Source: http://www.irs.gov/instructions/i5500sf/ch01.html
Timestamp: 2014-10-23 02:38:37
Document Index: 466670797

Matched Legal Cases: ['art 1', 'art 6', 'art 4', 'art 2580', 'art 2580', 'art 2580']

Instructions for Form 5500-SF (2009) Pension and Welfare Plans Required To File Annual Return/Report
Plans Exempt From Filing
Using Form 5558
Using Extension of Time To File Federal Income Tax Return
Other Extensions of Time
Delinquent Filer Voluntary Compliance (DFVC) Program
Change in Plan Year
How To File – Electronic Filing Requirement
Specific Instructions Only for One-Participant Plans
Schedule MB (Form 5500).
Schedule SB (Form 5500).
Part I – Annual Report Identification Information
Part II – Basic Plan Information
Part IV – Plan Characteristics
Part V – Compliance Questions
Part VI – Pension Funding Compliance
Part VII – Plan Terminations and Transfers of Assets
All pension benefit plans and welfare benefit plans covered by ERISA must file a Form 5500 or Form 5500-SF for a plan year
unless they are eligible for a filing exemption. (See Code sections 6058 and 6059 and ERISA sections 104 and 4065). An annual
return/report must be filed even if the plan is not “tax qualified,” benefits no longer accrue, contributions were not made during this plan year, or contributions are no longer made. Pension
benefit plans required to file include both defined benefit plans and defined contribution plans. Profit sharing plans, stock
bonus plans, money purchase plans, 401(k) plans, Code section 403(b) plans covered by Title I of ERISA, and IRA plans established
by an employer are among the pension benefit plans for which an annual return/report must be filed. Welfare benefit plans
provide benefits such as medical, dental, life insurance, apprenticeship and training, scholarship funds, severance pay, disability,
etc. Plans that cover residents of Puerto Rico, the U.S. Virgin Islands, Guam, Wake Island, or American Samoa also must file
unless they are eligible for a filing exemption. This includes a plan that elects to have the provisions of section 1022(i)(2)
of ERISA apply.
Under regulations and applicable guidance, some pension benefit plans and many welfare benefit plans with fewer than 100 participants
are exempt from filing an annual return/report. Do not file a Form 5500-SF for an employee benefit plan that is any of the
An unfunded excess benefit plan. See ERISA section 4(b)(5).
A pension benefit plan maintained outside the United States primarily for the benefit of persons substantially all of whom
are nonresident aliens.
An annuity or custodial account arrangement under Code section 403(b)(1) or (7) not established or maintained by an employer
as described in DOL Regulations 29 CFR 2510.3-2(f).
A simplified employee pension (SEP) described in Code section 408(k) that conforms to the alternative method of compliance
described in 29 CFR 2520.104-48 or 29 CFR 104-49. A SEP is a pension plan that meets certain minimum qualifications regarding
eligibility and employer contributions.
A Savings Incentive Match Plan for Employees of Small Employers (SIMPLE) that involves SIMPLE IRAs under Code section 408(p).
A church pension benefit plan not electing coverage under Code section 410(d).
An unfunded dues financed pension benefit plan that meets the alternative method of compliance provided by 29 CFR 2520.104-27.
An individual retirement account or annuity not considered a pension plan under 29 CFR 2510.3-2(d).
“One-participant plans,” as defined on page 6, that have assets (either alone or in combination with one or more one-participant plans maintained
by the employer) of $250,000 or less at the end of the plan year. (However, in any case, you must file for the final plan
year to indicate that all assets have been distributed.)
A governmental plan.
An unfunded pension benefit plan or an unfunded or insured welfare benefit plan: (a) whose benefits go only to a select group
of management or highly compensated employees, and (b) which meets the terms of 29 CFR 2520.104-23 (including the requirement
that a registration statement be timely filed with DOL) or 29 CFR 2520.104-24.
A welfare benefit plan that covers fewer than 100 participants as of the beginning of the plan year and is unfunded, fully
insured, or a combination of insured and unfunded. For this purpose:
An unfunded welfare benefit plan has its benefits paid as needed directly from the general assets of the employer or the employee
organization that sponsors the plan.
Plans that are NOT unfunded include those plans that received employee (or former employee) contributions during the plan
year and/or used a trust or separately maintained fund (including a Code section 501(c)(9) trust) to hold plan assets or act
as a conduit for the transfer of plan assets during the plan year.
A welfare benefit plan with employee contributions that is associated with a cafeteria plan under Code section 125 may be
treated for annual reporting purposes as an unfunded welfare benefit plan if it meets the requirements of DOL Technical Release
92-01, 57 Fed. Reg. 23272 (June 2, 1992) and 58 Fed. Reg. 45359 (Aug. 27, 1993). The mere receipt of COBRA contributions or
other after-tax participant contributions (e.g., retiree contributions) by a cafeteria plan would not by itself affect the
availability of the relief provided for cafeteria plans that otherwise meet the requirements of DOL Technical Release 92-01.
See 61 Fed. Reg. 41220, 41222-23 (Aug. 7, 1996).
A fully insured welfare benefit plan has its benefits provided exclusively through insurance contracts or policies, the premiums
of which must be paid directly to the insurance carrier by the employer or employee organization from its general assets or
partly from its general assets and partly from contributions by its employees or members (which the employer or employee organization
forwards within 3 months of receipt). The insurance contracts or policies discussed above must be issued by an insurance company
or similar organization (such as Blue Cross Blue Shield or a health maintenance organization) that is qualified to do business
A combination unfunded/insured welfare benefit plan has its benefits provided partially as an unfunded plan and partially
as a fully insured plan. An example of such a plan is a welfare benefit plan that provides medical benefits as in “a” above and life insurance benefits as in “b” above. See 29 CFR 2520.104-20 and the DOL Technical Release 92-01.
A voluntary employees' beneficiary association, as used in Code section 501(c)(9), (VEBA) should not be confused with the
employer or employee organization that sponsors the plan. See ERISA section 3(4).
Plans maintained only to comply with workers' compensation, unemployment compensation, or disability insurance laws.
A welfare benefit plan maintained outside the United States primarily for persons substantially all of whom are nonresident
A church welfare benefit plan under ERISA section 3(33).
An unfunded dues financed welfare benefit plan that meets the alternative method of compliance provided by 29 CFR 2520.104-26.
A welfare benefit plan that participates in a group insurance arrangement that files a return/report on its behalf under 29
CFR 2520.104-43. A group insurance arrangement generally is an arrangement that provides benefits to the employees of two
or more unaffiliated employers (not in connection with a multiemployer plan or a collectively bargained multiple-employer
plan), fully insures one or more welfare benefit plans of each participating employer, uses a trust (or other entity such
as a trade association) as the holder of the insurance contracts, and uses a trust as the conduit for payment of premiums
An apprenticeship or training plan meeting all of the conditions specified in 29 CFR 2520.104-22.
For more information on plans that are exempt from filing an annual return/report, call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278). For one-participant plan filers, see the Instructions for Form 5500-EZ or call the IRS Help Line at 1-877-829-5500.
If your plan is required to file an annual return/report, you may file the Form 5500-SF instead of the Form 5500 only if you
meet all of the eligibility conditions listed below.
The plan (a) covered fewer than 100 participants at the beginning of the plan year 2009, or (b) under 29 CFR 2520.103-1(d)
was eligible to and filed as a small plan for plan year 2008 and did not cover more than 120 participants at the beginning
of plan year 2009 (see instructions for line 5 on counting the number of participants);
If a Code section 403(b) plan would have been eligible to file as a small plan under 29 CFR 2520.103-1(d) in 2008 (that is,
the plan was eligible to file in the previous year under the small plans requirements and has a participant count of less
than 121 at the beginning of the 2009 plan year), then it can rely on 29 CFR 2520.103-1(d) to file as a small plan for the
2009 plan year.
For more information about annual return/report filings for Code section 403(b) plans covered by Title I of ERISA, see Field
Assistance Bulletin 2009-02, available on the DOL website at www.dol.gov.
The plan did not hold any employer securities at any time during the plan year;
At all times during the plan year, the plan was 100% invested in certain secure, easy to value assets that meet the definition
of “eligible plan assets” (see the instructions for line 6a), such as mutual fund shares, investment contracts with insurance companies and banks
valued at least annually, publicly traded securities held by a registered broker dealer, cash and cash equivalents, and plan
loans to participants;
The plan is eligible for the waiver of the annual examination and report of an independent qualified public accountant (IQPA)
under 29 CFR 2520.104-46 (but not by reason of enhanced bonding), which requirement includes, among others, giving certain
disclosures and supporting documents to participants and beneficiaries regarding the plan's investments (see instructions
for line 6b); and
The plan is not a multiemployer plan.
Employee Stock Ownership Plans (ESOPs) and Direct Filing Entities (DFEs) may not file the Form 5500-SF.
One-participant plans should follow the Specific Instructions Only for “One-Participant Plans”
in place of the instructions 1–5 above to see if Form 5500-SF may be filed instead of Form 5500-EZ.
