Annual Return/Report of Employee Benefit Plan

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Annual Return/Report of Employee Benefit Plan

OMB: 1545-1610

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2024-04-15 - No material or nonsubstantive change to a currently approved collection
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Instructions for Form 5500

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11/07/2008 HIGHLIGHTED, FINAL CUMULATIVE CHANGES.
Department of the Treasury
Internal Revenue Service

Department of Labor
Employee Benefits
Security Administration

Pension Benefit
Guaranty Corporation

2008
Instructions for Form 5500
Annual Return/Report of Employee Benefit Plan
• Clearly identify all attachments. At the top of each

EFAST Processing System

EFAST Processing Tips

About the Form 5500
The Form 5500 annual return/report is used to report
information concerning employee benefit plans and Direct Filing
Entities (DFEs). Any administrator or sponsor of an employee
benefit plan subject to ERISA must file information about each
plan every year (pursuant to Code section 6058 and ERISA
sections 104 and 4065). Some plans participate in certain
trusts, accounts, and other investment arrangements that file a
Form 5500 as DFEs. See Who Must File on page 3, When To
File on page 4, and Where To File on page 6.
The Internal Revenue Service (IRS), Department of Labor
(DOL), and Pension Benefit Guaranty Corporation (PBGC)
have consolidated certain returns and report forms to reduce
the filing burden for plan administrators and employers.
Employers and administrators who comply with the instructions
for the Form 5500 and schedules will generally satisfy the
annual reporting requirements for the IRS and DOL.
Plans covered by the PBGC have special additional
requirements, including premiums and reporting certain
transactions directly with that agency. See PBGC’s website
(www.pbgc.gov/practitioners/) for information on premium filings
and reporting and disclosure.
Each Form 5500 must accurately reflect the characteristics
and operations of the plan or arrangement being reported. The
requirements for completing the Form 5500 vary according to
the type of plan or arrangement. The section What To File on
page 8 summarizes what information must be reported for
different types of plans and arrangements. The chart on pages
13 and 14 gives a brief guide to the annual return/report
requirements for the 2008 Form 5500.
The Form 5500 and attachments are screened by a
computer process for internal consistency and completeness.
The filing may be rejected based upon this review. Employers
and plan administrators should provide complete and accurate
information and otherwise comply fully with the filing
requirements.
ERISA and the Code provide for the assessment or
imposition of penalties for not submitting the required
information when due. See Penalties on page 7.
Annual reports filed under Title I of ERISA must be made
available by plan administrators to plan participants and by the
DOL to the public pursuant to ERISA sections 104 and 106.
Schedules E and SSA are not part of the annual report filed
under Title I of ERISA, and are not open to public inspection.
The Pension Protection Act of 2006 (PPA) requires that the
Department of Labor post on its website the actuarial pension
funding information filed as part of a defined benefit pension
plan’s Form 5500 annual return/report. This requirement applies
beginning with 2008 Form 5500 annual return/report. The DOL

Under the computerized ERISA Filing Acceptance System
(EFAST), you can choose between two computer scannable
forms to complete and file your 2008 Form 5500: ‘‘machine
print’’ and ‘‘hand print.’’ Machine print forms are completed
using computer software from EFAST-approved vendors and
can be filed electronically or by mail (including certain private
delivery services). Hand print forms may be completed by hand,
typewriter, or by using computer software from
EFAST-approved vendors. Hand print forms can be filed by
mail (including certain private delivery services); however, they
cannot be filed electronically. For more information, see the
instructions for How To File beginning on page 6.

attachment, indicate the schedule and line, if any (e.g.,
Schedule I, line 4k), to which the attachment relates.
• Do not enter social security numbers on the Form 5500,
schedules, or other attachments unless specifically required by
the form, schedules, or instructions. The Form 5500 and most
of the schedules are open to public inspection, and the contents
are public information and are subject to publication on the
Internet.

Code section references are to the Internal Revenue Code
unless otherwise noted. ERISA refers to the Employee
Retirement Income Security Act of 1974.

To reduce the possibility of correspondence and penalties, we
remind filers that:
• Paper forms must be obtained from the IRS or printed using
software from an EFAST-approved software developer.
• Hand print and machine print forms generated by
EFAST-approved software will not be processed if they are
printed out blank, or with limited information, and then
completed by pen or typewriter. Only official hand print paper
forms printed by the IRS may be completed by pen or
typewriter.
• All information should be in the specific fields or boxes
provided on the forms and schedules. Information entered
outside of the fields or boxes may not be processed.
• Filings using photocopies of the computer scannable forms
and schedules may be returned or cause correspondence
requiring additional information.
• Do not use felt tip pens or other writing instruments that can
cause signatures or data to bleed through to the other side of
the paper. One-sided documents should have no markings on
the blank side.
• Paper should be clean without glue or other sticky
substances.
• Do not staple the forms. Use binder clips or other fasteners
that do not perforate the paper.
• Do not submit extraneous material or information, such as
arrows used to indicate where to sign, notes between preparers
of the report, notations on the form, e.g., “DOL copy,” etc.
• Do not submit unnecessary or blank schedules. Except for
certain Schedule SSA filings, schedules should be submitted
only with a Form 5500 or in response to correspondence
regarding the processing of your return/report.
• Submit all schedules (including the correct number of
schedules) for which a box is checked on Form 5500, Part II,
line 10.
• Do not attach or send any payments to EFAST.
• All Forms 5500 and 5500-EZ must be filed with the EBSA
either electronically using computer software from
EFAST-approved vendors or at the EBSA address specified
within the instructions. (See Where To File.)

Cat. No. 13502B

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Instructions for Form 5500

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website, located at www.dol.gov/ebsa/actuarialsearch.html, can
be searched by plan name, employer identification number
(EIN), plan number (PN), plan year, and type of actuarial
schedule. If a plan sponsor of defined benefit pension plan (or
the plan administrator on behalf of plan sponsors) maintains an
intranet website for the purpose of communicating with
employees and not the public, the PPA requires the sponsor (or
plan administrator) to post the plan’s 2008 Form 5500 actuarial
information on that intranet website.

Table of Contents
Paper and Electronic Filing . . . . . . . . . . . . . . . . . .
Form 5500 –
Completed by Pen . . . . . . . . . . . . . . . . . . . . . . . .
Completed by Typewriter . . . . . . . . . . . . . . . . . . .
Completed by Using Computer Software . . . . . . . .
Amended Return/Report . . . . . . . . . . . . . . . . . . . .
Final Return/Report . . . . . . . . . . . . . . . . . . . . . . . .
Signature and Date . . . . . . . . . . . . . . . . . . . . . . . .
Change in Plan Year . . . . . . . . . . . . . . . . . . . . . . .
Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Administrative Penalties . . . . . . . . . . . . . . . . . . . .
Other Penalties . . . . . . . . . . . . . . . . . . . . . . . . . .
Section 5: What To File . . . . . . . . . . . . . . . . . . . . .
Form 5500 Schedules . . . . . . . . . . . . . . . . . . . . . .
Pension Benefit Schedules . . . . . . . . . . . . . . . . .
Financial Schedules . . . . . . . . . . . . . . . . . . . . . .
Voluntary Alternative Reporting Option for Certain
Plans with Fewer Than 25 Participants . . . . . . . . .
Pension Benefit Plan Filing Requirements . . . . . . . .
Limited Pension Plan Reporting . . . . . . . . . . . . . .
Welfare Benefit Plan Filing Requirements . . . . . . . .
Direct Filing Entity (DFE) Filing Requirements . . . . .
Master Trust Investment Account (MTIA) . . . . . . . .
Common/Collective Trust (CCT) and Pooled
Separate Account (PSA) . . . . . . . . . . . . . . . . . .
103-12 Investment Entity (103-12 IE) . . . . . . . . . .
Group Insurance Arrangement (GIA) . . . . . . . . . . .
Quick Reference Chart for Form 5500,
Schedules and Attachments . . . . . . . . . . . . . . . . .
Section 6: Line-by-Line Instructions for the 2008
Form 5500 and Schedules . . . . . . . . . . . . . . . . . .
Form 5500 – Annual Report Identification
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 5500 – Basic Plan Information . . . . . . . . . . .
Schedule A – Insurance Information . . . . . . . . . . .
Schedule C – Service Provider Information . . . . . . .
Schedule D – DFE/Participating Plan Information . .
Schedule E – ESOP Annual Information . . . . . . . . .
Schedule G – Financial Transaction Schedules . . .
Schedule H – Financial Information . . . . . . . . . . . .
Schedule I – Financial Information – Small Plan . . .
Schedule MB – Multiemployer Defined Benefit Plan
and Certain Money Purchase Plan Actuarial
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule R – Retirement Plan Information . . . . . . .
Schedule SB – Single-employer Defined Benefit
Plan Actuarial Information . . . . . . . . . . . . . . . . . .
Schedule SSA – Annual Registration Statement
Identifying Separated Participants With Deferred
Vested Benefits . . . . . . . . . . . . . . . . . . . . . . . . . .
Paperwork Reduction Act Notice . . . . . . . . . . . . . .
Codes for Principal Business Activity . . . . . . . . . .
ERISA Compliance Quick Checklist . . . . . . . . . . . .
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• New Actuarial Schedules (Schedules MB and SB) –
Under the PPA, separate actuarial information schedules were
developed for 2008 plan year filings. Single-employer and
multiple-employer plans now will use the Schedule SB and
multiemployer and certain money purchase plans will now use
Schedule MB. The Schedule B is not a valid schedule to file
with a plan’s 2008 Form 5500 annual return/report. Filers
required to file an actuarial report cannot use the 2007 forms,
including the 2007 Schedule B (Form 5500), to satisfy their
2008 filing requirements.
• Schedule R – PPA requires filers of certain pension plans to
provide additional new information beginning with the 2008 plan
year. For the 2008 plan year, this new information will be filed
as attachments to the Schedule R. All multiemployer defined
benefit plans are required to file attachments providing the
information specified in the Schedule R instructions. In addition,
all defined benefit plans (single-employer, multiple-employer,
and multiemployer) with 1,000 or more participants are required
to provide financial asset breakout information as an
attachment to the Schedule R.
• 2008 Short Plan Year Filing Requirements for Plans
Required To File an Actuarial Schedule and Supplemental
Schedule R Information – Filers who must file a Schedule MB
or Schedule SB and/or a supplemental attachment to Schedule
R for 2008 have an automatic extension to file their complete
Form 5500 until 90 days after the 2008 forms are available to
use for filing. Welfare plans and pension plans not required to
file a Schedule MB, SB, or the supplemental questions on
Schedule R may still use the 2007 forms for filing and do not
have the extension of time.
• Voluntary Alternative Reporting Option for Certain Plans
with Fewer Than 25 Participants – Under the Pension
Protection Act of 2006 (PPA), a new simplified reporting option
which was first available for 2007 plan year filings is also
available for eligible plans for 2008 plan year filings for plans
with fewer than 25 participants as of the beginning of the plan
year. The instructions for Voluntary Alternative Reporting
Option for Certain Plans with Fewer Than 25 Participants on
page 9 describe this reporting option.
• 2009 Short Plan Year Filings – Short 2009 plan year filers
whose due date to submit their 2009 filing is before January 1,
2010, will be given an automatic extension to electronically file
their complete Form 5500 annual return/report within 90 days
after the 2009 filing system is available on the DOL website.
See When To File for more information on due dates for short
plan year filers. This special extension is being granted to
encourage such short 2009 plan year filers to file their 2009
Form 5500 annual return/report electronically under EFAST2.
Short 2009 plan year filers whose due date to submit their 2009
filing is before January 1, 2010, and who choose not to take
advantage of the special extension, must use plan year 2008
forms and must submit their 2009 filing to EFAST on or before
the due date for their short plan year filing.

Changes To Note

Table of Contents
Section 1: Who Must File .
Pension Benefit Plan . . . .
Welfare Benefit Plan . . . .
Direct Filing Entity (DFE) .
Section 2: When To File . .
Extension of Time To File
Private Delivery Service .
Section 3: Where To File .
Section 4: How To File . . .

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Telephone Assistance
If you need assistance completing this form, want to confirm the
receipt of forms you submitted, or have related questions, call
the EFAST Help Line at 1-866-463-3278 (toll-free) and follow
the directions as prompted. The EFAST Help Line is available
Monday through Friday from 8:00 am to 8:00 pm, Eastern Time.

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How To Get Forms and Related
Publications
Telephone
You can order forms and IRS publications by calling
1-800-TAX-FORM (1-800-829-3676). You can order EBSA
publications by calling 1-866-444-EBSA (3272).

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Instructions for Form 5500

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Personal Computer

Retirement Plan, rather than a Form 5500, provided that the
plan:
1. Satisfies the minimum coverage requirements of Code
section 410(b) without being combined with any other plan
maintained by the employer;
2. Does not cover a business that is a member of a
“controlled group;” and
3. Does not cover a business for which leased employees
(as defined in Code section 414(n)(2)) perform services.

You can access the EFAST website 24 hours a day, 7 days a
week at www.efast.dol.gov to:
• View forms and related instructions.
• Get information regarding EFAST, including approved
software vendors.
• See answers to frequently asked questions about the Form
5500 and EFAST.
• Access the main EBSA and DOL websites for news,
regulations, and publications.

A plan that fails to meet any of the above conditions must file
Form 5500 rather than Form 5500-EZ. A plan that meets all of
the above conditions is exempt from filing the Form 5500-EZ for
the plan year if the plan (and any other plans of the employer)
had total assets of $250,000 or less at the close of such plan
year effective on or after January 1, 2007. Plans beginning on
or before December 31, 2006, for which a Form 5500-EZ was
required to be filed, will not need to continue filing the Form
5500-EZ unless their total plan assets (for one or more
one-participant plans, separately or together) exceed $250,000
at the close of the plan year beginning on or after January 1,
2007. However, a Form 5500-EZ should be filed for the final
plan year regardless of whether the plan was required to file a
Form 5500-EZ for any prior year.

You can access the IRS website 24 hours a day, 7 days a week
at www.irs.gov to:
• View forms, instructions, and publications.
• See answers to frequently asked tax questions.
• Search publications on-line by topic or keyword.
• Send comments or request help by e-mail.
• Sign up to receive local and national tax news by e-mail.

Section 1: Who Must File
A return/report must be filed every year for every pension
benefit plan and welfare benefit plan, and for every entity that
files as a DFE as specified below (pursuant to Code section
6058 and ERISA sections 104 and 4065).

When filing Form 5500 for a plan described in Special

All pension benefit plans covered by ERISA are required to file
a Form 5500 except as provided in this Who Must File section.
The return/report is due whether or not the plan is qualified and
even if benefits no longer accrue, contributions were not made
this plan year, or contributions are no longer made. Pension
benefit plans required to file include both defined benefit plans
and defined contribution plans.

Pension Benefit Plan

For this purpose, 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) that
includes the business of the owner or partner covered by the
plan.

TIP Rules for Certain Plans of Partnerships and Wholly

Owned Trades or Businesses, enter code 3G on Part
II, line 8a.

The following are among the pension benefit plans for which
a return/report must be filed:
1. Profit-sharing plans, stock bonus plans, money purchase
plans, 401(k) plans, etc.
2. Annuity arrangements under Code section 403(b)(1).
3. Custodial accounts established under Code section
403(b)(7) for regulated investment company stock.
4. Individual retirement accounts (IRAs) established by an
employer under Code section 408(c).
5. Pension benefit plans maintained outside the United
States primarily for nonresident aliens if the employer who
maintains the plan is:
• a domestic employer, or
• a foreign employer with income derived from sources
within the United States (including foreign subsidiaries of
domestic employers) if contributions to the plan are deducted
on its U.S. income tax return. For this type of plan, enter 3A on
Form 5500, Part II, line 8a.
6. Church pension plans electing coverage under Code
section 410(d).
7. Pension benefit plans that cover residents of Puerto Rico,
the U.S. Virgin Islands, Guam, Wake Island, or American
Samoa. This includes a plan that elects to have the provisions
of section 1022(i)(2) of ERISA apply.
8. Plans that satisfy the Actual Deferral Percentage
requirements of Code section 401(k)(3)(A)(ii) by adopting the
‘‘SIMPLE’’ provisions of section 401(k)(11).

Do Not File a Form 5500 for a Pension Benefit Plan
That Is Any of the Following:

1. An unfunded excess benefit plan. See ERISA section
4(b)(5).
2. An annuity or custodial account arrangement under Code
section 403(b)(1) or (7) not established or maintained by an
employer as described in DOL Regulation 29 CFR 2510.3-2(f).
3. A Savings Incentive Match Plan for Employees of Small
Employers (SIMPLE) that involves SIMPLE IRAs under Code
section 408(p).
4. A simplified employee pension (SEP) or a salary
reduction SEP described in Code section 408(k) that conforms
to the alternative method of compliance in 29 CFR 2520.104-48
or 2520.104-49.
5. A church plan not electing coverage under Code section
410(d).
6. A pension plan that is a qualified foreign plan within the
meaning of Code section 404A(e) that does not qualify for the
treatment provided in Code section 402(e)(5).
7. An unfunded pension plan for a select group of
management or highly compensated employees that meets the
requirements of 29 CFR 2520.104-23, including timely filing of a
registration statement with the DOL.
8. An unfunded dues financed pension benefit plan that
meets the alternative method of compliance provided by 29
CFR 2520.104-27.
9. An individual retirement account or annuity not
considered a pension plan under 29 CFR 2510.3-2(d).
10. A governmental plan.

See What To File on page 8 for more information about
what must be completed for pension plans.

Special Rules for Certain Plans of Partnerships
and Wholly Owned Trades or Businesses

Welfare Benefit Plan
All welfare benefit plans covered by ERISA are required to file a
Form 5500 except as provided in this Who Must File section.
Welfare benefit plans provide benefits such as medical, dental,
life insurance, apprenticeship and training, scholarship funds,
severance pay, disability, etc.

A plan that provides deferred compensation solely for (1) an
individual or an individual and his or her spouse who wholly
own a trade or business, whether incorporated or
unincorporated, or (2) partners or the partners and the partners’
spouses in a partnership may generally file Form 5500-EZ,
Annual Return of One-Participant (Owners and Their Spouses)
General Instructions to Form 5500

See What To File on page 8 for more information.

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Instructions for Form 5500

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Reminder: The administrator of an employee welfare benefit
plan that provides benefits wholly or partially through a Multiple
Employer Welfare Arrangement (MEWA) as defined in ERISA
section 3(40) must file a Form 5500, unless otherwise exempt.

5. An employee benefit plan maintained only to comply with
workers’ compensation, unemployment compensation, or
disability insurance laws.
6. A welfare benefit plan that participates in a group
insurance arrangement that files a Form 5500 on behalf of the
welfare benefit plan as specified in 29 CFR 2520.103-2. See 29
CFR 2520.104-43.
7. An apprenticeship or training plan meeting all of the
conditions specified in 29 CFR 2520.104-22.
8. An unfunded dues financed welfare benefit plan
exempted by 29 CFR 2520.104-26.
9. A church plan under ERISA section 3(33).
10. A welfare benefit plan solely for (1) an individual or an
individual and his or her spouse, who wholly owns a trade or
business, whether incorporated or unincorporated, or
(2) partners or the partners and the partners’ spouses in a
partnership. See 29 CFR 2510.3-3(b).

IRS Notice 2002-24 does not suspend the filing of Form
5500 or any required schedules for a welfare plan
CAUTION subject to Title I of ERISA. Welfare plans that are
associated with fringe benefit plans must file the Form 5500 in
accordance with the Welfare Benefit Plan Filing
Requirements on page 10, unless they are exempt as
specified below. Welfare plans for which a Form 5500 must be
filed may be eligible for limited filing requirements. See the
limited reporting requirements for unfunded, fully insured or
combination unfunded/insured welfare plans on page 10.

Do Not File a Form 5500 for a Welfare Benefit Plan
That Is Any of the Following:

Direct Filing Entity (DFE)

Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 as a DFE in
accordance with the Direct Filing Entity (DFE) Filing
Requirements on page 11. A Form 5500 must be filed for a
master trust investment account (MTIA). A Form 5500 is not
required but may be filed for a common/collective trust (CCT),
pooled separate account (PSA), 103-12 investment entity
(103-12 IE), or group insurance arrangement (GIA). However,
plans that participate in CCTs, PSAs, 103-12 IEs, or GIAs that
file as DFEs generally are eligible for certain annual reporting
relief. For reporting purposes, a CCT, PSA, 103-12 IE, or GIA is
not considered a DFE unless a Form 5500 and all required
attachments are filed for it in accordance with the Direct Filing
Entity (DFE) Filing Requirements.
Note. Special requirements also apply to Schedules D and H
attached to the Form 5500 filed by plans participating in MTIAs,
CCTs, PSAs, and 103-12 IEs. See the instructions for these
schedules.

1. A welfare benefit plan that covered fewer than 100
participants as of the beginning of the plan year and is
unfunded, fully insured, or a combination of insured and
unfunded.
Note. To determine whether the plan covers fewer than 100
participants for purposes of these filing exemptions for insured
and unfunded welfare plans, see instructions for lines 6 and 7
on counting participants in a welfare plan. See also 29 CFR
2510.3-3(d).
a. An unfunded welfare benefit plan has its benefits paid as
needed directly from the general assets of the employer or
employee organization that sponsors the plan.
Note. Plans that are NOT unfunded include those plans that
received employee (or former employee) contributions during
the plan year and/or used a trust or separately maintained fund
(including a Code section 501(c)(9) trust) to hold plan assets or
act as a conduit for the transfer of plan assets during the year.
However, a welfare plan with employee contributions that is
associated with a cafeteria plan under Code section 125 may
be treated for annual reporting purposes as an unfunded
welfare plan if it meets the requirements of DOL Technical
Release 92-01, 57 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).
b. A fully insured welfare benefit plan has its benefits
provided exclusively through insurance contracts or policies, the
premiums of which must be paid directly to the insurance carrier
by the employer or employee organization from its general
assets or partly from its general assets and partly from
contributions by its employees or members (which the employer
or employee organization forwards within 3 months of receipt).
The insurance contracts or policies discussed above must be
issued by an insurance company or similar organization (such
as Blue Cross, Blue Shield or a health maintenance
organization) that is qualified to do business in any state.
c. A combination unfunded/insured welfare plan has its
benefits provided partially as an unfunded plan and partially as
a fully insured plan. An example of such a plan is a welfare
benefit plan that provides medical benefits as in a above and
life insurance benefits as in b above. See 29 CFR 2520.104-20.
Note. A ‘‘voluntary employees’ beneficiary association,’’ as
used in Code section 501(c)(9) (‘‘VEBA’’), should not be
confused with the employer or employee organization that
sponsors the plan. See ERISA section 3(4).
2. A welfare benefit plan maintained outside the United
States primarily for persons substantially all of whom are
nonresident aliens.
3. A governmental plan.
4. An unfunded or insured welfare plan for a select group of
management or highly compensated employees which meets
the requirements of 29 CFR 2520.104-24.

Section 2: When To File

Plans and GIAs. File 2008 return/reports for plan and GIA
years that began in 2008. All required forms, schedules,
statements, and attachments must be filed by the last day of the
7th calendar month after the end of the plan or GIA year (not to
exceed 12 months in length) that began in 2008. If the plan or
GIA year differs from the 2008 calendar year, fill in the fiscal
year beginning and ending dates on the line provided at the top
of the form.
DFEs other than GIAs. File 2008 return/reports no later than
91/2 months after the end of the DFE year that ended in 2008. A
Form 5500 filed for a DFE must report information for the DFE
year (not to exceed 12 months in length). If the DFE year differs
from the 2008 calendar year, fill in the fiscal year beginning and
ending dates on the line provided at the top of the form.
Short Years. For a plan year of less than 12 months (short
plan year), file the form and applicable schedules by the last
day of the 7th month after the short plan year ends. Fill in the
short plan year beginning and ending dates on the line provided
at the top of the form and check box B(4) in Part I. 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 on page 7 to determine if box B(3) should be checked.
Notes. (1) If the filing due date falls on a Saturday, Sunday, or
Federal holiday, the return/report may be filed on the next day
that is not a Saturday, Sunday, or Federal holiday. (2) If the
2008 Form 5500 is not available before the plan or DFE filing
due date, use the 2007 Form 5500 and enter the 2008 fiscal
year beginning and ending dates on the line provided at the top
of the form. However, see the following Caution. Plans required
to file an actuarial information schedule and some plans
required to file a Schedule R cannot use the 2007 forms in
place of the 2008 forms.

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2008 Short Plan Year Filings. Pursuant to the Pension
Protection Act of 2006 (PPA), separate actuarial
CAUTION schedules were developed for 2008 plan year filings for
single employer plans and multiemployer plans. For the 2008
plan year, the Schedule B is not a valid schedule. Rather, 2008
plan year filings must use the new Schedule SB
(Single-Employer Defined Benefit Plan Actuarial Information) or
Schedule MB (Multiemployer Defined Benefit Plan and Certain
Money Purchase Plan Actuarial Information). In addition, for
2008 plan year filings, multiemployer plans will need to file an
attachment to the Schedule R, Retirement Plan Information, to
report certain PPA-required information about contributing
employers and liabilities for two or more plans.

for extension of time to file the federal income tax return is
attached to the Form 5500. An extension granted by using this
automatic extension procedure CANNOT be extended further
by filing a Form 5558, nor can it be extended beyond a total of
91/2 months beyond the close of the plan year.

Defined benefit pension plans with 1,000 or more
participants will also be required to provide financial asset
breakout information as an attachment to the Schedule R. The
new supplemental attachments are described in the instructions
for the 2008 Schedule R.

Short plan year filers using this extension of time must check
Form 5500, Part I, box D, and attach a statement labeled with
the basis of the extension — “Form 5500, Box D – PPA
Actuarial Information Extension.”

Other Extensions of Time
The IRS, DOL, and PBGC may announce special extensions of
time under certain circumstances, such as extensions for
Presidentially-declared disasters or for service in, or in support
of, the Armed Forces of the United States in a combat zone.
See www.irs.gov, www.efast.dol.gov, and www.pbgc.gov/
practitioners for announcements regarding such special
extensions. If you are relying on one of these announced
special extensions, check Form 5500, Part I, box D and attach
a statement citing the announced authority for the extension.
The attachment must be appropriately labeled at the top of the
statement, for example, ‘‘Form 5500, Box D - DISASTER
RELIEF EXTENSION’’ or ‘‘Form 5500, Box D - COMBAT
ZONE EXTENSION.’’

Short plan year filers who are required to file a Schedule SB
or MB and/or required to file a supplemental attachment to
Schedule R for 2008 (filings for multiemployer defined benefit
plans and defined benefit plans with over 1,000 participants,
see the instructions to Schedule R on pages 51-53) cannot use
the 2007 forms to satisfy their 2008 filing requirements. These
filers will be granted an automatic extension of time for filing
their complete Form 5500 until 90 days after the 2008 forms
become available to use for filing.

Note. An extension of time to file the Form 5500 does not
operate as an extension of time to file a Form 5500 filed for a
DFE (other than a GIA) or to file PBGC premiums or annual
financial and actuarial reports (if required by section 4010 of
ERISA).

2009 Short Plan Year Filings. Short 2009 plan year filers
whose due date to submit their 2009 filing is before January 1,
2010, will be given an automatic extension to electronically file
their complete Form 5500 within 90 days after the 2009 filing
system is available on the DOL website. This special extension
is being granted to encourage such short 2009 plan year filers
to file their 2009 Form 5500 annual return/report electronically
under EFAST2. Short 2009 plan year filers whose due date to
submit their 2009 filing is before January 1, 2010, and who
choose not to take advantage of the special extension, must
use plan year 2008 forms and must submit their 2009 filing to
EFAST on or before the due date for their short plan year filing.

Delinquent Filer Voluntary Compliance (DFVC)
Program

The DFVC Program facilitates voluntary compliance by plan
administrators who are delinquent in filing annual reports under
Title I of ERISA by permitting administrators to pay reduced civil
penalties for voluntarily complying with their DOL annual
reporting obligations. If the Form 5500 is being filed under the
DFVC Program, check Form 5500, Part I, box D and attach a
statement explaining that the Form 5500 is being filed under the
DFVC Program with ‘‘Form 5500, Box D - DFVC FILING’’
prominently displayed at the top of the statement.

If the application for extension of time contains social
security numbers, ensure that these social security numbers
are not visible in the copy attached to the Form 5500. The Form
5500 and its attachments are open to public inspection, and the
contents are public information and are subject to publication on
the Internet. Because of privacy concerns, the inclusion of a
visible social security number on the Form 5500 or its
attachments may result in the rejection of the filing.

Extension of Time To File

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.

Using Form 5558

A plan or GIA may obtain a one-time extension of time to file
Form 5500 (up to 21/2 months) by filing Form 5558, Application
for Extension of Time To File Certain Employee Plan Returns,
on or before the normal due date (not including any extensions)
of the return/report. You MUST file Form 5558 with the IRS.

Private Delivery Service
You can use certain private delivery services designated by the
IRS to meet the “timely mailing as timely filing/paying” rule for
tax returns and payments. These private delivery services
include only the following:
• DHL Express (DHL): DHL Same Day Service, DHL Next Day
10:30 am, DHL Next Day 12:00 pm, DHL Next Day 3:00 pm,
and DHL 2nd Day Service.
• Federal Express (FedEx): FedEx Priority Overnight, FedEx
Standard Overnight, FedEx 2Day, FedEx International Priority,
and FedEx International First.
• United Parcel Service (UPS): UPS Next Day Air, UPS Next
Day Air Saver, UPS 2nd Day Air, UPS 2nd Day Air A.M., UPS
Worldwide Express Plus, and UPS Worldwide Express.

Approved copies of the Form 5558 will not be returned to the
filer. However, a photocopy of the completed extension request
that was filed must be attached to the Form 5500. (See Section
3: Where To File.)
File Form 5558 with the Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201-0027.

Using Extension of Time To File Federal Income Tax
Return
An automatic extension of time to file Form 5500 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; and (3) a copy of the application
General Instructions to Form 5500

The private delivery service can tell you how to get written
proof of the mailing date.
See Where To File on page 6 for the street address when
using a private delivery service.

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• Sign and date the Form 5500, and make sure that any
schedules or attachments that require a signature are properly
signed and dated.
• Check your math to avoid calculation errors.
• All lines on the Form 5500 must be completed unless
otherwise specified. All applicable schedules and/or
attachments must also be completed.
• All schedules and attachments to the Form 5500 must be
properly identified, and must include the name of the plan or
DFE, EIN, and plan number (PN) as found on the Form 5500,
lines 1a, 2b, and 1b, respectively. At the top of each
attachment, indicate the schedule and line, if any (e.g.,
Schedule H, line 4i ) to which the attachment relates. When
assembling the package for filing, you can place attachments to
a schedule either directly behind the schedule or at the end of
the filing.
• Attach the required accountant’s opinion and report. The
instructions in What To File on page 8 explain which plans and
DFEs are required to attach the opinion and report.
• Check boxes should be filled in completely or clearly marked
with an “X.” Do not mark on or near the bar code or in the upper
right corner of the form, as this will interfere with processing.
• Complete Part I - Annual Report Identification Information
at the top of the Form 5500. Do not mark final return/report in
line B of Part I if you are reporting participants and/or assets at
the end of the plan year.
• Complete Form 5500, lines 8 and 9, if applicable, to report all
benefits provided and plan funding/benefit arrangements.
• Enter on Form 5500, line 2d, if applicable, the correct
principal business activity code from pages 66, 67, or 68.

Section 3: Where To File
File the Form 5500, with any required schedules, statements,
and attachments, at the address indicated below. Beginning in
2010, check the EFAST website at www.efast.dol.gov for
updates to these addresses.

By mail:
Address for filing on paper
EBSA
P.O. Box 7043
Lawrence, KS 66044-7043

Address for filing on floppy disc, CD-ROM, or tape
EBSA
P.O. Box 7041
Lawrence, KS 66044-7041

By private delivery service:
Address for filing on paper, floppy disk, CD-ROM, or
tape

EBSA
Attn: EFAST
3833 Greenway Drive
Lawrence, KS 66046-5502

Section 4: How To File

Paper and Electronic Filing

As described in more detail below, the 2008 forms are available
in two computer scannable formats: machine print and hand
print (the questions are the same).

The return/report must be completed in accordance with the
Line-by-Line Instructions for the 2008 Form 5500 and
Schedules on page 15.
Answer all questions with respect to the plan or DFE year,
unless otherwise explicitly stated in the instructions or on the
form itself. Therefore, responses usually apply to the year
entered or printed at the top of the first page of the form.
Do not enter ‘‘N/A’’ or ‘‘Not Applicable’’ on the Form 5500 or
schedules unless specifically permitted by the form, schedules,
or instructions. ‘‘Yes’’ or ‘‘No’’ questions on the forms and
schedules must be marked either ‘‘Yes’’ or ‘‘No,’’ but not both.

CAUTION

Filers can choose a machine print format that is completed
by using EFAST-approved computer software that produces
computer scannable 2-D bar codes on the bottom of each page.
Machine print forms can be filed on paper, magnetic tape,
floppy diskette, or CD-ROM by mail (including certain private
delivery services) or filed electronically by approved EFAST
transmitters (authorized transmitters of forms by modem or file
transfer protocol). Filers can also choose a hand print format
that can be completed in one of two ways. You may complete
the IRS printed paper forms by hand or typewriter. You may
also choose to complete the hand print form by using computer
software from EFAST-approved vendors.

Do not enter social security numbers on the Form 5500,
schedules, or other attachments unless specifically
required by the form, schedules, or instructions.

Computer-generated forms CANNOT be printed out
blank, or with limited information, and then completed by
CAUTION pen or typewriter. These forms must be completed
entering the data by computer.

The Form 5500 and most of the schedules and attachments
are open to public inspection, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on the Form 5500 or on a schedule or attachment that
is open to public inspection may result in the rejection of the
filing.
An employer identification number (EIN) is a nine-digit
number assigned by the IRS for tax filing and reporting
purposes. Employers without an EIN must apply for one as
soon as possible. The EBSA does not issue EINs. To apply for
an EIN:
• 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.)
Filers make several common mistakes. To reduce the
possibility of correspondence and penalties:

The hand print format uses special printing standards that
enables EFAST to scan the hand, typewritten, and computer
entries and must be filed by mail (including certain private
delivery services). For plan year 2008 filings, paper Schedules
MB and SB are provided for completion by pen or typewriter
only. Forms are available from the IRS as discussed in How To
Get Forms and Related Publications on page 2. See www.
efast.dol.gov for a list of approved software vendors.

Form 5500 Completed by Pen
Use only the official hand print form. Enter only a single letter or
number within each box using blue or black ink. Abbreviate if
necessary. Where numbers are required, do not enter dollar
signs, commas, or decimal points. To indicate a negative
number, enter a minus sign “ – ” in the box to the left of the
number. See example below.

–

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beneficiaries or legally transferred to the control of another plan,
and when all liabilities for which benefits may be paid under a
welfare benefit plan have been satisfied, check the final return/
report box (Part I, box B(3)) at the top of the Form 5500. 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.

Form 5500 Completed by Typewriter
Use only the official hand print form. Type within the row of
boxes and ignore the vertical lines between the boxes. The
number of entries should not exceed the number of boxes (e.g.,
if there are 13 boxes, the numbers or letters entered should not
exceed 13). Abbreviate if necessary. Where numbers are
required, do not enter dollar signs, commas, or decimal points.
See the example of a typewritten positive number below. To
indicate a negative number, enter a minus sign “ – ” in the box to
the left of the number.

Examples:
Mergers/Consolidations

123456789012

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.

Form 5500 Completed by Using Computer
Software

Amended Return/Report

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).

Signature and Date

The plan administrator must sign and date a Form 5500 filed for
a pension or a welfare plan under ERISA sections 104 and/or
4065. Either the plan administrator or the employer may sign
and date a Form 5500 filed for a pension plan under Code
section 6058. Generally, a Form 5500 filed for a pension plan is
filed under both ERISA section 104 and Code section 6058.
When a joint employer-union board of trustees or committee
is the plan sponsor or plan administrator, at least one employer
representative and one union representative must sign and date
the Form 5500.

Use only software from an approved software vendor, which
may produce either a machine print or hand print form.
All forms completed using computer software must be
submitted on paper (except for machine print forms submitted
electronically, as described below). Paper filings must be
printed on only one side of standard 81/2 by 11 inch paper and
mailed to the address listed under Where To File on page 6.
To submit a machine print Form 5500 electronically, use only
software from an approved software vendor. An electronic
signature and an encryption key must be obtained by filing the
Application for EFAST Electronic Signature and Codes for
EFAST Transmitters and Software Developers Form
EFAST-1. You may, following the software’s instructions, either
(1) save the completed machine print Form 5500 to a 3.5 inch
floppy disc, CD-ROM, 4mm or 8mm DAT, 3480 or 3490
cartridge, or 9-track tape and submit the Form 5500 by mail or
private delivery service, or (2) submit by modem or FTP.
See www.efast.dol.gov for a list of approved software
vendors, the Form EFAST-1, and additional information.

Pension and Welfare Plans That Terminated Without
Distributing All Assets

File an amended return/report to correct errors and/or
omissions in a previously filed annual return/report for the 2008
plan year. The amended Form 5500 and any amended
schedules must conform to the requirements in this How To
File section.

A representative authorized to sign on behalf of the DFE
must sign the Form 5500 submitted for the DFE.
The administrator is required to maintain a copy of the
annual report with all required signatures, as part of the
CAUTION plan’s records, even if the annual report is filed
electronically. See 29 CFR 2520.103-1.

If you are filing a corrected return/report in response to
TIP correspondence from EBSA regarding the processing of
your return/report, do not check Part I, box B(2) to
identify the filing as an amended return/report unless the
correspondence includes instructions that specifically direct you
to check box B(2).
The procedure for amending the return/report depends upon
the type of form filed as specified below:

Change in Plan Year
Generally, only defined benefit pension plans need to get
approval for a change in plan year. However, under Rev. Proc. d
87-27, 1987-1 C.B. 769, these pension plans may be eligible for
automatic approval of a change in plan year. If a change in plan
year for a pension or a welfare plan creates a short plan year,
box B(4) in Part I of the Form 5500 must be checked and a
Form 5500, with all required schedules and attachments, must
be filed by the last day of the 7th calendar month after the end
of the short plan year.
Note. Plans required to file an actuarial information schedule
or the supplemental attachments to the Schedule R for certain
pension plans with their Form 5500 package must use the 2008
forms for their filings. See the Caution for 2008 Short Plan Year
Filings on page 5.

Paper Forms
Submit a completed, signed, and dated Form 5500 (be certain
to check box B(2)). Attach any schedules or attachments that
are being changed from the prior filing. Do not attach schedules
and attachments that are not being changed. Do not attach
schedules where only attachments are being amended. Only
identify schedules that are being amended on line 10 of Form
5500. If only attachments are being amended, do not identify
any schedules on line 10 of Form 5500.

Electronic Forms
Submit a completed and dated Form 5500 with electronic
signature (be certain to check box B(2)). Refile all schedules
and attachments, including those that are not being amended.
See the DOL website at www.efast.dol.gov for information on
electronic filing of amended return/reports.

Penalties
ERISA and the Code provide for the DOL and the IRS,
respectively, to assess or impose penalties for not giving
complete information and for not filing statements and returns/
reports. Certain penalties are administrative (i.e., they may be
imposed or assessed by one of the governmental agencies
delegated to administer the collection of the Form 5500 data).
Others require a legal conviction.

Final Return/Report
If all assets under the plan (including insurance/annuity
contracts) have been distributed to the participants and
General Instructions to Form 5500

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Exceptions:
(1) 80-120 Participant Rule: If the number of participants
reported on line 6 is between 80 and 120, and a Form 5500
was filed for the prior plan year, you may elect to complete the
return/report in the same category (‘‘large plan’’ or ‘‘small plan’’)
as was filed for the prior return/report. Thus, if a return/report
was filed for the 2007 plan year as a small plan, including the
Schedule I if applicable, and the number entered on line 6 of
the 2008 Form 5500 is 100 to 120, you may elect to complete
the 2008 Form 5500 and schedules in accordance with the
instructions for a small plan.
(2) Short Plan Year Rule: If the plan had a short plan year
of 7 months or less for either the prior plan year or the plan year
being reported on the 2008 Form 5500, an election can be
made to defer filing the accountant’s report in accordance with
29 CFR 2520.104-50. If such an election was made for the prior
plan year, the 2008 Form 5500 must be completed following the
requirements for a large plan, including the attachment of the
Schedule H and the accountant’s reports, regardless of the
number of participants entered in Part II, line 6.

Administrative Penalties
Listed below are various penalties under ERISA and the Code
that may be assessed or imposed for not meeting the Form
5500 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 explanation
for failure to file properly is for reasonable cause:
1. A penalty of up to $1,100 a day for each day a plan
administrator fails or refuses to file a complete report. See
ERISA section 502(c)(2) and 29 CFR 2560.502c-2.
2. A penalty of $25 a day (up to $15,000) for not filing
returns for certain plans of deferred compensation, trusts and
annuities, and bond purchase plans by the due date(s). See
Code section 6652(e).
3. A penalty of $1 a day (up to $5,000) for each participant
for whom a registration statement (Schedule SSA (Form 5500))
is required but not filed. See Code section 6652(d)(1).
4. A penalty of $1,000 for not filing an actuarial statement.
See Code section 6692.

Form 5500 Schedules
Pension Benefit Schedules

1. Any individual who willfully violates any provision of Part
1 of Title I of ERISA shall be fined not more than $100,000 or
imprisoned not more than 10 years, or both. See ERISA section
501.
2. A penalty up to $10,000, 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.

Schedule R (Retirement Plan Information) – is required for
a pension benefit plan that is a defined benefit plan or is
otherwise subject to Code section 412 or ERISA section 302.
Schedule R may also be required for certain other pension
benefit plans unless otherwise specified under Limited
Pension Plan Reporting on page 10. For additional
information, see the Schedule R instructions.
Schedule MB (Multiemployer Defined Benefit Plan and
Certain Money Purchase Plan Actuarial Information) – is
required for most multiemployer defined benefit plans and for
defined contribution pension plans that are currently amortizing
a funding waiver. For additional information, see the Schedule
MB and Schedule R instructions.
Schedule SB (Single-Employer Defined Benefit Plan
Actuarial Information) – is required for most single-employer
and multiple-employer defined benefit plans. For additional
information, see the Schedule SB instructions.
Schedule E (ESOP Annual Information) – is required for all
pension benefit plans with ESOP benefits. For additional
information, see the Schedule E instructions.
Schedule SSA (Annual Registration Statement Identifying
Separated Participants With Deferred Vested Benefits) –
may be used to report separated participants. For additional
information, see the Schedule SSA instructions.

Section 5: What To File

Other Penalties

The Form 5500 reporting requirements vary depending on
whether the Form 5500 is being filed for a ‘‘large plan,’’ a ‘‘small
plan,’’ and/or a DFE, and on the particular type of plan or DFE
involved (e.g., welfare plan, pension plan, common/collective
trust, pooled separate account, master trust investment
account, 103-12 IE, or group insurance arrangement).
The instructions below provide detailed information about
each of the Form 5500 schedules and which plans and DFEs
are required to file them. First, the schedules are grouped by
type: (1) Pension Benefit Schedules and (2) Financial
Schedules. Each schedule is listed separately with a description
of the subject matter covered by the schedule and the plans
and DFEs that are required to file the schedule.
Filing requirements are also listed by type of filer: (1)
Pension Benefit Plan Filing Requirements, (2) Welfare Benefit
Plan Filing Requirements, and (3) DFE Filing Requirements.
For each filer type there is a separate list of the schedules that
must be filed with the Form 5500 (including where applicable,
separate lists for large plan filers, small plan filers, and different
types of DFEs).
The filing requirements are summarized in a “Quick
Reference Chart for Form 5500, Schedules and Attachments”
on pages 13 and 14.
Generally, a return/report filed for a pension benefit plan or
welfare benefit plan that covered fewer than 100 participants as
of the beginning of the plan year should be completed following
the requirements below for a small pension plan or small
welfare plan, and a return/report filed for a plan that covered
100 or more participants as of the beginning of the plan year
should be completed following the requirements below for a
large pension plan or large welfare plan.
Use the number of participants required to be entered in line
6 of the Form 5500 to determine whether a plan is a “small
plan” or “large plan.”

Financial Schedules
Schedule H (Financial Information) – is required for
pension benefit plans and welfare benefit plans filing as “large
plans,” and for all DFE filings. Employee benefit plans, 103-12
IEs, and GIAs filing the Schedule H are generally required to
engage an independent qualified public accountant and attach
a report of the accountant pursuant to ERISA section
103(a)(3)(A). These plans and DFEs are also generally required
to attach to the Form 5500 a “Schedule of Assets (Held At
End of Year),” and, if applicable, a “Schedule of Assets
(Acquired and Disposed of Within Year),” and a “Schedule
of Reportable Transactions.” For additional information, see
the Schedule H instructions.
Exceptions: Insured, unfunded, or combination unfunded/
insured welfare plans as described in 29 CFR
2520.104-44(b)(1), and certain pension plans and
arrangements described in 29 CFR 2520.104-44(b)(2) and
Limited Pension Plan Reporting on page 10, are exempt from
completing the Schedule H.
Schedule I (Financial Information - Small Plan) – is
required for all pension benefit plans and welfare benefit plans
filing as ‘‘small plans,’’ except for certain pension plans and
arrangements described in 29 CFR 2520.104-44(b)(2) and

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8, respectively. If you are a small plan that does not meet the
eligibility conditions described below for the PPA-simplified
reporting option, you must file in accordance with the general
filing instructions in Who Must File and What To File.
You must meet all of these conditions to use the
PPA-simplified reporting option:
1. The plan must have had fewer than 25 participants at the
beginning of the plan year;
2. The plan must meet the conditions summarized on page
41 of these instructions for being exempt from the requirement
to be audited annually by an independent qualified public
accountant (but not by virtue of enhanced bonding);
3. The plan must not hold any employer securities at any
time during the plan year;
4. At all times during the plan year, the plan must be 100%
invested in assets that have a readily determinable fair market
value 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; and cash and cash equivalents held
by a bank. Participant loans meeting the requirements of ERISA
section 408(b)(1) are also eligible assets for this purpose
whether or not they have been deemed distributed; and
5. The plan must not be a multiemployer plan.

