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Instructions for Form 5500
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15:59 - 31-AUG-2009
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Department of the Treasury
Internal Revenue Service
Department of Labor
Employee Benefits
Security Administration
Pension Benefit
Guaranty Corporation
2009
8/31/2009 DRAFT for REVIEW.
9/15/09 Received proposed
changes to this draft are
highlighted on pages 1, 2, 24, 40,
42, 43, 50, and 55.
Instructions for Form 5500
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Annual Return/Report of Employee Benefit Plan
received, your form may be subject to further detailed review,
and your filing may be rejected based upon this further review.
Code section references are to the Internal Revenue Code
unless otherwise noted. ERISA refers to the Employee
Retirement Income Security Act of 1974.
ERISA and the Code provide for the assessment or
imposition of penalties for not submitting the required
for defined benefit pension plans
information when due. See Penalties.
EFAST2 Processing System
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Annual 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 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/actuarialresearch.html for 2008 and
short plan year 2009 actuarial information filed under the
previous paper-based system.
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Changes To Note
Electronic Filing Mandate. For plan years commencing on or
after January 1, 2009, you must file electronically using the
EFAST2 processing system. Plan administrators and direct
filing entities are reminded that they must maintain an original
copy of the Form 5500 annual return/report, with all required
signatures, as part of their records. Filers may use electronic
media for record maintenance and retention, so long as they
meet the applicable requirements.
Information on Participants With Deferred Vested Benefits
Who Separated From the Service Covered by the Plan.
Filers required to submit information on participants with a
deferred vested benefit, who separated from the service
covered by the plan, must file an annual registration statement
identifying those participants with the IRS. Filers cannot file this
information on a Schedule SSA or any other schedule or
attachment with their Form 5500 in EFAST2 because it contains
protected social security information and all information filed
with EFAST2 is subject to immediate publication on the
Internet. Filings that include social security information are
subject to rejection.
Removal of Schedules E and SSA. In connection with the
move to the electronic filing system, the Schedule E and
Schedule SSA have been removed from the Form 5500.
Limited Financial Reporting Exemption for Code Section
403(b) Plans Eliminated. Code section 403(b) plans that are
subject to Title I of ERISA for plan years commencing on or
after January 1, 2009, are now subject to the annual reporting
rules that apply to other ERISA-covered pension plans. Small
Code section 403(b) plans may be eligible to file the Form
5500-SF (Short Form Annual Return/Report of Employee
Benefit Plan). See instructions to the Form 5500-SF.
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The Form 5500, Annual Return/Report of Employee Benefit
Plan, including all required schedules and attachments (Form
5500 return/report), is used to report information concerning
employee benefit plans and Direct Filing Entities (DFEs). Any
administrator or sponsor of an employee benefit plan subject to
ERISA must file information about each benefit plan every year
(pursuant to Code section 6058 and ERISA sections 104 and
4065). Some plans participate in certain trusts, accounts, and
other investment arrangements that file a Form 5500 annual
return/report as DFEs. See Who Must File and When To File.
The Internal Revenue Service (IRS), Department of Labor
(DOL), and Pension Benefit Guaranty Corporation (PBGC)
have consolidated certain returns and report forms to reduce
the filing burden for plan administrators and employers.
Employers and administrators who comply with the instructions
for the Form 5500 generally will satisfy the annual reporting
requirements for the IRS and DOL.
Defined contribution and defined benefit pension plans may
have to file additional information with the IRS including Form
5330, Return of Excise Taxes Related to Employee Benefit
Plans, and Form 5310-A, Notice of Plan Mergers or
Consolidated, Spinoff, or Transfer of Plan Assets or Liabilities;
Notice of Qualified Separate Lines of Business. See www.irs.
gov for more information.
Plans covered by the PBGC have special additional
requirements, including premiums and reporting certain
transactions directly with that agency. See PBGC’s website
(www.pbgc.gov/practitioners/) for information on premium
payments and reporting and disclosure.
Each Form 5500 must accurately reflect the characteristics
and operations of the plan or arrangement being reported. The
requirements for completing the Form 5500 will vary according
to the type of plan or arrangement. The section What To File
summarizes what information must be reported for different
types of plans and arrangements. The Quick Reference Chart
of Form 5500, Schedules and Attachments, gives a brief guide
to the annual return/report requirements of the 2009 Form
5500.
The Form 5500 must be filed electronically as noted above.
See How To File – Electronic Filing Requirement instructions
and the EFAST2 website at www.efast.dol.gov. Your Form
5500 entries will be initially screened electronically. Your entries
must satisfy this screening for your filing to be received. Once
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About the Form 5500
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Under the computerized ERISA Filing Acceptance System
(EFAST2), you must electronically file your 2009 Form 5500.
Your Form 5500 entries will be initially screened electronically.
For more information, see the instructions for Electronic Filing
Requirement and the EFAST2 website at www.efast.dol.gov.
You cannot file a paper Form 5500 by mail or other delivery
service.
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/ebsa.
Cat. No. 13502B
Page 2 of 71
Instructions for Form 5500
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valuation information at least annually and mutual fund shares
are not reportable on line 4g.
Schedules H and I.
• A new standardized schedule is now provided for reporting
delinquent participant contributions on line 4a. The instructions
for line 4a now permit inclusion of delinquent forwarding of
participant loan repayments on line 4a, provided that filers that
choose to include such participant loan repayments on line 4a
use the same supplemental schedule and IQPA disclosure
requirements for the loan repayments as for delinquent
transmittals of participant contributions.
• Line 4l has been added to report whether the plan failed to
provide any benefit when due under the plan.
• Lines 4m and 4n have been added for plan administrators to
report whether there has been a blackout (temporary
suspension, limitation, or restriction lasting more than three
consecutive business days of any ability of participants or
beneficiaries to direct or diversify assets credited to their
accounts, to obtain loans from the plan, or to obtain plan
distributions). If there was a blackout, plan administrators will
have to state if participants either were provided the required
notice of this suspension period or one of the exceptions to
providing the blackout notice applies.
Schedule I. Line 2 has been revised to have plans separately
report expenses for administrative service providers (salaries,
fees, and commissions) and other expenses.
Schedule MB. For those sponsors of a multiemployer plan
who elected under section 204 of the Worker, Retiree, and beginning
Employer Recovery Act of 2008 (WRERA), for the plan year
during the period January 1, 2009, to September 30, 2009, to
treat the plan as being in the same status (i.e., endangered,
seriously endangered, critical, or not endangered or critical) as
for the preceding plan year, regardless of the plan’s status as
certified by the plan actuary, the status code entered on line 4a
must be based on the actuarial certification of the plan’s status,
without regard to the WRERA election. The notification of an
election to use the previous year’s status will be provided in an
attachment to the Schedule R.
Schedule R.
• A new Part IV has been added for reporting certain employee
stock ownership plan (ESOP) information formerly reported on
Schedule E.
• Some additional information for defined benefit plans that
was provided in an attachment to the 2008 Schedule R (Form
5500) is now reported in Parts V and VI of the Schedule R. The
instructions for Part V relating to required attachments for
multiemployer defined benefit plans have been modified to take
into account elections under sections 204 and 205 of WRERA.
Schedule SB. A number of changes have been made to the
instructions to Schedule SB to reflect recent guidance, changes
made by WRERA, and information that was not applicable in
the first year that PPA funding rules were effective. See the
instructions to Schedule SB for more information.
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Table of Contents
Section 1: Who Must File . . . . . . . . . . . . .
Pension Benefit Plan . . . . . . . . . . . . . . . .
Welfare Benefit Plan . . . . . . . . . . . . . . . .
Direct Filing Entity (DFE) . . . . . . . . . . . . .
Section 2: When To File . . . . . . . . . . . . . .
Extension of Time To File . . . . . . . . . . . .
Section 3: Electronic Filing Requirement .
Amended Return/Report . . . . . . . . . . . . .
Final Return/Report . . . . . . . . . . . . . . . . .
Signature and Date . . . . . . . . . . . . . . . . .
Change in Plan Year . . . . . . . . . . . . . . . .
Penalties . . . . . . . . . . . . . . . . . . . . . . . .
Administrative Penalties . . . . . . . . . . . . .
Other Penalties . . . . . . . . . . . . . . . . . . .
Section 4: What To File . . . . . . . . . . . . . .
Form 5500 Schedules . . . . . . . . . . . . . . .
Pension Schedules . . . . . . . . . . . . . . . .
General Schedules . . . . . . . . . . . . . . . .
Pension Benefit Plan Filing Requirements .
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Application for Extension of Time To File Certain Employee
Plan Returns. Filers are no longer required to attach a copy
of IRS Form 5558, Application for Extension of Time To File
Certain Employee Plan Returns, to their Form 5500 filing or an
explanation of a special extension. Filers now merely check the
box on the Form 5500, and if applicable, enter a description of
the special extension. Plans must keep a copy of the Form
5558 with their records.
Form 5500.
• The optional, preparer information (former line 5) has been
removed.
• Multiemployer plans are now required to provide information
about the number of employers contributing to the plan on a
new line 7.
• A one-participant plan may not file an annual return on Form
5500 for 2009. Every one-participant plan that is required to file
an annual return for 2009 must instead file Form 5500-EZ,
Annual Return of One-Participant (Owners and Their Spouses)
Retirement Plan, or, if eligible, Form 5500-SF, Short Form
Annual Return/Report of Small Employee Benefit Plan. A
“one-participant plan” for this purpose 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. See the Instructions for Form 5500-EZ
and the Instructions for Form 5500-SF. 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 type
of plans described above.
• A pension benefit plan maintained outside the United States
primarily for the benefit of persons substantially all of whom are
nonresident aliens is not subject to Title I of ERISA and may not
file an annual return on Form 5500 for 2009. Every such plan
that is required to file an annual return under the Code for 2009
must instead file Form 5500-EZ. See the Instructions for Form
5500-EZ.
• New “plan characteristics codes” have been added to the
instructions for line 8 for defined contribution plans that use
“automatic enrollment” and “default investment” features.
• Plan characteristic code 3E, previously used to identify
prototype pension plans, has been removed from the List of
Plan Characteristics Codes for Form 5500 for 2009. Code 3D
will be used to identify all pre-approved pension plans, including
master, prototype, and volume submitter plans, for 2009.
• Feature codes for certain types of plans that are not subject
to Title I of ERISA have been eliminated because they will not
be filing the Form 5500 with EFAST2.
Schedule A.
• Fee and commission information formerly reported on line 2
is now clarified and broken out on lines 2 and 3.
• A new Part IV has been added for plan administrators to be
able to report insurance companies that fail or refuse to
provided any information necessary to complete Schedule A.
• A reminder has been added to the Schedule A instructions to
advise plan administrators that they should notify the insurer
that the plan administrator intends to identify the insurer on the
Schedule A as not having provided the information needed.
Schedule C.
• Schedule C has been revised to require expanded reporting
of receipt by service providers of indirect compensation.
• The “top 40” reporting scheme has been eliminated. You
must now report all service providers who receive $5,000 or
more in direct or indirect compensation.
• The instructions have been modified to make it clear that
those plans that would not have to complete the Schedule H
because they meet the conditions of the limited exemption
under 29 CFR 2520.104-44 or Technical Release 92-01, are
also not required to complete and file a Schedule C to report
information on service provider compensation.
Schedule H.
• Line 2b(2)(C) has been added for reporting dividends on
registered investment company (mutual fund) shares.
• The instructions for line 4g have been modified to make clear
that insurance investment contracts for which the plan received
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Instructions for Form 5500
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If you are a small plan (generally under 100 participants at
the beginning of the plan year), you may be eligible to file the
Form 5500-SF instead of the Form 5500. For more information,
see the instructions to the Form 5500-SF.
. . . . 10
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All pension benefit plans covered by ERISA must file an annual
return/report except as provided in this section. The return/
report must be filed whether or not the plan is “tax-qualified,”
benefits no longer accrue, contributions were not made this
plan year, or contributions are no longer made. Pension benefit
plans required to file include both defined benefit plans and
defined contribution plans.
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Pension Benefit Plan
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The following are among the pension benefit plans for which
a return/report must be filed.
1. Profit-sharing plans, stock bonus plans, money purchase
plans, 401(k) plans, etc.
2. Annuity arrangements under Code section 403(b)(1) and
custodial accounts established under Code section 403(b)(7)
for regulated investment company stock.
3. Individual retirement accounts (IRAs) established by an
employer under Code section 408(c).
4. Church pension plans electing coverage under Code
section 410(d).
5. Pension benefit plans that cover residents of Puerto Rico,
the U.S. Virgin Islands, Guam, Wake Island, or American
Samoa. This includes a plan that elects to have the provisions
of section 1022(i)(2) of ERISA apply.
6. Plans that satisfy the Actual Deferral Percentage
requirements of Code section 401(k)(3)(A)(ii) by adopting the
‘‘SIMPLE’’ provisions of section 401(k)(11).
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How To Get Assistance
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1. An unfunded excess benefit plan. See ERISA section
4(b)(5).
2. An annuity or custodial account arrangement under Code
section 403(b)(1) or (7) not established or maintained by an
employer as described in DOL Regulation 29 CFR 2510.3-2(f).
3. A Savings Incentive Match Plan for Employees of Small
Employers (SIMPLE) that involves SIMPLE IRAs under Code
section 408(p).
4. A simplified employee pension (SEP) or a salary
reduction SEP described in Code section 408(k) that conforms
to the alternative method of compliance in 29 CFR 2520.104-48
or 2520.104-49.
5. A church plan not electing coverage under Code section
410(d).
6. A pension plan that is maintained outside the United
States primarily for the benefit of persons substantially all of
whom are nonresident aliens.
7. An unfunded pension plan for a select group of
management or highly compensated employees that meets the
requirements of 29 CFR 2520.104-23, including timely filing of a
registration statement with the DOL.
8. An unfunded dues financed pension benefit plan that
meets the alternative method of compliance provided by 29
CFR 2520.104-27.
9. An individual retirement account or annuity not
considered a pension plan under 29 CFR 2510.3-2(d).
10. A governmental plan.
11. One-Participant (Owners and Their Spouses) Retirement
Plan (generally referred to as a One-Participant Plan).
However, one-participant plans must file either the Form
5500-EZ, Annual Return of One-Participant (Owners and Their
Spouses) Retirement Plan, with the IRS or, if eligible, may file
the Form 5500-SF, Short Form Annual Return/Report of
Employee Benefit Plan, electronically with EFAST. For this
purpose, a one-participant plan is:
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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 EBSA and DOL websites for news,
regulations, and publications.
Do Not File a Form 5500 for a Pension Benefit Plan
That Is Any of the Following:
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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). The EFAST2 Help Line is available
Monday through Friday from 8:00 am to 8:00 pm, Eastern Time.
See What To File for more information about what must be
completed for pension plans.
You can access the IRS website 24 hours a day, 7 days a week
at www.irs.gov to:
• View forms, instructions, and publications.
• See answers to frequently asked tax questions.
• Search publications on-line by topic or keyword.
• Send comments or request help by e-mail.
• Sign up to receive local and national tax news by e-mail.
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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-EBSA (3272).
Section 1: Who Must File
A return/report must be filed every year for every pension
benefit plan, welfare benefit plan, and for every entity that files
as a DFE as specified below (pursuant to Code section 6058
and ERISA sections 104 and 4065).
General Instructions to Form 5500
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Table of Contents
Limited Pension Plan Reporting . . . . . . . . . . . . . .
Welfare Benefit Plan Filing Requirements . . . . . . . .
Direct Filing Entity (DFE) Filing Requirements . . . . .
Master Trust Investment Account (MTIA) . . . . . . . .
Common/Collective Trust (CCT) and Pooled
Separate Account (PSA) . . . . . . . . . . . . . . . . . .
103-12 Investment Entity (103-12 IE) . . . . . . . . . .
Group Insurance Arrangement (GIA) . . . . . . . . . . .
Quick Reference Chart of Form 5500, Schedules, and
Attachments . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Section 5: Line-by-Line Instructions for the 2009
Form 5500 and Schedules . . . . . . . . . . . . . . . . . .
Part I (Form 5500) – Annual Return/Report
Identification Information . . . . . . . . . . . . . . . . . . .
Part II (Form 5500) – Basic Plan Information . . . . .
Schedule A – Insurance Information . . . . . . . . . . .
Schedule C – Service Provider Information . . . . . . .
Schedule D – DFE/Participating Plan Information . .
Schedule G – Financial Transaction Schedules . . .
Schedule H – Financial Information . . . . . . . . . . . .
Schedule I – Financial Information – Small Plan . . .
Schedule MB – Multiemployer Defined Benefit Plan
and Certain Money Purchase Plan Actuarial
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule R – Retirement Plan Information . . . . . . .
Schedule SB – Single-Employer Defined Benefit
Plan Actuarial Information . . . . . . . . . . . . . . . . . .
Paperwork Reduction Act Notice . . . . . . . . . . . . . .
Codes for Principal Business Activity . . . . . . . . . .
ERISA Compliance Quick Checklist . . . . . . . . . . . .
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Instructions for Form 5500
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a. 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
b. a pension benefit plan for a partnership that covers only
the partners or the partners and the partners’ spouses.
2. A welfare benefit plan maintained outside the United
States primarily for persons substantially all of whom are
nonresident aliens.
3. A governmental plan.
4. An unfunded or insured welfare benefit plan maintained
for a select group of management or highly compensated
employees, which meets the requirements of 29 CFR
2520.104-24.
5. An employee benefit plan maintained only to comply with
workers’ compensation, unemployment compensation, or
disability insurance laws.
6. A welfare benefit plan that participates in a group
insurance arrangement that files a Form 5500 on behalf of the
welfare benefit plan as specified in 29 CFR 2520.103-2. See 29
CFR 2520.104-43.
7. An apprenticeship or training plan meeting all of the
conditions specified in 29 CFR 2520.104-22.
8. An unfunded dues financed welfare benefit plan
exempted by 29 CFR 2520.104-26.
9. A church plan under ERISA section 3(33).
10. A welfare benefit plan maintained solely for (1) an
individual or an individual and his or her spouse, who wholly
own a trade or business, whether incorporated or
unincorporated, or (2) partners or the partners and the partners’
spouses in a partnership. See 29 CFR 2510.3-3(b).
See the instructions to the Form 5500-EZ and the Form
5500-SF for eligibility conditions and filing requirements. For
more information, go to www.irs.gov/ep or call 1-877-829-5500.
Welfare Benefit Plan
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All welfare benefit plans covered by ERISA are required to file a
Form 5500 except as provided in this section. Welfare benefit
plans provide benefits such as medical, dental, life insurance,
apprenticeship and training, scholarship funds, severance pay,
disability, etc. See What To File for more information.
Reminder: The administrator of an employee welfare benefit
plan that provides benefits wholly or partially through a Multiple
Employer Welfare Arrangement (MEWA) as defined in ERISA
section 3(40) must file a Form 5500, unless otherwise exempt.
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1. A welfare benefit plan that covered fewer than 100
participants as of the beginning of the plan year and is
unfunded, fully insured, or a combination of insured and
unfunded.
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Direct Filing Entity (DFE)
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Note. Plans that are NOT unfunded include those plans that
received employee (or former employee) contributions during
the plan year and/or used a trust or separately maintained fund
(including a Code section 501(c)(9) trust) to hold plan assets or
act as a conduit for the transfer of plan assets during the year.
A welfare plan with employee contributions that is associated
with a cafeteria plan under Code section 125 may be treated for
annual reporting purposes as an unfunded welfare plan if it
meets the requirements of DOL Technical Release 92-01, 57
Fed. Reg. 23272 (June 2, 1992) and 58 Fed. Reg. 45359 (Aug.
27, 1993). The mere receipt of COBRA contributions or other
after-tax participant contributions (e.g., retiree contributions) by
a cafeteria plan would not by itself affect the availability of the
relief provided for cafeteria plans that otherwise meet the
requirements of DOL Technical Release 92-01. See 61 Fed.
Reg. 41220, 41222-23 (Aug. 7, 1996).
b. A fully insured welfare benefit plan has its benefits
provided exclusively through insurance contracts or policies, the
premiums of which must be paid directly to the insurance carrier
by the employer or employee organization from its general
assets or partly from its general assets and partly from
contributions by its employees or members (which the employer
or employee organization forwards within three (3) months of
receipt). The insurance contracts or policies discussed above
must be issued by an insurance company or similar
organization (such as Blue Cross, Blue Shield or a health
maintenance organization) that is qualified to do business in
any state.
c. A combination unfunded/insured welfare plan has its
benefits provided partially as an unfunded plan and partially as
a fully insured plan. An example of such a plan is a welfare
benefit plan that provides medical benefits as in a above and
life insurance benefits as in b above. See 29 CFR 2520.104-20.
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Note. To determine whether the plan covers fewer than 100
participants for purposes of these filing exemptions for insured
and unfunded welfare plans, see instructions for lines 5 and 6
on counting participants in a welfare plan. See also 29 CFR
2510.3-3(d).
a. An unfunded welfare benefit plan has its benefits paid as
needed directly from the general assets of the employer or
employee organization that sponsors the plan.
Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 annual return/
report as a DFE in accordance with the Direct Filing Entity
(DFE) Filing Requirements. A Form 5500 must be filed for a
master trust investment account (MTIA). A Form 5500 is not
required but may be filed for a common/collective trust (CCT),
pooled separate account (PSA), 103-12 investment entity
(103-12 IE), or group insurance arrangement (GIA). Plans that
participate in CCTs, PSAs, 103-12 IEs, or GIAs that file as
DFEs, however, generally are eligible for certain annual
reporting relief. For reporting purposes, a CCT, PSA, 103-12 IE,
or GIA is not considered a DFE unless a Form 5500 and all
required attachments are filed for it in accordance with the
Direct Filing Entity (DFE) Filing Requirements.
Note. Special requirements also apply to Schedules D and H
attached to the Form 5500 filed by plans participating in MTIAs,
CCTs, PSAs, and 103-12 IEs. See these schedules and their
instructions.
Section 2: When To File
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Plans and GIAs. File 2009 returns/reports for plan and GIA
years that began in 2009. All required forms, schedules,
statements, and attachments must be filed by the last day of the
7th calendar month after the end of the plan or GIA year (not to
exceed 12 months in length) that began in 2009. If the plan or
GIA year differs from the 2009 calendar year, fill in the fiscal
year beginning and ending dates in the space provided.
DFEs other than GIAs. File 2009 returns/reports no later than
91/2 months after the end of the DFE year that ended in 2009. A
Form 5500 filed for a DFE must report information for the DFE
year (not to exceed 12 months in length). If the DFE year differs
from the 2009 calendar year, fill in the fiscal year beginning and
ending dates in the space provided.
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. 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 “the final return/report” box in line B
should be checked.
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Do Not File a Form 5500 for a Welfare Benefit Plan
That Is Any of the Following:
Note. A ‘‘voluntary employees’ beneficiary association,’’ as
used in Code section 501(c)(9) (‘‘VEBA’’), should not be
confused with the employer or employee organization that
sponsors the plan. See ERISA section 3(4).
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General Instructions to Form 5500
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Instructions for Form 5500
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Delinquent Filer Voluntary Compliance (DFVC)
Program
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.
Using Form 5558
Under the computerized ERISA Filing Acceptance System
(EFAST2), you must file your 2009 Form 5500 annual return/
report electronically. You may file online using EFAST2’s
web-based filing system or you may file through an
EFAST2-approved vendor. Detailed information on electronic
filing is available at www.efast.dol.gov. For telephone
assistance, call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278). The EFAST2 Help Line is available Monday
through Friday from 8:00 am to 8:00 pm, Eastern Time.
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Extension of Time To File
Section 3: Electronic Filing Requirement
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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 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 2009 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 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.
Using Extension of Time To File Federal Income Tax
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An automatic extension of time to file the Form 5500 annual
return/report until the due date of the federal income tax return
of the employer will be granted if all of the following conditions
are met: (1) the plan year and the employer’s tax year are the
same; (2) the employer has been granted an extension of time
to file its federal income tax return to a date later than the
normal due date for filing the Form 5500; and (3) a copy of the
application for extension of time to file the federal income tax
return is maintained with the filer’s records. An extension
granted by using this automatic extension procedure CANNOT
be extended further by filing a Form 5558, nor can it be
extended beyond a total of 91/2 months beyond the close of the
plan year.
Note. An extension of time to file the Form 5500 does not
operate as an extension of time to file a Form 5500 filed for a
DFE (other than a GIA) or to file PBGC premiums or annual
financial and actuarial reports (if required by section 4010 of
ERISA).
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File Form 5558 with the Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201-0027.
Annual returns/reports filed under Title I of ERISA must
be made available by plan administrators to plan
CAUTION participants and beneficiaries and by the DOL to the
public pursuant to ERISA sections 104 and 106. Even though
the Form 5500 must be filed electronically, the administrator
must keep a copy of the Form 5500, including schedules and
attachments, with all required signatures on file as part of the
plan’s records and must make a paper copy available upon
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 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 with respect to the
2009 plan year unless otherwise explicitly stated in the
instructions or on the form itself.
Your entries must be in the proper format in order for the
EFAST2 system to process your filing. For example, if a
question requires you to enter a dollar amount, you cannot
enter a word. Your software will not let you submit your return/
report unless all entries are in the proper format. To reduce the
possibility of correspondence and penalties:
• Complete all lines on the Form 5500 unless otherwise
specified. Also complete and electronically attach, as required,
applicable schedules and attachments.
• Do not enter “N/A” or “Not Applicable” on the Form 5500
unless specifically permitted. “Yes” or “No” questions on the
forms and schedules cannot be left blank, unless specifically
permitted. Answer either “Yes” or “No,” but not both.
All schedules and attachments to the Form 5500 must be
properly identified, and must include the name of the plan or
DFE, EIN, and plan number (PN) as found on the Form 5500,
lines, 1a, 2b, and 1b, respectively. At the top of each
attachment, indicate the schedule and line, if any (e.g.,
Schedule H, line 4i) to which the attachment relates.
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
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A plan or GIA may obtain a one-time extension of time to file a
Form 5500 annual return/report (up to 21/2 months) by filing IRS
Form 5558, Application for Extension of Time To File Certain
Employee Plan Returns, on or before the normal due date (not
including any extensions) of the return/report. You MUST file
the Form 5558 with the IRS. Approved copies of the Form
5558 will not be returned to the filer. A copy of the completed
extension request must, however, be retained with the filer’s
records.
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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 Form 5500,
Part I, line D, and enter a description of the announced
authority for the extension.
General Instructions to Form 5500
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CAUTION
The DFVC Program facilitates voluntary compliance by plan
administrators who are delinquent in filing annual reports under
Title I of ERISA by permitting administrators to pay reduced civil
penalties for voluntarily complying with their DOL annual
reporting obligations. If the Form 5500 is being filed under the
DFVC Program, check the appropriate box in Form 5500, Part I,
line D, to indicate that the Form 5500 is being filed under the
DFVC Program.
See www.efast.dol.gov for additional information, including
information concerning DFVC Program filings and the
submission of penalty payments to the DFVC Program
processing center.
Plan administrators are reminded that they can use the
online calculator available 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.
2010 short plan year filers may not use the 2009 forms
for filing. They must use the 2010 forms, schedules, and
instructions.
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Instructions for Form 5500
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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 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.
requirements in these instructions. See the DOL website at
www.efast.dol.gov for information on filing amended returns/
reports for prior years.
Check the line B box for “an amended return/report” if
TIP you filed a previous 2009 annual return/report that was
Final Return/Report
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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, check the final return/
report box in Part I, line B at the top of the Form 5500. If a
trustee is appointed for a terminated defined benefit plan
pursuant to ERISA section 4042, the last plan year for which a
return/report must be filed is the year in which the trustee is
appointed.
Examples:
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Pension and Welfare Plans That Terminated Without
Distributing All Assets
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Do not enter social security numbers in response to
questions asking for an employer identification number
CAUTION (EIN). Because of privacy concerns, the inclusion of a
social security number on the Form 5500 or on a schedule or
attachment that is open to public inspection may result in the
rejection of the filing. If you discover a filing disclosed on the
EFAST2 website that contains a social security number,
immediately call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278).
Do not attach a copy of the annual registration statement
identifying separated participants with deferred vested benefits,
or a previous year’s Schedule SSA (Form 5500) to your 2009
Form 5500 annual return/report. The annual registration
statement must be filed directly with the IRS and cannot be
attached to a Form 5500 submission with EFAST2.
Employers without an EIN must apply for one as soon as
possible. The EBSA does not issue EINs. To apply for an EIN
from the IRS:
• Mail or fax Form SS-4, Application for Employer Identification
Number, obtained by calling 1-800-TAX-FORM
(1-800-829-3676) or at the IRS website at www.irs.gov.
• Call 1-800-829-4933 to receive your EIN by telephone.
• Select the Online EIN Application link at www.irs.gov. The
EIN is issued immediately once the application information is
validated. (The online application process is not yet available
for corporations with addresses in foreign countries or Puerto
Rico.)
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.
If the plan was terminated, but all plan assets were not
distributed, a return/report must be filed for each year the plan
has assets. The return/report must be filed by the plan
administrator, if designated, or by the person or persons who
actually control the plan’s assets/property.
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.
Welfare Plans Still Liable To Pay Benefits
A welfare plan cannot file a final return/report if the plan is still
liable to pay benefits for claims that were incurred prior to the
termination date, but not yet paid. See 29 CFR
2520.104b-2(g)(2)(ii).
Signature and Date
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For purposes of Title I of ERISA, the plan administrator is
required to file the Form 5500. 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. 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 submitted to EFAST2.
Note. The Code permits either the plan sponsor/employer or
the administrator to sign the filing. However, any Form 5500
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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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).
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For DFE filings, a person authorized to sign on behalf of the
DFE must sign for the DFE.
The Form 5500 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 PIN. Both the UserID and
PIN are needed to sign the Form 5500. The plan administrator
must keep a copy of the Form 5500, 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.
Amended Return/Report
File an amended return/report to correct errors and/or
omissions in a previously filed annual return/report for the 2009
plan year. The amended Form 5500 and any amended
schedules and/or attachments must conform to the
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General Instructions to Form 5500
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Instructions for Form 5500
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The schedules are grouped in the instructions by type: (1)
Pension Benefit Schedules and (2) General Schedules. Each
schedule is listed separately with a description of the subject
matter covered by the schedule and the plans and DFEs that
are required to file the schedule.
Change in Plan Year
Generally, only defined benefit pension plans need to get
approval for a change in the plan year. (See Code section
412(c)(5).) 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.
Filing requirements also are listed by type of filer: (1)
Pension Benefit Plan Filing Requirements; (2) Welfare Benefit
Plan Filing Requirements; and (3) DFE Filing Requirements.
For each filer type there is a separate list of the schedules that
must be filed with the Form 5500 (including where applicable,
separate lists for large plan filers, small plan filers, and different
types of DFEs).
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If a change in plan year for a pension or a welfare plan
creates a short plan year, the appropriate box in Part I, line B,
of the Form 5500 must be checked and a Form 5500, with all
required schedules and attachments, must be filed by the last
day of the 7th calendar month after the end of the short plan
year.
The filing requirements also are summarized in a “Quick
Reference Chart of Form 5500, Schedules, and Attachments.”
Penalties
Generally, a return/report filed for a pension benefit plan or
welfare benefit plan that covered fewer than 100 participants as
of the beginning of the plan year should be completed following
the requirements below for a “small plan,” and a return/report
filed for a plan that covered 100 or more participants as of the
beginning of the plan year should be completed following the
requirements below for a “large plan.”
Administrative Penalties
Exceptions:
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5 of the Form 5500 to determine whether a plan is a “small
plan” or “large plan.”
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(2) Short Plan Year Rule: If the plan had a short plan year
of seven (7) months or less for either the prior plan year or the
plan year being reported on the 2009 Form 5500, an election
can be made to defer filing the accountant’s report in
accordance with 29 CFR 2520.104-50. If such an election was
made for the prior plan year, the 2009 Form 5500 must be
completed following the requirements for a large plan, including
the attachment of the Schedule H and the accountant’s reports,
regardless of the number of participants entered in Part II, line
5.
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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.
Form 5500 Schedules
Pension Schedules
Schedule R (Retirement Plan Information) – is required for
a pension benefit plan that is a defined benefit plan or is
otherwise subject to Code section 412 or ERISA section 302.
Schedule R may also be required for certain other pension
benefit plans unless otherwise specified under Limited Pension
Plan Reporting. For additional information, see the Schedule R
instructions.
Schedule MB (Multiemployer Defined Benefit Plan and
Certain Money Purchase Plan Actuarial Information) – is
required for most multiemployer defined benefit plans and for
defined contribution pension plans that currently amortize a
waiver of the minimum funding requirements specified in the
instructions for the Schedule MB. For additional information,
see the instructions for the Schedule MB and the Schedule R.
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Section 4: What To File
The Form 5500 reporting requirements vary depending on
whether the Form 5500 is being filed for a ‘‘large plan,’’ a ‘‘small
plan,’’ and/or a DFE, and on the particular type of plan or DFE
involved (e.g., welfare plan, pension plan, common/collective
trust (CCT), pooled separate account (PSA), master trust
investment account (MTIA), 103-12 IE, or group insurance
arrangement (GIA)).
Schedule SB (Single-Employer Defined Benefit Plan
Actuarial Information) – is required for most single-employer
defined benefit plans, including multiple-employer defined
benefit pension plans. For additional information, see the
instructions for the Schedule SB.
The instructions below provide detailed information about
each of the Form 5500 schedules and which plans and DFEs
are required to file them.
General Instructions to Form 5500
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Other Penalties
(1) 80-120 Participant Rule: If the number of participants
reported on line 5 is between 80 and 120, and a Form 5500
annual return/report was filed for the prior plan year, you may
elect to complete the return/report in the same category (‘‘large
plan’’ or ‘‘small plan’’) as was filed for the prior return/report.
Thus, if a Form 5500 annual return/report was filed for the 2008
plan year as a small plan, including the Schedule I if applicable,
and the number entered on line 5 of the 2009 Form 5500 is 120
or less, you may elect to complete the 2009 Form 5500 and
schedules in accordance with the instructions for a small plan,
including for eligible filers, filing the Form 5500-SF instead of
the Form 5500.
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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 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 report. See
ERISA section 502(c)(2) and 29 CFR 2560.502c-2.
2. A penalty of $25 a day (up to $15,000) for not filing
returns for certain plans of deferred compensation, trusts and
annuities, and bond purchase plans by the due date(s). See
Code section 6652(e).
3. A penalty of $1,000 for not filing an actuarial statement.
See Code section 6692.
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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 (i.e., they may be imposed
or assessed by one of the governmental agencies delegated to
administer the collection of the annual return/report data).
Others require a legal conviction.
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otherwise specified, attach the following schedules and
information:
General Schedules
Schedule H (Financial Information) – is required for
pension benefit plans and welfare benefit plans filing as “large
plans” and for all DFE filings. Employee benefit plans, 103-12
IEs, and GIAs filing the Schedule H are generally required to
engage an independent qualified public accountant (IQPA) and
attach a report of the IQPA pursuant to ERISA section
103(a)(3)(A). These plans and DFEs are also generally required
to attach to the Form 5500 a “Schedule of Assets (Held At
End of Year),” and, if applicable, a “Schedule of Assets
(Acquired and Disposed of Within Year),” a “Schedule of
Reportable Transactions,” and a “Schedule of Delinquent
Participant Contributions.” For additional information, see the
Schedule H instructions.
Exceptions: Insured, unfunded, or combination unfunded/
insured welfare plans, as described in 29 CFR
2520.104-44(b)(1), and certain pension plans and
arrangements, as described in 29 CFR 2520.104-44(b)(2), and
in Limited Pension Plan Reporting, are exempt from completing
the Schedule H.
Small Pension Plan
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The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a small pension plan that is neither
exempt from filing nor is filing the Form 5500-SF:
1. Schedule A (as many as needed), to report insurance,
annuity, and investment contracts held by the plan.
2. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan participated at any time during the
plan year.
3. Schedule I, to report small plan financial information,
unless exempt.
4. Schedule MB or SB, to report actuarial information, if
applicable.
5. Schedule R, to report retirement plan information, if
applicable.
If Schedule I, line 4k, is checked “No,” you must attach
the report of the independent qualified public accountant
CAUTION (IQPA) or a statement that the plan is eligible and elects
to defer attaching the IQPA’s opinion pursuant to 29 CFR
2520.104-50 in connection with a short plan year of seven
months or less.
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CAUTION
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Schedule C (Service Provider Information) – is required for
a large plan, MTIA, 103-12 IE, or GIA if (1) any service provider
who rendered services to the plan or DFE during the plan or
DFE year received $5,000 or more in compensation, directly or
indirectly from the plan or DFE, or (2) an accountant and/or
enrolled actuary has been terminated. For additional
information, see the Schedule C instructions.
Schedule D (DFE/Participating Plan Information) – Part I
is required for a plan or DFE that invested or participated in any
MTIAs, 103-12 IEs, CCTs, and/or PSAs. Part II is required
when the Form 5500 is filed for a DFE. For additional
information, see the Schedule D instructions.
Schedule G (Financial Transaction Schedules) – is
required for a large plan, MTIA, 103-12 IE, or GIA when
Schedule H (Financial Information) lines 4b, 4c, and/or 4d are
checked ‘‘Yes.’’ Part I of the Schedule G reports loans or fixed
income obligations in default or classified as uncollectible. Part
II of the Schedule G reports leases in default or classified as
uncollectible. Part III of the Schedule G reports nonexempt
transactions. For additional information, see the Schedule G
instructions.
Large Pension Plan
The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a large pension plan:
1. Schedule A (as many as needed), to report insurance,
annuity, and investment contracts held by the plan.
2. Schedule C, if applicable, to report information on service
providers and, if applicable, any terminated accountants or
enrolled actuaries.
3. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan invested at any time during the
plan year.
4. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
plan year, leases in default or classified as uncollectible, and
nonexempt transactions, i.e., file Schedule G if Schedule H
(Form 5500) lines 4b, 4c, and/or 4d are checked ‘‘Yes.’’
5. Schedule H, to report large plan financial information,
unless exempt.
6. Schedule MB or SB, to report actuarial information, if
applicable.
7. Schedule R, to report retirement plan information, if
applicable.
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Schedule I (Financial Information - Small Plan) – is
required for all pension benefit plans and welfare benefit plans
filing the Form 5500 annual return/report, rather than the Form
5500-SF, as ‘‘small plans,’’ except for certain pension benefit
plans and arrangements described in 29 CFR
2520.104-44(b)(2) and Limited Pension Plan Reporting. For
additional information, see the Schedule I instructions.
Schedule A (Insurance Information) – is required if any
benefits under an employee benefit plan are provided by an
insurance company, insurance service or other similar
organization (such as Blue Cross, Blue Shield, or a health
maintenance organization). This includes investment contracts
with insurance companies, such as guaranteed investment
contracts and pooled separate accounts. For additional
information, see the Schedule A instructions.
Note. Do not file Schedule A for Administrative Services Only
(ASO) contracts. Do not file Schedule A if a Schedule A is filed
for the contract as part of the Form 5500 filed directly by a
master trust investment account (MTIA) or 103-12 IE.
You must attach the report of the independent qualified
public accountant (IQPA) identified on Schedule H, line
3c, unless line 3d(2) is checked.
Limited Pension Plan Reporting
D
The pension benefit plans or arrangements described below are
eligible for limited annual reporting:
1. IRA Plans: A pension plan using individual retirement
accounts or annuities (as described in Code section 408) as the
sole funding vehicle for providing pension benefits need
complete only Form 5500, Part I and Part II, lines 1 through 4,
and 8 (enter pension feature code 2N).
2. Fully Insured Pension Plan: A pension benefit plan
providing benefits exclusively through an insurance contract or
contracts that are fully guaranteed and that meet all of the
conditions of 29 CFR 2520.104-44(b)(2) during the entire plan
year must complete all the requirements listed under this
Pension Benefit Plan Filing Requirements section, except that
such a plan is exempt from attaching Schedule H, Schedule I,
and an independent qualified public accountant’s (IQPA’s)
opinion, and from the requirement to engage an IQPA.
A pension benefit plan that has insurance contracts of the
type described in 29 CFR 2520.104-44 as well as other assets
An unfunded, fully insured, or combination unfunded/
insured welfare plan with 100 or more participants
CAUTION exempt under 29 CFR 2520.104-44 from completing
Schedule H must still complete Schedule G, Part III, to report
nonexempt transactions.
!
Pension Benefit Plan Filing
Requirements
Pension benefit plan filers must complete the Form 5500 annual
return/report, including the signature block and, unless
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must complete all requirements for a pension benefit plan,
except that the value of the plan’s allocated contracts (see
below) should not be reported in Part I of Schedule H or I. All
other assets should be reported on Schedule H or Schedule I,
and any other required schedules. If Schedule H is filed, attach
an accountant’s report in accordance with the Schedule H
instructions.
Note. For purposes of the annual return/report and the
alternative method of compliance set forth in 29 CFR
2520.104-44, a contract is considered to be ‘‘allocated’’ only if
the insurance company or organization that issued the contract
unconditionally guarantees, upon receipt of the required
premium or consideration, to provide a retirement benefit of a
specified amount. This amount must be provided to each
participant without adjustment for fluctuations in the market
value of the underlying assets of the company or organization,
and each participant must have a legal right to such benefits,
which is legally enforceable directly against the insurance
company or organization. For example, deposit administration,
immediate participation guarantee, and guaranteed investment
contracts are NOT allocated contracts for Form 5500 annual
return/report purposes.
plan that uses a ‘‘voluntary employees’ beneficiary association’’
(VEBA) under Code section 501(c)(9) is generally not exempt
from the requirement of engaging an IQPA.
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Welfare benefit plan filers must complete the Form 5500 annual
return/report, including the signature block and, unless
otherwise specified, attach the following schedules and
information:
Large Welfare Plan
The administrator filing a Form 5500 for an employee benefit
plan is required to file or have a designee file a Form 5500 for
each MTIA in which the plan participated at any time during the
plan year. For reporting purposes, a ‘‘master trust’’ is a trust for
which a regulated financial institution (as defined below) serves
as trustee or custodian (regardless of whether such institution
exercises discretionary authority or control with respect to the
management of assets held in the trust), and in which assets of
more than one plan sponsored by a single employer or by a
group of employers under common control are held.
‘‘Common control’’ is determined on the basis of all relevant
facts and circumstances (whether or not such employers are
incorporated).
A ‘‘regulated financial institution’’ means a bank, trust
company, or similar financial institution that is regulated,
supervised, and subject to periodic examination by a state or
federal agency. A securities brokerage firm is not a ‘‘similar
financial institution’’ as used here. See DOL Advisory Opinion
93-21A (available at www.dol.gov/ebsa).
The assets of a master trust are considered for reporting
purposes to be held in one or more ‘‘investment accounts.’’ A
‘‘master trust investment account’’ may consist of a pool of
assets or a single asset. Each pool of assets held in a master
trust must be treated as a separate MTIA if each plan that has
an interest in the pool has the same fractional interest in each
asset in the pool as its fractional interest in the pool, and if each
such plan may not dispose of its interest in any asset in the pool
without disposing of its interest in the pool. A master trust may
also contain assets that are not held in such a pool. Each such
asset must be treated as a separate MTIA.