Plans required to file an annual return/report that meet all of the conditions for filing the Form 5500-SF may complete and
file the Form 5500-SF in accordance with its instructions. Single-employer defined benefit pension plans using the Form 5500-SF
must also file the Schedule SB (Form 5500), Single-Employer Defined Benefit Plan Actuarial Information, and its required attachments.
Money purchase plans amortizing a funding waiver using the Form 5500-SF must also file the Schedule MB (Form 5500), Multiemployer
Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information, and its required attachments. See the instructions
for Schedules SB and MB (Form 5500). No other schedules or attachments have to be filed with the Form 5500-SF.
One-participant plans see Specific Instructions Only for “One-Participant Plans.”
File the 2009 Form 5500-SF for plan years that began in 2009. The form, and any required schedules and attachments, must be
filed by the last day of the 7th calendar month after the end of the plan year (not to exceed 12 months in length) that began
For a plan year of less than 12 months (short plan year), file the form and applicable schedules by the last day of
the 7th calendar month after the short plan year ends or by the extended due date, if filing under an authorized extension
of time. Fill in the short plan year beginning and ending dates in the space provided and check the appropriate box in Part
I, line B, of the Form 5500-SF. For purposes of this return/report, a short plan year ends on the date of the change in accounting
period or upon the complete distribution of assets of the plan. Also see the instructions for Final Return/Report to determine if “the final return/report” box in line B should be checked.
If the filing due date falls on a Saturday, Sunday, or federal holiday, the return/report may be filed on the next day that
is not a Saturday, Sunday, or federal holiday.
2009 Short Plan Year Filings.
Short 2009 plan year filers whose due date to submit their 2009 filing is before January 1, 2010, are given an extended
due date to electronically file their complete Form 5500-SF within 90 days after the 2009 filing system is available on the
DOL website. The purpose of this extended due date was to encourage such short plan year filers to file electronically under
the new EFAST2 filing system. Short plan year filers that did not choose to wait and file under the EFAST2 system should have
filed their 2009 annual return/report by the due date under the current EFAST system using the 2008 forms. Short plan year
filers whose due date to submit their 2009 filings was before January 1, 2010, and who took advantage of the extended due
date to file electronically, must submit their complete Form 5500-SF with EFAST2 within 90 days after the 2009 filing system
is available on the DOL website, and fill in the short plan year beginning and ending dates in the space provided and check
the appropriate box in Part I, line C, of the Form 5500-SF to indicate they are filing under an extended due date.
2010 short plan year filers may not use the 2009 forms for filing. They must use the 2010 forms, schedules, and instructions.
If filing under an extension of time based on the filing of an IRS Form 5558, Application for Extension of Time To File Certain
Employee Plan Returns, check the appropriate box on the Form 5500-SF, Part I, line C. A one-time extension of time to file
the Form 5500-SF (up to 2½ months) may be obtained by filing Form 5558 on or before the normal due date (not including any
extensions) of the return/report. You must file the Form 5558 with the Department of Treasury, Internal Revenue Service Center, Ogden, UT 84201-0027. Approved copies of the Form 5558 will not be returned to the filer. A copy of the completed extension request must be retained
with the plan's records.
An automatic extension of time to file Form 5500-SF until the due date of the federal income tax return of the employer will
be granted if all of the following conditions are met: (1) the plan year and the employer's tax year are the same; (2) the
employer has been granted an extension of time to file its federal income tax return to a date later than the normal due date
for filing the Form 5500-SF; and (3) a copy of the application for extension of time to file the federal income tax return
is maintained with the filer's records. An extension of time granted by using this automatic extension procedure CANNOT be
extended further by filing an IRS Form 5558, nor can it be extended beyond a total of 9½ months beyond the close of the plan
An extension of time to file the Form 5500-SF does not operate as an extension of time to file PBGC premiums or annual financial
and actuarial reports (if required by section 4010 of ERISA) or to file the annual registration statement required to be filed
with the IRS under Code section 6057.
The IRS, DOL, and PBGC may announce special extensions of time under certain circumstances, such as extensions for Presidentially-declared
disasters or for service in, or in support of, the Armed Forces of the United States in a combat zone. See www.irs.gov,www.efast.dol.gov, and www.pbgc.gov/practitioners for announcements regarding such special extensions. If you are relying on one of these announced special extensions, check
the appropriate box on the Form 5500-SF, Part I, line C, and enter a description of the announced authority for the extension.
The DFVC Program facilitates voluntary compliance by plan administrators who are delinquent in filing annual return/report
forms under Title I of ERISA by permitting administrators to pay reduced civil penalties for voluntarily complying with their
DOL annual reporting obligations. If the Form 5500-SF is being filed under the DFVC Program, check the appropriate box on
Form 5500-SF, Part I, line C, to indicate that the Form 5500-SF is being filed under the DFVC Program.
See www.efast.dol.gov for additional information, including information concerning DFVC Program filings and the submission of penalty payments
to the DFVC Program processing center.
Plan administrators are reminded that they can use the online calculator available atwww.dol.gov/ebsa/calculator/dfvcpmain.html to compute the penalties due under the program. Payments under the DFVC Program also may be submitted electronically. For
information on how to pay DFVC Program payments online, go to www.dol.gov/ebsa.
Generally, only defined benefit pension plans need to get approval for a change in plan year. See Code section 412(d)(1).
However, under Rev. Proc. 87-27, 1987-1 C.B. 769, these pension plans may be eligible for automatic approval of a change in
If a change in plan year for a pension or a welfare benefit plan creates a short plan year, file the form and applicable schedules
by the last day of the 7th calendar month after the short plan year ends or by the extended due date, if filing under an authorized
extension of time. Fill in the short plan year beginning and ending dates in the space provided in Part I and check the appropriate
box in Part I, line B of the Form 5500-SF. For purposes of this return/report, the short plan year ends on the date of the
change in accounting period or upon the complete distribution of assets of the plan. Also, see the instructions for Final Return/Report to determine if “final return/report” in line B should be checked.
Plan administrators and plan sponsors must provide complete and accurate information and must otherwise comply fully with
the filing requirements. ERISA and the Code provide for the DOL and the IRS, respectively, to assess or impose penalties for
not giving complete and accurate information and for not filing complete and accurate statements and returns/reports. Certain
penalties are administrative (that is, they may be imposed or assessed in an administrative proceeding by one of the governmental
agencies delegated to administer the collection of the Form 5500-SF data). Others require a legal conviction.
Listed below are various penalties under ERISA and the Code that may be assessed or imposed for not meeting the annual return/report
filing requirements. Generally, whether the penalty is under ERISA or the Code, or both, depends upon the agency for which
the information is required to be filed. One or more of the following administrative penalties may be assessed or imposed
in the event of incomplete filings or filings received after the due date unless it is determined that your failure to file
properly is for reasonable cause.
A penalty of up to $1,100 a day (or higher amount if adjusted pursuant to the Federal Civil Penalties Inflation Adjustment
Act of 1990, as amended) for each day a plan administrator fails or refuses to file a complete and accurate annual return/report.
See ERISA section 502(c)(2) and 29 CFR 2560.502c-2.
A penalty of $25 a day (up to $15,000) for not filing the annual return/report for certain plans of deferred compensation,
trusts and annuities, and bond purchase plans by the due date(s). See Code section 6652(e).
A penalty of $1,000 for not filing an actuarial statement (Schedule MB (Form 5500) or Schedule SB (Form 5500)) required by
the applicable instructions. See Code section 6692.
Any individual who willfully violates any provision of Part 1 of Title I of ERISA shall on conviction be fined not more than
$100,000 or imprisoned not more than 10 years, or both. See ERISA section 501.
A penalty up to $10,000, five (5) years imprisonment, or both, may be imposed for making any false statement or representation
of fact, knowing it to be false, or for knowingly concealing or not disclosing any fact required by ERISA. See section 1027,
Title 18, U.S. Code, as amended by section 111 of ERISA.
Under the computerized ERISA Filing Acceptance System (EFAST2), you must file your 2009 Form 5500-SF electronically. You may
file your 2009 Form 5500-SF online using EFAST2's web-based filing system or you may file through an EFAST2-approved vendor.
Detailed information on electronic filing is available at www.efast.dol.gov. For telephone assistance, call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278). The EFAST2 Help Line is available
Monday through Friday from 8:00 am to 8:00 pm, Eastern Time.
Annual returns/reports filed under Title I of ERISA, including those filed using the Form 5500-SF, must be made available
by the plan administrators to plan participants and beneficiaries and by the DOL to the public pursuant to ERISA sections
104 and 106. Even though the Form 5500-SF must be filed electronically, the plan administrator must keep a copy of the Form
5500-SF, including schedules and attachments, with all required signatures on file as part of the plan's records, and must
make a paper copy available on request to participants, beneficiaries, and the DOL as required by section 104 of ERISA and
29 CFR 2520.103-1. Filers may use electronic media for record maintenance and retention, so long as they meet the applicable
Generally, questions on the Form 5500-SF relate to the plan year entered at the top of the first page of the form. Therefore,
answer all questions on the 2009 Form 5500-SF with respect to the 2009 plan year unless otherwise explicitly stated in the
instructions or on the form itself.
