result in the rejection of the filing.
EINs may be obtained by applying for one on Form SS-4, Application for Employer Identification Number, as soon as possible. You can
obtain Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or at the IRS Web Site at
www.irs.gov. The EBSA does not issue EINs.
"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 corrective distributions of excess deferrals,
excess contributions, or
excess aggregate contributions, or the income allocable to any of these amounts. It also does not include 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. Finally,
it does not include a loan treated as a distribution under Code section 72(p); however, it does include a distribution of
a plan loan offset amount as
defined in section 1.402(c)-2, Q&A 9(b).
"Participant"
means any present or former employee who at any time during the plan year had an accrued benefit (account balance
in a defined contribution plan)
in the plan.
Line 1.
Enter the total value of all distributions made during the year (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 Form 1099-R on behalf of the plan to participants or beneficiaries during the plan year. This is the EIN that appears on
the 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 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 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. 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.
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 plans are subject to the minimum funding requirements of Code section
412 unless they are
described in the exceptions listed under section 412(h). These exceptions include profit-sharing or stock bonus plans, insurance
contract plans
described in section 412(i), 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 defined benefit plan that is subject to the minimum funding requirements must file
Schedule B as an
attachment to Form 5500. Schedule B is not required to be filed for a money purchase defined contribution plan that is subject
to the minimum funding
requirements unless the plan is currently amortizing a waiver of the minimum funding requirements.
Line 4.
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(c)(8) or ERISA section 302(c)(8). Under Code section 412(c)(8) and ERISA section
302(c)(8), 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:
-
The amendment is adopted no later than two and one-half months after the close of such plan year (two years for a multiemployer
plan);
-
The amendment does not reduce the accrued benefit of any participant determined as of the beginning of such plan year; and
-
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 Temporary Regulations section 11.412(c)-7(b) for details on when and how to make the election and the information
to include on the statement
of election, which must be filed with the Form 5500.
Line 5.
If a money purchase defined contribution 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 B must be completed. The Schedule B must be attached to
Form 5500 but it need not
be signed by an enrolled actuary.
Line 6a.
The minimum required contribution for a money purchase defined contribution 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 6b.
Include all contributions for the plan year made not later than 8½ months after the end of the plan year. Show only
contributions
actually made to the plan by the date the form is filed, i.e., do not include receivable contributions for this purpose.
Line 6c.
If the minimum required contribution exceeds the contributions for the plan year made not later than 8½ months after
the end of the
plan year, the excess is an accumulated funding deficiency for the plan year and Form 5330, Return of Excise Taxes Related to Employee
Benefit Plans, should be filed with the IRS to pay the excise tax on the deficiency. There is a penalty for not filing Form
5330 on time.
Line 7.
A revenue procedure 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, 2000-2 C.B. 357.
Line 8.
-
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, and/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, and accruals being frozen for some or all participants.
-
If applicable, check both “Increase” and “Decrease.”
Line 9.
Questions regarding coverage were previously raised in the Schedule T but the Schedule T has been discontinued. The instructions
to the Schedule T
provided that the Schedule T need not be filed every year if the employer was using the three-year testing cycle of Rev. Proc.
93-42, 1993-2 C.B. 540.
That exception does not apply to Part IV of the Schedule R.
If the ratio percentage for the plan, or any disaggregated part of the plan, is less than 70%, the plan does not satisfy
the ratio percentage test.
An employer that is using single day "snapshot" testing may, in certain circumstances, need to adjust the 70% figure to compensate
for the fact that
the substantiation quality data or snapshot population does not reflect employee turnover and may overstate the plan's coverage.
See section 3 of Rev.
Proc. 93-42. If the plan, or any disaggregated part of the plan, does not satisfy the ratio percentage test, the plan will
satisfy the minimum
coverage requirements of the Code only if it satisfies the average benefit test.