Notes. (1) If a MTIA consists solely of one plan’s asset(s)
during the reporting period, the plan may report the asset(s)
either as an investment account on a MTIA Form 5500, or as a
plan asset(s) that is not part of the master trust (and therefore
subject to all instructions concerning assets not held in a master
trust) on the plan’s Form 5500. (2) If a master trust holds assets
attributable to participant or beneficiary directed transactions
under an individual account plan and the assets are interests in
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CAUTION
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The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a large welfare plan:
1. Schedule A (as many as needed), to report insurance
and investment contracts held by the plan.
2. Schedule C, if applicable, to report information on service
providers and any terminated accountants or actuaries.
3. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan invested at any time during the
plan year.
4. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
plan year, leases in default or classified as uncollectible, and
nonexempt transactions, i.e., file Schedule G if Schedule H
(Form 5500) lines 4b, 4c, and/or 4d are checked ‘‘Yes’’ or if a
large welfare plan that is not required to file a Schedule H has
nonexempt transactions.
5. Schedule H, to report financial information, unless
exempt.
Master Trust Investment Account (MTIA)
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The following schedules (including any additional information
required by the instructions to the schedules) must be attached
to a Form 5500 filed for a small welfare plan that is neither
exempt from filing nor filing the Form 5500-SF:
1. Schedule A (as many as needed), to report insurance
contracts held by the plan.
2. Schedule D, Part I, to list any CCTs, PSAs, MTIAs, and
103-12 IEs in which the plan participated at any time during the
plan year.
3. Schedule I, to report small plan financial information.
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Small Welfare Plan
Some plans participate in certain trusts, accounts, and other
investment arrangements that file the Form 5500 annual return/
report as a DFE. A Form 5500 must be filed for a master trust
investment account (MTIA). A Form 5500 is not required but
may be filed for a common/collective trust (CCT), pooled
separate account (PSA), 103-12 investment entity (103-12 IE),
or group insurance arrangement (GIA). However, plans that
participate in CCTs, PSAs, 103-12 IEs, or GIAs that file as
DFEs generally are eligible for certain annual reporting relief.
For reporting purposes, a CCT, PSA, 103-12 IE, or GIA is
considered a DFE only when a Form 5500 and all required
schedules and attachments are filed for it in accordance with
the following instructions.
Only one Form 5500 should be filed for each DFE for all
plans participating in the DFE; however, the Form 5500 filed for
the DFE, including all required schedules and attachments,
must report information for the DFE year (not to exceed 12
months in length) that ends with or within the participating
plan’s year.
Any Form 5500 filed for a DFE is an integral part of the
annual report of each participating plan, and the plan
administrator may be subject to penalties for failing to file a
complete annual report unless both the DFE Form 5500 and the
plan’s Form 5500 are properly filed. The information required
for a Form 5500 filed for a DFE varies according to the type of
DFE. The following paragraphs provide specific guidance for
the reporting requirements for each type of DFE.
Attach the report of the independent qualified public
accountant (IQPA) identified on Schedule H, line 3c,
unless line 3d(2) is checked.
Neither Schedule H nor an IQPA’s opinion should be
TIP attached to a Form 5500 filed for an unfunded, fully
insured or combination unfunded/insured welfare plan
that covered 100 or more participants as of the beginning of the
plan year that meets the requirements of 29 CFR 2520.104-44.
However, Schedule G, Part III, must be attached to the Form
5500 to report any nonexempt transactions. A welfare benefit
General Instructions to Form 5500
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Direct Filing Entity (DFE) Filing
Requirements
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registered investment companies, interests in contracts issued
by an insurance company licensed to do business in any state,
interests in common/collective trusts maintained by a bank,
trust company or similar institution, or the assets have a current
value that is readily determinable on an established market,
those assets may be treated as a single MTIA.
3. Schedule H, except lines 1b(1), 1b(2), 1c(8), 1d, 1e, 1g,
1h, 1i, 2a, 2b(1)(E), 2e, 2f, and 2g, to report financial
information. Part IV and an accountant’s (IQPA’s) opinion are
not required for a CCT or PSA.
Different requirements apply to the Schedules D and H
attached to the Form 5500 filed by plans and DFEs
CAUTION participating in CCTs and PSAs, depending upon
whether a DFE Form 5500 has been filed for the CCT or PSA.
See the instructions for these schedules.
!
The Form 5500 submitted for the MTIA must comply with the
Form 5500 instructions for a Large Pension Plan, unless
otherwise specified in the forms and instructions. The MTIA
must file:
1. Form 5500, except lines C, D, 1c, 2d, and 5 through 9.
Be certain to enter ‘‘M’’ in Part I, line A, as the DFE code.
2. Schedule A (as many as needed) to report insurance,
annuity and investment contracts held by the MTIA.
3. Schedule C, if applicable, to report service provider
information. Part III is not required for a MTIA.
4. Schedule D, to list CCTs, PSAs, and 103-12 IEs in which
the MTIA invested at any time during the MTIA year and to list
all plans that participated in the MTIA during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
MTIA year, all leases in default or classified as uncollectible,
and nonexempt transactions.
6. Schedule H, except lines 1b(1), 1b(2), 1c(8), 1g, 1h, 1i,
2a, 2b(1)(E), 2e, 2f, 2g, 4a, 4e, 4f, 4g, 4h, 4k, 4l, 4m, 4n, and 5,
to report financial information. An independent qualified public
accountant’s (IQPA’s) opinion is not required for a MTIA.
7. Additional information required by the instructions to the
above schedules, including, for example, the schedules of
assets held for investment and the schedule of reportable
transactions. For purposes of the schedule of reportable
transactions, the 5% figure shall be determined by comparing
the current value of the transaction at the transaction date with
the current value of the investment account assets at the
beginning of the applicable fiscal year of the MTIA. All
attachments must be properly labeled.
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A Form 5500 is not required to be filed for a CCT or PSA.
However, the administrator of a large plan or DFE that
participates in a CCT or PSA that files as specified below is
entitled to reporting relief that is not available to plans or DFEs
participating in a CCT or PSA for which a Form 5500 is not
filed.
For reporting purposes, ‘‘common/collective trust’’ and
‘‘pooled separate account’’ are, respectively: (1) a trust
maintained by a bank, trust company, or similar institution or (2)
an account maintained by an insurance carrier, which are
regulated, supervised, and subject to periodic examination by a
state or federal agency in the case of a CCT, or by a state
agency in the case of a PSA, for the collective investment and
reinvestment of assets contributed thereto from employee
benefit plans maintained by more than one employer or
controlled group of corporations as that term is used in Code
section 1563. See 29 CFR 2520.103-3, 103-4, 103-5, and
103-9.
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR
2510.3-101(h)(1)(iii) does not constitute a pooled separate
account.
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Common/Collective Trust (CCT) and Pooled
Separate Account (PSA)
D
The Form 5500 submitted for a CCT or PSA must comply
with the Form 5500 instructions for a Large Pension Plan,
unless otherwise specified in the forms and instructions.
The CCT or PSA must file:
1. Form 5500, except lines C, D, 1c, 2d, and 5 through 9.
Enter ‘‘C’’ or ‘‘P,’’ as appropriate, in Part I, line A, as the DFE
code.
2. Schedule D, to list all CCTs, PSAs, MTIAs, and 103-12
IEs in which the CCT or PSA invested at any time during the
CCT or PSA year and to list in Part II all plans that participated
in the CCT or PSA during its year.
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103-12 Investment Entity (103-12 IE)
DOL Regulation 2520.103-12 provides an alternative method of
reporting for plans that invest in an entity (other than a MTIA,
CCT, or PSA), whose underlying assets include ‘‘plan assets’’
within the meaning of 29 CFR 2510.3-101 of two or more plans
that are not members of a ‘‘related group’’ of employee benefit
plans. Such an entity for which a Form 5500 is filed constitutes
a ‘‘103-12 IE.’’ A Form 5500 is not required to be filed for such
entities; however, filing a Form 5500 as a 103-12 IE provides
certain reporting relief, including the limitation of the
examination and report of the independent qualified public
accountant (IQPA) provided by 29 CFR 2520.103-12(d), to
participating plans and DFEs. For this reporting purpose, a
‘‘related group’’ of employee benefit plans consists of each
group of two or more employee benefit plans (1) each of which
receives 10% or more of its aggregate contributions from the
same employer or from a member of the same controlled group
of corporations (as determined under Code section 1563(a),
without regard to Code section 1563(a)(4) thereof); or (2) each
of which is either maintained by, or maintained pursuant to a
collective-bargaining agreement negotiated by, the same
employee organization or affiliated employee organizations. For
purposes of this paragraph, an ‘‘affiliate’’ of an employee
organization means any person controlling, controlled by, or
under common control with such organization. See 29 CFR
2520.103-12.
The Form 5500 submitted for a 103-12 IE must comply with
the Form 5500 instructions for a Large Pension Plan, unless
otherwise specified in the forms and instructions. The 103-12 IE
must file:
1. Form 5500, except lines C, D, 1c, 2d, and 5 through 9.
Enter ‘‘E’’ in part I, line A, as the DFE code.
2. Schedule A (as many as needed), to report insurance,
annuity and investment contracts held by the 103-12 IE.
3. Schedule C, if applicable, to report service provider
information and any terminated accountants.
4. Schedule D, to list all CCTs, PSAs, and 103-12 IEs in
which the 103-12 IE invested at any time during the 103-12 IE’s
year, and to list all plans that participated in the 103-12 IE
during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
103-12 IE year, leases in default or classified as uncollectible,
and nonexempt transactions.
6. Schedule H, except lines 1b(1), 1b(2), 1c(8), 1d, 1e, 1g,
1h, 1i, 2a, 2b(1)(E), 2e, 2f, 2g, 4a, 4e, 4f, 4g, 4h, 4j, 4k, 4l, 4m,
4n, and 5, to report financial information.
7. Additional information required by the instructions to the
above schedules, including, for example, the report of the
independent qualified public accountant (IQPA) identified on
Schedule H, line 3c, and the schedule(s) of assets held for
investment. All attachments must be properly labeled.
Group Insurance Arrangement (GIA)
Each welfare benefit plan that is part of a group insurance
arrangement is exempted from the requirement to file a Form
5500 if a consolidated Form 5500 report for all the plans in the
arrangement was filed in accordance with 29 CFR 2520.104-43.
For reporting purposes, a ‘‘group insurance arrangement’’
provides benefits to the employees of two or more unaffiliated
employers (not in connection with a multiemployer plan or a
collectively-bargained multiple-employer plan), fully insures one
or more welfare plans of each participating employer, uses a
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GIA year, leases in default or classified as uncollectible, and
nonexempt transactions.
6. Schedule H, except lines 4a, 4e, 4f, 4g, 4h, 4k, 4m, 4n,
and 5, to report financial information.
7. Additional information required by the instructions to the
above schedules, including, for example, the report of the
independent qualified public accountant (IQPA) identified on
Schedule H, line 3c, the schedules of assets held for
investment and the schedule of reportable transactions. (All
attachments must be properly labeled.)
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trust or other entity as the holder of the insurance contracts,
and uses a trust as the conduit for payment of premiums to the
insurance company. The GIA must file:
1. Form 5500, except lines C and 2d. (Enter ‘‘G’’ in Part I,
line A, as the DFE code).
2. Schedule A (as many as needed), to report insurance,
annuity and investment contracts held by the GIA.
3. Schedule C, if applicable, to report service provider
information and any terminated accountants.
4. Schedule D, to list all CCTs, PSAs, and 103-12 IEs in
which the GIA invested at any time during the GIA year, and to
list all plans that participated in the GIA during its year.
5. Schedule G, to report loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
General Instructions to Form 5500
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Quick Reference Chart of Form 5500, Schedules, and Attachments (Not
Applicable for Form 5500-SF Filers)1
Large
Pension Plan
Small
Pension Plan2
Large Welfare
Plan
Small Welfare
Plan2
DFE
Must complete.
Must complete.3
Must complete.3
Must complete.
Schedule A
(Insurance
Information)
Must complete if
plan has insurance
contracts.
Must complete if
plan has insurance
contracts.4
Must complete if
plan has insurance
contracts.
Must complete if
plan has insurance
contracts.4
Must complete if
MTIA, 103-12 IE, or
GIA has insurance
contracts.
Schedule C
(Service Provider
Information)
Must complete Part
I if service provider
was paid $5,000 or
more, Part II if a
service provider
failed to provide
information
necessary for the
completion of Part I,
and Part III if an
accountant or
actuary was
terminated.
Not required.
Must complete Part
I if service provider
was paid $5,000 or
more, Part II if a
service provider
failed to provide
information
necessary for the
completion of Part I,
and Part III if an
accountant or
actuary was
terminated.
Not required.
MTIAs, GIAs, and
103-12 IEs must
complete Part I if
service provider
paid $5,000 or
more, and Part II if a
service provider
failed to provide
information
necessary for the
completion of Part I.
GIAs and 103-12
IEs must complete
Part III if accountant
was terminated.
Schedule D
(DFE/Participating
Plan Information)
Must complete Part
I if plan participated
in a CCT, PSA,
MTIA, or 103-12 IE.
Must complete Part I
if plan participated in
a CCT, PSA, MTIA,
or 103-12 IE.4
Must complete Part
I if plan participated
in a CCT, PSA,
MTIA, or 103-12 IE.
Must complete Part
I if plan participated
in CCT, PSA, MTIA,
or 103-12 IE.4
All DFEs must
complete Part II,
and DFEs that
invest in a CCT,
PSA, or 103-12 IE
must also complete
Part I.
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Not required.
Not required.
Must complete if
Schedule H, lines
4b, 4c, or 4d for a
GIA, MTIA, or
103-12 IE are “Yes.”
Not required.
All DFEs must
complete Parts I, II,
and III. MTIAs,
103-12 IEs, and
GIAs must also
complete Part IV.5
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Must complete if
Schedule H, lines
4b, 4c, or 4d are
“Yes.”
Must complete if
Schedule H, lines
4b, 4c, or 4d are
“Yes.”3
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(Financial
Schedules)
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Must complete.
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Form 5500
Must complete.5
Not required.
Schedule I
(Financial
Information)
Not required.
Must complete.4
Not required.
Schedule MB
(Actuarial
Information)
Must complete if
multiemployer
defined benefit plan
or money purchase
plan subject to
minimum funding
standards.6
Must complete if
multiemployer
defined benefit plan
or money purchase
plan subject to
minimum funding
standards.6
Not required.
Schedule R
(Pension Plan
Information)
Must complete.7
Must complete.4, 7
Not required.
Not required.
Not required.
Schedule SB
(Actuarial
Information)
Must complete if
single-employer or
multiple-employer
defined benefit plan.
Must complete if
single-employer or
multiple-employer
defined benefit plan.
Not required.
Not required.
Not required.
Must complete.4
Not required.
Not required.
Not required.
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Must complete.3, 5
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Schedule H
(Financial
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Large
Pension Plan
Accountant’s
Report
Must attach.
Small
Pension Plan2
Large Welfare
Plan
Not required unless
Schedule I, line 4k,
is checked “No.”
Must attach.3
Small Welfare
Plan2
Not required.
DFE
Must attach for a
GIA or 103-12 IE.
1
This chart provides only general guidance. Not all rules and requirements are reflected. Refer to specific Form 5500 instructions for complete
information on filing requirements (e.g., Who Must File and What To File). For example, a pension plan is exempt from filing any schedules if the
plan uses Code section 408 individual retirement accounts as the sole funding vehicle for providing benefits. See Limited Pension Plan Reporting.
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Pension plans and welfare plans with fewer than 100 participants at the beginning of the plan year that are not exempt from filing an annual
return/report may be eligible to file the Form 5500-SF, a simplified report. In addition to the limitation on the number of participants, a Form
5500-SF may only be filed for a plan that is exempt from the requirement that the plan’s books and records be audited by an independent qualified
public accountant (but not by reason of enhanced bonding), has 100 percent of its assets invested in certain secure investments with a readily
determinable fair market value, holds no employer securities, and is not a multiemployer plan. See Who Must File.
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Unfunded, fully insured, or combination unfunded/fully insured welfare plans covering fewer than 100 participants at the beginning of the plan
year that meet the requirements of 29 CFR 2520.104-20 are exempt from filing an annual report. See Who Must File. Such a plan with 100 or more
participants must file an annual report, but is exempt under 29 CFR 2520.104-44 from the accountant’s report requirement and completing
Schedule H, but MUST complete Schedule G, Part III, to report any nonexempt transactions. See What To File.
4Do not complete if filing the Form 5500-SF instead of the Form 5500.
5 Schedules of assets and reportable (5%) transactions also must be filed with the Form 5500 if Schedule H, line 4i or 4j is “Yes.”
6 Money purchase defined contribution plans that are amortizing a funding waiver are required to complete lines 3, 9, and 10 of the Schedule MB in
accordance with the instructions. Also see instructions for line 5 of Schedule R and line 12a of Form 5500-SF.
7 A pension plan is exempt from filing Schedule R if all of the following conditions are met:
• The plan is not a defined benefit plan or otherwise subject to the minimum funding standards of Code section 412 or ERISA section 302.
• No plan benefits that would be reportable on line 1 of Part I of this Schedule R were distributed during the plan year. See the instructions for
Schedule R, Part I, line 1, below.
• No benefits, as described in the instructions for Schedule R, Part I, line 2, below, were paid during the plan year other than by the plan sponsor
or plan administrator. (This condition is not met if benefits were paid by the trust or any other payor(s) which are reportable on IRS Form 1099-R,
Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., using an EIN other than that of the
plan sponsor or plan administrator reported on line 2b or 3b of Form 5500.)
• Unless the plan is a profit-sharing, ESOP or stock bonus plan, no plan benefits of living or deceased participants were distributed during the plan
year in the form of a single-sum distribution. See the instructions for Schedule R, Part I, line 3, below.
• The plan is not an ESOP.
• The plan is not a multiemployer defined benefit plan.
General Instructions to Form 5500
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Section 5: Line-by-Line
Instructions for the 2009
Form 5500 and Schedules
Part I - Annual Return/Report Identification
Information
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File the 2009 Form 5500 annual return/report for a plan year
that began in 2009 or a DFE year that ended in 2009. If the plan
or DFE year is not the 2009 calendar year, enter the dates in
Part I. The 2009 Form 5500 annual return/report must be filed
electronically. Because of this, filings for 2009 plan years,
including short plan years, cannot use prior year paper forms.
Enter the letter
Master Trust
Investment Account
M
Common/Collective Trust
C
Pooled Separate
Account
P
103-12 Investment
Entity
E
Group Insurance
Arrangement
G
Note. A separate annual report with “M” entered as the DFE
code on Form 5500, line A, must be filed for each MTIA. See
instructions on page 9.
One Form 5500 is generally filed for each plan or entity
described in the instructions to the boxes in line A. Do not
check more than one box.
Line B — Box for First Return/Report. Check this box if an
annual return/report has not been previously filed for this plan
or DFE. For the purpose of completing this box, the Form
5500-EZ is not considered an annual return/report.
A separate Form 5500, 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.
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Line B – Box for Amended Return/Report. Check this box if
this Form 5500 is being submitted as an amended return/report
to correct errors and/or omissions on a previously filed Form
5500 for the 2009 plan year. See instructions on page 6.
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Line B – Box for Short Plan Year Return/Report. Check this
box if this Form 5500 is being filed for a plan year of less than
12 months. Provide the dates in Part I, Plan Year Beginning
and Ending.
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Line A – Box for Multiemployer Plan. Check this box if the
Form 5500 is filed for a multiemployer plan. A plan is a
multiemployer plan if: (a) more than one employer is required to
contribute, (b) the plan is maintained pursuant to one or more
collective bargaining agreements between one or more
employee organizations and more than one employer; (c) an
election under Code section 414(f)(5) and ERISA section
3(37)(E) has not been made; and (d) the plan meets any other
applicable conditions of 29 CFR 2510.3-37. A plan that has
made a proper election under ERISA section 3(37)(G) and
Code section 414(f)(6) on or before August 17, 2007, is also a
multiemployer plan. Participating employers do not file
individually for these plans.
Note. Do not check box B (Final Return/Report) if “4R” is
entered on line 8b for a welfare plan that is not required to file a
Form 5500 for the next plan year because the welfare plan has
become eligible for an annual reporting exemption. For
example, certain unfunded and insured welfare plans may be
required to file the 2009 Form 5500 and be exempt from filing a
Form 5500 for the plan year 2010 if the number of participants
covered as of the beginning of the 2010 plan year drops below
100. See Who Must File. Should the number of participants
covered by such a plan increase to 100 or more in a future
year, the plan must resume filing Form 5500 and enter ‘‘4S’’ on
line 8b on that year’s Form 5500. See 29 CFR 2520.104-20.
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A “controlled group” is generally considered one employer
for Form 5500 reporting purposes. A “controlled group” is a
controlled group of corporations under Code section 414(b), a
group of trades or businesses under common control under
Code section 414(c), or an affiliated service group under Code
section 414(m).
Line B – Box for Final Return/Report. Check this box if this
Form 5500 is the last annual return/report required to be
submitted for this plan. (See Final Return/Report.)
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Line C – Box for Collectively-Bargained Plan. Check this
box when the contributions to the plan and/or the benefits paid
by the plan are subject to the collective bargaining process
(even if the plan is not established and administered by a joint
board of trustees and even if only some of the employees
covered by the plan are members of a collective bargaining unit
that negotiates contributions and/or benefits). The contributions
and/or benefits do not have to be identical for all employees
under the plan.
Line A – Box for Single-Employer Plan. Check this box if
the Form 5500 is filed for a single-employer plan. A
single-employer plan for this Form 5500 reporting purpose is an
employee benefit plan maintained by one employer or one
employee organization.
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Type of entity
Line D – Box for Extension. Check the appropriate box here
if:
• You filed for an extension of time to file this form with the IRS
using a completed Form 5558, Application for Extension of
Time To File Certain Employee Plan Returns (maintain a copy
of the Form 5558 with the filer’s records);
• You are filing using the automatic extension of time to file
Form 5500 until the due date of the federal income tax return of
the employer (maintain a copy of the employer’s extension of
time to file the income tax return with the filer’s records);
• You are filing using a special extension of time to file the
Form 5500 that has been announced by the IRS, DOL, and
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.
• You are filing under DOL’s Delinquent Filer Voluntary
Compliance (DFVC) Program.
D
Line A – Box for Multiple-Employer Plan. Check this box if
the Form 5500 is being filed for a multiple-employer plan. A
multiple-employer plan is a plan that is maintained by more than
one employer and is not one of the plans already described. A
multiple-employer plan can be collectively bargained and
collectively funded, but if covered by PBGC termination
insurance, must have properly elected before September 27,
1981, not to be treated as a multiemployer plan under Code
section 414(f)(5) or ERISA sections 3(37)(E) and 4001(a)(3).
Participating employers do not file individually for this type of
plan. Do not check this box if the employers maintaining the
plan are members of the same controlled group.
Line A – Box for Direct Filing Entity (DFE). Check this box
and enter the correct letter from the following chart in the space
provided to indicate the type of entity.
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2. Enter any ‘‘in care of’’ (C/O) name.
3. Enter the street address. A post office box number may
be entered if the Post Office does not deliver mail to the
sponsor’s street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of the U.S. state or
possession and zip code.
6. Enter the foreign routing code, if applicable. Leave U.S.
state and zip code blank if entering a foreign routing code and
country name.
7. Enter the foreign country, if applicable.
8. Enter the D/B/A (the doing business as) or trade name of
the sponsor if different from the plan sponsor’s name.
9. Enter any second address. Use only a street address
here, not a P.O. box.
Part II - Basic Plan Information
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Line 2b. Enter the nine-digit employer identification number
(EIN) assigned to the plan sponsor/employer, for example,
00-1234567. In the case of a DFE, enter the employer
identification number (EIN) assigned to the CCT, PSA, MTIA,
103-12 IE, or GIA.
Do not use a social security number in lieu of an EIN. The
Form 5500 is open to public inspection, and the contents are
public information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this line may result in the rejection of the filing.
Employers without an EIN must apply for one as soon as
possible. The EBSA does not issue EINs. To apply for an EIN
from the IRS:
• Mail or fax Form SS-4, Application for Employer Identification
Number, obtained by calling 1-800-TAX-FORM
(1-800-829-3676) or at the IRS website at www.irs.gov.
• Call 1-800-829-4933 to receive your EIN by telephone.
• Select the Online EIN Application link at www.irs.gov. The
EIN is issued immediately once the application information is
validated. (The online application process is not yet available
for corporations with addresses in foreign countries or Puerto
Rico.)
A multiple-employer plan or plan of a controlled group of
corporations should use the EIN of the sponsor identified in line
2a. The EIN must be used in all subsequent filings of the Form
5500 for these plans (see instructions to line 4 concerning
change in EIN).
If the plan sponsor is a group of individuals, get a single EIN
for the group. When you apply for the EIN, provide the name of
the group, such as ‘‘Joint Board of Trustees of the Local 187
Machinists’ Retirement Plan.’’ (If filing Form SS-4, enter the
group name on line 1.)
Note. EINs for funds (trusts or custodial accounts) associated
with plans (other than DFEs) are generally not required to be
furnished on the Form 5500; the IRS will issue EINs for such
funds for other reporting purposes. EINs may be obtained as
explained above. Plan sponsors should use the trust EIN
described above when opening a bank account or conducting
other transactions for a trust that require an EIN.
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 67, 68, and 69. 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. Please limit your response to the information
required:
1. Enter the name of the plan administrator unless the
administrator is the sponsor identified in line 2 or the Form 5500
is submitted for a DFE (Part I, line A, for a DFE should be
checked and the appropriate DFE code entered). 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.
The term “plan administrator” means:
• The person or group of persons specified as the
administrator by the instrument under which the plan is
operated;
Part II, line 8b is completed
and 8a is not checked, or
Part I, line A, for a DFE is
checked and a G is entered
501 to the first plan or GIA.
Consecutively number others
as 502, 503. . .
Instructions for Part I and Part II of Form 5500
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Exception. If Part II, line 8a is completed and 333 (or a higher
number in a sequence beginning with 333) was previously
assigned to the plan, that number may be entered on line 1b.
Line 1c. Enter the date the plan first became effective.
Line 2a. Limit your response to the information required in
each row as specified below:
1. Enter the name of the plan sponsor or, in the case of a
Form 5500 filed for a DFE, the name of the insurance company,
financial institution, or other sponsor of the DFE (e.g., in the
case of a GIA, the trust or other entity that holds the insurance
contract, or in the case of an MTIA, one of the sponsoring
employers). If the plan covers only the employees of one
employer, enter the employer’s name.
The term ‘‘plan sponsor’’ means:
• The employer, for an employee benefit plan that a single
employer established or maintains;
• The employee organization in the case of a plan of an
employee organization; or
• The association, committee, joint board of trustees, or
other similar group of representatives of the parties who
establish or maintain the plan, if the plan is established or
maintained jointly by one or more employers and one or more
employee organizations, or by two or more employers.
Note. In the case of a multiple-employer plan, if an association
or similar entity is not the sponsor, enter the name of a
participating employer as sponsor. A plan of a controlled group
of corporations should enter the name of one of the sponsoring
members. In either case, the same name must be used in all
subsequent filings of the Form 5500 for the multiple-employer
plan or controlled group (see instructions to line 4 concerning
change in sponsorship).
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001 to the first plan or DFE.
Consecutively number others
as 002, 003. . .
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Part II, line 8a is completed,
or Part I, line A, for a DFE is
checked and an M, C, P, or
E is entered
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Assign PN
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For each Form 5500
with the same EIN
(line 2b), when
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Line 1a. Enter the formal name of the plan or DFE or enough
information to identify the plan or DFE. Abbreviate if necessary.
If an annual return/report has previously been filed on behalf of
the plan, regardless of the type of form that was filed (Form
5500, Form 5500-EZ, or Form 5500-SF), use the same name or
abbreviation as was 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) the
employer or plan administrator assigned to the plan or DFE.
This three-digit number, in conjunction with the employer
identification number (EIN) entered on line 2b, is used by the
IRS, DOL, and PBGC as a unique 12-digit number to identify
the plan or DFE.
Start at 001 for plans providing pension benefits, plans
providing pension and welfare benefits, or DFEs as illustrated in
the table below. Start at 501 for plans providing only welfare
benefits and GIAs. Do not use 888 or 999.
Once you use a plan or DFE number, continue to use it for
that plan or DFE on all future filings with the IRS, DOL, and
PBGC. Do not use it for any other plan or DFE, even if the first
plan or DFE is terminated.
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• The plan sponsor/employer if an administrator is not so
designated; or
• Any other person prescribed by regulations if an
administrator is not designated and a plan sponsor cannot be
identified.
2. Enter any ‘‘in care of’’ (C/O) name.
3. Enter the street address. A post office box number may
be entered if the Post Office does not deliver mail to the
administrator’s street address.
4. Enter the name of the city.
5. Enter the two-character abbreviation of the U.S. state or
possession and zip code.
6. Enter the foreign routing code and foreign country, if
applicable. Leave U.S. state and zip code blank if entering
foreign routing code and country information.
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The failure to indicate on line 4 that a plan sponsor 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.
Lines 5 and 6. All filers must complete both lines 5 and 6
unless the Form 5500 is filed for an IRA Plan described in
Limited Pension Plan Reporting or for a DFE.
The description of ‘‘participant’’ in the instructions below 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;
• 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 lines 5 and 6. 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).
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Line 3b. Enter the plan administrator’s nine-digit EIN. A plan
administrator must have an EIN for Form 5500 reporting
purposes. If the plan administrator does not have an EIN, apply
for one as explained in the instructions for line 2b. One EIN
should be entered for a group of individuals who are,
collectively, the plan administrator.
Note. Employees of the plan sponsor who perform
administrative functions for the plan are generally not the plan
administrator unless specifically designated in the plan
document. If an employee of the plan sponsor is designated as
the plan administrator, that employee must get an EIN.
Line 4. If the plan sponsor’s or DFE’s name and/or EIN have
changed since the last return/report was filed for this plan or
DFE, enter the plan sponsor’s or DFE’s name, EIN, and the
plan number as it appeared on the last return/report filed.
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 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.
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Line 6g. Enter the number of participants included on line 6f
(total participants at the end of the plan year) who have account
balances. For example, for a Code section 401(k) plan the
number entered on line 6g should be the number of participants
counted on line 6f who have made a contribution, or for whom a
contribution has been made, to the plan for this plan year or any
prior plan year. Defined benefit plans should leave line 6g
blank.
Line 6h. Include any individual who terminated employment
during this plan year, whether or not he or she (a) incurred a
break in service, (b) received an irrevocable commitment from
an insurance company to pay all the benefits to which he or she
is entitled under the plan, and/or (c) received a cash distribution
or deemed cash distribution of his or her nonforfeitable accrued
benefit. Multiemployer plans and multiple-employer plans that
are collectively bargained do not have to complete line 6h.
Line 7. Only multiemployer plans should complete line 7.
Multiemployer plans should enter the total number of employers
obligated to contribute to the plan. For purposes of line 7 of the
Form 5500, an employer obligated to contribute is defined as an
employer who, during the 2009 plan year, is a party to the
collective bargaining agreement(s) pursuant to which the plan is
Before counting the number of participants, especially in
TIP 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
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maintained or who may otherwise be subject to withdrawal
liability pursuant to ERISA section 4203. Any two or more
contributing entities (e.g., places of business with separate
collective bargaining agreements) that have the same nine-digit
employer identification number (EIN) must be aggregated and
counted as one employer for this purpose.
guaranteed by an insurance carrier. In general, such contracts
must provide for level premium payments over the individual’s
period of participation in the plan (to retirement age), premiums
must be timely paid as currently required under the contract, no
rights under the contract may be subject to a security interest,
and no policy loans may be outstanding. If a plan is funded
exclusively by the purchase of such contracts, the otherwise
applicable minimum funding requirements of section 412 of the
Code and section 302 of ERISA do not apply for the year and
neither the Schedule MB nor the Schedule SB is required to be
filed.
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Line 8 - Benefits Provided Under the Plan. In line(s) 8a
and/or 8b, as appropriate, enter all applicable plan
characteristic codes from the List of Plan Characteristics Codes
in these instructions that describe the characteristics of the plan
being reported.
For plan sponsors of Puerto Rico plans, enter
characteristic code 3C only in instances where there
CAUTION was no election made under section 1022(i)(2) of ERISA
and, therefore, the plan does not intend to qualify under section
401(a) of the Internal Revenue Code. If an election was made
under section 1022(i)(2) of ERISA, do not enter characteristic
code 3C.
‘‘Trust’’ includes any fund or account that receives, holds,
transmits, or invests plan assets other than an account or policy
of an insurance company. A custodial account arrangement
under Code section 403(b)(7) that is required to complete the
Form 5500 should mark “trust” for both the plan funding
arrangement and plan benefit arrangement.
Line 9 - Funding and Benefit Arrangements. Check all
boxes that apply to indicate the funding and benefit
arrangements used during the plan year. The ‘‘funding
arrangement’’ is the method for the receipt, holding, investment,
and transmittal of plan assets prior to the time the plan actually
provides benefits. The ‘‘benefit arrangement’’ is the method by
which the plan provides benefits to participants. For purposes of
line 9:
‘‘General assets of the sponsor’’ means either the plan
had no assets or some assets were commingled with the
general assets of the plan sponsor prior to the time the plan
actually provided the benefits promised.
Example. If the plan holds all its assets invested in
registered investment companies and other non-insurance
company investments until it purchases annuities to pay out the
benefits promised under the plan, box 9a(3) should be checked
as the funding arrangement and box 9b(1) should be checked
as the benefit arrangement.
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‘‘Code section 412(e)(3) insurance contracts’’ are
contracts that provide retirement benefits under a plan that are
Note. An employee benefit plan that checks boxes 9a(1),
9a(2), 9b(1), and/or 9b(2) must attach Schedule A (Form
5500), Insurance Information, to provide information concerning
each contract year ending with or within the plan year. See the
instructions to the Schedule A and enter the number of
Schedules A on line 10b(3), if applicable.
Line 10. Check the boxes on line 10 to indicate the schedules
being filed and, where applicable, count the schedules and
enter the number of attached schedules in the space provided.
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‘‘Insurance’’ means the plan has an account, contract, or
policy with an insurance company, insurance service, or other
similar organization (such as Blue Cross, Blue Shield, or a
health maintenance organization) during the plan or DFE year.
(This includes investments with insurance companies such as
guaranteed investment contracts (GICs).) An annuity account
arrangement under Code section 403(b)(1) that is required to
complete the Form 5500 should mark “insurance” for both the
plan funding arrangement and plan benefit arrangement. Do not
check ‘‘insurance’’ if the sole function of the insurance company
was to provide administrative services.
LIST OF PLAN CHARACTERISTICS CODES FOR LINES 8a AND 8b
1G
Covered by PBGC – Plan is covered under the PBGC
insurance program (see ERISA section 4021).
Benefits are primarily pay related.
1B
Benefits are primarily flat dollar (includes dollars per year of
service).
1H
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.
1C
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).
1I
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).
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1A
Floor-offset plan – to offset for retirement benefits provided
by an employer-sponsored defined contribution plan.
1E
Code section 401(h) arrangement – Plan contains separate
accounts under Code section 401(h) to provide employee
health benefits.
1F
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).
Instructions for Part I and Part II of Form 5500
2A
Defined Contribution Pension Features
Age/service weighted or new comparability or similar plan –
Age/service weighted plan: Allocations are based on age,
service, or age and service. New comparability or similar
plan: Allocations are based on participant classifications and
a classification(s) consists entirely or predominantly of highly
compensated employees; or the plan provides an additional
allocation rate on compensation above a specified threshold,
and the threshold or additional rate exceeds the maximum
threshold or rate allowed under the permitted disparity rules
of Code section 401(l).
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2B
Target benefit plan.
2C
Money purchase (other than target benefit).
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LIST OF PLAN CHARACTERISTICS CODES FOR LINES 8a AND 8b (Continued)
2D
Offset plan – Plan benefits are subject to offset for retirement
benefits provided in another plan or arrangement of the
employer.
Profit-sharing.
2F
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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2G
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 2550.404c1 is intended to be met.
2I
Stock bonus.
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2H
Plan covering self-employed individuals.
3C
Plan not intended to be qualified – A plan not intended to be
qualified under Code section 401, 403, or 408.
3D
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.
3F
Plan sponsor(s) received services of leased employees, as
defined in Code section 414(n), during the plan year.
3H
Plan sponsor(s) is (are) a member(s) of a controlled group
(Code sections 414(b), (c), or (m)).
3I
Plan requiring that all or part of employer contributions be
invested and held, at least for a limited period, in employer
securities.
3J
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.
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CODE
Code section 401(m) arrangement – Employee contribution
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.
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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.
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3B
Welfare Benefit Features
4A
Health (other than vision or dental).
4B
Life insurance.
4C
Supplemental unemployment.
4D
Dental.
4E
Vision.
4F
Temporary disability (accident and sickness).
Code section 403(b)(1) arrangement.
4G
Prepaid legal.
Code section 403(b)(7) accounts.
4H
Long-term disability.
2N
Code section 408 accounts and annuities – See Limited
Pension Plan Reporting instructions for pension plan utilizing
Code section 408 individual retirement accounts or annuities
as the funding vehicle for providing benefits.
4I
Severance pay.
4J
Apprenticeship and training.
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Scholarship (funded).
4L
Death benefits (include travel accident but not life insurance).
4P
Taft-Hartley Financial Assistance for Employee Housing
Expenses.
4Q
Other.
4R
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.
Plan provides for automatic enrollment in plan that has
employee contributions deducted from payroll.
4S
Total or partial participant-directed account plan – plan uses
default investment account for participants who fail to direct
assets in their account.
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.
4T
10 or more employer plan under Code section 419A(f)(6).
4U
Collectively-bargained welfare benefit arrangement under
Code section 419A(f)(5).
2P
Leveraged ESOP – An ESOP that acquires employer
securities with borrowed money or other debt-financing
techniques.
2Q
The employer maintaining this ESOP is an S corporation.
2R
Participant-directed brokerage accounts provided as an
investment option under the plan.
2S
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ESOP other than a leveraged ESOP.
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Other Pension Benefit Features
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2M
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Instructions for Part I and Part II of Form 5500
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Instructions for Form 5500
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Part I - Information Concerning Insurance Contract
Coverage, Fees, and Commissions
2009 Instructions for Schedule A
(Form 5500)
Insurance Information
Line 1(c). Enter the code number assigned by the National
Association of Insurance Commissioners (NAIC) to the
insurance company. If none has been assigned, enter zeros
(-0-) in the spaces provided.
General Instructions
Line 1(d). If individual policies with the same carrier are
grouped as a unit for purposes of this report, and the group
does not have one identification number, you may use the
contract or identification number of one of the individual
contracts, provided this number is used consistently to report
these contracts as a group and the plan administrator maintains
the records necessary to disclose all the individual contract
numbers in the group upon request. Use separate Schedules A
to report individual contracts that cannot be grouped as a unit.
Line 1(e). Since plan coverage may fluctuate during the year,
the administrator should estimate the number of persons that
were covered by the contract at the end of the policy or contract
year. Where contracts covering individual employees are
grouped, compute entries as of the end of the plan year.
Lines 1(f) and (g). Enter the beginning and ending dates of
the policy year for the contract identified in 1(d). Leave 1(f)
blank if separate contracts covering individual employees are
grouped.
Who Must File
If Form 5500 line 9a(1), 9a(2), 9b(1), or 9b(2) is
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TIP checked, indicating that either the plan funding
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arrangement or plan benefit arrangement includes an
account, policy, or contract with an insurance company (or
similar organization), at least one Schedule A would be required
to be attached to the Form 5500 filed for a pension or welfare
plan to provide information concerning the contract year ending
with or within the plan year.
Specific Instructions
Insurers must provide plan administrators with a
proportionate allocation of commissions and fees attributable to
each contract. Any reasonable method of allocating
commissions and fees to policies or contracts is acceptable,
provided the method is disclosed to the plan administrator. A
reasonable allocation method could, in the Department of
Labor’s view, allocate fees and commissions to a Schedule A
based on a calendar year calculation even if the plan year or
policy year was not a calendar year. For additional information
on these Schedule A reporting requirements, see ERISA
Advisory Opinion 2005-02A, available on the Internet at www.
dol.gov/ebsa.
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Information entered on Schedule A should pertain to the
insurance contract or policy year ending with or within the plan
year (for reporting purposes, a year cannot exceed 12 months).
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Check the Schedule A box on the Form 5500 (Part II, line
10b(3)), and enter the number attached in the space provided if
one or more Schedules A are attached to the Form 5500.
For purposes of lines 2 and 3, commissions and fees include
sales and base commissions and all other monetary and
non-monetary forms of compensation where the broker’s,
agent’s, or other person’s eligibility for the payment or the
amount of the payment is based, in whole or in part, on the
value (e.g., policy amounts, premiums) of contracts or policies
(or classes thereof) placed with or retained by an ERISA plan,
including, for example, persistency and profitability bonuses.
The amount (or pro rata share of the total) of such commissions
or fees attributable to the contract or policy placed with or
retained by the plan must be reported in line 2 and in line 3,
element (b) and/or (c), as appropriate.
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Do not file Schedule A for a contract that is an Administrative
Services Only (ASO) contract, a fidelity bond or policy, or a
fiduciary liability insurance policy. Also, if a Schedule A for a
contract or policy is filed as part of a Form 5500 for a MTIA or
103-12 IE that holds the contract, do not include a Schedule A
for the contract or policy on the Form 5500s filed for the plans
participating in the MTIA or 103 – 12 IE.
Line 2. Report on line 2 the total of all insurance fees and
commissions directly or indirectly attributable to the contract or
policy placed with or retained by the plan.
Totals. Enter on line 2 the total of all such commissions and
fees paid to agents, brokers, and other persons listed on line 3.
Complete a separate line 3 item (elements (a) through (e)) for
each person listed.
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Example. If an insurance contract year begins on July 1
and ends on June 30, and the plan year begins on January 1
and ends on December 31, the information on the Schedule A
attached to the 2009 Form 5500 should be for the insurance
contract year ending on June 30, 2009.
Exception. If the insurance company maintains records on the
basis of a plan year rather than a policy or contract year, the
information entered on Schedule A may pertain to the plan year
instead of the policy or contract year.
Include only the contracts issued to or held by the plan, GIA,
MTIA, or 103-12 IE for which the Form 5500 is being filed.
Where benefits under a plan are purchased from and
guaranteed by an insurance company, insurance service, or
other similar organization, and the contract or policy is reported
on a Schedule A, 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 the 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 lines 2 and 3 of Schedule A. 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
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule A is
attached.
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Do not use a social security number in lieu of an EIN. The
Schedule A and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Schedule A or any
of its attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
Instructions for Schedule A (Form 5500)
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Schedule A (Form 5500) must be attached to the Form 5500
filed for every defined benefit pension plan, defined contribution
pension plan, and welfare benefit plan required to file a Form
5500 if any benefits under the plan are provided by an
insurance company, insurance service, or other similar
organization (such as Blue Cross, Blue Shield, or a health
maintenance organization). This includes investment contracts
with insurance companies such as guaranteed investment
contracts (GICs). In addition, Schedules A must be attached to
a Form 5500 filed for GIAs, MTIAs, and 103-12 IEs for each
insurance or annuity contract held in the MTIA, or 103-12 IE or
by the GIA.