Your entries must be in the proper format in order for the EFAST2 system to process your filing. For example, if a question
requires you to enter a dollar amount, you cannot enter a word. Your software will not let you submit your return/report unless
all entries are in the proper format. To reduce the possibility of correspondence and penalties:
Complete all lines on the Form 5500-SF unless otherwise specified. Also complete and electronically attach, as required, any
applicable schedules and attachments.
Do not enter “N/A” or “Not Applicable” on the Form 5500-SF or Schedules SB (Form 5500) and MB (Form 5500) unless specifically permitted. “Yes” or “No” questions on the form and schedules cannot be left blank, unless specifically permitted. Answer “Yes” or “No,” but not both.
Use the correct employer identification number (EIN) and plan number (PN) for the plan.
You should check your return/report for errors before signing or submitting it to EFAST2. Your filing software or, if you
are using it, the EFAST2 web-based filing system will allow you to check your return/report for errors. If, after reasonable
attempts to correct your filing to eliminate any identified problem or problems, you are unable to address them, or you believe
that you are receiving the message in error, call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278) or contact the service
provider you used to help prepare and file your annual return/report.
Once you complete the return/report and finish the electronic signature process, you can electronically submit it to EFAST2.
When you electronically submit your return/report, EFAST2 is designed to immediately notify you if your submission was received
and whether the return/report is ready to be processed by EFAST2. If EFAST2 does not notify you that your submission was successfully
received and is ready to be processed, you will need to take steps to correct the problem or you may be deemed a non-filer
subject to penalties from DOL, IRS, and/or PBGC.
Once EFAST2 receives your return/report, the EFAST2 system should be able to provide a filing status within 20 minutes. The
person submitting the filing should check back into the EFAST2 system to determine the filing status of your return/report.
The filing status message will include a list of any filing errors or warnings that EFAST2 may have identified in your filing.
If EFAST2 did not identify any filing errors or warnings, EFAST2 will show the filing status of your return/report as “Filing_Received.” Persons other than the submitter can check whether the filing was received by the system by calling the EFAST2 Help Line
at 1-866-GO-EFAST (1-866-463-3278) and using the automated telephone system.
To reduce the possibility of correspondence and penalties from the DOL, IRS, and/or PBGC, you should do the following: (1)
Before submitting your return/report to EFAST2, check it for errors, and (2) after you have submitted it to EFAST2, verify
that you have received a filing status of “Filing_Received” and attempt to correct and resolve any errors or warnings listed in the status report.
Even after being received by the EFAST2 system, your return/report filing may be subject to further detailed review by DOL,
IRS, and/or PBGC, and your filing may be deemed deficient based upon this further review. See Penalties on page 5.
The Form 5500-SF, Schedules SB (Form 5500) and MB (Form 5500), and any attachments that are filed under ERISA are open to
public inspection, and the contents are public information subject to publication on the Internet.
Do not enter social security numbers in response to questions asking for an employer identification number (EIN). Because
of privacy concerns, the inclusion of a social security number on the Form 5500-SF or on a schedule or attachment that is
open to public inspection may result in the rejection of the filing. If you discover a filing disclosed on the EFAST2 website
that contains a social security number, immediately call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278).
Do not attach a copy of the annual registration statement identifying separated participants with deferred vested benefits
or a previous year's Schedule SSA (Form 5500) to your 2009 Form 5500-SF annual return/report. The annual registration statement
must be filed directly with the IRS and cannot be attached for a Form 5500-SF submission with EFAST2.
Employers without an employer identification number (EIN) must apply to the IRS for one as soon as possible. The EBSA does
not issue EINs. To apply for an EIN from the IRS:
Mail or fax Form SS-4, Application for Employer Identification Number, obtained by calling 1-800-TAX-FORM (1-800-829-3676)
or at the IRS website at www.irs.gov.
Call 1-800-829-4933 to receive your EIN by telephone.
Select the Online EIN Application link at www.irs.gov. The EIN is issued immediately once the application information is validated. (The online application process is not yet
available for corporations with addresses in foreign countries or Puerto Rico.)
For purposes of Title I of ERISA, the plan administrator is required to file the Form 5500 or 5500-SF. Thus, the plan administrator
or, if the plan administrator is an entity, a person authorized to sign on behalf of the plan administrator must electronically
sign the Form 5500 or 5500-SF submitted to EFAST2. If the plan administrator does not sign a filing, the filing status will
indicate that there is an error with your filing, and your filing will be subject to further review, correspondence, rejection,
The Code permits either the plan sponsor/employer or the administrator to sign the filing. Therefore, in the case of a Form
5500-SF filed for a “one-participant plan” not subject to Title I of ERISA that is filing a Form 5500-SF with EFAST2 in lieu of filing a Form 5500-EZ on paper with
the IRS (see Specific Instructions Only for “One-Participant Plans”
), either may sign. However, any other Form 5500-SF that is not electronically signed by the plan administrator will be subject
to rejection and civil penalties under Title I of ERISA.
The Form 5500-SF annual return/report must be filed electronically and signed. To obtain an electronic signature, go to www.efast.dol.gov and register in EFAST2 as a signer. You will be provided with a UserID and a PIN. Both the UserID and PIN are needed to sign
the Form 5500-SF. The plan administrator must keep a copy of the Form 5500-SF, including schedules and attachments, with all
required signatures on file as part of the plan's records. See 29 CFR 2520.103-1. Electronic signatures on annual returns/reports
filed under EFAST2 are governed by the applicable statutory and regulatory requirements.
Specific Instructions Only for “One-Participant Plans”
A “one-participant plan” is: (1) a pension benefit plan that covers only an individual or an individual and his or her spouse who wholly own a trade
or business, whether incorporated or unincorporated; or (2) a pension benefit plan for a partnership that covers only the
partners or the partners and the partners' spouses. Thus, a “one-participant plan” can cover more than one participant. On the other hand, merely covering only one participant does not make you eligible
to file as a “one-participant plan” unless you are one of the types of plans described above.
The Form 5500-EZ generally is used by one-participant plans that are not subject to the requirements of section 104(a) of
ERISA to satisfy certain annual reporting and filing obligations imposed by the Code. One-participant plans that meet the
Conditions for Filing below may file the Form 5500-SF electronically in place of a Form 5500-EZ (on paper) to satisfy the filing obligations under
the Code. One-participant plans that file the Form 5500-SF electronically complete only certain questions on the Form 5500-SF.
These are the questions that would be completed if the filer filed Form 5500-EZ on paper. For more information on filing with
the IRS, go to www.irs.gov or call 1-877-829-5500.
A Form 5500-SF may be filed for one-participant plans that are either defined contribution plans (which include profit-sharing
and money purchase pension plans, but not an ESOP or stock bonus plan) or defined benefit plans.
Information filed on Form 5500-EZ is required to be made available to the public. Form 5500-SF is open to public inspection
and the contents are public information subject to publication on the Internet.
Conditions for Filing.
One-participant plan filers that meet the following conditions are eligible to file a Form 5500-SF.
The plan is a “one-participant plan.” This means either:
The plan only covers you (or you and your spouse) and you (or you and your spouse) own the entire business (which may be incorporated
or unincorporated) or
The plan only covers one or more partners (or partner(s) and spouse(s)) in a business partnership.
The plan does not provide benefits for anyone except you, or you and your spouse, or one or more partners and their spouses.
The plan covered fewer than 100 participants at the beginning of the plan year.
If you do not meet ALL the conditions listed above, you are not a one-participant plan filer who is eligible to file Form
5500-SF instead of Form 5500-EZ. You must file a paper Form 5500-EZ with the IRS if you meet the first two conditions but
do not meet the third condition.
Eligible one-participant plans need complete only the following questions on the Form 5500-SF:
Part I, lines A, B, and C;
Part II, lines 1a–5b;
Part III, lines 7a–c, and 8a;
Part IV, line 9a;
Part V, line 10g; and
Part VI, lines 11–12e.
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, complete lines 3, 9, and 10 of Schedule MB (Form 5500). See the Instructions
for Schedule MB in the Instructions for Form 5500. One-participant plans, however, do not attach Schedule MB to the Form 5500-SF.
Instead, one-participant plans must keep the completed Schedule MB in accordance with the applicable records retention requirements.
One-participant plans do not attach Schedule SB (Form 5500) to the Form 5500-SF. Instead, one-participant plans must keep
the completed Schedule SB that is signed by the plan actuary in accordance with the applicable records retention requirements.
Actuaries of one-participant plans that are defined benefit plans subject to the minimum funding standards for this plan year,
must complete Schedule SB (Form 5500) and forward the completed and signed Schedule SB to the plan administrator no later
than the filing due date. See the Instructions for Schedule SB in the Instructions for Form 5500.
Filing Form 5500-EZ with the IRS.
