Annual Information Return/Report

2009SFInstructions

Annual Information Return/Report

OMB: 1210-0110

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Instructions for Form 5500-SF

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Department of the Treasury
Internal Revenue Service

Department of Labor
Employee Benefits
Security Administration

Pension Benefit
Guaranty Corporation

8/31/2009 DRAFT for REVIEW.
9/15/09 Received proposed
changes to this draft are
highlighted on pages 2 and 16.

2009
Instructions for Form 5500-SF

Short Form Annual Return/Report of Small Employee Benefit Plan

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If you need help completing this form, or have related
questions, call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278) (toll free) or access the EFAST2 or IRS
websites. The EFAST2 Help Line is available Monday
through Friday from 8:00 am to 8:00 pm, Eastern Time.
You can access the EFAST2 website 24 hours a day, 7
days a week at www.efast.dol.gov to:
• File the Form 5500-SF or 5500, and any needed
schedules or attachments.
• Check on the status of a filing you submitted.
• View filings posted by EFAST2.
• Register for electronic credentials to sign or submit filings.
• View forms and related instructions.
• Get information regarding EFAST2, including approved
software vendors.
• See answers to frequently asked questions about the
Form 5500-SF, the Form 5500 and its schedules, and
EFAST2.
• Access the main Employee Benefits Security
Administration (EBSA) and DOL websites for news,
regulations, and publications.
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 online by topic or keyword.
• Send comments or request help by e-mail.
• Sign up to receive local and national tax news by e-mail.
You can order related forms and IRS publications by
calling 1-800-TAX-FORM (1-800-829-3676). You can order
EBSA publications by calling 1-866-444-3272.

General Instructions

Under the computerized ERISA Filing Acceptance System
(EFAST2), you must electronically file your 2009 Form
5500-SF, Short Form Annual Return/Report of Small
Employee Benefit Plan. You may file your 2009 Form
5500-SF online using EFAST2’s web-based filing system or
you may file through an EFAST2-approved vendor. You
cannot file a paper Form 5500-SF by mail or other delivery
service. For more information, see the instructions for How
To File – Electronic Filing Requirement on page 5 and the
EFAST2 website at www.efast.dol.gov.

The Form 5500-SF, Short Form Annual Return/Report of
Small Employee Benefit Plan, is a simplified annual
reporting form for use by certain small pension and welfare
benefit plans. To be eligible to use Form 5500-SF, the plan
must:
• Be a small plan (i.e., generally have fewer than 100
participants at the beginning of the plan year),
• Meet the conditions for being exempt from the
requirement that the plan’s books and records be audited by
an independent qualified public accountant (IQPA),
• Have 100% of its assets invested in certain secure
investments with a readily determinable fair value,
• Hold no employer securities, and
• Not be a multiemployer plan.
Plans required to file an annual return/report that are not
eligible to file the Form 5500-SF, must file a Form 5500,
Annual Return/Report of Employee Benefit Plan, with all

Cat. No. 47655R

EFAST2 Processing System

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Table of Contents
EFAST2 Processing System . . . . . . . . . . . . . . . .
How To Get Assistance . . . . . . . . . . . . . . . . . . . .
General Instructions . . . . . . . . . . . . . . . . . . . . .
Pension and Welfare Plans Required To File
Annual Return/Report . . . . . . . . . . . . . . . . . . .
Plans Exempt from Filing . . . . . . . . . . . . . . . . .
Who May File . . . . . . . . . . . . . . . . . . . . . . . . . .
What To File . . . . . . . . . . . . . . . . . . . . . . . . . .
When To File . . . . . . . . . . . . . . . . . . . . . . . . . .
Extension of Time To File . . . . . . . . . . . . . . . . .
Delinquent Filer Voluntary Compliance (DFVC)
Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Change in Plan Year . . . . . . . . . . . . . . . . . . . .
Penalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
How To File – Electronic Filing Requirement . . .
Signature and Date . . . . . . . . . . . . . . . . . . . . .
Specific Instructions Only for “One-Participant
Plans” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Specific Line-by-Line Instructions . . . . . . . . . .
Part I – Annual Report Identification Information
Part II – Basic Plan Information . . . . . . . . . . . .
Part III – Financial Information . . . . . . . . . . . . .
Part IV – Plan Characteristics . . . . . . . . . . . . .
Part V – Compliance Questions . . . . . . . . . . . .
Part VI – Pension Funding Compliance . . . . . .
Part VII – Plan Terminations and Transfers of
Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Paperwork Reduction Act Notice . . . . . . . . . . . . .
List of Plan Characteristics Codes . . . . . . . . . . . .
Codes for Principal Business Activity . . . . . . . . . .
ERISA Compliance Quick Checklist . . . . . . . . . . .
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How To Get Assistance

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

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Instructions for Form 5500-SF

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required schedules and attachments (Form 5500), or Form
5500-EZ, Annual Return of One Participant (Owners and
Their Spouses) Retirement Plan.
To reduce the possibility of correspondence and
penalties, we remind filers that the Internal Revenue Service
(IRS), Department of Labor (DOL), and Pension Benefit
Guaranty Corporation (PBGC) have consolidated their
annual return/report forms to minimize the filing burden for
employee benefit plans. Administrators and sponsors of
employee benefit plans generally will satisfy their IRS and
DOL annual reporting requirements for the plan under
ERISA sections 104 and 4065 and Code sections 6058 and
6059 by filing either the Form 5500, Form 5500-SF, or Form
5500-EZ. Defined contribution and defined benefit pension
plans may have to file additional information with the IRS
including: Form 8955-SSA, Annual Registration Statement
Identifying Separated Participants with Deferred Vested
Benefits; Form 5330, Return of Excise Taxes Related to
Employee Benefit Plans; and Form 5310-A, Notice of Plan
Merger or Consolidation, Spinoff, or Transfer of Plan Assets
or Liabilities; Notice of Qualified Separate Lines of Business.
See www.irs.gov for more information. Defined benefit
pension plans covered by the PBGC have special additional
requirements, including filing premiums and reporting certain
transactions directly with that agency. See the PBGC’s
website at www.pbgc.gov/practitioners for information on
premium filings and reporting and disclosure requirements.
Note. The Form 5500-EZ generally is used by
“one-participant plans” (as defined under Specific
Instructions Only for “One-Participant Plans” on page 6) that
are not subject to the requirements of section 104(a) of
ERISA to satisfy certain annual reporting and filing
obligations imposed by the Code. A “one-participant plan”
may also be eligible to file Form 5500-SF. See Specific
Instructions Only for “One-Participant Plans.” A
“one-participant plan” that is eligible to file Form 5500-SF
may elect to file Form 5500-SF electronically with EFAST2
rather than filing a Form 5500-EZ on paper with the IRS. A
“one-participant plan” that is not eligible to file Form
5500-SF must file Form 5500-EZ on paper with the IRS. For
more information on filing with the IRS, go to www.irs.gov or
call 1-877-829-5500.

of the plan’s annual return/report. To see 2009 Forms 5500,
including actuarial information, see www.dol.gov/ebsa. See
www.dol.gov/ebsa/actuarialsearch.html for 2008 and short
plan year 2009 actuarial information filed under the previous
paper-based system.

Pension and Welfare Plans
Required To File Annual
Return/Report

Plans Exempt From Filing
Under regulations and applicable guidance, some pension
benefit plans and many welfare benefit plans with fewer than
100 participants are exempt from filing an annual return/
report. Do not file a Form 5500-SF for an employee benefit
plan that is any of the following:

1. An unfunded excess benefit plan.
2. A pension benefit plan maintained outside the United
States primarily for the benefit of persons substantially all of
whom are nonresident aliens.
3. An annuity or custodial account arrangement under
Code section 403(b)(1) or (7) not established or maintained
by an employer as described in DOL Regulations 29 CFR
2510.3-2(f).
4. A simplified employee pension (SEP) described in
Code section 408(k) that conforms to the alternative method
of compliance described in 29 CFR 2520.104-48 or 29 CFR
104-49. A SEP is a pension plan that meets certain
minimum qualifications regarding eligibility and employer
contributions.
5. A Savings Incentive Match Plan for Employees of
Small Employers (SIMPLE) that involves SIMPLE IRAs
under Code section 408(p).
6. A church pension benefit plan not electing coverage
under Code section 410(d).
7. An unfunded dues financed pension benefit plan that
meets the alternative method of compliance provided by 29
CFR 2520.104-27.
8. An individual retirement account or annuity not
considered a pension plan under 29 CFR 2510.3-2(d).
9. “One-participant plans,” as defined on page 6, that
have assets (either alone or in combination with one or more
one-participant plans maintained by the employer) of
$250,000 or less at the end of the plan year. (However, in
any case, you must file for the final plan year to indicate that
all assets have been distributed.)
10. A governmental plan.

Abbreviated filing requirements apply for
one-participant plan filers who are eligible to file
CAUTION Form 5500-SF. See Specific Instructions Only for
“One-Participant Plans” on page 6.
The Form 5500-SF must be filed electronically. See How
To File – Electronic Filing Requirement instructions on page
5 and the EFAST2 website at www.efast.dol.gov. Your Form
5500-SF entries will be initially screened electronically. Your
entries must satisfy this screening for your filing to be
received. Once received, your form may be subject to
further detailed review, and your filing may be rejected
based upon this further review.
ERISA and the Code provide for the assessment or
imposition of penalties for not submitting the required
information when due. See Penalties on page 5.
Annual returns/reports filed under Title I of ERISA must
be made available by plan administrators to plan
participants and beneficiaries and by the DOL to the public
pursuant to ERISA sections 104 and 106. Pursuant to
Section 504 of the Pension Protection Act of 2006 (PPA),
this availability must include the posting of identification and
basic plan information and actuarial information on any plan
sponsor intranet website (or website maintained by the plan
administrator on behalf of the plan sponsor) that is used for
the purpose of communicating with employees and not the
public. Section 504 also requires DOL to display such
information on DOL’s website within 90 days after the filing
for defined benefit pension plans

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All pension benefit plans and welfare benefit plans covered
by ERISA must file a Form 5500 or Form 5500-SF for a plan
year unless they are eligible for a filing exemption. (See
Code sections 6058 and 6059 and ERISA sections 104 and
4065). An annual return/report must be filed even if the plan
is not “tax qualified,” benefits no longer accrue, contributions
were not made during this plan year, or contributions are no
longer made. Pension benefit plans required to file include
both defined benefit plans and defined contribution plans.
Profit sharing plans, stock bonus plans, money purchase
plans, 401(k) plans, Code section 403(b) plans covered by
Title I of ERISA, and IRA plans established by an employer
are among the pension benefit plans for which an annual
return/report must be filed. Welfare benefit plans provide
benefits such as medical, dental, life insurance,
apprenticeship and training, scholarship funds, severance
pay, disability, etc. Plans that cover residents of Puerto
Rico, the U.S. Virgin Islands, Guam, Wake Island, or
American Samoa also must file unless they are eligible for a
filing exemption. This includes a plan that elects to have the
provisions of section 1022(i)(2) of ERISA apply.