Limited Pension Plan Reporting on page 10. For additional
information, see the Schedule I instructions.
Schedule A (Insurance Information) – is required if any
benefits under an employee benefit plan are provided by an
insurance company, insurance service or other similar
organization (such as Blue Cross, Blue Shield, or a health
maintenance organization). This includes investment contracts
with insurance companies, such as guaranteed investment
contracts and pooled separate accounts. For additional
information, see the Schedule A instructions.
Note. Do not file Schedule A for Administrative Services Only
(ASO) contracts. Do not file Schedule A if a Schedule A is filed
for the contract as part of the Form 5500 filed directly by a
master trust investment account or 103-12 IE. Do not file
Schedule A if the plan covers only: (1) an individual or an
individual and his or her spouse who wholly own a trade or
business, whether incorporated or unincorporated; or (2)
partners, or partners and one or more of the partner’s spouses
in a partnership.
Schedule C (Service Provider Information) – is required for
a large plan, MTIA, 103-12 IE, or GIA if (1) any service provider
who rendered services to the plan or DFE during the plan or
DFE year received $5,000 or more in compensation, directly or
indirectly from the plan or DFE, or (2) an accountant and/or
enrolled actuary has been terminated. For additional
information, see the Schedule C instructions.
Schedule D (DFE/Participating Plan Information) – Part I
is required for a plan or DFE that invested or participated in any
MTIAs, 103-12 IEs, CCTs, and/or PSAs. Part II is required
when the Form 5500 is filed for a DFE. For additional
information, see the Schedule D instructions.
Schedule G (Financial Transaction Schedules) – is
required for a large plan, MTIA, 103-12 IE, or GIA when
Schedule H (Financial Information) lines 4b, 4c, and/or 4d are
checked ‘‘Yes.’’ Part I of the Schedule G reports loans or fixed
income obligations in default or classified as uncollectible. Part
II of the Schedule G reports leases in default or classified as
uncollectible. Part III of the Schedule G reports nonexempt
transactions. For additional information, see the Schedule G
instructions.

If the plan must answer “Yes” and enter an amount on

TIP Schedule I, line 3a, b, c, d, f, or g, the plan cannot use
the voluntary PPA-simplified option.

Note: Direct Filing Entities (DFEs) cannot use this reporting
option. The existing annual reporting exemption for welfare
plans with fewer than 100 participants in 29 CFR 2520.104-20
(described in footnote 3 on page 14 of these instructions) is not
affected by this PPA-simplified reporting option.

Pension Benefit Plan Filing
Requirements

Voluntary Alternative Reporting Option
for Certain Plans with Fewer Than 25
Participants

Pension benefit plan filers must complete the Form 5500,
including the signature block and, unless otherwise specified,
attach the following schedules and information:

The Pension Protection Act of 2006 (PPA) required the
Department of Labor and the Department of the Treasury to
provide a simplified report for plan years beginning after
December 31, 2006, for plans with fewer than 25 participants as
of the beginning of the plan year. For the 2008 plan year, plans
with fewer than 25 participants that meet the eligibility
conditions below may voluntarily choose to file the following, as
applicable, as a simplified annual return/report:
1. The entire Form 5500;
2. Schedule A for any insurance contract for which a
Schedule A is required under current rules for completing lines
A, B, C, D, and the insurance fee and commission information
in Part I;
3. The entire Schedule SB (or Schedule MB for certain
money purchase plans);
4. The entire Schedule I;
5. Schedule R identifying information and Part II; and
6. The entire Schedule SSA.

Small Pension Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a small pension plan:
1. Schedule A (as many as needed), to report insurance,
annuity, and investment contracts held by the plan.
2. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan participated at any time during the
plan year.
3. Schedule E, to report ESOP annual information, if
applicable.
4. Schedule I, to report small plan financial information,
unless exempt.
5. Schedule MB, to report actuarial information, if
applicable.
6. Schedule R, to report retirement plan information, if
applicable.
7. Schedule SB, to report actuarial information, if applicable.
8. Schedule SSA (only one page 1 with as many pages 2 as
needed), to report separated vested participant information, if
applicable.

This is a voluntary simplified reporting option. Small plan
filers that meet the eligibility conditions below can also choose
to file in accordance with the general filing instructions for a
small plan in Who Must File and What To File on pages 3 and
General Instructions to Form 5500

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If Schedule I, line 4k, is checked “No,” you must attach
the report of the independent qualified public accountant
CAUTION (IQPA) or a statement that the plan is eligible and elects
to defer attaching the IQPA’s opinion pursuant to 29 CFR
2520.104-50 in connection with a short plan year of seven
months or less.

below) should not be reported in Part I of Schedule H or I. All
other assets should be reported on Schedule H or Schedule I,
and any other required schedules. If Schedule H is filed, attach
an accountant’s report in accordance with the Schedule H
instructions.
Note. For purposes of the annual return/report and the
alternative method of compliance set forth in 29 CFR
2520.104-44, a contract is considered to be ‘‘allocated’’ only if
the insurance company or organization that issued the contract
unconditionally guarantees, upon receipt of the required
premium or consideration, to provide a retirement benefit of a
specified amount. This amount must be provided to each
participant without adjustment for fluctuations in the market
value of the underlying assets of the company or organization,
and each participant must have a legal right to such benefits,
which is legally enforceable directly against the insurance
company or organization. For example, deposit administration,
immediate participation guarantee, and guaranteed investment
contracts are NOT allocated contracts for Form 5500 purposes.
4. Nonqualified pension benefit plans maintained
outside the United States: Nonqualified pension benefit plans
maintained outside the United States primarily for nonresident
aliens required to file a return/report (see Who Must File on
page 3) must complete the entire Form 5500 and are not
required to attach any schedules (enter 3A in Part II, line 8a).

Large Pension Plan

CAUTION

Welfare benefit plan filers must complete the Form 5500,
including the signature block and, unless otherwise specified,
attach the following schedules and information:

Small Welfare Plan

Welfare Benefit Plan Filing Requirements

The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a small welfare plan:
1. Schedule A (as many as needed), to report insurance
contracts held by the plan.
2. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan participated at any time during the
plan year.
3. Schedule I, to report small plan financial information.

You must attach the report of the independent qualified
public accountant identified on Schedule H, line 3c,
unless line 3d(2) is checked.

Limited Pension Plan Reporting

The pension plans or arrangements described below are
eligible for limited annual reporting:
1. 403(b) Arrangements: A pension plan or arrangement
using a tax deferred annuity arrangement under Code section
403(b)(1) and/or a custodial account for regulated investment
company stock under Code section 403(b)(7) as the sole
funding vehicle for providing pension benefits need complete
only Form 5500, Part I and Part II, lines 1 through 5, and 8
(enter pension feature code 2L, 2M, or both).
Note. The administrator of an arrangement described above
is not required to engage an independent qualified public
accountant, attach an accountant’s opinion to the Form 5500, or
attach any schedules to the Form 5500.
2. IRA Plans: A pension plan utilizing individual retirement
accounts or annuities (as described in Code section 408) as the
sole funding vehicle for providing pension benefits need
complete only Form 5500, Part I and Part II, lines 1 through 5,
and 8 (enter pension feature code 2N).
3. Fully Insured Pension Plan: A pension benefit plan
providing benefits exclusively through an insurance contract or
contracts that are fully guaranteed and that meet all of the
conditions of 29 CFR 2520.104-44(b)(2) during the entire plan
year must complete all the requirements listed under this
Pension Benefit Plan Filing Requirements section, except
that such a plan is exempt from attaching Schedule H,
Schedule I, and an accountant’s opinion, and from the
requirement to engage an independent qualified public
accountant.
A pension benefit plan that has insurance contracts of the
type described in 29 CFR 2520.104-44 as well as other assets
must complete all requirements for a pension benefit plan,
except that the value of the plan’s allocated contracts (see

Large Welfare Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a large welfare plan:
1. Schedule A (as many as needed), to report insurance
and investment contracts held by the plan.
2. Schedule C, if applicable, to list service providers and
any terminated accountants or actuaries.
3. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan invested at any time during the
plan year.
4. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
plan year, leases in default or classified as uncollectible, and
nonexempt transactions, i.e., file Schedule G if Schedule H
(Form 5500) lines 4b, 4c, and/or 4d are checked ‘‘Yes’’ or if a
large welfare plan that is not required to file a Schedule H has
nonexempt transactions.
5. Schedule H, to report financial information, unless
exempt.

The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a large pension plan:
1. Schedule A (as many as needed), to report insurance,
annuity, and investment contracts held by the plan.
2. Schedule C, to list the 40 most highly compensated
service providers and, if applicable, any terminated accountants
or enrolled actuaries.
3. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan invested at any time during the
plan year.
4. Schedule E, to report ESOP annual information, if
applicable.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
plan year, leases in default or classified as uncollectible, and
nonexempt transactions, i.e., file Schedule G if Schedule H
(Form 5500) lines 4b, 4c, and/or 4d are checked ‘‘Yes.’’
6. Schedule H, to report financial information, unless
exempt.
7. Schedule MB, to report actuarial information, if
applicable.
8. Schedule R, to report retirement plan information, if
applicable.
9. Schedule SB, to report actuarial information, if applicable.
10. Schedule SSA (only one page 1 with as many pages 2 as
needed), to report separated vested participant information, if
applicable.

CAUTION

Attach the report of the independent qualified public
accountant identified on Schedule H, line 3c, unless line
3d(2) is checked.
Neither Schedule H nor an accountant’s opinion should

TIP be attached to a Form 5500 filed for an unfunded, fully
insured or combination unfunded/insured welfare plan
(as defined on page 4) that covered 100 or more participants as

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of the beginning of the plan year which meets the requirements
of 29 CFR 2520.104-44. However, Schedule G, Part III, must
be attached to the Form 5500 to report any nonexempt
transactions. A welfare benefit plan that uses a ‘‘voluntary
employees’ beneficiary association’’ (VEBA) under Code
section 501(c)(9) is generally not exempt from the requirement
of engaging an independent qualified public accountant.

trust) on the plan’s Form 5500. (2) If a master trust holds assets
attributable to participant or beneficiary directed transactions
under an individual account plan and the assets are interests in
registered investment companies, interests in contracts issued
by an insurance company licensed to do business in any state,
interests in common/collective trusts maintained by a bank,
trust company or similar institution, or the assets have a current
value that is readily determinable on an established market,
those assets may be treated as a single MTIA.

Direct Filing Entity (DFE) Filing
Requirements

The Form 5500 submitted for the MTIA must comply with the
Form 5500 instructions for a Large Pension Plan, unless
otherwise specified in the forms and instructions. The MTIA
must file:
1. Form 5500, except lines C, D, 1c, 2d, and 6 through 9.
Be certain to enter ‘‘M’’ on line A(4).
2. Schedule A (as many as needed) to report insurance,
annuity and investment contracts held by the MTIA.
3. Schedule C, to report service provider information. Part II
is not required for a MTIA.
4. Schedule D, to list CCTs, PSAs, and 103-12 IEs in which
the MTIA invested at any time during the MTIA year and to list
all plans that participated in the MTIA during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
MTIA year, all leases in default or classified as uncollectible,
and nonexempt transactions.
6. Schedule H, except lines 1b(1), 1b(2), 1c(8), 1g, 1h, 1i,
2a, 2b(1)(E), 2e, 2f, 2g, 4a, 4e, 4f, 4g, 4h, 4k, and 5, to report
financial information. An accountant’s opinion is not required for
a MTIA.
7. Additional information required by the instructions to the
above schedules, including, for example, the schedules of
assets held for investment and the schedule of reportable
transactions. For purposes of the schedule of reportable
transactions, the 5% figure shall be determined by comparing
the current value of the transaction at the transaction date with
the current value of the investment account assets at the
beginning of the applicable fiscal year of the MTIA. All
attachments must be properly labeled.

Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 as a DFE. A
Form 5500 must be filed for a master trust investment account
(MTIA). A Form 5500 is not required but may be filed for a
common/collective trust (CCT), pooled separate account (PSA),
103-12 investment entity (103-12 IE), or group insurance
arrangement (GIA). However, plans that participate in CCTs,
PSAs, 103-12 IEs, or GIAs that file as DFEs generally are
eligible for certain annual reporting relief. For reporting
purposes, a CCT, PSA, 103-12 IE, or GIA is considered a DFE
only when a Form 5500 and all required attachments are filed
for it in accordance with the following instructions.
Only one Form 5500 should be filed for each DFE for all
plans participating in the DFE; however, the Form 5500 filed for
the DFE, including all required schedules and attachments,
must report information for the DFE year (not to exceed 12
months in length) that ends with or within the participating
plan’s year.
Any Form 5500 filed for a DFE is an integral part of the
annual report of each participating plan and the plan
administrator may be subject to penalties for failing to file a
complete annual report unless both the DFE Form 5500 and the
plan’s Form 5500 are properly filed. The information required
for a Form 5500 filed for a DFE varies according to the type of
DFE. The following paragraphs provide specific guidance for
the reporting requirements for each type of DFE.

Master Trust Investment Account (MTIA)

The administrator filing a Form 5500 for an employee benefit
plan is required to file or have a designee file a Form 5500 for
each MTIA in which the plan participated at any time during the
plan year. For reporting purposes, a ‘‘master trust’’ is a trust for
which a regulated financial institution (as defined below) serves
as trustee or custodian (regardless of whether such institution
exercises discretionary authority or control with respect to the
management of assets held in the trust), and in which assets of
more than one plan sponsored by a single employer or by a
group of employers under common control are held.
‘‘Common control’’ is determined on the basis of all relevant
facts and circumstances (whether or not such employers are
incorporated).
A ‘‘regulated financial institution’’ means a bank, trust
company, or similar financial institution that is regulated,
supervised, and subject to periodic examination by a state or
federal agency. A securities brokerage firm is not a ‘‘similar
financial institution’’ as used here. See DOL Advisory Opinion
93-21A (available at www.dol.gov/ebsa).
The assets of a master trust are considered for reporting
purposes to be held in one or more ‘‘investment accounts.’’ A
‘‘master trust investment account’’ may consist of a pool of
assets or a single asset. Each pool of assets held in a master
trust must be treated as a separate MTIA if each plan that has
an interest in the pool has the same fractional interest in each
asset in the pool as its fractional interest in the pool, and if each
such plan may not dispose of its interest in any asset in the pool
without disposing of its interest in the pool. A master trust may
also contain assets that are not held in such a pool. Each such
asset must be treated as a separate MTIA.
Notes. (1) If a MTIA consists solely of one plan’s asset(s)
during the reporting period, the plan may report the asset(s)
either as an investment account on a MTIA Form 5500, or as a
plan asset(s) that is not part of the master trust (and therefore
subject to all instructions concerning assets not held in a master

Common/Collective Trust (CCT) and Pooled
Separate Account (PSA)

A Form 5500 is not required to be filed for a CCT or PSA.
However, the administrator of a large plan or DFE that
participates in a CCT or PSA that files as specified below is
entitled to reporting relief that is not available to plans or DFEs
participating in a CCT or PSA for which a Form 5500 is not
filed.

General Instructions to Form 5500

For reporting purposes, ‘‘common/collective trust’’ and
‘‘pooled separate account’’ are, respectively: (1) a trust
maintained by a bank, trust company, or similar institution or (2)
an account maintained by an insurance carrier, which are
regulated, supervised, and subject to periodic examination by a
state or federal agency in the case of a CCT, or by a state
agency in the case of a PSA, for the collective investment and
reinvestment of assets contributed thereto from employee
benefit plans maintained by more than one employer or
controlled group of corporations as that term is used in Code
section 1563. See 29 CFR 2520.103-3, 103-4, 103-5, and
103-9.
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR
2510.3-101(h)(1)(iii) does not constitute a pooled separate
account.
The Form 5500 submitted for a CCT or PSA must comply
with the Form 5500 instructions for a Large Pension Plan,
unless otherwise specified in the forms and instructions. The
CCT or PSA must file:
1. Form 5500, except lines C, D, 1c, 2d, and 6 through 9.
Enter ‘‘C’’ or ‘‘P,’’ as appropriate, on line A(4).
2. Schedule D, to list all CCTs, PSAs, MTIAs, and 103-12
IEs in which the CCT or PSA invested at any time during the

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CCT or PSA year and to list in Part II all plans that participated
in the CCT or PSA during its year.
3. Schedule H, except lines 1b(1), 1b(2), 1c(8), 1d, 1e, 1g,
1h, 1i, 2a, 2b(1)(E), 2e, 2f, and 2g, to report financial
information. Part IV and an accountant’s opinion are not
required for a CCT or PSA.

year, and to list all plans that participated in the 103-12 IE
during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
103-12 IE year, leases in default or classified as uncollectible,
and nonexempt transactions.
6. Schedule H, except lines 1b(1), 1b(2), 1c(8), 1d, 1e, 1g,
1h, 1i, 2a, 2b(1)(E), 2e, 2f, 2g, 4a, 4e, 4f, 4g, 4h, 4j, 4k, and 5,
to report financial information.
7. Additional information required by the instructions to the
above schedules, including, for example, the report of the
independent qualified public accountant identified on Schedule
H, line 3c, and the schedule(s) of assets held for investment. All
attachments must be properly labeled.

Different requirements apply to the Schedules D and H
attached to the Form 5500 filed by plans and DFEs
CAUTION participating in CCTs and PSAs, depending upon
whether a DFE Form 5500 has been filed for the CCT or PSA.
See the instructions for these schedules.

103-12 Investment Entity (103-12 IE)

Group Insurance Arrangement (GIA)

Each welfare benefit plan that is part of a group insurance
arrangement is exempted from the requirement to file a Form
5500 if a consolidated Form 5500 report for all the plans in the
arrangement was filed in accordance with 29 CFR 2520.104-43.
For reporting purposes, a ‘‘group insurance arrangement’’
provides benefits to the employees of two or more unaffiliated
employers (not in connection with a multiemployer plan or a
collectively-bargained multiple-employer plan), fully insures one
or more welfare plans of each participating employer, uses a
trust or other entity as the holder of the insurance contracts,
and uses a trust as the conduit for payment of premiums to the
insurance company. The GIA must file:
1. Form 5500, except lines C and 2d. (Enter ‘‘G’’ on line
A(4).)
2. Schedule A (as many as needed), to report insurance,
annuity and investment contracts held by the GIA.
3. Schedule C, to report service provider information and
any terminated accountants.
4. Schedule D, to list all CCTs, PSAs, and 103-12 IEs in
which the GIA invested at any time during the GIA year, and to
list all plans that participated in the GIA during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
GIA year, leases in default or classified as uncollectible, and
nonexempt transactions.
6. Schedule H, except lines 4a, 4e, 4f, 4g, 4h, 4k, and 5, to
report financial information.
7. Additional information required by the instructions to the
above schedules, including, for example, the report of the
independent qualified public accountant identified on Schedule
H, line 3c, the schedules of assets held for investment and the
schedule of reportable transactions. (All attachments must be
properly labeled.)

DOL Regulation 2520.103-12 provides an alternative method of
reporting for plans that invest in an entity (other than a MTIA,
CCT, or PSA), whose underlying assets include ‘‘plan assets’’
within the meaning of 29 CFR 2510.3-101 of two or more plans
that are not members of a ‘‘related group’’ of employee benefit
plans. Such an entity for which a Form 5500 is filed constitutes
a ‘‘103-12 IE.’’ A Form 5500 is not required to be filed for such
entities; however, filing a Form 5500 as a 103-12 IE provides
certain reporting relief, including the limitation of the
examination and report of the independent qualified public
accountant provided by 29 CFR 2520.103-12(d), to participating
plans and DFEs. For this reporting purpose, a ‘‘related group’’
of employee benefit plans consists of each group of two or
more employee benefit plans (1) each of which receives 10% or
more of its aggregate contributions from the same employer or
from a member of the same controlled group of corporations (as
determined under Code section 1563(a), without regard to
Code section 1563(a)(4) thereof); or (2) each of which is either
maintained by, or maintained pursuant to a
collective-bargaining agreement negotiated by, the same
employee organization or affiliated employee organizations. For
purposes of this paragraph, an ‘‘affiliate’’ of an employee
organization means any person controlling, controlled by, or
under common control with such organization. See 29 CFR
2520.103-12.
The Form 5500 submitted for a 103-12 IE must comply with
the Form 5500 instructions for a Large Pension Plan, unless
otherwise specified in the forms and instructions. The 103-12 IE
must file:
1. Form 5500, except lines C, D, 1c, 2d, and 6 through 9.
Enter ‘‘E’’ on line A(4).
2. Schedule A (as many as needed), to report insurance,
annuity and investment contracts held by the 103-12 IE.
3. Schedule C, to report service provider information and
any terminated accountants.
4. Schedule D, to list all CCTs, PSAs, and 103-12 IEs in
which the 103-12 IE invested at any time during the 103-12 IE’s

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Quick Reference Chart for Form 5500, Schedules and Attachments1
Large
Pension Plan

Small
Pension Plan2

Large Welfare
Plan

Small Welfare
Plan2

DFE

Form 5500

Must complete.

Must complete.3

Must complete.

Schedule A
(Insurance
Information)

Must complete if
plan has insurance
contracts for
benefits or
investments.

Must complete if
MTIA, 103-12 IE, or
GIA has insurance
contracts for
benefits or
investments.

Not required.

MTIAs, GIAs, and
103-12 IEs must
complete Part I if
service provider
paid $5,000 or
more. GIAs and
103-12 IEs must
complete Part II if
accountant was
terminated.

Not required.

Schedule D
(DFE/Participating
Plan Information)

Must complete Part I
if plan participated in
a CCT, PSA, MTIA,
or 103-12 IE.

Must complete Part I
if plan participated in
CCT, PSA, MTIA, or
103-12 IE.

Schedule E
(ESOP Annual
Information)
Schedule G
(Financial
Transaction
Schedules)

Must complete if
ESOP.

Must complete Part I
if plan participated in
CCT, PSA, MTIA, or
103-12 IE.

Must complete if
ESOP.

Not required.

Must complete if
Schedule H, line 4b,
4c, or 4d is “Yes.”3, 4

Must complete if
Schedule H, line 4b,
4c, or 4d is “Yes.”4

Must complete if
service provider was
paid $5,000 or more
and/or an
accountant or
actuary was
terminated.

Schedule C
(Service Provider
Information)

Must complete if
service provider was
paid $5,000 or more
and/or an
accountant or
actuary was
terminated.

Must complete Part
I if plan participated
in CCT, PSA, MTIA,
or 103-12 IE.

All DFEs must
complete Part II,
and DFEs that
invest in a CCT,
PSA, or 103-12 IE
must also complete
Part I.

Not required.

MTIAs, GIAs, and
103-12 IEs must
complete if
Schedule H, line 4b,
4c, or 4d is “Yes.”4

Not required.

Must complete.3, 4

Not required.

Must complete.

Not required.

Must complete.3

Not required.

Schedule MB
(Multiemployer
Defined Benefit Plan
and Certain Money
Purchase Plan
Actuarial
Information)

Must complete if
plan is subject to
minimum funding
standards.5

Not required.

Schedule R
(Retirement Plan
Information)

Must complete.6

Not required.

Schedule SB
(Single-Employer
Defined Benefit Plan
Actuarial
Information)

Must complete if
plan is subject to
minimum funding
standards.

Not required.

D
Must complete.4

All DFEs must
complete Parts I, II,
and III. MTIAs,
103-12 IEs, and
GIAs must also
complete Part IV.4

Schedule H
(Financial
Information)

Schedule I
(Financial
Information – Small
Plan)

General Instructions to Form 5500

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Large
Pension Plan
Schedule SSA
(Annual Registration
Statement
Identifying
Separated
Participants With
Deferred Vested
Benefits)
Accountant’s
Report

Small
Pension Plan2

Large Welfare
Plan

Small Welfare
Plan2

DFE

Must complete if
plan had separated
participants with
deferred vested
benefits to report.

Not required.

Must attach.

Not required unless
Schedule I, line 4k,
is checked “No.”

Must attach.3

Not required.

Must attach for a
GIA or 103-12 IE.

This chart provides only general guidance. Not all rules and requirements are reflected. Refer to specific Form 5500 instructions for complete
information on filing requirements (e.g., Who Must File on page 3 and What To File on page 8). For example, a pension plan is exempt from filing
any schedules if the plan uses a Code section 403(b)(1) annuity, 403(b)(7) custodial account, or 408 individual retirement accounts or annuities as
the sole funding vehicle for providing benefits. See Limited Pension Plan Reporting on page 10.

Pension benefit plans and welfare plans with fewer than 25 participants that are not exempt from filing an annual return/report may be eligible to
file a simplified report. See Voluntary Alternative Reporting Option for Certain Plans with Fewer Than 25 Participants on page 9 for a list of
d
conditions that must be met to be eligible for simplified reporting.
3 Unfunded, fully insured and combination unfunded/insured welfare plans covering fewer than 100 participants at the beginning of the plan year
that meet the requirements of 29 CFR 2520.104-20 are exempt from filing an annual report. (See Who Must File on page 3.) Such a plan with 100
or more participants must file an annual report, but is exempt under 29 CFR 2520.104-44 from the accountant’s report requirement and completing
Schedule H, but MUST complete Schedule G, Part III, to report any nonexempt transactions. See What To File on page 8.
4 Schedules of assets and reportable (5%) transactions also must be filed with the Form 5500 if Schedule H, line 4i or 4j is “Yes,” but use of printed
form is not required.
5 Certain money purchase defined contribution plans are required to complete Schedule MB, lines 3, 9, and 10 in accordance with the instructions
for Schedule R, line 5.
6 A pension plan is exempt from filing Schedule R if all of the following five conditions are met:
• The plan is not a multiemployer defined benefit plan.
• The plan is not a defined benefit plan or otherwise subject to the minimum funding standards of Code section 412 or ERISA section 302.
• No in-kind distributions reportable on line 1 of Schedule R were distributed during the plan year.
• No benefits were distributed during the plan year which are reportable on Form 1099-R using an EIN other than that of the plan sponsor or plan
administrator.
• In the case of a plan that is not a profit-sharing, ESOP or stock bonus plan, no plan benefits were distributed during the plan year in the form of a
single-sum distribution.

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General Instructions to Form 5500

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Section 6: Line-by-Line
Instructions for the 2008
Form 5500 and Schedules
Part I - Annual Report Identification Information
File Form 5500 with ‘‘2008’’ printed in the upper right corner for
a plan year that began in 2008 or a DFE year that ended in
2008. If the plan or DFE year is not the 2008 calendar year,
enter the dates in Part I. If the 2008 Form 5500 is not available
before the filing due date, use the 2007 Form 5500 and enter
the dates the plan or DFE year began and ended in Part I.
However, see the Caution on page 5 identifying plans that
cannot use the 2007 forms to satisfy their 2008 filing
requirements.

Master Trust
Investment Account

Common/Collective Trust

Pooled Separate
Account

103-12 Investment
Entity

Group Insurance
Arrangement

Box B(1). Check this box if an annual return/report has not
been previously filed for this plan or DFE. For the purpose of
completing box B(1), the Form 5500-EZ is not considered an
annual return/report.
Box B(2). Check this box if this Form 5500 is being submitted
as an amended return/report to correct errors and/or omissions
on a previously filed Form 5500 for the 2008 plan year. If you
are filing a corrected return/report in response to
correspondence from EBSA regarding the processing of your
return/report, do not check Part I, box B(2) to identify the filing
as an amended return/report unless the correspondence
includes instructions that specifically direct you to check box
B(2).
Box B(3). Check this box if this Form 5500 is the last Form
5500 required to be submitted for this plan. (See Final Return/
Report on page 7.)
Note. Do not check box B(3) if “4R” is entered on line 8b for a
welfare plan that is not required to file a Form 5500 for the next
plan year because the welfare plan has become eligible for an
annual reporting exemption. For example, certain unfunded and
insured welfare plans may be required to file the 2008 Form
5500 and be exempt from filing a Form 5500 for the plan year
2009 if the number of participants covered as of the beginning
of the 2009 plan year drops below 100. See Who Must File on
page 3. Should the number of participants covered by such a
plan increase to 100 or more in a future year, the plan should
resume filing Form 5500 and enter ‘‘4S’’ on line 8b on that
year’s Form 5500. See 29 CFR 2520.104-20.
Box B(4). Check this box if this Form 5500 is filed for a plan
year of less than 12 months.
Box C. Check box C when the contributions to the plan and/or
the benefits paid by the plan are subject to the collective
bargaining process (even if the plan is not established and
administered by a joint board of trustees and even if only some
of the employees covered by the plan are members of a
collective bargaining unit that negotiates contributions and/or
benefits). The contributions and/or benefits do not have to be
identical for all employees under the plan.
Box D. Check this box if:
• You filed for an extension of time to file this form with the IRS
using a completed Form 5558, Application for Extension of
Time To File Certain Employee Plan Returns (attach a copy of
the Form 5558 to the return/report);
• You are filing using the automatic extension of time to file
Form 5500 until the due date of the Federal income tax return
of the employer (attach a copy of the employer’s extension of
time to file the income tax return to the return/report);
• You are filing using a special extension of time to file Form
5500 that has been announced by the IRS, DOL, and PBGC.
Attach a statement citing the announced authority for the
extension. The attachment must be appropriately labeled at the
top of the statement (e.g., ‘‘Form 5500, Box D - DISASTER
RELIEF EXTENSION’’ or ‘‘Form 5500, Box D - COMBAT
ZONE EXTENSION’’). See Other Extensions of Time on
page 5, for more information.

A “controlled group” is generally considered one employer
for Form 5500 reporting purposes. A “controlled group” is a
controlled group of corporations under Code section 414(b), a
group of trades or businesses under common control under
Code section 414(c), or an affiliated service group under Code
section 414(m).

Enter the letter

Note. A separate annual report with “M” entered on Form
5500, box A(4), must be filed for each MTIA. See definition on
page 11.

One Form 5500 is generally filed for each plan or entity
described in the instructions to boxes A(1) through A(4) below.
Do not check more than one box.
A separate Form 5500, with box A(2) checked, must be filed
by each employer participating in a plan or program of benefits
in which the funds attributable to each employer are available to
pay benefits only for that employer’s employees, even if the
plan is maintained by a controlled group.

Type of entity

Box A(1). Multiemployer Plan. Check this box if the Form
5500 is filed for a multiemployer plan. A plan is a multiemployer
plan if: (a) more than one employer is required to contribute, (b)
the plan is maintained pursuant to one or more collective
bargaining agreements between one or more employee
organizations and more than one employer, and (c) an election
under Code section 414(f)(5) and ERISA section 3(37)(E) has
not been made. A plan that made a proper election under
ERISA section 3(37)(G) and Code section 414(f)(6) on or
before August 17, 2007, is also a multiemployer plan.
Participating employers do not file individually for these plans.
See 29 CFR 2510.3-37.
Box A(2). Single-Employer Plan. Check this box if the Form
5500 is filed for a single-employer plan. A single-employer plan
for this Form 5500 reporting purpose is an employee benefit
plan maintained by one employer or one employee
organization.

Box A(3). Multiple-Employer Plan. Check this box if the
Form 5500 is being filed for a multiple-employer plan. A
multiple-employer plan is a plan that is maintained by more than
one employer and is not one of the plans already described. A
multiple-employer plan can be collectively bargained and
collectively funded, but if covered by PBGC termination
insurance, must have properly elected before September 27,
1981, not to be treated as a multiemployer plan under Code
section 414(f)(5) or ERISA sections 3(37)(E) and 4001(a)(3).
Participating employers do not file individually for this type of
plan. Do not check this box if the employers maintaining the
plan are members of the same controlled group.
Box A(4). Direct Filing Entity. Check this box and enter the
correct letter from the following chart to indicate the type of
entity in the space provided.
Instructions for Part I and Part II of Form 5500

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• You are filing under DOL’s Delinquent Filer Voluntary

2. Enter in row 2) any ‘‘in care of (C/O)’’ name.
3. Enter in row 3) the street address. A post office box
number may be entered if the Post Office does not deliver mail
to the sponsor’s street address.
4. Enter in row 4) the name of the city.
5. Enter in row 5) the two-character abbreviation of the U.S.
state or possession and zip code.
6. Enter in row 6) the foreign routing code, if applicable.
Leave row 5), U.S. state and zip code, blank if entering
information in rows 6) and 7).
7. Enter in row 7) the foreign country, if applicable.
8. Enter in row 8) the ‘‘doing business as (D/B/A)’’ or trade
name of the sponsor if different from the name entered in 1).
9. Enter in the rows of boxes labeled 9) any second
address. Use only a street address, not a P.O. box, here. A
P.O. box may be entered only in row 3).

Compliance (DFVC) Program. Attach a statement that the
report is submitted under the DFVC Program with ‘‘Form 5500,
Box D - DFVC FILING’’ prominently displayed at the top of the
statement. See Delinquent Filer Voluntary Compliance
(DFVC) Program on page 5, for more information.

Part II - Basic Plan Information
Line 1a. Enter the formal name of the plan or DFE or enough
information to identify the plan or DFE. Abbreviate if necessary.
Line 1b. Enter the three-digit plan or entity number (PN) the
employer or plan administrator assigned to the plan or DFE.
This three-digit number, in conjunction with the employer
identification number (EIN) entered on line 2b, is used by the
IRS, DOL, and PBGC as a unique 12-digit number to identify
the plan or DFE.
Start at 001 for plans providing pension benefits or DFEs as
illustrated in the table below. Start at 501 for welfare plans and
GIAs. Do not use 888 or 999.
Once you use a plan or DFE number, continue to use it for
that plan or DFE on all future filings with the IRS, DOL, and
PBGC. Do not use it for any other plan or DFE, even if the first
plan or DFE is terminated.
Assign PN

001 to the first plan or DFE.
Consecutively number others
as 002, 003. . .

Part II, box 8b is checked
and 8a is not checked, or
Part I, A(4) is checked and a
G is entered

501 to the first plan or GIA.
Consecutively number others
as 502, 503. . .

Part II, box 8a is checked, or
Part I, A(4) is checked and
an M, C, P, or E is entered

For each Form 5500
with the same EIN
(line 2b), when

Line 2b. Enter the nine-digit employer identification number
(EIN) assigned to the plan sponsor/employer. For example,
00-1234567. In the case of a DFE, enter the employer
identification number (EIN) assigned to the CCT, PSA, MTIA,
103-12 IE, or GIA.
Do not use a social security number in lieu of an EIN. The
Form 5500 is open to public inspection, and the contents are
public information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this line may result in the rejection of the filing.
Employers without an EIN must apply for one as soon as
possible. The EBSA does not issue EINs. To apply for an EIN:
• 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.)
A multiple-employer plan or plan of a controlled group of
corporations should use the EIN of the sponsor identified in line
2a. The EIN must be used in all subsequent filings of the Form
5500 for these plans (see instructions to line 4 concerning
change in EIN).
If the plan sponsor is a group of individuals, get a single EIN
for the group. When you apply for an EIN, provide the name of
the group, such as ‘‘Joint Board of Trustees of the Local 187
Machinists’ Retirement Plan.’’ (If filing Form SS-4, enter the
group name on line 1.)
Note. EINs for funds (trusts or custodial accounts) associated
with plans (other than DFEs) are generally not required to be
furnished on the Form 5500; the IRS will issue EINs for such
funds for other reporting purposes. EINs may be obtained as
explained above. Plan sponsors should use the trust EIN
described above when opening a bank account or conducting
other transactions for a trust that require an EIN.

Exception. If Part II, box 8a is checked and 333 (or a higher
number in a sequence beginning with 333) was previously
assigned to the plan, that number may be entered on line 1b.
Line 1c. Enter the date the plan first became effective.
Line 2a. Each row of boxes on the hand print forms is
designed to contain specific information regarding the plan
sponsor. Please limit your response to the information required
in each row of boxes as specified below:
1. Enter in the first two rows of boxes labeled 1) the name of
the plan sponsor or, in the case of a Form 5500 filed for a DFE,
the name of the insurance company, financial institution, or
other sponsor of the DFE (e.g., in the case of a GIA, the trust or
other entity that holds the insurance contract, or in the case of
an MTIA, one of the sponsoring employers). If the plan covers
only the employees of one employer, enter the employer’s
name.
The term ‘‘plan sponsor’’ means:
• The employer, for an employee benefit plan that a single
employer established or maintains;
• The employee organization in the case of a plan of an
employee organization; or
• The association, committee, joint board of trustees, or
other similar group of representatives of the parties who
establish or maintain the plan, if the plan is established or
maintained jointly by one or more employers and one or more
employee organizations, or by two or more employers.
Note. In the case of a multiple-employer plan, if an association
or similar entity is not the sponsor, enter the name of a
participating employer as sponsor. A plan of a controlled group
of corporations should enter the name of one of the sponsoring
members. In either case, the same name must be used in all
subsequent filings of the Form 5500 for the multiple-employer
plan or controlled group (see instructions to line 4 concerning
change in sponsorship).

Line 2d. Enter the six-digit business code that best describes
the nature of the plan sponsor’s business from the list of
business codes on pages 66, 67, and 68. If more than one
employer or employee organization is involved, enter the
business code for the main business activity of the employers
and/or employee organizations.
Line 3a. Each row of boxes on the hand print forms is
designed to contain specific information regarding the plan
administrator. Please limit your response to the information
required in each row of boxes as specified below:
1. Enter in the first two rows of boxes labeled 1) the name of
the plan administrator unless the administrator is the sponsor
identified in line 2 or the Form 5500 is submitted for a DFE
(Part I, box A(4) should be checked). If this is the case, enter
the word ‘‘same’’ on line 3a and leave the remainder of line 3a,
and all of lines 3b and 3c blank.
Plan administrator means:

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• The person or group of persons specified as the
administrator by the instrument under which the plan is
operated;
• The plan sponsor/employer if an administrator is not so
designated; or
• Any other person prescribed by regulations if an
administrator is not designated and a plan sponsor cannot be
identified.
2. Enter in row 2) any ‘‘in care of (C/O)’’ name.
3. Enter in row 3) the street address. A post office box
number may be entered if the Post Office does not deliver mail
to the administrator’s street address.
4. Enter in row 4) the name of the city.
5. Enter in row 5) the two-character abbreviation of the U.S.
state or possession and zip code.
6. Enter in rows 6) and 7) the foreign routing code and
foreign country, if applicable. Leave row 5), U.S. state and zip
code, blank if entering information in rows 6) and 7).

Before counting the number of participants in welfare

TIP plans, it is important to determine whether the plan

sponsor has established one or more plans for Form
5500 reporting purposes. As a matter of plan design, plan
sponsors can offer benefits through various structures and
combinations. For example, a plan sponsor could create (i) one
plan providing major medical benefits, dental benefits, and
vision benefits, (ii) two plans with one providing major medical
benefits and the other providing self-insured dental and vision
benefits, or (iii) three separate plans. You must review the
governing documents and actual operations to determine
whether welfare benefits are being provided under a single plan
or separate plans.
The fact that you have separate insurance policies for each
different welfare benefit does not necessarily mean that you
have separate plans. Some plan sponsors use a “wrap”
document to incorporate various benefits and insurance policies
into one comprehensive plan. In addition, whether a benefit
arrangement is deemed to be a single plan may be different for
purposes other than Form 5500 reporting. For example, special
rules may apply for purposes of HIPAA, COBRA, and Internal
Revenue Code compliance. If you need help determining
whether you have a single welfare benefit plan for Form 5500
reporting purposes, you should consult a qualified benefits
consultant or legal counsel.

Line 3b. Enter the plan administrator’s nine-digit EIN. A plan
administrator must have an EIN for Form 5500 reporting
purposes. If the plan administrator does not have an EIN, apply
for one as explained in the instructions for line 2b. One EIN
should be entered for a group of individuals who are,
collectively, the plan administrator.
Note. Employees of the plan sponsor who perform
administrative functions for the plan are generally not the plan
administrator unless specifically designated in the plan
document. If an employee of the plan sponsor is designated as
the plan administrator, that employee must get an EIN.
Line 4. If the plan sponsor’s or DFE’s name and/or EIN have
changed since the last return/report was filed for this plan or
DFE, enter the plan sponsor’s or DFE’s name, EIN, and the
plan number as it appeared on the last return/report filed.

occurrence of the contingency for which the benefit is provided;
or the date on which the individual makes a contribution to the
plan, whether voluntary or mandatory. Dependents are
considered neither participants nor beneficiaries. A child who is
an “alternate recipient” entitled to health benefits under a
qualified medical child support order should not be counted as a
participant for lines 6 and 7. An individual is not a participant
covered under an employee welfare plan on the earliest date on
which the individual (A) is ineligible to receive any benefit under
the plan even if the contingency for which such benefit is
provided should occur, and (B) is not designated by the plan as
a participant. See 29 CFR 2510.3-3(d)(2). For pension benefit
plans, “alternate payees” entitled to benefits under a qualified
domestic relations order are not to be counted as participants
for these lines.

The failure to indicate on line 4 that a plan was
previously identified by a different Employer
CAUTION Identification Number (EIN) or Plan Number (PN) could
result in correspondence from the Department of Labor (DOL)
and the Internal Revenue Service (IRS).
Line 5. (Optional) You may use this line to designate the
person or entity that is principally responsible for the
preparation of the annual return/report.
Line 5a. Each row of boxes on the hand print forms is
designed to contain specific information regarding the preparer.
Please limit your response to the information required in each
row of boxes as specified below:
1. If the person who prepared the annual return/report is not
the employer named in line 2a or the plan administrator named
in line 3a, you may name the person in the first two rows of
boxes labeled 1).
2. Enter in row 2) the street address. If the Post Office does
not deliver mail to the street address and the preparer has a
P.O. box, enter the box number.
3. Enter in row 3) the name of the city.
4. Enter in row 4) the two-character abbreviation of the U.S.
state or possession and zip code.
5. Enter in rows 5) and 6) the foreign routing code and
foreign country, if applicable. Leave row 4), U.S. state and zip
code, blank if entering information in rows 5) and 6).

‘‘Participant’’ means any individual who is included in one of
the categories below:
1. Active participants include any individuals who are
currently in employment covered by a plan and who are earning
or retaining credited service under a plan. This category
includes any individuals who are eligible to elect to have the
employer make payments to a Code section 401(k) qualified
cash or deferred arrangement. Active participants also include
any nonvested individuals who are earning or retaining credited
service under a plan. This category does not include (a)
nonvested former employees who have incurred the break in
service period specified in the plan or (b) former employees
who have received a ‘‘cash-out’’ distribution or deemed
distribution of their entire nonforfeitable accrued benefit.
2. Retired or separated participants receiving benefits are
any individuals who are retired or separated from employment
covered by the plan and who are receiving benefits under the
plan. This includes former employees who are receiving group
health continuation coverage benefits pursuant to Part 6 of
ERISA and who are covered by the employee welfare benefit
plan. This category does not include any individual to whom an
insurance company has made an irrevocable commitment to
pay all the benefits to which the individual is entitled under the
plan.
3. Other retired or separated participants entitled to future
benefits are any individuals who are retired or separated from
employment covered by the plan and who are entitled to begin
receiving benefits under the plan in the future. This category
does not include any individual to whom an insurance company
has made an irrevocable commitment to pay all the benefits to
which the individual is entitled under the plan.
4. Deceased individuals who had one or more beneficiaries
who are receiving or are entitled to receive benefits under the

Lines 6 and 7. All filers must complete both lines 6 and 7
unless the Form 5500 is filed for a 403(b) Arrangement or IRA
Plan eligible for Limited Pension Plan Reporting as described
on page 10 or for a DFE.
The description of ‘‘participant’’ in the instructions below is
only for purposes of these lines.
For welfare plans, the number of participants should be
determined by reference to 29 CFR 2510.3-3(d), which provides
that an individual becomes a participant covered under an
employee welfare benefit plan on the earlier of: the date
designated by the plan as the date on which the individual
begins participation in the plan; the date on which the individual
becomes eligible under the plan for a benefit subject only to
Instructions for Part I and Part II of Form 5500

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LIST OF PLAN CHARACTERISTICS CODES FOR LINES 8a AND 8b
CODE

Defined Benefit Pension Features

Target benefit plan

Benefits are primarily pay related.

Money purchase (other than target benefit)

Benefits are primarily flat dollar (includes dollars
per year of service).

Cash balance or similar plan – Plan has a “cash
balance” formula. For this purpose, a “cash
balance” formula is a benefit formula in a defined
benefit plan by whatever name (e.g., personal
account plan, pension equity plan, life cycle plan,
cash account plan, etc.) that rather than, or in
addition to, expressing the accrued benefit as a
life annuity commencing at normal retirement
age, defines benefits for each employee in terms
more common to a defined contribution plan
such as a single sum distribution amount (e.g.,
10 percent of final average pay times years of
service, or the amount of the employee’s
hypothetical account balance).

Offset plan – Plan benefits are subject to offset
for retirement benefits provided in another plan
or arrangement of the employer.

Code section 401(h) arrangement – Plan
contains separate accounts under Code section
401(h) to provide employee health benefits.

Code section 414(k) arrangement – Benefits are
based partly on the balance of the separate
account of the participant (also include
appropriate defined contribution pension feature
codes).
Covered by PBGC – Plan is covered under the
PBGC insurance program (see ERISA section
4021).

Plan covered by PBGC that was terminated and
closed out for PBGC purposes – Before the end
of the plan year (or a prior plan year), (1) the plan
terminated in a standard (or distress) termination
and completed the distribution of plan assets in
satisfaction of all benefit liabilities (or all ERISA
Title IV benefits for distress termination); or (2) a
trustee was appointed for a terminated plan
pursuant to ERISA section 4042.

Total participant-directed account plan –
Participants have the opportunity to direct the
investment of all the assets allocated to their
individual accounts, regardless of whether 29
CFR 2550.404c-1 is intended to be met.

Partial participant-directed account plan –
Participants have the opportunity to direct the
investment of a portion of the assets allocated to
their individual accounts, regardless of whether
29 CFR 2550.404c-1 is intended to be met.

Stock bonus

Code section 401(k) feature – A cash or deferred
arrangement described in Code section 401(k)
that is part of a qualified defined contribution
plan that provides for an election by employees
to defer part of their compensation or receive
these amounts in cash.