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sale or renewal of a policy, such as finder’s fees, insurance
brokerage commissions and fees, or similar fees..
Element (d). Enter the purpose(s) for which fees were paid.
Element (e). Enter the most appropriate organization code for
the broker, agent, or other person entered in element (a).
Schedule A reporting also is not required for compensation
paid by the insurer to a “general agent” or “manager” for that
general agent’s or manager’s management of an agency or
performance of administrative functions for the insurer. For this
purpose, (1) a “general agent” or “manager” does not include
brokers representing insureds, and (2) payments would not be
treated as paid for managing an agency or performance of
administrative functions where the recipient’s eligibility for the
payment or the amount of the payment is dependent or based
on the value (e.g., policy amounts, premiums) of contracts or
policies (or classes thereof) placed with or retained by ERISA
plan(s).
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Code Type of Organization
1
Banking, Savings & Loan Association, Credit Union, or
other similar financial institution
2
Trust Company
3
Insurance Agent or Broker
4
Agent or Broker other than insurance
5
Third party administrator
6
Investment Company/Mutual Fund
7
Investment Manager/Adviser
8
Labor Union
9
Foreign entity (e.g., an agent or broker, bank, insurance
company, etc., not operating within the jurisdictional
boundaries of the United States)
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Other
For plans, GIAs, MTIAs, and 103-12 IEs required to file Part
I of Schedule C, commissions and fees listed on the Schedule
A are not required to be reported again on Schedule C. The
amount of the compensation that must be reported on Schedule
A must, however, be taken into account in determining whether
the agent’s, broker’s, or other person’s direct or indirect
compensation in relation to the plan or DFE is $5,000 or more
and, thus, requiring the compensation not listed on the
Schedule A to be reported on the Schedule C. See FAQs about
the “2009 Form 5500 Schedule C” available on the EBSA
website at www.dol.gov/ebsa/faqs.
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Line 4. Enter the current value of the plan’s interest at year
end in the contract reported on line 7, e.g., deposit
administration (DA), immediate participation guarantee (IPG), or
guaranteed investment contracts (GIC).
Exception. Contracts reported on line 7 need not be included
on line 4 if (1) the Schedule A is filed for a defined benefit
pension plan and the contract was entered into before March
20, 1992, or (2) the Schedule A is filed for a defined contribution
pension plan and the contract is a fully benefit-responsive
contract, i.e., it provides a liquidity guarantee by a financially
responsible third party of principal and previously accrued
interest for liquidations, transfers, loans, or hardship
withdrawals initiated by plan participants exercising their rights
to withdraw, borrow, or transfer funds under the terms of a
defined contribution plan that does not include substantial
restrictions to participants’ access to plan funds.
Important Reminder. Plans may treat multiple individual
annuity contracts, including Code section 403(b)(1) annuity
contracts, issued by the same insurance company as a single
group contract for reporting purposes on Schedule A.
Line 6a. The rate information called for here may be furnished
by attaching the appropriate schedules of current rates filed
with the appropriate state insurance department or by providing
a statement regarding the basis of the rates. Enter “see
attached” if appropriate.
Lines 7a through 7f. Report contracts with unallocated funds.
Do not include portions of these contracts maintained in
separate accounts. Show deposit fund amounts rather than
experience credit records when both are maintained.
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Line 3. Identify agents, brokers, and other persons individually
in descending order of the amount paid. Complete as many
entries as necessary to report all required information.
Complete elements (a) through (e) for each person as specified
below.
Element (a). Enter the name and address of the agents,
brokers, or other persons to whom commissions or fees were
paid.
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Element (b). Report all sales and base commissions here. For
purposes of this element, sales and/or base commissions are
monetary amounts paid by an insurer that are charged directly
to the contract or policy and that are paid to a licensed agent or
broker for the sale or placement of the contract or policy. All
other payments should be reported in element (c) as fees.
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These thresholds are for purposes of Schedule A 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.
Part II - Investment and Annuity Contract Information
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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 lines 2 and 3 of the Schedule A even though the
total cost of the refreshments for all the employees would be
$120.
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Schedule A reporting is not required for occasional
non-monetary gifts or meals of insubstantial value that are tax
deductible for federal income tax purposes by the person
providing the gift or meal and would not be taxable income to
the recipient. For this exemption to be available, the gift or
gratuity must be both occasional and insubstantial. For this
exemption to apply, the gift must be valued at less than $50, the
aggregate value of gifts from one source in a calendar year
must be less than $100, but gifts with a value of less than $10
do not need to be counted toward the $100 annual limit. If the
$100 aggregate value limit is exceeded, then the aggregate
value of all the gifts will be reportable. For this purpose,
non-monetary gifts of less than $10 also do not need to be
included in calculating the aggregate value of all gifts required
to be reported if the $100 limit is exceeded.
Part III - Welfare Benefit Contract Information
Line 8i. Report a stop-loss insurance policy that is an asset of
the plan.
Note. Employers sponsoring welfare plans may purchase a
stop-loss insurance policy with the employer as the insured to
help the employer manage its risk associated with its liabilities
under the plan. These employer contracts with premiums paid
exclusively out of the employer’s general assets without any
employee contributions generally are not plan assets and are
not reportable on Schedule A.
Element (c). Fees to be reported here represent payments by
an insurer attributable directly or indirectly to a contract or policy
to agents, brokers, and other persons for items other than sales
and/or base commissions (e.g., service fees, consulting fees,
finders fees, profitability and persistency bonuses, awards,
prizes, and non-monetary forms of compensation). Fees paid to
persons other than agents and brokers should be reported
here, not in Parts II and III on Schedule A as acquisition costs,
administrative charges, etc.
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Instructions for Schedule A (Form 5500)
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Part IV - Provision of Information
other similar organization to provide information, check “Yes” on
line 11 and enter a description of the information not provided
on line 12. If you received all the information necessary to
receive the Schedule A, check “No” and leave line 12 blank.
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. If you do not receive this information
in a timely manner, contact the insurance company, insurance
service, or other similar organization.
Lines 11 and 12. If information is missing on Schedule A due
to a refusal by the insurance company, insurance service, or
As noted above, the insurance company, insurance
TIP service, or other similar organization is statutorily
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required to provide you with all of the information
necessary to complete the Schedule A, but need not provide
the information on a Schedule A itself.
Instructions for Schedule A (Form 5500)
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Instructions for Form 5500
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Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
Do not list the PBGC or the IRS on Schedule C as service
providers.
Either the cash or accrual basis may be used for the
recognition of transactions reported on the Schedule C as long
as you use one method consistently.
If service provider compensation is reported on a Schedule
C filed as apart of a Form 5500 filed for a MITIA or a 103-12 IE,
do not report the same compensation again on the Schedule C
filed for the plans that participate in the MTIA or 103-12 IE.
2009 Instructions for Schedule C
(Form 5500)
Service Provider Information
General Instructions
Who Must File
Specific Instructions
Part I - Service Provider Information You must enter the
information required for each person who rendered services to
or had transactions with the plan and who received $5,000 or
more in total direct or indirect compensation in connection with
services rendered to the plan or the person’s position with the
plan during the plan year.
Example. A plan had service providers, A, B, C, and D,
who received $12,000, $6,000, $4,500, and $430, respectively,
in direct and indirect compensation from the plan. Service
providers A and B must be identified separately by name, EIN,
etc. As service providers C and D each received less than
$5,000, they do not need to be reported on the Schedule C.
For Schedule C purposes, reportable compensation includes
money and any other thing of value (for example, gifts, awards,
trips) received by a person, directly or indirectly, from the plan
(including fees charged as a percentage of assets and
deducted from investment returns) in connection with services
rendered to the plan, or the person’s position with the plan. The
term “person” for this purpose includes individuals, trades and
businesses (whether incorporated or unincorporated). See
ERISA section 3(9).
Direct Compensation: Payments made directly by the plan
for services rendered to the plan or because of a person’s
position with the plan are reportable as direct compensation.
Direct payments by the plan would include, for example, direct
payments by the plan out of a plan account, charges to plan
forfeiture accounts and fee recapture accounts, charges to a
plan’s trust account before allocations are made to individual
participant accounts, and direct charges to plan participant
individual accounts. Payments made by the plan sponsor,
which are not reimbursed by the plan, are not subject to
Schedule C reporting requirements even if the sponsor is
paying for services rendered to the plan.
Indirect Compensation: Compensation received from
sources other than directly from the plan or plan sponsor is
reportable on Schedule C as indirect compensation from the
plan if the compensation was received in connection with
services rendered to the plan during the plan year or the
person’s position with the plan. For this purpose, compensation
is considered to have been received in connection with services
rendered to the plan or the person’s position with the plan if the
person’s eligibility for a payment or the amount of the payment
is based, in whole or in part, on services that were rendered to
the plan or on a transaction or series of transactions with the
plan. Indirect compensation would not include compensation
that would have been received had the service not been
rendered or the transaction had not taken place and that cannot
be reasonably allocated to the services performed or
transaction(s) with the plan.
Persons that provide investment management,
recordkeeping, claims processing, participant communication,
brokerage, and other services to the plan as part of an
investment contract or transaction are considered to be
providing services to the plan for purposes of Schedule C
reporting and would be required to be identified in Part I if they
received $5,000 or more in reportable compensation for
providing those services.
Examples of reportable indirect compensation include fees
and expense reimbursement payments received by a person
from mutual funds, bank commingled trusts, insurance
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Health and welfare plans that meet the conditions of the
TIP limited exemption at 2520.104-44 or Technical Release
D
92-01 are not required to complete and file a Schedule
C.
Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule C is
attached.
Do not use a social security number in line D in lieu of an
EIN. The Schedule C and its attachments are open to public
inspection, and the contents are public information subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Schedule C or any
of its attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
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Only line 1 of Part I of the Schedule C must be completed for
persons who received only “eligible indirect compensation” as
defined below.
Part II of the Schedule C must be completed to report
service providers who fail or refuse to provide information
necessary to complete Part I of this Schedule.
Part III of the Schedule C must be completed to report a
termination in the appointment of an accountant or enrolled
actuary during the 2009 plan year.
For plans, GIAs, MTIAs, and 103-12 IEs required to file Part
I of Schedule C, commissions and fees listed on the Schedule
A are not required to be reported again on Schedule C. The
amount of the compensation that must be reported on Schedule
A must, however, be taken into account in determining whether
the service provider’s direct or indirect compensation in relation
to the plan or DFE is $5,000 or more and, thus, requiring the
compensation not listed on the Schedule A to be reported on
the Schedule C. See “FAQs About the 2009 Form 5500
Schedule C” available on the EBSA website at www.dol.gov/
ebsa/faqs.
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Schedule C (Form 5500) must be attached to a Form 5500 filed
for a large pension or welfare benefit plan, a MTIA, a 103-12 IE,
or a GIA to report certain information concerning service
providers. Remember to check the Schedule C box on the Form
5500 (Part II, line 10b(4)) if a Schedule C is attached to the
Form 5500.
Part I of the Schedule C must be completed to report
persons who rendered services to or who had transactions with
the plan (or with the DFE in the case of a Schedule C filed by a
DFE) during the reporting year if the person received, directly or
indirectly, $5,000 or more in reportable compensation in
connection with services rendered or their position with the plan
or DFE, except:
1. Employees of the plan whose only compensation in
relation to the plan was less than $25,000 for the plan year;
2. Employees of the plan sponsor or other business entity
where the plan sponsor or business entity is reported on the
Schedule C as a service provider, provided the employee did
not separately receive reportable direct or indirect
compensation in relation to the plan;
3. Persons whose only compensation in relation to the plan
consists of insurance fees and commissions listed in a
Schedule A filed for the plan; and
4. Payments made directly by the plan sponsor that are not
reimbursed by the plan.
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Instructions for Schedule C (Form 5500)
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company pooled separate accounts, and other separately
managed accounts and pooled investment funds in which the
plan invests that are charged against the fund or account and
reflected in the value of the plan’s investment (such as
management fees paid by a mutual fund to its investment
adviser, sub-transfer agency fees, shareholder servicing fees,
account maintenance fees, and 12b-1 distribution fees). The
investment of plan assets and payment of premiums for
insurance contracts, however, are not in and of themselves
payments for services rendered to the plan for purposes of
Schedule C reporting and the investment and payment of
premiums themselves are not reportable compensation for
purposes of Part I of the Schedule C.
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Direct payments by the plan to the bundled service provider
should be reported as direct compensation to the bundled
service provider. Such direct payments by the plan do not need
to be allocated among affiliates or subcontractors and do not
need to be reported as indirect compensation received by the
affiliates or subcontractors unless the amount paid to the
affiliate or subcontractor is set on a per transaction basis, e.g.,
brokerage fees and commissions.
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Special rules for non-monetary compensation of
insubstantial value, guaranteed benefit insurance policies,
bundled service arrangements, and allocating
compensation among multiple plans:
For each person who is a fiduciary to the plan or provides
one or more of the following services to the plan – contract
administrator, consulting, investment advisory (plan or
participants), investment management, securities brokerage, or
recordkeeping – commissions and other transaction based
fees, finder’s fees, float revenue, soft dollar and other
non-monetary compensation, would also be required to be
treated as separate compensation for Schedule C purposes
even if those fees were paid from mutual fund management
fees or other fees charged to the plan’s investment and
reflected in the net value of the investment.
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Excludable Non-Monetary Compensation: You may
exclude non-monetary compensation of insubstantial value
(such as gifts or meals of insubstantial value) that is tax
deductible for federal income tax purposes by the person
providing the gift or meal and would not be taxable income to
the recipient. The gift or gratuity must be valued at less than
$50, and 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 limit.
If the $100 aggregate value limit is exceeded, then the value of
all the gifts over $10 will be reportable. Gifts received by one
person from multiple employees of one entity must be treated
as originating from a single source when calculating whether
the $100 threshold applies. On the other hand, gifts received
from one person by multiple employees of one entity can be
treated as separate compensation when calculating the $50
and $100 thresholds. For more information, see FAQS about
the 2009 Form 5500 Schedule C, available on the EBSA
website at www.dol.gov/ebsa/faqs.
Instructions for Schedule C (Form 5500)
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Fees charged to the plan’s investment and reflected in the
net value of the investment, such as management fees paid by
mutual funds to their investment advisers, float revenue,
commissions (including “soft dollars”), finder’s fees, 12b-1
distribution fees, account maintenance fees, and shareholder
servicing fees, must, subject to the alternative reporting option
for “eligible indirect compensation,” described below, be treated
as separate reportable compensation by the person receiving
the fee for purposes of Schedule C reporting.
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For more information, see “FAQs About the 2009 Form 5500
Schedule C,” available on the EBSA website at www.dol.gov/
ebsa/faqs.
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Other examples of reportable indirect compensation are
finder’s fees, float revenue, brokerage commissions (regardless
of whether the broker is granted discretion), research or other
products or services, other than execution, received from a
broker-dealer or other third party in connection with securities
transactions (soft dollars), and other transaction based fees
received in connection with transactions or services involving
the plan whether or not they are capitalized as investment
costs.
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In the case of charges against an investment fund,
reportable “indirect compensation ” includes, for example, the
fund’s investment adviser asset-based investment management
fee from the fund, brokerage commissions and fees charged in
connection with purchases and sales of interests in the fund,
fees related to purchases and sales of interests in the fund
(including 12b-1 fees), fees for providing services to plan
investors or plan participants such as communication and other
shareholder services, and fees relating to the administration of
the employee benefit plan such as recordkeeping services,
Form 5500 return/report filing and other compliance services.
Amounts charged against the fund for other ordinary operating
expenses, such as attorneys’ fees, accountants’ fees, printers’
fees, are not reportable indirect compensation for Schedule C
purposes. Also, brokerage costs associated with a
broker-dealer effecting securities transactions within the
portfolio of a mutual fund or for the portfolio of an investment
fund that holds “plan assets” for ERISA purposes should be
treated for Schedule C purposes as an operating expense of
the investment fund, not reportable indirect compensation paid
to a plan service provider or in connection with a transaction
with the plan.
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These thresholds are for purposes of Schedule C
reporting only. Filers are strongly cautioned that gifts
CAUTION and gratuities of any amount paid to or received by plan
fiduciaries may violate ERISA and give rise to civil liabilities and
criminal penalties.
Fully Insured Group Health and Similarly Fully Insured
Benefits: Where benefits under a plan are purchased from
and guaranteed by an insurance company, insurance service,
or other similar organization, and the contract or policy is
reported on a Schedule A, payments of reasonable monetary
compensation by the insurer out of its general assets to
persons 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 the
administrative services other than the insurance premium,
would not be treated as indirect compensation for services
provided to the plan for Schedule C reporting purposes. 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
finder’s fees, insurance brokerage commissions and fees, or
similar fees. Insurance investment contracts are not eligible for
this exception.
Bundled Service Arrangements: For Schedule C
reporting purposes, a bundled service arrangement includes
any service arrangements where the plan hires one company to
provide a range of services either directly from the company,
through affiliates or subcontractors, or through a combination,
which are priced to the plan as a single package rather than on
a service-by-service basis. A bundled service arrangement
would also include an investment transaction in which the plan
receives a range of services either directly from the investment
provider, through affiliates or subcontractors, or through a
combination.
!
Other revenue sharing payments among members of a
bundled service arrangement do not need to be allocated
among affiliates or subcontractors and treated as indirect
compensation received by the affiliates or subcontractors in
determining whether the affiliate or subcontractor must be
separately identified on line 2 of the Schedule C.
For more information about bundled arrangements for
reporting purposes, see FAQs about the 2009 Form 5500
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Instructions for Form 5500
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and indirect compensation. Start with the most highly
compensated and list in descending order of compensation.
Enter in element (a) the person’s name and complete elements
(a) through (h) as specified below. Use as many entries as
necessary to list all persons and information required to be
reported.
Element (a). Enter the EIN for the person identified in element
(a). If the name of an individual is entered in elment (a) and the
individual does not have an EIN, enter the EIN of the
individual’s employer. If the person is self-employed and does
not have an EIN, you may enter the person’s address and
telephone number. Do not use a social security number in lieu
of an EIN. The Schedule C and its attachments are open to
public inspection and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule C or any of its attachments may result
in the rejection of the filing.
Element (b). Select from the list below all codes that describe
the services provided and compensation received. Enter as
many codes as apply.
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If any person received eligible indirect compensation
and either direct compensation and/or indirect
CAUTION compensation that does not meet the requirements of
this line to be eligible indirect compensation, you cannot rely on
the alternative reporting option for that person and must
complete line 2 for each such person who received $5,000 or
more in direct and indirect compensation.
Line 2. Except for those persons and eligible indirect
compensation for which you answered “Yes” to line 1 above,
complete as many entries as needed to list each person
receiving, directly or indirectly, $5,000 or more in total direct
!
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50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
70
71
72
73
99
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21
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23
24
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26
27
28
29
30
31
32
33
34
35
36
37
38
40
Service
Accounting (including auditing)
Actuarial
Claims processing
Contract Administrator
Plan Administrator
Recordkeeping and information management (computing,
tabulating, data processing, etc.)
Consulting (general)
Consulting (pension)
Custodial (other than securities)
Custodial (securities)
Trustee (individual)
Trustee (bank, trust company or similar financial institution)
Insurance agents and brokers
Insurance services
Trustee (discretionary)
Trustee (directed)
Investment advisory (participants)
Investment advisory (plan)
Investment management
Legal
Employee (plan)
Named fiduciary
Real estate brokerage
Securities brokerage
Valuation (appraisals, etc.)
Employee (plan sponsor)
Copying and duplicating
Participant loan processing
Participant communication
Foreign entity (e.g., an agent or broker, bank, insurance
company, etc. not operating within jurisdictional boundaries of
the United States)
Other services
Direct payment from the plan
Investment management fees paid directly by plan
Investment management fees paid indirectly by plan
Insurance brokerage commissions and fees
Sales loads (front end and deferred)
Other commissions
Non-monetary compensation
Redemption fees
Product termination fees (surrender charges, etc.)
Shareholder servicing fees
Sub-transfer agency fees
Finders’ fees/placement fees
Float revenue
Distribution (12b-1) fees
Recordkeeping fees
Account maintenance fees
Insurance mortality and expense charge
Other insurance wrap fees
“’Soft dollar’ commissions”
Consulting fees
Securities brokerage commissions and fees
Other investment fees and expenses
Other insurance fees and expenses
Other fees
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Schedule C, available on the EBSA website at www.dol.gov/
ebsa/faqs.
Allocating Compensation Among Multiple Plans: Where
reportable compensation is received by a person in connection
with several plans or DFEs, any reasonable method of
allocating the compensation among the plans or DFEs may be
used provided that the allocation method is disclosed to the
plan administrator. In calculating the $5,000 threshold for
purposes of determining whether a person must be identified in
Part I, include the amount of compensation received by the
person that is attributable to the plan or DFE filing the Form
5500, not the aggregate amount received in connection with all
the plans or DFEs.
Affiliates: For purposes of Schedule C reporting, an
“affiliate” of a person includes any person, directly or indirectly,
through one or more intermediaries, controlling, controlled by,
or under common control with the person applying principles
consistent with the regulations prescribed under section 414(c)
of the Code.
Line 1. Check “Yes” or “No” on line 1a to indicate whether you
are relying on the alternative reporting option for a person or
persons who received only “eligible indirect compensation.” If
you check “Yes” on line 1a, provide as many entries in line 1b
as necessary to identify the person or persons who provided
you with the necessary disclosures regarding the eligible
indirect compensation. If any indirect compensation is either not
of the type described below or if the plan did not receive the
written disclosures described below, the indirect compensation
is not “eligible indirect compensation” for purposes of Part 1.
(1) Eligible Indirect Compensation: The types of indirect
compensation that can be treated as eligible indirect
compensation are indirect compensation that is fees or expense
reimbursement payments charged to investment funds and
reflected in the value of the investment or return on investment
of the participating plan or its participants finder’s fees “soft
dollar” revenue, float revenue, and/or brokerage commissions
or other transaction-based fees for transactions or services
involving the plan that were not paid directly by the plan or plan
sponsor (whether or not they are capitalized as investment
costs).
Investment funds or accounts for this purpose would include
mutual funds, bank commingled trusts, including common and
collective trusts, insurance company pooled separate accounts,
and other separately managed accounts and pooled investment
vehicles in which the plan invests. Investment funds or
accounts would also include separately managed investment
accounts that contain assets of individual plans.
(2) Required Written Disclosures: For the types of
indirect compensation described above to be treated as eligible
indirect compensation for purposes of completing line 1, you
must have received written materials that disclosed and
described (a) the existence of the indirect compensation; (b) the
services provided for the indirect compensation or the purpose
for payment of the indirect compensation; (c) the amount (or
estimate) of the compensation or a description of the formula
used to calculate or determine the compensation; and (d) the
identity of the party or parties paying and receiving the
compensation. The written disclosures for a bundled
arrangement must separately disclose and describe each
element or indirect compensation that would be required to be
separately reported if you were not relying on this alternative
reporting option.
Instructions for Schedule C (Form 5500)
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Part II — Service Providers Who Fail or Refuse To Provide
Information
Line 4. Provide the requested information for each plan
fiduciary or service provider who you believe failed or refused to
provide any of the information necessary to complete Part I of
this schedule.
Element (d). Enter the total amount of compensation received
directly from the plan for services rendered to the plan during
the plan year. If a service provider charges the plan a fee or
commission, but agrees to offset the fee or commission with
any revenue received from a party other than the plan or plan
sponsor, for example, as part of a commission recapture or
other offset arrangement, only the amount paid directly by the
plan after any revenue sharing offset should be entered in
element (d).
Important Reminder. Before identifying a fiduciary or service
provider as a person who failed or refused to provide
information, you should contact the fiduciary or service provider
to request the necessary information and tell them that you will
list them on the Schedule C as a fiduciary or service provider
who failed or refused to provide information if they do not
provide the necessary information.
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Element (c). Enter any relationship of the person identified in
element (a) to the plan sponsor, to the participating employer or
employee organization, or to any person known to be a
party-in-interest, for example, employee of employer,
vice-president of employer, union officer, affiliate of plan
recordkeeper, etc.
Note. Do not leave element (d) blank. If no direct
compensation was received, enter “0”.
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Element (f). Check “Yes” if any of the indirect compensation
was eligible indirect compensation for which the plan received
the necessary disclosures. See instructions for line 1 for
definition of eligible indirect compensation. Check “No” if none
of the indirect compensation was eligible indirect compensation.
Do not use a social security number in lieu of an EIN. The
Schedule C and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on this Schedule C or any
of its attachments may result in the rejection of the filing.
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Line 3. For each person identified in line 2 who is a fiduciary to
the plan or provides one or more of the following services to the
plan – contract administrator, consulting, investment advisory
(plan or participants), investment management, securities
brokerage, or recordkeeping – enter the requested information
for each source from whom the person received indirect
compensation if (1) the amount of the compensation was
$1,000 or more, or (2) the plan was given a formula or other
description of the method used to determine the indirect
compensation rather than an amount or estimated amount of
the indirect compensation.
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Element (h). Check “Yes” if the service provider, instead of an
amount or an estimated amount, gave the plan a formula or
other description of the method used to determine some or all
of the indirect compensation received.
Provide an explanation of the reasons for the termination of
an accountant or enrolled actuary. Include a description of any
material disputes or matters of disagreement concerning the
termination, even if resolved prior to the termination. If an
individual is listed, and the individual does not have an EIN, the
EIN to be entered should be the EIN of the individual’s
employer.
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Element (g). Enter the total of all indirect compensation that is
not eligible indirect compensation for which the plan received
the necessary disclosure. Do not leave blank. If none, enter “0”.
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The plan administrator must also provide the terminated
accountant or enrolled actuary with a copy of the explanation
for the termination provided in Part III of the Schedule C, along
with a completed copy of the notice below.
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Element (e). Check “Yes” if the person identified in element
(a), or any related person, received during the plan year indirect
compensation in connection with the person’s position with the
plan or services provided to the plan. (See instructions above
on definition of indirect compensation.) If the answer is “No,”
skip elements (f) through (h) for the person identified in element
(a).
Part III - Termination Information on Accountants and
Enrolled Actuaries
Complete Part III if there was a termination in the appointment
of an accountant or enrolled actuary during the 2009 plan year.
This information must be provided on the Form 5500 for the
plan year during which the termination occurred. For example, if
an accountant was terminated in the 2009 plan year after
completing work on an audit for the 2007 plan year, the
termination should be reported on the Schedule C filed with the
2009 plan year Form 5500. If the accountant is a firm (such as
a corporation, partnership, etc.), report when the service
provider (not an individual within the firm) was terminated. An
enrolled actuary is by definition an individual and not a firm, and
you must report when the individual is terminated.
Notice to Terminated Accountant
or Enrolled Actuary
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I, as plan administrator, verify that the explanation that is reproduced below or attached to this notice is the explanation
concerning your termination reported on the Schedule C (Form 5500) attached to the 2009 Form 5500, Annual Return/
Report of Employee Benefit Plan, for the
(enter name of plan). This Form
5500 is identified in line 2b by the nine-digit EIN
(enter sponsor’s EIN), and in line 1b by the
three-digit PN
(enter plan number).
You have the opportunity to comment to the Department of Labor concerning any aspect of this explanation.
Comments should include the name, EIN, and PN of the plan and be submitted to: Office of Enforcement, Employee
Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, DC 20210.
Signed
Dated
Instructions for Schedule C (Form 5500)
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for a CCT or PSA named in element (a), enter the EIN for the
CCT or PSA and enter 000 for the PN. Do not use a social
security number in lieu of an EIN. The Schedule D and its
attachments are open to public inspection, and the contents are
public information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule D or any of its attachments may result
in the rejection of the filing.
2009 Instructions for Schedule D
(Form 5500)
DFE/Participating Plan Information
General Instructions
Element (d). Enter an M, C, P, or E, as appropriate, (see table
below) to identify the type of entity (MTIA, CCT, PSA, or 103-12
IE).
Purpose of Schedule
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When the Form 5500 is filed for a plan or Direct Filing Entity
(DFE) that invested or participated in any master trust
investment accounts (MTIAs), 103-12 Investment Entities
(103-12 IEs), common/collective trusts (CCTs), and/or pooled
separate accounts (PSAs), Part I provides information about
these entities. When the Form 5500 is filed for a DFE, Part II
provides information about plans participating in the DFE.
Enter in (d)
MTIA
M
Who Must File
CCT
C
Employee Benefit Plans: Schedule D (Form 5500) must be
attached to a Form 5500 filed for an employee benefit plan that
participated or invested in one or more CCTs, PSAs, MTIAs, or
103-12 IEs at anytime during the plan year.
PSA
P
103-12 IE
E
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Type of entity
Element (e). Enter the dollar value of the plan’s or DFE’s
interest as of the end of the year. If the plan or DFE for which
this Schedule D is filed had no interest in the MTIA, CCT, PSA,
or 103-12 IE listed at the end of the year, enter ‘‘0’’.
Check the Schedule D box on the Form 5500 (Part II, line
10b(5)) if a Schedule D is attached to the Form 5500. Complete
as many repeating entries as necessary to report the required
information.
Example for Part I: If a plan participates in a MTIA, the
MTIA is named in element (a); the MTIA’s sponsor is named in
element (b); the MTIA’s EIN and PN are entered in element (c)
(such as: 12-3456789-001); an ‘‘M’’ is entered in element (d);
and the dollar value of the plan’s interest in the MTIA as of the
end of the plan year is entered in element (e).
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Direct Filing Entities: Schedule D (Form 5500) must be
attached to a Form 5500 filed for a CCT, PSA, MTIA, 103-12 IE
or Group Insurance Arrangement (GIA), as a Direct Filing Entity
(i.e., when a “DFE” is checked on Part I, line A, of the Form
5500). For more information, see instructions for Direct Filing
Entity (DFE) Filing Requirements.
If the plan also participates in a CCT for which a Form 5500
was not filed, the CCT is named in another element (a); the
name of the CCT sponsor is entered in element (b); the EIN for
the CCT, followed by 000 is entered in element (c) (such as:
99-8765432-000); a ‘‘C’’ is entered in element (d); and the
dollar value of the plan’s interest in the CCT is entered in
element (e).
Specific Instructions
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If the plan also participates in a PSA for which a Form 5500
was filed, the PSA is named in a third element (a); the name of
the PSA sponsor is entered in element (b); the PSA’s EIN and
PN is entered in element (c) (such as: 98-7655555-001); a ‘‘P’’
is entered in element (d); and the dollar value of the plan’s
interest in the PSA is entered in element (e).
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You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
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Part II - Information on Participating Plans
(To Be Completed Only by DFEs)
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Do not use a social security number in line D in lieu of an
EIN. The Schedule D and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule D or any of its attachments may result in the rejection
of the filing.
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Lines A, B, C, and D. The information must be the same as
reported in Part II of the Form 5500 to which this Schedule D is
attached.
Complete as many repeating entries as necessary to enter the
information specified below for all plans that invested or
participated in the DFE at any time during the DFE year.
Part I - Information on Interests in MTIAs, CCTs,
PSAs, and 103-12 IEs (To Be Completed by Plans and
DFEs)
Complete a separate item (elements (a) through (c)) for
each plan.
Complete as many repeating entries as necessary to enter the
information specified below for all MTIAs, CCTs, PSAs, and
103-12 IEs in which the plan or DFE filing the Form 5500
participated at anytime during the plan or DFE year.
Element (a). Enter the name of each plan that invested or
participated in the DFE at any time during the DFE year. GIAs
need not complete element (a).
Element (b). Enter the name of the sponsor of each and
every plan investing or participating in the DFE.
Element (a). Enter the name of the MTIA, CCT, PSA, or
103-12 IE in which the plan or DFE filing the Form 5500
participated at any time during the plan or DFE year.
Element (c). Enter the nine-digit EIN and three-digit PN for
each plan named in element (a). This is the EIN and PN
entered on lines 2b and 1b of the plan’s Form 5500 or Form
5500-SF. GIAs should enter the EIN of the sponsor listed in
element (b). Do not use a social security number in lieu of an
EIN. The Schedule D and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule D or any of its attachments may result in the rejection
of the filing.
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Complete a separate item (elements (a) through (e)) for
each MTIA, CCT, PSA, or 103-12 IE.
Element (b). Enter the name of the sponsor of the MTIA, CCT,
PSA, or 103-12 IE named in element (a).
Element (c). Enter the nine-digit employer identification
number (EIN) and three-digit plan/entity number (PN) for each
MTIA, CCT, PSA, or 103-12 IE named in element (a). This
must be the same DFE EIN/PN as reported on lines 2b and 1b
of the Form 5500 filed for the DFE. If a Form 5500 was not filed
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Instructions for Schedule D (Form 5500)
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Do not report in Part I participant loans under an individual
account plan with investment experience segregated for each
account, that are made in accordance with 29 CFR
2550.408b-1, and that are secured solely by a portion of the
participant’s vested accrued benefit. Report all other participant
loans in default or classified as uncollectible on Part I, and list
each such loan individually.
2009 Instructions for Schedule G
(Form 5500)
Financial Transaction Schedules
General Instructions
Part II - Leases in Default or Classified as
Uncollectible
Who Must File
List any leases in default or classified as uncollectible. A lease
is an agreement conveying the right to use property, plant, or
equipment for a stated period. A lease is in default when the
required payment(s) has not been made. An uncollectible lease
is one where the required payments have not been made and
for which there is little probability that payment will be made.
Provide, on a separate attachment, an explanation of what
steps have been taken or will be taken to collect overdue
amounts for each lease listed and label the attachment
“Schedule G, Part II – Overdue Lease Explanation.”
All nonexempt party-in-interest transactions must be reported,
regardless of whether disclosed in the accountant’s report,
unless the nonexempt transaction is:
1. Statutorily exempt under Part 4 of Title I of ERISA;
2. Administratively exempt under ERISA section 408(a);
3. Exempt under Code sections 4975(c) or 4975(d);
4. The holding of participant contributions in the employer’s
general assets for a welfare plan that meets the conditions of
ERISA Technical Release 92-01;
5. A transaction of a 103-12 IE with parties other than the
plan; or
6. A delinquent participant contribution or a delinquent
participant loan repayment reported on Schedule H, line 4a.
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Specific Instructions
Part III - Nonexempt Transactions
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Schedule G (Form 5500) must be attached to a Form 5500 filed
for a plan, MTIA, 103-12 IE, or GIA to report loans or fixed
income obligations in default or determined to be uncollectible
as of the end of the plan year, leases in default or classified as
uncollectible, and nonexempt transactions. See Schedule H
(Form 5500) lines 4b, 4c, and/or 4d.
Check the Schedule G box on the Form 5500 (Part II, line
10b(6)) if a Schedule G is attached to the Form 5500. Complete
as many entries as necessary to report the required
information.
The Schedule G consists of three parts. Part I of the
Schedule G reports any loans or fixed income obligations in
default or determined to be uncollectible as of the end of the
plan year. Part II of the Schedule G reports any leases in
default or classified as uncollectible. Part III of the Schedule G
reports nonexempt transactions.
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Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule G is
attached.
Do not use a social security number in line D in lieu of an
EIN. The Schedule G and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule G or any of its attachments may result in the rejection
of the filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
Provide, on a separate attachment, an explanation of what
steps have been taken or will be taken to collect overdue
amounts for each loan listed and label the attachment
“Schedule G, Part I – Overdue Loan Explanation.”
The due date, payment amount, and conditions for
determining default in the case of a note or loan are usually
contained in the documents establishing the note or loan. A
loan is in default when the borrower is unable to pay the
obligation upon maturity. Obligations that require periodic
repayment can default at any time. Generally loans and fixed
income obligations are considered uncollectible when payment
has not been made and there is little probability that payment
will be made. A fixed income obligation has a fixed maturity
date at a specified interest rate.
For purposes of this form, party-in-interest is deemed to
include a disqualified person. See Code section 4975(e)(2). The
term ‘‘party-in-interest’’ means, as to an employee benefit plan:
A. Any fiduciary (including, but not limited to, any
administrator, officer, trustee or custodian), counsel, or
employee of the plan;
B. A person providing services to the plan;
C. An employer, any of whose employees are covered by
the plan;
D. An employee organization, any of whose members are
covered by the plan;
E. An owner, direct or indirect, of 50% or more of: (1) the
combined voting power of all classes of stock entitled to vote
Instructions for Schedule G (Form 5500)
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Part I - Loans or Fixed Income Obligations in Default
or Classified as Uncollectible
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List all loans or fixed income obligations in default or
determined to be uncollectible as of the end of the plan year or
the fiscal year of the GIA, MTIA, or 103-12 IE. Include:
• Obligations where the required payments have not been
made by the due date;
• Fixed income obligations that have matured, but have not
been paid, for which it has been determined that payment will
not be made; and
• Loans that were in default even if renegotiated later during
the year.
Note. Identify in element (a) each obligor known to be a
party-in-interest to the plan.
Nonexempt transactions with a party-in-interest include
any direct or indirect:
A. Sale or exchange, or lease, of any property between the
plan and a party-in-interest.
B. Lending of money or other extension of credit between
the plan and a party-in-interest.
C. Furnishing of goods, services, or facilities between the
plan and a party-in-interest.
D. Transfer to, or use by or for the benefit of, a
party-in-interest, of any income or assets of the plan.
E. Acquisition, on behalf of the plan, of any employer
security or employer real property in violation of ERISA
section 407(a).
F. Dealing with the assets of the plan for a fiduciary’s own
interest or own account.
G. Acting in a fiduciary’s individual or any other capacity in
any transaction involving the plan on behalf of a party (or
represent a party) whose interests are adverse to the
interests of the plan or the interests of its participants or
beneficiaries.
H. Receipt of any consideration for his or her own personal
account by a party-in-interest who is a fiduciary from any
party dealing with the plan in connection with a transaction
involving the income or assets of the plan.
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or the total value of shares of all classes of stock of a
corporation, (2) the capital interest or the profits interest of a
partnership, or (3) the beneficial interest of a trust or
unincorporated enterprise that is an employer or an
employee organization described in C or D;
F. A relative of any individual described in A , B, C, or E;
G. A corporation, partnership, or trust or estate of which (or
in which) 50% or more of: (1) the combined voting power of
all classes of stock entitled to vote or the total value of
shares of all classes of stock of such corporation, (2) the
capital interest or profits interest of such partnership, or (3)
the beneficial interest of such trust or estate is owned
directly or indirectly, or held by, persons described in A, B,
C, D, or E;
H. An employee, officer, director (or an individual having
powers or responsibilities similar to those of officers or
directors), or a 10% or more shareholder, directly or
indirectly, of a person described in B, C, D, E, or G, or of the
employee benefit plan; or
I. A 10% or more (directly or indirectly in capital or profits)
partner or joint venturer of a person described in B, C, D, E,
or G.
If you are unsure whether a transaction is exempt or not,
you should consult with either the plan’s independent qualified
public accountant or legal counsel or both.
You may indicate that an application for an administrative
exemption is pending.
If the plan is a qualified pension plan and a nonexempt
prohibited transaction occurred with respect to a disqualified
person, an IRS Form 5330, Return of Excise Taxes Related to
Employee Benefit Plans, is required to be filed with the IRS to
pay the excise tax on the transaction.
An unfunded, fully insured, or combination unfunded/
insured welfare plan with 100 or more participants
CAUTION exempt under 29 CFR 2520.104-44 from completing
Schedule H must still complete Schedule G, Part III, to report
nonexempt transactions.
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covered (which transactions include delinquent
participant contributions to pension and welfare plans), and
acceptable methods for correcting violations. In addition,
applicants that satisfy both the VFCP requirements and the
conditions of Prohibited Transaction Exemption (PTE) 2002-51
are eligible for immediate relief from payment of certain
prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). If the conditions of PTE 2002-51 are satisfied, corrected
transactions should be treated as exempt under Code section
4975(c) for the purposes of answering Schedule G, Part III.
Information about the VFCP is also available on the Internet at
www.dol.gov/ebsa.
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The DOL Voluntary Fiduciary Correction Program
TIP (VFCP) describes how to apply, the specific transactions
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under the terms of the plan by a trustee or a named fiduciary,
assuming an orderly liquidation at time of the determination.
See ERISA section 3(26).
Note. For the 2009 plan year, plans that provide
participant-directed brokerage accounts as an investment
alternative (and have entered pension feature code ‘‘2R’’ on line
8a of the Form 5500) may report investments in assets made
through participant-directed brokerage accounts either:
1. As individual investments on the applicable asset and
liability categories in Part I and the income and expense
categories in Part II, or
2. By including on line 1c(15) the total aggregate value of
the assets and on line 2c the total aggregate investment income
(loss) before expenses, provided the assets are not loans,
partnership or joint-venture interests, real property, employer
securities, or investments that could result in a loss in excess of
the account balance of the participant or beneficiary who
directed the transaction. Expenses charged to the accounts
must be reported on the applicable expense line items.
Participant-directed brokerage account assets reported in the
aggregate on line 1c(15) should be treated as one asset held
for investment for purposes of the line 4i schedules, except that
investments in tangible personal property must continue to be
reported as separate assets on the line 4i schedules.
2009 Instructions for Schedule H
(Form 5500)
Financial Information
General Instructions
Who Must File
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Instructions for Schedule H (Form 5500)
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Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule H is
attached.
Do not use a social security number in line D in lieu of an
EIN. The Schedule H and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule H or any of its attachments may result in the rejection
of the filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
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 Schedule H to the nearest dollar. Any other amounts are
subject to rejection. Check all subtotals and totals carefully.
If the assets of two or more plans are maintained in a fund
or account that is not a DFE, a registered investment company,
or the general account of an insurance company under an
unallocated contract (see the instructions for lines 1c(9) through
1c(14)), complete Parts I and II of the Schedule H by entering
the plan’s allocable part of each line item.
Exception. When completing Part II of the Schedule H for a
plan or DFE that participates in a CCT or PSA for which a Form
5500 has not been filed, do not allocate the income of the CCT
or PSA and expenses that were subtracted from the gross
income of the CCT or PSA in determining their net investment
gain (loss). Instead, enter the CCT or PSA net gain (loss) on
line 2b(6) or (7) in accordance with the instructions for these
lines.
If assets of one plan are maintained in two or more trust
funds, report the combined financial information in Parts I and
II.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith
In the event that investments made through a
participant-directed brokerage account are loans, partnership or
joint venture interests, real property, employer securities, or
investments that could result in a loss in excess of the account
balance of the participant or beneficiary who directed the
transaction, such assets must be broken out and treated as
separate assets on the applicable asset and liability categories
in Part I, income and expense categories in Part II, and on the
line 4i schedules. The remaining assets in the
participant-directed brokerage account may be reported in the
aggregate as set forth in paragraph 2 above.
Columns (a) and (b). Enter the current value on each line as
of the beginning and end of the plan year.
Note. Amounts reported in column (a) must be the same as
reported for the end of the plan year for corresponding line
items of the return/report for the preceding plan year. Do not
include contributions designated for the 2009 plan year in
column (a).
Line 1a. Total noninterest bearing cash includes, among other
things, cash on hand or cash in a noninterest bearing checking
account.
Line 1b(1). Noncash basis filers must include contributions
due the plan by the employer but not yet paid. Do not include
other amounts due from the employer such as the
reimbursement of an expense or the repayment of a loan.
Line 1b(2). Noncash basis filers must include contributions
withheld by the employer from participants and amounts due
directly from participants that have not yet been received by the
plan. Do not include the repayment of participant loans.