If you are filing a paper form, you must file the Form 5500-EZ with the IRS using the following address: Department
of the Treasury, Internal Revenue Service Center, Ogden, UT 84201-0027. You may order the paper Form 5500-EZ and its instructions
by calling 1-800-TAX-FORM (1-800-829-3676) or visiting the IRS website at www.irs.gov/formspubs/.
Filing an amendment.
If you are filing an amendment for a “one-participant plan” that filed a Form 5500-SF electronically, you may submit the amendment either electronically using the Form 5500-SF with
EFAST2 or on paper using the Form 5500-EZ with the IRS. If you are filing an amendment for a “one-participant plan” that previously filed on a paper Form 5500-EZ, you must submit the amendment using the paper Form 5500-EZ with the IRS.
Check only one of the line A box choices.
Line A – Box for Single-Employer Plan.
Check this box if the Form 5500-SF is filed for a single-employer plan. A single-employer plan for purposes of the
Form 5500-SF is an employee benefit plan maintained by one employer or one employee organization.
A “controlled group” is generally considered one employer for Form 5500 and Form 5500-SF reporting purposes. A “controlled group” is a controlled group of corporations under Code section 414(b), a group of trades or businesses under common control under
Code section 414(c), or an affiliated service group under Code section 414(m). A separate annual return/report with line A
(single-employer plan) 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.
Line A – Box for Multiple-Employer Plan.
Check this box if the Form 5500-SF is being filed for a multiple-employer plan. For purposes of the Form 5500-SF,
a multiple-employer plan is a plan that is maintained by more than one employer and is not a single-employer plan or a multiemployer
plan. Multiple-employer plans can be collectively bargained and collectively funded, but if covered by PBGC termination insurance,
they must have properly elected before September 27, 1981, not to be treated as a multiemployer plan under Code section 414(f)(5)
or ERISA sections 3(37)(E) and 4001(a)(3), and have not revoked that election or made an election to be treated as a multiemployer
plan under code section 414(f)(6) or ERISA section 3(37)(G). Participating employers do not file individually for multiple-employer
Do not check this box if all of the employers maintaining the plan are members of the same controlled group or affiliated
service group under Code section 414(b), (c), or (m).
Multiemployer plans cannot use the Form 5500-SF to satisfy their annual reporting obligations. They must file the Form 5500.
For these purposes, a plan is a multiemployer plan if: (a) more than one employer is required to contribute; (b) the plan
is maintained pursuant to one or more collective bargaining agreements between one or more employee organizations and more
than one employer; (c) an election under Code section 414(f)(5) and ERISA section 3(37)(E) has not been made; and (d) the
plan meets any other applicable conditions of 29 CFR 2510.3-37. A plan that made a proper election under ERISA section 3(37)(G)
and Code section 414(f)(6) on or before Aug. 17, 2007, is also a multiemployer plan.
Line A – Box for One-Participant Plan.
Check this box if the Form 5500-SF is being filed for a plan that is a “one-participant plan” (see page 6). Check the one-participant plan box only for those plans that are submitting the Form 5500-SF in place of a Form 5500-EZ (on paper) to satisfy the annual
return/report filing obligations under the Code. Plans checking the box for one-participant plan should not check either the box for single-employer plan or the box for multiple-employer plan. See Specific Instructions Only for “One-Participant Plans.”
Line B – Box for First Return/Report.
Check this box if an annual return/report has not been previously filed for this plan. For the purpose of completing
this box, the Form 5500-EZ is not considered an annual return/report.
Line B – Box for Amended Return/Report.
Check this box if you have already filed for the 2009 plan year and are now filing an amended return/report to correct
errors and/or omissions on the previously filed return/report.
Check the line B box for an “amended return/report” if you filed a previous 2009 annual return/report that was given a “Filing_Received,” “Filing_Error,” or “Filing_Stopped” status by EFAST2. Do not check the line B box for an “amended return/report” if your previous submission attempts were not successfully received by EFAST2 because of problems with the transmission
of your return/report. For more information, go to the EFAST2 website at www.efast.dol.gov or call the EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278).
If you need to file an amended return/report to correct errors and/or omissions in a previously filed annual return/report
for the 2009 plan year AND you are eligible to file the Form 5500-SF, you may use the Form 5500-SF even if the original filing
was a Form 5500. If you filed a Form 5500-SF, but determine that you were not eligible to file the Form 5500-SF, you must
use the Form 5500 or Form 5500-EZ to amend your return/report.
Line B – Box for Final Return/Report.
Check this box if this is the final report for the plan. Only check this box if all assets under the plan (including
insurance/annuity contracts) have been distributed to the participants and beneficiaries or legally transferred to the control
of another plan, and when all liabilities for which benefits may be paid under a welfare benefit plan have been satisfied.
Do not mark the final return/report box if you are reporting participants and/or assets at the end of the plan year. If a trustee is appointed for a terminated
defined benefit plan pursuant to ERISA section 4042, the last plan year for which a return/report must be filed is the year
in which the trustee is appointed.
Mergers/Consolidations.
A final return/report should be filed for the plan year (12 months or less) that ends when all plan assets were legally transferred
to the control of another plan.
Pension and Welfare Plans That Terminated Without Distributing All Assets.
If the plan was terminated but all plan assets were not distributed, a return/report must be filed for each year the plan
has assets. The return/report must be filed by the plan administrator, if designated, or by the person or persons who actually
control the plan's assets/property.
Welfare Plans Still Liable To Pay Benefits.
A welfare plan cannot file a final return/report if the plan is still liable to pay benefits for claims that were incurred
prior to the termination date, but not yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line B – Box for Short Plan Year Return/Report.
Check this box if this Form 5500-SF is being filed for a plan year period of less than 12 months. Provide the dates
in Part I, Plan Year Beginning and Ending.
Line C – Box for Extension and DFVC Program.
Check the appropriate box here if:
You filed for an extension of time to file this form with the IRS using Form 5558, Application for Extension of Time To File
Certain Employee Plan Returns, and maintain a copy of the Form 5558 with the filer's records.
You are filing using the automatic extension of time to file the Form 5500-SF return/report until the due date of the federal
Income tax return of the employer and maintain a copy of the employer's extension of time to file the income tax return with
the plan's records.
You are filing under the DFVC Program.
You are filing using a special extension of time to file the Form 5500-SF annual return/report that has been announced by
the IRS, DOL, or PBGC. If you checked that you are using a special extension of time, enter a description of the extension
of time in the space provided.
Enter the formal name of the plan or enough information to identify the plan. Abbreviate if necessary. If an annual
return/report has previously been filed on behalf of the plan, regardless of the type of Form that was filed (Form 5500, Form
5500-EZ, or Form 5500-SF), use the same name or abbreviations that were used on the prior filings. Once you use an abbreviation,
continue to use it for that plan on all future annual return/report filings with the IRS, DOL, and PBGC. Do not use the same
name or abbreviation for any other plan, even if the first plan is terminated.
Enter the three-digit plan or entity number (PN) that the employer or plan administrator assigned to the plan. This
three-digit number, in conjunction with the employer identification number (EIN) entered on line 2b, is used by the IRS, DOL,
and PBGC as a unique 12-digit number to identify the plan.
Start at 001 for plans providing pension benefits. Start at 501 for welfare plans. Do not use 888 or 999.
Once you use a plan number, continue to use it for that plan on all future filings with the IRS, DOL, and PBGC. Do
not use it for any other plan, even if the first plan is terminated.
For each Form 5500-SFwith the same EIN(line 2b), when ▿
Assign PN▿
Codes are entered in line 9a
001 to the first plan. Consecutively number others as 002, 003. . .
Codes are entered in line 9b, and not in line 9a
501 to the first plan. Consecutively number others as 502, 503. . .
If 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.
Enter the plan sponsor's (employer, if for a single-employer plan) name, postal address (only use a P.O. Box number
if the Post Office does not deliver mail to the employer's street address), foreign routing code where applicable, and “D/B/A” (doing business as) or trade name of the employer if different from the employer's name.
In the case of a multiple-employer plan, file only one annual return/report for the plan. If an association or other entity
is not the sponsor, enter the name of a participating employer as sponsor. For a plan of a controlled group of corporations,
the name of one of the sponsoring members should be entered. In either case, the same name must be used in all subsequent
filings of the Form 5500 return/report or Form 5500-SF for the multiple-employer plan or controlled group (see instructions
for line 4 concerning change in sponsorship).
Enter the employer's nine-digit employer identification number (EIN). Do not use a social security number (SSN). A
Form 5500-SF that is filed under ERISA 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.
Employers without an EIN number must apply to the IRS for one as soon as possible. The EBSA does not issue EINs.
To apply for an EIN from the IRS:
Select the Online EIN Application link at www.irs.gov.
The EIN is issued immediately once the application information is validated. (The online application process is not yet available
for corporations with addresses in foreign countries or Puerto Rico.)