Code section 401(m) arrangement – Employee
contributions are allocated to separate accounts
under the plan or employer contributions are
based, in whole or in part, on employee
deferrals or contributions to the plan. Not
applicable if plan is 401(k) plan with only QNECs
and/or QMACs. Also not applicable if Code
section 403(b)(1), 403(b)(7), or 408
arrangements/accounts annuities.

Code section 403(b)(1) arrangement – See
Limited Pension Plan Reporting instructions
for Code section 403(b)(1) arrangements for
certain exempt organizations.

Code section 403(b)(7) accounts – See Limited
Pension Plan Reporting instructions for Code
section 403(b)(7) custodial accounts for
regulated investment company stock for certain
exempt organizations.

Code section 408 accounts and annuities – See
Limited Pension Plan Reporting instructions
for pension plan utilizing individual Code section
408 retirement accounts or annuities as the
funding vehicle for providing benefits.

ESOP other than a leveraged ESOP – A
completed Schedule E must be attached to a
Form 5500 filed for an ESOP.

Leveraged ESOP – An ESOP that acquires
employer securities with borrowed money or
other debt-financing techniques. A completed
Schedule E must be attached to a Form 5500
filed for an ESOP.

The employer maintaining this ESOP is an
S corporation.

Participant-directed brokerage accounts
provided as an investment option under the
plan.

Frozen Plan – As of the last day of the plan year,
the plan provides that no participant will get any
new benefit accrual (whether because of service
or compensation).

CODE

ERISA section 404(c) Plan – This plan, or any
part of it, is intended to meet the conditions of
29 CFR 2550.404c-1.

Floor-offset plan – Plan benefits are subject to
offset for retirement benefits provided by an
employer-sponsored defined contribution plan.

Profit-sharing

Defined Contribution Pension Features

Age/Service Weighted or New Comparability or
Similar Plan – Age/Service Weighted Plan:
Allocations are based on age, service, or age
and service. New Comparability or Similar Plan:
Allocations are based on participant
classifications and a classification(s) consists
entirely or predominantly of highly compensated
employees; or the plan provides an additional
allocation rate on compensation above a
specified threshold, and the threshold or
additional rate exceeds the maximum threshold
or rate allowed under the permitted disparity
rules of Code section 401(l).

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LIST OF PLAN CHARACTERISTICS CODES FOR LINES 8a AND 8b (Continued)
3A

Other Pension Benefit Features

Plan covering Self-Employed individuals.

Plan not intended to be qualified – A plan not
intended to be qualified under Code sections
401, 403, or 408.

Welfare Benefit Features
Health (other than dental or vision)

Life insurance

Supplemental unemployment

Dental

Vision

Temporary disability (accident and sickness)

Master plan – A pension plan that is made
available by a sponsor for adoption by
employers; that is the subject of a favorable
opinion letter; and for which a single funding
medium (for example, a trust or custodial
account) is established for the joint use of all
adopting employers.

Prepaid legal

Long-term disability

Severance pay

Apprenticeship and training

Scholarship (funded)

Prototype plan – A pension plan that is made
available by a sponsor for adoption by
employers; that is the subject of a favorable
opinion or notification letter; and under which a
separate funding medium (for example, a
separate trust or custodial account) is
established for each adopting employer.

Death benefits (include travel accident but not
life insurance)

Taft-Hartley Financial Assistance for Employee
Housing Expenses

Other

Unfunded, fully insured, or combination
unfunded/insured welfare plan that will not file a
Form 5500 for next plan year pursuant to 29
CFR 2520.104-20.

Plan sponsor(s) received services of leased
employees, as defined in Code section 414(n),
during the plan year.

One-participant plan – A plan without employees
as defined in 29 CFR 2510.3-3(b).

Plan sponsor(s) is (are) a member(s) of a
controlled group (Code sections 414(b), (c), or
(m)).

Plan requiring that all or part of employer
contributions be invested and held, at least for a
limited period, in employer securities.

Unfunded, fully insured, or combination
unfunded/insured welfare plan that stopped
filing Form 5500s in an earlier plan year
pursuant to 29 CFR 2520.104-20.

10 or more employer plan under Code section
419A(f)(6)

Collectively bargained welfare benefit
arrangement under Code section 419A(f)(5)

U.S.-based plan that covers residents of Puerto
Rico and is qualified under both Code section
401 and section 8565 of the Puerto Rico Code.

CODE

Non-U.S. plan – Pension plan maintained
outside the United States primarily for
nonresident aliens.

CODE

plan. This category does not include an individual if an
insurance company has made an irrevocable commitment to
pay all the benefits to which the beneficiaries of that individual
are entitled under the plan.

and 19 that describe the characteristics of the plan being
reported. (See examples on page 20.)
Applicable to plan sponsors of Puerto Rico plans. Enter
condition code 3C only in instances where there was no
CAUTION election made under section 1022(i)(2) of ERISA and,
therefore, the plan does not intend to qualify under section
401(a) of the Internal Revenue Code. If an election was made
under section 1022(i)(2) of ERISA, do not enter characteristic
code 3C.
Line 9 - Funding and Benefit Arrangements. Check all
boxes that apply to indicate the funding and benefit
arrangements used during the plan year. The ‘‘funding
arrangement’’ is the method for the receipt, holding, investment,
and transmittal of plan assets prior to the time the plan actually
provides benefits. The ‘‘benefit arrangement’’ is the method by
which the plan provides benefits to participants. For purposes of
line 9:
‘‘Insurance’’ means the plan has an account, contract, or
policy with an insurance company, insurance service, or other
similar organization (such as Blue Cross, Blue Shield, or a
health maintenance organization) during the plan or DFE year.
(This includes investments with insurance companies such as
guaranteed investment contracts (GICs).) Do not check
‘‘insurance’’ if the sole function of the insurance company was
to provide administrative services.
‘‘Code section 412(e)(3) insurance contracts’’ are
contracts that provide retirement benefits under a plan that are
guaranteed by an insurance carrier. In general, such contracts
must provide for level premium payments over the individual’s
period of participation in the plan (to retirement age), premiums

Line 7g. Enter the number of participants included on line 7f
(total participants at the end of the plan year) who have account
balances. For example, for a Code section 401(k) plan the
number entered on line 7g should be the number of participants
counted on line 7f who have made a contribution to the plan for
this plan year or any prior plan year. Defined benefit plans
should leave line 7g blank.
Line 7h. Include any individual who terminated employment
during this plan year, whether or not he or she (a) incurred a
break in service, (b) received an irrevocable commitment from
an insurance company to pay all the benefits to which he or she
is entitled under the plan, and/or (c) received a cash distribution
or deemed cash distribution of his or her nonforfeitable accrued
benefit. Multiemployer plans and multiple-employer plans that
are collectively bargained do not have to complete line 7h.
Line 7i. If a number is entered on line 7i, you must file
Schedule SSA (Form 5500) as an attachment to the Form
5500.
Code section 6057(e) provides that the plan
administrator must give each participant a statement
CAUTION showing the same information reported on Schedule
SSA for that participant.
Line 8 - Benefits Provided Under the Plan. Check 8a and/or
8b, as appropriate. In addition, enter in the boxes provided all
applicable plan characteristic codes from the table on pages 18

Instructions for Part I and Part II of Form 5500

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Examples:
1. When filing Form 5500 for a qualified defined benefit pension plan, covered by the PBGC, which provides a benefit of 2% of
average annual compensation per year of service with a benefit offset based on benefits from an employer-provided defined
contribution plan, check box 8a and enter the codes “1A”, “1D”, and “1G” in the boxes under box 8a as illustrated below:
a

Pension benefits (check this box if the plan provides pension benefits and enter the applicable pension feature codes from the List of
Plan Characteristics Codes (printed in the instructions) below).

1 D

1 G

2. When filing Form 5500 for a welfare plan providing health insurance, life insurance, dental insurance, and eye examinations,
check box 8b and enter the codes “4A”, “4B”, “4D”, and “4E” in the boxes under box 8b as illustrated below:
b

Welfare benefits (check this box if the plan provides welfare benefits and enter the applicable welfare feature codes from the List of Plan
Characteristics Codes (printed in the instructions) below).

4 B

4 D

4 E

Pension benefits (check this box if the plan provides pension benefits and enter the applicable pension feature codes from the List of
Plan Characteristics Codes (printed in the instructions) below).

2
b

2 F

2 H

2 J

2 K

3 E

Welfare benefits (check this box if the plan provides welfare benefits and enter the applicable welfare feature codes from the List of Plan
Characteristics Codes (printed in the instructions) below).

3. When filing Form 5500 for a prototype profit-sharing plan with Code section 401(k) features, providing participant direction
with voluntary employee contributions and regular employer matching contributions which is intended to meet ERISA section
404(c), and which provides ancillary life insurance, check boxes 8a and 8b and enter the codes “2E”, “2F”, “2H”, “2J”, “2K”,
“3E”, and “4B” in the boxes under 8a and 8b as illustrated below:

must be timely paid as currently required under the contract, no
rights under the contract may be subject to a security interest,
and no policy loans may be outstanding. If a plan is funded
exclusively by the purchase of such contracts, the otherwise
applicable minimum funding requirements of section 412 of the
Code and section 302 of ERISA do not apply for the year and a
Schedule MB or Schedule SB is not required to be filed.
‘‘Trust’’ includes any fund or account that receives, holds,
transmits, or invests plan assets other than an account or policy
of an insurance company.
‘‘General assets of the sponsor’’ means either the plan
had no assets or some assets were commingled with the
general assets of the plan sponsor prior to the time the plan
actually provided the benefits promised.
Example. If the plan held all its assets invested in
registered investment companies and other non-insurance

company investments until it purchases annuities to pay out the
benefits promised under the plan, box 9a(3) should be checked
as the funding arrangement and box 9b(1) should be checked
as the benefit arrangement.
Note. An employee benefit plan that checks boxes 9a(1),
9a(2), 9b(1), and/or 9b(2) must attach Schedule A (Form
5500), Insurance Information, to provide information concerning
each contract year ending with or within the plan year. See the
instructions to the Schedule A and enter the number of
Schedules A on line 10b(3), if applicable.
Line 10. Check the boxes on line 10 to indicate the schedules
being filed and, where applicable, count the schedules and
enter the number of attached schedules in the space provided.
If the plan is required to file an actuarial information schedule,
check the box for Schedule B and attach either the Schedule
MB or the Schedule SB, whichever applies.

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Instructions for Part I and Part II of Form 5500

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information entered on Schedule A (Form 5500) may pertain to
the plan year instead of the policy or contract year.
Include only the contracts issued to or held by the plan, GIA,
MTIA, or 103-12 IE for which the Form 5500 is being filed.
Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule A is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.
Do not use a social security number in lieu of an EIN. The
Schedule A and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Schedule A or any
of its attachments may result in the rejection of the filing.
You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.

2008 Instructions for Schedule A
(Form 5500)
Insurance Information
General Instructions
Who Must File

Part I - Information Concerning Insurance Contract
Coverage, Fees, and Commissions

Line 1(c). Enter the code number assigned by the National
Association of Insurance Commissioners (NAIC) to the
insurance company. If none has been assigned, enter zeros
(-0-) in the spaces provided.
Line 1(d). If individual policies with the same carrier are
grouped as a unit for purposes of this report, and the group
does not have one identification number, you may use the
contract or identification number of one of the individual
contracts provided this number is used consistently to report
these contracts as a group and the plan administrator maintains
the records necessary to disclose all the individual contract
numbers in the group upon request. Use separate Schedules A
to report individual contracts that cannot be grouped as a unit.
Line 1(e). Since plan coverage may fluctuate during the year,
the administrator should estimate the number of persons that
were covered by the contract at the end of the policy or contract
year. Where contracts covering individual employees are
grouped, compute entries as of the end of the plan year.
Lines 1(f) and (g). Enter the beginning and ending dates of
the policy year for the contract identified in 1(d). Enter ‘‘N/A’’ in
1(f) if separate contracts covering individual employees are
grouped.
Line 2. Report on line 2 all insurance fees and commissions
directly or indirectly attributable to the contract or policy placed
with or retained by the plan. Identify agents, brokers, and other
persons individually in descending order of the amount paid.
Additional pages may be necessary. You can get additional
hand print pages by calling 1-800-TAX-FORM
(1-800-829-3676) and requesting additional schedules.
For purposes of line 2, commissions and fees include sales
and base commissions and all other monetary and
non-monetary forms of compensation where the broker’s,
agent’s, or other person’s eligibility for the payment or the
amount of the payment is based, in whole or in part, on the
value (e.g., policy amounts, premiums) of contracts or policies
(or classes thereof) placed with or retained by an ERISA plan,
including, for example, persistency and profitability bonuses.
The amount (or pro rata share of the total) of such
commissions or fees attributable to the contract or policy placed
with or retained by the plan must be reported in element (b) or
(c) as appropriate.
Insurers must provide plan administrators with a
proportionate allocation of commissions and fees attributable to
each contract. Any reasonable method of allocating
commissions and fees to policies or contracts is acceptable,
provided the method is disclosed to the plan administrator. A
reasonable allocation method could, in the Department of
Labor’s view, allocate fees and commissions to a Schedule A
based on a calendar year calculation even if the plan year or
policy year was not a calendar year. For additional information
on these Schedule A reporting requirements, see ERISA

Schedule A, Insurance Information, must be attached to the
Form 5500 filed for every defined benefit pension plan, defined
contribution pension plan, and welfare benefit plan if any
benefits under the plan are provided by an insurance company,
insurance service, or other similar organization (such as Blue
Cross, Blue Shield, or a health maintenance organization). This
includes investments with insurance companies such as
guaranteed investment contracts (GICs).
For example, if Form 5500 line 9a(1), 9a(2), 9b(1), or 9b(2)
is checked, indicating that either the plan funding arrangement
or plan benefit arrangement includes an account, policy, or
contract with an insurance company (or similar organization), at
least one Schedule A (Form 5500) would be required to be
attached to the Form 5500 filed for a pension or welfare plan to
provide information concerning the contract year ending with or
within the plan year.
In addition, Schedules A must be attached to a Form 5500
filed for GIAs, MTIAs, and 103-12 IEs for each insurance or
annuity contract held in the MTIA, or 103-12 IE or by the GIA.
See the Form 5500 instructions for specific requirements for
GIAs, MTIAs, and 103-12 IEs.
Do not file Schedule A if: (1) the contract is an Administrative
Services Only (ASO) contract; (2) the Form 5500 is being filed
for a plan participating in a MTIA or 103-12 IE for which a Form
5500 is being filed that reports the contract on a Schedule A
filed with the MTIA or 103-12 IE Form 5500; or (3) the Form
5500 is being filed for a plan that covers only: (A) an individual
or an individual and his or her spouse who wholly own a trade
or business, whether incorporated or unincorporated; or
(B) partners, or partners and one or more of the partners’
spouses in a partnership.
Check the Schedule A box on the Form 5500 (Part II, line
10b(3)), and enter the number attached in the space provided if
one or more Schedules A are attached to the Form 5500.
Important Reminder. The insurance company (or similar
organization) is required to provide the plan administrator with
the information needed to complete the return/report, pursuant
to ERISA section 103(a)(2). If you do not receive this
information in a timely manner, contact the insurance company
(or similar organization). If information is missing on Schedule A
(Form 5500) due to a refusal to provide information, note this on
the Schedule A.

Special Rule for Plans with Fewer Than 25
Participants
d

If the plan has fewer than 25 participants, meets all the
conditions for PPA-simplified reporting that are listed on page 9,
and elects to file under this simplified reporting option, then
complete only lines A, B, C, D, and the insurance fee and
commission information in Part I.

Specific Instructions
Information entered on Schedule A (Form 5500) should pertain
to the insurance contract or policy year ending with or within the
plan year (for reporting purposes, a year cannot exceed 12
months).
Example. If an insurance contract year begins on July 1
and ends on June 30, and the plan year begins on January 1
and ends on December 31, the information on the Schedule A
attached to the 2008 Form 5500 should be for the insurance
contract year ending on June 30, 2008.
Exception. If the insurance company maintains records on the
basis of a plan year rather than a policy or contract year, the
Instructions for Schedule A (Form 5500)

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5
6
7
8
9
0

Third party administrator
Investment Company/Mutual Fund
Investment Manager/Adviser
Labor Union
Foreign entity (e.g., an agent or broker, bank, insurance
company, etc., not operating within the jurisdictional
boundaries of the United States)
Other

For plans, GIAs, MTIAs, and 103-12 IEs required to file Part
I of Schedule C, commissions and fees listed on the Schedule
A are also to be reported on Schedule C (Form 5500), unless
the only compensation in relation to the plan or DFE consists of
insurance fees and commissions listed on the Schedule A.

Part II - Investment and Annuity Contract Information

Line 3. Enter the current value of the plan’s interest at year
end in the contract reported on line 6, e.g., deposit
administration (DA), immediate participation guarantee (IPG), or
guaranteed investment contracts (GIC).
Exception. Contracts reported on line 6 need not be included
on line 3 if (1) the Schedule A is filed for a defined benefit
pension plan and the contract was entered into before March
20, 1992, or (2) the Schedule A is filed for a defined contribution
pension plan and the contract is a fully benefit-responsive
contract, i.e., it provides a liquidity guarantee by a financially
responsible third party of principal and previously accrued
interest for liquidations, transfers, loans, or hardship
withdrawals initiated by plan participants exercising their rights
to withdraw, borrow, or transfer funds under the terms of a
defined contribution plan that does not include substantial
restrictions to participants’ access to plan funds.
Line 5a. The rate information called for here may be furnished
by attaching the appropriate schedules of current rates filed
with the appropriate state insurance department or by providing
a statement regarding the basis of the rates. Enter “see
attached” if appropriate.
Lines 6a through 6f. Report contracts with unallocated funds.
Do not include portions of these contracts maintained in
separate accounts. Show deposit fund amounts rather than
experience credit records when both are maintained.

Advisory Opinion 2005-02A, available on the Internet at www.
dol.gov/ebsa.
Schedule A reporting is not required for compensation paid
by the insurer to third parties for record keeping and claims
processing services provided to the insurer as part of the
insurer’s administration of the insurance policy. Schedule A
reporting also is not required for compensation paid by the
insurer to a “general agent” or “manager” for that general
agent’s or manager’s management of an agency or
performance of administrative functions for the insurer. For this
purpose, (1) a “general agent” or “manager” does not include
brokers representing insureds and (2) payments would not be
treated as paid for managing an agency or performance of
administrative functions where the recipient’s eligibility for the
payment or the amount of the payment is dependent or based
on the value (e.g., policy amounts, premiums) of contracts or
policies (or classes thereof) placed with or retained by ERISA
plan(s).
Totals. Enter the total of all commissions and fees paid to
agents, brokers, and other persons listed on line 2.
Complete a separate item (elements (a) through (e)) for
each person listed. Enter the name and address of the person
identified in element (a) and complete elements (b) through (e)
as specified below.
Element (a). Enter the name and address of the agents,
brokers, or other persons to whom commissions or fees were
paid.
Element (b). Report all sales and base commissions here. For
purposes of this element, sales and/or base commissions are
monetary amounts paid by an insurer that are charged directly
to the contract or policy and that are paid to a licensed agent or
broker for the sale or placement of the contract or policy. All
other payments should be reported in element (c) as fees.
Element (c). Fees to be reported here represent payments by
an insurer attributable directly or indirectly to a contract or policy
to agents, brokers, and other persons for items other than sales
and/or base commissions (e.g., service fees, consulting fees,
finders fees, profitability and persistency bonuses, awards,
prizes, and non-monetary forms of compensation). Fees paid to
persons other than agents and brokers should be reported
here, not in Parts II and III on Schedule A as acquisition costs,
administrative charges, etc.
Element (d). Enter the purpose(s) for which fees were paid.
Element (e). Enter the most appropriate organization code for
the broker, agent, or other person entered in element (a).

Part III - Welfare Benefit Contract Information

Line 7i. Report a stop-loss insurance policy that is an asset of
the plan.
Note. Employers sponsoring welfare plans may purchase a
stop-loss insurance policy with the employer as the insured to
help the employer manage its risk associated with its liabilities
under the plan. These employer contracts with premiums paid
exclusively out of the employer’s general assets without any
employee contributions generally are not plan assets and are
not reportable on Schedule A.

Code Type of Organization
1
Banking, Savings & Loan Association, Credit Union, or
other similar financial institution
2
Trust Company
3
Insurance Agent or Broker
4
Agent or Broker other than insurance

The instructions for Schedule B have been deleted. Under the Pension Protection Act
of 2006 (PPA), actuarial information is now provided by two new schedules (Schedule
MB and Schedule SB) and their instructions.

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Instructions for Schedule A (Form 5500)

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Specific Instructions

2008 Instructions for Schedule C
(Form 5500)
Service Provider Information

Part I - Service Provider Information
Line 1. Enter the total dollar amount of compensation received
by all persons who provided services to the plan who are not
listed in line 2 (except for those persons described in 2, 3, or 4
in the General Instructions).
Example. A plan had service providers, A, B, C, and D,
who received $12,000, $6,000, $4,500, and $430, respectively,
from the plan. Service providers A and B must be identified
separately in line 2 by name, EIN, official plan position, etc. As
service providers C and D each received less than $5,000, the
amount they received must be combined and $4,930 entered in
line 1.
Line 2. List up to 40 service providers, including the contract
administrator, as specified below.
First, list the contract administrator, if any, on the first item
(complete elements (a) through (g)) on line 2 where indicated.
A contract administrator is any individual, trade or business
(whether incorporated or unincorporated) responsible for
managing the clerical operations of the plan on a contractual
basis (e.g., handling membership rosters, claims payment,
maintaining books and records), except for salaried staff or
employees of the plan or banks or insurance carriers. If you do
not have a contract administrator, leave the first item blank and
skip to the next item. DO NOT cross out the preprinted words
“Contract administrator.”
Next, complete a separate item for each person required to
be reported in line 2 in the order of compensation received.
Start with the most highly compensated and end with the lowest
compensated. Enter in element (a) the person’s name and
complete elements (b) through (g) as specified below.
Additional pages may be necessary to list all service providers.
If you are using the official hand print forms, you can get
additional hand print pages by calling 1-800-TAX-FORM
(1-800-829-3676) and requesting additional schedules.
Element (b). An EIN must be entered. If the name of an
individual is entered in element (a), the EIN to be entered in
element (b) should be the EIN of the individual’s employer. Do
not use a social security number in lieu of an EIN. The
Schedule C and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Schedule C or any
of its attachments may result in the rejection of the filing.
Element (c). Enter, for example, employee, trustee,
accountant, attorney, etc.
Element (d). Enter, for example, employee, vice-president,
union president, etc.
Elements (e) and (f).
Plan Filers. Include the plan’s share of compensation for
services paid during the year to a MTIA or 103-12 IE trustee
and to persons providing services to the MTIA or 103-12 IE, if
such compensation is not subtracted from the total income in
determining the net income (loss) reported on the MTIA or
103-12 IE’s Schedule H, line 2k.
Include brokerage commissions or fees only if the broker is
granted some discretion (see 29 CFR 2510.3-21 paragraph (d),
regarding ‘‘discretion’’). Include all other commissions and fees
on investments, whether or not they are capitalized as
investment costs.
MTIA and 103-12 IEs. Include compensation for services
paid by the MTIA or 103-12 IE during its fiscal year to persons
providing services to the MTIA or 103-12 IE if such
compensation is subtracted from the total income in
determining the net income (loss) reported by the MTIA or
103-12 IE on Schedule H, line 2k.
Element (g). Select and enter all codes that describe the
nature of services provided from the list below. If more than one
service was provided, list the code for the primary service first.
If necessary, use a properly identified attachment to list all
applicable service codes.

General Instructions
Who Must File
Schedule C (Form 5500) must be attached to a Form 5500 filed
for a large pension or welfare benefit plan and to a Form 5500
filed for a MTIA, 103-12 IE, or GIA to report information
concerning service providers. See the instructions to the Form
5500 for Form 5500 Schedules and Direct Filing Entity
(DFE).

Do not use a social security number in line D in lieu of an
EIN. The Schedule C and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule C or any of its attachments may result in the rejection
of the filing.

Check the Schedule C box on the Form 5500 (Part II, line
10b(4)) if a Schedule C is attached to the Form 5500. Multiple
Schedule C pages must be attached to the Form 5500 if
necessary to report the required information.
Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule C is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.

You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.
Line 1 of Part I. Line 1 must be completed if line 2 of Part I is
required to be completed as specified below.
Line 2 of Part I. Line 2 of Part I must be completed to report
contract administrators and persons receiving, directly or
indirectly, $5,000 or more in compensation for all services
rendered to the plan or DFE during the plan or DFE year
except:
1. Employees of the plan whose only compensation in
relation to the plan was less than $1,000 for each month of
employment during the plan year;
2. Employees of the plan sponsor who did not receive direct
or indirect compensation from the plan;
3. Employees of a business entity (e.g., corporation,
partnership, etc.), other than the plan sponsor, who provided
services to the plan; or
4. Persons whose only compensation in relation to the plan
consists of insurance fees and commissions listed in a
Schedule A attached to the Form 5500 filed for this plan.
Generally, indirect compensation would not include
compensation that would have been received had the service
not been rendered and that cannot be reasonably allocated to
the services performed. Indirect compensation includes, among
other things, payment of ‘‘finder’s fees’’ or other fees and
commissions by a service provider to an independent agent or
employee for a transaction or service involving the plan.
Notes.
• Either the cash or accrual basis may be used for the
recognition of transactions reported on the Schedule C as long
as you use one method consistently.
• The compensation listed should only reflect the amount of
compensation received by the service provider from the plan or
DFE filing the Form 5500, not the aggregate amount received
for providing services to several plans or DFEs.
• The term ‘‘persons’’ on the Schedule C instructions includes
individuals, trades and businesses (whether incorporated or
unincorporated). See ERISA section 3(9).
Instructions for Schedule C (Form 5500)

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Part II - Termination Information on Accountants and
Enrolled Actuaries
Complete Part II if there was a termination in the appointment of
an accountant or enrolled actuary. In case the service provider
is not an individual (i.e., when the accountant is a legal entity
such as a corporation, partnership, etc.), report when the
service provider (not the individual) has been terminated.

Note. Do not list PBGC or IRS as a service provider on Part I
of Schedule C.
Service
Accounting (including auditing)
Actuarial
Contract Administrator
Administration
Brokerage (real estate)
Brokerage (stocks, bonds, commodities)
Computing, tabulating, ADP, etc.
Consulting (general)
Custodial (securities)
Insurance agents and brokers
Investment advisory
Investment management
Legal
Printing and duplicating
Recordkeeping
Trustee (individual)
Trustee (corporate)
Pension insurance advisor
Valuation services (appraisals, asset valuations, etc.)
Investment evaluations
Medical
Legal services to participants
Other (specify)

Provide an explanation of the reasons for the termination of
an accountant or enrolled actuary. Include a description of any
material disputes or matters of disagreement concerning the
termination, even if resolved prior to the termination. If an
individual is listed, the EIN to be entered should be the EIN of
the individual’s employer.
Do not use a social security number in lieu of an EIN. The
Schedule C and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Schedule C or any
of its attachments may result in the rejection of the filing.
The plan administrator must also provide the terminated
accountant or enrolled actuary with a copy of the explanation
for the termination provided in Part II of the Schedule C, along
with a completed copy of the notice below.

Code
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
99

Notice To Terminated Accountant
Or Enrolled Actuary

I, as plan administrator, verify that the explanation that is reproduced below or attached to this notice is the explanation
concerning your termination reported on the Schedule C (Form 5500) attached to the 2008 Annual Return/Report Form
5500 for the
(enter name of plan). This Form 5500 is identified in line 2b by
the nine-digit EIN
(enter sponsor’s EIN), and in line 1b by the three-digit PN
(enter plan
number).

Signed
Dated

You have the opportunity to comment to the Department of Labor concerning any aspect of this explanation.
Comments should include the name, EIN, and PN of the plan and be submitted to: Office of Enforcement, Employee
Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, DC 20210.

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5500 filed for the DFE. If a Form 5500 was not filed for a CCT
or PSA named in element (a), enter the EIN for the CCT or PSA
and enter 000 for the PN. Do not use a social security number
in lieu of an EIN. The Schedule D and its attachments are open
to public inspection, and the contents are public information and
are subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule D or any of its attachments may result in the rejection
of the filing.

2008 Instructions for Schedule D
(Form 5500)
DFE/Participating Plan Information
General Instructions
Purpose of Schedule

Element (d). Enter an M, C, P, or E, as appropriate, (see table
below) to identify the type of entity (MTIA, CCT, PSA, or 103-12
IE).

When the Form 5500 is filed for a plan or DFE that invested or
participated in any MTIAs, 103-12 IEs, CCTs and/or PSAs, Part
I provides information about these entities. When the Form
5500 is filed for a DFE, Part II provides information about plans
participating in the DFE.

Who Must File
Employee Benefit Plans: Schedule D must be attached to a
Form 5500 filed for an employee benefit plan that participated
or invested in one or more common/collective trusts (CCTs),
pooled separate accounts (PSAs), master trust investment
accounts (MTIAs), or 103-12 Investment Entities (103-12 IEs) at
anytime during the plan year.

Specific Instructions

MTIA

CCT

PSA

103-12 IE

Element (e). Enter the dollar value of the plan’s or DFE’s
interest as of the end of the year. If the plan or DFE for which
this Schedule D is filed had no interest in the MTIA, CCT, PSA,
or 103-12 IE listed at the end of the year, enter ‘‘0’’.
Example for Part I: If a plan participates in a MTIA, the
MTIA is named in element (a); the MTIA’s sponsor is named in
element (b); the MTIA’s EIN and PN is entered in element (c)
(such as: 12-3456789-001); an ‘‘M’’ is entered in element (d);
and the dollar value of the plan’s interest in the MTIA as of the
end of the plan year is entered in element (e).

Check the Schedule D box on the Form 5500 (Part II, line
10b(5)) if a Schedule D is attached to the Form 5500. Multiple
Schedule D pages must be attached to the Form 5500 if
necessary to report the required information. You can get
additional hand print pages by calling 1-800-TAX-FORM
(1-800-829-3676) to request additional schedules.

Enter in (d)

Direct Filing Entities: Schedule D must be attached to a
Form 5500 filed for a CCT, PSA, MTIA, 103-12 IE or Group
Insurance Arrangement (GIA), as a Direct Filing Entity (i.e.,
when Form 5500 Part I, line A(4) is checked). For more
information, see instructions for Direct Filing Entity (DFE) on
pages 4 and 11 of the instructions for the Form 5500.

Type of entity

If the plan also participates in a CCT for which a Form 5500
was not filed, the CCT is named in another element (a); the
name of the CCT sponsor is entered in element (b); the EIN for
the CCT, followed by 000 is entered in element (c) (such as:
99-8765432-000); a ‘‘C’’ is entered in element (d); and the
dollar value of the plan’s interest in the CCT is entered in
element (e).

Lines A, B, C, and D. The information should be the same as
reported in Part II of the Form 5500 to which this Schedule D is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided. Do not use a social security number in
line D in lieu of an EIN. The Schedule D and its attachments are
open to public inspection, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule D or any of its attachments may result
in the rejection of the filing.

If the plan also participates in a PSA for which a Form 5500
was filed, the PSA is named in a third element (a); the name of
the PSA sponsor is entered in element (b); the PSA’s EIN and
PN is entered in element (c) (such as: 98-7655555-001); a ‘‘P’’
is entered in element (d); and the dollar value of the plan’s
interest in the PSA is entered in element (e).

Part II - Information on Participating Plans
(To Be Completed Only by DFEs)
Use as many Schedule D, Part II pages as necessary to enter
the information specified below for all plans that invested or
participated in the DFE at any time during the DFE year.

Part I - Information on Interests in MTIAs, CCTs,
PSAs, and 103-12 IEs (To Be Completed by Plans and
DFEs)

Complete a separate item (elements (a) through (c)) for
each plan.

Use as many Schedule D, Part I pages as necessary to enter
the information specified below for all MTIAs, CCTs, PSAs, and
103-12 IEs in which the plan or DFE filing the Form 5500
participated at anytime during the plan or DFE year.

Element (a). Enter the name of each plan that invested or
participated in the DFE at any time during the DFE year. GIAs
need not complete element (a).

Complete a separate item (elements (a) through (e)) for
each MTIA, CCT, PSA, or 103-12 IE.

Element (b). Enter the sponsor of each investing or
participating plan.

Element (a). Enter the name of the MTIA, CCT, PSA, or
103-12 IE in which the plan or DFE filing the Form 5500
participated at any time during the plan or DFE year.

Element (c). Enter the nine-digit EIN and three-digit PN for
each plan named in element (a). This is the EIN and PN
entered on lines 2b and 1b of the plan’s Form 5500. GIAs
should enter the EIN of the sponsor listed in element (b). Do not
use a social security number in lieu of an EIN. The Schedule D
and its attachments are open to public inspection, and the
contents are public information and are subject to publication on
the Internet. Because of privacy concerns, the inclusion of a
social security number on this Schedule D or any of its
attachments may result in the rejection of the filing.

Element (b). Enter the name of the sponsor of the MTIA, CCT,
PSA, or 103-12 IE named in (a).
Element (c). Enter the nine-digit employer identification
number (EIN) and three-digit plan/entity number (PN) for each
MTIA, CCT, PSA, or 103-12 IE named in (a). This must be the
same DFE EIN/PN as reported on lines 2b and 1b of the Form
Instructions for Schedule D (Form 5500)

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Income Tax Regulations section 1.133-1T) to the repayment
terms of the loan from the corporation to the lender; and
3. If the loan from the corporation to the ESOP provides for
more rapid repayment of principal and interest, the allocations
under the ESOP attributable to such repayments do not
discriminate in favor of highly compensated employees (within
the meaning of Code section 414(q)).

2008 Instructions for Schedule E
(Form 5500)
ESOP Annual Information
General Instructions

Line 8. An immediate allocation loan is any loan to an
employer corporation to the extent that, within 30 days,
employer securities are transferred to the ESOP maintained by
the corporation in an amount equal to the proceeds of the loan
and the securities are allocable to the accounts of plan
participants within one year of the date of the loan. (See Code
section 133(b)(1)(B).)

Purpose of Schedule
Use this schedule to satisfy the requirements under Code
section 6047(e) for an annual information return for an
employee stock ownership plan (ESOP).

Who Must File
Every employer or plan administrator of a pension benefit plan
that contains ESOP benefits must file a Schedule E (Form
5500).

Line 9c. The transition rules of Act section 7301(f)(2) through
(6) of the Omnibus Budget Reconciliation Act of 1989 (OBRA),
P.L. 101-239, provide that the amendments made to Code
section 133 by OBRA will not apply to certain loans that satisfy
the requirements of those paragraphs. In general, the
amendments made by OBRA will not apply to:
1. Loans made pursuant to a binding written commitment in
effect on June 6, 1989, and at all times thereafter before the
loan was made, or pursuant to a written binding contract (or
tender offer registered with the Securities and Exchange
Commission (SEC)) in effect on June 6, 1989, and at all times
thereafter before such securities were acquired.
2. If subparagraph 1 does not apply, loans made pursuant
to a binding written commitment in effect on July 10, 1989, and
at all times thereafter before the loan was made, but only to the
extent that the proceeds were used to acquire employer
securities pursuant to a certain binding written contract (or
tender offer registered with the SEC) in effect on July 10, 1989,
and at all times thereafter before the securities are acquired.
3. Any loan made on or before July 10, 1992, pursuant to a
written agreement entered into before July 10, 1989, if the
agreement evidences the intent of the borrower to enter, on a
periodic basis, into securities acquisition loans described in
Code section 133(b)(1)(B) (as in effect before December 19,
1989). This rule applies only if one or more securities
acquisition loans were made to the borrower on or before July
10, 1989.

File Schedule E (Form 5500) annually as an attachment to
Form 5500 or Form 5500-EZ. If more than one securities
acquisition loan (see specific instructions for lines 7 through 12)
is outstanding, you must file one Schedule E (Form 5500) and
an attachment for each additional securities acquisition loan
and label the attachment “Schedule E, lines 7 through 12 –
Additional Securities Acquisition Loans.” Each attachment
must provide answers to questions 7 through 12, be in a similar
format to, and on the same size paper as, the Schedule E.
Check the Schedule E box on the Form 5500 (Part II, line
10a(3)) if a Schedule E is attached to the Form 5500.
Note. The Small Business Job Protection Act of 1996 repealed
the partial interest exclusion of Code section 133 effective, in
general, with respect to loans made after August 20, 1996.
However, Schedule E (Form 5500) must be filed for securities
acquisition loans made to ESOPs before August 21, 1996,
loans made pursuant to a written binding contract in effect
before June 10, 1996, and at all times thereafter before the loan
was made, and certain loans made after August 20, 1996, to
refinance a securities acquisition loan originally made on or
before August 20, 1996.

How To File

If the employer maintaining the ESOP is an S
corporation and Schedule E is attached to a Form 5500,
CAUTION enter 2Q and other applicable codes on Form 5500, Part
II, line 8.

Specific Instructions

See Act section 7301(f)(2) to determine the specific
requirements of the transition rules described above. See Act
section 7301(f)(3) through (6) for additional transition rules on
refinancings, collective-bargaining agreements, filings with the
United States, and the 30% test for certain loans.

Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule E is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.
Line 1b. Code section 409(p) precludes an ESOP from
making allocations in a nonallocation year (as defined in Code
section 409(p)(3)) to any disqualified person (within the
meaning of Code section 409(p)(4)). If an ESOP fails Code
section 409(p), allocations are taxed to the disqualified person
(see Code section 409(p)(2)) and an excise tax is imposed on
the S corporation under Code section 4979A. (See section
1.409(p)-1 of the Income Tax Regulations.)
Line 4. If the schedule does not provide enough space, enter
“ATTACHED” and provide the required formula(s) as an
attachment to Schedule E.
Lines 7 through 12. A ‘‘securities acquisition loan’’ is an
exempt loan to an ESOP to the extent that the proceeds are
used to acquire employer securities for the plan.
Line 7. A ‘‘back to back loan’’ is a securities acquisition loan
from a lender to an employer corporation followed by a loan
from the corporation to the ESOP maintained by the employer
corporation. A ‘‘back to back loan’’ constitutes a ‘‘securities
acquisition loan’’ under Code section 133 if the following
requirements are satisfied:
1. The loan from the employer corporation to the ESOP
qualifies as an exempt loan under Treasury Regulations
sections 54.4975-7 and 54.4975-11;
2. The repayment terms of the loan from the corporation to
the ESOP are ‘‘substantially similar’’ (as defined in Temporary

Line 10. If the loan is a back to back loan or an immediate
allocation loan, enter the amount of interest paid by the
employer corporation to the lender(s) during the plan year.
Line 12b. The repeal of Code section 133 by Act section 1602
of SBJPA 1996 does not apply to a refinancing of an ESOP
securities acquisition loan made after August 20, 1996, or
pursuant to a binding contract in effect before June 10, 1996, if:
1. The refinancing loan meets the requirements of Code
section 133 in effect on August 20, 1996,
2. The outstanding principal amount of the loan is not
increased, and
3. The term of the original loan is not extended.
Line 18. If there are more than three classes of stock, include
an attachment with the information required for elements (a)
through (f) for each additional class of stock and label the
attachment “Schedule E, line 18 – Additional Classes of
Stock.”
Line 18(d). In determining the dividend rate for a class of
common stock, use the percentage of the average dividends
paid on the class of common stock during the plan year over
the average value of the class of common stock during the plan
year.
In determining the dividend rate for a class of preferred
stock, use the dividend rate stated in the terms of the stock, or if
a dividend rate is not stated, use the percentage of the average
dividends paid on the class of preferred stock during the plan
year over the par value of the class of preferred stock.

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will be made. A fixed income obligation has a fixed maturity
date at a specified interest rate.
Do not report in Part I participant loans under an individual
account plan with investment experience segregated for each
account, that are made in accordance with 29 CFR
2550.408b-1, and that are secured solely by a portion of the
participant’s vested accrued benefit. Report all other participant
loans in default or classified as uncollectible on Part I, and list
each such loan individually.

2008 Instructions for Schedule G
(Form 5500)
Financial Transaction Schedules
General Instructions
Who Must File

Specific Instructions

List any leases in default or classified as uncollectible. A lease
is an agreement conveying the right to use property, plant, or
equipment for a stated period. A lease is in default when the
required payment(s) has not been made. An uncollectible lease
is one where the required payments have not been made and
for which there is little probability that payment will be made.
Provide, on a separate attachment, an explanation of what
steps have been taken or will be taken to collect overdue
amounts for each lease listed and label the attachment
“Schedule G, Part II – Overdue Lease Explanation.”

Part III - Nonexempt Transactions
All nonexempt party-in-interest transactions must be reported,
regardless of whether disclosed in the accountant’s report,
unless the nonexempt transaction is:
1. Statutorily exempt under Part 4 of Title I of ERISA;
2. Administratively exempt under ERISA section 408(a);
3. Exempt under Code sections 4975(c) or 4975(d);
4. The holding of participant contributions in the employer’s
general assets for a welfare plan that meets the conditions of
ERISA Technical Release 92-01;
5. A transaction of a 103-12 IE with parties other than the
plan; or
6. A delinquent participant contribution reported on
Schedule H, line 4a.

Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule G is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.
Do not use a social security number in line D in lieu of an
EIN. The Schedule G and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule G or any of its attachments may result in the rejection
of the filing.
You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.

Part II - Leases in Default or Classified as
Uncollectible

Schedule G (Form 5500) must be attached to a Form 5500 filed
for a plan, MTIA, 103-12 IE, or GIA to report loans or fixed
income obligations in default or determined to be uncollectible
as of the end of the plan year, leases in default or classified as
uncollectible, and nonexempt transactions. See Schedule H
(Form 5500) lines 4b, 4c, and/or 4d.
Check the Schedule G box on the Form 5500 (Part II, line
10b(6)) if a Schedule G is attached to the Form 5500. Multiple
Schedule G pages must be attached to the Form 5500 if
necessary to report the required information. You can get
additional hand print pages by calling 1-800-TAX-FORM
(1-800-829-3676) and requesting additional schedules.
The Schedule G consists of three parts. Part I of the
Schedule G reports any loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
plan year. Part II of the Schedule G reports any leases in
default or classified as uncollectible. Part III of the Schedule G
reports nonexempt transactions.

Provide, on a separate attachment, an explanation of what
steps have been taken or will be taken to collect overdue
amounts for each loan listed and label the attachment
“Schedule G, Part I – Overdue Loan Explanation.”
The due date, payment amount, and conditions for
determining default in the case of a note or loan are usually
contained in the documents establishing the note or loan. A
loan is in default when the borrower is unable to pay the
obligation upon maturity. Obligations that require periodic
repayment can default at any time. Generally loans and fixed
income obligations are considered uncollectible when payment
has not been made and there is little probability that payment

An unfunded, fully insured, or combination unfunded/
insured welfare plan with 100 or more participants
CAUTION exempt under 29 CFR 2520.104-44 from completing
Schedule H must still complete Schedule G, Part III, to report
nonexempt transactions.
If you are unsure whether a transaction is exempt or not,
you should consult with either the plan’s independent qualified
public accountant or legal counsel or both.
You may indicate that an application for an administrative
exemption is pending.

List all loans or fixed income obligations in default or
determined to be uncollectible as of the end of the plan year or
the fiscal year of the GIA, MTIA, or 103-12 IE. Include:
• Obligations where the required payments have not been
made by the due date;
• Fixed income obligations that have matured, but have not
been paid, for which it has been determined that payment will
not be made; and
• Loans that were in default even if renegotiated later during
the year.
Note. Identify in element (a) each obligator known to be a
party-in-interest to the plan.

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.

Part I - Loans or Fixed Income Obligations in Default
or Classified as Uncollectible

Instructions for Schedule G (Form 5500)

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If the plan is a qualified pension plan and a nonexempt
prohibited transaction occurred with respect to a disqualified
person, a Form 5330, Return of Excise Taxes Related to
Employee Benefit Plans, is required to be filed with the IRS to
pay the excise tax on the transaction.

C. An employer, any of whose employees are covered by
the plan;
D. An employee organization, any of whose members are
covered by the plan;
E. An owner, direct or indirect, of 50% or more of: (1) the
combined voting power of all classes of stock entitled to vote
or the total value of shares of all classes of stock of a
corporation, (2) the capital interest or the profits interest of a
partnership, or (3) the beneficial interest of a trust or
unincorporated enterprise that is an employer or an
employee organization described in C or D;
F. A relative of any individual described in A , B, C, or E;
G. A corporation, partnership, or trust or estate of which (or
in which) 50% or more of: (1) the combined voting power of
all classes of stock entitled to vote or the total value of
shares of all classes of stock of such corporation, (2) the
capital interest or profits interest of such partnership, or (3)
the beneficial interest of such trust or estate is owned
directly or indirectly, or held by, persons described in A, B,
C, D, or E;
H. An employee, officer, director (or an individual having
powers or responsibilities similar to those of officers or
directors), or a 10% or more shareholder, directly or
indirectly, of a person described in B, C, D, E, or G, or of the
employee benefit plan; or
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.

The DOL Voluntary Fiduciary Correction Program

TIP (VFCP) describes how to apply, the specific transactions

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Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith
under the terms of the plan by a trustee or a named fiduciary,
assuming an orderly liquidation at time of the determination.
See ERISA section 3(26).
Note. For the 2008 plan year, plans that provide
participant-directed brokerage accounts as an investment
alternative (and have entered pension feature code ‘‘2R’’ on line
8a of the Form 5500) may report investments in assets made
through participant-directed brokerage accounts either:
1. As individual investments on the applicable asset and
liability categories in Part I and the income and expense
categories in Part II, or
2. By including on line 1c(15) the total aggregate value of
the assets and on line 2c the total aggregate investment income
(loss) before expenses, provided the assets are not loans,
partnership or joint-venture interests, real property, employer
securities, or investments that could result in a loss in excess of
the account balance of the participant or beneficiary who
directed the transaction. Expenses charged to the accounts
must be reported on the applicable expense line items.
Participant-directed brokerage account assets reported in the
aggregate on line 1c(15) should be treated as one asset held
for investment for purposes of the line 4i schedules, except that
investments in tangible personal property must continue to be
reported as separate assets on the line 4i schedules.