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General Instructions to Form 5500-SF

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11. An unfunded pension benefit plan or an unfunded or
insured welfare benefit plan: (a) whose benefits go only to a
select group of management or highly compensated
employees, and (b) which meets the terms of 29 CFR
2520.104-23 (including the requirement that a registration
statement be timely filed with DOL) or 29 CFR 2520.104-24.
12. A welfare benefit plan that covers fewer than 100
participants as of the beginning of the plan year and is
unfunded, fully insured, or a combination of insured and
unfunded. For this purpose:
a. An unfunded welfare benefit plan has its benefits paid
as needed directly from the general assets of the employer
or the employee organization that sponsors the plan.
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 plan year.
A welfare benefit plan with employee contributions that is
associated with a cafeteria plan under Code section 125
may be treated for annual reporting purposes as an
unfunded welfare benefit plan if it meets the requirements of
DOL Technical Release 92-01, 57 Fed. Reg. 23272 (June 2,
1992) and 58 Fed. Reg. 45359 (Aug. 27, 1993). The mere
receipt of COBRA contributions or other after-tax participant
contributions (e.g., retiree contributions) by a cafeteria plan
would not by itself affect the availability of the relief provided
for cafeteria plans that otherwise meet the requirements of
DOL Technical Release 92-01. See 61 Fed. Reg. 41220,
41222-23 (Aug. 7, 1996).
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 benefit plan
has its benefits provided partially as an unfunded plan and
partially as a fully insured plan. An example of such a plan is
a welfare benefit plan that provides medical benefits as in
“a” above and life insurance benefits as in “b” above. See 29
CFR 2520.104-20 and the DOL Technical Release 92-01.
Note. A “voluntary employees’ beneficiary association”
(“VEBA”) as used in Code section 501(c)(9) should not be
confused with the employee organization or employer that
establishes and/or maintains (for example, sponsors) the
welfare benefit plan.
13. Plans maintained only to comply with workers’
compensation, unemployment compensation, or disability
insurance laws.
14. A welfare benefit plan maintained outside the United
States primarily for persons substantially all of whom are
nonresident aliens.
15. A church welfare benefit plan under ERISA section
3(33).
16. An unfunded dues financed welfare benefit plan that
meets the alternative method of compliance provided by 29
CFR 2520.104-26.
17. A welfare benefit plan that participates in a group
insurance arrangement that files a return/report on its behalf
under 29 CFR 2520.104-43. A group insurance arrangement
generally is an arrangement that provides benefits to the
employees of two or more unaffiliated employers (not in

connection with a multiemployer plan or a collectively
bargained multiple-employer plan), fully insures one or more
welfare benefit plans of each participating employer, uses a
trust (or other entity such as a trade association) as the
holder of the insurance contracts, and uses a trust as the
conduit for payment of premiums to the insurance company.
18. An apprenticeship or training plan meeting all of the
conditions specified in 29 CFR 2520.104-22.

For more information on plans that are exempt from filing
an annual return/report, call the EFAST2 Help Line at
1-866-GO-EFAST (1-866-463-3278). For one-participant
plan filers, see the Instructions for Form 5500-EZ or call the
IRS Help Line at 1-877-829-5500.

If your plan is required to file an annual return/report, you
may file the Form 5500-SF instead of the Form 5500 only if
you meet all of the eligibility conditions listed below.
1. The plan (a) covered fewer than 100 participants at
the beginning of the plan year 2009, or (b) under 29 CFR
2520.103-1(d) was eligible to and filed as a small plan for
plan year 2008 and did not cover more than 120 participants
at the beginning of plan year 2009 (see instructions for line 5
on counting the number of participants);
Note. If a Code section 403(b) plan would have been
eligible to file as a small plan under 29 CFR 2520.103-1(d)
in 2008 (that is, the plan was eligible to file in the previous
year under the small plans requirements and has a
participant count of less than 121 at the beginning of the
2009 plan year), then it can rely on 29 CFR 2520.103-1(d) to
file as a small plan for the 2009 plan year.
For more information about annual return/report filings for
Code section 403(b) plans covered by Title I of ERISA, see
Field Assistance Bulletin 2009-02, available on the DOL
website at www.dol.gov.
2. The plan did not hold any employer securities at any
time during the plan year;
3. At all times during the plan year, the plan was 100%
invested in certain secure, easy to value assets that meet
the definition of “eligible plan assets” (see the instructions
for line 6a), such as mutual fund shares, investment
contracts with insurance companies and banks valued at
least annually, publicly traded securities held by a registered
broker dealer, cash and cash equivalents, and plan loans to
participants;
4. The plan is eligible for the waiver of the annual
examination and report of an independent qualified public
accountant (IQPA) under 29 CFR 2520.104-46 (but not by
reason of enhanced bonding), which requirement includes,
among others, giving certain disclosures and supporting
documents to participants and beneficiaries regarding the
plan’s investments (see instructions for line 6b); and
5. The plan is not a multiemployer plan.

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Who May File

General Instructions to Form 5500-SF

Note. Employee Stock Ownership Plans (ESOPs) and
Direct Filing Entities (DFEs) may not file the Form 5500-SF.

Note. One-participant plans should follow the Specific
Instructions Only for “One-Participant Plans” in place of the
instructions 1 – 5 above to see if Form 5500-SF may be filed
instead of Form 5500-EZ.

What To File

Plans required to file an annual return/report that meet all of
the conditions for filing the Form 5500-SF may complete and
file the Form 5500-SF in accordance with its instructions.
Single-employer defined benefit pension plans using the
Form 5500-SF must also file the Schedule SB (Form 5500),

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Single-Employer Defined Benefit Plan Actuarial Information,
and its required attachments. Money purchase plans
amortizing a funding waiver using the Form 5500-SF must
also file the Schedule MB (Form 5500), Multiemployer
Defined Benefit Plan and Certain Money Purchase Plan
Actuarial Information, and its required attachments. See the
instructions for Schedules SB and MB (Form 5500). No
other schedules or attachments have to be filed with the
Form 5500-SF.
One-participant plans see Specific Instructions Only for
“One-Participant Plans.”

Treasury, Internal Revenue Service Center, Ogden, UT
84201-0027. Approved copies of the Form 5558 will not be
returned to the filer. A copy of the completed extension
request must be retained with the plan’s records.

Using Extension of Time To File Federal
Income Tax Return
An automatic extension of time to file Form 5500-SF until
the due date of the federal income tax return of the
employer will be granted if all of the following conditions are
met: (1) the plan year and the employer’s tax year are the
same; (2) the employer has been granted an extension of
time to file its federal income tax return to a date later than
the normal due date for filing the Form 5500-SF; and (3) a
copy of the application for extension of time to file the
federal income tax return is maintained with the filer’s
records. An extension of time granted by using this
automatic extension procedure CANNOT be extended
further by filing an IRS Form 5558, nor can it be extended
beyond a total of 91/2 months beyond the close of the plan
year.
Note. The extension of time to file the Form 5500-SF,
described in the preceding paragraph, does not operate as
an extension of time to file premiums with the PBGC or as
an extension of time to file Form 8955-SSA with the IRS.

When To File

Other Extensions of Time

The IRS, DOL, and PBGC may announce special
extensions of time under certain circumstances, such as
extensions for Presidentially-declared disasters or for
service in, or in support of, the Armed Forces of the United
States in a combat zone. See www.irs.gov, www.efast.dol.
gov, and www.pbgc.gov/practitioners for announcements
regarding such special extensions. If you are relying on one
of these announced special extensions, check the
appropriate box on the Form 5500-SF, Part I, line C, and
enter a brief citation to the announcement for the extension
in the space provided. For example, indicate “Disaster Relief
Extension” or “Combat Zone Extension.”

File the 2009 Form 5500-SF for plan years that began in
2009. The form, and any required schedules and
attachments, must be filed by the last day of the 7th
calendar month after the end of the plan year (not to exceed
12 months in length) that began in 2009.
Short Years. For a plan year of less than 12 months (short
plan year), file the form and applicable schedules by the last
day of the 7th calendar month after the short plan year ends
or by the extended due date, if filing under an authorized
extension of time. Fill in the short plan year beginning and
ending dates in the space provided and check the
appropriate box in Part I, line B, of the Form 5500-SF. For
purposes of this return/report, a short plan year ends on the
date of the change in accounting period or upon the
complete distribution of assets of the plan. Also see the
instructions for Final Return/Report to determine if “the final
return/report” box in line B should be checked.
Note. 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.

Delinquent Filer Voluntary
Compliance (DFVC) Program

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2009 Short Plan Year Filings. Short 2009 plan year filers
whose due date to submit their 2009 filing is before January
1, 2010, are given an automatic extension to electronically
file their complete Form 5500-SF within 90 days after the
2009 filing system is available on the DOL website. The
purpose of this extension was to encourage such short plan
year filers to file electronically under the new EFAST2 filing
system. Short plan year filers that did not choose to wait and
file under the EFAST2 system should have filed their 2009
annual return/report by the due date under the current
EFAST system using the 2008 forms. Short plan year filers
whose due date to submit their 2009 filings was before
January 1, 2010, and who took advantage of the automatic
extension to file electronically, must submit their complete
Form 5500-SF with EFAST2 within 90 days after the 2009
filing system is available on the DOL website, and fill in the
short plan year beginning and ending dates in the space
provided and check the appropriate box in Part I, line C, of
the Form 5500-SF to indicate they are filing under an
extension of time.

CAUTION

2010 short plan year filers may not use the 2009
forms for filing. They must use the 2010 forms,
schedules, and instructions.

Extension of Time To File

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The DFVC Program facilitates voluntary compliance by plan
administrators who are delinquent in filing annual return/
report forms under Title I of ERISA by permitting
administrators to pay reduced civil penalties for voluntarily
complying with their DOL annual reporting obligations. If the
Form 5500-SF is being filed under the DFVC Program,
check the appropriate box on Form 5500-SF, Part I, line C.
See www.efast.dol.gov for information concerning the DFVC
Program. Do not submit penalty payments to EFAST2.
Plan administrators are reminded that they can use the
online calculator available at www.dol.gov/ebsa/calculator/
dfvcpmain.html to compute the penalties due under the
program. Payments under the DFVC Program also may be
submitted electronically. For information on how to pay
DFVC Program payments online, go to www.dol.gov/ebsa.