A multiple-employer plan or plan of a controlled group of corporations should use the EIN number of the sponsor identified
in line 2a. The EIN must be used in all subsequent filings of the Form 5500-SF (or any subsequent Form 5500 or Form 5500-EZ
in a year where the plan is not eligible to file the Form 5500-SF) for these plans. (See instructions to line 4 concerning
change in EIN).
EINs for funds (trusts or custodial accounts) associated with plans are generally not required to be furnished on the Form
5500-SF. The IRS, however, will issue EINs for such funds for other reporting purposes. EINs may be obtained as explained
above. Plan sponsors should use the trust EIN when opening a bank account or conducting other transactions for a trust.
Line 2c.
Enter the telephone number for the plan sponsor. Use numbers only, including area code, and do not include any special
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 19–21. 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.
Enter the name of the plan administrator unless the administrator is the sponsor identified in line 2. 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. If the administrator is not the plan sponsor,
also enter on line 3a the postal address (only use a P.O. Box number if the Post Office does not deliver mail to the administrator's
street address), and foreign routing code where applicable.
Plan administrator for this purpose means:
The person or group of persons specified as the administrator by the instrument under which the plan is operated;
The plan sponsor/employer if an administrator is not so designated; or
Any other person prescribed by applicable regulations if an administrator is not designated and a plan sponsor cannot be
Enter the plan administrator's nine-digit EIN. A plan administrator must have an EIN for Form 5500-SF reporting.
If the plan administrator does not have an EIN, it must apply to the IRS for one as explained in the instructions for line
2b. One EIN should be entered for a group of individuals who are, collectively, the plan administrator.
Employees of the plan sponsor who perform administrative functions for the plan are generally not the plan administrator unless
specifically designated in the plan document. If an employee of the plan sponsor is designated as the plan administrator,
that employee must obtain an EIN.
Enter the telephone number for the plan administrator.
If the plan sponsor's name and/or EIN have changed since the last annual return/report was filed for this plan, enter
the plan sponsor's name, EIN, and the plan number as it appeared on the last annual return/report filed.
Failure to indicate on line 4 that a plan sponsor was previously identified by a different name or a different employer identification
number (EIN) could result in correspondence from the DOL and the IRS.
Enter in element (a) the total number of participants at the beginning of the plan year. Enter in element (b) the
total number of participants at the end of the plan year. Enter in element (c) the total number of participants with account
balances as of the end of the plan year. Welfare benefit plans and defined benefit plans do not complete element (c).
The description of “participant” in the following instructions is only for purposes of these lines.
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
See 29 CFR 2510.3-3(d)(1). This includes former employees who are receiving group health continuation coverage benefits
pursuant to Part 6 of ERISA and who are covered by the employee welfare benefit plan. Covered dependents are not counted as
participants. A child who is an “alternate recipient” entitled to health benefits under a qualified medical child support order (QMCSO) should not be counted as a participant
for line 5. 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).
Before counting the number of participants, especially in a welfare benefit plan, it is important to determine whether the
plan sponsor has established one or more plans for Form 5500/Form 5500-SF reporting purposes. As a matter of plan design,
plan sponsors can offer benefits through various structures and combinations. For example, a plan sponsor could create (i)
one plan providing major medical benefits, dental benefits, and vision benefits, (ii) two plans with one providing major medical
benefits and the other providing self-insured dental and vision benefits; or (iii) three separate plans. You must review the
governing documents and actual operations to determine whether welfare benefits are being provided under a single plan or
separate plans.
The fact that you have separate insurance policies for each different welfare benefit does not necessarily mean that you have
separate plans. Some plan sponsors use a “wrap” document to incorporate various benefits and insurance policies into one comprehensive plan. In addition, whether a benefit
arrangement is deemed to be a single plan may be different for purposes other than Form 5500/Form 5500-SF reporting. For example,
special rules may apply for purposes of HIPAA, COBRA, and Internal Revenue Code compliance. If you need help determining whether
you have a single welfare benefit plan for Form 5500/Form 5500-SF reporting purposes, you should consult a qualified benefits
consultant or legal counsel.
For pension benefit plans, “alternate payees” entitled to benefits under a qualified domestic relations order are not to be counted as participants for this line.
For pension benefit plans, “participant” for this line means any individual who is included in one of the categories below.
Active participants (i.e., any individuals who are currently in employment covered by the plan and who are earning or retaining
credited service under the plan). This includes any individuals who are eligible to elect to have the employer make payments
under a Code section 401(k) qualified cash or deferred arrangement. Active participants also include any nonvested individuals
who are earning or retaining credited service under the plan. This does not include (a) nonvested former employees who have
incurred the break in service period specified in the plan or (b) former employees who have received a “cash-out” distribution or deemed distribution of their entire nonforfeitable accrued benefit.
Retired or separated participants receiving benefits (i.e., individuals who are retired or separated from employment covered
by the plan and who are receiving benefits under the plan). This does not include any individual to whom an insurance company
has made an irrevocable commitment to pay all the benefits to which the individual is entitled under the plan.
Other retired or separated participants entitled to future benefits (i.e., any individuals who are retired or separated from
employment covered by the plan and who are entitled to begin receiving benefits under the plan in the future). This does not
include any individual to whom an insurance company has made an irrevocable commitment to pay all the benefits to which the
individual is entitled under the plan.
Deceased individuals who had one or more beneficiaries who are receiving or are entitled to receive benefits under the plan.
This does not include any individual to whom an insurance company has made an irrevocable commitment to pay all the benefits
to which the beneficiaries of that individual are entitled under the plan.
If your plan is required to file an annual return/report, you may file the Form 5500-SF instead of the Form 5500 only
if you meet all of the eligibility conditions listed below.
At all times during the plan year, the plan was 100% invested in certain secure, easy to value assets such as mutual fund
shares, investment contracts with insurance companies and banks valued at least annually, publicly traded securities held
by a registered broker dealer, cash and cash equivalents, and plan loans to participants that meet the definition of “eligible plan assets” (see the instructions for line 6a);
Special conditions for filing the Form 5500-SF apply to “one-participant plans.” See Specific Instructions for “One-Participant Plans”
Line 6a – Eligible Plan Assets.
To be eligible to file the Form 5500-SF, all of the plan's assets must be “eligible plan assets.” Answer line 6a “Yes” or “No.” Do not leave this question blank. If the answer to line 6a is “No” you CANNOT file the Form 5500-SF and must file the Form 5500. See discussion under Who May File Form 5500-SF.
For purposes of this line, “eligible plan assets” are assets that have a readily determinable fair market value for purposes of this annual reporting requirement as described
in 29 CFR 2520.103-1(c)(2)(ii)(C), are not employer securities, and are held or issued by one of the following regulated financial
institutions: a bank or similar financial institution as defined in 29 CFR 2550.408b-4(c) (for example, banks, trust companies,
savings and loan associations, domestic building and loan associations, and credit unions); an insurance company qualified
to do business under the laws of a state; organizations registered as broker-dealers under the Securities Exchange Act of
1934; investment companies registered under the Investment Company Act of 1940; or any other organization authorized to act
as a trustee for individual retirement accounts under Code section 408. Examples of assets that would qualify as eligible
plan assets for this annual reporting purpose are mutual fund shares, investment contracts with insurance companies or banks
that provide the plan with valuation information at least annually, publicly traded stock held by a registered broker dealer,
cash and cash equivalents held by a bank. Participant loans meeting the requirements of ERISA section 408(b)(1), are also
“eligible plan assets” for this purpose whether or not they have been deemed distributed.
In addition to all of the plan's assets being eligible plan assets as defined in line 6a, to be eligible to file
the Form 5500-SF the plan also must be exempt from the requirement to be audited annually by an independent qualified public
accountant (IQPA).
Welfare plans that cover fewer than 100 participants at the beginning of the plan year are exempt from the annual
audit requirement.
A pension plan is exempt from the annual audit requirement if it covered fewer than 100 participants at the beginning
of the plan year or under 29 CFR 2520.103-1(d) was eligible to and filed as a small plan for plan year 2008 and did not cover
more than 120 participants at the beginning of plan year 2009 and meets the following three requirements for the audit waiver
under 29 CFR 2520.104-46: (1) as of the last day of the preceding plan year, at least 95% of a small pension plan's assets
were “qualifying plan assets;” (2) the plan includes the required audit waiver disclosure in the Summary Annual Report (SAR) furnished to participants
and beneficiaries, in accordance with 29 CFR 2520.104b-10. For defined benefit pension plans that are required pursuant to
section 101(f) of ERISA to furnish an Annual Funding Notice (AFN), the administrator must instead either provide the information
to participants and beneficiaries with the AFN or as a stand-alone notification at the time a SAR would have been due and
in accordance with the rules for furnishing an SAR, although such plans do not have to furnish a SAR; and (3) in response
to a request from any participant or beneficiary, the plan administrator must furnish without charge copies of statements
from the regulated financial institutions holding or issuing the plan's “qualifying plan assets.”