2008 Instructions for Schedule H
(Form 5500)
Financial Information
General Instructions
Who Must File
Schedule H (Form 5500) must be attached to a Form 5500 filed
for a pension benefit plan or a welfare benefit plan that covered
100 or more participants as of the beginning of the plan year
and a Form 5500 filed for a MTIA, CCT, PSA, 103-12 IE, or
GIA. See the instructions to the Form 5500 for Direct Filing
Entity (DFE) Filing Requirements.
Exceptions: (1) Insured, unfunded, or a combination of
unfunded/insured welfare plans and fully insured pension plans
that meet the requirements of 29 CFR 2520.104-44 are exempt
from completing the Schedule H. (2) If a Schedule I was filed for
the plan for the 2007 plan year and the plan covered fewer than
121 participants as of the beginning of the 2008 plan year, the
Schedule I may be completed instead of a Schedule H. See
What To File on page 8.

Specific Instructions

Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule H is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.

In the event that investments made through a
participant-directed brokerage account are loans, partnership or
joint venture interests, real property, employer securities, or
investments that could result in a loss in excess of the account
balance of the participant or beneficiary who directed the
transaction, such assets must be broken out and treated as
separate assets on the applicable asset and liability categories
in Part I, income and expense categories in Part II, and on the
line 4i schedules. The remaining assets in the
participant-directed brokerage account may be reported in the
aggregate as set forth in paragraph 2 above. The agencies will
be evaluating whether, and to what extent, the aggregate
method of reporting is appropriate for future plan years.

Check the Schedule H box on the Form 5500 (Part II, line
10b(1)) if a Schedule H is attached to the Form 5500. Do not
attach both a Schedule H and a Schedule I to the same Form
5500.

Do not use a social security number in line D in lieu of an
EIN. The Schedule H and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule H or any of its attachments may result in the rejection
of the filing.

Columns (a) and (b). Enter the current value on each line as
of the beginning and end of the plan year.
Note. Amounts reported in column (a) must be the same as
reported for the end of the plan year for corresponding line
items of the return/report for the preceding plan year. Do not
include contributions designated for the 2008 plan year in
column (a).

You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.
Note. Do not mark through the printed line descriptions on the
Schedule H and insert your own description as this may cause
correspondence due to a computerized review of the Schedule
H.

Line 1a. Total noninterest bearing cash includes, among other
things, cash on hand or cash in a noninterest bearing checking
account.
Line 1b(1). Noncash basis filers should include contributions
due the plan by the employer but not yet paid. Do not include
other amounts due from the employer such as the
reimbursement of an expense or the repayment of a loan.
Line 1b(2). Noncash basis filers should include contributions
withheld by the employer from participants and amounts due
directly from participants that have not yet been received by the
plan. Do not include the repayment of participant loans.
Line 1b(3). Noncash basis filers should include amounts due
to the plan that are not includable in lines 1b(1) or 1b(2). These
amounts may include investment income earned but not yet
received by the plan and other amounts due to the plan such as
amounts due from the employer or another plan for expense
reimbursement or from a participant for the repayment of an
overpayment of benefits.
Line 1c(1). Include all assets that earn interest in a financial
institution account such as interest bearing checking accounts,
passbook savings accounts, or in money market accounts.
Line 1c(2). Include securities issued or guaranteed by the
U.S. Government or its designated agencies such as U.S.
Savings Bonds, Treasury bonds, Treasury bills, FNMA, and
GNMA.

The cash, modified cash, or accrual basis may be used for
recognition of transactions in Parts I and II, as long as you use
one method consistently. Round off all amounts reported on the
Schedule H to the nearest dollar. Any other amounts are
subject to rejection. Check all subtotals and totals carefully.
If the assets of two or more plans are maintained in a fund
or account that is not a DFE, a registered investment company,
or the general account of an insurance company under an
unallocated contract (see the instructions for lines 1c(9) through
1c(14)), complete Parts I and II of the Schedule H by entering
the plan’s allocable part of each line item.
Exception. When completing Part II of the Schedule H for a
plan or DFE that participates in a CCT or PSA for which a Form
5500 has not been filed, do not allocate the income of the CCT
or PSA and expenses that were subtracted from the gross
income of the CCT or PSA in determining their net investment
gain (loss). Instead, enter the CCT or PSA net gain (loss) on
line 2b(6) or (7) in accordance with the instructions for these
lines.
If assets of one plan are maintained in two or more trust
funds, report the combined financial information in Parts I and
II.
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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 1c(8), column (b), of Schedule H
(participant loans - end of year) or on line 1a, column (b), of
Schedule I (plan assets - end of year) must include the current
value of any participant loan that was reported as a deemed
distribution on line 2g for any earlier year if the participant
resumes repayment under the loan during the plan year. In
addition, the amount to be entered on line 2g must be reduced
by the amount of the participant loan that was reported as a
deemed distribution on line 2g for the earlier year.
Lines 1c(9), (10), (11), and (12). Enter the total current value
of the plan’s or DFE’s interest in DFEs on the appropriate lines
as of the beginning and end of the plan or DFE year. The value
of the plan’s or DFE’s interest in each DFE at the end of the
plan or DFE year must be reported on the Schedule D (Form
5500).
The plan’s or DFE’s interest in CCTs and PSAs for
which a DFE Form 5500 has not been filed may not be
CAUTION included on lines 1c(9) or 1c(10). The plan’s or DFE’s
interest in the underlying assets of such CCTs and PSAs must
be allocated and reported in the appropriate categories on a
line-by-line basis on Part I of the Schedule H.
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR
2510.3-101(h)(1)(iii) does not constitute a pooled separate
account.
Line 1c(14). Use the same method for determining the value
of the insurance contracts reported here as you used for line 3
of Schedule A (Form 5500), or, if line 3 is not required, line 6 of
Schedule A (Form 5500).
Line 1c(15). Include all other investments not includable in
lines 1c(1) through (14), such as options, index futures,
repurchase agreements, state and municipal securities,
collectibles, and other personal property.
Line 1d(1). An employer security is any security issued by an
employer (including affiliates) of employees covered by the
plan. These may include common stocks, preferred stocks,
bonds, zero coupon bonds, debentures, convertible debentures,
notes and commercial paper.
Line 1d(2). The term ‘‘employer real property’’ means real
property (and related personal property) that is leased to an
employer of employees covered by the plan, or to an affiliate of
such employer. For purposes of determining the time at which a
plan acquires employer real property for purposes of this line,
such property shall be deemed to be acquired by the plan on
the date on which the plan acquires the property or on the date
on which the lease to the employer (or affiliate) is entered into,
whichever is later.
Line 1e. Include the current (not book) value of the buildings
and other property used in the operation of the plan. Buildings
or other property held as plan investments should be reported
in 1c(6) and 1d(2).
Do not include the value of future pension payments on lines
1g, h, i, j, or k.
Line 1g. Noncash basis plans should include the total amount
of benefit claims that have been processed and approved for
payment by the plan. Welfare plans should also include
‘‘incurred but not reported’’ benefit claims.
Line 1h. Noncash basis plans should include the total amount
of obligations owed by the plan which were incurred in the
normal operations of the plan and have been approved for
payment by the plan but have not been paid.
Line 1i. ‘‘Acquisition indebtedness,’’ for debt-financed
property other than real property, means the outstanding
amount of the principal debt incurred:

Line 1c(3). Include investment securities (other than employer
securities defined below in 1d(1)) issued by a corporate entity at
a stated interest rate repayable on a particular future date such
as most bonds, debentures, convertible debentures,
commercial paper and zero coupon bonds. Do not include debt
securities of governmental units that should be reported on line
1c(2) or 1c(15).
‘‘Preferred’’ means any of the above securities that are
publicly traded on a recognized securities exchange and the
securities have a rating of ‘‘A’’ or above. If the securities are not
‘‘Preferred,’’ they are listed as ‘‘Other.’’
Line 1c(4)(A). Include stock issued by corporations (other
than employer securities defined in 1d(1) below) which is
accompanied by preferential rights such as the right to share in
distributions of earnings at a higher rate or which has general
priority over the common stock of the same entity. Include the
value of warrants convertible into preferred stock.
Line 1c(4)(B). Include any stock (other than employer
securities defined in 1d(1)) that represents regular ownership of
the corporation and is not accompanied by preferential rights.
Include the value of warrants convertible into common stock.
Line 1c(5). Include the value of the plan’s participation in a
partnership or joint venture if the underlying assets of the
partnership or joint venture are not considered to be plan assets
under 29 CFR 2510.3-101. Do not include the value of a plan’s
interest in a partnership or joint venture that is a 103-12 IE.
Include the value of a 103-12 IE in 1c(12).
Line 1c(6). Include the current value of both income and
non-income producing real property owned by the plan. Do not
include the value of property that is employer real property or
property used in plan operations that should be reported on
lines 1d and 1e, respectively.
Line 1c(7). Enter the current value of all loans made by the
plan, except participant loans reportable on line 1c(8). Include
the sum of the value of loans for construction, securities loans,
commercial and/or residential mortgage loans that are not
subject to Code section 72(p) (either by making or participating
in the loans directly or by purchasing loans originated by a third
party), and other miscellaneous loans.
Line 1c(8). Enter the current value of all loans to participants
including residential mortgage loans that are subject to Code
section 72(p). Include the sum of the value of the unpaid
principal balances, plus accrued but unpaid interest, if any, for
participant loans made under an individual account plan with
investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and secured
solely by a portion of the participant’s vested accrued benefit.
When applicable, combine this amount with the current value of
any other participant loans. Do not include in column (b) a
participant loan that has been deemed distributed during the
plan year under the provisions of Code section 72(p) and
Treasury Regulations section 1.72(p)-1, if both of the following
circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
If both of these circumstances apply, report the loan as a
deemed distribution on line 2g. However, if either of these
circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) should be included in column (b) without
regard to the occurrence of a deemed distribution.
Note. After a participant loan that has been deemed
distributed is reported on line 2g, it is no longer to be reported
as an asset on Schedule H or Schedule I unless, in a later year,
the participant resumes repayment under the loan. However,
such a loan (including interest accruing thereon after the
deemed distribution) that has not been repaid is still considered
outstanding for purposes of applying Code section 72(p)(2)(A)
to determine the maximum amount of subsequent loans. Also,

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1. By the organization in acquiring or improving the
property;
2. Before the acquisition or improvement of the property if
the debt was incurred only to acquire or improve the property;
or
3. After the acquisition or improvement of the property if the
debt was incurred only to acquire or improve the property and
was reasonably foreseeable at the time of such acquisition or
improvement. For further explanation, see Code section 514(c).

Note. Bond write-offs should be reported as realized losses.
Line 2b(5). Subtract the current value of assets at the
beginning of the year plus the cost of any assets acquired
during the plan year from the current value of assets at the end
of the year to obtain this figure. If entering a negative number,
enter a minus sign “ – ” to the left of the number. Do not include
the value of assets reportable in lines 2b(4) and 2b(6) through
2b(10).
Lines 2b(6), (7), (8), and (9). Report all earnings, expenses,
gains or losses, and unrealized appreciation or depreciation
included in computing the net investment gain (or loss) from all
CCTs, PSAs, MTIAs, and 103-12 IEs here. If some plan funds
are held in any of these entities and other plan funds are held in
other funding media, complete all applicable subitems of line 2
to report plan earnings and expenses relating to the other
funding media. The net investment gain (or loss) allocated to
the plan for the plan year from the plan’s investment in these
entities is equal to:
1. The sum of the current value of the plan’s interest in each
entity at the end of the plan year,
2. Minus the current value of the plan’s interest in each
entity at the beginning of the plan year,
3. Plus any amounts transferred out of each entity by the
plan during the plan year, and
4. Minus any amounts transferred into each entity by the
plan during the plan year.

Line 1j. Noncash basis plans should include amounts owed
for any liabilities that would not be classified as benefit claims
payable, operating payables, or acquisition indebtedness.
Line 1l. The entry in column (b) must equal the sum of the
entry in column (a) plus lines 2k, 2l(1), and 2l(2).
Line 2a. Include the total cash contributions received and/or
(for accrual basis plans) due to be received.
Note. Plans using the accrual basis of accounting should not
include contributions designated for years before the 2008 plan
year on line 2a.
Line 2a(1)(B). For welfare plans, report all employee
contributions, including all elective contributions under a
cafeteria plan (Code section 125). For pension plans,
participant contributions, for purposes of this item, also include
elective contributions under a qualified cash or deferred
arrangement (Code section 401(k)).
Line 2a(2). Use the current value, at date contributed, of
securities or other noncash property.
Line 2b(1)(A). Enter interest earned on interest-bearing cash,
including earnings from sweep accounts, STIF accounts,
money market accounts, certificates of deposit, etc. This is the
interest earned on the investments reported on line 1c(1).
Line 2b(1)(B). Enter interest earned on U.S. Government
Securities. This is the interest earned on the investments
reported on line 1c(2).
Line 2b(1)(C). Generally, this is the interest earned on
securities that are reported on lines 1(c)(3)(A) and (B) and
1d(1).
Line 2b(2). Generally, the dividends are for investments
reported on line 1c(4)(A) and (B) and 1d(1). For accrual basis
plans, include any dividends declared for stock held on the date
of record, but not yet received as of the end of the plan year.
Line 2b(3). Generally, rents represent the income earned on
the real property that is reported in items 1c(6) and 1d(2). Rents
should be entered as a ‘‘Net’’ figure. Net rents are determined
by taking the total rent received and subtracting all expenses
directly associated with the property. If the real property is
jointly used as income producing property and for the operation
of the plan, that portion of the expenses attributable to the
income producing portion of the property should be netted
against the total rents received.
Line 2b(4). Enter in column (b), the total of net gain (loss) on
sale of assets. This equals the sum of the net realized gain (or
loss) on each asset held at the beginning of the plan year which
was sold or exchanged during the plan year, and on each asset
that was both acquired and disposed of within the plan year.
Note. As current value reporting is required for the Form 5500,
assets are revalued to current value at the end of the plan year.
For purposes of this form, the increase or decrease in the value
of assets since the beginning of the plan year (if held on the first
day of the plan year) or their acquisition date (if purchased
during the plan year) is reported in line 2b(5) below, with two
exceptions: (1) the realized gain (or loss) on each asset that
was disposed of during the plan year is reported in 2b(4) (NOT
on line 2b(5)), and (2) the net investment gain (or loss) from
CCTs, PSAs, MTIAs, 103-12 IEs, and registered investment
companies is reported in lines 2b(6) through (10).

2. Enter in 2b(4)(B), column (a), the sum of the current
value of these former assets as of the beginning of the plan
year and the purchase price for assets both acquired and
disposed of during the plan year; and
3. Enter in 2b(4)(C), column (b), the result obtained when
2b(4)(B) is subtracted from 2b(4)(A). If entering a negative
number, enter a minus sign “ – ” to the left of the number.

Enter the net gain as a positive number or the net loss as a
negative number.
Note. Enter the combined net investment gain or loss from all
CCTs and PSAs, regardless of whether a DFE Form 5500 was
filed for the CCTs and PSAs.
Line 2b(10). Enter net investment gain (loss) from registered
investment companies here. Compute in the same manner as
discussed above for lines 2b(6) through (9).
Line 2c. Include all other plan income earned that is not
included in 2a or 2b. Do not include transfers from other plans
that should be reported in line 2l.
Line 2e(1). Include the current value of all cash, securities, or
other property at the date of distribution. Include all eligible
rollover distributions as defined in Code section 401(a)(31)(C)
paid at the participant’s election to an eligible retirement plan
(including an IRA within the meaning of section 401(a)(31)(D)).
Line 2e(2). Include payments to insurance companies and
similar organizations such as Blue Cross, Blue Shield, and
health maintenance organizations for the provision of plan
benefits (e.g., paid-up annuities, accident insurance, health
insurance, vision care, dental coverage, stop-loss insurance
whose claims are paid to the plan (or which is otherwise an
asset of the plan)), etc.
Line 2e(3). Include all payments made to other organizations
or individuals providing benefits. Generally, these are individual
providers of welfare benefits such as legal services, day care
services, training and apprenticeship services.
Line 2f. Include on this line all distributions paid during the
plan year of excess deferrals under Code section
402(g)(2)(A)(ii), excess contributions under section 401(k)(8),
and excess aggregate contributions under section 401(m)(6).
Include allocable income distributed. Also include on this line
any elective deferrals and employee contributions distributed or
returned to employees during the plan year in accordance with
Treasury Regulations section 1.415-6(b)(6)(iv), as well as any
attributable gains that were also distributed.
Line 2g. Report on line 2g a participant loan that has been
deemed distributed during the plan year under the provisions of

The sum of the realized gain (or loss) of assets sold or
exchanged during the plan year is to be calculated as follows:
1. Enter in 2b(4)(A), column (a), the sum of the amount
received for these former assets;
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Code section 72(p) and Treasury Regulations section 1.72(p)-1
only if both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.

Line 2i(4). Other expenses are those that cannot be included
in 2i(1) through 2i(3). These may include plan expenditures
such as salaries and other compensation and allowances (e.g.,
payment of premiums to provide health insurance benefits to
plan employees), expenses for office supplies and equipment,
cars, telephone, postage, rent, expenses associated with the
ownership of a building used in the operation of the plan, all
miscellaneous expenses and trustees’ fees and reimbursement
of expenses associated with trustees such as lost time,
seminars, travel, meetings, etc.

Line 2l. Include in these reconciliation figures the value of all
transfers of assets or liabilities into or out of the plan resulting
from, among other things, mergers and consolidations. A
transfer of assets or liabilities occurs when there is a reduction
of assets or liabilities with respect to one plan and the receipt of
these assets or the assumption of these liabilities by another
plan. A transfer is not a shifting of one plan’s assets or liabilities
from one investment to another. A transfer is not a distribution
of all or part of an individual participant’s account balance that
is reportable on Form 1099-R, Distributions From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance
Contracts, etc., (see the instructions for line 2e). Transfers out
at the end of the year should be reported as occurring during
the plan year.

Note. If this Schedule H is filed for a DFE, report the value of
all asset transfers to the DFE, including those resulting from
contributions to participating plans on line 2l(1), and report the
total value of all assets transferred out of the DFE, including
assets withdrawn for disbursement as benefit payments by
participating plans, on line 2l(2). Contributions and benefit
payments are considered to be made to/by the plan (not to/by a
DFE).

Line 3. The administrator of an employee benefit plan who
files a Schedule H (Form 5500) generally must engage an
independent qualified public accountant (IQPA) pursuant to
ERISA section 103(a)(3)(A) and 29 CFR 2520.103-1(b). This
requirement also applies to a Form 5500 filed for a 103-12 IE
and for a GIA (see 29 CFR 2520.103-12 and 29 CFR
2520.103-2). The accountant’s report must be attached to the
Form 5500 when a Schedule H (Form 5500) is attached unless
line 3d(1) or 3d(2) on the Schedule H is checked.

If either of these circumstances does not apply, a deemed
distribution of a participant loan should not be reported on line
2g. Instead, the current value of the participant loan (including
interest accruing thereon after the deemed distribution) should
be included on line 1c(8), column (b) (participant loans - end of
year), without regard to the occurrence of a deemed
distribution.
Note. The amount to be reported on line 2g of Schedule H or
Schedule I must be reduced if, during the plan year, a
participant resumes repayment under a participant loan
reported as a deemed distribution on line 2g for any earlier
year. The amount of the required reduction is the amount of the
participant loan reported as a deemed distribution on line 2g for
the earlier year. If entering a negative number, enter a minus
sign “ – ” to the left of the number. The current value of the
participant loan must then be included in line 1c(8), column (b),
of Schedule H (participant loans - end of year) or in line 1a,
column (b), of Schedule I (plan assets - end of year).
Although certain participant loans deemed distributed are to
be reported on line 2g of the Schedule H or Schedule I, and are
not to be reported on the Schedule H or Schedule I as an asset
thereafter (unless the participant resumes repayment under the
loan in a later year), they are still considered outstanding loans
and are not treated as actual distributions for certain purposes.
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
Line 2h. Interest expense is a monetary charge for the use of
money borrowed by the plan. This amount should include the
total of interest paid or to be paid (for accrual basis plans)
during the plan year.
Line 2i. Report all administrative expenses (by specified
category) paid by or charged to the plan, including those that
were not subtracted from the gross income of CCTs, PSAs,
MTIAs, and 103-12 IEs in determining their net investment
gain(s) or loss(es). Expenses incurred in the general operations
of the plan are classified as administrative expenses.
Line 2i(1). Include the total fees paid (or in the case of
accrual basis plans costs incurred during the plan year but not
paid as of the end of the plan year) by the plan for outside
accounting, actuarial, legal, and valuation/appraisal services.
Include fees for the annual audit of the plan by an independent
qualified public accountant; for payroll audits; for accounting/
bookkeeping services; for actuarial services rendered to the
plan, and to a lawyer for rendering legal opinions, litigation, and
advice (but not for providing legal services as a benefit to plan
participants). Include the fee(s) for valuations or appraisals to
determine the cost, quality, or value of an item such as real
property, personal property (gemstones, coins, etc.), and for
valuations of closely held securities for which there is no ready
market. Do not include amounts paid to plan employees to
perform bookkeeping/accounting functions that should be
included in 2i(4).
Line 2i(2). Enter the total fees paid (or in the case of accrual
basis plans, costs incurred during the plan year but not paid as
of the end of the plan year) to a contract administrator for
performing administrative services for the plan. For purposes of
the return/report, a contract administrator is any individual,
partnership or corporation, responsible for managing the clerical
operations (e.g., handling membership rosters, claims
payments, maintaining books and records) of the plan on a
contractual basis. Do not include salaried staff or employees of
the plan or banks or insurance carriers.
Line 2i(3). Enter the total fees paid (or in the case of accrual
basis plans, costs incurred during the plan year but not paid as
of the end of the plan year) to an individual, partnership or

corporation (or other person) for advice to the plan relating to its
investment portfolio. These may include fees paid to manage
the plan’s investments, fees for specific advice on a particular
investment, and fees for the evaluation of the plan’s investment
performance.

29 CFR 2520.103-1(b) requires that any separate financial
statements prepared in order for the independent qualified
public accountant to form the opinion and notes to these
financial statements must be attached to the Form 5500. Any
separate statements must include the information required to be
disclosed in Parts I and II of the Schedule H; however, they
may be aggregated into categories in a manner other than that
used on the Schedule H. The separate statements should be
either typewritten or printed and consist of reproductions of
Parts I and II or statements incorporating by references Parts I
and II. See ERISA section 103(a)(3)(A), and the DOL
regulations 29 CFR 2520.103-1(a)(2) and (b), 2520.103-2, and
2520.104-50.
Note. Delinquent participant contributions reported on line 4a
should be treated as part of the separate schedules referenced
in ERISA section 103(a)(3)(A) and 29 CFR 2520.103-1(b) and
2520.103-2(b) for purposes of preparing the accountant’s
opinion described on line 3 even though they are no longer
required to be listed on Part III of the Schedule G. If the
information contained on line 4a is not presented in accordance
with regulatory requirements, the IQPA report must make the
appropriate disclosures in accordance with generally accepted
auditing standards. Delinquent participant contributions that are
exempt because they satisfy the DOL Voluntary Fiduciary
Correction Program (VFCP) requirements and the conditions of
Prohibited Transaction Exemption (PTE) 2002-51 do not need

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to be treated as part of the schedule of nonexempt
party-in-interest transactions.

Note. Do not check the box on line 3d(2) if the Form 5500 is
filed for a 103-12 IE or a GIA. A deferral of the accountant’s
opinion is not permitted for a 103-12 IE or a GIA. If an E or G is
entered on Form 5500, Part I, line A(4), an accountant’s opinion
must be attached to the Form 5500 and the type of opinion
must be reported on Schedule H, line 3a.

Lines 4a through 4k. Plans completing Schedule H must
answer all these lines either ‘‘Yes’’ or ‘‘No.’’ If lines 4a through
4h are ‘‘Yes,’’ an amount must be entered where indicated.
Report investments in CCTs, PSAs, MTIAs, and 103-12 IEs, but
not the investments made by these entities. Plans with all of
their funds held in a master trust should check ‘‘No’’ on line 4b,
4c, 4i, and 4j. CCTs and PSAs do not complete Part IV. MTIAs,
103-12 IEs, and GIAs do not complete lines 4a, 4e, 4f, 4g, 4h,
or 4k. 103-12 IEs also do not complete line 4j.
Line 4a. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the
plan are participant contributions that become plan assets as of
the earliest date on which such contributions can reasonably be
segregated from the employer’s general assets (see 29 CFR
2510.3-102). An employer holding these assets after that date
commingled with its general assets will have engaged in a
prohibited use of plan assets (see ERISA section 406). If such a
nonexempt prohibited transaction occurred with respect to a
disqualified person (see Code section 4975(e)(2)), file Form
5330, Return of Excise Taxes Related to Employee Benefit
Plans, with the IRS to pay any applicable excise tax on the
transaction.

If the required accountant’s report is not attached to the
Form 5500, the filing is subject to rejection as incomplete and
penalties may be assessed.
Lines 3a(1) through 3a(4). These boxes identify the type of
opinion offered by the accountant.
Line 3a(1). Check if an unqualified opinion was issued.
Generally, an unqualified opinion is issued when the
independent qualified public accountant concludes that the
plan’s financial statements present fairly, in all material
respects, the financial status of the plan as of the end of the
period audited and the changes in its financial status for the
period under audit in conformity with generally accepted
accounting principles (GAAP) or an other comprehensive basis
of accounting (OCBOA), e.g., cash basis.
Line 3a(2). Check if a qualified opinion was issued. Generally,
a qualified opinion is issued by an independent qualified public
accountant when the plan’s financial statements present fairly,
in all material respects, the financial status of the plan as of the
end of the audit period and the changes in its financial status for
the period under audit in conformity with GAAP or OCBOA,
except for the effects of one or more matters described in the
opinion.
Line 3a(3). Check if a disclaimer of opinion was issued. A
disclaimer of opinion is issued when the independent qualified
public accountant does not express an opinion on the financial
statements because he or she has not performed an audit
sufficient in scope to enable him or her to form an opinion on
the financial statements.
Line 3a(4). Check if the plan received an adverse
accountant’s opinion. Generally, an adverse opinion is issued
by an independent qualified public accountant when the plan’s
financial statements do not present fairly, in all material
respects, the financial status of the plan as of the end of the
audit period and the changes in its financial status for the period
under audit in conformity with GAAP or OCBOA.
Line 3b. Check “Yes” if a box is checked on line 3a and the
scope of the plan’s audit was limited pursuant to DOL
regulations 29 CFR 2520.103-8 and 2520.103-12(d) because
the examination and report of an independent qualified public
accountant did not extend to: (a) statements or information
regarding assets held by a bank, similar institution or insurance
carrier that is regulated and supervised and subject to periodic
examination by a state or Federal agency provided that the
statements or information are prepared by and certified to by
the bank or similar institution or an insurance carrier, or (b)
information included with the Form 5500 filed for a 103-12 IE.
The term ‘‘similar institution’’ as used here does not extend to
securities brokerage firms (see DOL Advisory Opinion 93-21A).
See 29 CFR 2520.103-8 and 2520.103-12(d).
Note. These regulations do not exempt the plan administrator
from engaging an accountant or from attaching the accountant’s
report to the Form 5500. If you check line 3b, you must also
check the appropriate box on line 3a to identify the type of
opinion offered by the accountant.
Line 3c. Enter the name and EIN of the accountant (or
accounting firm) in the space provided on line 3c. Do not use a
social security number in lieu of an EIN. The Schedule H is
open to public inspection, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule H may result in the rejection of the
filing.
Line 3d(1). Check this box only if the Schedule H is being
filed for a CCT, PSA, or MTIA.
Line 3d(2). Check this box if the plan has elected to defer
attaching the accountant’s opinion for the first of 2 consecutive
plan years, one of which is a short plan year of 7 months or
less. The Form 5500 for the first of the 2 years must be
complete and accurate, with all required attachments, except
for the accountant’s report, including an attachment explaining

why one of the 2 plan years is of 7 or fewer months duration
and stating that the annual report for the immediately following
plan year will include a report of an independent qualified public
accountant with respect to the financial statements and
accompanying schedules for both of the 2 plan years. The Form
5500 for the second year must include: (a) financial schedules
and statements for both plan years; (b) a report of an
independent qualified public accountant with respect to the
financial schedules and statements for each of the 2 plan years
(regardless of the number of participants covered at the
beginning of each plan year); and (c) a statement identifying
any material differences between the unaudited financial
information submitted with the first Form 5500 and the audited
financial information submitted with the second Form 5500. See
29 CFR 2520.104-50.

Plans that check “Yes” must enter the aggregate amount of
all late contributions for the year. The total amount of the
delinquent contributions should be included on line 4a of the
Schedule H or I, as applicable, for the year in which the
contributions were delinquent and should be carried over and
reported again on line 4a of the Schedule H or I, as applicable,
for each subsequent year until the year after the violation has
been fully corrected, which correction includes payment of the
late contributions and reimbursement of the plan for lost
earnings or profits. If no participant contributions were received
or withheld by the employer during the plan year, answer ‘‘No.’’

Instructions for Schedule H (Form 5500)

Delinquent participant contributions reported on line 4a

TIP should be treated as part of the separate schedules
referenced in ERISA section 103(a)(3)(A) and 29 CFR
2520.103-1(b) and 2520.103-2(b) for purposes of preparing the
accountant’s opinion described on line 3 even though they are
no longer required to be listed on Part III of the Schedule G. If
the information contained on line 4a is not presented in
accordance with regulatory requirements, the IQPA report must
make the appropriate disclosures in accordance with generally
accepted auditing standards. For more information, see EBSA’s
Frequently Asked Questions About Reporting Delinquent
Contributions, available on the Internet at www.dol.gov/ebsa.
Although all delinquent participant contributions must be
reported on line 4a, delinquent contributions for which the DOL
Voluntary Fiduciary Correction Program (VFCP) requirements
and the conditions of Prohibited Transaction Exemption (PTE)
2002-51 have been satisfied do not need to be treated as
nonexempt party-in-interest transactions.

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‘‘handling’’ funds or other property of a plan, so as to require
bonding, whenever his or her other duties or activities with
respect to given funds are such that there is a risk that such
funds could be lost in the event of fraud or dishonesty on the
part of such person, acting either alone or in collusion with
others. Section 412 of ERISA and DOL regulations 29 CFR
2580 provide the bonding requirements, including the definition
of ‘‘handling’’ (29 CFR 2580.412-6), the permissible forms of
bonds (29 CFR 2580.412-10), the amount of the bond (29 CFR
2580, subpart C), and certain exemptions such as the
exemption for unfunded plans, certain banks and insurance
companies (ERISA section 412), and the exemption allowing
plan officials to purchase bonds from surety companies
authorized by the Secretary of the Treasury as acceptable
reinsurers on Federal bonds (29 CFR 2580.412-23).
Information concerning the list of approved sureties and
reinsurers is available on the Internet at www.fms.treas.gov/
c570.
Note. Plans are permitted under certain conditions to purchase
fiduciary liability insurance. These policies do not protect the
plan from dishonest acts and are not bonds that should be
reported in line 4e.
Line 4f. Check ‘‘Yes,’’ if the plan had suffered or discovered
any loss as a result of any dishonest or fraudulent act(s) even if
the loss was reimbursed by the plan’s fidelity bond or from any
other source. If ‘‘Yes’’ is checked enter the full amount of the
loss. If the full amount of the loss has not yet been determined,
provide an estimate and disclose that the figure is an estimate,
such as “@1000.”

Willful failure to report is a criminal offense. See ERISA
section 501.

CAUTION

The VFCP describes how to apply, the specific transactions
covered (which transactions include delinquent participant
contributions to pension and welfare plans), and acceptable
methods for correcting violations. In addition, applicants that
satisfy both the VFCP requirements and the conditions of PTE
2002-51 are eligible for immediate relief from payment of
certain prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). Information about the VFCP is also available on the
Internet at www.dol.gov/ebsa.
Line 4b. Plans that check ‘‘Yes’’ must enter the amount and
complete Part I of Schedule G. The due date, payment amount
and conditions for determining default of a note or loan are
usually contained in the documents establishing the note or
loan. A loan by the plan is in default when the borrower is
unable to pay the obligation upon maturity. Obligations that
require periodic repayment can default at any time. Generally,
loans and fixed income obligations are considered uncollectible
when payment has not been made and there is little probability
that payment will be made. A fixed income obligation has a
fixed maturity date at a specified interest rate. Do not include
participant loans made under an individual account plan with
investment experience segregated for each account that were
made in accordance with 29 CFR 2550.408b-1 and secured
solely by a portion of the participant’s vested accrued benefit.
Line 4c. Plans that check ‘‘Yes’’ must enter the amount and
complete Part II of Schedule G. A lease is an agreement
conveying the right to use property, plant or equipment for a
stated period. A lease is in default when the required
payment(s) has not been made. An uncollectible lease is one
where the required payments have not been made and for
which there is little probability that payment will be made.
Line 4d. Plans that check ‘‘Yes’’ must enter the amount and
complete Part III of Schedule G. Check ‘‘Yes’’ if any nonexempt
transaction with a party-in-interest occurred regardless of
whether the transaction is disclosed in the accountant’s report.
Do not check “Yes” or complete Schedule G, Part III, with
respect to transactions that are: (1) statutorily exempt under
Part 4 of Title I of ERISA; (2) administratively exempt under
ERISA section 408(a); (3) exempt under Code sections 4975(c)
or 4975(d); (4) the holding of participant contributions in the
employer’s general assets for a welfare plan that meets the
conditions of ERISA Technical Release 92-01; (5) a transaction
of a 103-12 IE with parties other than the plan; or (6) delinquent
participant contributions reported on line 4a.
Note. See the instructions for Part III of the Schedule G (Form
5500) concerning nonexempt transactions and party-in-interest.
You may indicate that an application for an administrative
exemption is pending. If you are unsure as to whether a
transaction is exempt or not, you should consult with either the
plan’s independent qualified public accountant or legal counsel
or both.

Lines 4g and 4h. Current value means fair market value
where available. Otherwise, it means the fair value as
determined in good faith under the terms of the plan by a
trustee or a named fiduciary, assuming an orderly liquidation at
the time of the determination. See ERISA section 3(26).
An accurate assessment of fair market value is essential to
a pension plan’s ability to comply with the requirements set
forth in the Code (e.g., the exclusive benefit rule of Code
section 401(a)(2), the limitations on benefits and contributions
under Code section 415, and the minimum funding
requirements under Code section 412) and must be determined
annually.
Examples of assets that may not have a readily
determinable value on an established market (e.g., NYSE,
AMEX, over the counter, etc.) include real estate, nonpublicly
traded securities, shares in a limited partnership, and
collectibles. Do not check ‘‘Yes’’ on line 4g if the plan is a
defined contribution plan and the only assets the plan holds,
that do not have a readily determinable value on an established
market, are: (1) participant loans not in default, or (2) assets
over which the participant exercises control within the meaning
of section 404(c) of ERISA.
Although the current value of plan assets must be
determined each year, there is no requirement that the assets
(other than certain nonpublicly traded employer securities held
in ESOPs) be valued every year by independent third-party
appraisers.
Enter in the amount column the fair market value of the
assets referred to on line 4g whose value was not readily
determinable on an established market and which were not
valued by an independent third-party appraiser in the plan year.
Generally, as it relates to these questions, an appraisal by an
independent third party is an evaluation of the value of an asset
prepared by an individual or firm who knows how to judge the
value of such assets and does not have an ongoing relationship
with the plan or plan fiduciaries except for preparing the
appraisals.
Line 4i. Check ‘‘Yes’’ if the plan had any assets held for
investment purposes, and attach a schedule of assets held for
investment purposes at end of year, a schedule of assets held

Applicants that satisfy the VFCP requirements and the

TIP conditions of PTE 2002-51 (see the instructions for line
4a) are eligible for immediate relief from payment of
certain prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). When the conditions of PTE 2002-51 have been
satisfied, the corrected transactions should be treated as
exempt under Code section 4975(c) for the purposes of
answering line 4d.
Line 4e. Plans that check ‘‘Yes’’ must enter the aggregate
amount of coverage for all claims. Check ‘‘Yes’’ only if the plan
itself (as opposed to the plan sponsor or administrator) is a
named insured under a fidelity bond from an approved surety
covering plan officials and that protects the plan as described in
29 CFR Part 2580. Generally, every plan official of an employee
benefit plan who ‘‘handles’’ funds or other property of such plan
must be bonded. Generally, a person shall be deemed to be

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Instructions for Schedule H (Form 5500)

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for investment purposes that were both acquired and disposed
of within the plan year, or both, as applicable. The schedules
must use the format set forth below or a similar format and the
same size paper as the Form 5500. See 29 CFR 2520.103-11.

Assets held for investment purposes shall not include any
investment that was not held by the plan on the last day of the
plan year if that investment is reported in the annual report for
that plan year in any of the following:
1. The schedule of loans or fixed income obligations in
default required by Schedule G, Part I;
2. The schedule of leases in default or classified as
uncollectible required by Schedule G, Part II;
3. The schedule of nonexempt transactions required by
d
Schedule G, Part III; and
4. The schedule of reportable transactions required by
Schedule H, line 4j.

Assets held for investment purposes shall include:

• Any investment asset held by the plan on the last day of the
plan year; and

• Any investment asset purchased during the plan year and

Line 4j. Check ‘‘Yes’’ and attach to the Form 5500 the
following schedule if the plan had any reportable transactions
(see 29 CFR 2520.103-6 and the examples provided in the
regulation). The schedule must use the format set forth on page
36 or a similar format and the same size paper as the Form
5500. See 29 CFR 2520.103-11.

A reportable transaction includes:
1. A single transaction within the plan year in excess of 5%
of the current value of the plan assets;
2. Any series of transactions with or in conjunction with the
same person, involving property other than securities, which
amount in the aggregate within the plan year (regardless of the
category of asset and the gain or loss on any transaction) to
more than 5% of the current value of plan assets;
3. Any transaction within the plan year involving securities
of the same issue if within the plan year any series of

sold before the end of the plan year except:
1. Debt obligations of the U.S. or any U.S. agency.
2. Interests issued by a company registered under the
Investment Company Act of 1940 (e.g., a mutual fund).
3. Bank certificates of deposit with a maturity of one year or
less.
4. Commercial paper with a maturity of 9 months or less if it
is valued in the highest rating category by at least two nationally
recognized statistical rating services and is issued by a
company required to file reports with the Securities and
Exchange Commission under section 13 of the Securities
Exchange Act of 1934.
5. Participations in a bank common or collective trust.
6. Participations in an insurance company pooled separate
account.
7. Securities purchased from a broker-dealer registered
under the Securities Exchange Act of 1934 and either: (1) listed
on a national securities exchange and registered under section
6 of the Securities Exchange Act of 1934, or (2) quoted on
NASDAQ.

Line 4i schedules. The first schedule required to be attached is a schedule of all assets held for investment purposes at the end
of the plan year, aggregated and identified by issue, maturity date, rate of interest, collateral, par or maturity value, cost and current
value, and, in the case of a loan, the payment schedule.
In column (a), place an asterisk (*) on the line of each identified person known to be a party-in-interest to the plan. In column
(c), include any restriction on transferability of corporate securities. (Include lending of securities permitted under Prohibited
Transactions Exemption 81-6.)
This schedule must be clearly labeled “Schedule H, line 4i—Schedule of Assets (Held At End of Year).”
(c) Description of investment including maturity date,
rate of interest, collateral, par, or maturity value

(d) Cost

(e) Current
value

(a) (b) Identity of issue, borrower, lessor, or similar party

The second schedule required to be attached is a schedule of investment assets that were both acquired and disposed of within
the plan year. This schedule must be clearly labeled “Schedule H, line 4i—Schedule of Assets (Acquired and Disposed of Within
Year).”
(a) Identity of issue, borrower, lessor, or similar party

(b) Description of investment including maturity date,
rate of interest, collateral, par, or maturity value

(d) Proceeds of
dispositions

Notes: (1) Participant loans under an individual account plan with investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and that are secured solely by a portion of the participant’s vested accrued benefit,
may be aggregated for reporting purposes in item 4i. Under identity of borrower enter “Participant loans,” under rate of interest
enter the lowest rate and the highest rate charged during the plan year (e.g., 8%–10%), under the cost and proceeds columns
enter zero, and under current value enter the total amount of these loans. (2) Column (d) cost information for the Schedule of
Assets (Held At End of Year) and the column (c) cost of acquisitions information for the Schedule of Assets (Acquired and
Disposed of Within Year) may be omitted when reporting investments of an individual account plan that a participant or beneficiary
directed with respect to assets allocated to his or her account (including a negative election authorized under the terms of the
plan). (3) Participant-directed brokerage account assets reported in the aggregate on line 1c(15) should be treated as one asset
held for investment for purposes of the line 4i schedules, except investments in tangible personal property must continue to be
reported as separate assets on the line 4i schedules.

Instructions for Schedule H (Form 5500)

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transactions with respect to such securities amount in the
aggregate to more than 5% of the current value of the plan
assets; and
4. Any transaction within the plan year with respect to
securities with, or in conjunction with, a person if any prior or
subsequent single transaction within the plan year with such
person, with respect to securities, exceeds 5% of the current
value of plan assets.

Note. If ‘‘Yes’’ was checked on line 4k because all plan assets
were distributed to participants and/or beneficiaries, you are
encouraged to complete Schedule SSA (Form 5500), listing
each participant reported on a previous Schedule SSA (Form
5500) who has received all of his/her plan benefits, and,
therefore, is no longer entitled to receive deferred vested
benefits. This will ensure that SSA’s records are correct, and
help eliminate confusion for participants and plan administrators
in the future. See the instructions to the Schedule SSA (Form
5500) for greater detail.
Line 5a. Check ‘‘Yes’’ if a resolution to terminate the plan was
adopted during this or any prior plan year, unless the
termination was revoked and no assets reverted to the
employer. If ‘‘Yes’’ is checked, enter the amount of plan assets
that reverted to the employer during the plan year in connection
with the implementation of such termination. Enter ‘‘-0-’’ if no
reversion occurred during the current plan year.

The 5% figure is determined by comparing the current value
of the transaction at the transaction date with the current value
of the plan assets at the beginning of the plan year. If this is the
initial plan year, you may use the current value of plan assets
at the end of the plan year to determine the 5% figure.

A Form 5500 must be filed for each year the plan has
assets, and, for a welfare benefit plan, if the plan is still
CAUTION liable to pay benefits for claims incurred before the
termination date, but not yet paid. See 29 CFR
2520.104b-2(g)(2)(ii).
Line 5b. Enter information concerning assets and/or liabilities
transferred from this plan to another plan(s) (including spin-offs)
during the plan year. A transfer of assets or liabilities occurs
when there is a reduction of assets or liabilities with respect to
one plan and the receipt of these assets or the assumption of
these liabilities by another plan. Enter the name, PN, and EIN of
the transferee plan(s) involved on lines 5b(1), (2), and (3). If
there are more than four plans, include an attachment with the
information required for 5b(1), (2), and (3) for each additional
plan and label the attachment ‘‘Schedule H, line 5b –
Additional Plans.’’
Do not use a social security number in lieu of an EIN or
include an attachment that contains visible social security
numbers. The Schedule H is open to public inspection, and the
contents are public information and are subject to publication on
the Internet. Because of privacy concerns, the inclusion of a
social security number on this Schedule H or the inclusion of a
visible social security number on an attachment may result in
the rejection of the filing.
Note. A distribution of all or part of an individual participant’s
account balance that is reportable on Form 1099-R should not
be included on line 5b. Do not submit Form 1099-R with the
Form 5500.

If the assets of two or more plans are maintained in one trust,
except as provided below, the plan’s allocable portion of the
transactions of the trust shall be combined with the other
transactions of the plan, if any, to determine which transactions
(or series of transactions) are reportable (5%) transactions.
For investments in common/collective trusts, pooled
separate accounts, 103-12 IEs and registered investment
companies, determine the 5% figure by comparing the
transaction date value of the acquisition and/or disposition of
units of participation or shares in the entity with the current
value of the plan assets at the beginning of the plan year. If the
Schedule H is attached to a Form 5500 filed for a plan with all
plan funds held in a master trust, check ‘‘No’’ on line 4j. Plans
with assets in a master trust that have other transactions should
determine the 5% figure by subtracting the current value of plan
assets held in the master trust from the current value of all plan
assets at the beginning of the plan year and check ‘‘Yes’’ or
‘‘No,’’ as appropriate. Do not include individual transactions of
common/collective trusts, pooled separate accounts, master
trust investment accounts, 103-12 IEs, and registered
investment companies in which this plan or DFE invests.
In the case of a purchase or sale of a security on the market,
do not identify the person from whom purchased or to whom
sold.
Special rule for certain participant-directed transactions.
Transactions under an individual account plan that a participant
or beneficiary directed with respect to assets allocated to his or
her account (including a negative election authorized under the
terms of the plan) should not be treated for purposes of line 4j
as reportable transactions. The current value of all assets of the
plan, including these participant-directed transactions, should
be included in determining the 5% figure for all other
transactions.
Line 4k. Check ‘‘Yes’’ if all the plan assets (including
insurance/annuity contracts) were distributed to the participants
and beneficiaries, legally transferred to the control of another
plan, or brought under the control of the PBGC.
Check ‘‘No’’ for a welfare benefit plan that is still liable to pay
benefits for claims incurred before the termination date, but not
yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).

Form 5310-A, Notice of Plan Merger or Consolidation,
Spinoff, or Transfer of Plan Assets or Liabilities; Notice
CAUTION of Qualified Separate Lines of Business, must be filed at
least 30 days before any plan merger or consolidation or any
transfer of plan assets or liabilities to another plan. There is a
penalty for not filing Form 5310-A on time. In addition, a transfer
of benefit liabilities involving a plan covered by PBGC insurance
may be reportable to the PBGC (see PBGC Form 10 and Form
10-Advance).