Change in Plan Year

Using Form 5558

Generally, only defined benefit pension plans need to get
approval for a change in plan year. See Code section
412(d)(1). However, under Rev. Proc. 87-27, 1987-1 C.B.
769, these pension plans may be eligible for automatic
approval of a change in plan year.
If a change in plan year for a pension or a welfare benefit
plan creates a short plan year, file the form and applicable
schedules by the last day of the 7th calendar month after the
short plan year ends or by the extended due date, if filing

If filing under an extension of time based on the filing of an
IRS Form 5558, Application for Extension of Time To File
Certain Employee Plan Returns, check the appropriate box
on the Form 5500-SF, Part I, line C. A one-time extension of
time to file the Form 5500-SF (up to 21/2 months) may be
obtained by filing Form 5558 on or before the normal due
date (not including any extensions) of the return/report. You
must file the Form 5558 with the Department of

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General Instructions to Form 5500-SF

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under an authorized extension of time. Fill in the short plan
year beginning and ending dates in the space provided in
Part I and check the appropriate box in Part I, line B of the
Form 5500-SF. For purposes of this return/report, the short
plan year ends on the date of the change in accounting
period or upon the complete distribution of assets of the
plan. Also, see the instructions for Final Return/Report to
determine if “final return/report” in line B should be checked.

on electronic filing is available at www.efast.dol.gov. For
telephone assistance, call the EFAST2 Help Line at
1-866-GO-EFAST (1-866-463-3278). The EFAST2 Help
Line is available Monday through Friday from 8:00 am to
8:00 pm, Eastern Time.
Annual returns/reports filed under Title I of ERISA,
including those filed using the Form 5500-SF, must
CAUTION be made available by the plan administrators to plan
participants and beneficiaries and by the DOL to the public
pursuant to ERISA sections 104 and 106. Even though the
Form 5500-SF must be filed electronically, the plan
administrator must keep a copy of the Form 5500-SF,
including schedules and attachments, with all required
signatures on file as part of the plan’s records, and must
make a paper copy available on request to participants,
beneficiaries, and the DOL as required by section 104 of
ERISA and 29 CFR 2520.103-1. Filers may use electronic
media for record maintenance and retention, so long as they
meet the applicable requirements.
Generally, questions on the Form 5500-SF relate to the
plan year entered at the top of the first page of the form.
Therefore, answer all questions on the 2009 Form 5500-SF
with respect to the 2009 plan year unless otherwise explicitly
stated in the instructions or on the form itself.
Your entries must be in the proper format in order for the
EFAST2 system to receive your return/report. For example,
if a question requires you to enter a dollar amount, you
cannot enter a word. Your software will not let you submit
your return/report unless all entries are in the proper format.
• Complete all lines on the Form 5500-SF unless otherwise
specified. Also complete and electronically attach, as
required, any applicable schedules and attachments.
• Do not enter “N/A” or “Not Applicable” on the Form
5500-SF or Schedules SB (Form 5500) and MB (Form
5500) unless specifically permitted. “Yes” or “No” questions
on the form and schedules cannot be left blank, unless
specifically permitted. Answer “Yes” or “No,” but not both.
• Use the correct employer identification number (EIN) and
plan number (PN) for the plan.
You should check your return/report for errors before
signing or submitting it to EFAST2. Your filing software or, if
you are using it, the EFAST2 web-based filing system will
allow you to check your return/report for errors. If, after
reasonable attempts to correct your filing to eliminate any
identified problem or problems, you are unable to address
them, or you believe that you are receiving the message in
error, call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278) or contact the service provider you used
to help prepare and file your annual return/report.
Once you complete the return/report and finish the
electronic signature process, you can electronically submit it
to EFAST2. When you electronically submit your return/
report, EFAST2 is designed to immediately notify you if your
submission was received and whether the return/report is
ready to be processed by EFAST2. If EFAST2 does not
notify you that your submission was successfully received
and is ready to be processed, you will need to take steps to
correct the problem or you may be deemed a non-filer
subject to penalties from DOL, IRS, and/or PBGC.
Once EFAST2 receives your return/report, the EFAST2
system should be able to provide a filing status within 20
minutes. The person submitting the filing should check back
into the EFAST2 system to determine the filing status of
your return/report. The filing status message will include a
list of any filing errors or warnings that EFAST2 may have
identified in your filing. If EFAST2 did not identify any filing
errors or warnings, EFAST2 will show the filing status of
your return/report as “Filing_Received.” Persons other than
the submitter can check whether the filing was received by

Penalties

Plan administrators and plan sponsors must provide
complete and accurate information and must otherwise
comply fully with the filing requirements. ERISA and the
Code provide for the DOL and the IRS, respectively, to
assess or impose penalties for not giving complete and
accurate information and for not filing complete and
accurate statements and returns/reports. Certain penalties
are administrative (that is, they may be imposed or
assessed in an administrative proceeding by one of the
governmental agencies delegated to administer the
collection of the Form 5500-SF data). Others require a legal
conviction.

Administrative Penalties

Other Penalties

1. Any individual who willfully violates any provision of
Part 1 of Title I of ERISA shall on conviction be fined not
more than $100,000 or imprisoned not more than 10 years,
or both. See ERISA section 501.
2. A penalty up to $10,000, five (5) years imprisonment,
or both, may be imposed for making any false statement or
representation of fact, knowing it to be false, or for
knowingly concealing or not disclosing any fact required by
ERISA. See section 1027, Title 18, U.S. Code, as amended
by section 111 of ERISA.

How To File – Electronic Filing
Requirement
Under the computerized ERISA Filing Acceptance System
(EFAST2), you must file your 2009 Form 5500-SF
electronically. You may file your 2009 Form 5500-SF online
using EFAST2’s web-based filing system or you may file
through an EFAST2-approved vendor. Detailed information
General Instructions to Form 5500-SF

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Listed below are various penalties under ERISA and the
Code that may be assessed or imposed for not meeting the
annual return/report filing requirements. Generally, whether
the penalty is assessed under ERISA or the Code, or both,
depends upon the agency for which the information is
required to be filed. One or more of the following
administrative penalties may be assessed or imposed in the
event of incomplete filings or filings received after the due
date unless it is determined that your failure to file properly
is for reasonable cause.
1. A penalty of up to $1,100 a day (or higher amount if
adjusted pursuant to the Federal Civil Penalties Inflation
Adjustment Act of 1990, as amended) for each day a plan
administrator fails or refuses to file a complete and accurate
annual return/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 the
annual return/report for certain plans of deferred
compensation, trusts and annuities, and bond purchase
plans by the due date(s). See Code section 6652(e).
3. A penalty of $1,000 for not filing an actuarial
statement (Schedule MB (Form 5500) or Schedule SB
(Form 5500)) required by the applicable instructions. See
Code section 6692.

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the system by calling the EFAST2 Help Line at
1-866-GO-EFAST (1-866-463-3278) and using the
automated telephone system.
To reduce the possibility of correspondence and
penalties from the DOL, IRS, and/or PBGC, you should do
the following: (1) Before submitting your return/report to
EFAST2, check it for errors, and (2) after you have
submitted it to EFAST2, verify that you have received a filing
status of “Filing_Received” and attempt to correct and
resolve any errors or warnings listed in the status report.
Note. Even after being received by the EFAST2 system,
your return/report filing may be subject to further detailed
review by DOL, IRS, and/or PBGC, and your filing may be
deemed deficient based upon this further review. See
Penalties on page 5.

The Form 5500-SF annual return/report must be filed
electronically and signed. To obtain an electronic signature,
go to www.efast.dol.gov and register in EFAST2 as a signer.
You will be provided with a UserID and a PIN. Both the
UserID and PIN are needed to sign the Form 5500-SF. The
plan administrator must keep a copy of the Form 5500-SF,
including schedules and attachments, with all required
signatures on file as part of the plan’s records. See 29 CFR
2520.103-1. Electronic signatures on annual returns/reports
filed under EFAST2 are governed by the applicable statutory
and regulatory requirements.

Specific Instructions Only for
“One-Participant Plans”
A “one-participant plan” is: (1) a pension benefit plan that
covers only an individual or an individual and his or her
spouse who wholly own a trade or business, whether
incorporated or unincorporated; or (2) a pension benefit plan
for a partnership that covers only the partners or the
partners and the partners’ spouses. Thus, a “one-participant
plan” can cover more than one participant. On the other
hand, merely covering only one participant does not make
you eligible to file as a “one-participant plan” unless you are
one of the types of plans described above.
The Form 5500-EZ generally is used by one-participant
plans that are not subject to the requirements of section
104(a) of ERISA to satisfy certain annual reporting and filing
obligations imposed by the Code. One-participant plans that
meet the Conditions for Filing below may file the Form
5500-SF electronically in place of a Form 5500-EZ (on
paper) to satisfy the filing obligations under the Code.
One-participant plans that file the Form 5500-SF
electronically complete only certain questions on the Form
5500-SF. These are the questions that would be completed
if the filer filed Form 5500-EZ on paper. For more
information on filing with the IRS, go to www.irs.gov or call
1-877-829-5500.
Note. A Form 5500-SF may be filed for one-participant
plans that are either defined contribution plans (which
include profit-sharing and money purchase pension plans,
but not an ESOP or stock bonus plan) or defined benefit
plans.
Note. Information filed on Form 5500-EZ is required to be
made available to the public. Form 5500-SF is open to
public inspection and the contents are public information
subject to publication on the Internet.
Conditions for Filing. One-participant plan filers that meet
the following conditions are eligible to file a Form 5500-SF.
1. The plan is a “one-participant plan.” This means
either:
a. The plan only covers you (or you and your spouse)
and you (or you and your spouse) own the entire business
(which may be incorporated or unincorporated) or
b. The plan only covers one or more partners (or
partner(s) and spouse(s)) in a business partnership.
2. The plan does not provide benefits for anyone except
you, or you and your spouse, or one or more partners and
their spouses.
3. The plan covered fewer than 100 participants at the
beginning of the plan year.

The Form 5500-SF, Schedules SB (Form 5500) and MB
(Form 5500), and any attachments that are filed under
ERISA are open to public inspection, and the contents are
public information subject to publication on the Internet.
Do not enter social security numbers in response to
questions asking for an employer identification
CAUTION number (EIN). Because of privacy concerns, the
inclusion of a social security number on the Form 5500-SF
or on a schedule or attachment that is open to public
inspection may result in the rejection of the filing. If you
discover a filing disclosed on the EFAST2 website that
contains a social security number, immediately call the
EFAST2 Help Line at 1-866-GO-EFAST (1-866-463-3278).
Do not attach a 2009 IRS Form 8955-SSA, Annual
Registration Statement Identifying Separated Participants
with Deferred Vested Benefits, or previous year’s Schedule
SSA (Form 5500). The Form 8955-SSA must be filed
directly with the IRS and cannot be attached to a Form
5500-SF submission with EFAST2.
Employers without an employer identification number
(EIN) must apply to the IRS for one as soon as possible.
The EBSA does not issue EINs. To apply for an EIN from
the IRS:
• Mail or fax Form SS-4, Application for Employer
Identification Number, obtained by calling 1-800-TAX-FORM
(1-800-829-3673) or at the IRS website at www.irs.gov.
• Call 1-800-829-4933 to receive your EIN by telephone.
• Select the Online EIN Application link at www.irs.gov. The
EIN is issued immediately once the application information
is validated. (The online application process is not yet
available for corporations with addresses in foreign
countries or Puerto Rico.)

For purposes of Title I of ERISA, the plan administrator is
required to file the Form 5500 or 5500-SF. Thus, the plan
administrator or, if the plan administrator is an entity, a
person authorized to sign on behalf of the plan administrator
must electronically sign the Form 5500 or 5500-SF
submitted to EFAST2. If the plan administrator does not sign
a filing, the filing status will indicate that there is an error
with your filing, and your filing will be subject to further
review, correspondence, rejection, and civil penalties.
Note. The Code permits either the plan sponsor/employer
or the administrator to sign the filing. Therefore, in the case
of a Form 5500-SF filed for a “one-participant plan” not
subject to Title I of ERISA that is filing a Form 5500-SF with
EFAST2 in lieu of filing a Form 5500-EZ on paper with the
IRS (see Specific Instructions Only for “One-Participant
Plans”), either may sign. However, any other Form 5500-SF
that is not electronically signed by the plan administrator will
be subject to rejection and civil penalties under Title I of
ERISA.