Line 1b(3). Noncash basis filers must include amounts due to
the plan that are not includable in lines 1b(1) or 1b(2). These
amounts may include investment income earned but not yet
received by the plan and other amounts due to the plan such as
amounts due from the employer or another plan for expense
reimbursement or from a participant for the repayment of an
overpayment of benefits.
Line 1c(1). Include all assets that earn interest in a financial
institution account such as interest bearing checking accounts,
passbook savings accounts, or in money market accounts.
Line 1c(2). Include securities issued or guaranteed by the
U.S. Government or its designated agencies such as U.S.
Savings Bonds, Treasury bonds, Treasury bills, FNMA, and
GNMA.
Line 1c(3). Include investment securities (other than employer
securities defined below in line 1d(1)) issued by a corporate
entity at a stated interest rate repayable on a particular future
date such as most bonds, debentures, convertible debentures,
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Schedule H (Form 5500) must be attached to a Form 5500 filed
for a pension benefit plan or a welfare benefit plan that covered
100 or more participants as of the beginning of the plan year
and a Form 5500 filed for a MTIA, CCT, PSA, 103-12 IE, or
GIA. See the instructions to the Form 5500 for Direct Filing
Entity (DFE) Filing Requirements.
Exceptions: (1) Insured, unfunded, or a combination of
unfunded/insured welfare plans and fully insured pension plans
that meet the requirements of 29 CFR 2520.104-44 are exempt
from completing the Schedule H. (2) If a Schedule I was filed for
the plan for the 2008 plan year and the plan covered fewer than
121 participants as of the beginning of the 2009 plan year, the
Schedule I may be completed instead of a Schedule H. See
What To File. If eligible, such a plan may file the Form 5500-SF
instead of the Form 5500 and its schedules, including the
Schedule I. See Instructions for Form 5500-SF. (3) Plans that
file a Form 5500-SF for the 2009 plan year are not required to
file a Schedule H for that year.
Check the Schedule H box on the Form 5500 (Part II, line
10b(1)) if a Schedule H is attached to the Form 5500. Do not
attach both a Schedule H and a Schedule I to the same Form
5500.
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Code section 401, including, for example, the determination of
top-heavy status under Code section 416 and the vesting
requirements of Treasury Regulations section 1.411(a)-7(d)(5).
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
The entry on line 1c(8), column (b), of Schedule H
(participant loans - end of year) or on line 1a, column (b), of
Schedule I (plan assets - end of year) must include the current
value of any participant loan that was reported as a deemed
distribution on line 2g for any earlier year if the participant
resumes repayment under the loan during the plan year. In
addition, the amount to be entered on line 2g must be reduced
by the amount of the participant loan that was reported as a
deemed distribution on line 2g for the earlier year.
Lines 1c(9), (10), (11), and (12). Enter the total current value
of the plan’s or DFE’s interest in DFEs on the appropriate lines
as of the beginning and end of the plan or DFE year. The value
of the plan’s or DFE’s interest in each DFE at the end of the
plan or DFE year must be reported on the Schedule D (Form
5500).
The plan’s or DFE’s interest in common/collective trusts
(CCTs) and pooled separate accounts (PSAs) for which
CAUTION a DFE Form 5500 has not been filed may not be
included on lines 1c(9) or 1c(10). The plan’s or DFE’s interest in
the underlying assets of such CCTs and PSAs must be
allocated and reported in the appropriate categories on a
line-by-line basis on Part I of the Schedule H.
Note. For reporting purposes, a separate account that is not
considered to be holding plan assets pursuant to 29 CFR
2510.3-101(h)(1)(iii) does not constitute a PSA.
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Line 1c(14). Use the same method for determining the value
of the insurance contracts reported here as you used for line 4
of Schedule A, or, if line 4 is not required, line 7 of Schedule A.
Line 1c(15). Include all other investments not includable in
lines 1c(1) through (14), such as options, index futures,
repurchase agreements, state and municipal securities,
collectibles, and other personal property.
Line 1d(1). An employer security is any security issued by an
employer (including affiliates) of employees covered by the
plan. These may include common stocks, preferred stocks,
bonds, zero coupon bonds, debentures, convertible debentures,
notes and commercial paper.
Line 1d(2). The term ‘‘employer real property’’ means real
property (and related personal property) that is leased to an
employer of employees covered by the plan, or to an affiliate of
such employer. For purposes of determining the time at which a
plan acquires employer real property for purposes of this line,
such property shall be deemed to be acquired by the plan on
the date on which the plan acquires the property or on the date
on which the lease to the employer (or affiliate) is entered into,
whichever is later.
Line 1e. Include the current (not book) value of the buildings
and other property used in the operation of the plan. Buildings
or other property held as plan investments should be reported
in 1c(6) and 1d(2).
Do not include the value of future pension payments on lines
1g, h, i, j, or k.
Line 1g. Noncash basis plans must include the total amount
of benefit claims that have been processed and approved for
payment by the plan. Include welfare plan ‘‘incurred but not
reported’’ (IBNR) benefit claims on this line.
Line 1h. Noncash basis plans must include the total amount
of obligations owed by the plan which were incurred in the
normal operations of the plan and have been approved for
payment by the plan but have not been paid.
Line 1i. ‘‘Acquisition indebtedness,’’ for debt-financed
property other than real property, means the outstanding
amount of the principal debt incurred:
1. By the organization in acquiring or improving the
property;
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If both of these circumstances apply, report the loan as a
deemed distribution on line 2g. However, if either of these
circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) must be included in column (b) without
regard to the occurrence of a deemed distribution.
Note. After a participant loan that has been deemed
distributed is reported on line 2g, it is no longer to be reported
as an asset on Schedule H or Schedule I unless, in a later year,
the participant resumes repayment under the loan. However,
such a loan (including interest accruing thereon after the
deemed distribution) that has not been repaid is still considered
outstanding for purposes of applying Code section 72(p)(2)(A)
to determine the maximum amount of subsequent loans. Also,
the deemed distribution is not treated as an actual distribution
for other purposes, such as the qualification requirements of
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commercial paper and zero coupon bonds. Do not include debt
securities of governmental units that should be reported on line
1c(2) or 1c(15).
‘‘Preferred’’ means any of the above securities that are
publicly traded on a recognized securities exchange and the
securities have a rating of ‘‘A’’ or above. If the securities are not
‘‘Preferred,’’ they are listed as ‘‘Other.’’
Line 1c(4)(A). Include stock issued by corporations (other
than employer securities defined in line 1d(1) below) which is
accompanied by preferential rights such as the right to share in
distributions of earnings at a higher rate or which has general
priority over the common stock of the same entity. Include the
value of warrants convertible into preferred stock.
Line 1c(4)(B). Include any stock (other than employer
securities defined in line 1d(1)) that represents regular
ownership of the corporation and is not accompanied by
preferential rights. Include the value of warrants convertible into
common stock.
Line 1c(5). Include the value of the plan’s participation in a
partnership or joint venture if the underlying assets of the
partnership or joint venture are not considered to be plan assets
under 29 CFR 2510.3-101. Do not include the value of a plan’s
interest in a partnership or joint venture that is a 103-12
Investment Entity (103-12 IE). Include the value of a 103-12 IE
in line 1c(12).
Line 1c(6). Include the current value of both income and
non-income producing real property owned by the plan. Do not
include the value of property that is employer real property or
property used in plan operations that must be reported on lines
1d and 1e, respectively.
Line 1c(7). Enter the current value of all loans made by the
plan, except participant loans reportable on line 1c(8). Include
the sum of the value of loans for construction, securities loans,
commercial and/or residential mortgage loans that are not
subject to Code section 72(p) (either by making or participating
in the loans directly or by purchasing loans originated by a third
party), and other miscellaneous loans.
Line 1c(8). Enter the current value of all loans to participants
including residential mortgage loans that are subject to Code
section 72(p). Include the sum of the value of the unpaid
principal balances, plus accrued but unpaid interest, if any, for
participant loans made under an individual account plan with
investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and secured
solely by a portion of the participant’s vested accrued benefit.
When applicable, combine this amount with the current value of
any other participant loans. Do not include in column (b) a
participant loan that has been deemed distributed during the
plan year under the provisions of Code section 72(p) and
Treasury Regulations section 1.72(p)-1, if both of the following
circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
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2. Before the acquisition or improvement of the property if
the debt was incurred only to acquire or improve the property;
or
3. After the acquisition or improvement of the property if the
debt was incurred only to acquire or improve the property and
was reasonably foreseeable at the time of such acquisition or
improvement. For further explanation, see Code section 514(c).
Note. Bond write-offs should be reported as realized losses.
Line 2b(5). Subtract the current value of assets at the
beginning of the year plus the cost of any assets acquired
during the plan year from the current value of assets at the end
of the year to obtain this figure. If entering a negative number,
enter a minus sign “ – ” to the left of the number. Do not include
the value of assets reportable in lines 2b(4) and 2b(6) through
2b(10).
Lines 2b(6), (7), (8), and (9). Report all earnings, expenses,
gains or losses, and unrealized appreciation or depreciation
included in computing the net investment gain (or loss) from all
CCTs, PSAs, MTIAs, and 103-12 IEs here. If some plan funds
are held in any of these entities and other plan funds are held in
other funding media, complete all applicable subitems of line 2
to report plan earnings and expenses relating to the other
funding media. The net investment gain (or loss) allocated to
the plan for the plan year from the plan’s investment in these
entities is equal to:
1. The sum of the current value of the plan’s interest in each
entity at the end of the plan year,
2. Minus the current value of the plan’s interest in each
entity at the beginning of the plan year,
3. Plus any amounts transferred out of each entity by the
plan during the plan year, and
4. Minus any amounts transferred into each entity by the
plan during the plan year.
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Enter the net gain as a positive number or the net loss as a
negative number.
Note. Enter the combined net investment gain or loss from all
CCTs and PSAs, regardless of whether a DFE Form 5500 was
filed for the CCTs and PSAs.
Line 2b(10). Enter net investment gain (loss) from registered
investment companies here. Compute in the same manner as
discussed above for lines 2b(6) through (9).
Line 2c. Include all other plan income earned that is not
included in line 2a or 2b. Do not include transfers from other
plans that should be reported in line 2l.
Line 2e(1). Include the current value of all cash, securities, or
other property at the date of distribution. Include all eligible
rollover distributions as defined in Code section 401(a)(31)(D)
paid at the participant’s election to an eligible retirement plan
(including an IRA within the meaning of section 401(a)(31)(E)).
Line 2e(2). Include payments to insurance companies and
similar organizations such as Blue Cross, Blue Shield, and
health maintenance organizations for the provision of plan
benefits (e.g., paid-up annuities, accident insurance, health
insurance, vision care, dental coverage, stop-loss insurance
whose claims are paid to the plan (or which is otherwise an
asset of the plan)), etc.
Line 2e(3). Include all payments made to other organizations
or individuals providing benefits. Generally, these are individual
providers of welfare benefits such as legal services, day care
services, training, and apprenticeship services.
Line 2f. Include on this line all distributions paid during the
plan year of excess deferrals under Code section
402(g)(2)(A)(ii), excess contributions under Code section
401(k)(8), and excess aggregate contributions under Code
section 401(m)(6). Include allocable income distributed. Also
include on this line any elective deferrals and employee
contributions distributed or returned to employees during the
plan year in accordance with Code section 415, as well as any
attributable gains that were also distributed.
Line 2g. Report on line 2g a participant loan that has been
deemed distributed during the plan year under the provisions of
Code section 72(p) and Treasury Regulations section 1.72(p)-1
only if both of the following circumstances apply:
The sum of the realized gain (or loss) of assets sold or
exchanged during the plan year is to be calculated as follows:
1. Enter in line 2b(4)(A), column (a), the sum of the amount
received for these former assets;
2. Enter in line 2b(4)(B), column (a), the sum of the current
value of these former assets as of the beginning of the plan
Instructions for Schedule H (Form 5500)
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Line 1j. Noncash basis plans must include amounts owed for
any liabilities that would not be classified as benefit claims
payable, operating payables, or acquisition indebtedness.
Line 1l. The entry in column (b) must equal the sum of the
entry in column (a) plus lines 2k, 2l(1), and 2l(2).
Line 2a. Include the total cash contributions received and/or
(for accrual basis plans) due to be received.
Note. Plans using the accrual basis of accounting should not
include contributions designated for years before the 2009 plan
year on line 2a.
Line 2a(1)(B). For welfare plans, report all employee
contributions, including all elective contributions under a
cafeteria plan (Code section 125). For pension benefit plans,
participant contributions, for purposes of this item, also include
elective contributions under a qualified cash or deferred
arrangement (Code section 401(k)).
Line 2a(2). Use the current value, at date contributed, of
securities or other noncash property.
Line 2b(1)(A). Enter interest earned on interest-bearing cash,
including earnings from sweep accounts, STIF accounts,
money market accounts, certificates of deposit, etc. This is the
interest earned on the investments reported on line 1c(1).
Line 2b(1)(B). Enter interest earned on U.S. Government
Securities. This is the interest earned on the investments
reported on line 1c(2).
Line 2b(1)(C). Generally, this is the interest earned on
securities that are reported on lines 1c(3)(A) and (B) and 1d(1).
Line 2b(2). Generally, the dividends are for investments
reported on lines 1c(4)(A) and (B), 1c(13), and 1d(1). For
accrual basis plans, include any dividends declared for stock
held on the date of record, but not yet received as of the end of
the plan year.
Line 2b(3). Generally, rents represent the income earned on
the real property that is reported in lines 1c(6) and 1d(2). Enter
rents as a ‘‘Net’’ figure. Net rents are determined by taking the
total rent received and subtracting all expenses directly
associated with the property. If the real property is jointly used
as income producing property and for the operation of the plan,
net that portion of the expenses attributable to the income
producing portion of the property against the total rents
received.
Line 2b(4). Enter in column (b), the total of net gain (loss) on
sale of assets. This equals the sum of the net realized gain (or
loss) on each asset held at the beginning of the plan year which
was sold or exchanged during the plan year, and on each asset
that was both acquired and disposed of within the plan year.
Note. As current value reporting is required for the Form 5500,
assets are revalued to current value at the end of the plan year.
For purposes of this form, the increase or decrease in the value
of assets since the beginning of the plan year (if held on the first
day of the plan year) or their acquisition date (if purchased
during the plan year) is reported in line 2b(5) below, with two
exceptions: (1) the realized gain (or loss) on each asset that
was disposed of during the plan year is reported in line 2b(4)
(NOT on line 2b(5)), and (2) the net investment gain (or loss)
from CCTs, PSAs, MTIAs, 103-12 IEs, and registered
investment companies is reported in lines 2b(6) through (10).
year and the purchase price for assets both acquired and
disposed of during the plan year; and
3. Enter in 2b(4)(C), column (b), the result obtained when
2b(4)(B) is subtracted from 2b(4)(A). If entering a negative
number, enter a minus sign “ – ” to the left of the number.
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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.
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Line 3. The administrator of an employee benefit plan who
files a Schedule H generally must engage an IQPA pursuant to
ERISA section 103(a)(3)(A) and 29 CFR 2520.103-1(b). This
requirement also applies to a Form 5500 filed for a 103-12 IE
and for a GIA (see 29 CFR 2520.103-12 and 29 CFR
2520.103-2). The IQPA’s report must be attached to the Form
5500 when a Schedule H is attached unless line 3d(1) or 3d(2)
on the Schedule H is checked.
29 CFR 2520.103-1(b) requires that any separate financial
statements prepared in order for the IQPA to form the opinion
and notes to these financial statements must be attached to the
Form 5500. Any separate statements must include the
information required to be disclosed in Parts I and II of the
Schedule H; however, they may be aggregated into categories
in a manner other than that used on the Schedule H. The
separate statements must consist of reproductions of Parts I
and II or statements incorporating by reference Parts I and II.
See ERISA section 103(a)(3)(A), and the DOL regulations 29
CFR 2520.103-1(a)(2) and (b), 2520.103-2, and 2520.104-50.
Note. Delinquent participant contributions reported on line 4a
should be treated as part of the separate schedules referenced
in ERISA section 103(a)(3)(A) and 29 CFR 2520.103-1(b) and
2520.103-2(b) for purposes of preparing the IQPA’s opinion
described on line 3 even though they are no longer required to
be listed on Part III of the Schedule G. If the information
contained on line 4a is not presented in accordance with
regulatory requirements, i.e., when the IQPA concludes that the
scheduled information required by line 4a does not contain all
the required information or contains information that is
inaccurate or is inconsistent with the plan’s financial
statements, the IQPA report must make the appropriate
disclosures in accordance with generally accepted auditing
standards. Delinquent participant contributions that are exempt
because they satisfy the DOL voluntary fiduciary correction
program (VFCP) requirements and the conditions of prohibited
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If either of these circumstances does not apply, a deemed
distribution of a participant loan should not be reported on line
2g. Instead, the current value of the participant loan (including
interest accruing thereon after the deemed distribution) must be
included on line 1c(8), column (b) (participant loans - end of
year), without regard to the occurrence of a deemed
distribution.
Note. The amount to be reported on line 2g of Schedule H or
Schedule I must be reduced if, during the plan year, a
participant resumes repayment under a participant loan
reported as a deemed distribution on line 2g for any earlier
year. The amount of the required reduction is the amount of the
participant loan reported as a deemed distribution on line 2g for
the earlier year. If entering a negative number, enter a minus
sign “ – ” to the left of the number. The current value of the
participant loan must then be included in line 1c(8), column (b),
of Schedule H (participant loans - end of year) or in line 1a,
column (b), of Schedule I (plan assets - end of year).
Although certain participant loans deemed distributed are to
be reported on line 2g of the Schedule H or Schedule I, and are
not to be reported on the Schedule H or Schedule I as an asset
thereafter (unless the participant resumes repayment under the
loan in a later year), they are still considered outstanding loans
and are not treated as actual distributions for certain purposes.
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
Line 2h. Interest expense is a monetary charge for the use of
money borrowed by the plan. This amount should include the
total of interest paid or to be paid (for accrual basis plans)
during the plan year.
Line 2i. Report all administrative expenses (by specified
category) paid by or charged to the plan, including those that
were not subtracted from the gross income of CCTs, PSAs,
MTIAs, and 103-12 IEs in determining their net investment
gain(s) or loss(es). Expenses incurred in the general operations
of the plan are classified as administrative expenses.
Line 2i(1). Include the total fees paid (or in the case of
accrual basis plans, costs incurred during the plan year but not
paid as of the end of the plan year) by the plan for outside
accounting, actuarial, legal, and valuation/appraisal services.
Include fees for the annual audit of the plan by an independent
qualified public accountant (IQPA); for payroll audits; for
accounting/bookkeeping services; for actuarial services
rendered to the plan; and to a lawyer for rendering legal
opinions, litigation, and advice (but not for providing legal
services as a benefit to plan participants). Report here fees and
expenses for corporate trustees and individual plan trustees,
including reimbursement of expenses associated with trustees,
such as lost time, seminars, travel, meetings, etc. Include the
fee(s) for valuations or appraisals to determine the cost, quality,
or value of an item such as real property, personal property
(gemstones, coins, etc.), and for valuations of closely held
securities for which there is no ready market. Do not include
amounts paid to plan employees to perform bookkeeping/
accounting functions that should be included in line 2i(4).
Line 2i(2). Enter the total fees paid (or in the case of accrual
basis plans, costs incurred during the plan year but not paid as
of the end of the plan year) to a contract administrator for
performing administrative services for the plan. For purposes of
the return/report, a contract administrator is any individual,
partnership or corporation, responsible for managing the clerical
operations (e.g., handling membership rosters, claims
payments, maintaining books and records) of the plan on a
contractual basis. Do not include salaried staff or employees of
the plan or banks or insurance carriers.
Line 2i(3). Enter the total fees paid (or in the case of accrual
basis plans, costs incurred during the plan year but not paid as
of the end of the plan year) to an individual, partnership or
corporation (or other person) for advice to the plan relating to its
investment portfolio. These may include fees paid to manage
the plan’s investments, fees for specific advice on a particular
investment, and fees for the evaluation of the plan’s investment
performance.
Line 2i(4). Other expenses are those that cannot be included
in 2i(1) through 2i(3). These may include plan expenditures
such as salaries and other compensation and allowances (e.g.,
payment of premiums to provide health insurance benefits to
plan employees), expenses for office supplies and equipment,
cars, telephone, postage, rent, expenses associated with the
ownership of a building used in the operation of the plan, and all
miscellaneous expenses.
Line 2l. Include in these reconciliation figures the value of all
transfers of assets or liabilities into or out of the plan resulting
from, among other things, mergers and consolidations. A
transfer of assets or liabilities occurs when there is a reduction
of assets or liabilities with respect to one plan and the receipt of
these assets or the assumption of these liabilities by another
plan. A transfer is not a shifting of one plan’s assets or liabilities
from one investment to another. A transfer is not a distribution
of all or part of an individual participant’s account balance that
is reportable on IRS Form 1099-R, Distributions From
Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs,
Insurance Contracts, etc., (see the instructions for line 2e).
Transfers out at the end of the year should be reported as
occurring during the plan year. Include premium payments to
the PBGC when paid from plan assets.
Note. If this Schedule H is filed for a CCT, PSA, MTIA, or
103-12 IE, report the value of all asset transfers to the CCT,
PSA, MTIA, or 103-12 IE, including those resulting from
contributions to participating plans on line 2l(1), and report the
total value of all assets transferred out of the CCT, PSA, MTIA,
or 103-12 IE, including assets withdrawn for disbursement as
benefit payments by participating plans, on line 2l(2).
Contributions and benefit payments are considered to be made
to/by the plan (not to/by a CCT, PSA, MTIA, or 103-12 IE).
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transaction exemption (PTE) 2002-51 do not need to be treated
as part of the schedule of nonexempt party-in-interest
transactions.
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CAUTION
Check “No” if the scope of the plan’s audit was limited
for any reason in addition to that pursuant to DOL
regulations 29 CFR 2520.103-8 and 2520.103-12.
Instructions for Schedule H (Form 5500)
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Note. These regulations do not exempt the plan administrator
from engaging an IQPA or from attaching the IQPA’s report to
the Form 5500. If you check line 3b, you must also check the
appropriate box on line 3a to identify the type of opinion offered
by the IQPA.
Line 3c. Enter the name and EIN of the accountant (or
accounting firm) in the space provided on line 3c. Do not use a
social security number in lieu of an EIN. The Schedule H is
open to public inspection, and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social security
number on this Schedule H may result in the rejection of the
filing.
Line 3d(1). Check this box only if the Schedule H is being
filed for a CCT, PSA, or MTIA.
Line 3d(2). Check this box if the plan has elected to defer
attaching the IQPA’s opinion for the first of two (2) consecutive
plan years, one of which is a short plan year of seven (7)
months or fewer. The Form 5500 for the first of the two (2)
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If the required IQPA’s report is not attached to the Form
5500, the filing is subject to rejection as incomplete and
penalties may be assessed.
Lines 3a(1) through 3a(4). These boxes identify the type of
opinion offered by the accountant.
Line 3a(1). Check if an unqualified opinion was issued.
Generally, an unqualified opinion is issued when the IQPA
concludes that the plan’s financial statements present fairly, in
all material respects, the financial status of the plan as of the
end of the period audited and the changes in its financial status
for the period under audit in conformity with generally accepted
accounting principles (GAAP) or an other comprehensive basis
of accounting (OCBOA), e.g., cash basis.
Line 3a(2). Check if a qualified opinion was issued. Generally,
a qualified opinion is issued by an IQPA when the plan’s
financial statements present fairly, in all material respects, the
financial status of the plan as of the end of the audit period and
the changes in its financial status for the period under audit in
conformity with GAAP or OCBOA, except for the effects of one
or more matters described in the opinion.
Line 3a(3). Check if a disclaimer of opinion was issued. A
disclaimer of opinion is issued when the IQPA does not express
an opinion on the financial statements because he or she has
not performed an audit sufficient in scope to enable him or her
to form an opinion on the financial statements.
Line 3a(4). Check if the plan received an adverse
accountant’s opinion. Generally, an adverse opinion is issued
by an IQPA when the plan’s financial statements do not present
fairly, in all material respects, the financial status of the plan as
of the end of the audit period and the changes in its financial
status for the period under audit in conformity with GAAP or
OCBOA.
Line 3b. Check “Yes” if a box is checked on line 3a and the
only limitation on the scope of the plan’s audit was pursuant to
DOL regulations 29 CFR 2520.103-8 and 2520.103-12(d)
because the examination and report of an IQPA did not extend
to: (a) statements or information regarding assets held by a
bank, similar institution or insurance carrier that is regulated
and supervised and subject to periodic examination by a state
or federal agency provided that the statements or information
are prepared by and certified to by the bank or similar institution
or an insurance carrier, or (b) information included with the
Form 5500 filed for a 103-12 IE. The term ‘‘similar institution’’ as
used here does not extend to securities brokerage firms (see
DOL Advisory Opinion 93-21A). See 29 CFR 2520.103-8 and
2520.103-12(d).
years must be complete and accurate, with all required
attachments, except for the IQPA’s report, including an
attachment explaining why one of the two (2) plan years is of
seven (7) or fewer months duration and stating that the annual
report for the immediately following plan year will include a
report of an IQPA with respect to the financial statements and
accompanying schedules for both of the two (2) plan years. The
Form 5500 for the second year must include: (a) financial
schedules and statements for both plan years; (b) a report of an
IQPA with respect to the financial schedules and statements for
each of the two (2) plan years (regardless of the number of
participants covered at the beginning of each plan year); and
(c) a statement identifying any material differences between the
unaudited financial information submitted with the first Form
5500 and the audited financial information submitted with the
second Form 5500. See 29 CFR 2520.104-50.
Note. Do not check the box on line 3d(2) if the Form 5500 is
filed for a 103-12 IE or a GIA. A deferral of the IQPA’s opinion is
not permitted for a 103-12 IE or a GIA. If an E or G is entered
on Form 5500, Part I, line A(4), an IQPA’s opinion must be
attached to the Form 5500 and the type of opinion must be
reported on Schedule H, line 3a.
Lines 4a through 4n. Plans completing Schedule H must
answer all these lines either ‘‘Yes’’ or ‘‘No.’’ Do not leave any
answer blank, unless otherwise directed. For lines 4a through
4h and line 4l, if the answer is “Yes,” an amount must be
entered.
Report investments in CCTs, PSAs, MTIAs, and 103-12 IEs,
but not the investments made by these entities. Plans with all of
their funds held in a master trust should check ‘‘No’’ on line 4b,
4c, 4i, and 4j. CCTs and PSAs do not complete Part IV. MTIAs,
103-12 IEs, and GIAs do not complete lines 4a, 4e, 4f, 4g, 4h,
4k, 4m, or 4n. 103-12 IEs also do not complete line 4j and 4l.
MTIAs also do not complete line 4l.
Line 4a. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the
plan are participant contributions that become plan assets as of
the earliest date on which such contributions can reasonably be
segregated from the employer’s general assets (see 29 CFR
2510.3-102). An employer holding these assets after that date
commingled with its general assets will have engaged in a
prohibited use of plan assets (see ERISA section 406). If such a
nonexempt prohibited transaction occurred with respect to a
disqualified person (see Code section 4975(e)(2)), file IRS
Form 5330, Return of Excise Taxes Related to Employee
Benefit Plans, with the IRS to pay any applicable excise tax on
the transaction.
Plans that check “Yes” must enter the aggregate amount of
all late contributions for the year. The total amount of the
delinquent contributions should be included on line 4a of the
Schedule H or I, as applicable, for the year in which the
contributions were delinquent and should be carried over and
reported again on line 4a of the Schedule H or I, as applicable,
for each subsequent year until the year after the violation has
been fully corrected, which correction includes payment of the
late contributions and reimbursement of the plan for lost
earnings or profits. If no participant contributions were received
or withheld by the employer during the plan year, answer ‘‘No.’’
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 4a in accordance with the reporting requirements
that apply to delinquent participant contributions or on line 4d.
See Advisory Opinion 2002-02A, available at www.dol.gov/
ebsa.
Delinquent participant contributions reported on line 4a
TIP should be treated as part of the separate schedules
referenced in ERISA section 103(a)(3)(A) and 29 CFR
2520.103-1(b) and 2520.103-2(b) for purposes of preparing the
IQPA’s opinion described on line 3 even though they are no
longer required to be listed on Part III of the Schedule G. If the
information contained on line 4a is not presented in accordance
with regulatory requirements, i.e., when the IQPA concludes
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payment(s) has not been made. An uncollectible lease is one
where the required payments have not been made and for
which there is little probability that payment will be made.
Line 4d. Plans that check ‘‘Yes’’ must enter the amount and
complete Part III of Schedule G. Check ‘‘Yes’’ if any nonexempt
transaction with a party-in-interest occurred regardless of
whether the transaction is disclosed in the IQPA’s report. Do
not check “Yes” or complete Schedule G, Part III, with respect
to transactions that are: (1) statutorily exempt under Part 4 of
Title I of ERISA; (2) administratively exempt under ERISA
section 408(a); (3) exempt under Code sections 4975(c) or
4975(d); (4) the holding of participant contributions in the
employer’s general assets for a welfare plan that meets the
conditions of ERISA Technical Release 92-01; (5) a transaction
of a 103-12 IE with parties other than the plan; or (6) delinquent
participant contributions or delinquent participant loan
repayments reported on line 4a.
Note. See the instructions for Part III of the Schedule G (Form
5500) concerning nonexempt transactions and party-in-interest.
You may indicate that an application for an administrative
exemption is pending. If you are unsure as to whether a
transaction is exempt or not, you should consult with either the
plan’s IQPA or legal counsel or both.
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Line 4b. Plans that check ‘‘Yes’’ must enter the amount and
complete Part I of Schedule G. The due date, payment amount
and conditions for determining default of a note or loan are
usually contained in the documents establishing the note or
loan. A loan by the plan is in default when the borrower is
unable to pay the obligation upon maturity. Obligations that
require periodic repayment can default at any time. Generally,
loans and fixed income obligations are considered uncollectible
when payment has not been made and there is little probability
that payment will be made. A fixed income obligation has a
fixed maturity date at a specified interest rate. Do not include
participant loans made under an individual account plan with
investment experience segregated for each account that were
made in accordance with 29 CFR 2550.408b-1 and secured
solely by a portion of the participant’s vested accrued benefit.
Line 4c. Plans that check ‘‘Yes’’ must enter the amount and
complete Part II of Schedule G. A lease is an agreement
conveying the right to use property, plant, or equipment for a
stated period. A lease is in default when the required
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Contributions
Pending
Correction in
VFCP
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Check here Contributions Contributions
if Late
Not Corrected Corrected
Participant
Outside
Loan
VFCP
Repayments
are included:
䡺
Total Fully
Corrected
Under
VFCP and
PTE
2002 – 51
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Participant
Total that Constitute Nonexempt Prohibited
Contributions
Transactions
Transferred
Late to Plan
4a) are eligible for immediate relief from payment of
certain prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
IRS Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). When the conditions of PTE 2002-51 have been
satisfied, the corrected transactions should be treated as
exempt under Code section 4975(c) for the purposes of
answering line 4d.
Line 4e. Plans that check ‘‘Yes’’ must enter the aggregate
amount of 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 from an
approved surety covering plan officials and that protects the
plan as described in 29 CFR Part 2580. Generally, every plan
official of an employee benefit plan who ‘‘handles’’ funds or
other property of such plan must be bonded. Generally, a
person shall be deemed to be ‘‘handling’’ funds or other
property of a plan, so as to require bonding, whenever his or
her duties or activities with respect to given funds are such that
there is a risk that such funds could be lost in the event of fraud
or dishonesty on the part of such person, acting either alone or
in collusion with others. Section 412 of ERISA and 29 CFR Part
2580 describe the bonding requirements, including the
definition of ‘‘handling’’ (29 CFR 2580.412-6), the permissible
forms of bonds (29 CFR 2580.412-10), the amount of the bond
(29 CFR Part 2580, subpart C), and certain exemptions such as
the exemption for unfunded plans, certain banks and insurance
companies (ERISA section 412), and the exemption allowing
plan officials to purchase bonds from surety companies
authorized by the Secretary of the Treasury as acceptable
reinsurers on federal bonds (29 CFR 2580.412-23). Information
concerning the list of approved sureties and reinsurers is
available on the Internet at www.fms.treas.gov/c570. For more
information on the fidelity bonding requirements, see Field
Assistance Bulletin 2008-04, available on the Internet 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 4c.
Line 4f. Check ‘‘Yes,’’ if the plan suffered or discovered any
loss as a result of any dishonest or fraudulent act(s) even if the
loss was reimbursed by the plan’s fidelity bond or from any
other source. If ‘‘Yes’’ is checked enter the full amount of the
loss. If the full amount of the loss has not yet been determined,
provide an estimate and disclose that the figure is an estimate
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Schedule H Line 4a — Schedule of Delinquent
Participant Contributions
Applicants that satisfy the VFCP requirements and the
TIP conditions of PTE 2002-51 (see the instructions for line
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that the scheduled information required by line 4a does not
contain all the required information or contains information that
is inaccurate or is inconsistent with the plan’s financial
statements, the IQPA report must make the appropriate
disclosures in accordance with generally accepted auditing
standards. For more information, see EBSA’s Frequently Asked
Questions About Reporting Delinquent Contributions on the
Form 5500, available on the Internet at www.dol.gov/ebsa.
These Frequently Asked Questions clarify that plans have an
obligation to include delinquent participant contributions on their
financial statements and supplemental schedules and that the
IQPA’s report covers such delinquent contributions even though
they are not required to be included on Part III of the Schedule
G. Although all delinquent participant contributions must be
reported on line 4a, delinquent contributions for which the DOL
VFCP requirements and the conditions of PTE 2002-51 have
been satisfied do not need to be treated as nonexempt
party-in-interest transactions.
The VFCP describes how to apply, the specific transactions
covered (which transactions include delinquent participant
contributions to pension and welfare plans), and acceptable
methods for correcting violations. In addition, applicants that
satisfy both the VFCP requirements and the conditions of PTE
2002-51 are eligible for immediate relief from payment of
certain prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
IRS Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). Information about the VFCP is also available on the
Internet at www.dol.gov/ebsa.
All delinquent participant contributions must be reported on
line 4a even if violations have been corrected.
Line 4a Schedule. Attach a Schedule of Delinquent
Participant Contributions using the format below if you entered
“Yes.” If you chose to include participant loan repayments on
line 4a, you must apply the same supplemental schedule and
IQPA disclosure requirements to the loan repayments as
applied to delinquent transmittals of participant contributions.
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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.
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are: (1) participant loans not in default, or (2) assets over which
the participant exercises control within the meaning of section
404(c) of ERISA.
Although the current value of plan assets must be
determined each year, there is no requirement that the assets
(other than certain nonpublicly traded employer securities held
in ESOPs) be valued every year by independent third-party
appraisers.
Willful failure to report is a criminal offense. See ERISA
section 501.
CAUTION
Lines 4g and 4h. Current value means fair market value
where available. Otherwise, it means the fair value as
determined in good faith under the terms of the plan by a
trustee or a named fiduciary, assuming an orderly liquidation at
the time of the determination. See ERISA section 3(26).
An accurate assessment of fair market value is essential to
a pension plan’s ability to comply with the requirements set
forth in the Code (e.g., the exclusive benefit rule of Code
section 401(a)(2), the limitations on benefits and contributions
under Code section 415, and the minimum funding
requirements under Code section 412) and must be determined
annually.
Examples of assets that may not have a readily
determinable value on an established market (e.g., NYSE,
AMEX, over the counter, etc.) include real estate, nonpublicly
traded securities, shares in a limited partnership, and
collectibles. Do not check “Yes” on line 4g for mutual fund
shares or insurance company investment contracts for which
the plan receives valuation information at least annually. Also,
do not check ‘‘Yes’’ on line 4g if the plan is a defined
contribution plan and the only assets the plan holds, that do not
have a readily determinable value on an established market,
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Line 4i. Check ‘‘Yes’’ if the plan had any assets held for
investment purposes, and attach a schedule of assets held for
investment purposes at end of year, a schedule of assets held
for investment purposes that were both acquired and disposed
of within the plan year, or both, as applicable. The schedules
must use the format set forth below or a similar format. See 29
CFR 2520.103-11.
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Enter in the amount column the fair market value of the
assets referred to on line 4g whose value was not readily
determinable on an established market and which were not
valued by an independent third-party appraiser in the plan year.
Generally, as it relates to these questions, an appraisal by an
independent third party is an evaluation of the value of an asset
prepared by an individual or firm who knows how to judge the
value of such assets and does not have an ongoing relationship
with the plan or plan fiduciaries except for preparing the
appraisals.
Assets held for investment purposes shall include:
• Any investment asset held by the plan on the last day of the
plan year; and
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(c) Description of investment including maturity date,
rate of interest, collateral, par, or maturity value
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(a) (b) Identity of issue, borrower, lessor, or similar party
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Line 4i schedules. The first schedule required to be attached is a schedule of all assets held for investment purposes at the end
of the plan year, aggregated and identified by issue, maturity date, rate of interest, collateral, par or maturity value, cost and current
value, and, in the case of a loan, the payment schedule.
In column (a), place an asterisk (*) on the line of each identified person known to be a party-in-interest to the plan. In column
(c), include any restriction on transferability of corporate securities. (Include lending of securities permitted under Prohibited
Transactions Exemption 81-6.)
This schedule must be clearly labeled “Schedule H, line 4i—Schedule of Assets (Held At End of Year).”
(d) Cost
(e) Current
value
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(a) Identity of issue, borrower, lessor, or similar party
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The second schedule required to be attached is a schedule of investment assets that were both acquired and disposed of within
the plan year. This schedule must be clearly labeled “Schedule H, line 4i—Schedule of Assets (Acquired and Disposed of Within
Year).”
(b) Description of investment including maturity date,
rate of interest, collateral, par, or maturity value
(c) Costs of
acquisitions
(d) Proceeds of
dispositions
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Notes: (1) Participant loans under an individual account plan with investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and that are secured solely by a portion of the participant’s vested accrued benefit,
may be aggregated for reporting purposes in line 4i. Under identity of borrower enter “Participant loans,” under rate of interest
enter the lowest rate and the highest rate charged during the plan year (e.g., 8%–10%), under the cost and proceeds columns enter
zero, and under current value enter the total amount of these loans. (2) Column (d) cost information for the Schedule of Assets
(Held At End of Year) and the column (c) cost of acquisitions information for the Schedule of Assets (Acquired and Disposed
of Within Year) may be omitted when reporting investments of an individual account plan that a participant or beneficiary directed
with respect to assets allocated to his or her account (including a negative election authorized under the terms of the plan). Likewise,
cost information for investments in Code sections 403(b)(1) annuity contracts and 403(b)(7) custodial accounts may also be omitted.
(3) Participant-directed brokerage account assets reported in the aggregate on line 1c(15) must be treated as one asset held for
investment for purposes of the line 4i schedules, except investments in tangible personal property must continue to be reported
as separate assets on the line 4i schedules. Investments in Code section 403(b) annuity contracts and Code section 403(b)(7)
custodial accounts should also be treated as one asset held for investment for purposes on the line 4i schedules.
Instructions for Schedule H (Form 5500)
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• Any investment asset purchased during the plan year and
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Assets held for investment purposes shall not include any
investment that was not held by the plan on the last day of the
plan year if that investment is reported in the annual report for
that plan year in any of the following:
1. The schedule of loans or fixed income obligations in
default required by Schedule G, Part I;
2. The schedule of leases in default or classified as
uncollectible required by Schedule G, Part II;
3. The schedule of nonexempt transactions required by
Schedule G, Part III; or
4. The schedule of reportable transactions required by
Schedule H, line 4j.
initial plan year, you may use the current value of plan assets at
the end of the plan year to determine the 5% figure.
If the assets of two or more plans are maintained in one
trust, except as provided below, the plan’s allocable portion of
the transactions of the trust shall be combined with the other
transactions of the plan, if any, to determine which transactions
(or series of transactions) are reportable (5%) transactions.
For investments in common/collective trusts (CCTs), pooled
separate accounts (PSAs), 103-12 IEs, and registered
investment companies, determine the 5% figure by comparing
the transaction date value of the acquisition and/or disposition
of units of participation or shares in the entity with the current
value of the plan assets at the beginning of the plan year. If the
Schedule H is attached to a Form 5500 filed for a plan with all
plan funds held in a master trust, check ‘‘No’’ on line 4j. Plans
with assets in a master trust that have other transactions should
determine the 5% figure by subtracting the current value of plan
assets held in the master trust from the current value of all plan
assets at the beginning of the plan year and check ‘‘Yes’’ or
‘‘No,’’ as appropriate. Do not include individual transactions of
(CCTs), (PSAs), master trust investment accounts (MTIAs),
103-12 IEs, and registered investment companies in which this
plan or DFE invests.
In the case of a purchase or sale of a security on the market,
do not identify the person from whom purchased or to whom
sold.
Special rule for certain participant-directed transactions.
Transactions under an individual account plan that a participant
or beneficiary directed with respect to assets allocated to his or
her account (including a negative election authorized under the
terms of the plan) should not be treated for purposes of line 4j
as reportable transactions. The current value of all assets of the
plan, including these participant-directed transactions, should
be included in determining the 5% figure for all other
transactions.
Line 4k. Check ‘‘Yes’’ if all the plan assets (including
insurance/annuity contracts) were distributed to the participants
and beneficiaries, legally transferred to the control of another
plan, or brought under the control of the PBGC.
Check ‘‘No’’ for a welfare benefit plan that is still liable to pay
benefits for claims incurred before the termination date, but not
yet paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line 4l. 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 4m. Check “Yes” if there was a “blackout period.” A
blackout period is a temporary suspension of more than three
(3) consecutive business days during which participants or
beneficiaries of a 401(k) or other individual account pension
plan were unable to, 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
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A reportable transaction includes:
1. A single transaction within the plan year in excess of 5%
of the current value of the plan assets;
2. Any series of transactions with or in conjunction with the
same person, involving property other than securities, which
amount in the aggregate within the plan year (regardless of the
category of asset and the gain or loss on any transaction) to
more than 5% of the current value of plan assets;
3. Any transaction within the plan year involving securities
of the same issue if within the plan year any series of
transactions with respect to such securities amount in the
aggregate to more than 5% of the current value of the plan
assets; and
4. Any transaction within the plan year with respect to
securities with, or in conjunction with, a person if any prior or
subsequent single transaction within the plan year with such
person, with respect to securities, exceeds 5% of the current
value of plan assets.
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Line 4j. Check ‘‘Yes’’ and attach to the Form 5500 the
following schedule if the plan had any reportable transactions
(see 29 CFR 2520.103-6 and the examples provided in the
regulation). The schedule must use the format set forth below
or a similar format. See 29 CFR 2520.103-11.
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The 5% figure is determined by comparing the current value
of the transaction at the transaction date with the current value
of the plan assets at the beginning of the plan year. If this is the
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sold before the end of the plan year except:
1. Debt obligations of the U.S. or any U.S. agency.
2. Interests issued by a company registered under the
Investment Company Act of 1940 (e.g., a mutual fund).
3. Bank certificates of deposit with a maturity of one year or
less.