Line 4j schedule. The schedule required to be attached is a schedule of reportable transactions that must be clearly labeled
“Schedule H, line 4j — Schedule of Reportable Transactions.”
(a) Identity of
party involved

(b) Description of asset
(include interest rate and
maturity in case of a loan)

(d) Selling
price

(e) Lease
rental

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(f) Expense
incurred
with transaction

(g) Cost of
asset

(h) Current
value of asset
on transaction
date

(i) Net gain
or (loss)

Instructions for Schedule H (Form 5500)

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Line 1a. A plan with assets held in common/collective trusts,
pooled separate accounts, master trust investment accounts,
and/or 103-12 IEs must also attach Schedule D (Form 5500).
Use the same method for determining the value of the
plan’s interest in an insurance company general account
(unallocated contracts) that you used for line 3 of Schedule A
(Form 5500), or, if line 3 is not required, line 6 of Schedule A
(Form 5500).
Note. Do not include in column (b) a participant loan that has
been deemed distributed during the plan year under the
provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1, if both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.

2008 Instructions for Schedule I
(Form 5500)
Financial Information – Small Plan
General Instructions
Who Must File
Schedule I (Form 5500) must be attached to a Form 5500 filed
for pension benefit plans and welfare benefit plans that covered
fewer than 100 participants as of the beginning of the plan year.
Exception. If a Schedule I was filed for the plan for the 2007
plan year and the plan covered fewer than 121 participants as
of the beginning of the 2008 plan year, the Schedule I may be
completed instead of a Schedule H.
Note. Certain insured, unfunded or combination unfunded/
insured welfare plans are exempt from filing the Form 5500 and
the Schedule I. In addition, certain fully insured pension plans
are exempt from completing the Schedule I. See the Form 5500
instructions for Who Must File on page 3 and Limited Pension
Plan Reporting on page 10 for more information.

If the deemed distributed participant loan is included in
column (a) and both of these circumstances apply, report the
loan as a deemed distribution on line 2g. However, if either of
these circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) should be included in column (b) without
regard to the occurrence of a deemed distribution.
After a participant loan that has been deemed distributed is
reported on line 2g, it is no longer to be reported as an asset on
Schedule H or Schedule I unless, in a later year, the participant
resumes repayment under the loan. However, such a loan
(including interest accruing thereon after the deemed
distribution) that has not been repaid is still considered
outstanding for purposes of applying Code section 72(p)(2)(A)
to determine the maximum amount of subsequent loans. Also,
the deemed distribution is not treated as an actual distribution
for other purposes, such as the qualification requirements of
Code section 401, including, for example, the determination of
top-heavy status under Code section 416 and the vesting
requirements of Treasury Regulations section 1.411(a)-7(d)(5).
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
The entry on line 1a, column (b), of Schedule I (plan assets end of year) or on line 1c(8), column (b), of Schedule H
(participant loans - end of year) must include the current value
of any participant loan reported as a deemed distribution on line
2g for any earlier year if, during the plan year, the participant
resumes repayment under the loan. In addition, the amount to
be entered on line 2g must be reduced by the amount of the
participant loan reported as a deemed distribution on line 2g for
the earlier year.
Line 1b. Enter the total liabilities at the beginning and end of
the plan year. Liabilities to be entered here do not include the
value of future pension payments to plan participants. However,
the amount to be entered in line 1b for accrual basis filers
includes, among other things:
1. Benefit claims that have been processed and approved
for payment by the plan but have not been paid (including all
incurred but not reported welfare benefit claims);
2. Accounts payable obligations owed by the plan that were
incurred in the normal operations of the plan but have not been
paid; and
3. Other liabilities such as acquisition indebtedness and any
other amount owed by the plan.

Specific Instructions

Lines A, B, C, and D. This information should be the same as
reported in Part II of the Form 5500 to which this Schedule I is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.
Do not use a social security number in line D in lieu of an
EIN. The Schedule I and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule I or any of its attachments may result in the rejection
of the filing.
You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.
Note. Do not mark through the printed line descriptions on the
Schedule I and insert your own description as this may cause
additional correspondence due to a computerized review of the
Schedule I.
Use either the cash, modified cash, or accrual basis for
recognition of transactions, as long as you use one method
consistently. Round off all amounts reported on the Schedule I
to the nearest dollar. Any other amounts are subject to
rejection. Check all subtotals and totals carefully.
If the assets of two or more plans are maintained in one
fund, such as when an employer has two plans funded through
a single trust (except a DFE), complete Parts I and II by
entering the plan’s allocable part of each line item.
If assets of one plan are maintained in two or more trust
funds, report the combined financial information in Part I.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith
under the terms of the plan by a trustee or a named fiduciary,
assuming an orderly liquidation at time of the determination.
See ERISA section 3(26).

Check the Schedule I box on the Form 5500 (Part II, line
10b(2)) if a Schedule I is attached to the Form 5500. Do not
attach both a Schedule I and a Schedule H to the same Form
5500.

Line 1c. Enter the net assets as of the beginning and end of
the plan year. (Subtract line 1b from 1a.) Line 1c, column (b)
must equal the sum of line 1c, column (a) plus lines 2j and 2k.
Line 2a. Include the total cash contributions received and/or
(for accrual basis plans) due to be received.
Line 2a(1). Plans using the accrual basis of accounting should
not include contributions designated for years before the 2008
plan year on line 2a(1).
Line 2a(2). For welfare plans, report all employee
contributions, including all elective contributions under a

Part I - Small Plan Financial Information
Amounts reported on lines 1a, 1b, and 1c for the beginning of
the plan year must be the same as reported for the end of the
plan year for corresponding lines on the return/report for the
preceding plan year.
Do not include contributions designated for the 2008 plan
year in column (a).
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Line 2d. Enter the total of all cash contributions (line 2a(1)
through (3)), noncash contributions (line 2b), and other plan
income (line 2c) during the plan year. If entering a negative
number, enter a minus sign “ – ” to the left of the number.
Line 2e. Include: (1) payments made (and for accrual basis
filers payments due) to or on behalf of participants or
beneficiaries in cash, securities, or other property (including
rollovers of an individual’s accrued benefit or account balance).
Include all eligible rollover distributions as defined in Code
section 401(a)(31)(D) paid at the participant’s election to an
eligible retirement plan (including an IRA within the meaning of
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 on the
date of distribution.
Line 2f. Include all distributions paid during the plan year of
excess deferrals under Code section 402(g)(2)(A)(ii), excess
contributions under Code section 401(k)(8), and excess
aggregate contributions under Code section 401(m)(6),
allocable income distributed, and any elective deferrals and
employee contributions distributed or returned to employees
during the plan year in accordance with Treasury Regulations
section 1.415-6(b)(6)(iv), as well as any attributable gains that
were also distributed.
Line 2g. Report on line 2g a participant loan included in line
1a, column (a) (participant loans - beginning of year) and that
has been deemed distributed during the plan year under the
provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1 only if both of the following circumstances
apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.

be included on line 1a, column (b) (plan assets - end of year),
without regard to the occurrence of a deemed distribution.
Note. The amount to be reported on line 2g of Schedule H or
Schedule I must be reduced if, during the plan year, a
participant resumes repayment under a participant loan
reported as a deemed distribution on line 2g for any earlier
year. The amount of the required reduction is the amount of the
participant loan reported as a deemed distribution on line 2g for
the earlier year. If entering a negative number, enter a minus
sign “ – ” to the left of the number. The current value of the
participant loan must then be included in line 1c(8), column (b),
of Schedule H (participant loans - end of year) or in line 1a,
column (b), of Schedule I (plan assets - end of year).
Although certain participant loans deemed distributed are to
be reported on line 2g of the Schedule H or Schedule I, and are
not to be reported on the Schedule H or Schedule I as an asset
thereafter (unless the participant resumes repayment under the
loan in a later year), they are still considered outstanding loans
and are not treated as actual distributions for certain purposes.
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
Line 2h. Other expenses (paid and/or payable) may include,
among others:
1. Salaries to employees of the plan;
2. Expenses for accounting, actuarial, legal, and investment
services;
3. Fees and expenses for trustees including reimbursement
for travel, seminars, and meeting expenses;
4. Fees paid for valuations and appraisals; and
5. Other administrative and miscellaneous expenses paid
by or charged to the plan, including those that were not
subtracted from the gross income of master trust investment
accounts and 103-12 IEs in determining their net investment
gain(s) or loss(es).

cafeteria plan (Code section 125). For pension plans,
participant contributions, for purposes of this item, also include
elective contributions under a qualified cash or deferred
arrangement (Code section 401(k)).
Line 2b. Use the current value, at date contributed, of
securities or other noncash property.
Line 2c. Enter all other plan income for the plan year. Do not
include transfers from other plans that should be reported on
line 2k. Other income received and/or receivable would include:
1. Interest on investments (including money market
accounts, sweep accounts, STIF accounts, etc.).
2. Dividends. (Accrual basis plans should include dividends
declared for all stock held by the plan even if the dividends
have not been received as of the end of the plan year.)
3. Rents from income-producing property owned by the
plan.
4. Royalities.
5. Net gain or loss from the sale of assets.
6. Other income, such as unrealized appreciation
(depreciation) in plan assets. To compute this amount subtract
the current value of all assets at the beginning of the year plus
the cost of any assets acquired during the plan year from the
current value of all assets at the end of the year minus assets
disposed of during the plan year.

Line 2i. Enter the total of all benefits paid or due as reported
on lines 2e, 2f, and 2g and all other plan expenses (line 2h)
during the year.
Line 2k. Enter the net value of all assets transferred to and
from the plan during the plan year including those resulting from
mergers and spin-offs. A transfer of assets or liabilities occurs
when there is a reduction of assets or liabilities with respect to
one plan and the receipt of these assets or the assumption of
these liabilities by another plan. Transfers out at the end of the
year should be reported as occurring during the plan year.
Note. A distribution of all or part of an individual participant’s
account balance that is reportable on Form 1099-R,
Distributions From Pensions, Annuities, Retirement or
Profit-Sharing Plans, IRAs, Insurance Contracts, etc., should
not be included on line 2k but must be included in benefit
payments reported on line 2e. Do not submit Form 1099-R with
Form 5500.
Lines 3a through 3g. You must check either “Yes” or “No” on
each line to report whether the plan held any assets in the listed
categories at any time during the plan year. If “Yes” is checked
on any line, enter in the amount column for that line the current
value of the assets held at the end of the plan year or “0” if no
assets remain in the category at the end of the plan year. You
should allocate the value of the plan’s interest in a commingled
trust containing the assets of more than one plan on a
line-by-line basis, except do not include on lines 3a through 3g
the value of the plan’s interest in any CCT, PSA, MTIA, or
103-12 IE (see page 11 for definitions of CCT, PSA, MTIA, and
103-12 IE).
Line 3a. Enter the value of the plan’s participation in a
partnership or joint venture, unless the partnership or joint
venture is a 103-12 IE.
Line 3b. The term ‘‘employer real property’’ means real
property (and related personal property) that is leased to an
employer of employees covered by the plan, or to an affiliate of
such employer. For purposes of determining the time at which a
plan acquires employer real property for purposes of this line,
such property shall be deemed to be acquired by the plan on

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the date on which the plan acquires the property or on the date
on which the lease to the employer (or affiliate) is entered into,
whichever is later.

months or less. Plans with all of their funds held in a master
trust should check “No” on Schedule I, lines 4b, c, and i.
Line 4a. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the
plan are participant contributions that become plan assets as of
the earliest date on which such contributions can reasonably be
segregated from the employer’s general assets (see 29 CFR
2510.3-102). An employer holding these assets after that date
commingled with its general assets will have engaged in a
prohibited use of plan assets (see ERISA section 406). If such a
nonexempt prohibited transaction occurred with respect to a
disqualified person (see Code section 4975(e)(2)), file Form
5330, Return of Excise Taxes Related to Employee Benefit
Plans, with the IRS to pay any applicable excise tax on the
transaction.
Plans that check “Yes” must enter the aggregate amount of
all late contributions for the year. The total amount of the
delinquent contributions should be included on line 4a of the
Schedule H or I, as applicable, for the year in which the
contributions were delinquent and should be carried over and
reported again on line 4a of the Schedule H or I, as applicable,
for each subsequent year until the year after the violation has
been fully corrected, which correction includes payment of the
late contributions and reimbursement of the plan for lost
earnings or profits. If no participant contributions were received
or withheld by the employer during the plan year, answer ‘‘No.’’

Line 3d. An employer security is any security issued by an
employer (including affiliates) of employees covered by the
plan. These may include common stocks, preferred stocks,
bonds, zero coupon bonds, debentures, convertible debentures,
notes and commercial paper.
Line 3e. Enter the current value of all loans to participants
including residential mortgage loans that are subject to Code
section 72(p). Include the sum of the value of the unpaid
principal balances, plus accrued but unpaid interest, if any, for
participant loans made under an individual account plan with
investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and secured
solely by a portion of the participant’s vested accrued benefit.
When applicable, combine this amount with the current value of
any other participant loans. Do not include any amount of a
participant loan deemed distributed during the plan year under
the provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1, if both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.

The DOL Voluntary Fiduciary Correction Program

TIP (VFCP) describes how to apply, the specific transactions

covered (which transactions include delinquent
participant contributions to pension and welfare plans), and
acceptable methods for correcting violations. In addition,
applicants that satisfy both the VFCP requirements and the
conditions of Prohibited Transaction Exemption (PTE) 2002-51
are eligible for immediate relief from payment of certain
prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). All delinquent participant contributions must be reported
on line 4a even if violations have been corrected. Information
about the VFCP is also available on the Internet at www.dol.
gov/ebsa.
Line 4b. Plans that check ‘‘Yes’’ must enter the amount. The
due date, payment amount and conditions for determining
default of a note or loan are usually contained in the documents
establishing the note or loan. A loan by the plan is in default
when the borrower is unable to pay the obligation upon
maturity. Obligations that require periodic repayment can
default at any time. Generally, loans and fixed income
obligations are considered uncollectible when payment has
not been made and there is little probability that payment will be
made. A fixed income obligation has a fixed maturity date at a
specified interest rate. Do not include participant loans made
under an individual account plan with investment experience
segregated for each account that were made in accordance
with 29 CFR 2550.408b-1 and secured solely by a portion of the
participant’s vested accrued benefit.
Line 4c. Plans that check ‘‘Yes’’ must enter the amount. A
lease is an agreement conveying the right to use property, plant
or equipment for a stated period. A lease is in default when the
required payment(s) has not been made. An uncollectible lease
is one where the required payments have not been made and
for which there is little probability that payment will be made.
Line 4d. Plans that check ‘‘Yes’’ must enter the amount.
Check ‘‘Yes’’ if any nonexempt transaction with a
party-in-interest occurred regardless of whether the transaction
is disclosed in the accountant’s report. Do not check “Yes” with
respect to transactions that are: (1) statutorily exempt under
Part 4 of Title I of ERISA; (2) administratively exempt under
ERISA section 408(a); (3) exempt under Code sections 4975(c)
or 4975(d); (4) the holding of participant contributions in the
employer’s general assets for a welfare plan that meets the
conditions of ERISA Technical Release 92-01; (5) a transaction

If both of these circumstances apply, report the loan as a
deemed distribution on line 2g. However, if either of these
circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) should be included on line 3e without
regard to the occurrence of a deemed distribution.

Note. After participant loans have been deemed distributed
and reported on line 2g of the Schedule I or H, they are no
longer required to be reported as assets on the Schedule I or H.
However, such loans (including interest accruing thereon after
the deemed distribution) that have not been repaid are still
considered outstanding for purposes of applying Code section
72(p)(2)(A) to determine the maximum amount of subsequent
loans. Also, the deemed distribution is not treated as an actual
distribution for other purposes, such as the qualification
requirements of Code section 401, including, for example, the
determination of top-heavy status under Code section 416 and
the vesting requirements of Treasury Regulations section
1.411(a)-7(d)(5). See Q&As 12 and 19 of Treasury Regulations
section 1.72(p)-1.
Line 3f. Enter the current value of all loans made by the plan,
except participant loans reportable on line 3e. Include the sum
of the value of loans for construction, securities loans,
commercial and/or residential mortgage loans that are not
subject to Code section 72(p) (either by making or participating
in the loans directly or by purchasing loans originated by a third
party), and other miscellaneous loans.
Line 3g. Include all property that has concrete existence and
is capable of being processed, such as goods, wares,
merchandise, furniture, machines, equipment, animals,
automobiles, etc. This includes collectibles, such as works of
art, rugs, antiques, metals, gems, stamps, coins, alcoholic
beverages, musical instruments, and historical objects
(documents, clothes, etc.). Do not include the value of a plan’s
interest in property reported on lines 3a through 3f, or intangible
property, such as patents, copyrights, goodwill, franchises,
notes, mortgages, stocks, claims, interests, or other property
that embodies intellectual or legal rights.

Part II - Transactions During Plan Year
Answer all lines either ‘‘Yes’’ or ‘‘No,’’ and if lines 4a through 4i
are ‘‘Yes,’’ an amount must be entered. If you check ‘‘No’’ on
line 4k you must attach the report of an independent qualified
public accountant or a statement that the plan is eligible and
elects to defer attaching the IQPA’s opinion pursuant to 29 CFR
2520.104-50 in connection with a short plan year of seven
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of a 103-12 IE with parties other than the plan; or (6) delinquent
participant contributions reported on line 4a. You may indicate
that an application for an administrative exemption is pending. If
you are unsure whether a transaction is exempt or not, you
should consult with either a qualified public accountant, legal
counsel or both. If the plan is a qualified pension plan and a
nonexempt prohibited transaction occurred with respect to a
disqualified person, a Form 5330 should be filed with the IRS to
pay the excise tax on the transaction.

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.

Applicants that satisfy the VFCP requirements and the

Line 4e. Plans that check ‘‘Yes’’ must enter the aggregate
amount of coverage for all claims. Check ‘‘Yes’’ only if the plan
itself (as opposed to the plan sponsor or administrator) is a
named insured under a fidelity bond from an approved surety
covering plan officials and that protects the plan as described in
29 CFR Part 2580. Generally, every plan official of an employee
benefit plan who ‘‘handles’’ funds or other property of such plan
must be bonded. Generally, a person shall be deemed to be
‘‘handling’’ funds or other property of a plan, so as to require
bonding, whenever his or her other duties or activities with
respect to given funds are such that there is a risk that such
funds could be lost in the event of fraud or dishonesty on the
part of such person, acting either alone or in collusion with
others. Section 412 of ERISA and DOL regulations 29 CFR
2580 provide the bonding requirements, including the definition
of ‘‘handling’’ (29 CFR 2580.412-6), the permissible forms of
bonds (29 CFR 2580.412-10), the amount of the bond (29 CFR
2580, subpart C), and certain exemptions such as the
exemption for unfunded plans, certain banks and insurance
companies (ERISA section 412), and the exemption allowing
plan officials to purchase bonds from surety companies
authorized by the Secretary of the Treasury as acceptable
reinsurers on Federal bonds (29 CFR 2580.412-23).
Information concerning the list of approved sureties and
reinsurers is available on the Internet at www.fms.treas.gov/
c570.
Note. Plans are permitted under certain conditions to
purchase fiduciary liability insurance. These policies do not
protect the plan from dishonest acts and are not bonds that
should be reported in line 4e.

TIP conditions of PTE 2002-51 (see the instructions for line

Party-in-Interest. For purposes of this form,
party-in-interest is deemed to include a disqualified person. See
Code section 4975(e)(2). The term ‘‘party-in-interest’’ means,
as to an employee benefit plan:
A. Any fiduciary (including, but not limited to, any
administrator, officer, trustee or custodian), counsel, or
employee of the plan;
B. A person providing services to the plan;
C. An employer, any of whose employees are covered by
the plan;
D. An employee organization, any of whose members are
covered by the plan;
E. An owner, direct or indirect, of 50% or more of: (1) the
combined voting power of all classes of stock entitled to vote
or the total value of shares of all classes of stock of a
corporation, (2) the capital interest or the profits interest of a
partnership, or (3) the beneficial interest of a trust or
unincorporated enterprise that is an employer or an
employee organization described in C or D;
F. A relative of any individual described in A, B, C, or E;
G. A corporation, partnership, or trust or estate of which (or
in which) 50% or more of: (1) the combined voting power of
all classes of stock entitled to vote or the total value of
shares of all classes of stock of such corporation, (2) the
capital interest or profits interest of such partnership, or (3)
the beneficial interest of such trust or estate is owned
directly or indirectly, or held by, persons described in A, B,
C, D, or E;
H. An employee, officer, director (or an individual having
powers or responsibilities similar to those of officers or
directors), or a 10% or more shareholder, directly or
indirectly, of a person described in B, C, D, E, or G, or of the
employee benefit plan; or
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.

4a) are eligible for immediate relief from payment of
certain prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). When the conditions of PTE 2002-51 have been
satisfied, the corrected transactions should be treated as
exempt under Code section 4975(c) for the purposes of
answering line 4d.

Line 4f. Check ‘‘Yes,’’ if the plan had suffered or discovered
any loss as a result of any dishonest or fraudulent act(s) even if
the loss was reimbursed by the plan’s fidelity bond or from any
other source. If ‘‘Yes’’ is checked enter the full amount of the
loss. If the full amount of the loss has not yet been determined,
provide an estimate and disclose that the figure is an estimate,
such as “@1000.”

Willful failure to report is a criminal offense. See ERISA
section 501.

CAUTION

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Condition 1: At least 95 percent of plan assets are
‘‘qualifying plan assets’’ as of the end of the preceding plan
year, or any person who handles assets of the plan that do not
constitute qualifying plan assets is bonded in accordance with
the requirements of ERISA section 412 (see the instructions for
line 4e), except that the amount of the bond shall not be less
than the value of such non-qualifying assets.
The determination of the ‘‘percent of plan assets’’ as of the
end of the preceding plan year and the amount of any required
bond must be made at the beginning of the plan’s reporting
year for which the waiver is being claimed. For purposes of this
line, you will have satisfied the requirement to make these
determinations at the beginning of the plan reporting year for
which the waiver is being claimed if they are made as soon
after the date when such year begins as the necessary
information from the preceding reporting year can practically be
ascertained. See 29 CFR 2580.412-11, 14 and 19 for additional
guidance on these determinations, and 29 CFR 2580.412-15 for
procedures to be used for estimating these amounts if there is
no preceding plan year.
The term ‘‘qualifying plan assets,’’ for purposes of this
line, means:
1. Any assets held by any of the following regulated
financial institutions:
a. A bank or similar financial institution as defined in 29
CFR 2550.408b-4(c);
b. An insurance company qualified to do business under the
laws of a state;
c. An organization registered as a broker-dealer under the
Securities Exchange Act of 1934; or
d. Any other organization authorized to act as a trustee for
individual retirement accounts under Code section 408.
2. Shares issued by an investment company registered
under the Investment Company Act of 1940 (e.g., mutual
funds);
3. Investment and annuity contracts issued by any
insurance company qualified to do business under the laws of a
state;
4. In the case of an individual account plan, any assets in
the individual account of a participant or beneficiary over which
the participant or beneficiary has the opportunity to exercise
control and with respect to which the participant or beneficiary
is furnished, at least annually, a statement from a regulated
financial institution referred to above describing the assets held
or issued by the institution and the amount of such assets;
5. Qualifying employer securities, as defined in ERISA
section 407(d)(5); and
6. Participant loans meeting the requirements of ERISA
section 408(b)(1).

Although the current value of plan assets must be
determined each year, there is no requirement that the assets
(other than certain nonpublicly traded employer securities held
in ESOPs) be valued every year by independent third-party
appraisers.
Enter in the amount column the fair market value of the
assets referred to on line 4g whose value was not readily
determinable on an established market and which were not
valued by an independent third-party appraiser in the plan year.
Generally, as it relates to these questions, an appraisal by an
independent third party is an evaluation of the value of an asset
prepared by an individual or firm who knows how to judge the
value of such assets and does not have an ongoing relationship
with the plan or plan fiduciaries except for preparing the
appraisals.
Line 4i. Include as a single security all securities of the same
issue. An example of a single issue is a certificate of deposit
issued by the XYZ Bank on July 1, 2006, which matures on
June 30, 2007, and yields 5.5%. For the purposes of line 4i, do
not check ‘‘Yes’’ for securities issued by the U.S. Government
or its agencies. Also, do not check “Yes” for securities held as a
result of participant-directed transactions.
Line 4j. Check ‘‘Yes’’ if all the plan assets (including
insurance/annuity contracts) were distributed to the participants
and beneficiaries, legally transferred to the control of another
plan, or brought under the control of the PBGC.
Check ‘‘No’’ for a welfare benefit plan that is still liable to pay
benefits for claims that were incurred before the termination
date, but not yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Note. If ‘‘Yes’’ was checked on line 4j because all plan assets
were distributed to participants and/or beneficiaries, you are
encouraged to complete Schedule SSA (Form 5500), listing
each participant reported on a previous Schedule SSA (Form
5500) who has received all of his/her plan benefits, and
therefore, is no longer entitled to receive deferred vested
benefits. This will ensure that SSA’s records are correct, and
help eliminate confusion for participants and plan administrators
in the future. See the instructions to the Schedule SSA (Form
5500) for greater detail.
Line 4k. Check ‘‘Yes’’ if you are claiming a waiver of the
annual examination and report of an independent qualified
public accountant (IQPA) under 29 CFR 2520.104-46. You are
eligible to claim the waiver if the Schedule I is being filed for:
1. A small welfare plan, or
2. A small pension plan for a plan year that began on or
after April 18, 2001, that complies with the conditions of 29 CFR
2520.104-46 summarized below.
Check ‘‘No’’ and attach the report of the IQPA meeting the
requirements of 29 CFR 2520.103-1(b) if you are not claiming
the waiver. Also check ‘‘No,’’ and attach the required IQPA
reports or the required explanatory statement if you are relying
on 29 CFR 2520.104-50 in connection with a short plan year of
seven months or less. At the top of any attached 2520.104-50
statement, enter “2520.104-50 Statement, Schedule I, Line 4k.”
For more information on the requirements for deferring an IQPA
report pursuant to 29 CFR 2520.104-50 in connection with a
short plan year of seven months or less and the contents of the
required explanatory statement, see the instructions for
Schedule H, line 3d(2) or call the EFAST Help Line at
1-866-463-3278.
Note. For plans that check “No,” the IQPA report must make
the appropriate disclosures in accordance with generally
accepted auditing standards if the information reported on line
4a is not presented in accordance with regulatory requirements.
The following summarizes the conditions of 29 CFR
2520.104-46 that must be met for a small pension plan with a
plan year beginning on or after April 18, 2001, to be eligible for
the waiver. For more information regarding these requirements,
see the EBSA’s Frequently Asked Questions on the Small
Pension Plan Audit Waiver Requirement and 29 CFR
2520.104-46, which are available at www.dol.gov/ebsa, or call
the EFAST Help Line at 1-866-463-3278.
Instructions for Schedule I (Form 5500)

Condition 2: The administrator must include in the
summary annual report (SAR) furnished to participants and
beneficiaries in accordance with 29 CFR 2520.104b-10, or for
defined benefit pension plans in the annual funding notice
furnished to participants and beneficiaries in accordance with
ERISA section 101(f):
1. The name of each regulated financial institution holding
or issuing qualifying plan assets and the amount of such assets
reported by the institution as of the end of the plan year (this
SAR disclosure requirement does not apply to qualifying
employer securities, participant loans and individual account
assets described in paragraphs 4, 5 and 6 above);
2. The name of the surety company issuing the fidelity
bond, if the plan has more than 5% of its assets in
non-qualifying plan assets;
3. A notice that participants and beneficiaries may, upon
request and without charge, examine or receive from the plan
evidence of the required bond and copies of statements from
the regulated financial institutions describing the qualifying plan
assets; and
4. A notice that participants and beneficiaries should contact
the EBSA Regional Office if they are unable to examine or
obtain copies of the regulated financial institution statements or
evidence of the required bond, if applicable.

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termination was revoked and no assets reverted to the
employer. If ‘‘Yes’’ is checked, enter the amount of plan assets
that reverted to the employer during the plan year in connection
with the implementation of such termination. Enter ‘‘-0-’’ if no
reversion occurred during the current plan year.
A Form 5500 must be filed for each year the plan has
assets, and, in the case of a welfare benefit plan, if the
CAUTION plan is still liable to pay benefits for claims that were
incurred before the termination date, but not yet paid. See 29
CFR 2520.104b-2(g)(2)(ii).

Line 5b. Enter information concerning assets and/or liabilities
transferred from this plan to another plan(s) (including spin-offs)
during the plan year. A transfer of assets or liabilities occurs
when there is a reduction of assets or liabilities with respect to
one plan and the receipt of these assets or the assumption of
these liabilities by another plan. Enter the name, PN, and EIN of
the transferee plan(s) involved on lines 5b(1), b(2) and b(3). If
there are more than three plans, include an attachment with the
information required for 5b(1), b(2) and b(3) for each additional
plan and label the attachment ‘‘Schedule I, line 5b –
Additional Plans.’’

Do not use a social security number in lieu of an EIN or
include an attachment that contains visible social security
numbers. The Schedule I and its attachments are open to
public inspection, and the contents are public information and
are subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule I or the inclusion of a visible social security number
on an attachment may result in the rejection of the filing.
Note. A distribution of all or part of an individual participant’s
account balance that is reportable on Form 1099-R should not
be included on line 5b. Do not submit Form 1099-R with the
Form 5500.

Condition 3: In addition, in response to a request from any
participant or beneficiary, the administrator, without charge to
the participant or beneficiary, must make available for
examination, or upon request furnish copies of, each regulated
financial institution statement and evidence of any required
bond.
Examples. Plan A, which has a plan year that began on or
after April 18, 2001, had total assets of $600,000 as of the end
of the 2000 plan year that included: investments in various
bank, insurance company and mutual fund products of
$520,000; investments in qualifying employer securities of
$40,000; participant loans (meeting the requirements of ERISA
section 408(b)(1)), totaling $20,000; and a $20,000 investment
in a real estate limited partnership. Because the only asset of
the plan that did not constitute a ‘‘qualifying plan asset’’ is the
$20,000 real estate limited partnership investment and that
investment represents less than 5% of the plan’s total assets,
no fidelity bond is required as a condition for the plan to be
eligible for the waiver for the 2001 plan year.
Plan B is identical to Plan A except that of Plan B’s total
assets of $600,000 as of the end of the 2000 plan year,
$558,000 constitutes ‘‘qualifying plan assets’’ and $42,000
constitutes non-qualifying plan assets. Because 7% – more
than 5% – of Plan B’s assets do not constitute ‘‘qualifying plan
assets,’’ Plan B, as a condition to be eligible for the waiver for
the 2001 plan year, must ensure that it has a fidelity bond in an
amount equal to at least $42,000 covering persons handling its
non-qualifying plan assets. Inasmuch as compliance with
ERISA section 412 generally requires the amount of the bond
be not less than 10% of the amount of all the plan’s funds or
other property handled, the bond acquired for ERISA section
412 purposes may be adequate to cover the non-qualifying plan
assets without an increase (i.e., if the amount of the bond
determined to be needed for the relevant persons for ERISA
section 412 purposes is at least $42,000). As demonstrated by
the foregoing example, where a plan has more than 5% of its
assets in non-qualifying plan assets, the required bond is for the
total amount of the non-qualifying plan assets, not just the
amount in excess of 5%.
If you need further information regarding these requirements,
see 29 CFR 2520.104-46 which is available at www.dol.gov/
ebsa or call the EFAST Help Line at 1-866-463-3278.
Line 5a. Check ‘‘Yes’’ if a resolution to terminate the plan was
adopted during this or any prior plan year, unless the

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Treasury Regulations section 301.6059-1(d) for permitted
qualifications. If the actuary has not fully reflected any final or
temporary regulation, revenue ruling, or notice promulgated
under the statute in completing the Schedule MB, check the box
on the last line of page 1. If this box is checked, indicate on an
attachment whether an accumulated funding deficiency or a
contribution that is not wholly deductible would result if the
actuary had fully reflected such regulation, revenue ruling, or
notice, and label this attachment “Schedule MB – Statement
by Enrolled Actuary.” A stamped or machine produced
signature is not acceptable. The most recent enrollment number
must be entered. In addition, the actuary may offer any other
comments related to the information contained in Schedule MB.

2008 Instructions for Schedule MB
(Form 5500)
Multiemployer Defined Benefit Plan and
Certain Money Purchase Plan Actuarial
Information
General Instructions
Who Must File

Do not include attachments that contain a visible social
security number. The Schedule MB and its attachments are
open to public inspection, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a visible social
security number on an attachment may result in the rejection of
the filing.

Specific Instructions

Line 1. All entries must be reported as of the valuation date.
Line 1a. Actuarial Valuation Date. The valuation for a plan
year may be as of any date in the plan year, including the first
or last day of the plan year. Valuations must be performed
within the period specified by ERISA section 304(c)(7) and
Code section 431(c)(7).
Line 1b(1). Current Value of Assets. Enter the current value
of assets as of the valuation date. The current value is the
same as the fair market value. Do not adjust for items such as
the existing credit balance or the outstanding balances of
certain amortization bases. Contributions designated for 2008
should not be included in this amount. Note that this entry may
be different from the entry in line 2a. Such a difference may
result, for example, if the valuation date is not the first day of
the plan year, or if insurance contracts are excluded from
assets reported on line 1b(1) but not on line 2a.

Check the Schedule B box on the Form 5500 (Part II, line
10a(2)) if a Schedule MB is attached to the Form 5500.
Lines A through E must be completed for ALL plans. If the
Schedule MB is attached to a Form 5500, lines A, B, C, and D
should include the same information as reported in Part II of the
Form 5500. You may abbreviate the plan name (if necessary) to
fit in the space provided.
Do not use a social security number in line D in lieu of an
EIN. The Schedule MB and its attachments are open to public
inspection if filed with a Form 5500, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule MB or any of its attachments may
result in the rejection of the filing.
You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.
All multiemployer defined benefit plans, regardless of size or
type, must complete and file Schedule MB.
Note. (1) For split-funded plans, the costs and contributions
reported on Schedule MB must include those relating to both
trust funds and insurance carriers. (2) For plans with funding
standard account amortization charges and credits, see the
instructions for lines 9c and 9h. (3) For terminating plans, Rev.
Rul. 79-237, 1979-2 C.B. 190, provides that minimum funding
standards apply until the end of the plan year that includes the
termination date. Accordingly, the Schedule MB is not required
to be filed for any later plan year. However, if a termination fails
to occur, whether because assets remain in the plan’s related
trust (see Rev. Rul. 89-87, 1989-2 C.B. 81) or for any other
reason (e.g., the PBGC issues a notice of noncompliance
pursuant to 29 CFR section 4041.31 for a standard
termination), there is no termination date, and therefore,
minimum funding standards continue to apply and a Schedule
MB continues to be required.

Attachments
All attachments to the Schedule MB must be properly identified,
and must include the name of the plan, the plan sponsor’s EIN,
and the plan number. Put “Schedule MB” and the line number
to which the attachment relates at the top of each attachment.
When assembling the package for filing, you can place
attachments for a schedule either directly behind that schedule
or at the end of the filing.

The employer or plan administrator of a multiemployer defined
benefit plan that is subject to the minimum funding standards
(see Code sections 412 and 431 and Part 3 of Title I of ERISA)
must complete and file this schedule as an attachment to the
Form 5500.
If a money purchase defined contribution plan (including a
target benefit plan) has received a waiver of the minimum
funding standard, and the waiver is currently being amortized,
lines 3, 9, and 10 of Schedule MB must be completed. In such a
case, the Schedule MB must be attached to Form 5500 but it
need not be signed by an enrolled actuary.
Note. The Schedule MB does not have to be filed with the
Form 5500-EZ, but it must be retained (in accordance with the
instructions for Form 5500-EZ under the What To File section).
Also, the funding standard account for the plan must continue to
be maintained, even if the Schedule MB is not filed.

Rollover amounts or other assets held in individual accounts
that are not available to provide defined benefits under the plan
should not be included on line 1b(1), regardless of whether they
are reported on the 2008 Schedule H (Form 5500) (line 1l,
column (a)) or Schedule I (Form 5500) (line 1c, column (a)).
Additionally, asset and liability amounts must be determined in
a consistent manner. Therefore, if the value of any insurance
contracts have been excluded from the amount reported on line
1b(1), liabilities satisfied by such contracts should also be
excluded from the liability values reported on lines 1c(1), 1c(2),
and 1d(2).
Line 1b(2). Actuarial Value of Assets. Enter the value of
assets determined in accordance with Code section 431(c)(2)
or ERISA section 304(c)(2). Do not adjust for items such as the
existing credit balance or the outstanding balances of certain
amortization bases, and do not include contributions designated
for 2008 in this amount.
Line 1c(1). Accrued Liability for Immediate Gain Methods.
Complete this line only if you use an immediate gain method
(see Rev. Rul. 81-213, 1981-2 C.B. 101, for a definition of
immediate gain method).
Lines 1c(2)(a), (b), and (c). Information for Plans Using
Spread Gain Methods. Complete these lines only if you use a
spread gain method (see Rev. Rul. 81-213 for a definition of
spread gain method).

Statement by Enrolled Actuary
An enrolled actuary must sign Schedule MB unless, as
described above, the plan is a money purchase defined
contribution plan that has received a waiver of the minimum
funding standard. The signature of the enrolled actuary may be
qualified to state that it is subject to attached qualifications. See
Instructions for Schedule MB (Form 5500)

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day of the plan year, the participant and beneficiary count
entries should be derived from the counts used in that valuation
in a manner consistent with the derivation of the current liability
reported in column (2).
Column (2) — Include the current liability attributable to all
benefits, with subtotals for vested and nonvested benefits in the
case of active participants.
Line 2c. This calculation is required under ERISA section
103(d)(11). Do not complete if line 2a divided by line 2b(4),
column (2), is 70% or greater.
Line 3. Contributions Made to Plan. Show all employer and
employee contributions for the plan year. Include employer
contributions made not later than 21/2 months (or the later date
allowed under Code section 431(c)(8) and ERISA section
304(c)(8)) after the end of the plan year. Show only
contributions actually made to the plan by the date this
Schedule MB is signed.
Add the amounts in both columns (b) and (c) and enter both
results on the total line. All contributions must be credited
toward a particular plan year.
Line 4. Information on Plan Status. All multiemployer plans
regardless of the number of participants must provide the
information indicated in accordance with these instructions.
Line 4a. Enter the code for the status of the multiemployer
plan for the plan year, as certified by the plan actuary, using
one of the following codes:
Code Plan Status
E
S
C
N

Endangered Status
Seriously Endangered Status
Critical Status
Not in Endangered or Critical Status

Line 1c(2)(a). Unfunded Liability for Methods with Bases.
Complete this line only if you use the frozen initial liability or
attained age normal cost method.
Lines 1c(2)(b) and (c). Entry Age Normal Accrued Liability
and Normal Cost. For spread gain methods, the full funding
limitation is calculated using the entry age normal method (see
Rev. Rul. 81-13, 1981-1 C.B. 229).
Line 1d(1). Amount Excluded from Current Liability. Enter
“N/A.”
Line 1d(2)(a). Current Liability. All multiemployer plans,
regardless of the number of participants, must provide the
information indicated in accordance with these instructions. The
interest rate used to compute the current liability must be in
accordance with guidelines issued by the IRS and, pursuant to
the Pension Protection Act of 2006 (PPA), must not be more
than 5 percent above and must not be more than 10 percent
below the weighted average of the rates of interest, as set forth
by the Treasury Department, on 30-year Treasury securities
during the 4-year period ending on the last day before the
beginning of the 2008 plan year.
The current liability must be computed using the mortality
tables referenced in section 1.431(c)(6)-1 of the Treasury
Regulations.
Each other actuarial assumption used in calculating the
current liability must be the same assumption used for
calculating other costs for the funding standard account. See
Notice 90-11, 1990-1 C.B. 319. The actuary must take into
account rates of early retirement and the plan’s early retirement
and turnover provisions as they relate to benefits, where these
would significantly affect the results. Regardless of the
valuation date, current liability is computed taking into account
only credited service through the end of the prior plan year. No
salary scale projections should be used in these computations.
Do not include the expected increase in current liability due to
benefits accruing during the plan year reported in line 1d(2)(b)
in these computations.
Line 1d(2)(b). Expected Increase in Current Liability. Enter
the amount by which the current liability is expected to increase
due to benefits accruing during the plan year on account of
credited service and/or salary changes for the current year. One
year’s salary scale may be reflected.
Line 1d(2)(c). Expected Release From Current Liability for
the Plan Year. Enter the expected release from current liability
on account of disbursements (including single-sum
distributions) from the plan expected to be paid after the
valuation date but prior to the end of the plan year (see also
Q&A-7 of Rev. Rul. 96-21, 1996-1 C.B. 64).
Line 1d(3). Expected Plan Disbursements. Enter the amount
of plan disbursements expected to be paid for the plan year.
Line 2. All entries must be reported as of the beginning of the
2008 plan year. Lines 2a and 2b should include all assets and
liabilities under the plan except for assets and liabilities
attributable to: (1) rollover amounts or other amounts in
individual accounts that are not available to provide defined
benefits, or (2) benefits for which an insurer has made an
irrevocable commitment as defined in 29 CFR 4001.2.
Line 2a. Current Value of Assets. Enter the current value of
net assets as of the first day of the plan year. Except for plans
with excluded assets as described above, this entry should be
the same as reported on the 2008 Schedule H (Form 5500)
(line 1l, column (a)) or Schedule I (Form 5500) (line 1c, column
(a)). Note that contributions designated for the 2008 plan year
are not included on those lines.
Line 2b. Current Liability (beginning of plan year). Enter
the current liability as of the first day of the plan year. Do not
include the expected increase in current liability due to benefits
accruing during the plan year. See the instructions for line
1d(2)(a) for actuarial assumptions used in determining current
liability.
Column (1) — Enter the number of participants and
beneficiaries as of the beginning of the plan year. If the current
liability figures are derived from a valuation that follows the first

If the plan is in endangered status, seriously endangered
status, or critical status, attach a copy of the actuarial
certification of such status to this Schedule MB. Also attach an
illustration showing the details providing support for the
actuarial certification of status and label the illustration
“Schedule MB, line 4a – Illustration Supporting Actuarial
Certification of Status.” For example, if a plan is in critical
status based on Code section 432(b)(2)(B), show the funded
percentage (if applicable) and the projection of funding to the
year where the accumulated funding deficiency occurs.
Line 4c. Attach documentation comparing the current status of
the plan to the scheduled progress under the applicable funding
improvement or rehabilitation plan to this Schedule MB. Label
the documentation “Schedule MB, line 4c – Documentation
Regarding Progress Under Funding Improvement or
Rehabilitation Plan.”
Line 5. Actuarial Cost Method. Enter the primary method
used. If the plan uses one actuarial cost method in one year as
the basis of establishing an accrued liability for use under the
frozen initial liability method in subsequent years, answer as if
the frozen initial liability method was used in all years. The
projected unit credit method is included in the “Accrued benefit
(unit credit)” category of line 5c. If a method other than a
method listed in lines 5a through 5g is used, check the box for
line 5j and specify the method. For example, if a modified
individual level premium method for which actuarial gains and
losses are spread as a part of future normal cost is used, check
the box for 5j and describe the cost method.
Check the appropriate box for the underlying actuarial cost
method used as the basis for this plan year’s funding standard
account computation. If box 5h is checked, enter the period of
use of the shortfall method in line 5k. For this purpose, enter the
calendar year (YY) which includes the first day of the plan year
in which the shortfall method was first used. For plans in
reorganization status, check the appropriate box for the
underlying actuarial cost method used to determine charges
and credits to the funding standard account and check the box
for 5i.

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provisions, including those that apply only to a subgroup of
employees (e.g., those with imputed service), supplemental
benefits, an identification of benefits not included in the
valuation (e.g., shutdown benefits), a description of any
significant events that occurred during the year, a summary of
any changes in principal eligibility or benefit provisions since the
last valuation, a description (or reasonably representative
sample) of plan early retirement factors, and any change in
actuarial assumptions or cost methods and justifications for any
such change (see section 103(d) of ERISA). Label the summary
“Schedule MB, line 6 – Summary of Plan Provisions.”
Also, include any other information needed to disclose the
actuarial position of the plan fully and fairly.
Line 6a. Current Liability Interest Rate. Enter the interest
rate used to determine current liability. The interest rate used
must be in accordance with the guidelines issued by the IRS
and, pursuant to PPA, must not be more than 5 percent above
and must not be more than 10 percent below the weighted
average of the rates of interest, as set forth by the Treasury
Department, on 30-year Treasury securities during the 4-year
period ending on the last day before the beginning of the 2008
plan year. Enter the rate to the nearest .01 percent.
Line 6b. Check “Yes,” if the rates in the contract were used
(e.g., purchase rates at retirement).
Line 6c. Mortality Table. The mortality table published in
section 1.431(c)(6)-1 of the Treasury Regulations must be used
in the calculation of current liability for non-disabled lives. Enter
the mortality table code for non-disabled lives used for valuation
purposes as follows:
Mortality Table

Changes in funding methods include changes in actuarial
cost method, changes in asset valuation method, and changes
in the valuation date of plan costs and liabilities or of plan
assets. Changes in the funding method of a plan include not
only changes to the overall funding method used by the plan,
but also changes to each specific method of computation used
in applying the overall method. Generally, these changes
require IRS approval. If the change was made pursuant to Rev.
Proc. 2000-40, 2000-2 C.B. 357, check “Yes” for line 5m. If
approval was granted for this plan by either an individual ruling
letter or a class ruling letter, enter the date of the applicable
ruling letter in line 5n. Note that the plan sponsor’s agreement
to a change in funding method (made pursuant to Rev. Proc.
2000-40, PPA section 201(b), or a class ruling letter) should be
reported on line 7 of Schedule R (Form 5500).
Shortfall Method: Only certain collectively bargained plans
may elect the shortfall funding method (see Treasury
Regulations section 1.412(c)(1)-2). Advance approval from the
IRS for the election of the shortfall method of funding is NOT
required if it is first adopted for the first plan year to which Code
section 412 applies. In addition, pursuant to PPA section
201(b), a plan does NOT need advance approval from the IRS
to adopt or cease using the shortfall method if the plan (1) has
not used the shortfall method during the 5-year period ending
on the day before the date the plan is to use the method, and
(2) is not operating under an amortization period extension and
did not operate under such an extension during such 5-year
period. In such a case, check “Yes” for line 5m. If a plan utilizes
this automatic approval to apply the shortfall method, the
benefit increase limitations of Code section 412(c)(7) apply.
If a plan is not eligible for automatic approval as set forth in
the preceding paragraph, advance approval from the IRS is
required if the shortfall funding method is adopted at a later
time, if a specific computation method is changed, or if the
shortfall method is discontinued. In such a case there is no
automatic limitation on benefit increases.
Reorganization Status: Attach an explanation of the basis for
the determination that the plan is in reorganization for this plan
year and label the explanation “Schedule MB, line 5 –
Reorganization Status Explanation.” Also, attach a
worksheet showing for this plan year:
1. The amounts considered contributed by employers,
2. Any amount waived by the IRS,
3. The development of the minimum contribution
requirement (taking into account the applicable overburden
credit, cash-flow amount, contribution bases and limitation on
required increases on the rate of employer contributions, and
any adjustments in accrued benefits), and
4. The resulting accumulated funding deficiency, if any,
which is to be reported on line 9n. (See Code sections 418B,
418C, and 418D.)