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Signature and Date

If you do not meet ALL the conditions listed above, you are
not a one-participant plan filer who is eligible to file Form
5500-SF instead of Form 5500-EZ. You must file a paper
Form 5500-EZ with the IRS if you meet the first two
conditions but do not meet the third condition.
Eligible one-participant plans need complete only the
following questions on the Form 5500-SF:

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•
•
•
•
•
•

Line A – Box for Multiple-Employer Plan. Check this
box if the Form 5500-SF is being filed for a
multiple-employer plan. For purposes of the Form 5500-SF,
a multiple-employer plan is a plan that is maintained by
more than one employer and is not a single-employer plan
or a multiemployer plan. Multiple-employer plans can be
collectively bargained and collectively funded, but if covered
by PBGC termination insurance, they must have properly
elected before September 27, 1981, not to be treated as a
multiemployer plan under Code section 414(f)(5) or ERISA
sections 3(37)(E) and 4001(a)(3), and have not revoked that
election or made an election to be treated as a
multiemployer plan under code section 414(f)(6) or ERISA
section 3(37)(G). Participating employers do not file
individually for multiple-employer plans.
Note. Do not check this box if all of the employers
maintaining the plan are members of the same controlled
group or affiliated service group under Code section 414(b),
(c), or (m).
Multiemployer plans cannot use the Form 5500-SF
to satisfy their annual reporting obligations. They
CAUTION must file the Form 5500. For these purposes, a plan
is a multiemployer plan if: (a) more than one employer is
required to contribute; (b) the plan is maintained pursuant to
one or more collective bargaining agreements between one
or more employee organizations and more than one
employer; (c) an election under Code section 414(f)(5) and
ERISA section 3(37)(E) has not been made; and (d) meets
any other applicable conditions of 29 CFR 2510.3-37. A plan
that made a proper election under ERISA section 3(37)(G)
and Code section 414(f)(6) on or before Aug. 17, 2007, is
also a multiemployer plan.
Line A – Box for One-Participant Plan. Check this box if
the Form 5500-SF is being filed for a plan that is a
“one-participant plan” (see page 6). Check the
one-participant plan box only for those plans that are
submitting the Form 5500-SF in place of a Form 5500-EZ
(on paper) to satisfy the annual return/report filing
obligations under the Code. Plans checking the box for
one-participant plan should not check either the box for
single-employer plan or the box for multiple-employer plan.
See Specific Instructions Only for “One-Participant Plans.”
Line B – Box for First Return/Report. Check this box if
an annual return/report has not been previously filed for this
plan. For the purpose of completing this box, the Form
5500-EZ is not considered an annual return/report.
Line B – Box for Amended Return/Report. Check this
box if you have already filed for the 2009 plan year and are
now filing an amended return to correct errors and/or
omissions on the previously filed return/report.

Check only one of the line A box choices.
Line A – Box for Single-Employer Plan. Check this box if
the Form 5500-SF is filed for a single-employer plan. A
single-employer plan for purposes of the Form 5500-SF is
an employee benefit plan maintained by one employer or
one employee organization.

Check the line B box for “an amended return/report”

TIP if you filed a previous 2009 annual return/report that

was given a “Filing_Received,” “Filing_Error,” or
“Filing_Stopped” status by EFAST2. Do not check the line B
box for “an amended return/report” if your previous
submission attempts were not successfully received by
EFAST2 because of problems with the transmission of your
return/report. For more information, go to the EFAST2
website at www.efast.dol.gov or call the EFAST2 Help Line
at 1-866-GO-EFAST (1-866-463-3278).
If you need to file an amended return/report to correct
errors and/or omissions in a previously filed annual return/
report for the 2009 plan year AND you are eligible to file the
Form 5500-SF, you may use the Form 5500-SF even if the
original filing was a Form 5500. If you filed a Form 5500-SF,
but determine that you were not eligible to file the Form
5500-SF, you must use the Form 5500 or Form 5500-EZ to
amend your return/report.

Note. A “controlled group” is generally considered one
employer for Form 5500 and Form 5500-SF reporting
purposes. A “controlled group” is a controlled group of
corporations under Code section 414(b), a group of trades
or businesses under common control under Code section
414(c), or an affiliated service group under Code section
414(m). A separate annual return/report with line A
(single-employer plan) checked must be filed by each
employer participating in a plan or program of benefits in
which the funds attributable to each employer are available
to pay benefits only for that employer’s employees, even if
the plan is maintained by a controlled group.
General Instructions to Form 5500-SF

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Part I – Annual Report Identification
Information

Specific Line-by-Line Instructions
(Form 5500-SF)

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Part I, lines A, B, and C;
Part II, lines 1a – 5b;
Part III, lines 7a – c, and 8a;
Part IV, line 9a;
Part V, line 10g; and
Part VI, lines 11 – 12e.
Schedule MB (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, complete lines 3, 9, and
10 of Schedule MB (Form 5500). See the Instructions for
Schedule MB in the Instructions for Form 5500.
One-participant plans, however, do not attach Schedule MB
to the Form 5500-SF. Instead, one-participant plans must
keep the completed Schedule MB in accordance with the
applicable records retention requirements.
Schedule SB (Form 5500). One-participant plans do
not attach Schedule SB (Form 5500) to the Form 5500-SF.
Instead, one-participant plans must keep the completed
Schedule SB that is signed by the plan actuary in
accordance with the applicable records retention
requirements. Actuaries of one-participant plans that are
defined benefit plans subject to the minimum funding
standards for this plan year, must complete Schedule SB
(Form 5500) and forward the completed and signed
Schedule SB to the plan administrator no later than the filing
due date. See the Instructions for Schedule SB in the
Instructions for Form 5500.
Filing Form 5500-EZ with the IRS. If you are filing a paper
form, you must file the Form 5500-EZ with the IRS using the
following address: Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201-0027. You may
order the paper Form 5500-EZ and its instructions by calling
1-800-TAX-FORM (1-800-829-3676) or visiting the IRS
website at www.irs.gov/formspubs/.
Filing an amendment. If you are filing an amendment for a
“one-participant plan” that filed a Form 5500-SF
electronically, you may submit the amendment either
electronically using the Form 5500-SF with EFAST2 or on
paper using the Form 5500-EZ with the IRS. If you are filing
an amendment for a “one-participant plan” that previously
filed on a paper Form 5500-EZ, you must submit the
amendment using the paper Form 5500-EZ with the IRS.

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Line B – Box for Final Return/Report. Check this box if
this is the final report for the plan. Only check this box if all
assets under the plan (including insurance/annuity
contracts) have been distributed to the participants and
beneficiaries or legally transferred to the control of another
plan, and when all liabilities for which benefits may be paid
under a welfare benefit plan have been satisfied. Do not
mark the final return/report box if you are reporting
participants and/or assets at the end of the plan year. If a
trustee is appointed for a terminated defined benefit plan
pursuant to ERISA section 4042, the last plan year for which
a return/report must be filed is the year in which the trustee
is appointed.
Examples:
Mergers/Consolidations. A final return/report should
be filed for the plan year (12 months or less) that ends when
all plan assets were legally transferred to the control of
another plan.
Pension and Welfare Plans That Terminated Without
Distributing All Assets. If the plan was terminated but all
plan assets were not distributed, a return/report must be
filed for each year the plan has assets. The return/report
must be filed by the plan administrator, if designated, the
employer, or by the person or persons who actually control
the plan’s assets/property.
Welfare Plans Still Liable To Pay Benefits. A welfare
plan cannot file a final return/report if the plan is still liable to
pay benefits for claims that were incurred prior to the
termination date, but not yet paid. See 29 CFR
2520.104b-2(g)(2)(ii).
Line B – Box for Short Plan Year Return/Report. Check
this box if this form is filed for a period of less than 12
months. Provide the dates in Part I, Plan Year Beginning
and Ending.
Line C – Box for Extension and DFVC Program. Check
the appropriate box here if:
• You filed for an extension of time to file this form with the
IRS using Form 5558, Application for Extension of Time To
File Certain Employee Plan Returns, and maintain a copy of
the Form 5558 with the filer’s records.
• You are filing using the automatic extension of time to file
the Form 5500-SF return/report until the due date of the
federal Income tax return of the employer and maintain a
copy of the employer’s extension of time to file the income
tax return with the plan’s records.
• You are filing under the DFVC Program.
• You are filing using a special extension of time to file the
Form 5500-SF annual return/report that has been
announced by the IRS, DOL, or PBGC. If you checked that
you are using a special extension of time, enter a
description of the extension of time in the space provided.

Start at 001 for plans providing pension benefits. Start at
501 for welfare plans. Do not use 888 or 999.
Once you use a plan number, continue to use it for that
plan on all future filings with the IRS, DOL, and PBGC. Do
not use it for any other plan, even if the first plan is
terminated.
Assign PN

Codes are entered in line 9a

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

Codes are entered in line 9b,
and not in line 9a

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

Exception. If 333 (or a higher number in a sequence
beginning with 333) was previously assigned to the plan,
that number may be entered on line 1b.
Line 1c. Enter the date the plan first became effective.
Line 2a. Enter the plan sponsor’s (employer, if for a
single-employer plan) name, postal address (only use a
P.O. Box number if the Post Office does not deliver mail to
the employer’s street address), foreign routing code where
applicable, and “D/B/A” (doing business as) or trade name
of the employer if different from the employer’s name.
Note. In the case of a multiple-employer plan, file only one
annual return/report for the plan. If an association or other
entity is not the sponsor, enter the name of a participating
employer as sponsor. For a plan of a controlled group of
corporations, the name of one of the sponsoring members
should be entered. In either case, the same name must be
used in all subsequent filings of the Form 5500 return/report
or Form 5500-SF for the multiple-employer plan or
controlled group (see instructions for line 4 concerning
change in sponsorship).
Line 2b. Enter the employer’s nine-digit employer
identification number (EIN). Do not use a social security
number (SSN). A Form 5500-SF that is filed under ERISA is
open to public inspection and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social
security number on this line may result in the rejection of the
filing.
Employers without an EIN number must apply to the IRS
for one as soon as possible. The EBSA does not issue
EINs. To apply for an EIN from the IRS:
• Mail or fax Form SS-4, Application for Employer
Identification Number, obtained by calling 1-800-TAX-FORM
(1-800-829-3673) 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 number of the sponsor
identified in line 2a. The EIN must be used in all subsequent
filings of the Form 5500-SF (or any subsequent Form 5500
or Form 5500-EZ in a year where the plan is not eligible to
file the Form 5500-SF) for these plans. (See instructions to
line 4 concerning change in EIN).
Note. EINs for funds (trusts or custodial accounts)
associated with plans are generally not required to be

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Line 1a. Enter the formal name of the plan or enough
information to identify the plan. Abbreviate if necessary. If an
annual return/report has previously been filed on behalf of
the plan, regardless of the type of Form that was filed (Form
5500, Form 5500-EZ, or Form 5500-SF), use the same
abbreviations that were used on the prior filings. Once you
use an abbreviation, continue to use it for that plan on all
future annual return/report filings with the IRS, DOL, and
PBGC. Do not use the same name or abbreviation for any
other plan, even if the first plan is terminated.
Line 1b. Enter the three-digit plan or entity number (PN)
that the employer or plan administrator assigned to the plan.
This three-digit number, in conjunction with the employer
identification number (EIN) entered on line 2b, is used by
the IRS, DOL, and PBGC as a unique 12-digit number to
identify the plan.