A plan satisfies the average benefit test if it satisfies both the nondiscriminatory classification test and the average
benefit percentage test. A
plan satisfies the nondiscriminatory classification test if the plan benefits such employees as qualify under a classification
set up by the employer
and found by the Secretary not to be discriminatory in favor of highly compensated employees. Under Treasury Regulation section
1.410(b)-4, a
classification will be deemed nondiscriminatory if the ratio percentage for the plan is equal to or greater than the safe
harbor percentage. The safe
harbor percentage is 50%, reduced by ¾ of a percentage point for each percentage point by which the nonhighly compensated
employee
concentration percentage exceeds 60%. The nonhighly compensated employee concentration percentage is the percentage of all
the employees of the
employer who are not highly compensated employees.
In general, a plan satisfies the average benefit percentage test if the actual benefit percentage for nonhighly compensated
employees is at least
70% of the actual benefit percentage for highly compensated employees. See Treasury Regulation section 1.410(b)-5. All qualified
plans of the
employer, including ESOPs, Code section 401(k) plans, and plans with employee or matching contributions (Code section 401(m)
plans) are aggregated in
determining the actual benefit percentages. Do not aggregate plans that may not be aggregated for purposes of satisfying the
ratio percentage test,
other than ESOPs and Code sections 401(k) and 401(m) plans. In addition, all nonexcludable employees, including those with
no benefit under any
qualified plan of the employer, are included in determining the actual benefit percentages.
Notes.
(1) Certain plans are required to be disaggregated, or may be permissively disaggregated, into two or more separate parts for
purpose of
applying the minimum coverage requirements of Code section 410(b). Check the box for “ ratio percentage test” or “ average benefit test,”
whichever is applicable to the disaggregated plans. Both boxes may be checked if each test is satisfied by one or more of
the disaggregated plans.
(2) Multiple-employer plan filers should complete one Schedule R to report satisfaction with the coverage rules by all of the
employers
that participate in the plan. Check the box for “ ratio percentage test,” “ average benefit test,” or both, if any participating employer uses
either test. Leave line 9 blank if all of the participating employers meet one of the exceptions noted below.
Plans may also satisfy the coverage rules of section 410(b) under one of the exceptions listed below. If one of the
following exceptions applies,
leave line 9 blank.
-
If, during the plan year, the employer employed only highly compensated employees (within the meaning of Code section 414(q)),
excluding
employees who were collectively bargained employees (within the meaning of Treasury Regulation section 1.410(b)-6(d)(2)).
-
If, during the plan year, the plan benefitted no highly compensated employees (within the meaning of Code section 414(q)),
excluding
employees who were collectively bargained employees (within the meaning of Treasury Regulation section 1.410(b)-6(d)(2)).
This exception also applies
if no employee received an allocation or accrued a benefit under the plan for the plan year.
-
If, during the plan year, the plan benefitted only collectively bargained employees (within the meaning of Treasury Regulation
section
1.410(b)-6(d)(2)). However, this exception does not apply if more than 2% of the employees covered by the plan were professional
employees (within the
meaning of Treasury Regulation section 1.410(b)-9).
-
If, during the plan year, the plan benefitted 100% of the nonexcludable nonhighly compensated employees of the employer. (This
exception
also applies if, during the plan year, all of the nonhighly compensated employees of the employer were excludable.) The nonhighly
compensated
employees of the employer include all the self-employed individuals, common-law employees, and leased employees (within the
meaning of Code section
414(n)) employed by the employer or any entity aggregated with the employer under Code section 414(b), (c), or (m) at any
time during the plan year,
excluding highly compensated employees (within the meaning of Code section 414(q)). Any such employee is a nonexcludable employee
unless the employee
is in one of the following categories:
-
Employees who have not attained the minimum age and service requirements of the plan.
Note.
If a plan has multiple age and service conditions or if the employer is treating a plan benefitting otherwise excludable employees
as two separate
plans pursuant to Treasury Regulation section 1.410(b)-6(b)(3), refer to section 1.410(b)-6(b) and section 1.410(b)-7(c)(3)
of the regulations
regarding the determination of excludable employees.
-
Collectively bargained employees within the meaning of Treasury Regulation section 1.410(b)-6(d)(2).
-
Nonresident aliens who receive no U.S. source income.