1951 Group Annuity . . . . . . . . . . . . . . . . . . . . . . . . . . .

1971 Group Annuity Mortality (G.A.M.) . . . . . . . . . . . . . .

1971 Individual Annuity Mortality (I.A.M.) . . . . . . . . . . . . .

UP-1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1983 I.A.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1983 G.A.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1983 G.A.M. (solely per Rev. Rul. 95-28) . . . . . . . . . . . . .

UP-1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mortality table applicable to current plan year under section
1.431(c)(6)-1 of the Income Tax Regulations . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Code 6 includes all sex-distinct versions of the 1983 G.A.M.
table other than the table published in Rev. Rul. 95-28. Thus,
for example, Code 6 also would include the 1983 G.A.M.
male-only table used for males, where the 1983 G.A.M.
male-only table with a 6-year setback is used for females. Code
A includes mortality tables other than those listed in Codes 1
through 9, including any unisex version of the 1983 G.A.M.
table.
Where an indicated table consists of separate tables for
males and females, add F to the female table (e.g., 1F). When
a projection is used with a table, follow the code with “P” and
the year of projection (omit the year if the projection is unrelated
to a single calendar year); the identity of the projection scale
should be omitted. When an age setback or set forward is used,
indicate with “ – ” or “+” and the number of years. For example, if
for females the 1951 Group Annuity Table with Projection C to
1971 is used with a 5-year setback, enter “1P71-5.” If the table
is not one of those listed, enter “A” with no further notation. If
the valuation assumes a maturity value to provide the
post-retirement income without separately identifying the
mortality, interest and expense elements, enter on line 6c,
under “Post-retirement,” the value of $1.00 of monthly pension
beginning at the plan’s weighted average retirement age,

Label the worksheet “Schedule MB, line 5 – Reorganization
Status Worksheet.”
Line 6. Actuarial Assumptions. If gender-based assumptions
are used in developing plan costs, enter those rates where
appropriate in line 6. Note that requests for gender-based cost
information do not suggest that gender-based benefits are
legal. If unisex tables are used, enter the values in both “Male”
and “Female” lines. Complete all blanks. Check “N/A” if not
applicable.
Attach a statement of actuarial assumptions (if not fully
described by line 6) and actuarial methods used to calculate the
figures shown in lines 1 and 9 (if not fully described by line 5),
and label the statement “Schedule MB, line 6 – Statement of
Actuarial Assumptions/Methods.” The statement must
describe all actuarial assumptions used to determine the
liabilities. For example, the statement for non-traditional plans
(e.g., cash balance plans) must include the assumptions used
to convert balances to annuities.
Also attach a summary of the principal eligibility and benefit
provisions on which the valuation was based, including the
status of the plan (e.g., eligibility frozen, service/pay frozen,
benefits frozen), optional forms of benefits, special plan
Instructions for Schedule MB (Form 5500)

Code

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see line 1b(1) instructions.) For this purpose, the rate of return
is determined by using the formula 2I/(A + B – I), where I is the
dollar amount of the investment return, A is the current value of
the assets one year ago, and B is the current value of the
assets on the current valuation date. Enter rates to the nearest
.1 percent. If entering a negative number, enter a minus sign
(“ – ”) to the left of the number.
Note. Use the above formula even if the actuary feels that the
result of using the formula does not represent the true
estimated rate of return on the current value of plan assets for
the 1-year period ending on the valuation date. The actuary
may attach a statement showing both the actuary’s estimate of
the rate of return and the actuary’s calculations of that rate, and
label the statement “Schedule MB, line 6h – Estimated Rate
of Investment Return (Current Value).”
Line 7. New Amortization Bases Established. List all new
amortization bases established in the current plan year (before
the combining of bases, if bases were combined). Use the
following table to indicate the type of base established, and
enter the appropriate code under “Type of base.” List
amortization bases and charges and/or credits as of the
valuation date. Bases that are considered fully amortized
because there is a credit for the plan year on line 9j(3) should
be listed. If entering a negative number, enter a minus sign
(“ – ”) to the left of the number.

Code Type of Amortization Base
1
2
3
4

Experience gain or loss
Shortfall gain or loss
Change in unfunded liability due to plan amendment
Change in unfunded liability due to change in
actuarial assumptions
Change in unfunded liability due to change in
actuarial cost method
Waiver of the minimum funding standard
Initial unfunded liability (for new plan)

assuming the normal form of annuity for an unmarried person.
In such a case, enter “N/A” on lines 6d and 6e.
Line 6d. Valuation Liability Interest Rate. Enter the
assumption as to the expected interest rate (investment return)
used to determine all the calculated values except for current
liability. If the assumed rate varies with the year, enter the
weighted average of the assumed rate for 20 years following
the valuation date. Enter rates to the nearest .01 percent.
Line 6e. Expense Loading. If there is no expense loading,
enter -0-. For instance, there would be no expense loading
attributable to investments if the rate of investment return on
assets is adjusted to take investment expenses into account. If
there is a single expense loading not separately identified as
pre-retirement or post-retirement, enter it under “Pre-retirement”
and enter “N/A” under “Post-retirement”. Where expenses are
assumed other than as a percentage of plan costs or liabilities,
enter the assumed pre-retirement expense as a percentage of
the plan’s normal cost, and enter the post-retirement expense
as a percentage of plan liabilities. If the normal cost of the plan
is zero, enter the assumed pre-retirement expense as a
percentage of the sum of lines 9c(1), 9c(2), and 9(c)(3), minus
line 9h. Enter rates to the nearest .1 percent.
Line 6f. Salary Scale. If a uniform level annual rate of salary
increase is used, enter that annual rate. Otherwise, enter the
level annual rate of salary increase that is equivalent to the
rate(s) of salary increase used. Enter the annual rate as a
percentage to the nearest .01 percent, used for a participant
from age 25 to assumed retirement age. If the plan’s benefit
formula is not related to compensation, enter “N/A” on line 6f.
Line 6g. Estimated Investment Return – Actuarial Value.
Enter the estimated rate of return on the actuarial value of plan
assets for the 1-year period ending on the valuation date. For
this purpose, the rate of return is determined by using the
formula 2I/(A + B – I), where I is the dollar amount of the
investment return under the asset valuation method used for
the plan, A is the actuarial value of the assets one year ago,
and B is the actuarial value of the assets on the current
valuation date. Enter rates to the nearest .1 percent. If entering
a negative number, enter a minus sign (“ – ”) to the left of the
number.
Note. Use the above formula even if the actuary feels that the
result of using the formula does not represent the true
estimated rate of return on the actuarial value of plan assets for
the 1-year period ending on the valuation date. The actuary
may attach a statement showing both the actuary’s estimate of
the rate of return and the actuary’s calculations of that rate, and
label the statement “Schedule MB, line 6g – Estimated Rate
of Investment Return (Actuarial Value).”
Line 6h. Estimated Investment Return – Current (Market)
Value. Enter the estimated rate of return on the current value
of plan assets for the 1-year period ending on the valuation
date. (The current value is the same as the fair market value —

6
7

Line 8a. Funding Waivers or Extensions. If a funding waiver
or extension request is approved after the Schedule MB is filed,
an amended Schedule MB must be filed with Form 5500 to
report the waiver or extension approval (also see instructions
for line 9k(1)).

Line 8b. Schedule of Active Participant Data. Check “Yes”
only if this is a multiemployer plan covered by Title IV of ERISA
that has active participants.
If line 8b is “Yes,” attach a schedule of the active plan
participant data used in the valuation for this plan year. Use the
format shown below and label the schedule “Schedule MB,
line 8b – Schedule of Active Participant Data.”

Schedule MB, Line 8b—Schedule of Active Participant Data
Under 1

Attained
Age
No.

Average
Comp. Cash Bal.

YEARS OF CREDITED SERVICE
1 to 4
No.

Average
Comp. Cash Bal.

5 to 9
No.

40 & up

Average
Comp. Cash Bal.

No.

Average
Comp. Cash Bal.

Under 25
25 to 29
30 to 34
35
40
45
50
55
60
65

to
to
to
to
to
to
to

39
44
49
54
59
64
69

70 & up

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Average cash balance accounts that are offset by amounts
from another plan may be reported either as amounts prior to
taking into account the offset, or as amounts after taking into
account the offset. Do not report the offset amount. For this or
any other unusual or unique situation, the attachment should
include an explanation of what is being provided.
Line 9. Shortfall Method. Under the shortfall method of
funding, the normal cost in the funding standard account is the
charge per unit of production (or per unit of service) multiplied
by the actual number of units of production (or units of service)
that occurred during the plan year. Each amortization
installment in the funding standard account is similarly
calculated.
Lines 9c and 9h. Amortization Charges and Credits. If
there are any amortization charges or credits, attach a
maintenance schedule of funding standard account bases and
label the schedule “Schedule MB, lines 9c and 9h –
Schedule of Funding Standard Account Bases.” The
attachment should clearly indicate the type of base (i.e., original
unfunded liability, amendments, actuarial losses, etc.), the
outstanding balance of each base, the number of years
remaining in the amortization period, and the amortization
amount. If bases were combined in the current year, the
attachment should show information on bases both prior to and
after the combining of bases.
The outstanding balance and amortization charges and
credits must be calculated as of the valuation date for the plan
year.
Note. If an election was made under Code section
412(b)(7)(F) as in effect prior to PPA to defer a portion of an
amount otherwise determined under previously effective section
412(b)(2)(B)(iv) (see Code section 431(b)(7)(E)), include an
attachment describing this calculation and label the schedule
“Schedule MB, line 9c – Deferral of Charge for Portion of
Net Experience Loss.”

Expand this schedule by adding columns after the “5 to 9”
column and before the “40 & up” column for active participants
with total years of credited service in the following ranges: 10 to
14; 15 to 19; 20 to 24; 25 to 29; 30 to 34; and 35 to 39. For
each column, enter the number of active participants with the
specified number of years of credited service divided according
to age group. For participants with partial years of credited
service, round the total number of years of credited service to
the next lower whole number. Years of credited service are the
years credited under the plan’s benefit formula.
Plans reporting 1,000 or more active participants on line
2b(3)(c), column (1), and using compensation to determine
benefits must also provide average compensation data. For
each grouping, enter the average compensation of the active
participants in that group. For this purpose, compensation is the
compensation taken into account for each participant under the
plan’s benefit formula, limited to the amount defined under
section 401(a)(17) of the Code. Do not enter the average
compensation in any grouping that contains fewer than 20
participants.
Cash balance plans (or any plans using characteristic code
1C on line 8a of Form 5500) reporting 1,000 or more active
participants on line 2b(3)(c), column (1), must also provide
average cash balance account data, regardless of whether all
active participants have cash balance accounts. For each age/
service bin, enter the average cash balance account of the
active participants in that bin. Do not enter the average cash
balance account in any age/service bin that contains fewer than
20 active participants.
General Rule. In general, data to be shown in each age/
service bin includes:
1. the number of active participants in the age/service bin,
2. the average compensation of the active participants in
the age/service bin, and
3. the average cash balance account of the active
participants in the age/service bin, using $0 for anyone who has
no cash balance account-based benefit.

Line 9d. Interest as Applicable. Interest as applicable should
be charged to the last day of the plan year.
Line 9f. Note that the credit balance or funding deficiency at
the end of “Year X” should be equal to the credit balance or
funding deficiency at the beginning of “Year X+1.” If such credit
balances or funding deficiencies are not equal, attach an
explanation and label the attachment “Schedule MB, line 9f –
Explanation of Prior Year Credit Balance/Funding
Deficiency Discrepancy.” For example, if the difference is
because contributions for a prior year that were not previously
reported are received this plan year, attach a listing of the
amounts and dates of such contributions.
Line 9j(1). ERISA Full Funding Limitation. Instructions for
this line are reserved pending published guidance.
Line 9j(2). “RPA ’94” Override. Instructions for this line are
reserved pending published guidance.
Line 9j(3). Full Funding Credit. Enter the excess of (1) the
accumulated funding deficiency, disregarding the credit balance
and contributions for the current year, if any, over (2) the
greater of lines 9j(1) or 9j(2).
Line 9k(1). Waived Funding Deficiency Credit. Enter a
credit for a waived funding deficiency for the current plan year
(Code section 431(b)(3)(C)). If a waiver of a funding deficiency
is pending, report a funding deficiency. If the waiver is granted
after Form 5500 is filed, file an amended Form 5500 with an
amended Schedule MB to report the funding waiver (see page
7 of the Instructions for Form 5500).
Line 9k(2). Other Credits. Enter a credit in the case of a plan
for which the accumulated funding deficiency is determined
under the funding standard account if such plan year follows a
plan year for which such deficiency was determined under the
alternative minimum funding standard.
Line 9o. Reconciliation Account. The reconciliation account
is made up of those components that upset the balance
equation of Treasury Regulations section 1.412(c)(3)-1(b).
Valuation assets must not be adjusted by the reconciliation

If the accrued benefit is the greater of a cash balance benefit or
some other benefit, average in only the cash balance account.
If the accrued benefit is the sum of a cash balance account
benefit and some other benefit, average in only the cash
balance account. For both the average compensation and the
average cash balance account, do not enter an amount for age/
service bins with fewer than 20 active participants.
In lieu of the above, two alternatives are provided for
showing compensation and cash balance accounts. Each
alternative provides for two age/service scatters (one showing
compensation and one showing cash balance accounts) as
follows:
Alternative A:
• Scatter 1 — Provide participant count and average
compensation for all active participants, whether or not
participants have account-based benefits.
• Scatter 2 — Provide participant count and average cash
balance account for all active participants, whether or not
participants have account-based benefits.
Alternative B:
• Scatter 1 — Provide participant count and average
compensation for all active participants, whether or not
participants have account-based benefits (i.e., identical to
Scatter 1 in Alternative A).
• Scatter 2 — Provide participant count and average cash
balance account for only those active participants with
account-based benefits. If the number of participants with
account-based benefits in a bin is fewer than 20, the average
account should not be shown even if there are more than 20
active participants in this bin on Scatter 1.
In general, information should be determined as of the
valuation date. Average cash balance accounts may be
determined as of either:
1. the valuation date or
2. the day immediately preceding the valuation date.
Instructions for Schedule MB (Form 5500)

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account balance when computing the required minimum
funding.
Line 9o(1). If a waived funding deficiency is being amortized at
an interest rate that differs from the valuation rate, enter the
prior year’s “reconciliation waiver outstanding balance”
increased with interest at the valuation rate to the current
valuation date and decreased by the year end amortization
amount based on the mandated interest rate. Enter the
amounts as of the valuation date.
Line 9o(2). Include in this line reconciliation amounts due to
extensions of amortization periods that have been approved by
the IRS.
Line 9o(3). Enter the sum of lines 9o(1), 9o(2)(a), and 9o(2)(b)
(each adjusted with interest at the valuation rate to the current
valuation date, if necessary).

Note. The net outstanding balance of amortization charges
and credits minus the prior year’s credit balance minus the
amount on line 9o(3) (each adjusted with interest at the
valuation rate, if necessary) must equal the unfunded liability.
Line 10. Contribution Necessary to Avoid Deficiency. Enter
the amount from line 9n. For plans in reorganization, see the
instructions for line 5. If applicable, file Form 5330, Return of
Excise Taxes Related to Employee Benefit Plans, with the IRS
to pay the 5% excise tax on the funding deficiency.

Line 11. In accordance with ERISA section 103(d)(3), attach a
justification for any change in actuarial assumptions for the
current plan year and label the attachment “Schedule MB, line
11 – Justification for Change in Actuarial Assumptions.”

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Contracts, etc., using an EIN other than that of the plan sponsor
or plan administrator reported on line 2b or 3b of Form 5500.)
• Unless the plan is a profit-sharing, ESOP or stock bonus
plan, no plan benefits of living or deceased participants were
distributed during the plan year in the form of a single-sum
distribution. See the instructions for Part I, line 3, below.
• The plan is not a multiemployer defined benefit plan.
Check the Schedule R box on the Form 5500 (Part II, line
10a(1)) if a Schedule R is attached to the Form 5500.
d
As a result of the PPA changes, the 2007 Schedule R
cannot be used by short plan year filers that are required to
report additional new information for 2008 on attachments to
the Schedule R. (See the Caution for 2008 Short Plan Year
Filings on page 5.)

2008 Instructions for Schedule R
(Form 5500)
Retirement Plan Information
General Instructions
Purpose of Schedule

Special Rule for Plans with Fewer Than 25
Participants
If the plan has fewer than 25 participants, meets all the
conditions for PPA-simplified reporting that are listed on page 9,
and elects to file under this simplified reporting option, then
complete only lines A, B, C, D, and Part II.

Specific Instructions

Who Must File

Schedule R must be attached to a Form 5500 filed for both
tax-qualified and nonqualified pension benefit plans. The parts
of Schedule R that must be completed depend on whether the
plan is subject to the minimum funding standards of Code
section 412 or ERISA section 302, the type of plan, and
minimum coverage requirement of Code section 410(b). See
line item requirements under Specific Instructions for more
details.
Exceptions: (1) Schedule R should not be completed when
the Form 5500 Return/Report is filed for a pension plan that
uses, as the sole funding vehicle for providing benefits, a tax
deferred annuity arrangement under Code section 403(b)(1), a
custodial account for regulated investment company stock
under Code section 403(b)(7), and/or individual retirement
accounts or annuities (as described in Code section 408). See
the Form 5500 instructions for Limited Pension Plan Reporting
on page 10 for more information.
(2) Schedule R also should not be completed if all of the
following conditions are met:
• The plan is not a defined benefit plan or otherwise subject to
the minimum funding standards of Code section 412 or ERISA
section 302.
• No plan benefits that would be reportable on line 1 of Part I of
this Schedule R were distributed during the plan year. See the
instructions for Part I, line 1, below.
• No benefits, as described in the instructions for Part I, line 2,
below, were paid during the plan year other than by the plan
sponsor or plan administrator. (This condition is not met if
benefits were paid by the trust or any other payor(s) which are
reportable on Form 1099-R, Distributions From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance

Part I – Distributions
“Distribution” includes only payments of benefits during the
plan year, in cash, in kind, by purchase for the distributee of an
annuity contract from an insurance company, or by distribution
of life insurance contracts. It does not include:
1. Corrective distributions of excess deferrals, excess
contributions, or excess aggregate contributions, or the income
allocable to any of these amounts;
2. Distributions of automatic contributions pursuant to Code
section 414(w);
3. The distribution of elective deferrals or the return of
employee contributions to correct excess annual additions
under Code section 415, or the gains attributable to these
amounts; and
4. A loan treated as a distribution under Code section 72(p).
Note. It does, however, include a distribution of a plan loan
offset amount as defined in Treasury Regulations section
1.402(c)-2, Q&A 9(b).

Instructions for Schedule R (Form 5500)

Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule R is
attached. You may abbreviate the plan name (if necessary) to
fit in the space provided.
Do not use a social security number in line D instead of an
EIN. Schedule R and its attachments are open to public
d
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 Schedule
d
R or any of its attachments may result in the rejection of the
filing.
You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.
“Participant” for purposes of Schedule R, means any present
or former employee who at any time during the plan year had
an accrued benefit in the plan (account balance in a defined
contribution plan).

Schedule R (Form 5500), Retirement Plan Information, reports
certain information on plan distributions, funding, and the
adoption of amendments increasing or decreasing the value of
benefits in a defined benefit pension plan.
Note. The Pension Protection Act of 2006 (PPA) requires filers
of certain pension plans to provide additional new information
beginning with the 2008 plan year. For the 2008 plan year, this
new information will be filed as attachments to Schedule R. All
multiemployer defined benefit plans are required to file
attachments providing the information specified in the
instructions. All defined benefit plans (single-employer,
multiple-employer, and multiemployer) with 1,000 or more
participants are required to provide financial asset breakout
information as an attachment to Schedule R. See Special Rules
for Defined Benefit Pension Plans on page 51. In addition, a
new attachment is required if line 6c shows a positive amount.
Attachments. All attachments to Schedule R must be properly
identified, and must include the name of the plan, plan
sponsor’s EIN, and plan number. Place “Schedule R” and the
required heading from the instructions at the top of each
attachment to identify the information to which the attachment
relates. When assembling the package for filing, you can place
attachments for a schedule either directly behind that schedule
or at the end of the filing.
Do not include attachments that contain a visible social
security number. Schedule R and its attachments are open to
public inspection, and the contents are public information and
are subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on Schedule
R or any of its attachments may result in the rejection of the
filing.

Line 1. Enter the total value of all distributions made during
the year (regardless of when the distribution began) in any form
other than cash, annuity contracts issued by an insurance
company, distribution of life insurance contracts, marketable
securities, within the meaning of Code section 731(c)(2), or plan
loan offset amounts. Do not include eligible rollover distributions
paid directly to eligible retirement plans in a direct rollover under
Code section 401(a)(31) unless such direct rollovers include
property other than that enumerated in the preceding sentence.
Line 2. Enter the EIN(s) of any payor(s) (other than the plan
sponsor or plan administrator on line 2b or 3b of the Form

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5500) who paid benefits reportable on Form 1099-R on behalf
of the plan to participants or beneficiaries during the plan year.
This is the EIN that appears on the Form 1099-R that is issued
to report the payments. Include the EIN of the trust if different
than that of the sponsor or plan administrator. If more than two
payors made such payments during the year, enter the EINs of
the two payors who paid the greatest dollar amounts during the
year. For purposes of this line 2, take into account all payments
made during the plan year, in cash or in kind, that are
reportable on Form 1099-R, regardless of when the payments
began, but take into account payments from an insurance
company under an annuity only in the year the contract was
purchased.

approved the amendment or failed to disapprove the
amendment within 90 days after the date the notice was filed.
See Temporary Regulations section 11.412(c)-7(b) for
details on when and how to make the election and what
information to include on the statement of election, which must
be filed with the Form 5500 annual return/report.
Line 5. If a money purchase defined contribution plan
(including a target benefit plan) has received a waiver of the
minimum funding standard, and the waiver is currently being
amortized, complete lines 3, 9, and 10 of Schedule MB. See
instructions for Schedule MB. Attach Schedule MB to Form
5500. The Schedule MB for a money purchase defined
contribution plan does not need to be signed by an enrolled
actuary.

Line 3. Enter the number of living or deceased participants
whose benefits under the plan were distributed during the plan
year in the form of a single-sum distribution. For this purpose, a
distribution of a participant’s benefits will not fail to be a
single-sum distribution merely because, after the date of the
distribution, the plan makes a supplemental distribution as a
result of earnings or other adjustments made after the date of
the single-sum distribution. Also include any participants whose
benefits were distributed in the form of a direct rollover to the
trustee or custodian of a qualified plan or individual retirement
account.

Line 6a. The minimum required contribution for a money
purchase defined contribution plan (including a target benefit
plan) for a plan year is the amount required to be contributed for
the year under the formula set forth in the plan document. If
there is an accumulated funding deficiency for a prior year that
has not been waived, that amount should also be included as
part of the contribution required for the current year.
Line 6b. Include all contributions for the plan year made not
later than 81/2 months after the end of the plan year. Show only
contributions actually made to the plan by the date the form is
filed. For example, do not include receivable contributions for
this purpose.

Complete Part II only if the plan is subject to the minimum
funding requirements of Code section 412 or ERISA section
302.

Line 6c. If line 6c shows a positive amount, attach a statement
indicating whether the sponsor will contribute the reported
minimum funding amount by the funding deadline. Label the
attachment “Schedule R, line 6c Information.” The
attachment must include the sponsor’s name, EIN, plan name,
and plan number. If the minimum required contribution exceeds
the contributions for the plan year made not later than 81/2
months after the end of the plan year, the excess is an
accumulated funding deficiency for the plan year. File 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.

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.

Part II – Funding Information

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).

Line 7. A revenue procedure providing for automatic approval
for a change in funding method for a plan year generally does
not apply unless the plan administrator or an authorized
representative of the plan sponsor explicitly agrees to the
change. If a change in funding method made pursuant to such a
revenue procedure (or a class ruling letter) is to be applicable
for the current plan year, this line generally must be checked
‘‘Yes.’’ In certain situations, however, the requirement that the
plan administrator or an authorized representative of the plan
sponsor agree to the change in funding method will be satisfied
if the plan administrator or an authorized representative of the
plan sponsor is made aware of the change. In these situations,
this line must be checked “N/A.” See section 6.01(2) of Rev.
Proc. 2000-40, 2000-42 I.R.B. 357.

The sponsor or plan administrator of a single-employer or
multiple-employer defined benefit plan that is subject to the
minimum funding requirements must file Schedule SB as an
attachment to Form 5500. Schedule MB is filed for
multiemployer defined benefit plans and certain money
purchase defined contribution plans (whether they are
single-employer or multiemployer plans). However, Schedule
MB is not required to be filed for a money purchase defined
contribution plan that is subject to the minimum funding
requirements unless the plan is currently amortizing a waiver of
the minimum funding requirements.
Line 4. Check ‘‘Yes’’ if, for purposes of computing the
minimum funding requirements for the plan year, the plan
administrator is making an election intended to satisfy the
requirements of Code section 412(d)(2) or ERISA section
302(d)(2). Under Code section 412(d)(2) and ERISA section
302(d)(2), a plan administrator may elect to have any
amendment, adopted after the close of the plan year for which it
applies, treated as having been made on the first day of the
plan year if all of the following requirements are met:
1. The amendment is adopted no later than two and
one-half months after the close of such plan year (two years for
a multiemployer plan);
2. The amendment does not reduce the accrued benefit of
any participant determined as of the beginning of such plan
year; and
3. The amendment does not reduce the accrued benefit of
any participant determined as of the adoption of the
amendment unless the plan administrator notified the Secretary
of the Treasury of the amendment and the Secretary either

Part III – Amendments
Line 8.
• Check “No” if no amendments were adopted during this plan
year that increased or decreased the value of benefits.
• Check “Increase” if an amendment was adopted during the
plan year that increased the value of benefits in any way. This
includes an amendment providing for an increase in the amount
of benefits or rate of accrual, more generous lump sum factors,
COLAs, more rapid vesting, additional payment forms, or earlier
eligibility for some benefits.
• Check “Decrease” if an amendment was adopted during the
plan year that decreased the value of benefits in any way. This
includes a decrease in future accruals, closure of the plan to
new employees, or accruals being frozen for some or all
participants.
• If applicable, check both “Increase” and “Decrease.”

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Part IV – Coverage

bargained employees (within the meaning of Treasury
Regulations section 1.410(b)-6(d)(2)).
2. If, during the plan year, the plan benefitted no highly
compensated employees (within the meaning of Code section
414(q)), excluding employees who were collectively bargained
employees (within the meaning of Treasury Regulations section
1.410(b)-6(d)(2)). This exception also applies if no employee
received an allocation or accrued a benefit under the plan for
the plan year.
3. If, during the plan year, the plan benefitted only
collectively bargained employees (within the meaning of
Treasury Regulations section 1.410(b)-6(d)(2)). However, this
exception does not apply if more than 2% of the employees
covered by the plan were professional employees (within the
meaning of Treasury Regulations section 1.410(b)-9).
4. If, during the plan year, the plan benefitted 100% of the
nonexcludable nonhighly compensated employees of the
employer. (This exception also applies if, during the plan year,
all of the nonhighly compensated employees of the employer
were excludable.) The nonhighly compensated employees of
the employer include all the self-employed individuals,
common-law employees, and leased employees (within the
meaning of Code section 414(n)) employed by the employer or
any entity aggregated with the employer under Code section
414(b), (c), or (m) at any time during the plan year, excluding
highly compensated employees (within the meaning of Code
section 414(q)). Any such employee is a nonexcludable
employee unless the employee is in one of the following
categories:
a. Employees who have not attained the minimum age and
service requirements of the plan.

Line 9.
Questions regarding coverage were previously raised in
Schedule T (Form 5500), Qualified Pension Plan
CAUTION Coverage information, but Schedule T has been
discontinued. The instructions to the Schedule T provided that
Schedule T need not be filed every year if the employer was
using the three-year testing cycle of Rev. Proc. 93-42, 1993-2
C.B. 540. That exception does not apply to Part IV of Schedule
R.
If the ratio percentage for the plan, or any disaggregated part
of the plan, is less than 70%, the plan does not satisfy the ratio
percentage test. An employer that is using single day
‘‘snapshot’’ testing may, in certain circumstances, need to
adjust the 70% figure to compensate for the fact that the
substantiation quality data or snapshot population does not
reflect employee turnover and may overstate the plan’s
coverage. See section 3 of Rev. Proc. 93-42. If the plan, or any
disaggregated part of the plan, does not satisfy the ratio
percentage test, the plan will satisfy the minimum coverage
requirements of the Code only if it satisfies the average benefit
test.
A plan satisfies the average benefit test if it satisfies both the
nondiscriminatory classification test and the average benefit
percentage test. A plan satisfies the nondiscriminatory
classification test if the plan benefits such employees as qualify
under a classification set up by the employer and found by the
Secretary not to be discriminatory in favor of highly
compensated employees. Under Treasury Regulations section
1.410(b)-4, a classification will be deemed nondiscriminatory if
the ratio percentage for the plan is equal to or greater than the
safe harbor percentage. The safe harbor percentage is 50%,
reduced by 3/4 of a percentage point for each percentage point
by which the nonhighly compensated employee concentration
percentage exceeds 60%. The nonhighly compensated
employee concentration percentage is the percentage of all the
employees of the employer who are not highly compensated
employees.
In general, a plan satisfies the average benefit percentage
test if the actual benefit percentage for nonhighly compensated
employees is at least 70% of the actual benefit percentage for
highly compensated employees. See Treasury Regulations
section 1.410(b)-5. All qualified plans of the employer, including
ESOPs, Code section 401(k) plans, and plans with employee or
matching contributions (Code section 401(m) plans) are
aggregated in determining the actual benefit percentages. Do
not aggregate plans that may not be aggregated for purposes of
satisfying the ratio percentage test, other than ESOPs and
Code sections 401(k) and 401(m) plans. In addition, all
nonexcludable employees, including those with no benefit
under any qualified plan of the employer, are included in
determining the actual benefit percentages.
Notes. (1) Certain plans are required to be disaggregated, or
may be permissively disaggregated, into two or more separate
parts for purposes of applying the minimum coverage
requirements of Code section 410(b). Check the box for “ratio
percentage test” or “average benefit test,” whichever is
applicable to the disaggregated plans. Both boxes may be
checked if each test is satisfied by one or more of the
disaggregated plans. (2) Multiple-employer plan filers should
complete one Schedule R to report satisfaction of the coverage
rules by all of the employers that participate in the plan. Check
the box for “ratio percentage test,” “average benefit test,” or
both, if any participating employer uses either test. Leave line 9
blank if all of the participating employers meet one of the
exceptions noted below.
Plans may also satisfy the coverage rules of Code section
410(b) under one of the exceptions listed below. If one of the
following exceptions applies, leave line 9 blank.
1. If, during the plan year, the employer employed only
highly compensated employees (within the meaning of Code
section 414(q)), excluding employees who were collectively

Note. If a plan has multiple age and service conditions or if the
employer is treating a plan benefitting otherwise excludable
employees as two separate plans pursuant to Treasury
Regulations section 1.410(b)-6(b)(3), refer to section
1.410(b)-6(b) and section 1.410(b)-7(c)(3) of the regulations
regarding the determination of excludable employees.
b. Collectively bargained employees within the meaning of
Treasury Regulations section 1.410(b)-6(d)(2).
c. Nonresident aliens who receive no U.S. source income.
d. Employees who fail to accrue a benefit solely because
they: (1) fail to satisfy a minimum hour of service or a last day
requirement under the plan; (2) do not have more than 500
hours of service for the plan year; and (3) are not employed on
the last day of the plan year.
e. Employees of QSLOBs other than the one with respect to
which this Schedule R is being filed.
5. If, for the plan year, the plan is treated as satisfying the
minimum coverage requirements of Code section 410(b) under
the ‘‘acquisition or disposition’’ rule in Code section
410(b)(6)(C).

Instructions for Schedule R (Form 5500)

Special Rules for Defined Benefit Pension Plans.
PPA requires filers of certain pension plans to provide
additional new information beginning with the 2008 plan year.
For the 2008 plan year, this new information will be filed as
attachments to Schedule R. Multiemployer defined benefit plans
that are deemed to be in “Endangered Status,” “Seriously
Endangered Status,” or “Critical Status” must attach a summary
of their Funding Improvement Plan or Rehabilitation Plan. In
addition, all multiemployer defined benefit plans must file an
attachment to Schedule R reporting information about
contributing employers, number of participants for whom no
contributions are being made, number of employers
withdrawing from the plan and their assessed withdrawal
liabilities, and information on transfers to, or mergers with, the
plan. Also, all defined benefit pension plans with 1,000 or more
participants must file an attachment providing financial asset
breakout information.
Note. For the 2009 and later plan years, this new information
will be collected in a new Part V (Additional Employer
Information for Multiemployer Defined Benefit Pension Plans)
and Part VI (Additional Information for Single-Employer and

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Multiemployer Defined Benefit Pension Plans) of the revised
Schedule R. See 72 Fed. Reg. 64809-810.

b. The plan year immediately preceding the current plan
year (i.e., 2007).
c. The second preceding plan year (i.e., 2006).
For this purpose, count only those participants whose
employers or former employers had withdrawn from the plan by
the beginning of the relevant plan year. Disregard any
participants whose employers had not withdrawn from the plan,
even if, in the relevant year, no contributions were made by the
employer on behalf of those participants. Thus, for the limited
purposes of this item and notwithstanding any contrary
definition of such participants applicable elsewhere, the
deferred vested and retired participants of employers who have
not withdrawn from the plan should not be included in these
numbers.

Attachment for Multiemployer Plans with a
Funding Improvement or Rehabilitation Plan

Note. Withdrawal liability payments are not to be treated as
contributions for the purpose of determining the number of
participants here.
4. Enter:
a. The ratio of the number of participants on whose behalf
no employer had an obligation to make a contribution for the
current (2008) plan year to the corresponding number for the
preceding (2007) plan year, and
b. The ratio of the number of participants on whose behalf
no employer had an obligation to make a contribution for the
current (2008) plan year to the corresponding number for the
second preceding (2006) plan year.
For the purpose of paragraphs a and b, count all participants
whose employers have withdrawn from the plan as well as all
deferred vested and retired participants of employers still active
in the plan (unless the collective bargaining agreement
specifically requires the employer to make contributions for
such participants).

If the Plan Status Code on line 4a of Schedule MB is an “E”
(Endangered Status), “S” (Seriously Endangered Status), or “C”
(Critical Status), a summary of either the Funding Improvement
Plan (for plans in Endangered and Seriously Endangered
Status) or the Rehabilitation Plan (for plans in Critical Status)
must be attached to Schedule R. This attachment must be
labeled “Schedule R, Summary of Funding Improvement
Plan” or “Schedule R, Summary of Rehabilitation Plan,” as
appropriate, and must include the plan name, the plan
sponsor’s name and EIN, and the plan number. The summary
document must reflect the plan in effect at the end of the plan
year (whether the original funding improvement plan or
rehabilitation plan or as modified) and must include a
description of the various contribution and benefit schedules
that are being provided to the bargaining parties and any other
actions taken in connection with the rehabilitation plan or the
funding improvement plan, such as use of the shortfall funding
method or extensions of the amortization period. The summary
should also include a schedule of the expected progress for the
funded percentage or other relevant factors under the
rehabilitation plan or the funding improvement plan. The
summary must also include the information described in the last
sentence of Code section 432(e)(3)(A). The plan sponsor is
required by Code section 432(c)(6) and Code section
432(e)(3)(B) to update annually the funding improvement or
rehabilitation plan, schedule of contribution rates (to reflect the
experience of the plan), and duration of this schedule of
contributions. These annual updates should also be a part of
the summary document attachment.

Note. Withdrawal liability payments are not to be treated as
contributions for this purpose.
5. If any employers withdrew from the plan during the
preceding (2007) plan year:
a. Enter the number of employers that withdrew from the
plan.
b. Enter the aggregate amount of withdrawal liability
assessed against these employers. If the withdrawal liability for
one or more withdrawing employers has not yet been
determined, include the amounts estimated to be assessed
against them in the aggregate amount.
The definitions of withdrawal are those contained in Section
4203 of ERISA. If the plan is in the building and construction
industry, entertainment industry, or another industry that has
special withdrawal rules, withdrawing employers should only be
counted if the withdrawal adheres to the special rules applying
to its specific industry.
6. If assets and liabilities from another plan were transferred
to or merged with the assets and liabilities of this plan during
the 2008 plan year, provide the following information:
a. The names and EINs of all plans that transferred assets
and liabilities to, or merged with, this plan.
b. For each plan, including this plan, report the actuarial
valuation of the total assets and total liabilities for the 2007 plan
year, based on the most recent data available as of the day
before the first day of the 2008 plan year.

Attachment for ALL Multiemployer Defined
Benefit Pension Plans

Multiemployer defined benefit pension plans that are subject to
the minimum funding standards (see Code section 412 and Part
3 of Title I of ERISA) must provide certain information as an
attachment to Schedule R. Label the attachment “Schedule R,
Certain Information for Multiemployer Plan,” and include
the following information:

1. Report the total number of employers obligated to
contribute to the plan in 2008.
2. For each employer contributing more than five (5) percent
of the plan’s total contributions for the 2008 plan year, indicate:
a. The name of the contributing employer.
b. The EIN of the contributing employer.
c. The dollar amount contributed by the employer.
d. The date the collective bargaining agreement expires. If
the employer has more than one collective bargaining
agreement requiring contributions to the plan, state the
expiration date of each collective bargaining agreement
(regardless of the amount of contributions arising from such
agreement).
e. The contribution rate (in dollars and cents) per
contribution base unit and the base unit measure. Indicate
whether the base unit is measured on an hourly, weekly,
unit-of-production, or other basis. If “other,” specify the base
unit measure used. If the contribution rate changed during the
plan year, enter the last contribution rate in effect for the plan
year. If the employer has different contribution rates for different
classifications of employees or different places of business, list
each contribution rate and corresponding base unit measure
under which the employer made contributions (regardless of the
amount of contributions resulting from each rate).
Note. The employers must be listed in descending order
according to the dollar amount of their contributions to the plan.
3. Provide the number of participants on whose behalf no
contributions were made by an employer as an employer of the
participant for:
a. The current (2008) plan year.

Additional Information for Single-Employer and
Multiemployer Defined Benefit Pension Plans
Liabilities from other plans. If any liabilities to participants or
their beneficiaries under the plan at the end of the plan year
consist of liabilities under two (2) or more plans as of
immediately before the 2008 plan year, provide the following
information as an attachment:
1. The names, EINs, and plan numbers of all plans that
provided a portion of liabilities of the participants and
beneficiaries in question. The current plan and its identifiers
should be listed first.
2. The funded percentage of each plan as of the last day of
the 2007 plan year.

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The funded percentages are the ratios where the numerators
are the actuarial values of the plans’ assets at the end of the
2007 plan year and the denominators are the accrued liabilities
of the plans at the end of the 2007 plan year. Label the
attachment “Schedule R, Funded Percentages of Plans
Contributing to the Liabilities of Plan Participants.”

under “Other assets classes,” unless the trust contains no
stocks, bonds, or real estate holdings. The same methodology
should be used in disaggregating trust assets as is used when
disclosing the allocation of plan assets on the sponsor’s 10-K
filings to the Securities and Exchange Commission. Real estate
investment trusts (REITs) should be listed with stocks, while
real estate limited partnerships should be included in the Real
Estate category. The percentage should be based on the
assets current (fair market) value at the beginning of the plan
year. The percentages in the five categories should sum up to
100 percent.
2. Indicate the average duration of the plan’s debt portfolio
by using one of the following categories: (a) 0 – 3 years; (b) 3 – 6
years; (c) 6 – 9 years; (d) 9 – 12 years; (e) 12 – 15 years; (f)
15 – 18 years; (g) 18 – 21 years; (h) 21 years or more. If the
average duration falls exactly on the boundary of two
categories, report the category with the lower duration.
3. To determine the average duration, use the “effective
duration” or any other generally accepted measure of duration.
Report the duration measure used from one of the following: (a)
Effective duration; (b) Macaulay duration; (c) Modified duration;
or (d) Other (and specify the measure used).

Asset Distribution Information for Large Defined
Benefit Plans

If bonds are held in multiple bond portfolios, report the
weighted average of the average durations of the various
portfolios where the weights are the dollar values of the
individual portfolios.

The following information must be provided by all defined
benefit pension plans with 1,000 or more participants as of the
beginning of the plan year, as shown on line 3d, column (1), of
the Schedule SB for single-employer plans or on line 2b(4),
column (1), of the Schedule MB for multiemployer plans. Label
the attachment “Schedule R, Distribution of Assets
Information.”
1. Show the beginning-of-year distribution of assets for the
following categories:
a. Stocks,
b. Investment-grade debt instruments,
c. High-yield debt instruments,
d. Real estate, and
e. Other asset classes.
These percentages, expressed to the nearest whole percent,
should reflect the total assets held in each category, regardless
of how they are listed on Schedule H. For example, assets held
in master trusts should be disaggregated into the five asset
components and properly distributed. They should not be listed

Instructions for Schedule R (Form 5500)

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Code section 413(c)(4)(A) (i.e., it is funded as if each employer
were maintaining a separate plan). This includes plans
established before January 1, 1989, for which an election was
made to fund in accordance with Code section 413(c)(4)(A).
• Check “Multiple-B” if the Form 5500 is being filed for a
multiple-employer plan and the plan is subject to the rules of
Code section 412(c)(4)(B) (i.e., it is funded as if all participants
were employed by a single employer.)
If “Multiple-A” is checked, compute the entries on Schedule
SB filed for the plan as the sum of the individual amounts
computed for each employer. Complete a Schedule SB for each
employer showing information relative to that employer’s portion
of the plan, and submit them as an attachment to the Schedule
SB for the plan. Label the attachment, “Schedule SB –
Information for Each Individual Employer.”
Line F. Prior Year Plan Size. Check the applicable box based
on the highest number of participants (both active and inactive)
on any day of the preceding plan year, taking into account
participants in all defined benefit plans maintained by the same
employer (or any member of such employer’s controlled group)
who are or were also employees of that employer or member.
For this purpose, participants whose only defined benefit plan is
a multiemployer plan (as defined in Code section 414(f)) are not
counted, and participants who are covered in more than one of
the defined benefit plans described above are counted only
once. Inactive participants include vested terminated and retired
employees as well as beneficiaries of deceased participants. If
this is the first plan year that a plan described in this paragraph
exists, complete this line based on the highest number of
participants that the plan is reasonably expected to have on any
day during the first plan year.

2008 Instructions for Schedule SB
(Form 5500)
Single-employer Defined Benefit Plan
Actuarial Information
General Instructions
Note. Proposed regulations under Code sections 430, 436,
and 4971 and ERISA sections 206(g) and 303 were published
in the Federal Register on May 29, 2007, August 31, 2007,
December 31, 2007, and April 15, 2008. However, with the
exception of sections 1.430(h)(3)-1 and 54.4971(c)-1 of the
proposed regulations, the provisions of the final regulations will
not be effective until the plan year beginning in 2009. With
respect to those provisions proposed to become effective after
2008, plan sponsors may either rely on the provisions of the
proposed regulations for plan years beginning in 2008 or may
generally follow a reasonable interpretation of the funding rules
in the statute, taking into account any technical corrections to
the funding rules that are enacted. In addition, once final
regulations are issued, plan sponsors will be able to rely on the
provisions of those final regulations for plan years beginning in
2008.