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Part II – Basic Plan Information

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

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• The date on which the individual becomes eligible under
the plan for a benefit subject only to occurrence of the
contingency for which the benefit is provided; or
• The date on which the individual makes a contribution to
the plan, whether voluntary or mandatory.
See 29 CFR 2510.3-3(d)(1). This includes former
employees who are receiving group health continuation
coverage benefits pursuant to Part 6 of ERISA and who are
covered by the employee welfare benefit plan. Covered
dependents are not counted as participants. A child who is
an “alternate recipient” entitled to health benefits under a
qualified medical child support order (QMCSO) should not
be counted as a participant for line 5. An individual is not a
participant covered under an employee welfare plan on the
earliest date on which the individual (A) is ineligible to
receive any benefit under the plan even if the contingency
for which such benefit is provided should occur, and (B) is
not designated by the plan as a participant. See 29 CFR
2510.3-3(d)(2).
Before counting the number of participants,

TIP especially in a welfare benefit plan, it is important to
determine whether the plan sponsor has established
one or more plans for Form 5500/Form 5500-SF reporting
purposes. As a matter of plan design, plan sponsors can
offer benefits through various structures and combinations.
For example, a plan sponsor could create (i) one plan
providing major medical benefits, dental benefits, and vision
benefits, (ii) two plans with one providing major medical
benefits and the other providing self-insured dental and
vision benefits; or (iii) three separate plans. You must review
the governing documents and actual operations to
determine whether welfare benefits are being provided
under a single plan or separate plans.
The fact that you have separate insurance policies for
each different welfare benefit does not necessarily mean
that you have separate plans. Some plan sponsors use a
“wrap” document to incorporate various benefits and
insurance policies into one comprehensive plan. In addition,
whether a benefit arrangement is deemed to be a single
plan may be different for purposes other than Form 5500/
Form 5500-SF reporting. For example, special rules may
apply for purposes of HIPAA, COBRA, and Internal
Revenue Code compliance. If you need help determining
whether you have a single welfare benefit plan for Form
5500/Form 5500-SF reporting purposes, you should consult
a qualified benefits consultant or legal counsel.
For pension benefit plans, “alternate payees” entitled to
benefits under a qualified domestic relations order are not to
be counted as participants for this line.
For pension benefit plans, “participant” for this line means
any individual who is included in one of the categories
below.
1. Active participants (i.e., any individuals who are
currently in employment covered by the plan and who are
earning or retaining credited service under the plan). This
includes any individuals who are eligible to elect to have the
employer make payments under a Code section 401(k)
qualified cash or deferred arrangement. Active participants
also include any nonvested individuals who are earning or
retaining credited service under the plan. This does not
include (a) nonvested former employees who have incurred
the break in service period specified in the plan or (b) former
employees who have received a “cash-out” distribution or
deemed distribution of their entire nonforfeitable accrued
benefit.
2. Retired or separated participants receiving benefits
(i.e., individuals who are retired or separated from
employment covered by the plan and who are receiving
benefits under the plan). This does not include any

General Instructions to Form 5500-SF

Failure to indicate on line 4 that a plan was
previously identified by a different name or a different
CAUTION employer identification number (EIN) could result in
correspondence from the DOL and the IRS.
Line 5. Enter in element (a) the total number of participants
at the beginning of the plan year. Enter in element (b) the
total number of participants at the end of the plan year.
Enter in element (c) the total number of participants with
account balances as of the end of the plan year. Welfare
benefit plans and defined benefit plans do not complete
element (c).
The description of “participant” in the following
instructions is only for purposes of these lines.
An individual becomes a participant covered under an
employee welfare benefit plan on the earliest of:
• The date designated by the plan as the date on which the
individual begins participation in the plan;

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furnished on the Form 5500-SF. The IRS, however, will
issue EINs for such funds for other reporting purposes. EINs
may be obtained as explained above. Plan sponsors should
use the trust EIN when opening a bank account or
conducting other transactions for a trust.
Line 2c. Enter the telephone number for the plan sponsor.
Use numbers only, including area code, and do not include
any special characters.
Line 2d. Enter the six-digit business code that best
describes the nature of the plan sponsor’s business from the
list of business codes on pages 20 – 22. 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. Enter the name of the plan administrator unless
the administrator is the sponsor identified in line 2. If this is
the case, enter the word “same” on line 3a and leave the
remainder of line 3a and all of lines 3b and 3c blank. If the
administrator is not the plan sponsor, also enter on line 3a
the postal address (only use a P.O. Box number if the Post
Office does not deliver mail to the administrator’s street
address), and foreign routing code where applicable.
Plan administrator for this purpose means:
• The person or group of persons specified as the
administrator by the instrument under which the plan is
operated;
• The plan sponsor/employer if an administrator is not so
designated; or
• Any other person prescribed by applicable regulations if
an administrator is not designated and a plan sponsor
cannot be identified.
Line 3b. Enter the plan administrator’s nine-digit EIN. A
plan administrator must have an EIN for Form 5500-SF
reporting. If the plan administrator does not have an EIN, it
must apply to the IRS for one as explained in the
instructions for line 2b. One EIN should be entered for a
group of individuals who are, collectively, the plan
administrator.
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 obtain an
EIN.
Line 3c. Enter the telephone number for the plan
administrator.
Line 4. If the plan sponsor’s name and/or EIN have
changed since the last annual return/report was filed for this
plan, enter the plan sponsor’s name, EIN, and the plan
number as it appeared on the last annual return/report filed.

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individual to whom an insurance company has made an
irrevocable commitment to pay all the benefits to which the
individual is entitled under the plan.
3. Other retired or separated participants entitled to
future benefits (i.e., any individuals who are retired or
separated from employment covered by the plan and who
are entitled to begin receiving benefits under the plan in the
future). This does not include any individual to whom an
insurance company has made an irrevocable commitment to
pay all the benefits to which the individual is entitled under
the plan.
4. Deceased individuals who had one or more
beneficiaries who are receiving or are entitled to receive
benefits under the plan. This does not include any individual
to whom an insurance company has made an irrevocable
commitment to pay all the benefits to which the beneficiaries
of that individual are entitled under the plan.

accounts under Code section 408. Examples of assets that
would qualify as eligible plan assets for this annual reporting
purpose are mutual fund shares, investment contracts with
insurance companies or banks that provide the plan with
valuation information at least annually, publicly traded stock
held by a registered broker dealer, cash and cash
equivalents held by a bank. Participant loans meeting the
requirements of ERISA section 408(b)(1), are also “eligible
plan assets” for this purpose whether or not they have been
deemed distributed.

Line 6b. In addition to all of the plan’s assets being eligible
plan assets as defined in line 6a, to be eligible to file the
Form 5500-SF the plan also must be exempt from the
requirement to be audited annually by an independent
qualified public accountant (IQPA).

Welfare plans that cover fewer than 100 participants at
the beginning of the plan year are exempt from the annual
audit requirement.

A pension plan is exempt from the annual audit
requirement if it covered fewer than 100 participants at the
beginning of the plan year or under 29 CFR 2520.103-1(d)
was eligible to and filed as a small plan for plan year 2008
and did not cover more than 120 participants at the
beginning of plan year 2009 and meets the following three
requirements for the audit waiver under 29 CFR
2520.104-46: (1) as of the last day of the preceding plan
year, at least 95% of a small pension plan’s assets were
“qualifying plan assets;” (2) the plan includes the required
audit waiver disclosure in the Summary Annual Report
(SAR) furnished to participants and beneficiaries, in
accordance with 29 CFR 2520.104b-10. For defined benefit
pension plans that are required pursuant to section 101(f) of
ERISA to furnish an Annual Funding Notice (AFN), the
administrator must instead either provide the information to
participants and beneficiaries with the AFN or as a
stand-alone notification at the time a SAR would have been
due and in accordance with the rules for furnishing an SAR,
although such plans do not have to furnish a SAR; and (3) in
response to a request from any participant or beneficiary,
the plan administrator must furnish without charge copies of
statements from the regulated financial institutions holding
or issuing the plan’s “qualifying plan assets.”

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In order to be eligible to file the Form 5500-SF, a
small pension plan must meet the audit waiver
CAUTION conditions by virtue of having 95% or more of its
assets as “qualifying plan assets” in accordance with 29
CFR 2520.104-46(b)(1)(i)(A)(1). If the small plan satisfies
the conditions of the audit waiver by virtue of having
enhanced fidelity bond under 29 CFR
2520.104-46(b)(1)(i)(A)(2), the plan does not satisfy the
conditions for filing the Form 5500-SF and must file the
Form 5500, along with the appropriate schedules and
attachments. Also, although many “qualifying plan assets”
for audit waiver purposes will also be “eligible plan assets”
as described in the instructions for line 6a, the definitions
are not the same. If, as of the last day of the preceding plan
year, the plan was 100% invested in “eligible plan assets,”
the plan would satisfy the “qualifying plan asset” prong of
the audit waiver conditions. Holding all the plan’s
investments in “qualifying plan assets,” however, would not
necessarily satisfy the conditions for filing the Form
5500-SF. For example, real estate held by a bank as trustee
for a plan could be a qualifying plan asset for purposes of
the small pension plan audit waiver conditions but it would
not be a “eligible plan asset” for purposes of the plan being
eligible to file the Form 5500-SF because real estate would
not have a readily determinable fair market value as
described in 29 CFR 2520.103-1(c)(2)(ii)(C).

Special conditions for filing the Form 5500-SF apply to
“one-participant plans.” See Specific Instructions for
“One-Participant Plans” on page 6.
Line 6a – Eligible Plan Assets. To be eligible to file the
Form 5500-SF, all of the plan’s assets must be “eligible plan
assets.” Answer line 6a “Yes” or “No.” Do not leave this
question blank. If the answer to line 6a is “No” you CANNOT
file the Form 5500-SF and must file the Form 5500. See
discussion under Who May File Form 5500-SF.
For purposes of this line, “eligible plan assets” are assets
that have a readily determinable fair market value for
purposes of this annual reporting requirement as described
in 29 CFR 2520.103-1(c)(2)(ii)(C), are not employer
securities, and are held or issued by one of the following
regulated financial institutions: a bank or similar financial
institution as defined in 29 CFR 2550.408b-4(c) (for
example, banks, trust companies, savings and loan
associations, domestic building and loan associations, and
credit unions); an insurance company qualified to do
business under the laws of a state; organizations registered
as broker-dealers under the Securities Exchange Act of
1934; investment companies registered under the
Investment Company Act of 1940; or any other organization
authorized to act as a trustee for individual retirement

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Line 6. If your plan is required to file an annual return/
report, you may file the Form 5500-SF instead of the Form
5500 only if you meet all of the eligibility conditions listed
below.
1. The plan (a) covered fewer than 100 participants at
the beginning of the plan year 2009, or (b) under 29 CFR
2520.103-1(d) was eligible to and filed as a small plan for
plan year 2008 and did not cover more than 120 participants
at the beginning of plan year 2009 (see instructions for line 5
on counting the number of participants);
2. The plan did not hold any employer securities at any
time during the plan year;
3. At all times during the plan year, the plan was 100%
invested in certain secure, easy to value assets such as
mutual fund shares, investment contracts with insurance
companies and banks valued at least annually, publicly
traded securities held by a registered broker dealer, cash
and cash equivalents, and plan loans to participants that
meet the definition of “eligible plan assets” (see the
instructions for line 6a);
4. The plan is eligible for the waiver of the annual
examination and report of an independent qualified public
accountant (IQPA) under 29 CFR 2520.104-46 (but not by
reason of enhanced bonding), which requirement includes,
among others, giving certain disclosures and supporting
documents to participants and beneficiaries regarding the
plan’s investments (see instructions for line 6b); and
5. The plan is not a multiemployer plan.