-
Employees who fail to accrue a benefit solely because they: (a) fail to satisfy a minimum hour of service or a last day
requirement under the plan; (b) do not have more than 500 hours of service for the plan year; and (c) are not employed on the
last day of the plan year.
-
Employees of QSLOBs other than the one with respect to which this Schedule R is being filed.
-
If, for the plan year, the plan is treated as satisfying the minimum coverage requirements of Code section 410(b) under the
"acquisition or
disposition" rule in Code section 410(b)(6)(C).
2006 Instructions for Schedule SSA (Form 5500) Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits
Use Schedule SSA to report information concerning separated participants with deferred vested benefit rights. Report participants
who:
-
separated from your company during the plan year; or
-
transferred into this plan during the plan year; or
-
previously were reported under this plan but are no longer entitled to those deferred vested benefits.
Also use Schedule SSA to correct information previously reported concerning participants with deferred vested benefits.
The information on this schedule is given to the Social Security Administration to provide to participants when they file
for Social Security
benefits.
Note.
Beginning with the 2004 Schedule SSA, report required information regarding separated participants only on page 2 of Schedule SSA. Use
additional pages 2 when you need to report information for more separated participants than one page 2 allows. Do not use
attachments other than the
page 2 Schedule SSA.
The Social Security Administration is revising its processing of participant plan data to avoid inaccurate information in
the pension notice.
The plan administrator is responsible for filing Schedule SSA. Plans that cover only owners and their spouses do not have
to file this schedule.
Check the Schedule SSA box on the Form 5500 (Part II, line 10a(4)) if a Schedule SSA is attached to the Form 5500.
Note.
Government, church, or other plans that elect to file the Schedule SSA voluntarily must check the appropriate box on the schedule
and complete lines 2 through 3c.
When to Report a Separated Participant
In general, for a plan to which only one employer contributes, a participant must be reported on Schedule SSA if:
-
The participant separates from service covered by the plan in a plan year, and
-
The participant is entitled to a deferred vested benefit under the plan.
The separated participant must be reported no later than on the Schedule SSA filed for the plan year following the plan year
in which separation
occurred. However, you can report the separation in the plan year in which it occurs, if you want to report earlier. Do not
report a participant more
than once unless you wish to revise or update a prior Schedule SSA (see instructions for line 4, box (a), under codes B, C,
or D).
In general, for a plan to which more than one employer contributes, a participant must be reported on Schedule SSA if:
-
The participant incurs two successive 1-year breaks in service (as defined in the plan for vesting purposes), and
-
The participant is (or may be) entitled to a deferred vested benefit under the plan.
The participant must be reported no later than on the Schedule SSA filed for the plan year in which the participant completed
the second of the two
consecutive 1-year breaks in service. The participant may be reported earlier (i.e., on the Schedule SSA filed for the plan
year in which he or she
separated from service or completed the first 1-year break in service).
When NOT to Report a Participant
A participant is not required to be reported on Schedule SSA if, before the date the Schedule SSA is required to be filed
(including any extension
of time for filing), the participant:
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Is paid some or all of the deferred vested retirement benefit (see the Caution below), or
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Returns to service covered by the plan and/or accrues additional retirement benefits under the plan, or
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Forfeits all the deferred vested retirement benefit.
If payment of the deferred vested retirement benefit ceases before ALL of the benefit to which the participant is entitled is paid to
the participant, information relating to the deferred vested retirement benefit to which the participant remains entitled
shall be filed on the
Schedule SSA filed for the year following the last plan year within which a portion of the benefit is paid to the participant.
Separation of a Re-Employed Employee
If the deferred vested benefit of a separated employee is different from that previously reported, you may use code B (see
below) to report that
employee's total vested benefit.
Use Schedule SSA to report revisions to pension information for a participant you reported on a previous Schedule SSA. This
will ensure that SSA's
records are correct. This is important since SSA provides Schedule SSA information that it has on file to participants when
they file for Social
Security benefits. If this information is not up-to-date, the participant may contact the plan administrator to resolve the
difference.