General Instructions, Parts I through VIII, Statement
by Enrolled Actuary, and Attachments

The sponsor or plan administrator of a single-employer defined
benefit plan (including a multiple-employer defined benefit plan)
that is subject to the minimum funding standards (see Code
section 412 and Part 3 of Title I of ERISA) must file this
schedule as an attachment to the Form 5500.
Note. This schedule is not filed for a multiemployer plan nor for
a money purchase defined contribution plan (including a target
benefit plan) for which a waiver of the minimum funding
requirements is currently being amortized. Information for these
plans must be filed using Schedule MB.
Note. The Schedule SB does not have to be filed with the
Form 5500-EZ, but it must be retained (in accordance with the
Instructions for Form 5500-EZ under the What To File section).
The enrolled actuary must complete and sign the Schedule SB
and forward it to the person responsible for filing the Form
5500-EZ, even if the Schedule SB is not filed.
Check the Schedule B box on the Form 5500 (Part II, line
10a(2)) if a Schedule SB is attached to Form 5500.
Lines A through D. Identifying Information. Include the
same information as reported in corresponding lines in Part II of
the Form 5500. You may abbreviate the plan name (if
necessary) to fit in the space provided.
Do not use a social security number in line D instead of an
EIN. The Schedule SB and its attachments are open to public
inspection if filed with a Form 5500, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule SB or any of its attachments may
result in the rejection of the filing.
You can apply for an EIN online, by telephone, by fax, or by
mail depending on how soon you need to use the EIN. For
more information, see Section 4: How To File under General
Instructions to Form 5500. The EBSA does not issue EINs.
Line E. Type of Plan. Check the applicable box to indicate the
type of plan. A single-employer plan for this Form 5500
reporting purpose is an employee benefit plan maintained by
one employer or one employee organization. A
multiple-employer plan is a plan that is maintained by more than
one employer, but is not a multiemployer plan. (See the
Instructions for Form 5500, box A(1) for additional information
on the definition of a multiemployer plan.)
• Check “Single” if the Form 5500 is filed for a single-employer
plan (including a plan maintained by more than one member of
the same controlled group).
• Check “Multiple-A” if the Form 5500 is being filed for a
multiple-employer plan and the plan is subject to the rules of

Who Must File

Except as noted below, all single and multiple-employer defined
benefit plans, regardless of size or type, must complete Parts I
through VIII. See instructions for line 27 for additional
information to be provided for certain plans with special
circumstances.
The Pension Protection Act of 2006, as amended (PPA),
provides delayed effective dates for the new funding rules for
plans meeting certain criteria (certain multiple-employer plans
maintained by rural cooperatives or related organizations,
PBGC settlement plans, and certain plans maintained by
government contractors, as described in PPA sections 104
through 106). Eligible plans to which these delayed effective
dates apply do not need to complete the entire Schedule SB,
but will have to file information relating to pre-PPA calculations
in an attachment using the 2007 Schedule B form.
The PPA provides funding relief for certain defined benefit
plans (other than multiemployer plans) maintained by a
commercial passenger airline or by an employer whose
principal business is providing catering services to a
commercial passenger airline, based on an alternative 17-year
funding schedule. Plans using this funding relief do not need to
complete the entire Schedule SB, but are required to provide
supplemental information as an attachment to Schedule SB.
Alternatively, these plans can elect to apply the funding rules
generally applicable to single-employer defined benefit plans,
but amortize the funding shortfall over 10 years instead of the
standard 7-year period and use a special interest rate to
determine the funding target. Plans using this 10-year funding
option must complete the entire Schedule SB and provide
additional information. See the instructions for line 27 for more
information.
Notes. (1) For split-funded plans, the costs and contributions
reported on Schedule SB should include those related to both
trust funds and insurance carriers. (2) For terminating plans,
Rev. Rul. 79-237, 1979-2 C.B. 190, provides that minimum
funding standards apply until the end of the plan year that
includes the termination date. Accordingly, the Schedule SB is
not required to be filed for any later plan year. However, if a
termination fails to occur — whether because assets remain in
the plan’s related trust (see Rev. Rul. 89-87, 1989-2 C.B. 81) or

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for any other reason (e.g., the PBGC issues a notice of
noncompliance pursuant to 29 CFR section 4041.31 for a
standard termination) — there is no termination date, and
therefore, minimum funding standards continue to apply and a
Schedule SB continues to be required.

and liability amounts must be determined in a consistent
manner. Therefore, if the value of any insurance contracts has
been excluded from the amount reported in line 2a, liabilities
satisfied by such contracts should also be excluded from the
funding target values reported in lines 3 and 4.
Line 2b. Actuarial Value of Assets. If an averaging method is
used to value plan assets (as permitted under Code section
430(g)(3)(B) and ERISA section 303(g)(3)(B)), enter the value
as of the valuation date taking into account the requirement that
such value must be within 90% to 110% of the fair market value
of assets.
Do not adjust the actuarial value of assets for items such as
the funding standard carryover balance or the present value of
any remaining shortfall or waiver amortization installments.
Treat contributions designated for a current or prior plan year,
rollover amounts, insurance contracts, and other items in the
same manner as for line 2a.
Note. Under Code section 430(g)(3)(B), the use of averaging
methods in determining the value of plan assets is permitted
only in accordance with methods prescribed in Treasury
regulations. Accordingly, for plan years beginning in 2008,
taxpayers cannot use asset valuation methods other than fair
market value (as described in Code section 430(g)(3)(A)),
except as provided under Treasury regulations. As provided in
Notice 2008-21, 2008-7 I.R.B. 431, the final regulations will
permit the averaging method set forth in section
1.430(g)-1(c)(2) of the proposed Treasury regulations to apply
for plan years beginning during 2008.
Line 3. Funding Target/Participant Count Breakdown. All
amounts should be reported as of the valuation date.
• Column (1) — Enter the number of participants, including
beneficiaries of deceased participants, who are or who will be
entitled to benefits under the plan.
• Column (2) — Enter the funding target calculated using the
methods and assumptions provided in ERISA sections 303(h)
and (i), Code sections 430(h) and (i), and other related
guidance. When allocating the funding target for active
participants (line 3c(3)) between vested and non-vested
benefits (lines 3c(2) and 3c(1) respectively), benefits
considered vested for PBGC premium purposes must be
included in line 3c(2).
Unless the plan sponsor has received approval to use
substitute mortality tables in accordance with ERISA section
303(h)(3)(C) and Code section 430(h)(3)(C), the funding target
must be computed using the mortality tables for non-disabled
lives, as published in section 1.430(h)(3)-1 of the Income Tax
Regulations. If substitute mortality tables have been approved
(or deemed to have been approved) by the IRS, such tables
must be used instead of the mortality tables described in the
previous sentence, subject to the rules of ERISA section
303(h)(3) and Code section 430(h)(3). The funding target may
be computed taking into account the mortality tables for
disabled lives published in Rev. Rul. 96-7, 1996-1 C.B. 59, and
as provided in Notice 2008-29, 2008-12 I.R.B. 637.
Special rules for plans that are in at-risk status. If a plan
is in at-risk status, report the amount reflecting the additional
assumptions required in ERISA section 303(i)(1)(B) and Code
section 430(i)(1)(B).
If the plan has been in at-risk status for any two or more of
the preceding four plan years, also include the loading factor
required in ERISA section 303(i)(1)(C) and Code section
430(i)(1)(C). If the plan is in at-risk status and has been in
at-risk status for fewer than five consecutive years, report the
funding target amounts after reflecting the transition rule
provided in ERISA section 303(i)(5) and Code section 430(i)(5).
Years beginning before 2008 do not count for this purpose.
Therefore, the funding target for any plan that is in at-risk status
for the 2008 plan year will reflect 20% of the funding target
using the special at-risk assumptions and 80% of the funding
target determined without regard to the at-risk assumptions.
Determining whether a plan is in at-risk status. Refer to
ERISA section 303(i)(4) and Code section 430(i)(4) to
determine whether the plan is in at-risk status. Generally, a plan

Statement by Enrolled Actuary
An enrolled actuary must sign Schedule SB. The signature of
the enrolled actuary may be qualified to state that it is subject to
attached qualifications. See Treasury Regulations section
301.6059-1(d) for permitted qualifications. If the actuary has not
fully reflected any final or temporary regulation, revenue ruling,
or notice promulgated under the statute in completing the
Schedule SB, check the box on the last line of page 1. If this
box is checked, indicate on an attachment whether any unpaid
required contribution or a contribution that is not wholly
deductible would result if the actuary had fully reflected such
regulation, revenue ruling, or notice, and label this attachment
“Schedule SB – Statement by Enrolled Actuary.” A
stamped or machine produced signature is not acceptable. The
most recent enrollment number must be entered. In addition,
the actuary may offer any other comments related to the
information contained in Schedule SB.

All attachments to the Schedule SB must be properly identified
as attachments to the Schedule SB, and must include the name
of the plan, plan sponsor’s EIN, plan number, and line number
to which the schedule relates. When assembling the package
for filing, attachments for a schedule should be placed either
directly behind that schedule or at the end of the filing.
Do not include attachments that contain a visible social
security number. Except for certain one-participant plans, the
Schedule SB and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a visible social security number on an attachment
may result in the rejection of the filing.

Attachments

Specific Instructions for Part I — Basic
Information

Note. All entries in Part I must be reported as of the valuation
date.
Line 1. Valuation Date. The valuation date for a plan year
must be the first day of the plan year unless the plan meets the
small-plan exception of ERISA section 303(g)(2)(B) and Code
section 430(g)(2)(B). For plans that qualify for the exception,
the valuation date may be any date in the plan year, including
the first or last day of the plan year.
A plan qualifies for this small-plan exception if there were
100 or fewer participants on each day of the prior plan year. For
the definition of participant, as it applies in this case, see the
instructions for line F.
Line 2a. Market Value of Assets. Enter the fair market value
of assets as of the valuation date. Include contributions
designated for the previous plan year that are made after the
valuation date (but within the 81/2 -month period after the end of
the prior plan year).
Contributions made for the current plan year must be
excluded from the amount reported in line 2a. If these
contributions were made prior to the valuation date (which can
only occur for small plans with a valuation date other than the
first day of the plan year), the asset value must be adjusted to
exclude not only the contribution amounts, but interest on the
contributions from the date of payment to the valuation date,
using the current-year effective interest rate.
Do not adjust for items such as the funding standard
carryover balance or prefunding balance or the present value of
remaining shortfall or waiver amortization installments. Rollover
amounts or other assets held in individual accounts that are not
available to provide defined benefits under the plan should not
be included on line 2a regardless of whether they are reported
on the Schedule H (Form 5500) (line 1l, column (a)) or
Schedule I (Form 5500) (line 1c, column (a)). Additionally, asset
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(121 Stat.112)) states that for plans electing the 10-year
amortization period, the funding target during that period is
determined using an interest rate of 8.25% rather than the
interest rates or segment rates calculated on the basis of the
corporate bond yield curve. However, this special 8.25%
interest rate does not apply for other purposes, including the
calculation of target normal cost or the amortization of the
funding shortfall. Report the target normal cost using the
interest rates or segment rates otherwise applicable under
Code section 430(h)(2) and ERISA section 303(h)(2).

Specific Instructions for Part II — Beginning of
Year Carryover and Prefunding Balances

Line 7. Balance at Beginning of Prior Plan Year After
Applicable Adjustments. Enter “N/A” in both columns.
Line 8. Portion Used To Satisfy Prior Year’s Funding
Requirement. Enter “N/A” in both columns.
Line 9. Amount Remaining.
• Carryover balance (line 9, column (a)) — Enter the amount
reported in line 9o on the 2007 Schedule B. If there has been
any adjustment to this amount so that it does not match the
amount in line 9o of the 2007 Schedule B, attach an
explanation and label the attachment “Schedule SB, line 9 –
Explanation of 2007 Credit Balance Discrepancy.” If the
plan did not exist before 2008, enter “N/A.”
• Prefunding balance (line 9, column (b)) — Enter “N/A.”
Line 10. Interest on Line 9. Enter “N/A” in both columns.
Line 11. Prior Year’s Excess Contributions to be Added to
Prefunding Balance. Enter “N/A” in lines 11a – d.
Line 12. Reduction in Balances Due to Elections or Deemed
Elections.
• Carryover balance (line 12, column (a)) — Enter the amount
by which the employer elects to reduce (or is deemed to elect to
reduce, per ERISA section 206(g)(5)(C) and Code section
436(f)(3)) the funding standard carryover balance under ERISA
section 303(f) and Code section 430(f). This amount cannot be
greater than the amount reported in line 9, column (a).
• Prefunding balance (line 12, column (b)) — Enter “N/A.”
If the valuation date is not the beginning of the plan year,
adjust the amount reported in line 12, column (a), to the
beginning of the plan year using the effective interest rate for
the current plan year. If the plan did not exist in the prior year
and is not a successor plan, enter “N/A” in both columns.
Line 13. Balance at Beginning of Current Year.
• Carryover balance (line 13, column (a)) — Enter the amount
in line 9, column (a), reduced by line 12, column (a).
• Prefunding balance (line 13, column (b)) — Enter “N/A.”

is in at-risk status for a plan year if it had more than 500
participants on any day during the preceding plan year (see
instructions for line F for the definition of participants) and the
plan’s funding target attainment percentage (“FTAP”) falls
below specified thresholds.
A plan with over 500 participants is in at-risk status for 2008
if the FTAP for 2007 is less than 65%. Section 1.430(i)-1(f)(5) of
the proposed Treasury regulations provides that the FTAP for
2007 may be determined as the ratio of the adjusted actuarial
value of assets to the current liability from line 1d(2)(a) of the
2007 Schedule B. For this purpose, the actuarial value of
assets for the 2007 plan year (line 1b(2) of the 2007 Schedule
B) is adjusted if necessary to be no less than 90% and no more
than 110% of the fair market value of assets, and then reduced
by the amount of the credit balance in the funding standard
account (line 9h of the 2007 Schedule B). If the plan’s valuation
date for 2007 was not the first day of the plan year, adjust the
credit balance in line 9h of the 2007 Schedule B for interest
between the beginning of the plan year and the valuation date.
See section 1.430(i)-1(f)(5)(ii)(C) of the proposed Treasury
regulations for a special rule permitting an adjustment to the
amount of the credit balance used for the purposes of this
calculation, if the plan sponsor has made an election to reduce
the funding standard carryover balance for the 2008 plan year.
Line 4. Additional Information for Plans in At-Risk Status.
If the plan is in at-risk status as provided under ERISA section
303(i)(4) and Code section 430(i)(4), check the box, complete
lines 4a and 4b, and include as an attachment the information
described below. Do not complete line 4 if the plan is not in
at-risk status for the current plan year.
• Line 4a — Enter the amount of the funding target determined
as if the plan were not in at-risk status.
• Line 4b — Report the funding target disregarding the
transition rule of ERISA section 303(i)(5) and Code section
430(i)(5), and disregarding the loading factor in ERISA section
303(i)(1)(C), and Code section 430(i)(1)(C).
If the plan is in at-risk status for the current plan year, attach
a description of the at-risk assumption for assumed form of
payment (i.e., optional form resulting in the highest present
value). Label the attachment “Schedule SB, line 4 –
Additional Information for Plans in At-Risk Status.”
Line 5. Effective Interest Rate. Enter the single rate of
interest which, if used instead of the interest rate(s) reported in
line 21 to determine the present value of the benefits that are
taken into account in determining the plan’s funding target for a
plan year, would result in an amount equal to the plan’s funding
target determined for the plan year, without regard to
calculations for plans in at-risk status. (This is the funding target
reported in line 3d(2) for plans not in at-risk status, or in line 4a
for plans in at-risk status.) See section 1.430(h)(2)-1(f)(1) of the
proposed Treasury Regulations. Enter rate to the nearest .01%
(e.g., 5.26%).
Line 6. Target Normal Cost. Report the present value of all
benefits which have been accrued or have been earned (or that
are expected to accrue or to be earned) under the plan during
the plan year. Include any increase in benefits during the plan
year that is a result of any actual or projected increase in
compensation during the current plan year, even if that increase
in benefits is with respect to benefits attributable to services
performed in a preceding plan year.
This amount must generally be calculated as of the valuation
date and must be based on the same assumptions used to
determine the funding target reported in line 3c(3), column (2),
reflecting the special assumptions and the loading factor for
at-risk plans, if applicable. If the plan is in at-risk status and has
been for fewer than five consecutive years, report the target
normal cost after reflecting the transition rule provided in ERISA
section 303(i)(5) and Code section 430(i)(5).
Special rule for airlines using 10-year amortization
period under section 402(a)(2) of the PPA. Section
402(a)(2) of PPA (as amended by section 6615 of the U.S.
Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq
Accountability Appropriations Act, 2007, Public Law 110-28

Specific Instructions for Part III — Funding
Percentages
Enter all percentages in this section to the nearest .01% (e.g.,
82.64%).
Line 14. Funding Target Attainment Percentage. Enter the
funding target attainment percentage (FTAP) determined in
accordance with ERISA section 303(d)(2) and Code section
430(d)(2). The FTAP is the ratio (expressed as a percentage)
which the actuarial value of plan assets (reduced by the funding
standard carryover balance and prefunding balance) bears to
the funding target determined without regard to the additional
rules for plans in at-risk status.
For plans that are not in at-risk status, this percentage is
determined by subtracting the amount reported in line 13,
column (a), from line 2b and dividing the result by the funding
target reported in line 3d, column (2). If the plan’s valuation date
is not the first day of the plan year, adjust the amount reported
in line 13, column (a), for interest between the beginning of the
plan year and the valuation date before subtracting from the
amount reported in line 2b. For plans that are in at-risk status,
the numerator is the same, but the denominator is the funding
target reported in line 4a.
Line 15. Adjusted Funding Target Attainment Percentage.
Enter the adjusted funding target attainment percentage

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restrictions under ERISA section 206(g) and Code section 436
must be credited toward minimum funding requirements for a
particular plan year.
Line 19. Discounted Employer Contributions. Employer
contributions reported in line 18 that were made on a date other
than the valuation date must be adjusted to reflect interest for
the time period between the valuation date for the plan year to
which the contribution is allocated and the date the contribution
was made. In general, adjust each contribution using the
effective interest rate for the plan year to which the contribution
is allocated.
Allocate the interest-adjusted employer contributions to lines
19a, 19b, and 19c to report the purpose for which they were
made (as described below).

Attach a schedule showing the dates and amounts of
individual contributions, the year to which the contributions (or
the portion of individual contributions) are applied, the
applicable effective interest rate (including increased rate for
late quarterly installments, where applicable), and the
interest-adjusted contribution. It is not necessary to include
interest-adjusted contributions allocated toward the minimum
required contribution for the current year (reported in line 19c)
in this schedule, unless any of those contributions represent
late quarterly installments. However, if any of the contributions
reported in line 19c represent late quarterly installments,
include all contributions reported in line 19c on this schedule.
Label the attachment “Schedule SB, line 19 – Discounted
Employer Contributions.”
Special note for small plans with valuation dates after
the beginning of the plan year. If the valuation date is after
the beginning of the plan year and contributions for the current
year were made during the plan year but before the valuation
date, such contributions are increased with interest to the
valuation date using the effective interest rate for the current
plan year. These contributions and the interest calculated as
described in the preceding sentence are excluded from the
value of assets reported in lines 2a and 2b.

(AFTAP) determined in accordance with Code section 436(j)(2)
and ERISA section 206(g)(9)(B). The AFTAP is generally the
same as the FTAP reported in line 14, except that both the
assets and the funding target used to calculate the AFTAP are
increased by the aggregate amount of purchases of annuities
for employees other than highly compensated employees (as
defined in Code section 414(q)) which were made by the plan
during the preceding two plan years.
See Code section 436(j)(3) and ERISA section 206(g)(9)(C)
for rules regarding circumstances in which the actuarial value of
plan assets is not reduced by the funding standard carryover
balance and prefunding balance for certain fully-funded plans
when determining the AFTAP. Note that this special rule applies
only to the calculation of the AFTAP and not to the FTAP
reported in line 14.
Special rules for airlines using 10-year amortization
period under section 402(a)(2) of PPA. Section 402(a)(2) of
PPA (as amended) states that for plans electing the 10-year
funding amortization period, the funding target during that
period is determined using an interest rate of 8.25% rather than
the interest rates or segment rates calculated on the basis of
the corporate bond yield curve. Report the AFTAP for these
plans based on the funding target determined using the special
8.25% interest rate.
Line 16. Prior Year’s Funding Percentage for Purposes of
Determining Whether Carryover/Prefunding Balances May
Be Used To Offset Current Year’s Funding Requirement.
Under ERISA section 303(f)(3) and Code section 430(f)(3), the
funding standard carryover balance and prefunding balance
may not be applied toward minimum contribution requirements
unless the ratio of plan assets for the preceding plan year to the
funding target for the preceding plan year (as described in
ERISA section 303(f)(3)(C) and Code section 430(f)(3)(C)) is
80% or more.
Under Code section 430(f)(3)(C) and ERISA section
303(f)(3)(C), this ratio may be determined using estimation
methods provided by the IRS. Section 1.430(f)-1(h)(5) of the
proposed Treasury regulations provides that the ratio may be
determined as the ratio of the actuarial value of assets to the
current liability from line 1d(2)(a) of the 2007 Schedule B. For
this purpose, the actuarial value of assets is the amount
reported on line 1b(2) of the 2007 Schedule B, adjusted if
necessary to be no less than 90% and no more than 110% of
the fair market value of assets reported on line 1b(1) of the
2007 Schedule B. Do not reduce this amount by the credit
balance or increase it by a funding deficiency.
Line 17. Ratio of Current Value of Assets to Funding Target
if Below 70%. This calculation is required under ERISA
section 103(d)(11). If line 2b divided by the funding target
reported in line 3d, column (2), is less than 70%, enter such
percentage. Otherwise, leave this line blank.

Interest adjustment for contributions representing late
required quarterly installments — installments due after
the valuation date. If the full amount of a required installment
due after the 2008 valuation date is not paid by the due date for
that installment, increase the effective interest rate used to
discount the contribution by 5 percentage points for the period
between the due date for the required installment and the date
on which the payment is made. If all or a portion of the late
required quarterly installment is due to a liquidity shortfall, the
increased interest rate is used for a period of time
corresponding to the period between the due date for the
installment and the end of that quarter, regardless of when the
contribution is actually paid.

Line 19a. Contributions Allocated Toward Unpaid Minimum
Required Contribution from Prior Plan Years. Code section
4971(c)(4)(B) provides that any payment to or under a plan for
any plan year shall be allocated first to unpaid minimum
required contributions for all preceding plan years on a first-in,
first-out basis and then to the minimum required contribution for
the current plan year. Report any contributions from line 18 that
are allocated toward unpaid minimum required contributions
from prior plan years, discounted for interest from the date the
contribution was made to the valuation date for the plan year for
which the contribution was originally required as described
above. Increase the effective interest rate for the applicable
plan year by 5 percentage points for any portion of the unpaid
minimum required contribution that represents a late quarterly
installment, for the period between the due date for the
installment and the date of payment. Reflect the increased
interest rate for any portion of the unpaid minimum required
contribution that represents a late liquidity shortfall installment,
for the period corresponding to the time between the date the
installment was due and the end of the quarter during which it
was due. The amount reported in line 19a cannot be larger than
the amount reported in line 28.

Specific Instructions for Part IV —
Contributions and Liquidity Shortfalls
Line 18. Contributions Made to the Plan. Show all employer
and employee contributions for the plan year. Include employer
contributions made within 81/2 months after the end of the plan
year to the extent such contributions are designated for this
plan year. Include amounts that will be allocated toward an
unpaid minimum required contribution for a prior year.
Show only contributions actually made to the plan by the
date Schedule SB is signed. Do not adjust contributions to
reflect interest.
Certain employer contributions must be made in quarterly
installments. See ERISA section 303(j) and Code section
430(j). Contributions made to meet the liquidity requirement of
ERISA section 303(j)(4) and Code section 430(j)(4) should be
reported. Include contributions made to avoid benefit
restrictions under ERISA section 206(g) and Code section 436.
Add the amounts in both columns 18(b) and 18(c) separately
and enter each result in the corresponding column on the total
line. All contributions except those made to avoid benefit
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period ending with the month preceding that month).
Alternatively, at the election of the plan sponsor, the segment
rate(s) used to measure the funding target may be those
published by Treasury for any of the four months that precede
the month that includes the valuation date.
Enter the applicable month to indicate which segment rates
were used to determine the funding target. Enter “0” if the rates
used to determine the funding target were published for the
month that includes the valuation date. Enter “1” if the rates
were published for the month immediately preceding the month
that includes the valuation date, “2” for the second preceding
month, and “3” or “4,” respectively, for the third or fourth
preceding months. For example, if the valuation date is January
1 and the funding target was determined based on rates
published for November, enter “2.”
Note. The plan sponsor’s election as to which interest rates to
use (segment rates with or without the transition rules in ERISA
section 303(h)(2)(G) and Code section 430(h)(2)(G) versus the
full yield curve, and the applicable month for determining these
interest rates) generally may not be changed unless the plan
sponsor obtains approval from the IRS.
Line 22. Weighted Average Retirement Age. Enter the
weighted average retirement age for active participants. If the
plan is in at-risk status, enter the weighted average retirement
age as if the plan were not in at-risk status. If each participant is
assumed to retire at his/her normal retirement age, enter the
age specified in the plan as normal retirement age. If the normal
retirement age differs for individual participants, enter the age
that is the weighted average normal retirement age; do not
enter “NRA.” Otherwise, enter the assumed retirement age. If
the valuation uses rates of retirement at various ages, enter the
nearest whole age that is the weighted average retirement age.
On an attachment to Schedule SB, list the rate of retirement
at each age and describe the methodology used to compute the
weighted average retirement age, including a description of the
weight applied at each potential retirement age, and label the
attachment “Schedule SB, line 22 – Description of
Weighted Average Retirement Age.”
Line 23. Mortality Table. Mortality tables described in Code
section 430(h)(3), ERISA section 303(h)(3), and section
1.430(h)(3)-1 of the Treasury Regulations as published by the
IRS must be used to determine the funding target and target
normal cost for non-disabled participants and may be used to
determine the funding target and target normal cost for disabled
participants, unless Treasury has approved (or was deemed to
have approved) the use of a substitute mortality table reflecting
the plan’s actual experience and projected trends in general
mortality experience. Standard mortality tables must be either
applied on a generational basis, or the tables must be updated
to reflect the static tables published for the year in which the
valuation date occurs. Substitute mortality tables must be
applied in accordance with the terms of the IRS ruling letter.
Separate standard mortality tables were published by the
IRS for annuitants (rates applying for periods when a participant
is assumed to receive a benefit under the plan) and
nonannuitants (rates applying to periods before a participant is
assumed to receive a benefit under the plan). If a plan has 500
or fewer participants as of the valuation date for the current plan
year as reported in line 3d, column (1), the plan sponsor can
elect to use the combined mortality tables published by the IRS,
which reflect combined rates for both annuitants and
nonannuitants.
Check the applicable box(es) to indicate which mortality
tables were used to determine the funding target and target
normal cost. If prescribed tables were used for certain
populations within the plan and substitute mortality tables for
other populations, check all boxes that apply.
• Check “Prescribed – combined” if the funding target and
target normal cost are based on the prescribed tables with
combined annuitant/nonannuitant mortality rates.
• Check “Prescribed – separate” if the funding target and target
normal cost are based on the prescribed tables with separate
mortality rates for nonannuitants and annuitants.

Line 19b. Contributions Made To Avoid Benefit
Restrictions. Include in this category contributions made to
avoid benefit restrictions under ERISA section 206(g) and Code
section 436. Adjust each contribution for interest from the date
the contribution was made to the valuation date as described
above.
Line 19c. Contributions Allocated Toward Minimum
Required Contribution for Current Year. Include in this
category contributions (including any contributions made in
excess of the minimum required contribution) that are not
included in line 19a or 19b. Adjust each contribution for interest
from the date the contribution was made to the valuation date
as described above.
Line 20. Quarterly Contributions and Liquidity Shortfalls.
Line 20a. Did the Plan Have a Funding Shortfall for the
Prior Plan Year? In accordance with ERISA section 303(j)(3)
and Code section 430(j)(3), only plans that have a funding
shortfall for the preceding plan year are subject to an
accelerated quarterly contribution schedule. This includes plans
that have a funding shortfall even if they are exempt from
establishing a shortfall amortization base under the provisions
of ERISA section 303(c)(5) and Code section 430(c)(5).
Line 20b. If line 20a is “No” (i.e., if the plan did not have a
funding shortfall in the prior plan year), the plan is not subject to
the quarterly contribution rules, and this line should not be
completed. If line 20a is “Yes,” check the “Yes” box on line 20b
if required installments for the current plan year were made in a
timely manner; otherwise, check “No.”
Line 20c. If line 20a is “No,” or the plan had 100 or fewer
participants on every day of the preceding plan year (as defined
for line F), the plan is not subject to the liquidity requirement of
ERISA section 303(j)(4) and Code section 430(j)(4) and this line
should not be completed. Attach a certification by the enrolled
actuary if the special rule for nonrecurring circumstances is
used, and label the certification “Schedule SB, line 20c –
Liquidity Requirement Certification.” (See ERISA section
303(j)(4)(E)(ii)(II) and Code section 430(j)(4)(E)(ii)(II).)
If the plan is subject to the liquidity requirement and has a
liquidity shortfall for any quarter of the plan year (see ERISA
section 303(j)(4)(E) and Code section 430(j)(4)(E)), enter the
amount of the liquidity shortfall for each such quarter. If the plan
was subject to the liquidity requirement but did not have a
liquidity shortfall, enter zero. File Form 5330, Return of Excise
Taxes Related to Employee Benefit Plans, with the IRS to pay
the 10% excise tax(es) if there is a failure to pay any liquidity
shortfall by the required due date, unless a waiver of the 10%
tax under Code section 4971(f) has been granted.

Specific Instructions for Part V — Assumptions
Used To Determine Funding Target and Target
Normal Cost
Line 21. Discount Rate.
Line 21a. Enter the three segment rates used to calculate the
funding target as provided under ERISA section 303(h)(2)(C)
and Code section 430(h)(2)(C) and as published by the IRS,
unless the plan sponsor has elected to use the full yield curve.
Enter rates after application of the transition rule provided under
ERISA section 303(h)(2)(G) and Code section 430(h)(2)(G)
unless the sponsor has elected to not have the transition rule
apply. If the sponsor has elected to use the full yield curve,
check the “N/A, full yield curve used” box.
Special rules for airlines using 10-year amortization
period under section 402(a)(2) of PPA (as amended). Enter
the information described above to reflect the discount rates
used to determine the target normal cost in accordance with
Code section 430(h)(2) and ERISA section 303(h)(2). Do not
enter the special 8.25% interest rate used to determine the
funding target under section 402(a)(2) of the PPA.
Line 21b. ERISA section 303(h)(2)(E) and Code section
430(h)(2)(E) provide that the segment rate(s) used to measure
the funding target are those published by Treasury for the
month that includes the valuation date (based on the average of
the monthly corporate bond yield curves for the 24-month

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• Check “Substitute” if the funding target and target normal

assumption changes are statutorily required changes in the
discount or mortality rates, or changes required for plans in
at-risk status, check “No.” Include as an attachment a
description of any change in non-prescribed actuarial
assumptions and justifications for any such change. (See
section 103(d) of ERISA.) Label the attachment “Schedule SB,
line 24 – Change in Actuarial Assumptions.”
Generally, if the “Yes” box is checked and the
non-prescribed assumptions have been changed in a way that
decreases the funding shortfall for the current plan year,
approval for such a change may be required. However,
approval is not required with respect to any actuarial
assumptions that are adopted for the first plan year for which
Code section 430 and ERISA section 303 apply to the plan, and
that are not inconsistent with the requirements of Code section
430.
Line 25. Change in Funding Method. If a change in the
funding method has been made for the current plan year, check
“Yes.” For this purpose, “funding method” refers to not only the
overall method used by the plan, but also each specific method
of computation used in applying the overall method.
Accordingly, method changes include modifications such as a
change in the method for calculating the actuarial value of
assets or a change in the valuation date (not an exclusive list).
Any changes in a plan’s funding methods that are made for the
first plan year for which Code section 430 applies to the plan
and that are not inconsistent with the requirements of Code
section 430 do not need IRS approval.
Include, as an attachment, a description of the change.
Label the attachment “Schedule SB, line 25 – Change in
Method.”
Note. The plan sponsor’s agreement to any change in funding
method should be reported on line 7 of Schedule R (Form
5500).
Line 26. Schedule of Active Participant Data. Check “Yes”
only if (a) the plan is covered by Title IV of ERISA and (b) the
plan has active participants.
If line 26 is “Yes,” attach a schedule of the active plan
participant data used in the valuation for this plan year. Use the
format shown below and label the schedule “Schedule SB,
line 26 – Schedule of Active Participant Data.”
Expand this schedule by adding columns after the “5 to 9”
column and before the “40 & up” column for active participants
with total years of credited service in the following ranges: 10 to
14; 15 to 19; 20 to 24; 25 to 29; 30 to 34; and 35 to 39. For
each column, enter the number of active participants with the
specified number of years of credited service divided according
to age group. For participants with partial years of credited
service, round the total number of years of credited service to
the next lower whole number. Years of credited service are the
years credited under the plan’s benefit formula.

cost are based on substitute mortality tables. If substitute
mortality tables are used, attach a statement including a
summary of plan populations for which substitute mortality
tables are used, plan populations for which the prescribed
tables are used, and the last plan year for which the IRS
approval of the substitute mortality tables applies. Label the
attachment “Schedule SB, line 23 – Information on Use of
Substitute Mortality Tables.”
Attach a statement of actuarial assumptions and funding
methods used to calculate the Schedule SB entries and label
the statement “Schedule SB, Part V – Statement of
Actuarial Assumptions/Methods.” The statement must
describe all non-prescribed actuarial assumptions (e.g.,
retirement, withdrawal rates) used to determine the funding
target and target normal cost, including the assumption as to
the frequency with which participants are assumed to elect
each optional form of benefit (including lump sum distributions),
whether mortality tables are applied on a static or generational
basis, whether combined mortality tables are used instead of
separate annuitant and nonannuitant mortality tables (for plans
with 500 or fewer participants as of the valuation date), and (for
target normal cost) expected increases in compensation. For
applicable defined benefit plans under ERISA section 203(f)(3)
and Code section 411(a)(13)(C) (e.g., cash balance plans) the
statement must include the assumptions used to convert
balances to annuities. In addition, the statement must describe
the method for determining the actuarial value of assets and
any other aspects of the funding method for determining the
Schedule SB entries that are not prescribed by law.
Also attach a summary of the principal eligibility and benefit
provisions on which the valuation was based, including the
status of the plan (e.g., frozen eligibility, service/pay, or
benefits), optional forms of benefits, special plan provisions,
including those that apply only to a subgroup of employees
(e.g., those with imputed service), supplemental benefits, and
identification of benefits not included in the valuation, a
description of any significant events that occurred during the
year, a summary of any changes in principal eligibility or benefit
provisions since the last valuation, a description (or reasonably
representative sample) of plan early retirement reduction
factors and optional form conversion factors. Label the
summary “Schedule SB, Part V – Summary of Plan
Provisions.”
Also, include any other information needed to disclose the
actuarial position of the plan fully and fairly.

Specific Instructions for Part VI —
Miscellaneous Items

Line 24. Change in Non-Prescribed Actuarial Assumptions.
If a change has been made in the non-prescribed actuarial
assumptions for the current plan year, check “Yes.” If the only

Schedule SB, Line 26—Schedule of Active Participant Data
Under 1

Attained
Age
No.

YEARS OF CREDITED SERVICE
1 to 4

Average
Comp. Cash Bal.

No.

Average
Comp. Cash Bal.

Under 25
25 to 29
30 to 34
35
40
45
50
55
60
65

to
to
to
to
to
to
to

39
44
49
54
59
64
69

70 & up

Instructions for Schedule SB (Form 5500)

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5 to 9
No.

Average
Comp. Cash Bal.

40 & up
No.

Average
Comp. Cash Bal.

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Plans reporting 1,000 or more active participants on line
3c(3), column 1, must also provide average compensation data.
For each grouping, enter the average compensation of the
active participants in that group. For this purpose,
compensation is the compensation taken into account for each
participant under the plan’s benefit formula, limited to the
amount defined under section 401(a)(17) of the Code. Do not
enter the average compensation in any grouping that contains
fewer than 20 participants.
Cash balance plans (or any plans using characteristic code
1C on line 8a of Form 5500) reporting 1,000 or more active
participants on line 3c(3), column 1, must also provide average
cash balance account data, regardless of whether all active
participants have cash balance accounts. For each age/service
bin, enter the average cash balance account of the active
participants in that bin. Do not enter the average cash balance
account in any age/service bin that contains fewer than 20
active participants.
General Rule. In general, data to be shown in each age/
service bin includes:
1. the number of active participants in the age/service bin,
2. the average compensation of the active participants in
the age/service bin, and
3. the average cash balance account of the active
participants in the age/service bin, using $0 for anyone who has
no cash balance account-based benefit.

Line 27. Alternative Funding Rules. If one of the alternative
funding rules was used for this plan year, enter the appropriate
code from the table below and follow the special instructions
applicable to that code, including completion of any required
attachments.
Code
1

2
3
4

Certain multiple-employer plans maintained by
rural cooperatives or related organizations as
described in section 104 of PPA
Temporary relief for certain PBGC settlement
plans described in section 105 of PPA
Certain plans maintained by government
contractors as described in section 106 of PPA
Plans with binding agreements with PBGC to
maintain prefunding and/or funding standard
carryover balances described in Code section
430(f)(4)(B)(ii) and ERISA section 303(f)(4)(B)(ii)
Airlines using 10-year amortization period for initial
post-PPA shortfall amortization base under section
402(a)(2) of PPA (as amended)
Alternative 17-year funding schedule for airlines
with frozen plans under section 402(a)(1) of PPA
Interstate transit company described in section
115 of PPA

Alternative Funding Rule

if each participating employer maintained a separate plan,
attach a separate “Schedule SB, line 26 – Schedule of
Active Participant Data” for each participating employer in the
multiple-employer plan.

Plans entitled to delayed effective dates for PPA funding
rules (codes 1, 2, and 3). For plan years before Code section
430 and ERISA section 303 apply to the plan, complete only the
following lines on Schedule SB:
• Lines A through F.
• Part I (including signature of enrolled actuary), determined as
if PPA provisions were effective for the plan year beginning in
2008.
• Part III, line 14, determined as if PPA provisions were
effective for the plan year beginning in 2008.

Also, report other information for the current plan year using
a 2007 Schedule B (Form 5500). Label this attachment “2008
Schedule SB, line 27 – Actuarial Information Based on
Pre-PPA Funding Rules.” Complete all items, and attach the
form and all applicable attachments to the Schedule SB. Note
that under PPA, the third segment rate determined under Code
section 430(h)(2)(C)(iii) and ERISA section 303(h)(2)(C)(iii) is
substituted for the current liability interest rate under Code
section 412(b)(5)(B) and ERISA section 302(b)(5)(B) (as in
effect before PPA).
Plans with binding agreements with the PBGC to
maintain prefunding and/or carryover balances (code 4).
Complete entire Schedule SB and attachments as outlined in
these instructions. In addition, report on an attachment the
amount subject to the binding agreement with the PBGC,
reported separately for the funding standard carryover balance
and prefunding balance. Label the attachment “Schedule SB,
line 27 – Balances Subject to Binding Agreement with
PBGC.”
Airline using 10-year amortization period for initial
post-PPA shortfall amortization base (code 5). Complete
the entire Schedule SB and attachments as outlined in these
instructions. Under section 402(a)(2) of PPA (as amended), the
funding target for plans funded using this alternative is
determined using an interest rate of 8.25% for each of the 10
years during the amortization period instead of the interest rates
otherwise required under Code section 430(h)(2) and ERISA
section 303(h)(2). However, this special 8.25% interest rate
does not apply for other purposes, including the calculation of
target normal cost or the amortization of the funding shortfall.

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Specific Instructions for Part VIII – Minimum
Required Contribution for Current Year

Line 31. Target Normal Cost, Adjusted if Applicable. In
general, enter the target normal cost as reported in line 6.
However, if the minimum contribution is determined under Code
section 430(a)(2) or ERISA section 303(a)(2) (relating to plans
with excess assets), enter the amount of the minimum required
contribution. For this purpose, excess assets are determined as
the value of assets reported on line 2b reduced by the funding
standard carryover balance reported in line 13, column (a),
minus the funding target reported in line 3d, column (2) (but not
less than zero). If the plan’s valuation date is not the first day of
the plan year, adjust the amount reported in line 13, column (a),
for interest between the beginning of the plan year and the
valuation date before subtracting from the value of assets
reported in line 2b.
Line 32. Amortization Installments.
Line 32a. Shortfall Amortization Bases and Amortization
Installments. Outstanding balance — If the plan is exempt
from the requirement to establish a shortfall amortization base
in accordance with Code section 430(c)(5) and ERISA section
303(c)(5), enter zero. Otherwise, enter the shortfall amortization
base for the plan year beginning in 2008.
A plan is generally exempt from the requirement to establish
a new shortfall amortization base for 2008 if the funding target
reported in line 3d, column (2), is less than or equal to the value
of assets reported in line 2b. The assets are not reduced by the
amount of any funding standard carryover balance for this
calculation. However, if the plan existed during 2007 and was
not subject to Code section 412(l) for the last plan year
beginning prior to 2008, only 92% of the funding target is taken
into account for this calculation.
The amount of the shortfall amortization base is based on
the plan’s funding shortfall. For this purpose, the plan’s funding
shortfall is equal to the amount of the funding target reported in
line 3d, column (2), minus the adjusted value of assets, but not
less than zero. The adjusted value of assets is generally the
amount reported in line 2b, reduced by the funding standard
carryover balance reported in line 13, column (a). If the plan’s
valuation date is not the first day of the plan year, adjust the
amount reported in line 13, column (a), for interest between the
beginning of the plan year and the valuation date before
subtracting from the value of assets reported in line 2b.
However, see Code section 430(f)(4)(B)(ii) for special rules in
the case of a binding agreement with the PBGC providing that
all or a portion of the funding standard carryover balance is not
available to offset the minimum required contribution for the
prior plan year.
Shortfall amortization installment — Enter the level
amortization payment that will amortize the initial shortfall
amortization base over 7 annual payments, using the same
segment interest rates or rates from the full yield curve used to
calculate the target normal cost for the current plan year.
Note. Shortfall amortization installments for a given shortfall
amortization base are not re-determined from year to year
regardless of any changes in interest rates.
Line 32b. Waiver Amortization Bases and Amortization
Installments. Outstanding balance — If the plan’s funding
shortfall (determined under Code section 430(c)(4) and ERISA
section 303(c)(4)) is zero, all waiver amortization bases and
related installments are considered fully amortized. In this case,
enter zero. Otherwise, enter the present value as of the
valuation date of all remaining waiver amortization installments
(including any installment for the 2008 plan year), using the
same segment interest rates or rates from the full yield curve
used to calculate the target normal cost for the 2008 plan year.
Do not include any new waiver amortization base established
for a waiver of minimum funding requirements for the current
plan year.
Waiver amortization installments — Enter the sum of any
remaining waiver amortization installments that were
established to amortize any waiver amortization bases for prior

Alternative 17-year funding schedule for airlines with
frozen plans (code 6). Complete the following lines on
Schedule SB and provide associated attachments:
• Lines A through F.
• Part I (including signature of enrolled actuary) – complete all
lines.
• Parts III through VII – complete all lines.
For this purpose, disregard the special funding rules under
section 402(e) of PPA except for the information reported on
the following lines:
• Line 19 – Discount contributions to the applicable valuation
date using the 8.85% discount rate provided under section
402(e)(4)(B) of PPA.
• Line 20 – Reflect required quarterly installments based on
the minimum required contribution determined under section
402(e) of PPA to the extent applicable (i.e., for purposes of
calculating the required annual payment under Code section
430(j)(3)(D)(ii)(l) and ERISA section 303(j)(3)(D)(ii)(l)).
• Line 29 – Reflect the minimum required contribution
determined under section 402(e) of PPA when determining the
unpaid minimum required contribution.
Also, attach a worksheet showing the information below,
determined in accordance with section 402(e) of the PPA. Label
this worksheet “Schedule SB, line 27 – Alternative 17-Year
Funding Schedule for Airlines.”
• Date as of which plan benefits were frozen as required under
section 402(b)(2) of PPA.
• Date on which the first applicable plan year began.
• Accrued liability under the unit credit method calculated as of
the first day of the plan year, using an interest rate of 8.85%.
• A summary of all other assumptions used to calculate the unit
credit accrued liability.
• Fair market value of assets as of the first day of the plan
year.
• Unfunded liability under section 402(e)(3)(A) of PPA.
• Alternative funding schedule:
1. Contribution necessary to amortize the unfunded liability
over the remaining number of years, assuming payments at the
valuation date for each plan year and using an interest rate of
8.85%;
2. Employer contributions for the plan year, discounted for
interest to the valuation date for the plan year, and using a rate
of 8.85%; and
3. Contribution shortfall, if any ((1)-(2) but not less than
zero).

Interstate transit company (code 7). Complete the entire
Schedule SB, reflecting the modifications to the
otherwise-required funding rules under section 115(b) of PPA,
and disregarding the attachment required for plans reporting the
use of the substitute mortality table in line 23.

Specific Instructions for Part VII –
Reconciliation of Unpaid Minimum Required
Contributions for Prior Years
Line 28. Unpaid Minimum Required Contributions for Prior
Years. Enter the amount of any accumulated funding
deficiency from line 9p of the 2007 Schedule B. The
accumulated funding deficiency is treated as a single
contribution due on the last day of the 2007 plan year (without
separately identifying any portion of the accumulated funding
deficiency attributable to late quarterly installments or late
liquidity shortfall installments), and the associated effective
interest rate is deemed to be the valuation interest rate for the
2007 plan year.
Line 29. Employer Contributions Allocated Toward Unpaid
Minimum Required Contributions from Prior Years. Enter
the total amount of discounted contributions made for the
current plan year allocated toward unpaid minimum required
contributions from prior years as reported in line 19a.
Line 30. Remaining Unpaid Minimum Required
Contributions. Enter the amount in line 28 minus the amount
in line 29.
Instructions for Schedule SB (Form 5500)

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Note. Waiver amortization installments (including the waiver
amortization installments of any waiver amortization base
established for the prior plan year) are not re-determined from
year to year regardless of any changes in interest rates.
Required attachment. If there are any shortfall or waiver
amortization bases, include as an attachment a listing of all
bases (other than a base established for a funding waiver for
the current plan year) showing for each base:
1. The type of base (shortfall or waiver),
2. The present value of any remaining installments
(including the installment for the current plan year),
3. The valuation date as of which the base was established,
4. The number of years remaining in the amortization
period, and
5. The amortization installment.

provided. If a waiver is pending, do not complete this line. If a
pending waiver is granted after Form 5500 is filed, file an
amended Form 5500 with an amended Schedule SB.
Line 34. Total Funding Requirement Before Reflecting
Carryover/Prefunding Balances. Enter the sum of line 31
and the amortization installments reported in lines 32a and 32b,
reduced by line 33. (Result cannot be less than zero.)
Line 35. Carryover Balance Used to Offset Funding
Requirement. If the percentage reported in line 16 is at least
80%, and the plan has a funding standard carryover balance
(as reported in line 13, column (a)), the plan sponsor may elect
to credit such balance against the minimum funding
requirement. Enter the amount of any funding standard
carryover balance to be used for this purpose in the applicable
column and in the column headed “Total balance.” The
amounts entered in line 35 cannot be larger than the amount in
line 13, column (a) (unless the plan’s valuation date is not the
first day of the plan year, as discussed below), or the amount in
line 34.
If the plan’s valuation date is not the first day of the plan
year, adjust the funding standard carryover balance for interest
between the beginning of the plan year and the valuation date.
Line 36. Additional Cash Requirement. Enter the amount in
line 34 minus the amount in line 35. (The result cannot be less
than zero.) This represents the contribution needed to satisfy
the minimum funding requirement for the current year, adjusted
for interest to the valuation date.
Line 37. Contributions Allocated Toward Minimum
Required Contribution for Current Year, Adjusted to
Valuation Date. Enter the amount reported in line 19c.
Line 38. Interest-Adjusted Excess Contributions for Current
Year. Report the interest-adjusted excess contributions. This
amount is the maximum amount by which the employer may
elect to increase the prefunding balance. Do not enter a
negative number.
Line 39. Unpaid Minimum Required Contribution for
Current Year. If line 37 is less than line 36, enter the amount
by which line 36 exceeds line 37. Otherwise, enter “$0.”
Line 40. Unpaid Minimum Required Contribution for All
Years. Enter the sum of the remaining unpaid minimum
required contributions from line 30 and the unpaid minimum
required contribution for the current year from line 39.

plan years, unless such bases have been or are deemed to be
fully amortized. Do not include an amortization installment for
any new waiver amortization base established for a waiver of
minimum funding requirements for the current plan year.
Note. If a waiver of minimum funding requirements has been
granted for the current plan year, a waiver amortization base is
established as of the valuation date for the current plan year
equal to the amount of the funding waiver reported in line 33.
The waiver amortization installment that corresponds to any
waiver amortization base established for the current year is the
level amortization payment that will amortize the new waiver
amortization base over 5 annual payments, with the first
payment due on the valuation date for the following plan year.
The amount of the waiver amortization base and the waiver
amortization installments for this base are not reported in line
32b for the year in which they are established. Rather, these
are included in the entries for line 32b on the Schedule SB for
the following plan year.