4. Commercial paper with a maturity of 9 months or less if it
is valued in the highest rating category by at least two nationally
recognized statistical rating services and is issued by a
company required to file reports with the Securities and
Exchange Commission under section 13 of the Securities
Exchange Act of 1934.
5. Participations in a bank common or collective trust.
6. Participations in an insurance company pooled separate
account.
7. Securities purchased from a broker-dealer registered
under the Securities Exchange Act of 1934 and either: (1) listed
on a national securities exchange and registered under section
6 of the Securities Exchange Act of 1934 or (2) quoted on
NASDAQ.
Line 4j schedule. The schedule required to be attached is a schedule of reportable transactions that must be clearly labeled
“Schedule H, line 4j — Schedule of Reportable Transactions.”
(a) Identity of
party involved
(b) Description of asset
(include interest rate and
maturity in case of a loan)
(c) Purchase
price
(d) Selling
price
(e) Lease
rental
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(f) Expense
incurred
with transaction
(g) Cost of
asset
(h) Current
value of asset
on transaction
date
(i) Net gain
or (loss)
Instructions for Schedule H (Form 5500)
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(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 29 CFR 2520.101-3
(available at www.dol.gov/ebsa).
Line 4n. 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.
Line 5a. Check ‘‘Yes’’ if a resolution to terminate the plan was
adopted during this or any prior plan year, unless the
termination was revoked and no assets reverted to the
employer. If ‘‘Yes’’ is checked, enter the amount of plan assets
that reverted to the employer during the plan year in connection
with the implementation of such termination. Enter ‘‘0’’ if no
reversion occurred during the current plan year.
during the plan year. A transfer of assets or liabilities occurs
when there is a reduction of assets or liabilities with respect to
one plan and the receipt of these assets or the assumption of
these liabilities by another plan. Enter the name, EIN, and PN
for the transferee plan(s) involved on lines 5b(1), (2), and (3).
Note. A distribution of all or part of an individual participant’s
account balance that is reportable on Form 1099-R should not
be included on line 5b. Do not submit Form 1099-R with the
Form 5500.
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
Events, and PBGC Form 10-Advance, Advance Notice of
Reportable Events.
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A Form 5500 must be filed for each year the plan has
assets, and, for a welfare benefit plan, if the plan is still
CAUTION liable to pay benefits for claims incurred before the
termination date, but not yet paid. See 29 CFR
2520.104b-2(g)(2)(ii).
Line 5b. Enter information concerning assets and/or liabilities
transferred from this plan to another plan(s) (including spinoffs)
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Do not use a social security number in lieu of an EIN or
include an attachment that contains visible social security
numbers. The Schedule H is open to public inspection, and the
contents are public information and are subject to publication on
the Internet. Because of privacy concerns, the inclusion of a
social security number on this Schedule H or the inclusion of a
visible social security number on an attachment may result in
the rejection of the filing.
Instructions for Schedule H (Form 5500)
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investment accounts (MTIAs), and/or 103-12 IEs must also
attach Schedule D.
Use the same method for determining the value of the
plan’s interest in an insurance company general account
(unallocated contracts) that you used for line 4 of Schedule A,
or, if line 4 is not required, line 7 of Schedule A.
Note. Do not include in column (b) a participant loan that has
been deemed distributed during the plan year under the
provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1, if both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
2009 Instructions for Schedule I
(Form 5500)
Financial Information – Small Plan
General Instructions
Who Must File
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Schedule I (Form 5500) must be attached to a Form 5500 filed
for pension benefit plans and welfare benefit plans that covered
fewer than 100 participants as of the beginning of the plan year
and that are not eligible to file Form 5500-SF.
Note. If a Schedule I was filed for the plan for the 2008 plan
year and the plan covered fewer than 121 participants as of the
beginning of the 2009 plan year, the Schedule I may be
completed instead of a Schedule H.
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If the assets of two or more plans are maintained in one
fund, such as when an employer has two plans funded through
a single trust (except a DFE), complete Parts I and II by
entering the plan’s allocable part of each line item.
If assets of one plan are maintained in two or more trust
funds, report the combined financial information in Part I.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good faith
under the terms of the plan by a trustee or a named fiduciary,
assuming an orderly liquidation at time of the determination.
See ERISA section 3(26).
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Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule I is
attached.
Do not use a social security number in line D in lieu of an
EIN. The Schedule I and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule I or any of its attachments may result in the rejection
of the filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
Note. Use the cash, modified cash, or accrual basis for
recognition of transactions, as long as you use one method
consistently. Round off all amounts reported on the Schedule I
to the nearest dollar. Any other amounts are subject to
rejection. Check all subtotals and totals carefully.
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Specific Instructions
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Exception. Certain insured, unfunded or combination
unfunded/insured welfare plans are exempt from filing the Form
5500 and the Schedule I. In addition, certain fully insured
pension benefit plans are exempt from completing the Schedule
I. See the Form 5500 instructions for Who Must File and Limited
Pension Plan Reporting for more information.
Check the Schedule I box on the Form 5500 (Part II, line
10b(2)) if a Schedule I is attached to the Form 5500. Do not
attach both a Schedule I and a Schedule H to the same Form
5500.
If the deemed distributed participant loan is included in
column (a) and both of these circumstances apply, report the
loan as a deemed distribution on line 2g. However, if either of
these circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) should be included in column (b) without
regard to the occurrence of a deemed distribution.
After a participant loan that has been deemed distributed is
reported on line 2g, it is no longer to be reported as an asset on
Schedule H or Schedule I unless, in a later year, the participant
resumes repayment under the loan. However, such a loan
(including interest accruing thereon after the deemed
distribution) that has not been repaid is still considered
outstanding for purposes of applying Code section 72(p)(2)(A)
to determine the maximum amount of subsequent loans. Also,
the deemed distribution is not treated as an actual distribution
for other purposes, such as the qualification requirements of
Code section 401, including, for example, the determination of
top-heavy status under Code section 416 and the vesting
requirements of Treasury Regulations section 1.411(a)-7(d)(5).
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
The entry on line 1a, column (b), of Schedule I (plan assets end of year) or on line 1c(8), column (b), of Schedule H
(participant loans - end of year) must include the current value
of any participant loan reported as a deemed distribution on line
2g for any earlier year if, during the plan year, the participant
resumes repayment under the loan. In addition, the amount to
be entered on line 2g must be reduced by the amount of the
participant loan reported as a deemed distribution on line 2g for
the earlier year.
Line 1b. Enter the total liabilities at the beginning and end of
the plan year. Liabilities to be entered here do not include the
value of future pension payments to plan participants. However,
the amount to be entered in line 1b for accrual basis filers
includes, among other things:
1. Benefit claims that have been processed and approved
for payment by the plan but have not been paid (including all
incurred but not reported welfare benefit claims);
2. Accounts payable obligations owed by the plan that were
incurred in the normal operations of the plan but have not been
paid; and
3. Other liabilities such as acquisition indebtedness and any
other amount owed by the plan.
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Line 1c. Enter the net assets as of the beginning and end of
the plan year. (Subtract line 1b from 1a.) Line 1c, column (b)
must equal the sum of line 1c, column (a) plus lines 2j and 2k.
Line 2a. Include the total cash contributions received and/or
(for accrual basis plans) due to be received.
Line 2a(1). Plans using the accrual basis of accounting must
not include contributions designated for years before the 2009
plan year on line 2a(1).
Line 2a(2). For welfare plans, report all employee
contributions, including all elective contributions under a
cafeteria plan (Code section 125). For pension benefit plans,
participant contributions, for purposes of this item, also include
Part I - Small Plan Financial Information
Amounts reported on lines 1a, 1b, and 1c for the beginning of
the plan year must be the same as reported for the end of the
plan year for corresponding lines on the return/report for the
preceding plan year.
Do not include contributions designated for the 2009 plan
year in column (a).
Line 1a. A plan with assets held in common/collective trusts
(CCTs), pooled separate accounts (PSAs), master trust
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Instructions for Schedule I (Form 5500)
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elective contributions under a qualified cash or deferred
arrangement (Code section 401(k)).
Line 2b. Use the current value, at date contributed, of
securities or other noncash property.
Line 2c. Enter all other plan income for the plan year. Do not
include transfers from other plans that are reported on line 2l.
Other income received and/or receivable would include:
1. Interest on investments (including money market
accounts, sweep accounts, STIF accounts, etc.).
2. Dividends. (Accrual basis plans should include dividends
declared for all stock held by the plan even if the dividends
have not been received as of the end of the plan year.)
3. Rents from income-producing property owned by the
plan.
4. Royalties.
5. Net gain or loss from the sale of assets.
6. Other income, such as unrealized appreciation
(depreciation) in plan assets. To compute this amount subtract
the current value of all assets at the beginning of the year plus
the cost of any assets acquired during the plan year from the
current value of all assets at the end of the year minus assets
disposed of during the plan year.
Note. The amount to be reported on line 2g of Schedule H or
Schedule I must be reduced if, during the plan year, a
participant resumes repayment under a participant loan
reported as a deemed distribution on line 2g for any earlier
year. The amount of the required reduction is the amount of the
participant loan reported as a deemed distribution on line 2g for
the earlier year. If entering a negative number, enter a minus
sign “ – ” to the left of the number. The current value of the
participant loan must then be included in line 1c(8), column (b),
of Schedule H (participant loans - end of year) or in line 1a,
column (b), of Schedule I (plan assets - end of year).
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Line 2i. 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, postage, rent and expenses associated
with the ownership of a building used in operation of the plan.
Line 2j. Enter the total of all benefits paid or due as reported
on lines 2e, 2f, and 2g and all other plan expenses (lines 2h
and 2i) during the year.
Line 2l. 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 2l but must be included in benefit
payments reported on line 2e. Do not submit IRS Form 1099-R
with Form 5500.
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Lines 3a through 3g. You must check either “Yes” or “No” on
each line to report whether the plan held any assets in the listed
categories at any time during the plan year. If “Yes” is checked
on any line, enter in the amount column for that line the current
value of the assets held at the end of the plan year or “0” if no
assets remain in the category at the end of the plan year. You
should allocate the value of the plan’s interest in a commingled
trust containing the assets of more than one plan on a
line-by-line basis, except do not include on lines 3a through 3g
the value of the plan’s interest in any CCT, PSA, MTIA, or
103-12 IE (see instructions for definitions of CCT, PSA, MTIA,
and 103-12 IE).
Line 3a. Enter the value of the plan’s participation in a
partnership or joint venture, unless the partnership or joint
venture is a 103-12 IE.
If either of these circumstances does not apply, a deemed
distribution of a participant loan should not be reported on line
2g. Instead, the current value of the participant loan (including
interest accruing thereon after the deemed distribution) should
be included on line 1a, column (b) (plan assets - end of year),
without regard to the occurrence of a deemed distribution.
Instructions for Schedule I (Form 5500)
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Line 2d. Enter the total of all cash contributions (lines 2a(1)
through (3)), noncash contributions (line 2b), and other plan
income (line 2c) during the plan year. If entering a negative
number, enter a minus sign “ – ” to the left of the number.
Line 2e. Include: (1) payments made (and for accrual basis
filers payments due) to or on behalf of participants or
beneficiaries in cash, securities, or other property (including
rollovers of an individual’s accrued benefit or account balance).
Include all eligible rollover distributions as defined in Code
section 401(a)(31)(D) paid at the participant’s election to an
eligible retirement plan (including an IRA within the meaning of
Code section 401(a)(31)(E)); (2) payments to insurance
companies and similar organizations such as Blue Cross, Blue
Shield, and health maintenance organizations for the provision
of plan benefits (e.g., paid-up annuities, accident insurance,
health insurance, vision care, dental coverage, etc.); and (3)
payments made to other organizations or individuals providing
benefits. Generally, these payments discussed in (3) are made
to individual providers of welfare benefits such as legal
services, day care services, and training and apprenticeship
services. If securities or other property are distributed to plan
participants or beneficiaries, include the current value on the
date of distribution.
Line 2f. Include on this line all distributions paid during the
plan year of excess deferrals under Code section
402(g)(2)(A)(ii), excess contributions under Code section
401(k)(8), and excess aggregate contributions under Code
section 401(m)(6). Include allocable income distributed. Also
include on this line any elective deferrals and employee
contributions distributed or returned to employees during the
plan year in accordance with Code section 415, as well as any
attributable gains that were also distributed.
Line 2g. Report on line 2g a participant loan included in line
1a, column (a) (participant loans - beginning of year) and that
has been deemed distributed during the plan year under the
provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1 only if both of the following circumstances
apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
Line 2h. The amount to be reported for expenses involving
administrative service providers (salaries, fees, and
commissions) includes the total fees paid (or in the case of
accrual basis plans, costs incurred during the plan year but not
paid as of the end of the plan year) by the plan for, among
others:
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;
4. Fees and expenses for individual plan trustees, including
reimbursement for travel, seminars, and meeting expenses; and
5. Fees and expenses paid for valuations and appraisals of
real estate and closely held securities.
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Although certain participant loans deemed distributed are to
be reported on line 2g of the Schedule H or Schedule I, and are
not to be reported on the Schedule H or Schedule I as an asset
thereafter (unless the participant resumes repayment under the
loan in a later year), they are still considered outstanding loans
and are not treated as actual distributions for certain purposes.
See Q&As 12 and 19 of Treasury Regulations section
1.72(p)-1.
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Part II - Compliance Questions
Line 3b. The term ‘‘employer real property’’ means real
property (and related personal property) that is leased to an
employer of employees covered by the plan, or to an affiliate of
such employer. For purposes of determining the time at which a
plan acquires employer real property for purposes of this line,
such property shall be deemed to be acquired by the plan on
the date on which the plan acquires the property or on the date
on which the lease to the employer (or affiliate) is entered into,
whichever is later.
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Line 3d. An employer security is any security issued by an
employer (including affiliates) of employees covered by the
plan. These may include common stocks, preferred stocks,
bonds, zero coupon bonds, debentures, convertible debentures,
notes and commercial paper.
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For those Schedule I filers required to submit an IQPA
TIP report, delinquent participant contributions reported on
line 4a must be treated as part of the separate
schedules referenced in ERISA section 103(a)(3)(A) and 29
CFR 2520.103-1(b) and 2520.103-2(b) for purposes of
preparing the IQPA’s opinion even though they are not required
to be listed on Part III of the Schedule G. If the information
contained on line 4a is not presented in accordance with
regulatory requirements, i.e., when the IQPA concludes that the
scheduled information required by line 4a does not contain all
the required information or contains information that is
inaccurate or is inconsistent with the plan’s financial
statements, the IQPA report must make the appropriate
disclosures in accordance with generally accepted auditing
standards. For more information, see EBSA’s Frequently Asked
Questions about Reporting Delinquent Contributions on the
Form 5500, available on the Internet at www.dol.gov/ebsa.
These Frequently Asked Questions clarify that plans have an
obligation to include delinquent participant contributions on their
financial statements and supplemental schedules and that the
IQPA’s report covers such delinquent contributions even though
they are no longer required to be included on Part III of the
Schdule G. Although all delinquent participant contributions
must be reported on line 4a, delinquent contributions for which
the DOL Voluntary Fiduciary Correction Program (VFCP)
requirements and the conditions of Prohibited Transaction
Exemption (PTE) 2002-51 have been satisfied do not need to
be treated as nonexempt party-in-interest transactions.
The VFCP describes how to apply, the specific transactions
covered (which transactions include delinquent participant
contributions to pension and welfare plans), and acceptable
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Note. After participant loans have been deemed distributed
and reported on line 2g of the Schedule I or H, they are no
longer required to be reported as assets on the Schedule I or H.
However, such loans (including interest accruing thereon after
the deemed distribution) that have not been repaid are still
considered outstanding for purposes of applying Code section
72(p)(2)(A) to determine the maximum amount of subsequent
loans. Also, the deemed distribution is not treated as an actual
distribution for other purposes, such as the qualification
requirements of Code section 401, including, for example, the
determination of top-heavy status under Code section 416 and
the vesting requirements of Treasury Regulations section
1.411(a)-7(d)(5). See Q&As 12 and 19 of Treasury Regulations
section 1.72(p)-1.
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If both of these circumstances apply, report the loan as a
deemed distribution on line 2g. However, if either of these
circumstances does not apply, the current value of the
participant loan (including interest accruing thereon after the
deemed distribution) should be included on line 3e without
regard to the occurrence of a deemed distribution.
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Line 3f. Enter the current value of all loans made by the plan,
except participant loans reportable on line 3e. Include the sum
of the value of loans for construction, securities loans,
commercial and/or residential mortgage loans that are not
subject to Code section 72(p) (either by making or participating
in the loans directly or by purchasing loans originated by a third
party), and other miscellaneous loans.
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Line 3e. Enter the current value of all loans to participants
including residential mortgage loans that are subject to Code
section 72(p). Include the sum of the value of the unpaid
principal balances, plus accrued but unpaid interest, if any, for
participant loans made under an individual account plan with
investment experience segregated for each account, that are
made in accordance with 29 CFR 2550.408b-1 and secured
solely by a portion of the participant’s vested accrued benefit.
When applicable, combine this amount with the current value of
any other participant loans. Do not include any amount of a
participant loan deemed distributed during the plan year under
the provisions of Code section 72(p) and Treasury Regulations
section 1.72(p)-1, if both of the following circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is not
continuing repayment under the loan.
Answer all lines either ‘‘Yes’’ or ‘‘No.’’ Do not leave any answer
blank, unless otherwise directed. For lines 4a through 4i and
line 4l, if the answer is “Yes,” an amount must be entered. If you
check ‘‘No’’ on line 4k you must attach the report of an
independent qualified public accountant (IQPA) or a statement
that the plan is eligible and elects to defer attaching the IQPA’s
opinion pursuant to 29 CFR 2520.104-50 in connection with a
short plan year of seven months or less. Plans with all of their
funds held in a master trust should check “No” on Schedule I,
lines 4b, c, and i.
Line 4a. Amounts paid by a participant or beneficiary to an
employer and/or withheld by an employer for contribution to the
plan are participant contributions that become plan assets as of
the earliest date on which such contributions can reasonably be
segregated from the employer’s general assets (see 29 CFR
2510.3-102). An employer holding these assets after that date
commingled with its general assets will have engaged in a
prohibited use of plan assets (see ERISA section 406). If such a
nonexempt prohibited transaction occurred with respect to a
disqualified person (see Code section 4975(e)(2)), file IRS
Form 5330, Return of Excise Taxes Related to Employee
Benefit Plans, with the IRS to pay any applicable excise tax on
the transaction.
Plans that check “Yes” must enter the aggregate amount of
all late contributions for the year. The total amount of the
delinquent contributions must be included on line 4a of the
Schedule H or I, as applicable, for the year in which the
contributions were delinquent and must be carried over and
reported again on line 4a of the Schedule H or I, as applicable,
for each subsequent year until the year after the violation has
been fully corrected, which correction includes payment of the
late contributions and reimbursement of the plan for lost
earnings or profits. If no participant contributions were received
or withheld by the employer during the plan year, answer ‘‘No.’’
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 4a in accordance with the reporting requirements
that apply to delinquent participant contributions or on line 4d.
See Advisory Opinion 2002-02A, available at www.dol.gov/
ebsa.
Line 3g. Include all property that has concrete existence and
is capable of being processed, such as goods, wares,
merchandise, furniture, machines, equipment, animals,
automobiles, etc. This includes collectibles, such as works of
art, rugs, antiques, metals, gems, stamps, coins, alcoholic
beverages, musical instruments, and historical objects
(documents, clothes, etc.). Do not include the value of a plan’s
interest in property reported on lines 3a through 3f, or intangible
property, such as patents, copyrights, goodwill, franchises,
notes, mortgages, stocks, claims, interests, or other property
that embodies intellectual or legal rights.
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methods for correcting violations. In addition, applicants that
satisfy both the VFCP requirements and the conditions of
Prohibited Transaction Exemption (PTE) 2002-51 are eligible
for immediate relief from payment of certain prohibited
transaction excise taxes for certain corrected transactions, and
are also relieved from the obligation to file the IRS Form 5330
with the IRS. For more information, see 71 Fed. Reg. 20261
(Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19, 2006). All
delinquent participant contributions must be reported on line 4a
even if violations have been corrected. Information about the
VFCP is also available on the Internet at www.dol.gov/ebsa.
Line 4a Schedule. Attach a Schedule of Delinquent
Participant Contributions using the format below if you entered
“Yes” on line 4a and you are checking “No” on line 4k because
you are not claiming the audit waiver for the plan. If you choose
to include participant loan repayments on line 4a, you must
apply the same supplemental schedule and IQPA disclosure
requirements to the loan repayments as apply to delinquent
transmittals of participant contributions.
prohibited transaction occurred with respect to a disqualified
person, an IRS Form 5330 should be filed with the IRS to pay
the excise tax on the transaction.
Applicants that satisfy the VFCP requirements and the
TIP conditions of PTE 2002-51 (see the instructions for line
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4a) are eligible for immediate relief from payment of
certain prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the obligation to file the
Form 5330 with the IRS. For more information, see 71 Fed.
Reg. 20261 (Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19,
2006). When the conditions of PTE 2002-51 have been
satisfied, the corrected transactions should be treated as
exempt under Code section 4975(c) for the purposes of
answering line 4d.
Total Fully
Corrected
Under
VFCP and
PTE
2002 – 51
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Line 4b. Plans that check ‘‘Yes’’ must enter the amount. The
due date, payment amount and conditions for determining
default of a note or loan are usually contained in the documents
establishing the note or loan. A loan by the plan is in default
when the borrower is unable to pay the obligation upon
maturity. Obligations that require periodic repayment can
default at any time. Generally, loans and fixed income
obligations are considered uncollectible when payment has not
been made and there is little probability that payment will be
made. A fixed income obligation has a fixed maturity date at a
specified interest rate. Do not include participant loans made
under an individual account plan with investment experience
segregated for each account that were made in accordance
with 29 CFR 2550.408b-1 and secured solely by a portion of the
participant’s vested accrued benefit.
Line 4c. Plans that check ‘‘Yes’’ must enter the amount. A
lease is an agreement conveying the right to use property, plant
or equipment for a stated period. A lease is in default when the
required payment(s) has not been made. An uncollectible lease
is one where the required payments have not been made and
for which there is little probability that payment will be made.
Line 4d. Plans that check ‘‘Yes’’ must enter the amount.
Check ‘‘Yes’’ if any nonexempt transaction with a
party-in-interest occurred regardless of whether the transaction
is disclosed in the IQPA’s report. Do not check “Yes” with
respect to transactions that are: (1) statutorily exempt under
Part 4 of Title I of ERISA; (2) administratively exempt under
ERISA section 408(a); (3) exempt under Code sections 4975(c)
or 4975(d); (4) the holding of participant contributions in the
employer’s general assets for a welfare plan that meets the
conditions of ERISA Technical Release 92-01; (5) a transaction
of a 103-12 IE with parties other than the plan; or (6) delinquent
participant contributions or delinquent participant loan
repayments reported on line 4a. You may indicate that an
application for an administrative exemption is pending. If you
are unsure whether a transaction is exempt or not, you should
consult with either a qualified public accountant, legal counsel
or both. If the plan is a qualified pension plan and a nonexempt
Instructions for Schedule I (Form 5500)
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Contributions
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Check here Contributions Contributions
if Late
Not Corrected Corrected
Participant
Outside
Loan
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Schedule I Line 4a — Schedule of Delinquent
Participant Contributions
Party-in-Interest. For purposes of this form,
party-in-interest is deemed to include a disqualified person. See
Code section 4975(e)(2). The term ‘‘party-in-interest’’ means,
as to an employee benefit plan:
A. Any fiduciary (including, but not limited to, any
administrator, officer, trustee or custodian), counsel, or
employee of the plan;
B. A person providing services to the plan;
C. An employer, any of whose employees are covered by
the plan;
D. An employee organization, any of whose members are
covered by the plan;
E. An owner, direct or indirect, of 50% or more of: (1) the
combined voting power of all classes of stock entitled to vote
or the total value of shares of all classes of stock of a
corporation, (2) the capital interest or the profits interest of a
partnership, or (3) the beneficial interest of a trust or
unincorporated enterprise that is an employer or an
employee organization described in C or D;
F. A relative of any individual described in A, B, C, or E;
G. A corporation, partnership, or trust or estate of which (or
in which) 50% or more of: (1) the combined voting power of
all classes of stock entitled to vote or the total value of
shares of all classes of stock of such corporation, (2) the
capital interest or profits interest of such partnership, or (3)
the beneficial interest of such trust or estate is owned
directly or indirectly, or held by, persons described in A, B,
C, D, or E;
H. An employee, officer, director (or an individual having
powers or responsibilities similar to those of officers or
directors), or a 10% or more shareholder, directly or
indirectly, of a person described in B, C, D, E, or G, or of the
employee benefit plan; or
I. A 10% or more (directly or indirectly in capital or profits)
partner or joint venturer of a person described in B, C, D, E,
or G.
D
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
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party dealing with the plan in connection with a transaction
involving the income or assets of the plan.
Although the current value of plan assets must be
determined each year, there is no requirement that the assets
(other than certain nonpublicly traded employer securities held
in ESOPs) be valued every year by independent third-party
appraisers.
Line 4e. 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 from an
approved surety covering plan officials and that protects the
plan as described in 29 CFR Part 2580. Generally, every plan
official of an employee benefit plan who ‘‘handles’’ funds or
other property of such plan must be bonded. Generally, a
person shall be deemed to be ‘‘handling’’ funds or other
property of a plan, so as to require bonding, whenever his or
her duties or activities with respect to given funds are such that
there is a risk that such funds could be lost in the event of fraud
or dishonesty on the part of such person, acting either alone or
in collusion with others. Section 412 of ERISA and 29 CFR Part
2580 describe the bonding requirements, including the
definition of ‘‘handling’’ (29 CFR 2580.412-6), the permissible
forms of bonds (29 CFR 2580.412-10), the amount of the bond
(29 CFR Part 2580, subpart C), and certain exemptions such as
the exemption for unfunded plans, certain banks and insurance
companies (ERISA section 412), and the exemption allowing
plan officials to purchase bonds from surety companies
authorized by the Secretary of the Treasury as acceptable
reinsurers on federal bonds (29 CFR 2580.412-23). Information
concerning the list of approved sureties and reinsurers is
available on the Internet at www.fms.treas.gov/c570. For more
information on the fidelity bonding requirements, see Field
Assistance Bulletin 2008-04, available on the Internet 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 4e.
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For more information on the requirements for deferring an
IQPA report pursuant to 29 CFR 2520.104-50 in connection
with a short plan year of seven months or less and the contents
of the required explanatory statement, see the instructions for
Schedule H, line 3d(2) or call the EFAST Help Line at
1-866-GO-EFAST (1-866-463-3278).
Note. For plans that check “No,” the IQPA report must make
the appropriate disclosures in accordance with generally
accepted auditing standards if the information reported on line
4a is not presented in accordance with regulatory requirements.
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Lines 4g and 4h. Current value means fair market value
where available. Otherwise, it means the fair value as
determined in good faith under the terms of the plan by a
trustee or a named fiduciary, assuming an orderly liquidation at
time of the determination. See ERISA section 3(26).
An accurate assessment of fair market value is essential to
a pension plan’s ability to comply with the requirements set
forth in the Code (e.g., the exclusive benefit rule of Code
section 401(a)(2), the limitations on benefits and contributions
under Code section 415, and the minimum funding
requirements under Code section 412) and must be determined
annually.
Examples of assets that may not have a readily
determinable value on an established market (e.g., NYSE,
AMEX, over the counter, etc.) include real estate, nonpublicly
traded securities, shares in a limited partnership, and
collectibles. Do not check ‘‘Yes’’ on line 4g for mutual fund
shares or insurance company investment contracts for which
the plan received valuation information at least annually. Also
do not check “Yes” on line 4g if the plan is a defined
contribution plan and the only assets the plan holds, that do not
have a readily determinable value on an established market,
are: (1) participant loans not in default, or (2) assets over which
the participant exercises control within the meaning of section
404(c) of ERISA.
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CAUTION
Willful failure to report is a criminal offense. See ERISA
section 501.
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Check ‘‘No’’ and attach the report of the IQPA meeting the
requirements of 29 CFR 2520.103-1(b) if you are not claiming
the waiver. Also check ‘‘No,’’ and attach the required IQPA
reports or the required explanatory statement if you are relying
on 29 CFR 2520.104-50 in connection with a short plan year of
seven months or less. At the top of any attached 2520.104-50
statement, enter “2520.104-50 Statement, Schedule I, Line
4k.”
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Line 4f. Check ‘‘Yes,’’ if the plan had suffered or discovered
any loss as a result of any dishonest or fraudulent act(s) even if
the loss was reimbursed by the plan’s fidelity bond or from any
other source. If ‘‘Yes’’ is checked enter the full amount of the
loss. If the full amount of the loss has not yet been determined,
provide an estimate 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.
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 4k. Check ‘‘Yes’’ if you are claiming a waiver of the
annual examination and report of an independent qualified
public accountant (IQPA) under 29 CFR 2520.104-46. You are
eligible to claim the waiver if the Schedule I is being filed for:
1. A small welfare plan, or
2. A small pension plan for a plan year that began on or
after April 18, 2001, that complies with the conditions of 29 CFR
2520.104-46 summarized below.
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Enter in the amount column the fair market value of the
assets referred to on line 4g whose value was not readily
determinable on an established market and which were not
valued by an independent third-party appraiser in the plan year.
Generally, as it relates to these questions, an appraisal by an
independent third party is an evaluation of the value of an asset
prepared by an individual or firm who knows how to judge the
value of such assets and does not have an ongoing relationship
with the plan or plan fiduciaries except for preparing the
appraisals.
Line 4i. Include as a single security all securities of the same
issue. An example of a single issue is a certificate of deposit
issued by the XYZ Bank on July 1, 2008, which matures on
June 30, 2009, and yields 5.5%. For the purposes of line 4i, do
not check ‘‘Yes’’ for securities issued by the U.S. Government
or its agencies. Also, do not check “Yes” for securities held as a
result of participant-directed transactions.
Line 4j. Check ‘‘Yes’’ if all the plan assets (including
insurance/annuity contracts) were distributed to the participants
and beneficiaries, legally transferred to the control of another
plan, or brought under the control of the PBGC.
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The following summarizes the conditions of 29 CFR
2520.104-46 that must be met for a small pension plan with a
plan year beginning on or after April 18, 2001, to be eligible for
the waiver. For more information regarding these requirements,
see the EBSA’s Frequently Asked Questions on the Small
Pension Plan Audit Waiver Regulation and 29 CFR
2520.104-46, which are available at www.dol.gov/ebsa, or call
the EFAST Help Line at 1-866-GO-EFAST (1-866-463-3278).
Condition 1: At least 95 percent of plan assets are
‘‘qualifying plan assets’’ as of the end of the preceding plan
year, or any person who handles assets of the plan that do not
constitute qualifying plan assets is bonded in accordance with
the requirements of ERISA section 412 (see the instructions for
line 4e), except that the amount of the bond shall not be less
than the value of such non-qualifying assets.
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The determination of the ‘‘percent of plan assets’’ as of the
end of the preceding plan year and the amount of any required
bond must be made at the beginning of the plan’s reporting
year for which the waiver is being claimed. For purposes of this
line, you will have satisfied the requirement to make these
determinations at the beginning of the plan reporting year for
which the waiver is being claimed if they are made as soon
after the date when such year begins as the necessary
information from the preceding reporting year can practically be
ascertained. See 29 CFR 2580.412-11, 14 and 19 for additional
guidance on these determinations, and 29 CFR 2580.412-15 for
procedures to be used for estimating these amounts if there is
no preceding plan year.
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Condition 2: The administrator must disclose the following
information 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 a SAR, although such plans do not have to furnish a
SAR.
1. The name of each regulated financial institution holding
or issuing qualifying plan assets and the amount of such assets
reported by the institution as of the end of the plan year (this
SAR disclosure requirement does not apply to qualifying
employer securities, participant loans and individual account
assets described in paragraphs 4, 5 and 6 above);
2. The name of the surety company issuing the fidelity
bond, if the plan has more than 5% of its assets in
non-qualifying plan assets;
3. A notice that participants and beneficiaries may, upon
request and without charge, examine or receive from the plan
evidence of the required bond and copies of statements from
the regulated financial institutions describing the qualifying plan
assets; and
4. A notice that participants and beneficiaries should contact
the EBSA Regional Office if they are unable to examine or
obtain copies of the regulated financial institution statements or
evidence of the required bond, if applicable.
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The term ‘‘qualifying plan assets,’’ for purposes of this line,
means:
1. Any assets held by any of the following regulated
financial institutions:
a. A bank or similar financial institution as defined in 29
CFR 2550.408b-4(c);
b. An insurance company qualified to do business under the
laws of a state;
c. An organization registered as a broker-dealer under the
Securities Exchange Act of 1934; or
d. Any other organization authorized to act as a trustee for
individual retirement accounts under Code section 408.
2. Shares issued by an investment company registered
under the Investment Company Act of 1940 (e.g., mutual
funds);
3. Investment and annuity contracts issued by any
insurance company qualified to do business under the laws of a
state;
4. In the case of an individual account plan, any assets in
the individual account of a participant or beneficiary over which
the participant or beneficiary has the opportunity to exercise
control and with respect to which the participant or beneficiary
is furnished, at least annually, a statement from a regulated
financial institution referred to above describing the assets held
or issued by the institution and the amount of such assets;
5. Qualifying employer securities, as defined in ERISA
section 407(d)(5); and
6. Participant loans meeting the requirements of ERISA
section 408(b)(1).
A Model Notice that plans can use to satisfy the enhanced
disclosure requirements to be eligible for the audit waiver is
available as an Appendix to 29 CFR 2520.104-46.
Condition 3: In addition, in response to a request from any
participant or beneficiary, the administrator, without charge to
the participant or beneficiary, must make available for
examination, or upon request furnish copies of, each regulated
financial institution statement and evidence of any required
bond.
Examples. Plan A, which has a plan year that began on or
after April 18, 2001, had total assets of $600,000 as of the end
of the 2000 plan year that included: investments in various
bank, insurance company and mutual fund products of
$520,000; investments in qualifying employer securities of
$40,000; participant loans (meeting the requirements of ERISA
section 408(b)(1)), totaling $20,000; and a $20,000 investment
in a real estate limited partnership. Because the only asset of
the plan that did not constitute a ‘‘qualifying plan asset’’ is the
$20,000 real estate limited partnership investment and that
investment represents less than 5% of the plan’s total assets,
no fidelity bond is required as a condition for the plan to be
eligible for the waiver for the 2001 plan year.
Plan B is identical to Plan A except that of Plan B’s total
assets of $600,000 as of the end of the 2000 plan year,
$558,000 constitutes ‘‘qualifying plan assets’’ and $42,000
constitutes non-qualifying plan assets. Because 7% – more
than 5% – of Plan B’s assets do not constitute ‘‘qualifying plan
assets,’’ Plan B, as a condition to be eligible for the waiver for
the 2001 plan year, must ensure that it has a fidelity bond in an
amount equal to at least $42,000 covering persons handling its
non-qualifying plan assets. Inasmuch as compliance with
ERISA section 412 generally requires the amount of the bond
be not less than 10% of the amount of all the plan’s funds or
other property handled, the bond acquired for ERISA section
412 purposes may be adequate to cover the non-qualifying plan
assets without an increase (i.e., if the amount of the bond
determined to be needed for the relevant persons for ERISA
section 412 purposes is at least $42,000). As demonstrated by
the foregoing example, where a plan has more than 5% of its
assets in non-qualifying plan assets, the required bond is for the
total amount of the non-qualifying plan assets, not just the
amount in excess of 5%.
1-866-GO-EFAST (1-866-463-3278)
If you need further information regarding these requirements,
see 29 CFR 2520.104-46 which is available at www.dol.gov/
ebsa or call the EFAST Help Line at [number to be provided].
2
Line 4l. 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 4m. Check “Yes” if there was a “blackout period.” A
blackout period is a temporary suspension of more than three
(3) consecutive business days during which participants or
beneficiaries of a 401(k) or other individual account pension
plan were unable to, 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; (4) by application of federal
securities laws. For more information, see 29 CFR 2520.101-3
(available at www.dol.gov/ebsa).
Line 4n. If there was a blackout period, did you provide the
required notice not less than 30 days nor more than 60 days in
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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.
Line 5a. Check ‘‘Yes’’ if a resolution to terminate the plan was
adopted during this or any prior plan year, unless the
termination was revoked and no assets reverted to the
employer. If ‘‘Yes’’ is checked, enter the amount of plan assets
that reverted to the employer during the plan year in connection
with the implementation of such termination. Enter ‘‘0’’ if no
reversion occurred during the current plan year.
Do not use a social security number in lieu of an EIN or
include an attachment that contains visible social security
numbers. The Schedule I and its attachments are open to
public inspection, and the contents are public information and
are subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Schedule I or the inclusion of a visible social security number
on an attachment may result in the rejection of the filing.
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Note. A distribution of all or part of an individual participant’s
account balance that is reportable on IRS Form 1099-R should
not be included on line 5b. Do not submit IRS Form 1099-R with
the Form 5500.
A Form 5500 must be filed for each year the plan has
assets, and, for a welfare benefit plan, if the plan is still
CAUTION liable to pay benefits for claims that were incurred
before the termination date, but not yet paid. See 29 CFR
2520.104b-2(g)(2)(ii).
Line 5b. Enter information concerning assets and/or liabilities
transferred from this plan to another plan(s) (including spinoffs)
during the plan year. A transfer of assets or liabilities occurs
when there is a reduction of assets or liabilities with respect to
one plan and the receipt of these assets or the assumption of
these liabilities by another plan. Enter the name, EIN, and PN
for the transferee plan(s).
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
Events, and PBGC Form 10-Advance, Advance Notice of
Reportable Events.
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Instructions for Schedule I (Form 5500)
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Instructions for Form 5500
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Requirement under the General Instructions to Form 5500 and
How To File – Electronic Filing Requirement under the General
Instructions to Form 5500-SF. The EBSA does not issue EINs.
Note. (1) For split-funded plans, the costs and contributions
reported on Schedule MB must include those relating to both
trust funds and insurance carriers. (2) For plans with funding
standard account amortization charges and credits, see the
instructions for lines 9c and 9h. (3) For terminating
multiemployer plans, Code section 412(e)(4) and ERISA
section 301(c) provide that minimum funding standards apply
until the last day of the plan year in which the plan terminates
within the meaning of section 4041A(a)(2) of ERISA.
Accordingly, the Schedule MB is not required to be filed for any
later plan year.
2009 Instructions for Schedule MB
(Form 5500)
Multiemployer Defined Benefit Plan and
Certain Money Purchase Plan Actuarial
Information
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General Instructions
Instructions for Schedule MB (Form 5500)
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Statement by Enrolled Actuary
An enrolled actuary must sign Schedule MB unless, as
described above, the plan is a money purchase defined
contribution plan that has received a waiver of the minimum
funding standard. The signature of the enrolled actuary may be
qualified to state that it is subject to attached qualifications. See
Treasury Regulations section 301.6059-1(d) for permitted
qualifications. A stamped or machine produced signature is not
acceptable. If the actuary has not fully reflected any final or
temporary regulation, revenue ruling, or notice promulgated
under the statute in completing the Schedule MB, check the box
on the last line of page 1. If this box is checked, indicate on an
attachment whether an accumulated funding deficiency or a
contribution that is not wholly deductible would result if the
actuary had fully reflected such regulation, revenue ruling, or
notice, and label this attachment “Schedule MB – Statement
by Enrolled Actuary.” In addition, the actuary may offer any
other comments related to the information contained in
Schedule MB.
The actuary must provide the completed and signed
Schedule MB to the plan administrator to be retained with the
plan records and included (in accordance with these
instructions) with the Form 5500 that is submitted under
EFAST2. The actuary’s most recent enrollment number must be
entered on the Schedule MB that is prepared and signed by the
plan’s actuary.
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Attachments
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All attachments to the Schedule MB must be properly identified,
and must include the name of the plan, the plan sponsor’s EIN,
and the plan number. Put “Schedule MB” and the line number
to which the attachment relates at the top of each attachment.
Do not include attachments that contain a visible social security
number. The Schedule MB and its attachments are open to
public inspection, and the contents are public information and
are subject to publication on the Internet. Because of privacy
concerns, the inclusion of a visible social security number on an
attachment may result in the rejection of the filing.
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As the first step, the plan administrator of any multiemployer
defined benefit plan that is subject to the minimum funding
standards (see Code sections 412 and 431 and Part 3 of Title I
of ERISA) must obtain a completed Schedule MB (Form 5500)
that is prepared and signed by the plan’s enrolled actuary as
discussed below in the Statement by Enrolled Actuary section.
The plan administrator must retain with the plan records the
Schedule MB that is prepared and signed by the plan’s actuary.
Next, the plan administrator of a multiemployer defined
benefit plan must ensure that the information from the actuary’s
Schedule MB is entered electronically into the annual return/
report being submitted. When entering the information, whether
using EFAST2-approved software or EFAST2’s web-based
filing system, all the fields required for the type of plan must be
completed (see instructions for fields that need to be
completed).
Further, the plan administrator of a multiemployer defined
benefit plan must attach to the Form 5500 an electronic
reproduction of the Schedule MB prepared and signed by the
plan’s enrolled actuary. This electronic reproduction must be
included as a Portable Document Format (PDF) attachment to
the Form 5500 and labeled “MB SB Actuary Signature.”
If a money purchase defined contribution plan (including a
target benefit plan) has received a waiver of the minimum
funding standard, and the waiver is currently being amortized,
lines 3, 9, and 10 of Schedule MB must be completed but it
need not be signed by an enrolled actuary. In such a case, the
Form 5500 or the Form 5500-SF that is submitted under
EFAST2 must include the Schedule MB with lines 3, 9 and 10
completed, but is not required to include a PDF attachment of a
signed Schedule MB.
Note. The Schedule MB does not have to be filed with the
Form 5500-EZ, but, if required, it must be retained (in
accordance with the instructions for Form 5500-EZ under the
What To File section). Similarly, if a plan is a one participant
plan that meets the requirements for filing a Form 5500-EZ, but
a Form 5500-SF is instead filed for the plan, the Schedule MB,
if required, does not have to be filed with the Form 5500-SF, but
it must be retained (in accordance with the instructions for the
Form 5500-SF under Schedule MB in the Specific Instructions
Only for “One-Participant Plans” section). Also, the funding
standard account for the plan must continue to be maintained,
even if the Schedule MB is not filed.
Check the Schedule MB box on the Form 5500 (Part II, line
10a(2)) if a Schedule MB is attached to the Form 5500.
Lines A through E must be completed for ALL plans. If the
Schedule MB is attached to a Form 5500 or Form 5500-SF,
lines A, B, C, and D should include the same information as
reported in Part II of the Form 5500 or Form 5500-SF. You may
abbreviate the plan name.
Do not use a social security number in line D in lieu of an
EIN. The Schedule MB and its attachments are open to public
inspection if filed with a Form 5500 or Form 5500-SF, and the
contents are public information and are subject to publication on
the Internet. Because of privacy concerns, the inclusion of a
social security number on this Schedule MB or any of its
attachments may result in the rejection of the filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
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Who Must File
Specific Instructions
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Line 1. All entries must be reported as of the valuation date.