In order to be eligible to file the Form 5500-SF, a small pension plan must meet the audit waiver conditions by virtue of
having 95% or more of its assets as “qualifying plan assets” in accordance with 29 CFR 2520.104-46(b)(1)(i)(A)(1). If the small plan satisfies the conditions of the audit waiver by
virtue of having enhanced fidelity bond under29 CFR 2520.104-46(b)(1)(i)(A)(2), the plan does not satisfy the conditions for filing the Form 5500-SF and must file the
Form 5500, along with the appropriate schedules and attachments. Also, although many “qualifying plan assets” for audit waiver purposes will also be “eligible plan assets” as described in the instructions for line 6a, the definitions are not the same. If, as of the last day of the preceding
plan year, the plan was 100% invested in “eligible plan assets,” the plan would satisfy the “qualifying plan asset” prong of the audit waiver conditions. Holding all the plan's investments in “qualifying plan assets,” however, would not necessarily satisfy the conditions for filing the Form 5500-SF. For example, real estate held by a bank
as trustee for a plan could be a qualifying plan asset for purposes of the small pension plan audit waiver conditions but
it would not be a “eligible plan asset” for purposes of the plan being eligible to file the Form 5500-SF because real estate would not have a readily determinable
fair market value as described in 29 CFR 2520.103-1(c)(2)(ii)(C).
The cash, modified cash, or accrual basis may be used for recognition of transactions in Parts I and II, as long as you use
one method consistently. Round off all amounts reported on the Form 5500-SF to the nearest dollar. Any other amounts are subject
to rejection. Check all subtotals and totals carefully.
Current value means fair market value where available. Otherwise, it means the fair value as determined in good faith under
the terms of the plan by a trustee or a named fiduciary, assuming an orderly liquidation at the time of the determination.
See ERISA section 3(26).
Line 7 – Plan Assets and Liabilities.
Amounts reported on lines 7a, 7b, and 7c of the Form 5500-SF for the beginning of the plan year must be the same as
reported for the end of the plan year for the corresponding lines on the return/report for the preceding plan year. That means
that if the Form 5500 was filed the previous year, the amounts reported on the Form 5500-SF, lines 7a, column (a), 7b, column
(a), and 7c, column (a), should correspond to the amounts entered in lines 1a, column (b), 1b, column (b), and 1c, column
(b), of the 2008 Schedule I (Form 5500) or the amounts entered in lines 1f, column (b), 1k, column (b), and 1l, column (b),
of Schedule H (Form 5500) whichever schedule was filed.
Line 7a.
Enter the total amount of plan assets at the beginning of the plan year in column (a). Do not include contributions
designated for the 2009 plan year in column (a).
Enter the total amount of plan assets at the end of the plan year in column (b). Do not include in column (b) a participant
loan that has been deemed distributed during the plan year under the provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1 if both the following circumstances apply: (1) Under the plan, the participant loan is treated as a directed
investment solely of the participant's individual account; and (2) As of the end of the plan year, the participant is not
continuing repayment under the loan.
If the deemed distributed participant loan is included in column (a) and both of these circumstances apply, include
the value of the loan as a deemed distribution on line 8e. However, if either of these two circumstances does not apply, the
current value of the participant loan (including interest accruing thereon after the deemed distribution) should be included
in column (b) without regard to the occurrence of a deemed distribution.
After a participant loan that has been deemed distributed is included in the amount reported on line 8e, it is no
longer to be reported as an asset on line 7a unless, in a later year, the participant resumes repayment under the loan. However,
such a loan (including interest accruing thereon after the deemed distribution) that has not been repaid is still considered
outstanding for purposes of applying Code section 72(p)(2)(A) to determine the maximum amount of subsequent loans. Also, the
deemed distribution is not treated as an actual distribution for other purposes, such as the qualification requirements of
Code section 401, including, for example, the determination of top-heavy status under Code section 416 and the vesting requirements
of Treasury Regulations section 1.411(a)-7(d)(5). See Q&As 12 and 19 of Treasury Regulations section 1.72(p)-1.
The entry on line 7a, column (b) (plan assets at end of year) must include the current value of any participant loan
included as a deemed distribution in the amount reported for any earlier year if, during the plan year, the participant resumes
repayment under the loan. In addition, the amount to be entered on line 8e must be reduced by the amount of the participant
loan reported as a deemed distribution for the earlier year.
Line 7b.
Enter the total liabilities at the beginning and end of the plan year. Liabilities to be entered here do not include
the value of future pension payments to participants. The amount to be entered in line 7b for accrual basis filers includes,
Benefit claims that have been processed and approved for payment by the plan but have not been paid (including all incurred
but not reported (IBNR) welfare benefit claims);
Accounts payable obligations owed by the plan that were incurred in the normal operations of the plan but have not been paid;
Other liabilities such as acquisition indebtedness and any other amount owed by the plan.
Line 7c.
Enter the net assets as of the beginning and end of the plan year. (Subtract line 7b from 7a). Line 7c, column (b),
must equal the sum of line 7c, column (a), plus lines 8i (net income (loss)) and 8j (transfers to (from) the plan).
Line 8 – Income, Expenses, and Transfers for this Plan Year.
Include the total cash contributions received and/or (for accrual basis plans) due to be received.
Line 8a(1).
Plans using the accrual basis of accounting must not include contributions designated for years before the 2009 plan
year on line 8a(1).
Line 8a(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 line item, also include elective contributions
under a qualified cash or deferred arrangement (Code section 401(k)).
Line 8a(3).
Enter the current value, at date contributed, of all other contributions, including rollovers from other plans.
Enter all other plan income for the plan year. Do not include transfers from other plans that are reported on line
8j. Examples of other income received and/or receivable include:
Interest on investments (including money market accounts, sweep 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.)
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
Line 8c.
Enter the total of all cash contributions (line 8a(1) through line 8a(3)) and other plan income (line 8b) during the
plan year. If entering a negative number, enter a minus sign (“–”) to the left of the number.
Line 8d.
Include (1) payments made (and for accrual basis filers payments due) to or on behalf of participants or beneficiaries
in cash, securities, or other property (including rollovers of an individual's accrued benefit or account balance). Include
all eligible rollover distributions as defined in Code section 401(a)(31)(D) paid at the participant's election to an eligible
retirement plan (including an IRA within the meaning of Code section 401(a)(31)(E)); (2) payments to insurance companies and
similar organizations 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 as of the date of distribution.
Line 8e.
Include on this line all distributions paid during the plan year of excess deferrals under Code section 402(g)(2)(A)(ii),
excess contributions under Code section 401(k)(8), and excess aggregate contributions under Code section 401(m)(6). Include
allocable income distributed. Also include on this line any elective deferrals and employee contributions distributed or returned
to employees during the plan year as well as any attributable income that was also distributed.
For line 8e, also include in the total amount a participant loan included in line 7a, column (a) that has been deemed
distributed during the plan year under the provisions of Code section 72(p) and Treasury Regulations section 1.72(p)-1 only
if both of the following circumstances apply:
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 included
in the total on line 8e. Instead, the current value of the participant loan (including interest accruing thereon after the
deemed distribution) should be included on lines 7a, column (b) (plan assets – end of year), and 10g (participant loans –
end of year), without regard to the occurrence of a deemed distribution.
The amount to be reported on line 8e must be reduced if, during the plan year, a participant resumes repayment under a participant
loan reported as a deemed distribution on line 2g of Schedule H or Schedule I of a prior Form 5500 or line 8e of a prior Form
5500-SF for any earlier year. The amount of the required reduction is the amount of the participant loan that was reported
as a deemed distribution on such line for any earlier year. If entering a negative number, enter a minus sign (“–”) to the left of the number. The current value of the participant loan must then be included on line 7a, column (b) (plan
assets – end of year).
Although certain participant loans deemed distributed are to be reported on line 8e, and are not to be reported on
the Form 5500-SF or on the Schedule H or Schedule I of the Form 5500 as an asset thereafter (unless the participant resumes
repayment under the loan in a later year), they are still considered outstanding loans and are not treated as actual distributions
for certain purposes. See Q&As 12 and 19 of Treasury Regulations section 1.72(p)-1.
Line 8f.
The amount to be reported for expenses involving administrative service providers (salaries, fees, and commissions)
includes the total fees paid (or in the case of accrual basis plans, costs incurred during the plan year but not paid as of
the end of the plan year) by the plan for, among others:
Salaries to employees of the plan;
Fees and expenses for accounting, actuarial, legal, investment management, investment advice, and securities brokerage services;
Contract administrator fees; and
Fees and expenses for individual plan trustees, including reimbursement for travel, seminars, and meeting expenses.
Line 8g.
Other expenses (paid and/or payable) include other administrative and miscellaneous expenses paid by or charged to
the plan, including among others office supplies and equipment, telephone, and postage.
Line 8h.
Enter the total of all benefits paid or due reported on lines 8d and 8e and all other plan expenses reported on lines
8f and 8g during the year.
Line 8i.
Subtract line 8h from line 8c.
Line 8j.
