Schedule E ESOP Annual Information

Official Use Only

SCHEDULE E
(Form 5500)
Department of the Treasury
Internal Revenue Service

ESOP Annual Information
Under Section 6047(e) of the Internal Revenue Code

2007

έ File as an attachment to Form 5500 or 5500-EZ.

This Form is NOT Open
to Public Inspection.

For calendar plan year 2007 or fiscal plan year beginning
A Name of plan

C

OMB No. 1210-0110

,

Plan sponsor's name as shown on line 2a of Form 5500 or 5500-EZ

and ending
,
B Three-digit
plan number έ
D Employer Identification Number
Yes

1a
b
2a
b

3
4
5
a
b
c
6

No

Is the ESOP maintained by an S corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," answer line 1b. (Also, "2Q" must be entered on Form 5500, line 8.)
Were any prohibited allocations of securities in an S corporation made to any disqualified person? . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the employee stock ownership plan (ESOP) have an outstanding securities acquisition loan within the meaning
of Code section 133 during the plan year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the employer maintaining the ESOP pay dividends (deductible under section 404(k)) on the employer's stock
held by the ESOP during the employer's tax year in which the plan year ends? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If both line 2a and line 2b are "No," DO NOT complete any other questions on this schedule. Attach the schedule
to the Form 5500 or 5500-EZ you file for your ESOP plan.
What is the total value of the ESOP assets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . έ
If the ESOP holds preferred stock, under what formula(s) is the preferred stock convertible into common stock of
the employer corporation?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . έ
If unallocated employer securities were released from a loan suspense account, indicate below the methods used:
Principal and interest (Excise Tax Regulations section 54.4975-7(b)(8)(i));
Principal only (Excise Tax Regulations section 54.4975-7(b)(8)(ii));
Other (attach an explanation)
Were unallocated securities or proceeds from the sale of unallocated securities used to repay any exempt loan
(within the meaning of Code section 4975(d)(3))? If "Yes," attach a description of the transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If the ESOP or the employer corporation has one or more outstanding securities acquisition loans intended to
satisfy Code section 133, complete lines 7 through 12, otherwise skip to line 13.

7a
b
c

Was the ESOP loan part of a "back to back" loan? (See instructions for definition of "back to back" loan.) . . . . . . . . . . . . . . . . . . . . . .
If line 7a is "Yes," are the terms of the two loans substantially similar? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do the two loans have the same amortization schedule? If "No," attach an explanation of how the amortization
schedules differ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Is the loan an immediate allocation loan as defined in Code section 133(b)(1)(B)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9a What was the date of the securities acquisition loan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . έ
month day year
For Paperwork Reduction Act Notice and OMB Control Numbers,
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Schedule E (Form 5500) 2007
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Schedule E (Form 5500) 2007

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9b

c
d

10
11 a
b
12 a
b

At all times after the acquisition of the employer securities with the loan proceeds, did the ESOP own more than
50% of: (i) each class of outstanding stock of the employer corporation, or (ii) the total value of all outstanding
stock of the corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 9b is "No," does the securities acquisition loan satisfy one of the transition rules of Act section 7301(f) of OBRA
1989 or satisfy the exception in Code section 133(b)(6)(B)(ii)? (See instructions for explanation of transition rules.) . . . . . . . . . . . . . . .
If line 9c is "No," enter the name and address of payees to whom interest with respect to securities acquisition loans was
paid έ

What was the amount of interest paid on the securities acquisition loan? . . . . . . . . . . . . . έ
Were any securities disposed of within 3 years after the plan acquired section 133 securities in a taxable event
described in Code section 4978B(c)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 11a is "Yes," does one or more of the exceptions provided in Code section 4978B(d) apply to all dispositions
of employer securities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Were any of the ESOP's securities acquisition loans refinanced during this reporting period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 12a is "Yes," does the refinancing meet the requirements of Act section 1602 of SBJPA 1996? . . . . . . . . . . . . . . . . . . . . . . . . . .
If the employer maintaining the ESOP deducted dividends under Code section 404(k), answer the questions on
lines 13 through 16, otherwise skip to line 17.

13 a
b
14
15
16
17a

b
c

Did the amount of the dividends paid exceed the employer's current or accumulated earnings and profits within
the meaning of Code section 316? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is the amount paid a dividend under applicable state law? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If dividends deducted under Code section 404(k) were used to repay an exempt loan, were any dividends used
to repay the loan generated by securities that were not acquired with the proceeds of the loan being repaid?. . . . . . . . . . . . . . . . . . .
If the answer to line 14 is "Yes," were the dividends paid with respect to employer securities that satisfy the
transition rules of Act section 7302(b)(2) of OBRA 1989? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the employer make payments in redemption of stock held by an ESOP to terminating ESOP participants and
deduct them under Code section 404(k)(1)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Were any dividends subject to an election by participants or their beneficiaries under Code section 404(k)(2)(A)(iii)
to reinvest the dividends in employer securities?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," answer lines 17b and 17c. If "No," skip to line 18a.
Did the election comply with the requirements of Notice 2002-2? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Are dividends reinvested in employer securities pursuant to the election fully vested? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Yes

No

Schedule E (Form 5500) 2007

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18

Complete the following information for each class of stock owned by the ESOP:
(b)
(c)
(d)
(e)
Common
Readily
(a)
Dividends
stock (C) tradable* Dividend rate
Class of stock
during plan
paid to
Preferred
Yes (Y)
year**
participants***
stock (P)
No (N)

(f)
Dividends used to repay exempt loan
(1) allocated
stock

(2) unallocated
stock

$

$

$

$

$

$

$
$
$
Totals of dividends reported on lines 18(e) and (f)
for all classes of stock (including any reported on
$
$
attachments, see instructions) . . . . . . . . . . . . . . . . . . . έ $
* If the stock is readily tradable on an established securities market within the meaning of Code section 409(l), enter "Y," otherwise enter "N."
** Dividend rate paid for each class of stock during the plan year.
*** Dividends paid directly to or distributed to participants.
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