Line 1a. Actuarial Valuation Date. The valuation for a plan
year may be as of any date in the plan year, including the first
or last day of the plan year. Valuations must be performed
within the period specified by Code section 431(c)(7) and
ERISA section 304(c)(7).
Line 1b(1). Current Value of Assets. Enter the current value
of assets as of the valuation date. The current value is the
same as the fair market value. Do not adjust for items such as
the existing credit balance or the outstanding balances of
certain amortization bases. Contributions designated for 2009
should not be included in this amount. Note that this entry may
be different from the entry in line 2a. Such a difference may
result, for example, if the valuation date is not the first day of
the plan year, or if insurance contracts are excluded from
assets reported on line 1b(1) but not on line 2a.
Rollover amounts or other assets held in individual accounts
that are not available to provide defined benefits under the plan
should not be included on line 1b(1), regardless of whether they
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Line 2. All entries must be reported as of the beginning of the
2009 plan year. Lines 2a and 2b should include all assets and
liabilities under the plan except for assets and liabilities
attributable to: (1) rollover amounts or other amounts in
individual accounts that are not available to provide defined
benefits, or (2) benefits for which an insurer has made an
irrevocable commitment as defined in 29 CFR 4001.2.
Line 2a. Current Value of Assets. Enter the current value of
net assets as of the first day of the plan year. Except for plans
with excluded assets as described above, this entry should be
the same as reported on the 2009 Schedule H (Form 5500)
(line 1l, column (a)) or Schedule I (Form 5500) (line 1c, column
(a)). Note that contributions designated for the 2009 plan year
are not included on those lines.
Line 2b. Current Liability (beginning of plan year). Enter
the current liability as of the first day of the plan year. Do not
include the expected increase in current liability due to benefits
accruing during the plan year. See the instructions for line
1d(2)(a) for actuarial assumptions used in determining current
liability.
Column (1) — Enter the number of participants and
beneficiaries as of the beginning of the plan year. If the current
liability figures are derived from a valuation that follows the first
day of the plan year, the participant and beneficiary count
entries should be derived from the counts used in that valuation
in a manner consistent with the derivation of the current liability
reported in column (2).
Column (2) — Include the current liability attributable to all
benefits, with subtotals for vested and nonvested benefits in the
case of active participants.
Line 2c. This calculation is required under ERISA section
103(d)(11). Do not complete if line 2a divided by line 2b(4),
column (2), is 70% or greater.
Line 3. Contributions Made to Plan. Show all employer and
employee contributions for the plan year. Include employer
contributions made not later than 21/2 months (or the later date
allowed under Code section 431(c)(8) and ERISA section
304(c)(8)) after the end of the plan year. Show only
contributions actually made to the plan by the date this
Schedule MB is signed.
Add the amounts in both columns (b) and (c) and enter both
results on the total line. All contributions must be credited
toward a particular plan year.
Line 4. Information on Plan Status. All multiemployer plans
regardless of the number of participants must provide the
information indicated in accordance with these instructions.
Line 4a. Enter the code for the status of the multiemployer
plan for the plan year, as certified by the plan actuary, using
one of the following codes:
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Code Plan Status
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Endangered Status
Seriously Endangered Status
Critical Status
Not in Endangered or Critical Status
Under section 204 of the Worker, Retiree, and Employer
Recovery Act of 2008 (“WRERA”), for the first plan year
beginning during the period October 1, 2008, to September 30,
2009, the sponsor of a multiemployer plan may elect to treat the
plan as being in the same status (i.e., endangered, seriously
endangered, critical, or not endangered or critical) as for the
preceding plan year, regardless of the plan’s status as certified
by the plan actuary. If an election under section 204 of WRERA
has been made for the plan year beginning during the period
January 1, 2009, to September 30, 2009, the code entered on
the Schedule MB must be based on the actuarial certification of
the plan’s status, without regard to the WRERA election. (An
election under section 204 of WRERA cannot be made for a
plan year beginning during the period October 1, 2009, to
December 31, 2009.) The instructions for the Schedule R (Form
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are reported on the 2009 Schedule H (Form 5500) (line 1l,
column (a)) or Schedule I (Form 5500) (line 1c, column (a)).
Additionally, asset and liability amounts must be determined in
a consistent manner. Therefore, if the value of any insurance
contracts have been excluded from the amount reported on line
1b(1), liabilities satisfied by such contracts should also be
excluded from the liability values reported on lines 1c(1), 1c(2),
and 1d(2) of the Schedule MB.
Line 1b(2). Actuarial Value of Assets. Enter the value of
assets determined in accordance with Code section 431(c)(2)
and ERISA section 304(c)(2). Do not adjust for items such as
the existing credit balance or the outstanding balances of
certain amortization bases, and do not include contributions
designated for 2009 in this amount.
Line 1c(1). Accrued Liability for Immediate Gain Methods.
Complete this line only if you use an immediate gain method
(see Rev. Rul. 81-213, 1981-2 C.B. 101, for a definition of
immediate gain method).
Lines 1c(2)(a), (b), and (c). Information for Plans Using
Spread Gain Methods. Complete these lines only if you use a
spread gain method (see Rev. Rul. 81-213 for a definition of
spread gain method).
Line 1c(2)(a). Unfunded Liability for Methods with Bases.
Complete this line only if you use the frozen initial liability or
attained age normal cost method.
Lines 1c(2)(b) and (c). Entry Age Normal Accrued Liability
and Normal Cost. For spread gain methods, these
calculations are used for purposes of the full funding limitation
(see Rev. Rul. 81-13, 1981-1 C.B. 229).
Line 1d(1). Amount Excluded from Current Liability. Leave
line 1(d)1 blank.
Line 1d(2)(a). Current Liability. All multiemployer plans,
regardless of the number of participants, must provide the
information indicated in accordance with these instructions. The
interest rate used to compute the current liability must be in
accordance with guidelines issued by the IRS and, pursuant to
the Pension Protection Act of 2006 (PPA), must not be more
than 5 percent above and must not be more than 10 percent
below the weighted average of the rates of interest, as set forth
by the Treasury Department, on 30-year Treasury securities
during the 4-year period ending on the last day before the
beginning of the 2009 plan year.
The current liability must be computed using the mortality
tables referenced in section 1.431(c)(6)-1 of the Treasury
Regulations.
Each other actuarial assumption used in calculating the
current liability must be the same assumption used for
calculating other costs for the funding standard account. See
Notice 90-11, 1990-1 C.B. 319. The actuary must take into
account rates of early retirement and the plan’s early retirement
and turnover provisions as they relate to benefits, where these
would significantly affect the results. Regardless of the
valuation date, current liability is computed taking into account
only credited service through the end of the prior plan year. No
salary scale projections should be used in these computations.
Do not include the expected increase in current liability due to
benefits accruing during the plan year reported on line 1d(2)(b)
in these computations.
Line 1d(2)(b). Expected Increase in Current Liability. Enter
the amount by which the current liability is expected to increase
due to benefits accruing during the plan year on account of
credited service and/or salary changes for the current year. One
year’s salary scale may be reflected.
Line 1d(2)(c). Expected Release From Current Liability for
the Plan Year. Enter the expected release from current liability
on account of disbursements (including single-sum
distributions) from the plan expected to be paid after the
valuation date but prior to the end of the plan year (see also
Q&A-7 of Rev. Rul. 96-21, 1996-1 C.B. 64).
Line 1d(3). Expected Plan Disbursements. Enter the amount
of plan disbursements expected to be paid for the plan year.
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Instructions for Schedule MB (Form 5500)
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Shortfall Method: Only certain plans may elect the shortfall
funding method (see Treasury Regulations section
1.412(c)(1)-2). Advance approval from the IRS for the election
of the shortfall method of funding is NOT required if it is first
adopted for the first plan year to which Code section 412
applies. In addition, pursuant to PPA section 201(b), a plan
does NOT need advance approval from the IRS to adopt or
cease using the shortfall method if the plan (1) has not adopted
or ceased using the shortfall method during the 5-year period
ending on the day before the date the plan is to use the
method, and (2) is not operating under an amortization period
extension and did not operate under such an extension during
such 5-year period. In such a case, check “Yes” for line 5m. If a
plan utilizes this automatic approval to apply the shortfall
method, the benefit increase limitations of Code section
412(c)(7) apply.
If a plan is not eligible for automatic approval as set forth in
the preceding paragraph, advance approval from the IRS is
required if the shortfall funding method is adopted at a later
time, if a specific computation method is changed, or if the
shortfall method is discontinued. In such a case there is no
automatic limitation on benefit increases.
Reorganization Status: Attach an explanation of the basis for
the determination that the plan is in reorganization for this plan
year and label the explanation “Schedule MB, line 5 –
Reorganization Status Explanation.” Also, attach a
worksheet showing for this plan year:
1. The amounts considered contributed by employers,
2. Any amount waived by the IRS,
3. The development of the minimum contribution
requirement (taking into account the applicable overburden
credit, cash-flow amount, contribution bases and limitation on
required increases on the rate of employer contributions, and
any adjustments in accrued benefits), and
4. The resulting accumulated funding deficiency, if any,
which is to be reported on line 9n. (See Code sections 418B,
418C, and 418D.)
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Instructions for Schedule MB (Form 5500)
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Label the worksheet “Schedule MB, line 5 – Reorganization
Status Worksheet.”
Line 6. Actuarial Assumptions. If gender-based assumptions
are used in developing plan costs, enter those rates where
appropriate in line 6. Note that requests for gender-based cost
information do not suggest that gender-based benefits are
legal. If unisex tables are used, enter the values in both “Male”
and “Female” lines. Check “N/A” for line 6b if the question is not
applicable.
Attach a statement of actuarial assumptions (if not fully
described by line 6) and actuarial methods used to calculate the
figures shown in lines 1 and 9 (if not fully described by line 5),
and label the statement “Schedule MB, line 6 – Statement of
Actuarial Assumptions/Methods.” The statement must
describe all actuarial assumptions used to determine the
liabilities. For example, the statement for non-traditional plans
(e.g., cash balance plans) must include the assumptions used
to convert balances to annuities.
Also attach a summary of the principal eligibility and benefit
provisions on which the valuation was based, including the
status of the plan (e.g., eligibility frozen, service/pay frozen,
benefits frozen), optional forms of benefits, special plan
provisions, including those that apply only to a subgroup of
employees (e.g., those with imputed service), supplemental
benefits, an identification of benefits not included in the
valuation (e.g., shutdown benefits), a description of any
significant events that occurred during the year, a summary of
any changes in principal eligibility or benefit provisions since the
last valuation, a description (or reasonably representative
sample) of plan early retirement factors, and any change in
actuarial assumptions or cost methods and justifications for any
such change (see section 103(d) of ERISA). Label the summary
“Schedule MB, line 6 – Summary of Plan Provisions.”
Also, include any other information needed to disclose the
actuarial position of the plan fully and fairly.
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5500), Part V, describe additional information to be provided
with respect to a WRERA election.
If the plan is certified to be in endangered status, seriously
endangered status, or critical status, attach a copy of the
actuarial certification of such status to this Schedule MB. Also
attach an illustration showing the details providing support for
the actuarial certification of status and label the illustration
“Schedule MB, line 4a – Illustration Supporting Actuarial
Certification of Status.” For example, if a plan is certified to
be in critical status based on Code section 432(b)(2)(B), show
the funded percentage (if applicable) and the projection of the
funding standard account to the year where the accumulated
funding deficiency occurs.
Line 4c. If, in the plan year in which the Schedule MB is filed,
a certification was required to be made under Code section
432(b(3)(A)(ii) and ERISA section 305(B)(A)(ii) with respect to
scheduled progress during the plan year for which the Schedule
MB is filed, check “Yes” or “No” to reflect the certification.
Attach documentation comparing the current status of the plan
to the scheduled progress under the applicable funding
improvement or rehabilitation plan to this Schedule MB. Label
the documentation “Schedule MB, line 4c – Documentation
Regarding Progress Under Funding Improvement or
Rehabilitation Plan.”
Lines 4d and 4e. If Code C (Critical Status) was entered on
line 4a, an entry on line 4d is required. For purposes of lines 4d
and 4e, in determining whether adjustable benefits have been
reduced, only adjustable benefits that would otherwise be
protected under Code section 411(d)(6) and ERISA section
204(g) are taken into account regardless of whether an election
under section 204 of WRERA has been made.
Note. If a plan is certified to be in critical status but, as a result
of an election under section 204 of WRERA, the plan is treated
as not being in critical status, benefits that are protected under
Code section 411(d)(6) and ERISA section 204(g) are not
permitted to be reduced.
Line 5. Actuarial Cost Method. Enter the primary method
used. If the plan uses one actuarial cost method in one year as
the basis of establishing an accrued liability for use under the
frozen initial liability method in subsequent years, answer as if
the frozen initial liability method was used in all years. The
projected unit credit method is included in the “Accrued benefit
(unit credit)” category of line 5c. If a method other than a
method listed on lines 5a through 5g is used, check the box for
line 5j and specify the method. For example, if a modified
individual level premium method for which actuarial gains and
losses are spread as a part of future normal cost is used, check
the box for 5j and describe the cost method.
Check the appropriate box for the underlying actuarial cost
method used as the basis for this plan year’s funding standard
account computation. If box 5h is checked, enter the period of
use of the shortfall method in line 5k. For this purpose, enter the
calendar year (YY) which includes the first day of the plan year
in which the shortfall method was first used. For plans in
reorganization status, check the appropriate box for the
underlying actuarial cost method used to determine charges
and credits to the funding standard account and check the box
for 5i.
Changes in funding methods include changes in actuarial
cost method, changes in asset valuation method, and changes
in the valuation date of plan costs and liabilities or of plan
assets. Changes in the funding method of a plan include not
only changes to the overall funding method used by the plan,
but also changes to each specific method of computation used
in applying the overall method. Generally, these changes
require IRS approval. If the change was made pursuant to Rev.
Proc. 2000-40, 2000-2 C.B. 357, check “Yes” for line 5m. If
approval was granted for this plan by either an individual ruling
letter or a class ruling letter, enter the date of the applicable
ruling letter in line 5n. Note that the plan sponsor’s agreement
to a change in funding method (made pursuant to Rev. Proc.
2000-40, PPA section 201(b), or a class ruling letter) should be
reported on line 8 of Schedule R (Form 5500).
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Line 6a. Current Liability Interest Rate. Enter the interest
rate used to determine current liability. The interest rate used
must be in accordance with the guidelines issued by the IRS
and, pursuant to PPA, must not be more than 5 percent above
and must not be more than 10 percent below the weighted
average of the rates of interest, as set forth by the Treasury
Department, on 30-year Treasury securities during the 4-year
period ending on the last day before the beginning of the 2009
plan year. Enter the rate to the nearest .01 percent.
attributable to investments if the rate of investment return on
assets is adjusted to take investment expenses into account. If
there is a single expense loading not separately identified as
pre-retirement or post-retirement, enter it under “Pre-retirement”
and leave “Post-retirement” blank. Where expenses are
assumed other than as a percentage of plan costs or liabilities,
enter the assumed pre-retirement expense as a percentage of
the plan’s normal cost, and enter the post-retirement expense
as a percentage of plan liabilities. If the normal cost of the plan
is zero, enter the assumed pre-retirement expense as a
percentage of the sum of lines 9c(1), 9c(2), and 9c(3), minus
line 9h. Enter rates to the nearest .1 percent.
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Line 6b. Check “Yes,” if the rates in the contract were used
(e.g., purchase rates at retirement).
Line 6c. Mortality Table. The mortality table published in
section 1.431(c)(6)-1 of the Treasury Regulations must be used
in the calculation of current liability for non-disabled lives. Enter
the mortality table code for non-disabled lives used for valuation
purposes as follows:
Mortality Table
Code
1
1971 Group Annuity Mortality (G.A.M.) . . . . . . . . . . . . . .
2
1971 Individual Annuity Mortality (I.A.M.) . . . . . . . . . . . . .
3
Line 6g. Estimated Investment Return – Actuarial Value.
Enter the estimated rate of return on the actuarial value of plan
assets for the 1-year period ending on the valuation date. For
this purpose, the rate of return is determined by using the
formula 2I/(A + B – I), where I is the dollar amount of the
investment return under the asset valuation method used for
the plan, A is the actuarial value of the assets one year ago,
and B is the actuarial value of the assets on the current
valuation date. Enter rates to the nearest .1 percent. If entering
a negative number, enter a minus sign (“ – ”) to the left of the
number.
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1951 Group Annuity . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
1983 G.A.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
1983 G.A.M. (solely per Rev. Rul. 95-28) . . . . . . . . . . . . .
7
UP-1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
Mortality table applicable to current plan year under section
1.431(c)(6)-1 of the Income Tax Regulations . . . . . . . . . .
9
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A
None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
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Line 6h. Estimated Investment Return – Current (Market)
Value. Enter the estimated rate of return on the current value
of plan assets for the 1-year period ending on the valuation
date. (The current value is the same as the fair market value —
see line 1b(1) instructions.) For this purpose, the rate of return
is determined by using the formula 2I/(A + B – I), where I is the
dollar amount of the investment return, A is the current value of
the assets one year ago, and B is the current value of the
assets on the current valuation date. Enter rates to the nearest
.1 percent. If entering a negative number, enter a minus sign
(“ – ”) to the left of the number.
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Code 6 includes all sex-distinct versions of the 1983 G.A.M.
table other than the table published in Rev. Rul. 95-28, 1995-1
C.B. 74. Thus, for example, Code 6 also would include the 1983
G.A.M. male-only table used for males, where the 1983 G.A.M.
male-only table with a 6-year setback is used for females. Code
A includes mortality tables other than those listed in Codes 1
through 9, including any unisex version of the 1983 G.A.M.
table.
Note. Use the above formula even if the actuary feels that the
result of using the formula does not represent the true
estimated rate of return on the actuarial value of plan assets for
the 1-year period ending on the valuation date. The actuary
may attach a statement showing both the actuary’s estimate of
the rate of return and the actuary’s calculations of that rate, and
label the statement “Schedule MB, line 6g – Estimated Rate
of Investment Return (Actuarial Value).”
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Where an indicated table consists of separate tables for
males and females, add F to the female table (e.g., 1F). When
a projection is used with a table, follow the code with “P” and
the year of projection (omit the year if the projection is unrelated
to a single calendar year); the identity of the projection scale
should be omitted. When an age setback or set forward is used,
indicate with “ – ” or “+” and the number of years. For example, if
for females the 1951 Group Annuity Table with Projection C to
1971 is used with a 5-year setback, enter “1P71-5.” If the table
is not one of those listed, enter “A” with no further notation. If
the valuation assumes a maturity value to provide the
post-retirement income without separately identifying the
mortality, interest and expense elements, enter on line 6c,
under “Post-retirement,” the value of $1.00 of monthly pension
beginning at the plan’s weighted average retirement age,
assuming the normal form of annuity for an unmarried person.
In such a case, leave lines 6d and 6e blank.
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1983 I.A.M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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UP-1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Line 6f. Salary Scale. If a uniform level annual rate of salary
increase is used, enter that annual rate. Otherwise, enter the
level annual rate of salary increase that is equivalent to the
rate(s) of salary increase used. Enter the annual rate as a
percentage to the nearest .01 percent, used for a participant
from age 25 to assumed retirement age. If the plan’s benefit
formula is not related to compensation, leave line 6f blank.
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Note. Use the above formula even if the actuary feels that the
result of using the formula does not represent the true
estimated rate of return on the current value of plan assets for
the 1-year period ending on the valuation date. The actuary
may attach a statement showing both the actuary’s estimate of
the rate of return and the actuary’s calculations of that rate, and
label the statement “Schedule MB, line 6h – Estimated Rate
of Investment Return (Current Value).”
Line 7. New Amortization Bases Established. List all new
amortization bases established in the current plan year (before
the combining of bases, if bases were combined). Use the
following table to indicate the type of base established, and
enter the appropriate code under “Type of base.” List
amortization bases and charges and/or credits as of the
valuation date. Bases that are considered fully amortized
because there is a credit for the plan year on line 9j(3) should
be listed. If entering a negative number, enter a minus sign
(“ – ”) to the left of the number.
Line 6d. Valuation Liability Interest Rate. Enter the
assumption as to the expected interest rate (investment return)
used to determine all the calculated values except for current
liability. If the assumed rate varies with the year, enter the
weighted average of the assumed rate for 20 years following
the valuation date. Enter rates to the nearest .01 percent.
Line 6e. Expense Loading. If there is no expense loading,
enter “0”. For instance, there would be no expense loading
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Instructions for Schedule MB (Form 5500)
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balance account in any age/service bin that contains fewer than
20 active participants.
Code Type of Amortization Base
Experience gain or loss
Shortfall gain or loss
Change in unfunded liability due to plan amendment
Change in unfunded liability due to change in
actuarial assumptions
Change in unfunded liability due to change in
actuarial cost method
Waiver of the minimum funding standard
Initial unfunded liability (for new plan)
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If the accrued benefit is the greater of a cash balance benefit or
some other benefit, average in only the cash balance account.
If the accrued benefit is the sum of a cash balance account
benefit and some other benefit, average in only the cash
balance account. For both the average compensation and the
average cash balance account, do not enter an amount for age/
service bins with fewer than 20 active participants.
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General Rule. In general, data to be shown in each age/
service bin includes:
1. the number of active participants in the age/service bin,
2. the average compensation of the active participants in
the age/service bin, and
3. the average cash balance account of the active
participants in the age/service bin, using $0 for anyone who has
no cash balance account-based benefit.
In lieu of the above, two alternatives are provided for
showing compensation and cash balance accounts. Each
alternative provides for two age/service scatters (one showing
compensation and one showing cash balance accounts) as
follows:
Alternative A:
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Line 8a and 8d. Funding Waivers or Extensions. If a
funding waiver or extension request is approved after the
Schedule MB is filed, an amended Schedule MB must be filed
with Form 5500 to report the waiver or extension approval (also
see instructions for line 9k(1)).
Line 8b. Schedule of Active Participant Data. Check “Yes”
only if this is a multiemployer plan covered by Title IV of ERISA
that has active participants.
If line 8b is “Yes,” attach a schedule of the active plan
participant data used in the valuation for this plan year. Use the
format shown below and label the schedule “Schedule MB,
line 8b – Schedule of Active Participant Data.”
Expand this schedule by adding columns after the “5 to 9”
column and before the “40 & up” column for active participants
with total years of credited service in the following ranges: 10 to
14; 15 to 19; 20 to 24; 25 to 29; 30 to 34; and 35 to 39. For
each column, enter the number of active participants with the
specified number of years of credited service divided according
to age group. For participants with partial years of credited
service, round the total number of years of credited service to
the next lower whole number. Years of credited service are the
years credited under the plan’s benefit formula.
Plans reporting 1,000 or more active participants on line
2b(3)(c), column (1), and using compensation to determine
benefits must also provide average compensation data. For
each grouping, enter the average compensation of the active
participants in that group. For this purpose, compensation is the
compensation taken into account for each participant under the
plan’s benefit formula, limited to the amount defined under
section 401(a)(17) of the Code. Do not enter the average
compensation in any grouping that contains fewer than 20
participants.
Cash balance plans (or any plans using characteristic code
1C on line 8a of Form 5500) reporting 1,000 or more active
participants on line 2b(3)(c), column (1), must also provide
average cash balance account data, regardless of whether all
active participants have cash balance accounts. For each age/
service bin, enter the average cash balance account of the
active participants in that bin. Do not enter the average cash
compensation for all active participants, whether or not
participants have account-based benefits.
• Scatter 2 — Provide participant count and average cash
balance account for all active participants, whether or not
participants have account-based benefits.
Alternative B:
• Scatter 1 — Provide participant count and average
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compensation for all active participants, whether or not
participants have account-based benefits (i.e., identical to
Scatter 1 in Alternative A).
• Scatter 2 — Provide participant count and average cash
balance account for only those active participants with
account-based benefits. If the number of participants with
account-based benefits in a bin is fewer than 20, the average
account should not be shown even if there are more than 20
active participants in this bin on Scatter 1.
In general, information should be determined as of the
valuation date. Average cash balance accounts may be
determined as of either:
1. the valuation date or
2. the day immediately preceding the valuation date.
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• Scatter 1 — Provide participant count and average
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Average cash balance accounts that are offset by amounts
from another plan may be reported either as amounts prior to
taking into account the offset, or as amounts after taking into
account the offset. Do not report the offset amount. For this or
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1
2
3
4
Schedule MB, Line 8b—Schedule of Active Participant Data
Under 1
Attained
Age
No.
YEARS OF CREDITED SERVICE
1 to 4
Average
Comp. Cash Bal.
No.
Average
Comp. Cash Bal.
35
40
45
50
55
60
65
to
to
to
to
to
to
to
39
44
49
54
59
64
69
70 & up
Instructions for Schedule MB (Form 5500)
No.
Average
Comp. Cash Bal.
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Under 25
25 to 29
30 to 34
5 to 9
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40 & up
No.
Average
Comp. Cash Bal.
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(Code section 431(b)(3)(C)). If a waiver of a funding deficiency
is pending, report a funding deficiency. If the waiver is granted
after Form 5500 or Form 5500-SF is filed, file an amended
Form 5500 or Form 5500-SF, as applicable, with an amended
Schedule MB to report the funding waiver (see Amended
Return/Report in the instructions for Form 5500 or Line B – Box
for Amended Return/Report in the instructions for Form
5500-SF, as applicable).
Line 9k(2). Other Credits. Enter a credit in the case of a plan
for which the accumulated funding deficiency is determined
under the funding standard account if such plan year follows a
plan year for which such deficiency was determined under the
alternative minimum funding standard.
Line 9o. Reconciliation Account. The reconciliation account
is made up of those components that upset the balance
equation of Treasury Regulations section 1.412(c)(3)-1(b).
Valuation assets must not be adjusted by the reconciliation
account balance when computing the required minimum
funding.
Line 9o(1). If a waived funding deficiency is being amortized at
an interest rate that differs from the valuation rate, enter the
prior year’s “reconciliation waiver outstanding balance”
increased with interest at the valuation rate to the current
valuation date and decreased by the year end amortization
amount based on the mandated interest rate. Enter the
amounts as of the valuation date.
Line 9o(2). Include in this line reconciliation amounts due to
extensions of amortization periods that have been approved by (a)
the IRS.
Line 9o(3). Enter the sum of lines 9o(1), 9o(2)(a), and 9o(2)(b) DELETE:
(each adjusted with interest at the valuation rate to the current ", 9o(2)(a),"
valuation date, if necessary).
Note. The net outstanding balance of amortization charges
and credits minus the prior year’s credit balance minus the
amount on line 9o(3) (each adjusted with interest at the
valuation rate, if necessary) must equal the unfunded liability.
Line 10. Contribution Necessary to Avoid Deficiency. Enter
the amount from line 9n. For plans in reorganization, see the
instructions for line 5. If applicable, file IRS Form 5330, Return
of Excise Taxes Related to Employee Benefit Plans, with the
IRS to pay the excise tax on the funding deficiency. There is a
penalty for not filing the Form 5330 on time.
Line 11. In accordance with ERISA section 103(d)(3), attach a
justification for any change in actuarial assumptions for the
current plan year and label the attachment “Schedule MB, line
11 – Justification for Change in Actuarial Assumptions.”
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This amount is equal to the prior year's
accumulated reconciliation amount due to prior
waived funding deficiencies, increased with interest
at the valuation rate to the current valuation date.
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Notice 1389, Changes for the 2008 Instructions for Schedule MB (Form
5500), revised the instructions for line 9o of the 2008 Schedule MB, but this
notice did not require an amended 2008 Schedule MB to be filed. If the
accumulated reconciliation account reported on line 9o(3) of the filed 2008
Schedule MB was calculated pursuant to the originally published
instructions, an attachment must be included with the 2009 Schedule MB
reflecting the corrected accumulated reconciliation account, calculated
pursuant to the instructions contained in this notice, with an explanation of
the change. Label the attachment, "Schedule MB, Explanation of 2008
Reconciliation Account Change.
If an amortization extension is being amortized at an interest rate that differs from the
valuation rate, enter the prior year's "reconciliation amortization extension outstanding
balance," increased with interest at the valuation interest rate to the current valuation date,
and decreased by the year end amortization amount based on the amortization interest
rate.
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any other unusual or unique situation, the attachment should
include an explanation of what is being provided.
Line 9. Shortfall Method. Under the shortfall method of
funding, the normal cost in the funding standard account is the
charge per unit of production (or per unit of service) multiplied
by the actual number of units of production (or units of service)
that occurred during the plan year. Each amortization
installment in the funding standard account is similarly
calculated.
Lines 9c and 9h. Amortization Charges and Credits. If
there are any amortization charges or credits, attach a
maintenance schedule of funding standard account bases and
label the schedule “Schedule MB, lines 9c and 9h –
Schedule of Funding Standard Account Bases.” The
attachment should clearly indicate the type of base (i.e., original
unfunded liability, amendments, actuarial losses, etc.), the
outstanding balance of each base, the number of years
remaining in the amortization period, and the amortization
amount. If bases were combined in the current year, the
attachment should show information on bases both prior to and
after the combining of bases.
The outstanding balance and amortization charges and
credits must be calculated as of the valuation date for the plan
year.
Line 9d. Interest as Applicable. Interest as applicable should
be charged to the last day of the plan year.
Line 9f. Note that the credit balance or funding deficiency at
the end of “Year X” should be equal to the credit balance or
funding deficiency at the beginning of “Year X+1.” If such credit
balances or funding deficiencies are not equal, attach an
explanation and label the attachment “Schedule MB, line 9f –
Explanation of Prior Year Credit Balance/Funding
Deficiency Discrepancy.” For example, if the difference is
because contributions for a prior year that were not previously
reported are received this plan year, attach a listing of the
amounts and dates of such contributions.
Line 9j(1). ERISA Full Funding Limitation. Instructions for
this line are reserved pending published guidance.
Line 9j(2). “RPA ’94” Override. Instructions for this line are
reserved pending published guidance.
Line 9j(3). Full Funding Credit. Enter the excess of (1) the
accumulated funding deficiency, disregarding the credit balance
and contributions for the current year, if any, over (2) the
greater of lines 9j(1) or 9j(2).
Line 9k(1). Waived Funding Deficiency Credit. Enter a
credit for a waived funding deficiency for the current plan year
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concerns, the inclusion of a social security number on Schedule
R or any of its attachments may result in the rejection of the
filing.
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement. The EBSA does not issue EINs.
“Participant” for purposes of Schedule R, means any
present or former employee who at any time during the plan
year had an accrued benefit in the plan (account balance in a
defined contribution plan).
2009 Instructions for Schedule R
(Form 5500)
Retirement Plan Information
General Instructions
Purpose of Schedule
Who Must File
Part I — Distributions
“Distribution” includes only payments of benefits during the
plan year, in cash, in kind, by purchase for the distributee of an
annuity contract from an insurance company, or by distribution
of life insurance contracts. It does not include:
1. Corrective distributions of excess deferrals, excess
contributions, or excess aggregate contributions, or the income
allocable to any of these amounts;
2. Distributions of automatic contributions pursuant to Code
section 414(w);
3. The distribution of elective deferrals or the return of
employee contributions to correct excess annual additions
under Code section 415, or the gains attributable to these
amounts; and
4. A loan treated as a distribution under Code section 72(p).
Note. It does, however, include a distribution of a plan loan
offset amount as defined in Treasury Regulations section
1.402(c)-2, Q&A 9(b).
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Schedule R (Form 5500) reports certain information on plan
distributions, funding, and the adoption of amendments
increasing or decreasing the value of benefits in a defined
benefit pension plan, as well as certain information on
employee stock ownership plans (ESOPs), and multiemployer
defined benefit plans.
Electronic Attachments. All attachments to Schedule R must
be properly identified, must include the name of the plan, plan
sponsor’s EIN, and plan number. Place “Schedule R” and the
Schedule R line number at the top of each attachment to
identify the information to which the attachment relates. Do not
include attachments that contain a visible social security
number. The Schedule R and its attachments are open to public
inspection, and the contents are subject to publication on the
Internet. Because of privacy concerns, the inclusion of a visible
social security number on an attachment may result in the
rejection of the filing.
Schedule R must be attached to a Form 5500 filed for both
tax-qualified and nonqualified pension benefit plans. The parts
of Schedule R that must be completed depend on whether the
plan is subject to the minimum funding standards of Code
section 412 or ERISA section 302 and the type of plan. See line
item requirements under Specific Instructions for more details.
Exceptions: (1) Schedule R should not be completed when
the Form 5500 annual return/report is filed for a pension plan
that uses, as the sole funding vehicle for providing benefits,
individual retirement accounts or annuities (as described in
Code section 408). See the Form 5500 instructions for Limited
Pension Plan Reporting for more information.
(2) Schedule R also should not be completed if all of the
following conditions are met:
• The plan is not a defined benefit plan or otherwise subject to
the minimum funding standards of Code section 412 or ERISA
section 302.
• No plan benefits that would be reportable on line 1 of Part I of
this Schedule R were distributed during the plan year. See the
instructions for Part I, line 1, below.
• No benefits, as described in the instructions for Part I, line 2,
below, were paid during the plan year other than by the plan
sponsor or plan administrator. (This condition is not met if
benefits were paid by the trust or any other payor(s) which are
reportable on IRS Form 1099-R, Distributions From Pensions,
Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance
Contracts, etc., using an EIN other than that of the plan sponsor
or plan administrator reported on line 2b or 3b of Form 5500.)
• Unless the plan is a profit-sharing, ESOP, or stock bonus
plan, no plan benefits of living or deceased participants were
distributed during the plan year in the form of a single-sum
distribution. See the instructions for Part I, line 3, below.
• The plan is not an ESOP.
• The plan is not a multiemployer defined benefit plan.
Check the Schedule R box on the Form 5500 (Part II, line
10a(1)) if a Schedule R is attached to the Form 5500.
Complete Part II only if the plan is subject to the minimum
funding requirements of Code section 412 or ERISA section
302.
All qualified defined benefit and defined contribution plans
are subject to the minimum funding requirements of Code
section 412 unless they are described in the exceptions listed
Instructions for Schedule R (Form 5500)
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Lines A, B, C, and D. This information must be the same as
reported in Part II of the Form 5500 to which this Schedule R is
attached.
Do not use a social security number in line D instead of an
EIN. Schedule R and its attachments are open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
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Specific Instructions
Line 1. Enter the total value of all distributions made during
the year (regardless of when the distribution began) in any form
other than cash, annuity contracts issued by an insurance
company, distribution of life insurance contracts, marketable
securities within the meaning of Code section 731(c)(2), or plan
loan offset amounts. Do not include eligible rollover distributions
paid directly to eligible retirement plans in a direct rollover under
Code section 401(a)(31) unless such direct rollovers include
property other than that enumerated in the preceding sentence.
Line 2. Enter the EIN(s) of any payor(s) (other than the plan
sponsor or plan administrator on line 2b or 3b of the Form
5500) who paid benefits reportable on IRS Form 1099-R on
behalf of the plan to participants or beneficiaries during the plan
year. This is the EIN that appears on the IRS Forms 1099-R
that are issued to report the payments. Include the EIN of the
trust if different than that of the sponsor or plan administrator. If
more than two payors made such payments during the year,
enter the EINs of the two payors who paid the greatest dollar
amounts during the year. For purposes of this line 2, take into
account all payments made during the plan year, in cash or in
kind, that are reportable on IRS Form 1099-R, regardless of
when the payments began, but take into account payments
from an insurance company under an annuity only in the year
the contract was purchased.
Line 3. Enter the number of living or deceased participants
whose benefits under the plan were distributed during the plan
year in the form of a single-sum distribution. For this purpose, a
distribution of a participant’s benefits will not fail to be a
single-sum distribution merely because, after the date of the
distribution, the plan makes a supplemental distribution as a
result of earnings or other adjustments made after the date of
the single-sum distribution. Also include any participants whose
benefits were distributed in the form of a direct rollover to the
trustee or custodian of a qualified plan or individual retirement
account.
Part II — Funding Information
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under Code section 412(e)(2). These exceptions include
profit-sharing or stock bonus plans, insurance contract plans
described in Code section 412(e)(3), and certain plans to which
no employer contributions are made.
Line 7. Will the minimum required contribution remaining in 6c
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.
Line 8. Revenue Procedure 2000-40, 2002-2 C.B. 357,
providing for automatic approval for a change in funding method
for a plan year, generally does not apply unless the plan
administrator or an authorized representative of the plan
sponsor explicitly agrees to the change. If a change in funding
method made pursuant to such a revenue procedure (or a class
ruling letter) is to be applicable for the current plan year, this
line generally must be checked ‘‘Yes.’’ In certain situations,
however, the requirement that the plan administrator or an
authorized representative of the plan sponsor agree to the
change in funding method will be satisfied if the plan
administrator or an authorized representative of the plan
sponsor is made aware of the change. In these situations, this
line must be checked “N/A.” See section 6.01(2) of Rev. Proc.
2000-40. If the plan’s change in funding method is not made
pursuant to a revenue procedure providing automatic approval
or a class ruling letter (e.g., it is pursuant to a regulation or
Notice 2009-22), then this line should be checked “N/A.”
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).
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Part III — Amendments
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Part IV — ESOP Information
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Line 11b. A loan is a “back-to-back loan” if the following
requirements are satisfied:
1. The loan from the employer corporation to the ESOP
qualifies as an exempt loan under DOL regulations at 29 CFR
2550.408b-3 and under Treasury Regulations sections
54.4975-7 and 54.4975-11; and
2. The repayment terms of the loan from the sponsoring
corporation to the ESOP are substantially similar to the
repayment terms of the loan from the commercial lender to the
sponsoring employer.
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See Temporary Regulations section 11.412(c)-7(b) for
details on when and how to make the election and what
information to include on the statement of election, which must
be filed with the Form 5500 annual return/report.
Line 5. If a money purchase defined contribution plan
(including a target benefit plan) has received a waiver of the
minimum funding standard, and the waiver is currently being
amortized, complete lines 3, 9, and 10 of Schedule MB. See
instructions for Schedule MB. Attach Schedule MB to Form
5500. The Schedule MB for a money purchase defined
contribution plan does not need to be signed by an enrolled
actuary.
Line 6a. The minimum required contribution for a money
purchase defined contribution plan (including a target benefit
plan) for a plan year is the amount required to be contributed for
the year under the formula set forth in the plan document. If
there is an accumulated funding deficiency for a prior year that
has not been waived, that amount should also be included as
part of the contribution required for the current year.
Line 6b. Include all contributions for the plan year made not
later than 81/2 months after the end of the plan year. Show only
contributions actually made to the plan by the date the form is
filed. For example, do not include receivable contributions for
this purpose.
Line 6c. 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 IRS Form 5330 on time.
Line 9.
• Check “No” if no amendments were adopted during this plan
year that increased or decreased the value of benefits.
• Check “Increase” if an amendment was adopted during the
plan year that increased the value of benefits in any way. This
includes an amendment providing for an increase in the amount
of benefits or rate of accrual, more generous lump sum factors,
COLAs, more rapid vesting, additional payment forms, or earlier
eligibility for some benefits.
• Check “Decrease” if an amendment was adopted during the
plan year that decreased the value of benefits in any way. This
includes a decrease in future accruals, closure of the plan to
new employees, or accruals being frozen for some or all
participants.
• If the amendments that were adopted increased the value of
some benefits but decreased the value of others, check “Both.”
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Part V — Additional Employer Information for
Multiemployer Defined Benefit Pension Plans
Required Attachments. Multiemployer defined benefit plans
that are in Endangered Status or Critical Status must attach a
summary of their Funding Improvement Plan or Rehabilitation
Plan (as updated, if applicable) and also any update to a
Funding Improvement Plan or Rehabilitation Plan. For this
purpose, whether a plan is in Endangered Status or Critical
Status is determined by taking into account any election under
section 204 of the Worker, Retiree, and Employer Recovery Act
of 2009 (“WRERA”). The instructions for line 4a of Schedule MB
provide that the Plan Status Code entered on line 4a of
Schedule MB must be based on the actuarial certification of the
plan’s status, without regard to the election under section 204 of
WRERA. In certain cases, as a result of the WRERA election,
the plan status for purposes of attaching a summary of the
multiemployer plan’s Funding Improvement Plan or
Rehabilitation Plan to the Schedule R may not be the same as
shown by the Plan Status Code entered on line 4a of Schedule
MB. In such a case, an explanation of why the plan’s status is
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The sponsor or plan administrator of a single-employer or
multiple-employer defined benefit plan that is subject to the
minimum funding requirements must file Schedule SB as an
attachment to Form 5500. Schedule MB is filed for
multiemployer defined benefit plans and certain money
purchase defined contribution plans (whether they are
single-employer or multiemployer plans). However, Schedule
MB is not required to be filed for a money purchase defined
contribution plan that is subject to the minimum funding
requirements unless the plan is currently amortizing a waiver of
the minimum funding requirements.
Line 4. Check ‘‘Yes’’ if, for purposes of computing the
minimum funding requirements for the plan year, the plan
administrator is making an election intended to satisfy the
requirements of Code section 412(d)(2) or ERISA section
302(d)(2). Under Code section 412(d)(2) and ERISA section
302(d)(2), a plan administrator may elect to have any
amendment, adopted after the close of the plan year for which it
applies, treated as having been made on the first day of the
plan year if all of the following requirements are met:
1. The amendment is adopted no later than two and
one-half months (two years for a multiemployer plan) after the
close of such plan year;
2. The amendment does not reduce the accrued benefit of
any participant determined as of the beginning of such plan
year; and
3. The amendment does not reduce the accrued benefit of
any participant determined as of the adoption of the
amendment unless the plan administrator notified the Secretary
of the Treasury of the amendment and the Secretary either
approved the amendment or failed to disapprove the
amendment within 90 days after the date the notice was filed.
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different must be included either with the summary of the plan’s
Funding Improvement Plan or Rehabilitation Plan or as a
separate attachment to the Schedule R (if the plan is neither in
Endangered Status nor Critical Status, taking into account the
election). The explanation must include the date that the
WRERA election was filed with the IRS.
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Unless an election was made under section 204 of WRERA,
the plan sponsor is required to annually update a Funding
Improvement Plan or Rehabilitation Plan that was adopted in a
prior year. The update must be filed as an attachment to the
Schedule R. The update attachment must identify the
modifications made to the Funding Improvement Plan or
Rehabilitation Plan during the plan year, including contribution
increases, benefit reductions, or other actions. If an update of
the Funding Improvement Plan or Rehabilitation Plan is not
required because of an election under section 204 of WRERA,
the update attachment must include a statement to that effect
and the date that the election was filed with the IRS.
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The summary must also include a schedule of the expected
annual progress for the funded percentage or other relevant
factors under the Funding Improvement Plan or Rehabilitation
Plan. If the sponsor of a multiemployer plan in Critical Status
has determined that, based on reasonable actuarial
assumptions and upon exhaustion of all reasonable measures,
the plan cannot emerge from Critical Status by the end of the
Rehabilitation Period as described in Code section
432(e)(3)(A)(ii), the summary must include an explanation of
the alternatives considered, why the plan is not reasonably
expected to emerge from Critical Status by the end of the
Rehabilitation Period, and when, if ever, it is expected to
emerge from Critical Status under the Rehabilitation Plan.