Enter the net value of all assets transferred to and from the plan during the plan year including those resulting
from mergers and spinoffs. A transfer of assets or liabilities occurs when there is a reduction of assets or liabilities with
respect to one plan and the receipt of these assets or the assumption of these liabilities by another plan. Transfers out
at the end of the year should be reported as occurring during the plan year.
A distribution of all or part of an individual participant's account balance that is reportable on Form 1099-R, Distributions
From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., should not be included on line
8j but must be included in benefit payments reported on line 8d. Do not submit IRS Form 1099-R with the Form 5500-SF.
Enter on lines 9a and 9b, as appropriate, all applicable plan characteristics codes. See the List of Plan Characteristics Codes on pages 17 and 18.
Answer all lines either “Yes” or “No.” Do not leave any answer blank unless otherwise directed. For lines 10a, b, c, d, e, f, and g, if the answer is “Yes,” an amount must be entered.
“One-participant plans” should complete only question 10g.
Amounts paid by a participant or beneficiary to an employer and/or withheld by an employer for contribution to the
plan are participant contributions that become plan assets as of the earliest date on which such contributions can reasonably
be segregated from the employer's general assets. See 29 CFR 2510.3-102. Plans that check “Yes,” must enter the aggregate amount of all late contributions for the year. The total amount of the delinquent contributions
must be included on line 10a for the year in which the contributions were delinquent and must be carried over and reported
again on line 10a for each subsequent year (or on line 4a of Schedule H or I of the Form 5500 if not eligible to file the
Form 5500-SF in the subsequent year) until the year after the violation has been fully corrected by payment of the late contributions
and reimbursement of the plan for lost earnings or profits. If no participant contributions were received or withheld by the
employer during the plan year, answer “No.”
An employer holding participant contributions commingled with its general assets after the earliest date on which
such contributions can reasonably be segregated from the employer's general assets will have engaged in a prohibited use of
plan assets (see ERISA section 406). If such a nonexempt prohibited transaction occurred with respect to a disqualified person
(see Code section 4975(e)(2)), file IRS Form 5330, Return of Excise Taxes Related to Employee Benefit Plans, with the IRS
to pay any applicable excise tax on the transaction.
Participant loan repayments paid to and/or withheld by an employer for purposes of transmittal to the plan that were
not transmitted to the plan in a timely fashion must be reported either on line 10a in accordance with the reporting requirements
that apply to delinquent participant contributions or on line 10b. See Advisory Opinion 2002-02A, available at www.dol.gov/ebsa.
Applicants that satisfy both the DOL Voluntary Fiduciary Correction Program (VFCP) and the conditions of Prohibited
Transaction Exemption (PTE) 2002-51 are eligible for immediate relief from payment of certain prohibited transaction excise
taxes for certain corrected transactions, and are also relieved from the requirement to file the IRS Form 5330 with the IRS.
For more information on how to apply under the VFCP, the specific transactions covered (which transactions include delinquent
participant contributions to pension and welfare plans), and acceptable methods for correcting violations, see 71 Fed. Reg.
20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19, 2006). All delinquent participant contributions must be reported on
line 10a at least for the year in which they were delinquent even if violations have been fully corrected by the close of
the plan year. Information about the VFCP is also available on the Internet at www.dol.gov/ebsa.
Plans that check “Yes” must enter the amount. Check “Yes” if any nonexempt transaction with a party-in-interest occurred. Do not check “Yes” with respect to transactions that are: (1) statutorily exempt under Part 4 of Title I of ERISA; (2) administratively exempt
under ERISA section 408(a); (3) exempt under Code sections 4975(c) or 4975(d); (4) the holding of participant contributions
in the employer's general assets for a welfare plan that meets the conditions of ERISA Technical Release 92-01; or (5) delinquent
participant contributions or delinquent loan repayments reported on line 10a. You may indicate that an application for an
administrative exemption is pending. If you are unsure whether a transaction is exempt or not, you should consult either with
a qualified public accountant, legal counsel, or both. If the plan is a qualified pension plan and a nonexempt prohibited
transaction occurred with respect to a disqualified person, an IRS Form 5330 is required to be filed with the IRS to pay the
excise tax on the transaction.
Nonexempt transactions.
Nonexempt transactions with a party-in-interest include any direct or indirect:
A. Sale or exchange, or lease, of any property between the plan and a party-in-interest.
B. Lending of money or other extension of credit between the plan and a party-in-interest.
C. Furnishing of goods, services, or facilities between the plan and a party-in-interest.
D. Transfer to, or use by or for the benefit of, a party-in-interest, of any income or assets of the plan.
E. Acquisition, on behalf of the plan, of any employer security or employer real property in violation of ERISA section 407(a).
F. Dealing with the assets of the plan for a fiduciary's own interest or own account.
G. Acting in a fiduciary's individual or any other capacity in any transaction involving the plan on behalf of a party (or represent
a party) whose interests are adverse to the interests of the plan or the interests of its participants or beneficiaries.
H. Receipt of any consideration for his or her own personal account by a party-in-interest who is a fiduciary from any party
dealing with the plan in connection with a transaction involving the income or assets of the plan.
Party-in-Interest.
For purposes of this form, party-in-interest is deemed to include a disqualified person. See Code section 4975(e)(2). The
term “party-in-interest” means, as to an employee benefit plan:
A. Any fiduciary (including, but not limited to, any administrator, officer, trustee, or custodian), counsel, or employee of
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:
the combined voting power of all classes of stock entitled to vote or the total value of shares of all classes of stock of
the capital interest or the profits interest of a partnership; or
the beneficial interest of a trust or unincorporated enterprise which is an employer or an employee organization described
in C or D;
F. A relative of any individual described in A, B, C, or E;
G. A corporation, partnership, or trust or estate of which (or in which) 50% or more of:
such corporation,
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
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.
Applicants that satisfy the VFCP requirements and the conditions of PTE 2002-51 (see the instructions for line 10a) are eligible
for immediate relief from payment of certain prohibited transaction excise taxes for certain corrected transactions and the
requirement to file the Form 5330 with the IRS. For more information, see 71 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 10b.
Plans that check “Yes” must enter the aggregate amount of fidelity bond coverage for all claims. Check “Yes” only if the plan itself (as opposed to the plan sponsor or administrator) is a named insured under a fidelity bond that
is from an approved surety covering plan officials and that protects the plan from losses due to fraud or dishonesty as described
in 29 CFR Part 2580. Generally, every plan official of an employee benefit plan who “handles” funds or other property of such plan must be bonded. Generally, a person shall be deemed to be “handling” funds or other property of a plan, so as to require bonding, whenever his or her duties or activities with respect to given
funds are such that there is a risk that such funds could be lost in the event of fraud or dishonesty on the part of such
person, acting either alone or in collusion with others. Section 412 of ERISA and 29 CFR Part 2580 describe the bonding requirements,
including the definition of “handling” (29 CFR 2580.412-6), the permissible forms of bonds (29 CFR 2580.412-10), the amount of the bond (29 CFR Part 2580, Subpart
C), and certain exemptions such as the exemption for unfunded plans, certain banks and insurance companies (ERISA section
412), and the exemption allowing plan officials to purchase bonds from surety companies authorized by the Secretary of the
Treasury as acceptable reinsurers on federal bonds (29 CFR 2580.412-23). Information concerning the list of approved sureties
and reinsurers is available on the Internet atwww.fms.treas.gov/c570. For more information on the fidelity bonding requirements, see Field Assistance Bulletin 2008-04, available at www.dol.gov/ebsa.
Plans are permitted under certain conditions to purchase fiduciary liability insurance. These fiduciary liability insurance
policies are not written specifically to protect the plan from losses due to dishonest acts and cannot be reported as fidelity
bonds on line 10c.
Check “Yes” if the plan had suffered or discovered any loss as a result of any dishonest or fraudulent act(s) even if the loss was reimbursed
by the plan's fidelity bond or from any other source. If “Yes” is checked enter the full amount of the loss. If the full amount of the loss has not yet been determined, provide an estimate
as determined in good faith by a plan fiduciary. You must keep, in accordance with ERISA section 107, records showing how
the estimate was determined.
Willful failure to report is a criminal offense. See ERISA section 501.
Line 10e.
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) or if the plan has investments with insurance companies
such as guaranteed investment contracts (GICs), report the total of all insurance fees and commissions paid to agents, brokers
and/or other persons directly or indirectly attributable to the contract(s) placed with or retained by the plan.
For purposes of line 10e, commissions and fees include sales or base commissions and all other monetary and non-monetary
forms of compensation where the broker's, agent's, or other person's eligibility for the payment or the amount of the payment
is based, in whole or in part, on the value (e.g., policy amounts, premiums) of contracts or policies (or classes thereof)
placed with or retained by an ERISA plan, including, for example, persistency and profitability bonuses. The amount (or pro
rata share of the total) of such commissions or fees attributable to the contract or policy placed with or retained by the
plan must be reported. Insurers must provide plan administrators with a proportionate allocation of commissions and fees attributable
to each contract. Any reasonable method of allocating commissions and fees to policies or contracts is acceptable, provided
the method is disclosed to the plan administrator. A reasonable allocation method could allocate fees and commissions based
on a calendar year calculation even if the plan year or policy year was not a calendar year. For additional information on
these reporting requirements, see ERISA Advisory opinion 2005-02A, available on the Internet at www.dol.gov/ebsa.