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Line 7b. Enter the total liabilities at the beginning and end
of the plan year. Liabilities to be entered here do not include
the value of future pension payments to participants. The
amount to be entered in line 7b for accrual basis filers
includes, 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 (IBNR) 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.

Part III – Financial Information

Note. The cash, modified cash, or accrual basis may be
used for recognition of transactions in Parts I and II, as long
as you use one method consistently. Round off all amounts
reported on the Form 5500-SF to the nearest dollar. Any
other amounts are subject to rejection. Check all subtotals
and totals carefully.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good
faith under the terms of the plan by a trustee or a named
fiduciary, assuming an orderly liquidation at the time of the
determination. See ERISA section 3(26).
Line 7 – Plan Assets and Liabilities. Amounts reported
on lines 7a, 7b, and 7c of the Form 5500-SF for the
beginning of the plan year must be the same as reported for
the end of the plan year for the corresponding lines on the
return/report for the preceding plan year. That means that if
the Form 5500 was filed the previous year, the amounts
reported on the Form 5500-SF, lines 7a, column (a), 7b,
column (a), and 7c, column (a), should correspond to the
amounts entered in lines 1a, column (b), 1b, column (b), and
1c, column (b), of the 2008 Schedule I (Form 5500) or the
amounts entered in lines 1f, column (b), 1k, column (b), and
1l, column (b), of Schedule H (Form 5500) whichever
schedule was filed.
Line 7a. Enter the total amount of plan assets at the
beginning of the plan year in column (a). Do not include
contributions designated for the 2009 plan year in column
(a).
Enter the total amount of plan assets at the end of the
plan year in column (b). Do not include in column (b) a
participant loan that has been deemed distributed during the
plan year under the provisions of Code section 72(p) and
Treasury Regulations section 1.72(p)-1 if both the following
circumstances apply: (1) Under the plan, the participant loan
is treated as a directed investment solely of the participant’s
individual account; and (2) As of the end of the plan year,
the participant is not continuing repayment under the loan.
If the deemed distributed participant loan is included in
column (a) and both of these circumstances apply, include
the value of the loan as a deemed distribution on line 8e.
However, if either of these two circumstances does not
apply, the current value of the participant loan (including
interest accruing thereon after the deemed distribution)
should be included in column (b) without regard to the
occurrence of a deemed distribution.
After a participant loan that has been deemed distributed
is included in the amount reported on line 8e, it is no longer
to be reported as an asset on line 7a unless, in a later year,
the participant resumes repayment under the loan.
However, such a loan (including interest accruing thereon
after the deemed distribution) that has not been repaid is still
considered outstanding for purposes of applying Code
section 72(p)(2)(A) to determine the maximum amount of
subsequent loans. Also, the deemed distribution is not
treated as an actual distribution for other purposes, such as
the qualification requirements of Code section 401,
including, for example, the determination of top-heavy status
under Code section 416 and the vesting requirements of
Treasury Regulations section 1.411(a)-7(d)(5). See Q&As
12 and 19 of Treasury Regulations section 1.72(p)-1.
The entry on line 7a, column (b) (plan assets at end of
year) must include the current value of any participant loan
included as a deemed distribution in the amount reported for
any earlier year if, during the plan year, the participant
resumes repayment under the loan. In addition, the amount
to be entered on line 8e must be reduced by the amount of
the participant loan reported as a deemed distribution for the
earlier year.

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General Instructions to Form 5500-SF

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Line 8c. Enter the total of all cash contributions (line 8a(1)
through line 8a(3)) and other plan income (line 8b) during
the plan year. If entering a negative number, enter a minus
sign (“ – ”) to the left of the number.
Line 8d. Include (1) payments made (and for accrual basis
filers payments due) to or on behalf of participants or
beneficiaries in cash, securities, or other property (including
rollovers of an individual’s accrued benefit or account
balance). Include all eligible rollover distributions as defined
in Code section 401(a)(31)(D) paid at the participant’s
election to an eligible retirement plan (including an IRA
within the meaning of 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

Line 7c. Enter the net assets as of the beginning and end
of the plan year. (Subtract line 7b from 7a). Line 7c, column
(b), must equal the sum of line 7c, column (a), plus lines 8i
(net income (loss)) and 8j (transfers to (from) the plan).
Line 8 – Income, Expenses, and Transfers for this Plan
Year.
Line 8a. Include the total cash contributions received and/
or (for accrual basis plans) due to be received.
Line 8a(1). Plans using the accrual basis of accounting
must not include contributions designated for years before
the 2009 plan year on line 8a(1).
Line 8a(2). For welfare plans, report all employee
contributions, including all elective contributions under a
cafeteria plan (Code section 125). For pension plans,
participant contributions, for purposes of this line item, also
include elective contributions under a qualified cash or
deferred arrangement (Code section 401(k)).
Line 8a(3). Enter the current value, at date contributed, of
all other contributions, including rollovers from other plans.
Line 8b. Enter all other plan income for the plan year. Do
not include transfers from other plans that are reported on
line 8j. Examples of other income received and/or receivable
include:
1. Interest on investments (including money market
accounts, sweep 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. Net gain or loss from the sale of assets.
4. Other income such as unrealized appreciation
(depreciation) in plan assets.

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participants or beneficiaries, include the current value as of
the date of distribution.
Line 8e. Include on this line all distributions paid during the
plan year of excess deferrals under Code section
402(g)(2)(A)(ii), excess contributions under 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 as well as any attributable income that was also
distributed.
For line 8e, also include in the total amount a participant
loan included in line 7a, column (a) that has been deemed
distributed during the plan year under the provisions of Code
section 72(p) and Treasury Regulations section 1.72(p)-1
only if both of the following circumstances apply:
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 8h. Enter the total of all benefits paid or due reported
on lines 8d and 8e and all other plan expenses reported on
lines 8f and 8g during the year.
Line 8i. Subtract line 8h from line 8c.
Line 8j. Enter the net value of all assets transferred to and
from the plan during the plan year including those resulting
from mergers and spinoffs. A transfer of assets or liabilities
occurs when there is a reduction of assets or liabilities with
respect to one plan and the receipt of these assets or the
assumption of these liabilities by another plan. Transfers out
at the end of the year should be reported as occurring
during the plan year.

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 8j but must be included in
benefit payments reported on line 8d. Do not submit IRS
Form 1099-R with the Form 5500-SF.

Part IV – Plan Characteristics

Line 9. Enter on lines 9a and 9b, as appropriate, all
applicable plan characteristics codes. See the List of Plan
Characteristics Codes on pages 18 and 19.

Part V – Compliance Questions
Line 10. Answer all lines either “Yes” or “No.” Do not leave
any answer blank unless otherwise directed. For lines 10a,
b, c, d, e, f, and g, if the answer is “Yes,” an amount must be
entered.

Note. The amount to be reported on line 8e must be
reduced if, during the plan year, a participant resumes
repayment under a participant loan reported as a deemed
distribution on line 2g of Schedule H or Schedule I of a prior
Form 5500 or line 8e of a prior Form 5500-SF for any earlier
year. The amount of the required reduction is the amount of
the participant loan that was reported as a deemed
distribution on such line for any earlier year. If entering a
negative number, enter a minus sign (“ – ”) to the left of the
number. The current value of the participant loan must then
be included on line 7a, column (b) (plan assets – end of
year).

Note. “One-participant plans” should complete only
question 10g.

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Line 10a. Amounts paid by a participant or beneficiary to
an employer and/or withheld by an employer for contribution
to the plan are participant contributions that become plan
assets as of the earliest date on which such contributions
can reasonably be segregated from the employer’s general
assets. See 29 CFR 2510.3-102. Plans that check “Yes,”
must enter the aggregate amount of all late contributions for
the year. The total amount of the delinquent contributions
should be included on line 10a for the year in which the
contributions were delinquent and should be carried over
and reported again on line 10a for each subsequent year (or
on line 4a of Schedule H or I of the Form 5500 if not eligible
to file the Form 5500-SF in the subsequent year) until the
year after the violation has been fully corrected by payment
of the late contributions and reimbursement of the plan for
lost earnings or profits. If no participant contributions were
received or withheld by the employer during the plan year,
answer “No.”

Although certain participant loans deemed distributed are
to be reported on line 8e, and are not to be reported on the
Form 5500-SF or on the Schedule H or Schedule I of the
Form 5500 as an asset thereafter (unless the participant
resumes repayment under the loan in a later year), they are
still considered outstanding loans and are not treated as
actual distributions for certain purposes. See Q&As 12 and
19 of Treasury Regulations section 1.72(p)-1.
Line 8f. The amount to be reported for expenses involving
administrative service providers (salaries, fees, and
commissions) 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,
among others:
1. Salaries to employees of the plan;
2. Fees and expenses for accounting, actuarial, legal,
investment management, investment advice, and securities
brokerage services;
3. Contract administrator fees; and
4. Fees and expenses for individual plan trustees,
including reimbursement for travel, seminars, and meeting
expenses.

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If either of these circumstances does not apply, a
deemed distribution of a participant loan should not be
included in the total on line 8e. Instead, the current value of
the participant loan (including interest accruing thereon after
the deemed distribution) should be included on lines 7a,
column (b) (plan assets – end of year), and 10j (participant
loans – end of year), without regard to the occurrence of a
deemed distribution.

An employer holding participant contributions
commingled with its general assets after the earliest date on
which such contributions can reasonably be segregated
from the employer’s general assets will have engaged in a
prohibited use of plan assets (see ERISA section 406). If
such a nonexempt prohibited transaction occurred with
respect to a disqualified person (see Code section
4975(e)(2)), file IRS Form 5330, Return of Excise Taxes
Related to Employee Benefit Plans, with the IRS to pay any
applicable excise tax on the transaction.

Participant loan repayments paid to and/or withheld by an
employer for purposes of transmittal to the plan that were
not transmitted to the plan in a timely fashion must be
reported either on line 10a in accordance with the reporting
requirements that apply to delinquent participant
contributions or on line 10b. See Advisory Opinion
2002-02A, available at www.dol.gov/ebsa.

Line 8g. Other expenses (paid and/or payable) include
other administrative and miscellaneous expenses paid by or
charged to the plan, including among others office supplies
and equipment, telephone, and postage.

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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 which is an employer or an employee
organization described in C or D;
F. A relative of any individual described in A, B, C, or E;
G. A corporation, partnership, or trust or estate of which
(or in which) 50% or more of:
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.

for line 10a) are eligible for immediate relief from
payment of certain prohibited transaction excise taxes for
certain corrected transactions and the requirement to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr.
19, 2006). When the conditions of PTE 2002-51 have been
satisfied, the corrected transactions should be treated as
exempt under Code section 4975(c) for the purposes of
answering line 10b.