If the base is negative (i.e., a “gain base”), show amounts in
parentheses or with a negative sign in front of them. All
amounts must be calculated as of the valuation date for the
plan year. Label the schedule “Schedule SB, line 32 –
Schedule of Amortization Bases.”
Line 33. Funding Waiver. If a waiver of minimum funding
requirements has been approved for the current plan year,
enter the date of the ruling letter granting the approval and the
waived amount (reported as of the valuation date) in the spaces

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Schedule SSA filed for the plan year in which he or she
separated from service or completed the first 1-year break in
service).

2008 Instructions for Schedule SSA
(Form 5500)
Annual Registration Statement
Identifying Separated Participants With
Deferred Vested Benefits

When NOT to Report a Participant
A participant is not required to be reported on Schedule SSA if,
before the date the Schedule SSA is required to be filed
(including any extension of time for filing), the participant:
1. Is paid some or all of the deferred vested retirement
benefit (see the Caution below), or
2. Returns to service covered by the plan and/or accrues
additional retirement benefits under the plan, or
3. Forfeits all the deferred vested retirement benefit.

General Instructions
Purpose of Schedule

Who Must File

Separation of a Re-Employed Employee
If the deferred vested benefit of a separated employee is
different from that previously reported, you may use code B
(see below) to report that employee’s total vested benefit.

Revising Prior Report
Use Schedule SSA to report revisions to pension information for
a participant you reported on a previous Schedule SSA. This
will ensure that SSA’s records are correct. This is important
since SSA provides Schedule SSA information that it has on file
to participants when they file for Social Security benefits. If this
information is not up-to-date, the participant may contact the
plan administrator to resolve the difference.
You do not need to report changes in the value of the
employees’ accounts, since that is likely to change. However,
you may report these changes if you want.

The Social Security Administration is revising its processing
of participant plan data to avoid inaccurate information in the
pension notice.

If payment of the deferred vested retirement benefit
ceases before ALL of the benefit to which the
CAUTION participant is entitled is paid to the participant,
information relating to the deferred vested retirement benefit to
which the participant remains entitled shall be filed on the
Schedule SSA filed for the year following the last plan year
within which a portion of the benefit is paid to the participant.

Use Schedule SSA to report information concerning separated
participants with deferred vested benefit rights. Report
participants who:
• separated from your company during the plan year; or
• transferred into this plan during the plan year; or
• previously were reported under this plan but are no longer
entitled to those deferred vested benefits.
Also use Schedule SSA to correct information previously
reported concerning participants with deferred vested benefits.
The information on this schedule is given to the Social
Security Administration to provide to participants when they file
for Social Security benefits.
Note. Beginning with the 2004 Schedule SSA, report required
information regarding separated participants only on page 2 of
Schedule SSA. Use additional pages 2 when you need to report
information for more separated participants than one page 2
allows. Do not use attachments other than the page 2 Schedule
SSA.

The plan administrator is responsible for filing Schedule SSA.
Plans that cover only owners and their spouses do not have to
file this schedule.
Check the Schedule SSA box on the Form 5500 (Part II, line
10a(4)) if a Schedule SSA is attached to the Form 5500.
Note. Government, church, or other plans that elect to file the
Schedule SSA voluntarily must check the appropriate box on
the schedule and complete lines 2 through 3c.

Transfer of a Participant to a New Plan

When a separated participant with deferred vested benefits is
transferred from the plan he or she was originally reported
under to a new plan,
1. The new plan administrator should complete a Schedule
SSA using:
• Entry Code C for line 4, box (a), when the original plan
information is available, or
• Entry Code A for line 4, box (a), when the original plan
information is not available.
2. The original plan administrator should complete a
Schedule SSA using Entry Code D for line 4, box (a).

When to Report a Separated Participant

In general, for a plan to which only one employer
contributes, a participant must be reported on Schedule SSA
if:
1. The participant separates from service covered by the
plan in a plan year, and
2. The participant is entitled to a deferred vested benefit
under the plan.

Where and How To File
File as an attachment to Form 5500.
Note. Government, church, or other plans that elect to
voluntarily file the Schedule SSA are not required to attach their
Schedule SSA to a Form 5500, but must check the appropriate
box on the schedule.

The separated participant must be reported no later than on
the Schedule SSA filed for the plan year following the plan year
in which separation occurred. However, you can report the
separation in the plan year in which it occurs, if you want to
report earlier. Do not report a participant more than once unless
you wish to revise or update a prior Schedule SSA (see
instructions for line 4, box (a), under codes B, C, or D).
In general, for a plan to which more than one employer
contributes, a participant must be reported on Schedule SSA
if:
1. The participant incurs two successive 1-year breaks in
service (as defined in the plan for vesting purposes), and
2. The participant is (or may be) entitled to a deferred
vested benefit under the plan.

CAUTION

Specific Instructions

• Complete all applicable fields on Schedule SSA.
• Please verify that the EIN and plan number being used on

the Form 5500 and this Schedule SSA are correct for this plan.
Line D. Enter the sponsor’s employer identification number
(EIN) shown on Form 5500, line 2b.
Line 2. If the Post Office does not deliver mail to the street
address and you have a P.O. box, enter the box number
instead of the street address.

The participant must be reported no later than on the
Schedule SSA filed for the plan year in which the participant
completed the second of the two consecutive 1-year breaks in
service. The participant may be reported earlier (i.e., on the
Instructions for Schedule SSA (Form 5500)

A penalty may be assessed if Schedule SSA (Form
5500) is not timely filed or critical information is not
furnished.

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Line 4, box (a).
list.

Type of Annuity Code
A A single sum
B Annuity payable over fixed number of years
C Life annuity
D Life annuity with period certain
E Cash refund life annuity
F Modified cash refund life annuity
G Joint and last survivor life annuity
M Other

Enter the appropriate code from the following

Code A — Use this code for a participant not previously
reported. Also complete boxes (b) through (h).
Code B — Use this code for a participant previously
reported under the plan number shown on this schedule to
modify some of the previously reported information. Enter all
the current information for boxes (b) through (h).
Code C — Use this code for a participant previously
reported under another plan number who will now be
receiving his/her future benefit from the plan reported on this
schedule. Also complete boxes (b), (c), (i), and (j).
Code D — Use this code for a participant previously
reported under the plan number shown on this schedule who
is no longer entitled to those deferred vested benefits. This
includes a participant who has begun receiving benefits, has
received a lump-sum payout, or has been transferred to
another plan. Also complete boxes (b) and (c).

Line 4, box (e). From the following list, select the code that
describes the benefit payment frequency during a 12-month
period.
Type of Payment Code
A Lump sum
B Annually
C Semiannually
D Quarterly
E Monthly
M Other
Line 4, box (f). For a defined benefit plan, enter the amount
of the periodic payment that a participant is entitled to receive
under line 4, box (f).
For a plan to which more than one employer contributes, if
the amount of the periodic payment cannot be accurately
determined because the plan administrator does not maintain
complete records of covered service, enter an estimated
amount.
Line 4, box (g). For a defined contribution plan, if the plan
states that a participant’s share of the fund will be determined
on the basis of units, enter the number of units credited to the
participant.
If, under the plan, participation is determined on the basis of
shares of stock of the employer, enter the number of shares
and add the letters ‘‘S’’ to indicate shares. A number without the
‘‘S’’ will be interpreted to mean units.
Line 4, box (h). For defined contribution plans, enter the
value of the participant’s account at the time of separation.
Line 4, boxes (i) and (j). Show the EIN and plan number of
the plan under which the participant was previously reported.
Signature. This form must be signed by the plan
administrator. If more than one Schedule SSA is filed for one
plan, only the initial page one should be signed.

Line 4, box (c). Enter each participant’s name exactly as it
appears on the participant’s social security card. Do not enter
periods; however, initials, if on the social security card, are
permitted. Space is available for the first eleven characters of
the participant’s first name, one for their middle initial, and the
first fifteen characters of their last name. If the participant does
not have a middle initial, leave the space for the middle initial
blank.

Line 4, box (b). Enter the exact social security number (SSN)
of each participant listed. If the participant is a foreign national
employed outside the United States who does not have an
SSN, enter the word ‘‘FOREIGN.’’

Line 4, box (d). From the following list, select the code that
describes the type of annuity that will be provided for the
participant. Enter the code that describes the type of annuity
that normally accrues under the plan at the time of the
participant’s separation from service covered by the plan (or for
a plan to which more than one employer contributes at the time
the participant incurs the second consecutive 1-year break in
service under the plan).

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OMB Control Numbers
Agency
OMB Number
Employee Benefits Security Administration . . . . . 1210 – 0110
1210 – 0089
Internal Revenue Service . . . . . . . . . . . . . . . . . 1545 – 1610

Agency
OMB Number
Pension Benefit Guaranty Corporation . . . . . . . . . 1212 – 0057
Social Security Administration . . . . . . . . . . . . . . . 0960 – 0606

Paperwork Reduction Act Notice
We ask for the information on this form to carry out the law as specified in ERISA and Code sections 6047(e), 6057(b), and 6058(a).
You are required to give us the information. We need it to determine whether the plan is operating according to the law.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Books and records relating to a form or its instructions must be retained as long as their
contents may become material in the administration of the Internal Revenue Code or are required to be maintained pursuant to Title
I or IV of ERISA. Generally, the Form 5500 return/reports are open to public inspection. However, Schedules E and SSA (Form
5500) are confidential, as required by Code section 6103.
The time needed to complete and file the forms listed below reflects the combined requirements of the Internal Revenue Service,
Department of Labor, Pension Benefit Guaranty Corporation, and the Social Security Administration. These times will vary
depending on individual circumstances. The estimated average times are:

Pension Plans
Small*

1 hr., 17 min.
2 hr., 44 min.

Large

1 hr., 45 min.
3 hr., 30 min.
3 hr., 8 min.
1 hr., 52 min.

20 min.
3 hr., 18 min.

9 hr., 12 min.
1 hr., 55 min.
9 hr., 8 min.
6 hr., 25 min.

Small*
1 hr., 14 min.
2 hr., 36 min.
20 min.

11 hr.
8 hr.

1 hr., 57 min.
4 hr., 29 min.
1 hr., 10 min.
9 hr., 19 min.
1 hr., 42 min.

1 hr., 48 min.

*In 2008, certain small plans have a simplified reporting alternative, as described in the instructions, which allows eligible filers to complete fewer schedules
and line items on certain schedules. We have assumed for purposes of assessing the paperwork burden that not all filers will use the simplified reporting
method because this method of filing is optional. For eligible plans that choose to use the simplified reporting option, the burden of filing will be smaller than the
table indicates, because this option allows eligible plans to fill out fewer line items and schedules.

If you have comments concerning the accuracy of these time estimates or suggestions for making these forms simpler, we would be
happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP,
1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send any of these forms or schedules to this address. Instead, see
Where To File on page 6.

1 hr., 43 min.
2 hr., 41 min.
2 hr., 22 min.
1 hr., 39 min.
3 hr., 18 min.
11 hr., 29 min.
7 hr., 12 min.

Large
Form 5500
Schedule A
Schedule C
Schedule D
Schedule E
Schedule G
Schedule H
Schedule I
Schedule MB
Schedule R
Schedule SB
Schedule SSA

Welfare Plans

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Forms 5500 and 5500-EZ
Codes for Principal Business
Activity

This list of principal business activities and their
associated codes is designed to classify an
enterprise by the type of activity in which it is

engaged. These principal activity codes are based
on the North American Industry Classification
System.

Code

Agriculture, Forestry, Fishing
and Hunting

Specialty Trade Contractors
238100 Foundation, Structure, &
Building Exterior Contractors
(including framing carpentry,
masonry, glass, roofing, &
siding)
238210 Electrical Contractors
238220 Plumbing, Heating, &
Air-Conditioning Contractors
238290 Other Building Equipment
Contractors
238300 Building Finishing
Contractors (including
drywall, insulation, painting,
wallcovering, flooring, tile, &
finish carpentry)
238900 Other Specialty Trade
Contractors (including site
preparation)

Petroleum and Coal Products
Manufacturing
324110 Petroleum Refineries
(including integrated)
324120 Asphalt Paving, Roofing, &
Saturated Materials Mfg
324190 Other Petroleum & Coal
Products Mfg
Chemical Manufacturing
325100 Basic Chemical Mfg
325200 Resin, Synthetic Rubber, &
Artificial & Synthetic Fibers &
Filaments Mfg
325300 Pesticide, Fertilizer, & Other
Agricultural Chemical Mfg
325410 Pharmaceutical & Medicine
Mfg
325500 Paint, Coating, & Adhesive
Mfg
325600 Soap, Cleaning Compound, &
Toilet Preparation Mfg
325900 Other Chemical Product &
Preparation Mfg
Plastics and Rubber Products
Manufacturing
326100 Plastics Product Mfg
326200 Rubber Product Mfg
Nonmetallic Mineral Product
Manufacturing
327100 Clay Product & Refractory
Mfg
327210 Glass & Glass Product Mfg
327300 Cement & Concrete Product
Mfg
327400 Lime & Gypsum Product Mfg
327900 Other Nonmetallic Mineral
Product Mfg
Primary Metal Manufacturing
331110 Iron & Steel Mills & Ferroalloy
Mfg
331200 Steel Product Mfg from
Purchased Steel
331310 Alumina & Aluminum
Production & Processing
331400 Nonferrous Metal (except
Aluminum) Production &
Processing
331500 Foundries
Fabricated Metal Product
Manufacturing
332110 Forging & Stamping
332210 Cutlery & Handtool Mfg
332300 Architectural & Structural
Metals Mfg
332400 Boiler, Tank, & Shipping
Container Mfg
332510 Hardware Mfg
332610 Spring & Wire Product Mfg
332700 Machine Shops; Turned
Product; & Screw, Nut, & Bolt
Mfg
332810 Coating, Engraving, Heat
Treating, & Allied Activities
332900 Other Fabricated Metal
Product Mfg
Machinery Manufacturing
333100 Agriculture, Construction, &
Mining Machinery Mfg
333200 Industrial Machinery Mfg
333310 Commercial & Service
Industry Machinery Mfg
333410 Ventilation, Heating,
Air-Conditioning, &
Commercial Refrigeration
Equipment Mfg
333510 Metalworking Machinery Mfg
333610 Engine, Turbine & Power
Transmission Equipment Mfg
333900 Other General Purpose
Machinery Mfg

Computer and Electronic Product
Manufacturing
334110 Computer & Peripheral
Equipment Mfg
334200 Communications Equipment
Mfg
334310 Audio & Video Equipment
Mfg
334410 Semiconductor & Other
Electronic Component Mfg
334500 Navigational, Measuring,
Electromedical, & Control
Instruments Mfg
334610 Manufacturing & Reproducing
Magnetic & Optical Media
Electrical Equipment, Appliance, and
Component Manufacturing
335100 Electric Lighting Equipment
Mfg
335200 Household Appliance Mfg
335310 Electrical Equipment Mfg
335900 Other Electrical Equipment &
Component Mfg
Transportation Equipment
Manufacturing
336100 Motor Vehicle Mfg
336210 Motor Vehicle Body & Trailer
Mfg
336300 Motor Vehicle Parts Mfg
336410 Aerospace Product & Parts
Mfg
336510 Railroad Rolling Stock Mfg
336610 Ship & Boat Building
336990 Other Transportation
Equipment Mfg
Furniture and Related Product
Manufacturing
337000 Furniture & Related Product
Manufacturing
Miscellaneous Manufacturing
339110 Medical Equipment &
Supplies Mfg
339900 Other Miscellaneous
Manufacturing

Mining

Oil & Gas Extraction
Coal Mining
Metal Ore Mining
Stone Mining & Quarrying
Sand, Gravel, Clay, &
Ceramic & Refractory
Minerals Mining & Quarrying
212390 Other Nonmetallic Mineral
Mining & Quarrying
213110 Support Activities for Mining

211110
212110
212200
212310
212320

Manufacturing
Food Manufacturing
311110 Animal Food Mfg
311200 Grain & Oilseed Milling
311300 Sugar & Confectionery
Product Mfg
311400 Fruit & Vegetable Preserving
& Specialty Food Mfg
311500 Dairy Product Mfg
311610 Animal Slaughtering and
Processing
311710 Seafood Product Preparation
& Packaging
311800 Bakeries & Tortilla Mfg
311900 Other Food Mfg (including
coffee, tea, flavorings &
seasonings)
Beverage and Tobacco Product
Manufacturing
312110 Soft Drink & Ice Mfg
312120 Breweries
312130 Wineries
312140 Distilleries
312200 Tobacco Manufacturing
Textile Mills and Textile Product
Mills
313000 Textile Mills
314000 Textile Product Mills
Apparel Manufacturing
315100 Apparel Knitting Mills
315210 Cut & Sew Apparel
Contractors
315220 Men’s & Boys’ Cut & Sew
Apparel Mfg
315230 Women’s & Girls’ Cut & Sew
Apparel Mfg
315290 Other Cut & Sew Apparel Mfg
315990 Apparel Accessories & Other
Apparel Mfg
Leather and Allied Product
Manufacturing
316110 Leather & Hide Tanning &
Finishing
316210 Footwear Mfg (including
rubber & plastics)
316990 Other Leather & Allied
Product Mfg
Wood Product Manufacturing
321110 Sawmills & Wood
Preservation
321210 Veneer, Plywood, &
Engineered Wood Product
Mfg
321900 Other Wood Product Mfg
Paper Manufacturing
322100 Pulp, Paper, & Paperboard
Mills
322200 Converted Paper Product Mfg
Printing and Related Support
Activities
323100 Printing & Related Support
Activities

Crop Production
111100 Oilseed & Grain Farming
111210 Vegetable & Melon Farming
(including potatoes & yams)
111300 Fruit & Tree Nut Farming
111400 Greenhouse, Nursery, &
Floriculture Production
111900 Other Crop Farming
(including tobacco, cotton,
sugarcane, hay, peanut,
sugar beet, & all other crop
farming)
Animal Production
112111 Beef Cattle Ranching &
Farming
112112 Cattle Feedlots
112120 Dairy Cattle & Milk
Production
112210 Hog & Pig Farming
112300 Poultry & Egg Production
112400 Sheep & Goat Farming
112510 Aquaculture (including
shellfish & finfish farms &
hatcheries)
112900 Other Animal Production
Forestry and Logging
113110 Timber Tract Operations
113210 Forest Nurseries & Gathering
of Forest Products
113310 Logging
Fishing, Hunting and Trapping
114110 Fishing
114210 Hunting & Trapping
Support Activities for Agriculture
and Forestry
115110 Support Activities for Crop
Production (including cotton
ginning, soil preparation,
planting, & cultivating)
115210 Support Activities for Animal
Production
115310 Support Activities For
Forestry

Utilities
221100 Electric Power Generation,
Transmission & Distribution
221210 Natural Gas Distribution
221300 Water, Sewage, & Other
Systems
221500 Combination Gas & Electric

Construction
Construction of Buildings
236110 Residential Building
Construction
236200 Nonresidential Building
Construction
Heavy and Civil Engineering
Construction
237100 Utility System Construction
237210 Land Subdivision
237310 Highway, Street, & Bridge
Construction
237990 Other Heavy & Civil
Engineering Construction

Code

-66-

Wholesale Trade
Merchant Wholesalers, Durable
Goods
423100 Motor Vehicle & Motor
Vehicle Parts & Supplies
423200 Furniture & Home
Furnishings
423300 Lumber & Other Construction
Materials
423400 Professional & Commercial
Equipment & Supplies
423500 Metals & Minerals (except
Petroleum)
423600 Electrical & Electronic Goods
423700 Hardware, Plumbing &
Heating Equipment &
Supplies
423800 Machinery, Equipment, &
Supplies
423910 Sporting & Recreational
Goods & Supplies
423920 Toy & Hobby Goods &
Supplies
423930 Recyclable Materials
423940 Jewelry, Watches, Precious
Stones, & Precious Metals
423990 Other Miscellaneous Durable
Goods
Merchant Wholesalers, Nondurable
Goods
424100 Paper & Paper Products
424210 Drugs & Druggists’ Sundries
424300 Apparel, Piece Goods, &
Notions
424400 Grocery & Related Products
424500 Farm Product Raw Materials
424600 Chemical & Allied Products

Page 67 of 70

Instructions for Form 5500

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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Forms 5500 and 5500-EZ Codes for Principal Business Activity (continued)
Code

Code

424700 Petroleum & Petroleum
Products
424800 Beer, Wine, & Distilled
Alcoholic Beverages
424910 Farm Supplies
424920 Books, Periodicals, &
Newspapers
424930 Flower, Nursery Stock, &
Florists’ Supplies
424940 Tobacco & Tobacco Products
424950 Paint, Varnish, & Supplies
424990 Other Miscellaneous
Nondurable Goods
Wholesale Electronic Markets and
Agents and Brokers
425110 Business to Business
Electronic Markets
425120 Wholesale Trade Agents &
Brokers

448140
448150
448190
448210
448310
448320

Support Activities for Transportation
488100 Support Activities for Air
Transportation
488210 Support Activities for Rail
Transportation
488300 Support Activities for Water
Transportation
488410 Motor Vehicle Towing
488490 Other Support Activities for
Road Transportation
488510 Freight Transportation
Arrangement
488990 Other Support Activities for
Transportation
Couriers and Messengers
492110 Couriers
492210 Local Messengers & Local
Delivery
Warehousing and Storage
493100 Warehousing & Storage
(except lessors of
miniwarehouses &
self-storage units)

Activities Related to Credit
Intermediation
522300 Activities Related to Credit
Intermediation (including loan
brokers, check clearing, &
money transmitting)
Securities, Commodity Contracts,
and Other Financial Investments and
Related Activities
523110 Investment Banking &
Securities Dealing
523120 Securities Brokerage
523130 Commodity Contracts
Dealing
523140 Commodity Contracts
Brokerage
523210 Securities & Commodity
Exchanges
523900 Other Financial Investment
Activities (including portfolio
management & investment
advice)
Insurance Carriers and Related
Activities
524140 Direct Life, Health, & Medical
Insurance & Reinsurance
Carriers
524150 Direct Insurance &
Reinsurance (except Life,
Health & Medical) Carriers
524210 Insurance Agencies &
Brokerages
524290 Other Insurance Related
Activities (including
third-party administration of
insurance and pension funds)
Funds, Trusts, and Other Financial
Vehicles
525100 Insurance & Employee
Benefit Funds
525910 Open-End Investment Funds
(Form 1120-RIC)
525920 Trusts, Estates, & Agency
Accounts
525990 Other Financial Vehicles
(including mortgage REITs &
closed-end investment funds)
“Offices of Bank Holding Companies”
and “Offices of Other Holding
Companies” are located under
Management of Companies (Holding
Companies).

Information

Publishing Industries (except
Internet)
511110 Newspaper Publishers
511120 Periodical Publishers
511130 Book Publishers
511140 Directory & Mailing List
Publishers
511190 Other Publishers
511210 Software Publishers
Motion Picture and Sound
Recording Industries
512100 Motion Picture & Video
Industries (except video
rental)
512200 Sound Recording Industries
Broadcasting (except Internet)
515100 Radio & Television
Broadcasting
515210 Cable & Other Subscription
Programming
Telecommunications
517000 Telecommunications
(including paging, cellular,
satellite, cable & other
program distribution,
resellers, other
telecommunications, &
internet service providers)
Data Processing Services
518210 Data Processing, Hosting, &
Related Services
Other Information Services
519100 Other Information Services
(including news syndicates,
libraries, internet publishing &
broadcasting)

Retail Trade
Motor Vehicle and Parts Dealers
441110 New Car Dealers
441120 Used Car Dealers
441210 Recreational Vehicle Dealers
441221 Motorcycle Dealers
441222 Boat Dealers
441229 All Other Motor Vehicle
Dealers
441300 Automotive Parts,
Accessories, & Tire Stores
Furniture and Home Furnishings
Stores
442110 Furniture Stores
442210 Floor Covering Stores
442291 Window Treatment Stores
442299 All Other Home Furnishings
Stores
Electronics and Appliance Stores
443111 Household Appliance Stores
443112 Radio, Television, & Other
Electronics Stores
443120 Computer & Software Stores
443130 Camera & Photographic
Supplies Stores
Building Material and Garden
Equipment and Supplies Dealers
444110 Home Centers
444120 Paint & Wallpaper Stores
444130 Hardware Stores
444190 Other Building Material
Dealers
444200 Lawn & Garden Equipment &
Supplies Stores
Food and Beverage Stores
445110 Supermarkets and Other
Grocery (except
Convenience) Stores
445120 Convenience Stores
445210 Meat Markets
445220 Fish & Seafood Markets
445230 Fruit & Vegetable Markets
445291 Baked Goods Stores
445292 Confectionery & Nut Stores
445299 All Other Specialty Food
Stores
445310 Beer, Wine, & Liquor Stores
Health and Personal Care Stores
446110 Pharmacies & Drug Stores
446120 Cosmetics, Beauty Supplies,
& Perfume Stores
446130 Optical Goods Stores
446190 Other Health & Personal
Care Stores
Gasoline Stations
447100 Gasoline Stations (including
convenience stores with gas)
Clothing and Clothing Accessories
Stores
448110 Men’s Clothing Stores
448120 Women’s Clothing Stores
448130 Children’s & Infants’ Clothing
Stores

Family Clothing Stores
Clothing Accessories Stores
Other Clothing Stores
Shoe Stores
Jewelry Stores
Luggage & Leather Goods
Stores
Sporting Goods, Hobby, Book, and
Music Stores
451110 Sporting Goods Stores
451120 Hobby, Toy, & Game Stores
451130 Sewing, Needlework, & Piece
Goods Stores
451140 Musical Instrument &
Supplies Stores
451211 Book Stores
451212 News Dealers & Newsstands
451220 Prerecorded Tape, Compact
Disc, & Record Stores
General Merchandise Stores
452110 Department Stores
452900 Other General Merchandise
Stores
Miscellaneous Store Retailers
453110 Florists
453210 Office Supplies & Stationery
Stores
453220 Gift, Novelty, & Souvenir
Stores
453310 Used Merchandise Stores
453910 Pet & Pet Supplies Stores
453920 Art Dealers
453930 Manufactured (Mobile) Home
Dealers
453990 All Other Miscellaneous Store
Retailers (including tobacco,
candle, & trophy shops)
Nonstore Retailers
454110 Electronic Shopping &
Mail-Order Houses
454210 Vending Machine Operators
454311 Heating Oil Dealers
454312 Liquefied Petroleum Gas
(bottled gas) Dealers
454319 Other Fuel Dealers
454390 Other Direct Selling
Establishments (including
door-to-door retailing, frozen
food plan providers, party
plan merchandisers, &
coffee-break service
providers)

Transportation and
Warehousing

Air, Rail, and Water Transportation
481000 Air Transportation
482110 Rail Transportation
483000 Water Transportation
Truck Transportation
484110 General Freight Trucking,
Local
484120 General Freight Trucking,
Long-distance
484200 Specialized Freight Trucking
Transit and Ground Passenger
Transportation
485110 Urban Transit Systems
485210 Interurban & Rural Bus
Transportation
485310 Taxi Service
485320 Limousine Service
485410 School & Employee Bus
Transportation
485510 Charter Bus Industry
485990 Other Transit & Ground
Passenger Transportation
Pipeline Transportation
486000 Pipeline Transportation
Scenic & Sightseeing Transportation
487000 Scenic & Sightseeing
Transportation

Finance and Insurance
Depository Credit Intermediation
522110 Commercial Banking
522120 Savings Institutions
522130 Credit Unions
522190 Other Depository Credit
Intermediation
Nondepository Credit Intermediation
522210 Credit Card Issuing
522220 Sales Financing
522291 Consumer Lending
522292 Real Estate Credit (including
mortgage bankers &
originators)
522293 International Trade Financing
522294 Secondary Market Financing
522298 All Other Nondepository
Credit Intermediation

-67-

Real Estate and Rental and
Leasing
Real Estate
531110 Lessors of Residential
Buildings & Dwellings
(including equity REITs)
531114 Cooperative Housing
(including equity REITs)
531120 Lessors of Nonresidential
Buildings (except
Miniwarehouses) (including
equity REITs)
531130 Lessors of Miniwarehouses &
Self-Storage Units (including
equity REITs)
531190 Lessors of Other Real Estate
Property (including equity
REITs)
531210 Offices of Real Estate Agents
& Brokers
531310 Real Estate Property
Managers
531320 Offices of Real Estate
Appraisers
531390 Other Activities Related to
Real Estate
Rental and Leasing Services
532100 Automotive Equipment Rental
& Leasing
532210 Consumer Electronics &
Appliances Rental
532220 Formal Wear & Costume
Rental
532230 Video Tape & Disc Rental

Page 68 of 70

Instructions for Form 5500

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Forms 5500 and 5500-EZ Codes for Principal Business Activity (continued)
Code

Code

532290 Other Consumer Goods
Rental
532310 General Rental Centers
532400 Commercial & Industrial
Machinery & Equipment
Rental & Leasing
Lessors of Nonfinancial Intangible
Assets (except copyrighted works)
533110 Lessors of Nonfinancial
Intangible Assets (except
copyrighted works)

Administrative and Support
and Waste Management and
Remediation Services

Medical and Diagnostic Laboratories
621510 Medical & Diagnostic
Laboratories
Home Health Care Services
621610 Home Health Care Services
Other Ambulatory Health Care
Services
621900 Other Ambulatory Health
Care Services (including
ambulance services & blood
& organ banks)
Hospitals
622000 Hospitals
Nursing and Residential Care
Facilities
623000 Nursing & Residential Care
Facilities
Social Assistance
624100 Individual & Family Services
624200 Community Food & Housing,
& Emergency & Other Relief
Services
624310 Vocational Rehabilitation
Services
624410 Child Day Care Services

Other Services

Educational Services

611000 Educational Services
(including schools, colleges,
& universities)

R
Health Care and Social
Assistance

Offices of Physicians and Dentists
621111 Offices of Physicians (except
mental health specialists)
621112 Offices of Physicians, Mental
Health Specialists
621210 Offices of Dentists
Offices of Other Health Practitioners
621310 Offices of Chiropractors
621320 Offices of Optometrists
621330 Offices of Mental Health
Practitioners (except
Physicians)
621340 Offices of Physical,
Occupational & Speech
Therapists, & Audiologists
621391 Offices of Podiatrists
621399 Offices of All Other
Miscellaneous Health
Practitioners
Outpatient Care Centers
621410 Family Planning Centers
621420 Outpatient Mental Health &
Substance Abuse Centers
621491 HMO Medical Centers
621492 Kidney Dialysis Centers
621493 Freestanding Ambulatory
Surgical & Emergency
Centers
621498 All Other Outpatient Care
Centers

Management of Companies
(Holding Companies)
551111 Offices of Bank Holding
Companies
551112 Offices of Other Holding
Companies

Arts, Entertainment, and
Recreation
Performing Arts, Spectator Sports,
and Related Industries
711100 Performing Arts Companies
711210 Spectator Sports (including
sports clubs & racetracks)
711300 Promoters of Performing Arts,
Sports, & Similar Events
711410 Agents & Managers for
Artists, Athletes, Entertainers,
& Other Public Figures
711510 Independent Artists, Writers,
& Performers
Museums, Historical Sites, and
Similar Institutions
712100 Museums, Historical Sites, &
Similar Institutions
Amusement, Gambling, and
Recreation Industries
713100 Amusement Parks & Arcades
713200 Gambling Industries
713900 Other Amusement &
Recreation Industries
(including golf courses, skiing
facilities, marinas, fitness
centers, & bowling centers)

Legal Services
541110 Offices of Lawyers
541190 Other Legal Services
Accounting, Tax Preparation,
Bookkeeping, and Payroll Services
541211 Offices of Certified Public
Accountants
541213 Tax Preparation Services
541214 Payroll Services
541219 Other Accounting Services
Architectural, Engineering, and
Related Services
541310 Architectural Services
541320 Landscape Architecture
Services
541330 Engineering Services
541340 Drafting Services
541350 Building Inspection Services
541360 Geophysical Surveying &
Mapping Services
541370 Surveying & Mapping (except
Geophysical) Services
541380 Testing Laboratories
Specialized Design Services
541400 Specialized Design Services
(including interior, industrial,
graphic, & fashion design)
Computer Systems Design and
Related Services
541511 Custom Computer
Programming Services
541512 Computer Systems Design
Services
541513 Computer Facilities
Management Services
541519 Other Computer Related
Services
Other Professional, Scientific, and
Technical Services
541600 Management, Scientific, &
Technical Consulting
Services
541700 Scientific Research &
Development Services
541800 Advertising & Related
Services
541910 Marketing Research & Public
Opinion Polling
541920 Photographic Services
541930 Translation & Interpretation
Services
541940 Veterinary Services
541990 All Other Professional,
Scientific, & Technical
Services

Professional, Scientific, and
Technical Services

Administrative and Support Services
561110 Office Administrative
Services
561210 Facilities Support Services
561300 Employment Services
561410 Document Preparation
Services
561420 Telephone Call Centers
561430 Business Service Centers
(including private mail centers
& copy shops)
561440 Collection Agencies
561450 Credit Bureaus
561490 Other Business Support
Services (including
repossession services, court
reporting, & stenotype
services)
561500 Travel Arrangement &
Reservation Services
561600 Investigation & Security
Services
561710 Exterminating & Pest Control
Services
561720 Janitorial Services
561730 Landscaping Services
561740 Carpet & Upholstery Cleaning
Services
561790 Other Services to Buildings &
Dwellings
561900 Other Support Services
(including packaging &
labeling services, &
convention & trade show
organizers)
Waste Management and
Remediation Services
562000 Waste Management &
Remediation Services

Accommodation and Food
Services
Accommodation
721110 Hotels (except Casino Hotels)
& Motels
721120 Casino Hotels
721191 Bed & Breakfast Inns
721199 All Other Traveler
Accommodation
721210 RV (Recreational Vehicle)
Parks & Recreational Camps
721310 Rooming & Boarding Houses
Food Services and Drinking Places
722110 Full-Service Restaurants
722210 Limited-Service Eating
Places
722300 Special Food Services
(including food service
contractors & caterers)
722410 Drinking Places (Alcoholic
Beverages)

-68-

Repair and Maintenance
811110 Automotive Mechanical &
Electrical Repair &
Maintenance
811120 Automotive Body, Paint,
Interior, & Glass Repair
811190 Other Automotive Repair &
Maintenance (including oil
change & lubrication shops &
car washes)
811210 Electronic & Precision
Equipment Repair &
Maintenance
811310 Commercial & Industrial
Machinery & Equipment
(except Automotive &
Electronic) Repair &
Maintenance
811410 Home & Garden Equipment &
Appliance Repair &
Maintenance
811420 Reupholstery & Furniture
Repair
811430 Footwear & Leather Goods
Repair
811490 Other Personal & Household
Goods Repair & Maintenance
Personal and Laundry Services
812111 Barber Shops
812112 Beauty Salons
812113 Nail Salons
812190 Other Personal Care
Services (including diet &
weight reducing centers)
812210 Funeral Homes & Funeral
Services
812220 Cemeteries & Crematories
812310 Coin-Operated Laundries &
Drycleaners
812320 Drycleaning & Laundry
Services (except
Coin-Operated)
812330 Linen & Uniform Supply
812910 Pet Care (except Veterinary)
Services
812920 Photofinishing
812930 Parking Lots & Garages
812990 All Other Personal Services
Religious, Grantmaking, Civic,
Professional, and Similar
Organizations
813000 Religious, Grantmaking,
Civic, Professional, & Similiar
Organizations (including
condominium and
homeowners associations)
813930 Labor Unions and Similar
Labor Organizations
921000 Governmental Instrumentality
or Agency

Page 69 of 70

Instructions for Form 5500

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ERISA COMPLIANCE QUICK CHECKLIST
Compliance with the Employee Retirement Income Security Act (ERISA) begins with knowing the rules. Plan
administrators and other plan officials can use this checklist as a quick diagnostic tool for assessing a plan’s compliance
with certain important ERISA rules; it is not a complete description of all ERISA’s rules and it is not a substitute for a
comprehensive compliance review. Use of this checklist is voluntary, and it should not be filed with your Form 5500.
If you answer “No” to any of the questions below, you should review your plan’s operations because you may
not be in full compliance with ERISA’s requirements.
Have you provided plan participants with a summary plan description, summaries of any material modifications
of the plan, and annual summary financial reports?

Do you maintain copies of plan documents at the principal office of the plan administrator for examination by
participants and beneficiaries?

Do you respond to written participant inquires for copies of plan documents and information within 30 days?

Does your plan include written procedures for making benefit claims and appealing denied claims, and are you
complying with those procedures?

Is your plan covered by a fidelity bond against losses due to fraud or dishonesty?

Are the plan’s investments diversified so as to minimize the risk of large losses?

If the plan permits participants to select the investments in their plan accounts, has the plan provided them with
enough information to make informed decisions?

Has a plan official determined that the investments are prudent and solely in the interest of the plan’s
participants and beneficiaries, and evaluated the risks associated with plan investments before making the
investments?

Did the employer or other plan sponsor send participant contributions to the plan on a timely basis?

10.

Did the plan pay participant benefits on time and in the correct amounts?

11.

Did the plan give participants and beneficiaries 30 days advance notice before imposing a “blackout period” of at
least three consecutive business days during which participants or beneficiaries of a 401(k) or other individual
account pension plan were unable to change their plan investments, obtain loans from the plan, or obtain
distributions from the plan?

If you answer “Yes” to any of the questions below, you should review your plan’s operations because you may
not be in full compliance with ERISA’s requirements.
Has the plan engaged in any financial transactions with persons related to the plan or any plan official? (For
example, has the plan made a loan to or participated in an investment with the employer?)

Has the plan official used the assets of the plan for his/her own interest?

Have plan assets been used to pay expenses that were not authorized in the plan document, were not
necessary to the proper administration of the plan, or were more than reasonable in amount?

If you need help answering these questions or want additional guidance about ERISA requirements, a plan
official should contact the U.S. Department of Labor Employee Benefits Security Administration office in your
region or consult with the plan’s legal counsel or professional employee benefit advisor.

-69-

Page 70 of 70

Instructions for Form 5500

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Index

I
Information Concerning Insurance
Contract Coverage, Fees, and
Commissions . . . . . . . . . . . . . . . . . . . . . . . 21
Instructions for Schedule A:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 21
A
d
About the Form 5500 . . . . . . . . . . . . . . . . . . 1 Instructions for Schedule C:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 23
Amended Return/Report . . . . . . . . . . . . . . . 7
Instructions
for Schedule D:
Amendments . . . . . . . . . . . . . . . . . . . . . . . . . 50
Who Must File . . . . . . . . . . . . . . . . . . . . . . 25
Instructions for Schedule E:
C
Who Must File . . . . . . . . . . . . . . . . . . . . . . 26
Change in Plan Year . . . . . . . . . . . . . . . . . . . 7 Instructions for Schedule G:
Changes To Note . . . . . . . . . . . . . . . . . . . . . . 2
Who Must File . . . . . . . . . . . . . . . . . . . . . . 27
Combination unfunded/insured welfare
Instructions for Schedule H:
plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Who Must File . . . . . . . . . . . . . . . . . . . . . . 29
Common/Collective Trust (CCT) . . . . . . 11 Instructions for Schedule I:
Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Who Must File . . . . . . . . . . . . . . . . . . . . . . 37
Instructions for Schedule MB:
Statement by Enrolled Actuary . . . . . . 43
D
Who Must File . . . . . . . . . . . . . . . . . . . . . . 43
Direct Filing Entity (DFE) - Who Must
File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Instructions for Schedule R:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 49
Direct Filing Entity (DFE) Filing
Requirements . . . . . . . . . . . . . . . . . . . . . . 11 Instructions for Schedule SB:
Statement by Enrolled Actuary . . . . . . 54
Distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Who Must File . . . . . . . . . . . . . . . . . . . . . . 54
Instructions for Schedule SSA:
E
Revising a Prior Report . . . . . . . . . . . . . 63
d
EFAST Processing System . . . . . . . . . . . . 1
When NOT to Report a Separated
EFAST Processing Tips . . . . . . . . . . . . . . . 1
Participant . . . . . . . . . . . . . . . . . . . . . . . 63
Extension of Time To File . . . . . . . . . . . . . . 5
When to Report a Separated
Participant . . . . . . . . . . . . . . . . . . . . . . . 63
Where and How To File . . . . . . . . . . . . 63
F
Who Must File . . . . . . . . . . . . . . . . . . . . . . 63
Final Return/Report:
Mergers/Consolidations . . . . . . . . . . . . . . 7 Investment and Annuity Contract
Information . . . . . . . . . . . . . . . . . . . . . . . . . 22
Pension and Welfare Plans That
Terminated Without Distributing All
Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 L
Welfare Plans Still Liable To Pay
Limited Pension Plan Reporting . . . . . . . 10
Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Loans or Fixed Income Obligations in
Financial Schedules . . . . . . . . . . . . . . . . . . . 8
Default or Classified as
Form 5500 Completed by Pen . . . . . . . . . 6
Uncollectible . . . . . . . . . . . . . . . . . . . . . . . 27
Form 5500 Completed by
Typewriter . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 M
Form 5500 Completed by Using
Master Trust Investment Account
Computer Software . . . . . . . . . . . . . . . . . . 7
(MTIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Form 5500 Schedules . . . . . . . . . . . . . . . . . 8
Fully insured welfare benefit plan . . . . . . 4
N
Funding Information . . . . . . . . . . . . . . . . . . 50
Nonexempt Transactions . . . . . . . . . 27, 40
Notice To Terminated Accountant Or
G
Enrolled Actuary . . . . . . . . . . . . . . . . . . . . 24
Group Insurance Arrangement
(GIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
P
Paper and Electronic Filing . . . . . . . . . . . . 6
H
Party-in-Interest . . . . . . . . . . . . . . . . . . 27, 40
How To File . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Penalties:
How To Get Forms and Related
Administrative . . . . . . . . . . . . . . . . . . . . . . . 7
Publications:
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Personal Computer . . . . . . . . . . . . . . . . . . 2 Pension Benefit Plan - Who Must
Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Pension Benefit Plan Filing
Requirements . . . . . . . . . . . . . . . . . . . . . . . 9

Pension Benefit Schedules . . . . . . . . . . . . 8
Plan sponsor . . . . . . . . . . . . . . . . . . . . . . . . . 16
Pooled Separate Account (PSA) . . . . . . 11
Private Delivery Service . . . . . . . . . . . . . . . . 5
Processing Tips . . . . . . . . . . . . . . . . . . . . . . . 1
R
Reportable transaction . . . . . . . . . . . . . . . . 35
S
Schedule of Reportable
Transactions . . . . . . . . . . . . . . . . . . . . . . . 36
Securities acquisition loan . . . . . . . . . . . . 26
Service Provider Information . . . . . . . . . . 23
Short Plan Year Rule . . . . . . . . . . . . . . . . . . 8
Signature and Date . . . . . . . . . . . . . . . . . . . . 7
Small Plan Financial Information . . . . . . 37
Special rule for certain
participant-directed transactions . . . . 36
Special Rules for Certain Plans of
Partnerships and Wholly Owned
Trades or Businesses . . . . . . . . . . . . . . . 3
Statement by Enrolled Actuary . . . . 43, 55

80-120 Participant Rule . . . . . . . . . . . . . . . . 8
103-12 Investment Entity (103-12
IE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

-70-

T
Telephone Assistance . . . . . . . . . . . . . . . . . 2
Termination Information on Accountants
and Enrolled Actuaries . . . . . . . . . . . . . 24
Transactions During Plan Year . . . . . . . . 39
U
Unfunded welfare benefit plan . . . . . . . . . 4
V
Voluntary Alternative Reporting Option for
Certain Plans with Fewer Than 25
Participants . . . . . . . . . . . . . . . . . . . . . . . . . 9

W
Welfare Benefit Contract
Information . . . . . . . . . . . . . . . . . . . . . . . . . 22
Welfare Benefit Plan - Who Must
File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Welfare Benefit Plan Filing
Requirements . . . . . . . . . . . . . . . . . . . . . . 10
What To File . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
When To File:
DFEs other than GIAs . . . . . . . . . . . . . . . 4
Extensions . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Plans and GIAs . . . . . . . . . . . . . . . . . . . . . 4
Short Years . . . . . . . . . . . . . . . . . . . . . . . . . 4
When to Report a Separated
Participant . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Where To File . . . . . . . . . . . . . . . . . . . . . . . . . 6
Who Must File . . . . . . . . . . . . . . . . . . . . . . . . . 3

■

File Type	application/pdf
File Title	C:\Batch\Users\Pagersvc[DS]\I5500\I5500.
File Modified	2008-11-10
File Created	2008-10-29