Where benefits under a plan are purchased from and guaranteed by an insurance company, insurance service, or other
similar organization, and the total fees and commissions are reported on the Form 5500-SF, payments of reasonable monetary
compensation by the insurer out of its general assets to affiliates or third parties for performing administrative activities
necessary for the insurer to fulfill its contractual obligation to provide benefits, where there is no direct or indirect
charge to the plan for administrative services other than the insurance premium, then the payments for administrative services
by the insurer to the affiliates or third parties do not need to be reported on line 10e. This would include compensation
for services such as recordkeeping and claims processing services provided by a third party pursuant to a contract with the
insurer to provide those services but would not include compensation provided by the insurer incidental to the sale or renewal
of a policy, such as finders' fees, insurance brokerage commissions and fees, or similar fees.
Reporting also is not required for compensation paid by the insurer to a “general agent” or “manager” for that general agent's or manager's management of an agency or performance of administrative functions for the insurer.
For this purpose, (1) a “general agent” or “manager” does not include brokers representing insureds, and (2) payments would not be treated as paid for managing an agency or
performance of administrative functions where the recipient's eligibility for the payment or the amount of the payment is
dependent or based on the value (e.g., policy amounts, premiums) of contracts or policies (or classes thereof) placed with
or retained by ERISA plan(s).
Reporting is not required for occasional gifts or meals of insubstantial value which are tax deductible for federal
income tax purposes by the person providing the gift or meal and would not be taxable income to the recipient. For this exemption
to be available, the gift or gratuity must be both occasional and insubstantial. For this exemption to apply, the gift must
be valued at less than $50, the aggregate value of gifts from one source in a calendar year must be less than $100, but gifts
with a value of less than $10 do not need to be counted toward the $100 annual limit. If the $100 aggregate value limit is
exceeded, then the aggregate value of all the gifts will be reportable. For this purpose, non-monetary gifts of less than
$10 also do not need to be included in calculating the aggregate value of all gifts required to be reported if the $100 limit
is exceeded.
Gifts from multiple employees of one service provider should be treated as originating from a single source when calculating
whether the $100 threshold applies. On the other hand, in applying the threshold to an occasional gift received from one source
by multiple employees of a single service provider, the amount received by each employee should be separately determined in
applying the $50 and $100 thresholds. For example, if six employees of a broker attend a business conference put on by an
insurer designed to educate and explain the insurer's products for employee benefit plans, and the insurer provides, at no
cost to the attendees, refreshments valued at $20 per individual, the gratuities would not be reportable on this line even
though the total cost of the refreshments for all the employees would be $120.
These thresholds are for purposes of line 10e reporting. Filers are cautioned that the payment or receipt of gifts
and gratuities of any amount by plan fiduciaries may violate ERISA and give rise to civil liabilities and criminal penalties.
The insurance company, insurance service, or other similar organization is required under ERISA section 103(a)(2) to provide
the plan administrator with the information needed to complete this return/report. Your insurance company must provide you
with the information you need to answer this question. If your insurance company, insurance service, or other similar organization
does not automatically send you this information, you should make a written request for the information. If you have difficulty
getting the information from your insurance company, contact the nearest office of the DOL's Employee Benefits Security Administration.
Line 10f.
You must check “Yes” if any benefits due under the plan were not timely paid or not paid in full. Include in this amount the total of any outstanding
amounts that were not paid when due in previous years that have continued to remain unpaid.
Line 10g.
You must check “Yes” if the plan had any participant loans outstanding at any time during the plan year and enter the amount outstanding as of
the end of the plan year. If no participant loans are outstanding as of the end of the plan year, enter “0.”
Line 10h.
Code section 401(k) and other individual account pension plans must complete line 10h. Other filers should leave line
10h blank. Check “Yes” if there was a “blackout period.” A blackout period is a temporary suspension of more than three consecutive business days during which participants or beneficiaries
of a 401(k) or other individual account pension plan were unable, or were limited or restricted in their ability, to direct
or diversify assets credited to their accounts, obtain loans from the plan, or obtain distributions from the plan. A “blackout period” generally does not include a temporary suspension of the right of participants and beneficiaries to direct or diversify
assets credited to their accounts, obtain loans from the plan, or obtain distributions from the plan if the temporary suspension
is: (1) part of the regularly scheduled operations of the plan that has been disclosed to participants and beneficiaries;
(2) due to a qualified domestic relations order (QDRO) or because of a pending determination as to whether a domestic relations
order is a QDRO; (3) due to an action or a failure to take action by an individual participant or because of an action or
claim by someone other than the plan regarding a participant's individual account; or (4) by application of federal securities
laws. For more information, see the DOL's regulation at 29 CFR 2520.101-3 (available at www.dol.gov/ebsa).
Line 10i.
Code section 401(k) and other individual account pension plans who answered “Yes” to line 10h must complete line 10i. Other filers should leave line 10i blank. If there was a blackout period, did you provide
the required notice not less than 30 days nor more than 60 days in advance of restricting the rights of participants and beneficiaries
to change their plan investments, obtain loans from the plan, or obtain distributions from the plan? If so, check “Yes.” See 29 CFR 2520.101-3 for specific notice requirements and for exceptions from the notice requirement. Also, answer “Yes” if one of the exceptions to the notice requirement under 29 CFR 2520.101-3 applies.
Complete Part VI only if the plan is subject to the minimum funding requirements of Code section 412 or ERISA section 302.
All qualified defined benefit and defined contribution plans are subject to the minimum funding requirements of Code section
412 unless they are described in the exceptions listed under Code section 412(e)(2). These exceptions include profit-sharing
or stock bonus plans, insurance contract plans described in Code section 412(e)(3), and certain plans to which no employer
contributions are made.
Nonqualified employee pension benefit plans are subject to the minimum funding requirements of ERISA section 302 unless specifically
exempted under ERISA sections 4(a) or 301(a).
The employer or plan administrator of a single-employer or multiple-employer defined benefit plan that is subject to the minimum
funding requirements must file the Schedule SB (Form 5500) as an attachment to the Form 5500-SF. The employer or plan administrator
of a money purchase plan that is currently amortizing a waiver of the minimum funding requirements must complete lines 3,
9, and 10 of the Schedule MB (Form 5500) and file it as an attachment to the Form 5500-SF.
If “Yes” is checked, attach a completed and signed Schedule SB (Form 5500). See the instructions for the Schedule SB in the Instructions
for Form 5500. If this is a defined contribution pension plan, leave blank.
Check the “Yes” box if the plan is a defined contribution plan subject to the minimum funding requirements of Code section 412 and ERISA
section 302. Those money purchase plans (including target benefit plans) that are amortizing a waiver of the minimum funding
standard for a prior year should fill out line 12a and then skip to line 13. Those defined contribution plans answering “Yes” to the line 12 question that do not fill out line 12a should fill out lines 12b-12e.
Line 12a.
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, complete lines 3, 9, and 10 of Schedule MB (Form 5500). See
instructions for Schedule MB in the Instructions for Form 5500. The Schedule MB for a money purchase defined contribution
plan does not need to be signed by an enrolled actuary.
Line 12b.
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.
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. For example, do not include receivable contributions
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. File IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit Plans, with the IRS to pay the excise tax on the deficiency. There is a penalty for
not filing Form 5330 on time.
Line 12e.
Check “Yes” if the minimum required contribution remaining in line 12d will be made not later than 8½ months after the end of the plan
year. If “Yes,” and contributions are actually made by this date, then there will be no reportable deficiency and IRS Form 5330 will not
need to be filed.
Line 13a.
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 or a Form 5500-SF 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 13b.
Check “Yes” if all of 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).
Line 13c.
Enter information concerning assets and/or liabilities transferred from this plan to another plan(s) (including spinoffs)
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, EIN, and
PN of the transferee plan(s) involved on lines 13c(1), c(2) and c(3).
Do not use a social security number in place of an EIN or include an attachment that contains visible social security
numbers. The Form 5500-SF is open to public inspection, and the contents are public information and are subject to publication
on the Internet. Because of privacy concerns, the inclusion of a social security number on this Form 5500-SF may result in
the rejection of the filing.
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 13c. Do not submit Form 1099-R with the Form 5500-SF.
IRS Form 5310-A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities; Notice of Qualified
Separate Lines of Business, 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 IRS Form 5310-A on time. In addition, a transfer
of benefit liabilities involving a plan covered by PBGC insurance may be reportable to the PBGC. See PBGC Form 10, Post-Event
Notice of Reportable Event, and PBGC Form 10-Advance, Advance Notice of Reportable Event (see the “Reportable Events and Large Unpaid Contributions” section of the Practitioners page on PBGC's website, which is available at www.pbgc.gov/practitioners).