You do not need to report changes in the value of the employees' accounts, since that is likely to change. However, you may
report these changes if
you want.
Transfer of a Participant to a New Plan
When a separated participant with deferred vested benefits is transferred from the plan he or she was originally reported
under to a new plan,
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The new plan administrator should complete a Schedule SSA using:
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Entry Code C for line 4, box (a), when the original plan information is available, or
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Entry Code A for line 4, box (a), when the original plan information is not available.
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The original plan administrator should complete a Schedule SSA using Entry Code D for line 4, box (a).
File as an attachment to Form 5500.
Note.
Government, church, or other plans that elect to voluntarily file the Schedule SSA are not required to attach their Schedule
SSA to a Form 5500,
but must check the appropriate box on the schedule.
A penalty may be assessed if Schedule SSA (Form 5500) is not timely filed or critical information is not furnished.
Line D.
Enter the sponsor's employer identification number (EIN) shown on Form 5500, line 2b.
Line 2.
If the Post Office does not deliver mail to the street address and you have a P.O. box, enter the box number instead
of the street address.
Line 4, box (a).
Enter the appropriate code from the following list.
Code A — Use this code for a participant not previously reported. Also complete boxes (b) through (h).
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Code B — Use this code for a participant previously reported under the plan number shown on this schedule to modify some of
the previously reported information. Enter all the current information for boxes (b) through (h).
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Code C — Use this code for a participant previously reported under another plan number who will now be receiving his/her
future benefit from the plan reported on this schedule. Also complete boxes (b), (c), (i), and (j).
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Code D — Use this code for a participant previously reported under the plan number shown on this schedule who is no longer
entitled to those deferred vested benefits. This includes a participant who has begun receiving benefits, has received a lump-sum
payout, or has been
transferred to another plan. Also complete boxes (b) and (c).
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Line 4, box (b).
Enter the exact social security number (SSN) of each participant listed. If the participant is a foreign national
employed outside the United
States who does not have an SSN, enter the word "FOREIGN."
Line 4, box (c).
Enter each participant's name exactly as it appears on the participant's social security card. Do not enter periods;
however, initials, if on the
social security card, are permitted. Space is available for the first eleven characters of the participant's first name, one
for their middle initial,
and the first fifteen characters of their last name. If the participant does not have a middle initial, leave the space for
the middle initial blank.
Line 4, box (d).
From the following list, select the code that describes the type of annuity that will be provided for the participant.
Enter the code that
describes the type of annuity that normally accrues under the plan at the time of the participant's separation from service
covered by the plan (or
for a plan to which more than one employer contributes at the time the participant incurs the second consecutive 1-year break
in service under the
plan).
Type of Annuity Code
A A single sum
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B Annuity payable over fixed number of years
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C Life annuity
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D Life annuity with period certain
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E Cash refund life annuity
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F Modified cash refund life annuity
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G Joint and last survivor life annuity
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M Other
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Line 4, box (e).
From the following list, select the code that describes the benefit payment frequency during a 12-month period.
Type of Payment Code
A Lump sum
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B Annually
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C Semiannually
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D Quarterly
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E Monthly
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M Other
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Line 4, box (f).
For a defined benefit plan, enter the amount of the periodic payment that a participant is entitled to receive under
line 4, box (f).
For a plan to which more than one employer contributes, if the amount of the periodic payment cannot be accurately determined because
the plan administrator does not maintain complete records of covered service, enter an estimated amount.
Line 4, box (g).
For a defined contribution plan, if the plan states that a participant's share of the fund will be determined on
the basis of units, enter the
number of units credited to the participant.
If, under the plan, participation is determined on the basis of shares of stock of the employer, enter the number
of shares and add the letters
"S" to indicate shares. A number without the "S" will be interpreted to mean units.
Line 4, box (h).
For defined contribution plans, enter the value of the participant's account at the time of separation.
Line 4, boxes (i) and (j).
Show the EIN and plan number of the plan under which the participant was previously reported.
Signature.
This form must be signed by the plan administrator. If more than one Schedule SSA is filed for one plan, only the
initial page one should be
signed.
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