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Line 10c. Plans that check “Yes” must enter the aggregate
amount of fidelity bond coverage for all claims. Check “Yes”
only if the plan itself (as opposed to the plan sponsor or
administrator) is a named insured under a fidelity bond that
is from an approved surety covering plan officials and that
protects the plan from losses due to fraud or dishonesty as
described in 29 CFR Part 2580. Generally, every plan
official of an employee benefit plan who “handles” funds or
other property of such plan must be bonded. Generally, a
person shall be deemed to be “handling” funds or other
property of a plan, so as to require bonding, whenever his or
her duties or activities with respect to given funds are such
that there is a risk that such funds could be lost in the event
of fraud or dishonesty on the part of such person, acting
either alone or in collusion with others. Section 412 of
ERISA and 29 CFR Part 2580 describe the bonding
requirements, including the definition of “handling” (29 CFR
2580.412-6), the permissible forms of bonds (29 CFR
2580.412-10), the amount of the bond (29 CFR Part 2580,
Subpart C), and certain exemptions such as the exemption
for certain banks and insurance companies 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. For more information on the

Applicants that satisfy the VFCP requirements and

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

General Instructions to Form 5500-SF

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;

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Applicants that satisfy both the DOL Voluntary Fiduciary
Correction Program (VFCP) and the conditions of Prohibited
Transaction Exemption (PTE) 2002-51 are eligible for
immediate relief from payment of certain prohibited
transaction excise taxes for certain corrected transactions,
and are also relieved from the requirement to file the IRS
Form 5330 with the IRS. For more information on how to
apply under the VFCP, the specific transactions covered
(which transactions include delinquent participant
contributions to pension and welfare plans), and acceptable
methods for correcting violations, see 71 Fed. Reg. 20261
(Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19, 2006). All
delinquent participant contributions must be reported on line
10a at least for the year in which they were delinquent even
if violations have been fully corrected by the close of the
plan year. Information about the VFCP is also available on
the Internet at www.dol.gov/ebsa.
Line 10b. Plans that check “Yes” must enter the amount.
Check “Yes” if any nonexempt transaction with a
party-in-interest occurred. Do not check “Yes” with respect
to transactions that are: (1) statutorily exempt under Part 4
of Title I of ERISA; (2) administratively exempt under ERISA
section 408(a); (3) exempt under Code sections 4975(c) or
4975(d); (4) the holding of participant contributions in the
employer’s general assets for a welfare plan that meets the
conditions of ERISA Technical Release 92-01; or (5)
delinquent participant contributions or delinquent loan
repayments reported on line 10a. You may indicate that an
application for an administrative exemption is pending. If you
are unsure whether a transaction is exempt or not, you
should consult either with a qualified public accountant, legal
counsel, or both. If the plan is a qualified pension plan and a
nonexempt prohibited transaction occurred with respect to a
disqualified person, an IRS Form 5330 is required to be filed
with the IRS to pay the excise tax on the transaction.
Nonexempt transactions. Nonexempt transactions with
a party-in-interest include any direct or indirect:
A. Sale or exchange, or lease, of any property between
the plan and a party-in-interest.
B. Lending of money or other extension of credit between
the plan and a party-in-interest.
C. Furnishing of goods, services, or facilities between the
plan and a party-in-interest.
D. Transfer to, or use by or for the benefit of, a
party-in-interest, of any income or assets of the plan.
E. Acquisition, on behalf of the plan, of any employer
security or employer real property in violation of ERISA
section 407(a).
F. Dealing with the assets of the plan for a fiduciary’s own
interest or own account.
G. Acting in a fiduciary’s individual or any other capacity
in any transaction involving the plan on behalf of a party
(or represent a party) whose interests are adverse to the
interests of the plan or the interests of its participants or
beneficiaries.
H. Receipt of any consideration for his or her own
personal account by a party-in-interest who is a fiduciary
from any party dealing with the plan in connection with a
transaction involving the income or assets of the plan.

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fidelity bonding requirements, see Field Assistance Bulletin
2008-04, available at www.dol.gov/ebsa.
Note. Plans are permitted under certain conditions to
purchase fiduciary liability insurance. These fiduciary liability
insurance policies are not written specifically to protect the
plan from losses due to dishonest acts and cannot be
reported as fidelity bonds on line 10c.
Line 10d. Check “Yes” if the plan had suffered or
discovered any loss as a result of any dishonest or
fraudulent act(s) even if the loss was reimbursed by the
plan’s fidelity bond or from any other source. If “Yes” is
checked enter the full amount of the loss. If the full amount
of the loss has not yet been determined, provide an estimate
as determined in good faith by a plan fiduciary. You must
keep, in accordance with ERISA section 107, records
showing how the estimate was determined.

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).

CAUTION

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

Gifts from multiple employees of one service provider
should be treated as originating from a single source when
calculating whether the $100 threshold applies. On the other
hand, in applying the threshold to an occasional gift received
from one source by multiple employees of a single service
provider, the amount received by each employee should be
separately determined in applying the $50 and $100
thresholds. For example, if six employees of a broker attend
a business conference put on by an insurer designed to
educate and explain the insurer’s products for employee
benefit plans, and the insurer provides, at no cost to the
attendees, refreshments valued at $20 per individual, the
gratuities would not be reportable on this line even though
the total cost of the refreshments for all the employees
would be $120.

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These thresholds are for purposes of line 10e reporting.
Filers are cautioned that the payment or receipt of gifts and
gratuities of any amount by plan fiduciaries may violate
ERISA and give rise to civil liabilities and criminal penalties.
Important Reminder. The insurance company,
insurance service, or other similar organization is required
under ERISA section 103(a)(2) to provide the plan
administrator with the information needed to complete this
return/report. Your insurance company must provide you
with the information you need to answer this question. If
your insurance company, insurance service, or other similar
organization does not automatically send you this
information, you should make a written request for the
information. If you have difficulty getting the information from
your insurance company, contact the nearest office of the
DOL’s Employee Benefits Security Administration.

Line 10f. You must check “Yes” if any benefits due under
the plan were not timely paid or not paid in full. Include in
this amount the total of any outstanding amounts that were
not paid when due in previous years that have continued to
remain unpaid.

Line 10e. If any benefits under the plan are provided by an
insurance company, insurance service, or other similar
organization (such as Blue Cross Blue Shield or a health
maintenance organization) or if the plan has investments
with insurance companies such as guaranteed investment
contracts (GICs), report the total of all insurance fees and
commissions paid to agents, brokers and/or other persons
directly or indirectly attributable to the contract(s) placed
with or retained by the plan.
For purposes of line 10e, commissions and fees include
sales or base commissions and all other monetary and
non-monetary compensation where the broker’s, agent’s, or
other person’s eligibility for the payment or the amount of
the payment is based, in whole or in part, on the value (e.g.,
policy amounts, premiums) of contracts or policies (or
classes thereof) placed with or retained by an ERISA plan,
including, for example, persistency and profitability bonuses.
The amount (or pro rata share of the total) of such
commissions or fees attributable to the contract or policy
placed with or retained by the plan must be reported.
Insurers must provide plan administrators with a
proportionate allocation of commissions and fees
attributable to each contract. Any reasonable method of
allocating commissions and fees to policies or contracts is
acceptable, provided the method is disclosed to the plan
administrator. A reasonable allocation method could allocate
fees and commissions based on a calendar year calculation
even if the plan year or policy year was not a calendar year.
For additional information on these reporting requirements,
see ERISA Advisory opinion 2005-02A, available on the
Internet at www.dol.gov/ebsa.
Where benefits under a plan are purchased from and
guaranteed by an insurance company, insurance service, or
other similar organization, and the total fees and
commissions are reported on the Form 5500-SF, payments
of reasonable monetary compensation by the insurer out of
its general assets to affiliates or third parties for performing
administrative activities necessary for the insurer to fulfill its
contractual obligation to provide benefits, where there is no
direct or indirect charge to the plan for administrative
services other than the insurance premium, then the
payments for administrative services by the insurer to the
affiliates or third parties do not need to be reported on line
10e. This would include compensation for services such as
recordkeeping and claims processing services provided by a
third party pursuant to a contract with the insurer to provide
those services but would not include compensation provided
by the insurer incidental to the sale or renewal of a policy,
such as finders’ fees, insurance brokerage commissions and
fees, or similar fees.

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Reporting is not required for occasional gifts or meals of
insubstantial value which are tax deductible for federal
income tax purposes by the person providing the gift or meal
and would not be taxable income to the recipient. For this
exemption to be available, the gift or gratuity must be both
occasional and insubstantial. For this exemption to apply,
the gift must be valued at less than $50, the aggregate value
of gifts from one source in a calendar year must be less than
$100, but gifts with a value of less than $10 do not need to
be counted toward the $100 annual limit. If the $100
aggregate value limit is exceeded, then the aggregate value
of all the gifts will be reportable. For this purpose, gifts of
less than $10 also do not need to be included in calculating
the aggregate value of all gifts required to be reported if the
$100 limit is exceeded.

Line 10g. You must check “Yes” if the plan had any
participant loans outstanding at any time during the plan
year and enter the amount outstanding as of the end of the
plan year. If no participant loans are outstanding as of the
end of the plan year, enter “0.”

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General Instructions to Form 5500-SF

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that are amortizing a waiver of the minimum funding
standard for a prior year should fill out line 12a and then skip
to line 13. Those defined contribution plans answering “Yes”
to the line 12 question that do not fill out line 12a should fill
out lines 12b-12e.
Line 12a. If a money purchase defined contribution plan
(including a target benefit plan) has received a waiver of the
minimum funding standard, and the waiver is currently being
amortized, complete lines 3, 9, and 10 of Schedule MB
(Form 5500). See instructions for Schedule MB in the
Instructions for Form 5500.
Line 12b. The minimum required contribution for a money
purchase defined contribution 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 12c. Include all contributions for the plan year made
not later than 81/2 months after the end of the plan year.
Show only contributions actually made to the plan by the
date the form is filed. For example, do not include receivable
contributions for this purpose.
Line 12d. If the minimum required contribution exceeds the
contributions for the plan year made not later than 81/2
months after the end of the plan year, the excess is an
accumulated funding deficiency for the plan year. File IRS
Form 5330, Return of Excise Taxes Related to Employee
Benefit Plans, with the IRS to pay the excise tax on the
deficiency. There is a penalty for not filing Form 5330 on
time.
Line 12e. Check “Yes” if the minimum required contribution
remaining in line 12d will be made not later than 81/2 months
after the end of the plan year. If “Yes,” and contributions are
actually made by this date, then there will be no reportable
deficiency and IRS Form 5330 will not need to be filed.

Part VI – Pension Funding Compliance

Part VII – Plan Terminations and Transfers
of Assets

Line 10h. Code section 401(k) and other individual account
pension plans must complete line 10h. Other filers should
leave line 10h blank. Check “Yes” if there was a “blackout
period.” A blackout period is a temporary suspension of
more than three consecutive business days during which
participants or beneficiaries of a 401(k) or other individual
account pension plan were unable, or were limited or
restricted in their ability, to direct or diversify assets credited
to their accounts, obtain loans from the plan, or obtain
distributions from the plan. A “blackout period” generally
does not include a temporary suspension of the right of
participants and beneficiaries to direct or diversify assets
credited to their accounts, obtain loans from the plan, or
obtain distributions from the plan if the temporary
suspension is: (1) part of the regularly scheduled operations
of the plan that has been disclosed to participants and
beneficiaries; (2) due to a qualified domestic relations order
(QDRO) or because of a pending determination as to
whether a domestic relations order is a QDRO; (3) due to an
action or a failure to take action by an individual participant
or because of an action or claim by someone other than the
plan regarding a participant’s individual account; or (4) by
application of federal securities laws. For more information,
see the DOL’s regulation at 29 CFR 2520.101-3 (available
at www.dol.gov/ebsa).
Line 10i. Code section 401(k) and other individual account
pension plans who answered “Yes” to line 10h must
complete line 10i. Other filers should leave line 10i blank. If
there was a blackout period, did you provide the required
notice not less than 30 days nor more than 60 days in
advance of restricting the rights of participants and
beneficiaries to change their plan investments, obtain loans
from the plan, or obtain distributions from the plan? If so,
check “Yes.” See 29 CFR 2520.101-3 for specific notice
requirements and for exceptions from the notice
requirement. Also, answer “Yes” if one of the exceptions to
the notice requirement under 29 CFR 2520.101-3 applies.