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The attachment described above must be labeled “Schedule
R, Summary of Funding Improvement Plan,” “Schedule R,
Summary of Rehabilitation Plan,” or “Schedule R,
Explanation of Status,” as appropriate, and if applicable,
“Schedule R, Update of Funding Improvement Plan or
Rehabilitation Plan.” Each attachment must also include the
plan name, the plan sponsor’s name and EIN, and the plan
number.
Line 13. This line should be completed only by multiemployer
defined benefit pension plans that are subject to the minimum
funding standards (see Code section 412 and Part 3 of Title I of
ERISA). Enter the information on lines 13a through 13e for any
employer that contributed more than five (5) percent of the
plan’s total contributions for the 2009 plan year. List employers
in descending order according to the dollar amount of their
contributions to the plan. Complete as many entries as are
necessary to list all employers that contributed more than five
(5) percent of the plan’s contributions.
Line 13a. Enter the name of the employer contributing to the
plan.
Line 13b. Enter the EIN of the employer contributing to the
plan. Do not enter a social security number in lieu of an EIN;
therefore, ensure that you have the employer’s EIN and not a
social security number. The Form 5500 is open to public
inspection, and the contents are public information and are
Instructions for Schedule R (Form 5500)
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The summary of any Funding Improvement Plan or
Rehabilitation Plan must reflect the plan in effect at the end of
the plan year (whether the original Funding Improvement Plan
or Rehabilitation Plan or as updated) and must include a
description of the various contribution and benefit schedules
that are being provided to the bargaining parties and any other
actions taken in connection with the Funding Improvement Plan
or Rehabilitation Plan, such as use of the shortfall funding
method or extension of an amortization period. The summary
must also identify the first year and the last year of the Funding
Improvement Period or the Rehabilitation Period. If an extended
Funding Improvement Period (of 13 or 18 years) or
Rehabilitation Period (of 13 years) applies because of an
election under section 205 of WRERA, the summary must
include a statement to that effect and the date that the election
was filed with the IRS.
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this line
may result in the rejection of the filing.
EINs can be obtained from the IRS online, by telephone, by
fax, or by mail depending on when you need to use the EIN. For
more information, see Section 3: Electronic Filing Requirement.
The EBSA does not issue EINs.
Line 13c. Dollar Amount Contributed. Enter the total dollar
amount contributed to the plan by the employer for all covered
workers in all locations for the plan year. Do not include the
portion of an aggregated contribution that is for another plan,
such as a welfare benefit plan, a defined contribution pension
plan or another defined benefit pension plan.
Line 13d. Collective Bargaining Agreement Expiration Date.
Enter the date on which the employer’s collective bargaining
agreement expires. If the employer has more than one
collective bargaining agreement requiring contributions to the
plan, check the box and include, as an attachment, the
expiration date of each collective bargaining agreement
(regardless of the amount of contributions arising from such
agreement). Label the attachment: “Schedule R, line 13d –
Collective Bargaining Agreement Expiration Date.” Include
the plan name and the sponsor’s name and EIN.
Line 13e. Contribution Rate Information. Enter the
contribution rate (in dollars and cents) per contribution base unit
in line 13e(1) and the base unit measure in line 13e(2). Indicate
whether the base unit is measured on an hourly, weekly,
unit-of-production, or other basis. If “other,” specify the base
unit measure used. If the contribution rate changed during the
plan year, enter the last contribution rate in effect for the plan
year.
If the employer has different contribution rates for different
classifications of employees or different places of business,
check the box in the first line of line 13e and list in an
attachment each contribution rate and corresponding base unit
measure under which the employer made contributions
(regardless of the amount of contributions resulting from each
rate). Label the attachment: “Schedule R, line 13e –
Information on Contribution Rates and Base Units.” Include
the plan name and the sponsor’s name and EIN.
Line 14. Enter the number of participants on whose behalf no
contributions were made by an employer as an employer of the
participant. For purposes of line 14, count only those
participants whose employers or former employers had
withdrawn from the plan by the beginning of the relevant plan
year. Disregard any participants whose employers had not
withdrawn from the plan, even if, in the relevant year, no
contributions were made by the employer on behalf of those
participants. Thus, for the limited purposes of line 14 and
notwithstanding any contrary definition of such participants
applicable elsewhere, the deferred vested and retired
participants of employers who have not withdrawn from the plan
should not be included in these numbers.
Note. Withdrawal liability payments are not to be treated as
contributions for the purpose of determining the number of
participants for line 14.
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Line 14a. Enter the number of participants for the 2009 plan
year described in the line 14 instructions.
Line 14b. Enter the number of participants for the 2008 plan
year described in the line 14 instructions.
Line 14c. Enter the number of participants for the 2007 plan
year described in the line 14 instructions.
Line 15. Enter the ratio of number of participants on whose
behalf no employer had an obligation to make a contribution for
the 2009 plan year to the corresponding number for each of the
two preceding plan years. For the purpose of these ratios, count
all participants whose employers have withdrawn from the plan
as well as all deferred vested and retired participants of
employers still active in the plan (unless the collective
bargaining agreement specifically requires the employer to
make contributions for such participants.)
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funding percentage is the ratio where the numerator is the
actuarial value of the plan’s assets and the denominator is the
accrued liability of the plan. If a plan whose funding percentage
is required to be reported has terminated, write “Terminated” in
the space where the plan’s funding percentage would otherwise
have been reported. Label the attachment “Schedule R, line
18 – Funded Percentage of Plans Contributing to the
Liabilities of Plan Participants” and include the plan name
and the plan sponsor’s name and EIN.
Line 19. This line must be completed by all defined benefit
pension plans (except DFEs) with 1,000 or more participants at
the beginning of the plan year. To determine if the plan has
1,000 or more participants, use the participant count shown on
line 3d(1) of the Schedule SB for single-employer plans or on
line 2b(4)(1) of the Schedule MB for multiemployer plans.
Line 19a. Show the beginning-of-year distribution of assets for
the categories shown. Use the market value of assets and do
not include the value of any receivables. These percentages,
expressed to the nearest whole percent, should reflect the total
assets held in stocks, investment-grade debt instruments,
high-yield debt instruments, real estate, or other asset classes,
regardless of how they are listed on the Schedule H. The
percentages in the five categories should sum to 100 percent.
Assets held in trusts, accounts, and other investment
arrangements should be disaggregated and properly distributed
among the five asset components. The assets in these trusts,
accounts and investment arrangements should not be included
in the “Other” component unless these investments contain no
stocks, bonds, or real estate holdings. The same methodology
should be used in disaggregating trust assets as is used when
disclosing the allocation of plan assets on the sponsor’s 10-K
filings to the Securities and Exchange Commission. Real estate
investment trusts (REITs) should be listed with stocks, while
real estate limited partnerships should be included in the Real
Estate category.
Investment-grade debt-instruments are those with an S&P
rating of BBB – or higher, a Moody’s rating of Baa3 or higher, or
an equivalent rating from another rating agency. High-yield debt
instruments are those that have ratings below these rating
levels. If the debt does not have a rating, it should be included
in the “high-yield” category if it does not have the backing of a
government entity. Unrated debt with the backing of a
government entity would generally be included in the
“investment-grade” category unless it is generally accepted that
the debt should be considered as “high-yield.” Use the ratings in
effect as of the beginning of the plan year.
Line 19b. Check the box that shows the average duration of
the plan’s combined investment-grade and high-yield debt
portfolio. If the average duration falls exactly on the boundary of
two boxes, check the box with the lower duration. To determine
the average duration, use the “effective duration” or any other
generally accepted measure of duration. Report the duration
measure used in line 19c. If debt instruments are held in
multiple debt portfolios, report the weighted average of the
average durations of the various portfolios where the weights
are the dollar values of the individual portfolios.
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Line 18. If any liabilities to participants or their beneficiaries
under the plan at the end of the plan year consist of liabilities
under two (2) or more plans as of immediately before the 2009
plan year, check the box and provide the following information
as an attachment. The attachment should include the names,
employer identification numbers, and plan numbers of all plans,
including the current plan, that provided a portion of liabilities of
the participants and beneficiaries in question. The attachment
should also include the funding percentage of each plan as of
the last day of the 2008 plan year. For single-employer plans,
the funding percentage is the funding target attainment
percentage, where the numerator is the value of plan assets
reduced by the sum of the amount of the prefunding balance
and the funding standard carryover balance, and the
denominator is the funding target for the plan (without regard to
the at-risk status of the plan). For multiemployer plans, the
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Part VI — Additional Information for Single-Employer
and Multiemployer Defined Benefit Pension Plans
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Line 15a. Enter the ratio of the number of participants as
described in the line 15 instructions for the 2009 plan year to
the number for the 2008 plan year.
Line 15b. Enter the ratio of the number of participants as
described on the line 15 instructions for the 2009 plan year to
the number for the 2007 plan year.
Note. Withdrawal liability payments are not to be treated as
contributions for determining the number of participants on line
15.
Line 16a. Enter the number of employers that withdrew from
the plan during the 2008 plan year.
Line 16b. If line 16a is greater than zero, enter the aggregate
amount of withdrawal liability assessed against these
employers. If the withdrawal liability for one or more
withdrawing employers has not yet been determined, include
the amounts estimated to be assessed against them in the
aggregate amount.
The definitions of withdrawal are those contained in Section
4203 of ERISA. If the plan is in the building and construction,
entertainment, or another industry that has special withdrawal
rules, withdrawing employers should only be counted if the
withdrawal adheres to the special rules applying to its specific
industry.
Line 17. If assets and liabilities from another plan were
transferred to or merged with the assets and liabilities of this
plan during the 2009 plan year, check the box and provide the
following information as an attachment. The attachment should
include the names and employer identification numbers of all
plans that transferred assets and liabilities to, or merged with,
this plan. For each plan, including this plan, the attachment
should also include the actuarial valuation of the total assets
and total liabilities for the year preceding the transfer or merger,
based on the most recent data available as of the day before
the first day of the 2009 plan year. Label the attachment
“Schedule R, line 17 – Information on Assets and
Liabilities Transferred to or Merged with This Plan” and
include the plan name and the plan sponsor’s name and EIN.
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Lines A through F. Identifying Information. Lines A – E
must be completed by all plans. If the Schedule SB is attached
to a Form 5500 or Form 5500-SF, lines A through D should
include the same information as reported in corresponding lines
in Part II of the Form 5500, Form 5500-SF, or Form 5500-EZ.
You may abbreviate the plan name (if necessary) to fit in the
space provided.
2009 Instructions for Schedule SB
(Form 5500)
Single-Employer Defined Benefit Plan
Actuarial Information
for
Do not use a social security number in line D instead of an
EIN. The Schedule SB and its attachments are open to public
inspection if filed with a Form 5500 or Form 5500-SF, and the
contents are public information and are generally subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a social security number on the Schedule SB or any
of its attachments may result in the rejection of the filing.
General Instructions
You can apply for an EIN from the IRS online, by telephone,
by fax, or by mail depending on how soon you need to use the
EIN. For more information, see Section 3: Electronic Filing
Requirement under General Instructions to Form 5500. The
EBSA does not issue EINs.
Line E. Type of Plan. Check the applicable box to indicate the
type of plan. A single-employer plan for this reporting purpose is
an employee benefit plan maintained by one employer or one
employee organization. A multiple-employer plan is a plan that
is maintained by more than one employer, but is not a
multiemployer plan. (See the Instructions for Form 5500, box
A(1) for additional information on the definition of a
multiemployer plan.)
• Check “Single” if the Form 5500, Form 5500-SF, or Form
5500-EZ is filed for a single-employer plan (including a plan
maintained by more than one member of the same controlled
group).
• Check “Multiple-A” if the Form 5500 or Form 5500-SF is
being filed for a multiple-employer plan and the plan is subject
to the rules of Code section 413(c)(4)(A) (i.e., it is funded as if
each employer were maintaining a separate plan). This includes
plans established before January 1, 1989, for which an election
was made to fund in accordance with Code section
413(c)(4)(A).
• Check “Multiple-B” if the Form 5500 or Form 5500-SF is
being filed for a multiple-employer plan and the plan is subject
to the rules of Code section 413(c)(4)(B) (i.e., it is funded as if
all participants were employed by a single employer).
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Note. Proposed regulations under Code sections 430, 436,
and 4971 and ERISA sections 206(g) and 303 were published
in the Federal Register on May 29, 2007, August 31, 2007,
December 31, 2007, and April 15, 2008. However, with the
exception of sections 1.430(h)(3)-1 and 54.4971(c)-1 of the
proposed regulations, the provisions of the final regulations will
not be effective until the plan year beginning in 2010. With
respect to those provisions proposed to become effective after
2008, plan sponsors may rely on the provisions of the proposed
or final regulations for plan years beginning in 2008 or 2009, or
they may generally follow a reasonable interpretation of the
funding rules in the statute, taking into account the provisions of
the Worker, Retiree, and Employer Recovery Act of 2008
(“WRERA”) and any other amendments to the funding rules that
are enacted.
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If “Multiple-A” is checked, compute the entries on Schedule
SB filed for the plan as the sum of the individual amounts
computed for each employer. Complete a Schedule SB for each
employer showing information relative to that employer’s portion
of the plan, and submit them as an attachment to the Schedule
SB for the plan. Label the attachment “Schedule SB –
Information for Each Individual Employer.”
Line F. Prior Year Plan Size. Check the applicable box based
on the highest number of participants (both active and inactive)
on any day of the preceding plan year, taking into account
participants in all defined benefit plans maintained by the same
employer (or any member of such employer’s controlled group)
who are or were also employees of that employer or member.
For this purpose, participants whose only defined benefit plan is
a multiemployer plan (as defined in Code section 414(f)) are not
counted, and participants who are covered in more than one of
the defined benefit plans described above are counted only
once. Inactive participants include vested terminated and retired
employees as well as beneficiaries of deceased participants. If
this is the first plan year that a plan described in this paragraph
exists, complete this line based on the highest number of
participants that the plan is reasonably expected to have on any
day during the first plan year.
Instructions for Schedule SB (Form 5500)
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As the first step, the plan administrator of any single-employer
defined benefit plan (including a multiple-employer defined
benefit plan) that is subject to the minimum funding standards
(see Code section 412 and Part 3 of Title I of ERISA) must
obtain a completed Schedule SB that is prepared and signed by
the plan’s enrolled actuary as discussed below in the Statement
by Enrolled Actuary section. The plan administrator must retain
with the plan records the Schedule SB that is prepared and
signed by the plan’s actuary.
Next, the plan administrator must ensure that the information
from the actuary’s Schedule SB is entered electronically into the
annual return/report being submitted. When entering the
information, whether using EFAST2-approved software or
EFAST2’s web-based filing system, all the fields required for
the type of plan must be completed (see instructions for fields
that need to be completed).
Further, the plan administrator of a single-employer defined
benefit plan must attach to the Form 5500 or Form 5500-SF an
electronic reproduction of the Schedule SB prepared and
signed by the plan’s enrolled actuary. This electronic
reproduction must be included as a Portable Document Format
(PDF) attachment to the Form 5500 or Form 5500-SF and
labeled “SB Actuary Signature.”
Note. The Schedule SB (Form 5500) does not have to be filed
with the Form 5500-EZ, but it must be retained (in accordance
with the Instructions for Form 5500-EZ under the What To File
section). Similarly, if a plan is a one-participant plan that meets
the requirements for filing a Form 5500-EZ, but a Form
5500-SF is instead filed for the plan, the Schedule SB does not
have to be filed with the Form 5500-SF. However, it must be
retained in accordance with the Instructions for Form 5500-SF
under the section headed Specific Instructions Only for
“One-Participant Plans.” The enrolled actuary must complete
and sign the Schedule SB and forward it to the person
responsible for filing the Form 5500-EZ, even if the Schedule
SB is not filed.
Check the Schedule SB box on the Form 5500 (Part II, line
10a(3)) if a Schedule SB is attached to Form 5500. Check “Yes”
on line 11 in Part VI of the Form 5500-SF if a Schedule SB is
required to be prepared for the plan, even if Schedule SB is not
required to be attached to Form 5500-SF (see instructions in
the Note above, pertaining to “one-participant plans”).
Note. This schedule is not filed for a multiemployer plan nor for
a money purchase defined contribution plan (including a target
benefit plan) for which a waiver of the minimum funding
requirements is currently being amortized. Information for these
plans must be filed using Schedule MB (Form 5500).
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Who Must File
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General Instructions, Parts I through VIII, Statement
by Enrolled Actuary, and Attachments
Except as noted below, all single and multiple-employer defined
benefit plans, regardless of size or type, must complete Parts I
through VIII. See instructions for line 27 for additional
information to be provided for certain plans with special
circumstances.
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The Pension Protection Act of 2006, as amended (PPA),
provides delayed effective dates for the new funding rules for
plans meeting certain criteria (certain multiple-employer plans
maintained by rural cooperatives or related organizations,
PBGC settlement plans, and certain plans maintained by
government contractors, as described in PPA sections 104
through 106). Eligible plans to which these delayed effective
dates apply do not need to complete the entire Schedule SB,
but will have to file information relating to pre-PPA calculations
in an attachment using the 2007 Schedule B form. See the
instructions for line 27 for more information about which lines of
Schedule SB need to be completed and what additional
attachments are required.
Do not include attachments that contain a visible social
security number. Except for certain one-participant plans, the
Schedule SB and its attachments are open to public inspection,
and the contents are public information and are subject to
publication on the Internet. Because of privacy concerns, the
inclusion of a visible social security number on an attachment
may result in the rejection of the filing.
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Specific Instructions for Part I — Basic
Information
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An enrolled actuary must sign Schedule SB. The signature of
the enrolled actuary may be qualified to state that it is subject to
attached qualifications. See Treasury Regulations section
301.6059-1(d) for permitted qualifications. If the actuary has not
fully reflected any final or temporary regulation, revenue ruling,
or notice promulgated under the statute in completing the
Schedule SB, check the box on the last line of page 1. If this
box is checked, indicate on an attachment whether any unpaid
required contribution or a contribution that is not wholly
deductible would result if the actuary had fully reflected such
regulation, revenue ruling, or notice, and label this attachment
“Schedule SB – Statement by Enrolled Actuary.” A
stamped or machine produced signature is not acceptable.
The actuary must provide the completed and signed
Schedule SB to the plan administrator to be retained with the
plan records and included (in accordance with these
instructions) with the Form 5500 or Form 5500-SF that is
submitted under EFAST2. The actuary’s most recent enrollment
number must be entered on the Schedule SB that is prepared
and signed by the plan’s actuary.
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Statement by Enrolled Actuary
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PPA provides funding relief for certain defined benefit plans
(other than multiemployer plans) maintained by a commercial
passenger airline or by an employer whose principal business is
providing catering services to a commercial passenger airline,
based on an alternative 17-year funding schedule. Plans using
this funding relief do not need to complete the entire Schedule
SB, but are required to provide supplemental information as an
attachment to Schedule SB. Alternatively, these plans can elect
to apply the funding rules generally applicable to
single-employer defined benefit plans, but amortize the funding
shortfall over 10 years instead of the standard 7-year period
and use a special interest rate to determine the funding target.
Plans using this 10-year funding option must complete the
entire Schedule SB and provide additional information. See the
instructions for line 27 for more information about which lines of
Schedule SB need to be completed and what additional
attachments are required.
Notes. (1) For split-funded plans, the costs and contributions
reported on Schedule SB should include those related to both
trust funds and insurance carriers. (2) For terminating plans,
Rev. Rul. 79-237, 1979-2 C.B. 190, provides that minimum
funding standards apply until the end of the plan year that
includes the termination date. Accordingly, the Schedule SB is
not required to be filed for any later plan year. However, if a
termination fails to occur — whether because assets remain in
the plan’s related trust (see Rev. Rul. 89-87, 1989-2 C.B. 81) or
for any other reason (e.g., the PBGC issues a notice of
noncompliance pursuant to 29 CFR section 4041.31 for a
standard termination) — there is no termination date, and
therefore, minimum funding standards continue to apply and a
Schedule SB continues to be required.
Note. All entries in Part I must be reported as of the valuation
date.
Line 1. Valuation Date. The valuation date for a plan year
must be the first day of the plan year unless the plan meets the
small-plan exception of ERISA section 303(g)(2)(B) and Code
section 430(g)(2)(B). For plans that qualify for the exception,
the valuation date may be any date in the plan year, including
the first or last day of the plan year.
A plan qualifies for this small-plan exception if there were
100 or fewer participants on each day of the prior plan year. For
the definition of participant, as it applies in this case, see the
instructions for line F.
Line 2a. Market Value of Assets. Enter the fair market value
of assets as of the valuation date. Include contributions
designated for the previous plan year that are made after the
valuation date (but within the 81/2 -month period after the end of
the prior plan year), adjusted for interest for the period between
the date of payment and the valuation date using the effective
interest rate for the prior plan year.
Contributions made for the current plan year must be
excluded from the amount reported in line 2a. If these
contributions were made prior to the valuation date (which can
only occur for small plans with a valuation date other than the
first day of the plan year), the asset value must be adjusted to
exclude not only the contribution amounts, but interest on the
contributions from the date of payment to the valuation date,
using the current-year effective interest rate.
Do not adjust for items such as the funding standard
carryover balance, prefunding balance, any unpaid minimum
required contributions, or the present value of remaining
shortfall or waiver amortization installments. Rollover amounts
or other assets held in individual accounts that are not available
to provide defined benefits under the plan should not be
included on line 2a regardless of whether they are reported on
the Schedule H (Form 5500) (line 1l, column (a)) or Schedule I
(Form 5500) (line 1c, column (a)), or Form 5500-SF (line 7c,
column (a)). Additionally, asset and liability amounts must be
determined in a consistent manner. Therefore, if the value of
any insurance contracts has been excluded from the amount
reported in line 2a, liabilities satisfied by such contracts should
also be excluded from the funding target values reported in
lines 3 and 4.
Line 2b. Actuarial Value of Assets. If an averaging method is
used to value plan assets (as permitted under Code section
430(g)(3)(B) and ERISA section 303(g)(3)(B)), as amended by
WRERA, enter the value as of the valuation date taking into
account the requirement that such value must be within 90% to
110% of the fair market value of assets.
Do not adjust the actuarial value of assets for items such as
the funding standard carryover balance, the prefunding
balance, unpaid minimum required contributions, or the present
value of any remaining shortfall or waiver amortization
installments. Treat contributions designated for a current or
prior plan year, rollover amounts, insurance contracts, and
other items in the same manner as for line 2a.
Note. Under Code section 430(g)(3)(B), the use of averaging
methods in determining the value of plan assets is permitted
only in accordance with methods prescribed in Treasury
Regulations. Accordingly, for plan years beginning in 2009,
taxpayers cannot use asset valuation methods other than fair
market value (as described in Code section 430(g)(3)(A)),
except as provided under Notice 2009-22, 2009-14, I.R.B. 741
and Treasury Regulations that reflect the amendments made by
Attachments
All attachments to the Schedule SB must be properly identified
as attachments to the Schedule SB, and must include the name
of the plan, plan sponsor’s EIN, plan number, and line number
to which the schedule relates. When assembling the package
for filing, attachments for a schedule should be placed either
directly behind that schedule or at the end of the filing.
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WRERA. An actuarial value of assets calculated using the
averaging method provided by PPA prior to amendment by
WRERA (which does not reflect expected earnings) is not
permitted for the plan year that begins in 2009, regardless of
whether that method was used to determine the actuarial value
of assets for the plan year beginning in 2008.
If the plan is in at-risk status for the current plan year, attach
a description of the at-risk assumptions for the assumed form of
payment (i.e., the optional form resulting in the highest present
value). Label the attachment “Schedule SB, line 4 –
Additional Information for Plans in At-Risk Status.”
Line 5. Effective Interest Rate. Enter the single rate of
interest which, if used instead of the interest rate(s) reported in
line 21 to determine the present value of the benefits that are
taken into account in determining the plan’s funding target for a
plan year, would result in an amount equal to the plan’s funding
target determined for the plan year, without regard to
calculations for plans in at-risk status. (This is the funding target
reported in line 3d(2) for plans not in at-risk status, or in line 4a
for plans in at-risk status.) However, if the funding target for the
plan year is zero, the effective interest rate is determined as the
single rate that would result in an amount equal to the plan’s
target normal cost determined for the plan year, without regard
to calculations for plans in at-risk status. See the provisions of
Code section 430(h)(2)(A), ERISA section 303(h)(2)(A), and the
applicable regulations. Enter rate to the nearest .01% (e.g.,
5.26%).
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Line 3. Funding Target/Participant Count Breakdown. All
amounts should be reported as of the valuation date.
• Column (1) — Enter the number of participants, including
beneficiaries of deceased participants, who are or who will be
entitled to benefits under the plan.
• Column (2) — Enter the funding target calculated using the
methods and assumptions provided in ERISA sections 303(h)
and (i), Code sections 430(h) and (i), and other related
guidance. When allocating the funding target for active
participants (line 3c(3)) between vested and non-vested
benefits (lines 3c(2) and 3c(1) respectively), benefits
considered vested for PBGC premium purposes must be
included in line 3c(2).
Line 6. Target Normal Cost. Report the present value of all
benefits which have been accrued or have been earned (or that
are expected to accrue or to be earned) under the plan during
the plan year, increased by any plan-related expenses
expected to be paid from plan assets during the plan year, and
decreased (but not below zero) by any mandatory employee
contributions expected to be made during the plan year. Include
any increase in benefits during the plan year that is a result of
any actual or projected increase in compensation during the
current plan year, even if that increase in benefits is with
respect to benefits attributable to services performed in a
preceding plan year.
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A plan with over 500 participants is in at-risk status for 2009
if the FTAP for 2008 (line 14 of the 2008 Schedule SB) is less
than 70%.
Line 4. Additional Information for Plans in At-Risk Status.
If the plan is in at-risk status as provided under ERISA section
303(i)(4) and Code section 430(i)(4), check the box, complete
lines 4a and 4b, and include as an attachment the information
described below. Do not complete line 4 if the plan is not in
at-risk status for the current plan year.
• Line 4a — Enter the amount of the funding target determined
as if the plan were not in at-risk status.
• Line 4b — Report the funding target disregarding the
transition rule of ERISA section 303(i)(5) and Code section
430(i)(5), and disregarding the loading factor in ERISA section
303(i)(1)(C) and Code section 430(i)(1)(C).
Instructions for Schedule SB (Form 5500)
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Special rule for airlines using 10-year amortization
period under section 402(a)(2) of PPA. Section 402(a)(2) of
PPA (as amended by section 6615 of the U.S. Troop
Readiness, Veterans’ Care, Katrina Recovery, and Iraq
Accountability Appropriations Act, 2007, Public Law 110-28
(121 Stat.112)) states that for plans electing the 10-year
amortization period, the funding target during that period is
determined using an interest rate of 8.25% rather than the
interest rates or segment rates calculated on the basis of the
corporate bond yield curve. However, this special 8.25%
interest rate does not apply for other purposes, including the
calculation of target normal cost or the amortization of the
funding shortfall. Report the target normal cost using the
interest rates or segment rates otherwise applicable under
Code section 430(h)(2) and ERISA section 303(h)(2).
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If the plan has been in at-risk status for any two or more of
the preceding four plan years, also include the loading factor
required in ERISA section 303(i)(1)(C) and Code section
430(i)(1)(C). If the plan is in at-risk status and has been in
at-risk status for fewer than five consecutive years, report the
funding target amounts after reflecting the transition rule
provided in ERISA section 303(i)(5) and Code section 430(i)(5).
Years beginning before 2008 do not count for this purpose.
Thus, for example, the funding target for a plan that was in
at-risk status for both the 2008 and 2009 plan years will reflect
40% of the funding target using the special at-risk assumptions
and 60% of the funding target determined without regard to the
at-risk assumptions.
Determining whether a plan is in at-risk status. Refer to
ERISA section 303(i)(4) and Code section 430(i)(4) to
determine whether the plan is in at-risk status. Generally, a plan
is in at-risk status for a plan year if it had more than 500
participants on any day during the preceding plan year (see
instructions for line F for the definition of participants) and the
plan’s funding target attainment percentage (“FTAP”) falls
below specified thresholds.
This amount must generally be calculated as of the valuation
date and must be based on the same assumptions used to
determine the funding target reported in line 3c(3), column (2),
reflecting the special assumptions and the loading factor for
at-risk plans, if applicable. If the plan is in at-risk status and has
been for fewer than five consecutive years, report the target
normal cost after reflecting the transition rule provided in ERISA
section 303(i)(5) and Code section 430(i)(5).
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Unless the plan sponsor has received approval to use
substitute mortality tables in accordance with ERISA section
303(h)(3)(C) and Code section 430(h)(3)(C), the funding target
must be computed using the mortality tables for non-disabled
lives, as published in section 1.430(h)(3)-1 of the Income Tax
Regulations. If substitute mortality tables have been approved
(or deemed to have been approved) by the IRS, such tables
must be used instead of the mortality tables described in the
previous sentence, subject to the rules of ERISA section
303(h)(3) and Code section 430(h)(3). The funding target may
be computed taking into account the mortality tables for
disabled lives published in Rev. Rul. 96-7, 1996-1 C.B. 59, and
as provided in Notice 2008-29, 2008-12 I.R.B. 637.
Special rules for plans that are in at-risk status. If a plan
is in at-risk status, report the amount reflecting the additional
assumptions required in ERISA section 303(i)(1)(B) and Code
section 430(i)(1)(B).
Specific Instructions for Part II — Beginning of
Year Carryover and Prefunding Balances
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Line 7. Balance at Beginning of Prior Plan Year After
Applicable Adjustments. In general, report the amount in the
corresponding column of line 13 of the prior-year Schedule SB.
However, if the balance from the prior year has been adjusted
so that it does not match the corresponding amount in line 13 of
the prior-year Schedule SB, attach an explanation and label the
attachment “Schedule SB, Line 7 – Explanation of
Discrepancy in Prior Year Funding Standard Carryover
Balance or Prefunding Balance.” Note that elections to add
interest-adjusted excess contributions or reduce balances have
specific deadlines, and generally cannot be changed once they
have been made.
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Line 11c. Enter the sum of lines 11a and 11b.
Line 11d. Enter the amount of the excess contributions for the
prior year (with interest) that the plan sponsor elected to use to
increase the prefunding balance. This amount cannot be
greater than the amount reported on line 11c.
If this is the first year for which the plan is subject to the
minimum funding rules of ERISA section 303 or Code section
430, leave lines 11a – d blank.
Line 12. Reduction in Balances Due to Elections or Deemed
Elections. In each column, enter the amount by which the
employer elects to reduce (or is deemed to elect to reduce, per
ERISA section 206(g)(5)(C) and Code section 436(f)(3)) the
funding standard carryover balance or prefunding balance, as
applicable, under ERISA section 303(f) and Code section
430(f). This amount cannot be greater than the sum of the
amounts reported in the corresponding column of lines 9, 10
and, if applicable, 11d. Note that an election (or deemed
election) cannot be made to reduce the prefunding balance in
column (b) until the funding standard carryover balance in
column (a) has been reduced to zero.
If the valuation date is not the first day of the plan year,
adjust the amounts reported in line 12 to the first day of the plan
year, using the effective interest rate for the current plan year. If
the plan did not exist in the prior year and is not a successor
plan, leave both columns blank.
If this is the first year for which the plan is subject to the
minimum funding rules of ERISA section 303 or Code section
430, leave column (b) blank.
Line 13. Balance at Beginning of Current Year.
• Column (a) -- Enter the sum of the amounts reported on lines
9 and 10 of column (a), minus the amount reported on line 12 of
column (a).
• Column (b) -- Enter the sum of the amounts reported on lines
9, 10 and 11d of column (b), minus the amount reported on line
12 of column (b).
If this is the first year for which the plan is subject to the
minimum funding rules of ERISA section 303 or Code section
430, leave column (b) blank.
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Specific Instructions for Part III — Funding
Percentages
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Enter all percentages in this section by truncating at .01% (e.g.,
report 82.649% as 82.64%).
Line 14. Funding Target Attainment Percentage. Enter the
funding target attainment percentage (FTAP) determined in
accordance with ERISA section 303(d)(2) and Code section
430(d)(2). The FTAP is the ratio (expressed as a percentage)
which the actuarial value of plan assets (reduced by the funding
standard carryover balance and prefunding balance) bears to
the funding target determined without regard to the additional
rules for plans in at-risk status.
For plans that are not in at-risk status, this percentage is
determined by subtracting the sum of the amounts reported in
line 13 from line 2b and dividing the result by the funding target
reported in line 3d, column (2), for plans that are not in at-risk
status (line 4a for plans that are in at-risk status). If the plan’s
valuation date is not the first day of the plan year, adjust the
amounts reported in line 13 for interest between the beginning
of the plan year and the valuation date before subtracting those
amounts from the amount reported in line 2b, using the effective
interest rate for the current plan year.
Line 15. Adjusted Funding Target Attainment Percentage.
Enter the adjusted funding target attainment percentage
(AFTAP) determined in accordance with Code section 436(j)(2)
and ERISA section 206(g)(9)(B). The AFTAP is generally the
same as the FTAP reported in line 14, except that both the
assets and the funding target used to calculate the AFTAP are
increased by the aggregate amount of purchases of annuities
for employees other than highly compensated employees (as
defined in Code section 414(q)) which were made by the plan
during the preceding two plan years.
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If this is the first year for which the plan is subject to the
minimum funding rules of ERISA section 303 or Code section
430, leave both columns blank.
Line 8. Portion Used To Offset Prior Year’s Funding
Requirement. Report the amount for each column from the
corresponding column of line 35 of the prior-year Schedule SB.
If the valuation date is not the first day of the plan year, report
the amounts from line 35 of the prior-year Schedule SB,
discounted to the beginning of the prior plan year using the
effective interest rate for the prior plan year.
If this is the first year for which the plan is subject to the
minimum funding rules of ERISA section 303 or Code section
430, leave both columns blank.
Special rule for late election to apply balances to
quarterly installments. If an election was made to use the
funding standard carryover balance or the prefunding balance
to offset the amount of a required quarterly installment, but the
election was made after the due date of the installment, the
amount reported on line 8 may not be the same as the amount
reported on line 35 for the prior year. Refer to the Income Tax
Regulations under section 430 of the Code for additional
information. An attachment to Schedule SB should explain why
the amount is different. Label the attachment “Schedule SB,
line 8 – Late Election to Apply Balances to Quarterly
Installments.”
Line 9. Amount Remaining. Enter the amount equal to line 7
minus line 8 in each column.
If this is the first year that the plan is subject to the minimum
funding requirements of ERISA section 303 or Code section
430, enter the amount of any credit balance at the end of the
prior year (the “pre-effective plan year”) on line 9, column (a),
and leave line 9, column (b), blank. The amount entered on line
9, column (a) is generally the amount reported on line 9o of the
2007 Schedule B form that was submitted as an attachment to
the Schedule SB for the pre-effective plan year. If there has
been any adjustment to this amount so that it does not match
the amount so reported for the pre-effective plan year, attach an
explanation and label the attachment“ Schedule SB, Line 9 –
Explanation of Credit Balance Discrepancy.”
Line 10. Interest on Line 9. Enter the actual rate of return on
plan assets during the preceding plan year in the space
provided. Enter the rate to the nearest .01% (e.g., 6.53%). If
entering a negative number, enter a minus sign (“ – ”) to the left
of the number. In each column, enter the product of this interest
rate and the amount reported in the corresponding column of
line 9.
If this is the first year for which the plan is subject to the
minimum funding rules of ERISA section 303 or Code section
430, leave both columns blank.
Line 11. Prior Year’s Excess Contributions to be Added to
Prefunding Balance.
Line 11a. Enter the amount reported in line 38 on the
Schedule SB for the 2008 plan year, adjusted for interest to the
valuation date for the 2008 plan year, if the amount was
reported on the 2008 Schedule SB as of any other date.
Line 11b. Enter the effective interest rate for the prior plan
year, as reported on line 5 of the Schedule SB for the prior plan
year, in the space provided. Enter the rate to the nearest .01%
(e.g., 6.35%). Enter the product of that rate and the amount
reported on line 11a. However, if the valuation date is not the
first day of the plan year, report the amount of interest (at the
rate reported on this line 11b) for the period between the prior
year’s valuation date and the end of the prior plan year.
Note. Under the regulations, if a contribution (or a portion of a
contribution) reported on line 11a is an excess contribution
solely because an election was made to offset the minimum
required contribution for the prior year by the funding standard
carryover balance or the prefunding balance, calculate the
interest on that contribution (or portion of a contribution) using
the actual rate return on assets reported on line 10 instead of
the effective interest rate.
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See Code section 436(j)(3) and ERISA section 206(g)(9)(C)
for rules regarding circumstances in which the actuarial value of
plan assets is not reduced by the funding standard carryover
balance and prefunding balance for certain fully-funded plans
when determining the AFTAP. Note that this special rule applies
only to the calculation of the AFTAP and not to the FTAP
reported in line 14.
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Specific Instructions for Part IV —
Contributions and Liquidity Shortfalls
Line 18. Contributions Made to the Plan. Show all employer
and employee contributions for the plan year. Include employer
contributions made within 81/2 months after the end of the plan
year to the extent such contributions are designated for this
plan year. Include amounts that will be allocated toward an
unpaid minimum required contribution for a prior year.
Show only contributions actually made to the plan by the
date Schedule SB is signed. Do not adjust contributions to
reflect interest.
Instructions for Schedule SB (Form 5500)
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Report the final certified AFTAP for the plan year, reflecting
any adjustments pertaining to the plan year subsequent to the
valuation. The AFTAP reported on line 15 must reflect the final
certified AFTAP for the current plan year, even if the plan
administrator elects to apply the limitation on benefit accruals
under Code section 436(e) and ERISA section 206(g)(4) based
on the 2008 AFTAP as permitted under section 203 of WRERA.
For plans with valuation dates other than the first day of the
plan year, report the AFTAP that is the final certified AFTAP
based on the valuation results for the current plan year at the
time that the Schedule SB is filed (reflecting contributions for
the current plan year and reflecting other adjustments as
described in applicable guidance), even if that AFTAP is not
used to apply the restrictions under Code section 436 and
ERISA section 206(g) until the following plan year.
Special rules for airlines using 10-year amortization
period under section 402(a)(2) of PPA. Section 402(a)(2) of
PPA (as amended) states that for plans electing the 10-year
funding amortization period, the funding target during that
period is determined using an interest rate of 8.25% rather than
the interest rates or segment rates calculated on the basis of
the corporate bond yield curve. Report the AFTAP for these
plans based on the funding target determined using the special
8.25% interest rate.
Line 16. Prior Year’s Funding Percentage for Purposes of
Determining Whether Carryover/Prefunding Balances May
Be Used To Offset Current Year’s Funding Requirement.
Under ERISA section 303(f)(3) and Code section 430(f)(3), the
funding standard carryover balance and prefunding balance
may not be applied toward minimum contribution requirements
unless the ratio of plan assets for the preceding plan year to the
funding target for the preceding plan year (as described in
ERISA section 303(f)(3)(C) and Code section 430(f)(3)(C)) is
80% or more.
Enter the applicable percentage as described below,
truncated at .01% (e.g., report 81.239% as 81.23%). In general,
the percentage is the ratio that the prior-year actuarial value of
plan assets (reduced by the amount of any prefunding balance,
but not the funding standard carryover balance) bears to the
prior-year funding target determined without regard to the
additional rules for plans in at-risk status. For the 2009 plan
year, this percentage is determined as follows:
• For plans that are not in at-risk status, divide the amount
reported on line 2b of the 2008 Schedule SB by the funding
target reported on line 3d of the 2008 Schedule SB.
• For plans that are in at-risk status, divide the amount
reported on line 2b of the 2008 Schedule SB by the funding
target reported on line 4a of the 2008 Schedule SB.
Line 17. Ratio of Current Value of Assets to Funding Target
if Below 70%. This calculation is required under ERISA
section 103(d)(11). If line 2b divided by the funding target
reported in line 3d, column (2), is less than 70%, enter such
percentage. Otherwise, leave this line blank.
Certain employer contributions must be made in quarterly
installments. See ERISA section 303(j) and Code section
430(j). Contributions made to meet the liquidity requirement of
ERISA section 303(j)(4) and Code section 430(j)(4) should be
reported. Include contributions made to avoid benefit
restrictions under ERISA section 206(g) and Code section 436.
Add the amounts in both columns 18(b) and 18(c) separately
and enter each result in the corresponding column on the total
line. All contributions except those made to avoid benefit
restrictions under ERISA section 206(g) and Code section 436
must be credited toward minimum funding requirements for a
particular plan year.
Line 19. Discounted Employer Contributions. Employer
contributions reported in line 18 that were made on a date other
than the valuation date must be adjusted to reflect interest for
the time period between the valuation date for the plan year to
which the contribution is allocated and the date the contribution
was made. In general, adjust each contribution using the
effective interest rate for the plan year to which the contribution
is allocated.
Allocate the interest-adjusted employer contributions to lines
19a, 19b, and 19c to report the purpose for which they were
made (as described below).
Attach a schedule showing the dates and amounts of
individual contributions, the year to which the contributions (or
the portion of individual contributions) are applied, the
applicable effective interest rate (including increased rate for
late quarterly installments, where applicable), and the
interest-adjusted contribution. It is not necessary to include
interest-adjusted contributions allocated toward the minimum
required contribution for the current year (reported in line 19c)
in this schedule, unless any of those contributions represent
late quarterly installments. However, if any of the contributions
reported in line 19c represent late quarterly installments,
include all contributions reported in line 19c on this schedule.
Label the attachment “Schedule SB, line 19 – Discounted
Employer Contributions.”
Special note for small plans with valuation dates after
the beginning of the plan year. If the valuation date is after
the beginning of the plan year and contributions for the current
year were made during the plan year but before the valuation
date, such contributions are increased with interest to the
valuation date using the effective interest rate for the current
plan year. These contributions and the interest calculated as
described in the preceding sentence are excluded from the
value of assets reported in lines 2a and 2b.
Interest adjustment for contributions representing late
required quarterly installments — installments due after
the valuation date. If the full amount of a required installment
due after the valuation date for the current plan year is not paid
by the due date for that installment, increase the effective
interest rate used to discount the contribution by 5 percentage
points for the period between the due date for the required
installment and the date on which the payment is made. If all or
a portion of the late required quarterly installment is due to a
liquidity shortfall, the increased interest rate is used for a period
of time corresponding to the period between the due date for
the installment and the end of that quarter, regardless of when
the contribution is actually paid.
Line 19a. Contributions Allocated Toward Unpaid Minimum
Required Contribution from Prior Plan Years. Code section
4971(c)(4)(B) provides that any payment to or under a plan for
any plan year shall be allocated first to unpaid minimum
required contributions for all preceding plan years on a first-in,
first-out basis and then to the minimum required contribution for
the current plan year. Report any contributions from line 18 that
are allocated toward unpaid minimum required contributions
from prior plan years, discounted for interest from the date the
contribution was made to the valuation date for the plan year for
which the contribution was originally required as described
above. Increase the effective interest rate for the applicable
plan year by 5 percentage points for any portion of the unpaid
minimum required contribution that represents a late quarterly
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amount of the liquidity shortfall for each such quarter. If the plan
was subject to the liquidity requirement but did not have a
liquidity shortfall, enter zero. File IRS Form 5330, Return of
Excise Taxes Related to Employee Benefit Plans, with the IRS
to pay the 10% excise tax(es) if there is a failure to pay any
liquidity shortfall by the required due date, unless a waiver of
the 10% tax under Code section 4971(f) has been granted.