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Line 13a. Check “Yes” if a resolution to terminate the plan
was adopted during this or any prior plan year, unless the
termination was revoked and no assets reverted to the
employer. If “Yes” is checked, enter the amount of plan
assets that reverted to the employer during the plan year in
connection with the implementation of such termination.
Enter “0” if no reversion occurred during the current plan
year.

General Instructions to Form 5500-SF

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A Form 5500 or a Form 5500-SF must be filed for
each year the plan has assets, and, for a welfare
CAUTION benefit plan, if the plan is still liable to pay benefits
for claims incurred before the termination date, but not yet
paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line 13b. Check “Yes” if all of the plan assets (including
insurance/annuity contracts) were distributed to the
participants and beneficiaries, legally transferred to the
control of another plan, or brought under the control of the
PBGC. (Include the amount of assets brought under the
control of the PBGC on line 8d.)
Check “No” for a welfare benefit plan that is still liable to
pay benefits for claims that were incurred before the
termination date, but not yet paid. See 29 CFR
2520.104b-2(g)(2)(ii).
Line 13c. Enter information concerning assets and/or
liabilities transferred from this plan to another plan(s)
(including spinoffs) during the plan year. A transfer of assets
or liabilities occurs when there is a reduction of assets or
liabilities with respect to one plan and the receipt of these
assets or the assumption of these liabilities by another plan.

Complete Part VI only if the plan is subject to the minimum
funding requirements of Code section 412 or ERISA section
302.
All qualified defined benefit and defined contribution
plans are subject to the minimum funding requirements of
Code section 412 unless they are described in the
exceptions listed under section 412(e)(2). These exceptions
include profit-sharing or stock bonus plans, insurance
contract plans described in section 412(e)(3), and certain
plans to which no employer contributions are made.
Nonqualified employee pension benefit plans are subject
to the minimum funding requirements of ERISA section 302
unless specifically exempted under ERISA sections 4(a) or
301(a).
The employer or plan administrator of a single-employer
or multiple-employer defined benefit plan that is subject to
the minimum funding requirements must file the Schedule
SB (Form 5500) as an attachment to the Form 5500-SF.
The employer or plan administrator of a money purchase
plan that is currently amortizing a waiver of the minimum
funding requirements must complete lines 3, 9, and 10 of
the Schedule MB (Form 5500) and file it as an attachment to
the Form 5500-SF.
Line 11. If “Yes” is checked, attach a completed and
signed Schedule SB (Form 5500). See the instructions for
the Schedule SB in the Instructions for Form 5500. If this is
a defined contribution pension plan, leave blank.
Line 12. Check the “Yes” box if the plan is a defined
contribution plan subject to the minimum funding
requirements of Code section 412 and ERISA section 302.
Those money purchase plans (including target benefit plans)

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Enter the name, EIN, and PN of the transferee plan(s)
involved on lines 13c(1), c(2) and c(3).

IRS Form 5310-A, Notice of Plan Merger or
Consolidation, Spinoff, or Transfer of Plan Assets or
CAUTION Liabilities; Notice of Qualified Separate Lines of
Business, must be filed at least 30 days before any plan
merger or consolidation or any transfer of plan assets or
liabilities to another plan. There is a penalty for not filing IRS
Form 5310-A on time. In addition, a transfer of benefit
liabilities involving a plan covered by PBGC insurance may
be reportable to the PBGC. See PBGC Form 10, Post-Event
Notice of Reportable Event, and PBGC Form 10-Advance,
Advance Notice of Reportable Event (see the “Reportable
Events and Large Unpaid Contributions” section of the
Practitioners page on PBGC’s website, which is available at
www.pbgc.gov/practitioners).
DELETE: ""

Do not use a social security number in place of an EIN or
include an attachment that contains visible social security
numbers. The Form 5500-SF is open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Form 5500-SF
may result in the rejection of the filing.

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 13c. Do not submit
Form 1099-R with the Form 5500-SF.

OMB Control Numbers

Agency
OMB Number
Employee Benefits Security Administration . . . . . . . 1210 – 0110
1210 – 0089
Internal Revenue Service . . . . . . . . . . . . . . . . . . . 1545 – 1610
Pension Benefit Guaranty Corporation . . . . . . . . . . 1212 – 0057

Paperwork Reduction Act Notice

Form
Form 5500-SF
Schedule MB (Form 5500)
Schedule SB (Form 5500)

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We ask for the information on this form to carry out the law as specified in ERISA and in Code sections 6058(a) and
6059(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. The Form 5500-SF return/reports are open to public inspection and are subject
to publication on the Internet.
The time needed to complete and file the Form 5500-SF and the Schedules SB (Form 5500) and MB (Form 5500) shown
in the list below reflects the combined requirements of the Internal Revenue Service, Department of Labor, and Pension
Benefit Guaranty Corporation. These times will vary depending on individual circumstances. The estimated average times
are:

Pension Plans

Welfare Plans

2 hr., 32 min.
3 hr., 20 min.
6 hr., 49 min.

2 hr., 32 min.
N/A
N/A

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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 this form or these
schedules to this address. The form and schedules must be filed electronically. See How To File – Electronic Filing
Requirement.

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LIST OF PLAN CHARACTERISTICS CODES FOR LINES 9a AND 9b
Defined Benefit Pension Features
Benefits are primarily pay related.

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 (for example, 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 (for example, 10 percent of final average pay
times years of service, or the amount of the employee’s
hypothetical account balance).
Floor-offset plan – Plan benefits are subject to offset for
retirement benefits provided by an employer-sponsored
defined contribution plan.
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).

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.

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) with only QNECs and/or
QMACs. Also not applicable if Code section 403(b)(1),
403(b)(7), or 408 arrangement/accounts annuities.

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.

Code section 403(b)(7) accounts.

Code section 408 accounts and annuities.

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

Plan provides for automatic enrollment in plan that has
employee contributions deducted from payroll.

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).

Total or partial participant-directed account plan – plan
uses default investment account for participants who fail
to direct assets in their account.

Code section 403(b)(1) arrangement.

Defined Contribution Pension Features

CODE

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).

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.

Pre-approved pension plan – A master, prototype, or
volume submitter plan that is the subject of a favorable
opinion or advisory letter from the IRS.

A one-participant plan that satisfies minimum coverage
requirements of Code section 410(b) only when combined
with another plan of the employer.

Target benefit plan.

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

Money purchase (other than target benefit).

Other Pension Benefit Features

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

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CODE

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Profit-sharing.

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

CODE

General Instructions to Form 5500-SF

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LIST OF PLAN CHARACTERISTICS CODES FOR LINES 9a AND 9b (Continued)
3H

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

U.S.-based plan that covers residents of Puerto Rico and
is qualified under both Code section 401 and section
1165 of Puerto Rico Code.
Welfare Benefit Features
Health (other than vision or dental).

Life insurance.

Supplemental unemployment.

Dental.

Vision.

Temporary disability (accident and sickness).

Prepaid legal.

Long-term disability.

Scholarship (funded).

Death benefits (include travel accident but not life
insurance).

Taft-Hartley Financial Assistance for Employee Housing
Expenses.

Other.

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

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

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

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D

Severance pay.

Apprenticeship and training.

CODE

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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

Forms 5500, 5500-SF, and
5500-EZ Codes for Principal
Business Activity

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

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

General Instructions to Form 5500-SF

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Utilities

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

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

Wholesale Trade

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211110
212110
212200
212310
212320

Mining

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

Code

Page 20 of 23

Instructions for Form 5500-SF

16:05 - 31-AUG-2009

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

Forms 5500, 5500-SF, 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)

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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

-20-

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

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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

Real Estate and Rental and
Leasing

Transportation and
Warehousing

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)

General Instructions to Form 5500-SF

Page 21 of 23

Instructions for Form 5500-SF

16:05 - 31-AUG-2009

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

Forms 5500, 5500-SF, 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

551111 Offices of Bank Holding
Companies
551112 Offices of Other Holding
Companies

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)

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Health Care and Social
Assistance

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

General Instructions to Form 5500-SF

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)

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

-21-

921000 Governmental Instrumentality
or Agency

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Management of Companies
(Holding Companies)

Arts, Entertainment, and
Recreation

R
Educational Services

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

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

Page 22 of 23

Instructions for Form 5500-SF

16:05 - 31-AUG-2009

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

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 is not be filed with your Form 5500-SF.
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 or annual pension funding 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 fidelity bonds protecting the plan against losses due to fraud or dishonesty by persons
who handle plan funds or other property?

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?

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

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?

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?

10.

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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.
1.

Has the plan engaged in any financial transactions with persons related to the plan or any plan official? (For
example, has the plan made a loan to or participated in an investment with the employer?)

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?

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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.

-22-

General Instructions to Form 5500-SF

Page 23 of 23

Instructions for Form 5500-SF

16:05 - 31-AUG-2009

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

Index

A
Annual Report Identification
Information . . . . . . . . . . . . . . . . . . . . . . . . . . 7
B
Basic Plan Information . . . . . . . . . . . . . . . . . 8

H
How To File – Electronic Filing
Requirement . . . . . . . . . . . . . . . . . . . . . . . . 5
How To Get Assistance . . . . . . . . . . . . . . . . 1
N
Nonexempt Transactions . . . . . . . . . . . . . 13
O
One-Participant Plans . . . . . . . . . . . . . . . . . . 6

T
Transfers of Assets . . . . . . . . . . . . . . . . . . . 15

P
Paperwork Reduction Act Notice . . . . . . 16
Party-In-Interest . . . . . . . . . . . . . . . . . . . . . . 13
Penalties:
Administrative . . . . . . . . . . . . . . . . . . . . . . . 5
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Pension and Welfare Plans Required To
File Annual Return/Report . . . . . . . . . . . 2

W
What To File . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
When To File . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Who May File . . . . . . . . . . . . . . . . . . . . . . . . . . 3

■

T
D

R
AF
T

R
AF
D

E
EFAST2 Processing System . . . . . . . . . . . 1
ERISA Compliance Quick
Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Extension of Time To File . . . . . . . . . . . . . . 4

D
Delinquent Filer Voluntary Compliance
(DFVC) Program . . . . . . . . . . . . . . . . . . . . 4

Pension Funding Compliance . . . . . . . . . 15
Plan Assets and Liabilities . . . . . . . . . . . . 11
Plan Characteristics Codes . . . . . . . . . . . 17
Plan Terminations . . . . . . . . . . . . . . . . . . . . 15
Plans Exempt From Filing . . . . . . . . . . . . . . 2
S
Signature and Date . . . . . . . . . . . . . . . . . . . . 6
Specific Line-by-Line Instructions (Form
5500-SF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

C
Change in Plan Year . . . . . . . . . . . . . . . . . . . 4
Codes for Principal Business
Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Compliance Questions . . . . . . . . . . . . . . . . 12

F
Financial Information . . . . . . . . . . . . . . . . . . 11

General Instructions to Form 5500-SF

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File Type	application/pdf
File Title	C:\Batch\Users\Pagersvc[DS]\I5500SF\I550
File Modified	2009-09-15
File Created	2009-08-31