Specific Instructions for Part V — Assumptions
Used To Determine Funding Target and Target
Normal Cost
Line 21. Discount Rate.
Line 21a. Enter the three segment rates used to calculate the
funding target as provided under ERISA section 303(h)(2)(C)
and Code section 430(h)(2)(C) and as published by the IRS,
unless the plan sponsor has elected to use the full yield curve.
Enter rates after application of the transition rule provided under
ERISA section 303(h)(2)(G) and Code section 430(h)(2)(G)
unless the sponsor has elected to not have the transition rule
apply. If the sponsor has elected to use the full yield curve,
check the “N/A, full yield curve used” box.
Special rules for airlines using 10-year amortization
period under section 402(a)(2) of PPA (as amended). Enter
the information described above to reflect the discount rates
used to determine the target normal cost in accordance with
Code section 430(h)(2) and ERISA section 303(h)(2). Do not
enter the special 8.25% interest rate used to determine the
funding target under section 402(a)(2) of the PPA.
Line 21b. ERISA section 303(h)(2)(E) and Code section
430(h)(2)(E) provide that the segment rate(s) used to measure
the funding target are those published by Treasury for the
month that includes the valuation date (based on the average of
the monthly corporate bond yield curves for the 24-month
period ending with the month preceding that month).
Alternatively, at the election of the plan sponsor, the rate(s)
used to measure the funding target may be those published by
Treasury for any of the four months that precede the month that
includes the valuation date. The IRS has indicated that it will not
challenge the use of the monthly yield curve based on interest
rates published by the IRS for the month including the valuation
date or any one of the immediately preceding four months, for
plan years beginning in 2008 and 2009.
Enter the applicable month to indicate which rates were used
to determine the funding target. Enter “0” if the rates used to
determine the funding target were published for the month that
includes the valuation date. Enter “1” if the rates were published
for the month immediately preceding the month that includes
the valuation date, “2” for the second preceding month, and “3”
or “4,” respectively, for the third or fourth preceding months. For
example, if the valuation date is January 1 and the funding
target was determined based on rates published for November,
enter “2.”
Note. The plan sponsor’s election under ERISA section
303(h)(2) or Code section 430(h)(2) regarding the interest rate
used (election to use yield curve, election of applicable month
other than the default month, or election not to use transition
rules in ERISA section 303(h)(2)(G) and Code section
430(h)(2)(G)) generally may not be changed unless the plan
sponsor obtains approval from the IRS. However, see the
regulations for circumstances in which changes to an interest
rate election may be made for the 2009 plan year without
obtaining approval from the IRS.
Line 22. Weighted Average Retirement Age. Enter the
weighted average retirement age for active participants. If the
plan is in at-risk status, enter the weighted average retirement
age as if the plan were not in at-risk status. If each participant is
assumed to retire at his/her normal retirement age, enter the
age specified in the plan as normal retirement age. If the normal
retirement age differs for individual participants, enter the age
that is the weighted average normal retirement age; do not
enter “NRA.” Otherwise, enter the assumed retirement age. If
the valuation uses rates of retirement at various ages, enter the
nearest whole age that is the weighted average retirement age.
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installment, for the period between the due date for the
installment and the date of payment. Reflect the increased
interest rate for any portion of the unpaid minimum required
contribution that represents a late liquidity shortfall installment,
for the period corresponding to the time between the date the
installment was due and the end of the quarter during which it
was due. The amount reported in line 19a cannot be larger than
the amount reported in line 28.
For the purpose of allocating contribution amounts to unpaid
minimum required contributions, any unpaid minimum required
contribution attributable to an accumulated funding deficiency at
the end of the last plan year before ERISA section 303 or Code
section 430 applied to the plan (the “pre-effective plan year”) is
treated as a single contribution due on the last day of the
pre-effective plan year (without separately identifying any
portion of the accumulated funding deficiency attributable to late
quarterly installments or late liquidity shortfall installments), and
the associated effective interest rate is deemed to be the
valuation interest rate for the pre-effective plan year.
Line 19b. Contributions Made To Avoid Benefit
Restrictions. Include in this category contributions made to
avoid benefit restrictions under ERISA section 206(g) and Code
section 436. Adjust each contribution for interest from the date
the contribution was made to the valuation date as described
above.
Line 19c. Contributions Allocated Toward Minimum
Required Contribution for Current Year. Include in this
category contributions (including any contributions made in
excess of the minimum required contribution) that are not
included in line 19a or 19b. Adjust each contribution for interest
from the date the contribution was made to the valuation date
as described above.
Line 20. Quarterly Contributions and Liquidity Shortfalls.
Line 20a. Did the Plan Have a Funding Shortfall for the
Prior Plan Year? In accordance with ERISA section 303(j)(3)
and Code section 430(j)(3), only plans that have a funding
shortfall for the preceding plan year are subject to an
accelerated quarterly contribution schedule. For this purpose, a
plan is considered to have a funding shortfall for the prior year if
the funding target reported on line 3d, column (2) is greater
than the actuarial value of assets reported on line 2b, reduced
by the sum of the funding standard carryover balance and
prefunding balance reported on line 13, columns (a) and (b),
with all figures taken from the prior year’s Schedule SB.
However, see Code section 430(f)(4)(B)(ii) and ERISA section
303(f)(4)(B)(ii) for special rules in the case of a binding
agreement with the PBGC providing that all or a portion of the
funding standard carryover balance and/or prefunding balance
is not available to offset the minimum required contribution for
the prior plan year.
Please note that a plan may be considered to have a funding
shortfall for this purpose even if it is exempt from establishing a
shortfall amortization base under the provisions of ERISA
section 303(c)(5) and Code section 430(c)(5), as amended by
WRERA.
Line 20b. If line 20a is “No” (i.e., if the plan did not have a
funding shortfall in the prior plan year), the plan is not subject to
the quarterly contribution rules, and this line should not be
completed. If line 20a is “Yes,” check the “Yes” box on line 20b
if required installments for the current plan year were made in a
timely manner; otherwise, check “No.”
Line 20c. If line 20a is “No,” or the plan had 100 or fewer
participants on every day of the preceding plan year (as defined
for line F), the plan is not subject to the liquidity requirement of
ERISA section 303(j)(4) and Code section 430(j)(4) and this line
should not be completed. Attach a certification by the enrolled
actuary if the special rule for nonrecurring circumstances is
used, and label the certification “Schedule SB, line 20c –
Liquidity Requirement Certification.” (See ERISA section
303(j)(4)(E)(ii)(II) and Code section 430(j)(4)(E)(ii)(II).)
If the plan is subject to the liquidity requirement and has a
liquidity shortfall for any quarter of the plan year (see ERISA
section 303(j)(4)(E) and Code section 430(j)(4)(E)), enter the
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any other aspects of the funding method for determining the
Schedule SB entries that are not prescribed by law.
Also attach a summary of the principal eligibility and benefit
provisions on which the valuation was based, including the
status of the plan (e.g., frozen eligibility, service/pay, or
benefits), optional forms of benefits, special plan provisions,
including those that apply only to a subgroup of employees
(e.g., those with imputed service), supplemental benefits, and
identification of benefits not included in the valuation, and a
description of any significant events that occurred during the
year, a summary of any changes in principal eligibility or benefit
provisions since the last valuation, and a description (or
reasonably representative sample) of plan early retirement
reduction factors and optional form conversion factors. Label
the summary “Schedule SB, Part V – Summary of Plan
Provisions.”
Also, include any other information needed to disclose the
actuarial position of the plan fully and fairly.
Specific Instructions for Part VI —
Miscellaneous Items
Line 24. Change in Non-Prescribed Actuarial Assumptions.
If a change has been made in the non-prescribed actuarial
assumptions for the current plan year, check “Yes.” If the only
assumption changes are statutorily required changes in the
discount or mortality rates, or changes required for plans in
at-risk status, check “No.” Include as an attachment a
description of any change in non-prescribed actuarial
assumptions and justifications for any such change. (See
section 103(d) of ERISA.) Label the attachment “Schedule SB,
line 24 – Change in Actuarial Assumptions.”
Generally, if the “Yes” box is checked and the
non-prescribed assumptions have been changed in a way that
decreases the funding shortfall for the current plan year,
approval for such a change may be required. However,
approval is not required with respect to any actuarial
assumptions that are adopted for the first plan year for which
Code section 430 and ERISA section 303 apply to the plan, and
that are not inconsistent with the requirements of Code section
430.
Line 25. Change in Funding Method. If a change in the
funding method has been made for the current plan year, check
“Yes.” For this purpose, “funding method” refers to not only the
overall method used by the plan, but also each specific method
of computation used in applying the overall method.
Accordingly, method changes include modifications such as a
change in the method for calculating the actuarial value of
assets or a change in the valuation date (not an exclusive list).
In general, any changes in a plan’s funding method must be
approved by the IRS. However, see the regulations and Notice
2009-22 for circumstances in which a change in funding method
may be made for the 2009 plan year without obtaining approval
from the IRS.
Include, as an attachment, a description of the change.
Label the attachment “Schedule SB, line 25 – Change in
Method.”
Note. The plan sponsor’s agreement to any change in funding
method that is required by a class ruling letter or other
published guidance should be reported on line 8 of Schedule R
(Form 5500).
Line 26. Schedule of Active Participant Data. Check “Yes”
only if (a) the plan is covered by Title IV of ERISA and (b) the
plan has active participants.
If line 26 is “Yes,” attach a schedule of the active plan
participant data used in the valuation for this plan year. Use the
format shown on the following page and label the schedule
“Schedule SB, line 26 – Schedule of Active Participant
Data.”
Expand this schedule by adding columns after the “5 to 9”
column and before the “40 & up” column for active participants
with total years of credited service in the following ranges: 10 to
14; 15 to 19; 20 to 24; 25 to 29; 30 to 34; and 35 to 39. For
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On an attachment to Schedule SB, list the rate of retirement
at each age and describe the methodology used to compute the
weighted average retirement age, including a description of the
weight applied at each potential retirement age, and label the
attachment “Schedule SB, line 22 – Description of
Weighted Average Retirement Age.”
Line 23. Mortality Tables. Mortality tables described in Code
section 430(h)(3), ERISA section 303(h)(3), and section
1.430(h)(3)-1 of the Treasury Regulations as published by the
IRS must be used to determine the funding target and target
normal cost for non-disabled participants and may be used to
determine the funding target and target normal cost for disabled
participants, unless the IRS has approved (or was deemed to
have approved) the use of a substitute mortality table reflecting
the plan’s actual experience and projected trends in general
mortality experience. Standard mortality tables must be either
applied on a generational basis, or the tables must be updated
to reflect the static tables published for the year in which the
valuation date occurs. Substitute mortality tables must be
applied in accordance with the terms of the IRS ruling letter.
Separate standard mortality tables were published by the
IRS for annuitants (rates applying for periods when a participant
is assumed to receive a benefit under the plan) and
nonannuitants (rates applying to periods before a participant is
assumed to receive a benefit under the plan). If a plan has 500
or fewer participants as of the valuation date for the current plan
year as reported in line 3d, column (1), the plan sponsor can
elect to use the combined mortality tables published by the IRS,
which reflect combined rates for both annuitants and
nonannuitants.
Check the applicable box to indicate which mortality table
was used to determine the funding target and target normal
cost. If one mortality table was used for certain populations
within the plan and a different mortality table was used for other
populations, check the box for the table that applied to the
largest population. If more than one mortality table was used,
attach a statement describing the mortality table used for each
population and the size of that population. Label the attachment
“Schedule SB, line 23 – Information on Use of Multiple
Mortality Tables.”
• Check “Prescribed – combined” if the funding target and
target normal cost are based on the prescribed tables with
combined annuitant/nonannuitant mortality rates.
• Check “Prescribed – separate” if the funding target and target
normal cost are based on the prescribed tables with separate
mortality rates for nonannuitants and annuitants.
• Check “Substitute” if the funding target and target normal
cost are based on substitute mortality tables. If substitute
mortality tables are used, attach a statement including a
summary of plan populations for which substitute mortality
tables are used, plan populations for which the prescribed
tables are used, and the last plan year for which the IRS
approval of the substitute mortality tables applies. Label the
attachment “Schedule SB, line 23 – Information on Use of
Substitute Mortality Tables.”
Attach a statement of actuarial assumptions and funding
methods used to calculate the Schedule SB entries and label
the statement “Schedule SB, Part V – Statement of
Actuarial Assumptions/Methods.” The statement must
describe all non-prescribed actuarial assumptions (e.g.,
retirement, withdrawal rates) used to determine the funding
target and target normal cost, including the assumption as to
the frequency with which participants are assumed to elect
each optional form of benefit (including lump sum distributions),
whether mortality tables are applied on a static or generational
basis, whether combined mortality tables are used instead of
separate annuitant and nonannuitant mortality tables (for plans
with 500 or fewer participants as of the valuation date), and (for
target normal cost) expected increases in compensation. For
applicable defined benefit plans under ERISA section 203(f)(3)
and Code section 411(a)(13)(C) (e.g., cash balance plans) the
statement must include the assumptions used to convert
balances to annuities. In addition, the statement must describe
the method for determining the actuarial value of assets and
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each column, enter the number of active participants with the
specified number of years of credited service divided according
to age group. For participants with partial years of credited
service, round the total number of years of credited service to
the next lower whole number. Years of credited service are the
years credited under the plan’s benefit formula.
alternative provides for two age/service scatters (one showing
compensation and one showing cash balance accounts) as
follows:
Plans reporting 1,000 or more active participants on line
3c(3), column 1, must also provide average compensation data.
For each grouping, enter the average compensation of the
active participants in that group. For this purpose,
compensation is the compensation taken into account for each
participant under the plan’s benefit formula, limited to the
amount defined under section 401(a)(17) of the Code. Do not
enter the average compensation in any grouping that contains
fewer than 20 participants.
compensation for all active participants, whether or not
participants have account-based benefits.
• Scatter 2 — Provide participant count and average cash
balance account for all active participants, whether or not
participants have account-based benefits.
Alternative A:
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• Scatter 1 — Provide participant count and average
Alternative B:
• Scatter 1 — Provide participant count and average
compensation for all active participants, whether or not
participants have account-based benefits (i.e., identical to
Scatter 1 in Alternative A).
• Scatter 2 — Provide participant count and average cash
balance account for only those active participants with
account-based benefits. If the number of participants with
account-based benefits in a bin is fewer than 20, the average
account should not be shown even if there are 20 or more
active participants in this bin on Scatter 1.
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In the case of a plan under which benefits are primarily
pay-related and under which no future accruals are granted
(i.e., a “hard-frozen” plan as defined in the instructions for plan
characteristic “1I” applicable to line 8a of the Form 5500), report
the average annual accrued benefit in lieu of average
compensation. Include a note on the scatter indicating that the
plan is “hard frozen” and the average accrued benefits are in
lieu of compensation.
If the plan is a multiple-employer plan, complete one or more
schedules of active-participant data in a manner consistent with
the computations for the funding requirements reported in Part
VIII. For example, if the funding requirements are computed as
if each participating employer maintained a separate plan,
attach a separate “Schedule SB, line 26 – Schedule of
Active Participant Data” for each participating employer in the
multiple-employer plan.
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Line 27. Alternative Funding Rules. If one of the alternative
funding rules was used for this plan year, enter the appropriate
code from the table below and follow the special instructions
applicable to that code, including completion of any required
attachments.
In lieu of the above, two alternatives are provided for
showing compensation and cash balance accounts. Each
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If the accrued benefit is the greater of a cash balance benefit or
some other benefit, average in only the cash balance account.
If the accrued benefit is the sum of a cash balance account
benefit and some other benefit, average in only the cash
balance account. For both the average compensation and the
average cash balance account, do not enter an amount for age/
service bins with fewer than 20 active participants.
Average cash balance accounts that are offset by amounts
from another plan may be reported either as amounts prior to
taking into account the offset, or as amounts after taking into
account the offset. Do not report the offset amount. For this or
any other unusual or unique situation, the attachment should
include an explanation of what is being provided.
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General Rule. In general, data to be shown in each age/
service bin includes:
1. The number of active participants in the age/service bin,
2. The average compensation of the active participants in
the age/service bin, and
3. The average cash balance account of the active
participants in the age/service bin, using $0 for anyone who has
no cash balance account-based benefit.
In general, information should be determined as of the
valuation date. Average cash balance accounts may be
determined as of either:
1. The valuation date or
2. The day immediately preceding the valuation date.
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Cash balance plans (or any plans using characteristic code
1C on line 8a of Form 5500) reporting 1,000 or more active
participants on line 3c(3), column 1, must also provide average
cash balance account data, regardless of whether all active
participants have cash balance accounts. For each age/service
bin, enter the average cash balance account of the active
participants in that bin. Do not enter the average cash balance
account in any age/service bin that contains fewer than 20
active participants.
Schedule SB, Line 26—Schedule of Active Participant Data
Under 1
Attained
Age
No.
Average
Comp. Cash Bal.
YEARS OF CREDITED SERVICE
1 to 4
No.
Average
Comp. Cash Bal.
35
40
45
50
55
60
65
to
to
to
to
to
to
to
No.
40 & up
Average
Comp. Cash Bal.
No.
Average
Comp. Cash Bal.
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Under 25
25 to 29
30 to 34
5 to 9
39
44
49
54
59
64
69
70 & up
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Certain multiple-employer plans maintained by
rural cooperatives or related organizations as
described in section 104 of PPA
Temporary relief for certain PBGC settlement
plans described in section 105 of PPA
Certain plans maintained by government
contractors as described in section 106 of PPA
Plans with binding agreements with PBGC to
maintain prefunding and/or funding standard
carryover balances described in Code section
430(f)(4)(B)(ii) and ERISA section 303(f)(4)(B)(ii)
Airlines using 10-year amortization period for initial
post-PPA shortfall amortization base under section
402(a)(2) of PPA (as amended)
Alternative 17-year funding schedule for airlines
with frozen plans under section 402(a)(1) of PPA
Interstate transit company described in section
115 of PPA
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Plans entitled to delayed effective dates for PPA funding
rules (codes 1, 2, and 3). For plan years before Code section
430 and ERISA section 303 apply to the plan, complete only the
following lines on Schedule SB:
• Lines A through F.
• Part I (including signature of enrolled actuary), determined as
if PPA provisions were effective for the plan year beginning in
2008.
• Part III, line 14, determined as if PPA provisions were
effective for the plan year beginning in 2008.
• Line 19 – Discount contributions to the applicable valuation
date using the 8.85% discount rate provided under section
402(e)(4)(B) of PPA.
• Line 20 – Reflect required quarterly installments based on
the minimum required contribution determined under section
402(e) of PPA to the extent applicable (i.e., for purposes of
calculating the required annual payment under Code section
430(j)(3)(D)(ii)(l) and ERISA section 303(j)(3)(D)(ii)(l)).
• Line 29 – Reflect the minimum required contribution
determined under section 402(e) of PPA when determining the
unpaid minimum required contribution.
Also, attach a worksheet showing the information below,
determined in accordance with section 402(e) of PPA. Label
this worksheet “Schedule SB, line 27 – Alternative 17-Year
Funding Schedule for Airlines.”
• Date as of which plan benefits were frozen as required under
section 402(b)(2) of PPA.
• Date on which the first applicable plan year began.
• Accrued liability under the unit credit method calculated as of
the first day of the plan year, using an interest rate of 8.85%.
• A summary of all other assumptions used to calculate the unit
credit accrued liability.
• Fair market value of assets as of the first day of the plan
year.
• Unfunded liability under section 402(e)(3)(A) of PPA.
• Alternative funding schedule:
1. Contribution necessary to amortize the unfunded liability
over the remaining number of years, assuming payments at the
valuation date for each plan year and using an interest rate of
8.85%;
2. Employer contributions for the plan year, discounted for
interest to the valuation date for the plan year, and using a rate
of 8.85%; and
3. Contribution shortfall, if any ((1)-(2) but not less than
zero).
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Specific Instructions for Part VII —
Reconciliation of Unpaid Minimum Required
Contributions for Prior Years
Line 28. Unpaid Minimum Required Contributions for Prior
Years. Enter the total amount of any unpaid minimum required
contributions for all years from line 40 of the Schedule SB for
the prior plan year.
If this is the first year that the plan is subject to the minimum
funding requirements of ERISA section 303 or Code section
430, enter the amount of any accumulated funding deficiency at
the end of the prior year (the pre-effective plan year). This is the
amount reported on line 9p of the 2007 Schedule B form that
was submitted as an attachment to the Schedule SB for the
pre-effective plan year.
Line 29. Employer Contributions Allocated Toward Unpaid
Minimum Required Contributions from Prior Years. Enter
the total amount of discounted contributions made for the
current plan year allocated toward unpaid minimum required
contributions from prior years as reported in line 19a.
Line 30. Remaining Unpaid Minimum Required
Contributions. Enter the amount in line 28 minus the amount
in line 29.
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Plans with binding agreements with the PBGC to
maintain prefunding and/or carryover balances (code 4).
Complete entire Schedule SB and attachments as outlined in
these instructions. In addition, report on an attachment the
amount subject to the binding agreement with the PBGC,
reported separately for the funding standard carryover balance
and prefunding balance. Label the attachment “Schedule SB,
line 27 – Balances Subject to Binding Agreement with
PBGC.”
Interstate transit company (code 7). Complete the entire
Schedule SB, reflecting the modifications to the
otherwise-required funding rules under section 115(b) of PPA,
and disregarding the attachment required for plans reporting the
use of the substitute mortality table in line 23.
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Also, report other information for the current plan year using
a 2007 Schedule B (Form 5500). Label this attachment “2009
Schedule SB, line 27 – Actuarial Information Based on
Pre-PPA Funding Rules.” Complete all items, and attach the
form and all applicable attachments to the Schedule SB. Note
that under PPA, the third segment rate determined under Code
section 430(h)(2)(C)(iii) and ERISA section 303(h)(2)(C)(iii) is
substituted for the current liability interest rate under Code
section 412(b)(5)(B) and ERISA section 302(b)(5)(B) (as in
effect before PPA).
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Airline using 10-year amortization period for initial
post-PPA shortfall amortization base (code 5). Complete
the entire Schedule SB and attachments as outlined in these
instructions. Under section 402(a)(2) of PPA (as amended), the
funding target for plans funded using this alternative is
determined using an interest rate of 8.25% for each of the 10
years during the amortization period instead of the interest rates
otherwise required under Code section 430(h)(2) and ERISA
section 303(h)(2). However, this special 8.25% interest rate
does not apply for other purposes, including the calculation of
target normal cost or the amortization of the funding shortfall.
Alternative 17-year funding schedule for airlines with
frozen plans (code 6). Complete the following lines on
Schedule SB and provide associated attachments:
• Lines A through F.
• Part I (including signature of enrolled actuary) – complete all
lines.
• Parts III through VII – complete all lines.
Specific Instructions for Part VIII — Minimum
Required Contribution for Current Year
Line 31. Target Normal Cost, Adjusted if Applicable. In
general, enter the target normal cost as reported in line 6.
However, if the minimum required contribution is determined
under Code section 430(a)(2) or ERISA section 303(a)(2)
(relating to plans with excess assets), enter the amount of the
minimum required contribution. For this purpose, excess assets
For this purpose, disregard the special funding rules under
section 402(e) of PPA except for the information reported on
the following lines:
Instructions for Schedule SB (Form 5500)
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beginning of the plan year and the valuation date (using the
effective interest rate for the current plan year) before
subtracting from the value of assets reported on line 2b.
However, see Code section 430(f)(4)(B)(ii) and ERISA section
303(f)(4)(B)(ii) for special rules in the case of a binding
agreement with the PBGC providing that all or a portion of the
funding standard carryover balance and/or prefunding balance
is not available to offset the minimum required contribution for
the plan year.
Shortfall amortization installment — Enter the sum of:
1. Any shortfall amortization installments that were
established to amortize shortfall amortization bases established
in prior years, excluding amortization installments for bases that
have been or are deemed to be fully amortized, and
2. The shortfall amortization installment that corresponds to
any new shortfall amortization base established for the current
plan year. This amount is the level amortization payment that
will amortize the new shortfall amortization base over 7 annual
payments, using the interest rates reported in line 21 for the
current plan year.
Note. Shortfall amortization installments for a given shortfall
amortization base are not re-determined from year to year
regardless of any changes in interest rates.
Line 32b. Waiver Amortization Bases and Amortization
Installments. Outstanding balance — If the plan’s funding
shortfall (determined under Code section 430(c)(4) and ERISA
section 303(c)(4)) is zero, all waiver amortization bases and
related installments are considered fully amortized. In this case,
enter zero. Otherwise, enter the present value as of the
valuation date of all remaining waiver amortization installments
(including any installment for the current plan year), using the
interest rates reported on line 21. Do not include any new
waiver amortization base established for a waiver of minimum
funding requirements for the current plan year.
Waiver amortization installments — Enter the sum of any
remaining waiver amortization installments that were
established to amortize any waiver amortization bases for prior
plan years, unless such bases have been or are deemed to be
fully amortized. Do not include an amortization installment for
any new waiver amortization base established for a waiver of
minimum funding requirements for the current plan year.
Note. If a waiver of minimum funding requirements has been
granted for the current plan year, a waiver amortization base is
established as of the valuation date for the current plan year
equal to the amount of the funding waiver reported in line 33.
The waiver amortization installment that corresponds to any
waiver amortization base established for the current year is the
level amortization payment that will amortize the new waiver
amortization base over 5 annual payments, using the same
segment interest rates or rates from the full yield curve reported
on line 21 for the current plan year, but with the first payment
due on the valuation date for the following plan year. The
amount of the waiver amortization base and the waiver
amortization installments for this base are not reported in line
32b for the year in which they are established. Rather, these
are included in the entries for line 32b on the Schedule SB for
the following plan year.
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Note. Waiver amortization installments (including the waiver
amortization installments of any waiver amortization base
established for the prior plan year) are not re-determined from
year to year regardless of any changes in interest rates.
Required attachment. If there are any shortfall or waiver
amortization bases, include as an attachment a listing of all
bases (other than a base established for a funding waiver for
the current plan year) showing for each base:
1. The type of base (shortfall or waiver),
2. The present value of any remaining installments
(including the installment for the current plan year),
3. The valuation date as of which the base was established,
4. The number of years remaining in the amortization
period, and
5. The amortization installment.
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are determined as the value of assets reported on line 2b
reduced by any funding standard carryover balance and
prefunding balance reported on line 13, columns (a) and (b),
minus the funding target reported on line 3d, column (2) (but not
less than zero). If the plan’s valuation date is not the first day of
the plan year, adjust the amounts reported on line 13, columns
(a) and (b), for interest at the effective interest rate for the
period between the beginning of the plan year and the valuation
date, before subtracting those amounts from the value of assets
reported on line 2b.
Line 32. Amortization Installments.
Line 32a. Shortfall Amortization Bases and Amortization
Installments. Outstanding balance — If the plan’s funding
shortfall (determined under Code section 430(c)(4) and ERISA
section 303(c)(4)) is zero, all amortization bases and related
installments are considered fully amortized. In this case, enter
zero. Otherwise, enter the sum of the outstanding balances of
all shortfall amortization bases (including any new shortfall
amortization base established for the current plan year). The
outstanding balance for each amortization base established in
past years is equal to the present value as of the valuation date
of any remaining amortization installments for each base
(including the amortization installment for the current plan year),
using the interest rates reported on line 21.
A plan is generally exempt from the requirement to establish
a new shortfall amortization base for the current plan year if the
funding target reported on line 3d, column (2), is less than or
equal to the adjusted value of assets. However, if the plan
existed during 2007 and was not subject to Code section 412(l)
or ERISA section 302(d) for the last plan year beginning before
the plan was subject to ERISA section 303 or Code section 430
(the “pre-effective plan year”), only 94% of the funding target is
taken into account for this calculation for plan years beginning
in 2009.
For the purpose of determining whether a plan is exempt
from the requirement to establish a new shortfall amortization
base for the current plan year, the adjusted value of assets is
the amount reported on line 2b, reduced by the full value of the
prefunding balance reported on line 13, column (b) if (and only
if) the plan sponsor has elected to use any portion of the
prefunding balance to offset the minimum required contribution
for the current plan year, as reported on line 35. If the plan’s
valuation date is not the first day of the plan year, adjust the
amount reported in line 13, column (b) for interest for the period
between the beginning of the plan year and the valuation date
(using the effective interest rate for the current plan year) before
subtracting it from the value of assets reported on line 2b. The
assets are not reduced by the amount of any funding standard
carryover balance for this calculation regardless of whether any
portion of the funding standard carryover balance is used to
offset the minimum required contribution for the plan year.
If the plan is not exempt from the requirement to establish a
new shortfall amortization base for the current plan year, the
amount of that base is equal to the difference between the
funding shortfall as of the valuation date (determined under
Code section 430(c)(4) and ERISA section 303(c)(4)) and the
sum of any outstanding balances of any previously established
shortfall and waiver amortization bases. The new shortfall
amortization base may be either greater than or less than zero.
For the purpose of determining the amount of any new
shortfall amortization base, the funding shortfall is generally
equal to the amount of the funding target reported on line 3d,
column (2), minus the adjusted value of assets, but not less
than zero. However, if the plan existed during 2007 and was not
subject to Code section 412(l) or ERISA section 302(d) for the
pre-effective plan year, only 94% of the funding target is taken
into account for this calculation for plan years beginning in
2009. The adjusted value of assets is generally the amount
reported on line 2b, reduced by the sum of the funding standard
carryover balance and the prefunding balance reported on line
13, columns (a) and (b). If the plan’s valuation date is not the
first day of the plan year, adjust the amounts reported on line
13, columns (a) and (b), for interest for the period between the
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If a base is negative (i.e., a “gain base”), show amounts in
parentheses or with a negative sign in front of them. All
amounts must be calculated as of the valuation date for the
plan year. Label the schedule “Schedule SB, line 32 –
Schedule of Amortization Bases.”
Line 33. Funding Waiver. If a waiver of minimum funding
requirements has been approved for the current plan year,
enter the date of the ruling letter granting the approval and the
waived amount (reported as of the valuation date) in the spaces
provided. If a waiver is pending, do not complete this line. If a
pending waiver is granted after Form 5500 is filed, file an
amended Form 5500 with an amended Schedule SB.
Line 34. Total Funding Requirement Before Reflecting
Carryover/Prefunding Balances. Enter the sum of line 31
and the amortization installments reported in lines 32a and 32b,
reduced by line 33. (Result cannot be less than zero.)
Line 35. Balances Used to Offset Funding Requirement. If
the percentage reported on line 16 is at least 80%, and the plan
has a funding standard carryover balance and/or prefunding
balance (as reported on line 13, columns (a) and (b)), the plan
sponsor may elect to credit all or a portion of such balances
against the minimum required contribution. Enter the amount of
any balance to be used for this purpose in the applicable
column of line 35, and enter the total in the column headed
“Total balance.” No portion of the prefunding balance can be
used for this purpose unless the full amount of any remaining
funding standard carryover balance (line 13, column (a)) is
used. The amounts entered on line 35 cannot be larger than the
corresponding amounts on line 13 (unless the plan’s valuation
date is not the first day of the plan year, as discussed below), or
the corresponding amount on line 34.
If the plan’s valuation date is not the first day of the plan
year, adjust the portion of the funding standard carryover
balance and prefunding balance used to offset the minimum
required contribution for interest between the beginning of the
plan year and the valuation date using the effective interest rate
for the current plan year.
Line 36. Additional Cash Requirement. Enter the amount in
line 34 minus the amount in the “Total Balance” column in line
35. (The result cannot be less than zero.) This represents the
contribution needed to satisfy the minimum funding requirement
for the current year, adjusted for interest to the valuation date.
Line 37. Contributions Allocated Toward Minimum
Required Contribution for Current Year, Adjusted to
Valuation Date. Enter the amount reported in line 19c.
Line 38. Interest-Adjusted Excess Contributions for Current
Year. Report the interest-adjusted excess contributions as of
the valuation date. This amount (plus interest, if applicable) is
the maximum amount by which the plan sponsor may elect to
increase the prefunding balance. Do not enter a negative
number.
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Line 39. Unpaid Minimum Required Contribution for
Current Year. If line 37 is less than line 36, enter the amount
by which line 36 exceeds line 37. Otherwise, enter “0”.
Line 40. Unpaid Minimum Required Contribution for All
Years. Enter the sum of the remaining unpaid minimum
required contributions from line 30 and the unpaid minimum
required contribution for the current year from line 39.
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Special rule for late election to apply balances to
quarterly installments. If an election was made to use the
funding standard carryover balance or the prefunding balance
to offset the amount of a required quarterly installment, but the
election was made after the due date of the installment, the
amount reported on line 35 may not be the same amount that is
subtracted from the plan’s balances in the following plan year
(to be reported in line 8 of Schedule SB for the following plan
year). Refer to the Tax Regulations under section 430 of the
Code for additional information.
Instructions for Schedule SB (Form 5500)
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Page 66 of 71
Instructions for Form 5500
15:59 - 31-AUG-2009
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OMB Control Numbers
Agency
OMB Number
Employee Benefits Security Administration . . . . . . . . . . . . . . . . . . . . . . . 1210 – 0110 and 1210 – 0089
Pension Benefit Guaranty Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . 1212 – 0057
Internal Revenue Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1545 – 1610
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Paperwork Reduction Act Notice
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Welfare Plans
Large
Small
Large
AF
1 hr., 54 min.
2 hr., 52 min.
3 hr., 4 min.
1 hr., 39 min.
11 hr., 29 min.
7 hr., 42 min.
N/A
7 hr., 52 min.
1 hr., 43 min.
6 hr., 38 min.
1 hr., 19 min.
2 hr., 51 min.
N/A
20 min.
N/A
N/A
2 hr., 5 min.
4 hr., 14 min.
1 hr., 5 min.
6 hr., 49 min.
1 hr., 45 min.
3 hr., 39 min.
3 hr., 38 min.
1 hr., 52 min.
11 hr.
8 hr., 35 min.
N/A
N/A
N/A
N/A
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Form 5500
Schedule A
Schedule C
Schedule D
Schedule G
Schedule H
Schedule I
Schedule MB
Schedule R
Schedule SB
Pension Plans
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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 6047(e), 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. Generally, the Form 5500 return/reports are open to public inspection and are subject to publication on the Internet.
The time needed to complete and file the forms listed 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:
Small
1 hr., 14 min.
2 hr., 43 min.
N/A
20 min.
N/A
N/A
1 hr., 55 min.
N/A
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 any of these forms or schedules to this address. The forms and
schedules must be filed electronically. See How To File – Electronic Filing Requirement.
-66-
Page 67 of 71
Instructions for Form 5500
15:59 - 31-AUG-2009
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Forms 5500, 5500-SF, and
5500-EZ Codes for Principal
Business Activity
This list of principal business activities and their
associated codes is designed to classify an
enterprise by the type of activity in which it is
engaged. These principal activity codes are based
on the North American Industry Classification
System.
Code
Code
Code
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
Manufacturing
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
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Wholesale Trade
Merchant Wholesalers, Durable
Goods
423100 Motor Vehicle & Motor
Vehicle Parts & Supplies
423200 Furniture & Home
Furnishings
423300 Lumber & Other Construction
Materials
423400 Professional & Commercial
Equipment & Supplies
423500 Metals & Minerals (except
Petroleum)
423600 Electrical & Electronic Goods
423700 Hardware, Plumbing &
Heating Equipment &
Supplies
423800 Machinery, Equipment, &
Supplies
423910 Sporting & Recreational
Goods & Supplies
423920 Toy & Hobby Goods &
Supplies
423930 Recyclable Materials
423940 Jewelry, Watches, Precious
Stones, & Precious Metals
423990 Other Miscellaneous Durable
Goods
Merchant Wholesalers, Nondurable
Goods
424100 Paper & Paper Products
424210 Drugs & Druggists’ Sundries
424300 Apparel, Piece Goods, &
Notions
424400 Grocery & Related Products
424500 Farm Product Raw Materials
424600 Chemical & Allied Products
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221100 Electric Power Generation,
Transmission & Distribution
221210 Natural Gas Distribution
221300 Water, Sewage, & Other
Systems
221500 Combination Gas & Electric
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Utilities
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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
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Mining
211110
212110
212200
212310
212320
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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
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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
Page 68 of 71
Instructions for Form 5500
15:59 - 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
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
-68-
Real Estate and Rental and
Leasing
Real Estate
531110 Lessors of Residential
Buildings & Dwellings
(including equity REITs)
531114 Cooperative Housing
(including equity REITs)
531120 Lessors of Nonresidential
Buildings (except
Miniwarehouses) (including
equity REITs)
531130 Lessors of Miniwarehouses &
Self-Storage Units (including
equity REITs)
531190 Lessors of Other Real Estate
Property (including equity
REITs)
531210 Offices of Real Estate Agents
& Brokers
531310 Real Estate Property
Managers
531320 Offices of Real Estate
Appraisers
531390 Other Activities Related to
Real Estate
Rental and Leasing Services
532100 Automotive Equipment Rental
& Leasing
532210 Consumer Electronics &
Appliances Rental
532220 Formal Wear & Costume
Rental
532230 Video Tape & Disc Rental
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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
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Transportation and
Warehousing
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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
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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)
Page 69 of 71
Instructions for Form 5500
15:59 - 31-AUG-2009
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Forms 5500, 5500-SF, and 5500-EZ Codes for Principal Business Activity (continued)
Code
Code
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
Health Care and Social
Assistance
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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
Accommodation and Food
Services
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551111 Offices of Bank Holding
Companies
551112 Offices of Other Holding
Companies
611000 Educational Services
(including schools, colleges,
& universities)
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)
D
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)
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Management of Companies
(Holding Companies)
Educational Services
Arts, Entertainment, and
Recreation
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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
AF
Professional, Scientific, and
Technical Services
T
AF
T
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
921000 Governmental Instrumentality
or Agency
Page 70 of 71
Instructions for Form 5500
15:59 - 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 should not be filed with your Form 5500.
If you answer “No” to any of the questions below, you should review your plan’s operations because you may
not be in full compliance with ERISA’s requirements.
Have you provided plan participants with a summary plan description, summaries of any material modifications
of the plan, and annual summary financial reports or annual pension funding reports?
2.
Do you maintain copies of plan documents at the principal office of the plan administrator for examination by
participants and beneficiaries?
3.
Do you respond to written participant inquires for copies of plan documents and information within 30 days?
4.
Does your plan include written procedures for making benefit claims and appealing denied claims, and are you
complying with those procedures?
5.
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?
6.
Are the plan’s investments diversified so as to minimize the risk of large losses?
7.
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?
8.
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?
9.
Did the employer or other plan sponsor send participant contributions to the plan on a timely basis?
T
AF
D
R
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1.
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?
T
Did the plan pay participant benefits on time and in the correct amounts?
D
R
10.
AF
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.
2.
Has the plan official used the assets of the plan for his/her own interest?
3.
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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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?)
R
1.
D
D
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.
-70-
Page 71 of 71
Instructions for Form 5500
15:59 - 31-AUG-2009
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Index
AF
T
A
About the Form 5500 . . . . . . . . . . . . . . . . . . 1
Additional Employer Information for
Multiemployer Defined Benefit Pension
Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Additional Information for
Single-Employer and Multiemployer
Defined Benefit Pension Plans . . . . . . 54
Amended Return/Report . . . . . . . . . . . . . . . 6
Amendments . . . . . . . . . . . . . . . . . . . . . . . . . 52
I
Information Concerning Insurance
Contract Coverage, Fees, and
Commissions . . . . . . . . . . . . . . . . . . . . . . . 19
Instructions for Schedule A:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 19
Instructions for Schedule C:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 22
Instructions for Schedule D:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 26
Instructions for Schedule G:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 27
Instructions for Schedule H:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 29
Instructions for Schedule I:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 38
Instructions for Schedule MB:
Statement by Enrolled Actuary . . . . . . 45
Who Must File . . . . . . . . . . . . . . . . . . . . . . 45
Instructions for Schedule R:
Who Must File . . . . . . . . . . . . . . . . . . . . . . 51
Instructions for Schedule SB:
Statement by Enrolled Actuary . . . . . . 55
Who Must File . . . . . . . . . . . . . . . . . . . . . . 55
Investment and Annuity Contract
Information . . . . . . . . . . . . . . . . . . . . . . . . . 20
AF
D
R
S
Schedule of Reportable
Transactions . . . . . . . . . . . . . . . . . . . . . . . 36
Service Provider Information . . . . . . . . . . 22
Service Providers Who Fail or Refuse To
Provide Information . . . . . . . . . . . . . . . . . 25
Short Plan Year Rule . . . . . . . . . . . . . . . . . . 7
Signature and Date . . . . . . . . . . . . . . . . . . . . 6
Small Plan Financial Information . . . . . . 38
Special rule for certain
participant-directed transactions . . . . 36
Statement by Enrolled Actuary . . . . 45, 56
T
Telephone Assistance . . . . . . . . . . . . . . . . . 3
Termination Information on Accountants
and Enrolled Actuaries . . . . . . . . . . . . . 25
Transactions During Plan Year . . . . . . . . 40
T
U
Unfunded welfare benefit plan . . . . . . . . . 4
W
Welfare Benefit Contract
Information . . . . . . . . . . . . . . . . . . . . . . . . . 20
Welfare Benefit Plan - Who Must
File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Welfare Benefit Plan Filing
Requirements . . . . . . . . . . . . . . . . . . . . . . . 9
What To File . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
When To File:
DFEs other than GIAs . . . . . . . . . . . . . . . 4
Extensions . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Plans and GIAs . . . . . . . . . . . . . . . . . . . . . 4
Short Years . . . . . . . . . . . . . . . . . . . . . . . . . 4
Who Must File . . . . . . . . . . . . . . . . . . . . . . . . . 3
N
Nonexempt Transactions . . . . . . . . . 27, 41
Notice to Terminated Accountant or
Enrolled Actuary . . . . . . . . . . . . . . . . . . . . 25
R
AF
T
G
General Schedules . . . . . . . . . . . . . . . . . . . . 8
M
Master Trust Investment Account
(MTIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
R
F
Final Return/Report:
Mergers/Consolidations . . . . . . . . . . . . . . 6
Pension and Welfare Plans That
Terminated Without Distributing All
Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Welfare Plans Still Liable To Pay
Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Form 5500 Schedules . . . . . . . . . . . . . . . . . 7
Fully insured welfare benefit plan . . . . . . 4
Funding Information . . . . . . . . . . . . . . . . . . 51
L
Limited Pension Plan Reporting . . . . . . . . 8
Loans or Fixed Income Obligations in
Default or Classified as
Uncollectible . . . . . . . . . . . . . . . . . . . . . . . 27
D
E
EFAST Processing System . . . . . . . . . . . . 1
Electronic Filing Requirement . . . . . . . . . . 5
ESOP Information . . . . . . . . . . . . . . . . . . . . 52
Extension of Time To File . . . . . . . . . . . . . . 5
R
Reportable transaction . . . . . . . . . . . . . . . . 36
P
Party-in-Interest . . . . . . . . . . . . . . . . . . 27, 41
Penalties:
Administrative . . . . . . . . . . . . . . . . . . . . . . . 7
Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Pension Benefit Plan - Who Must
File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
D
D
Direct Filing Entity (DFE) - Who Must
File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Direct Filing Entity (DFE) Filing
Requirements . . . . . . . . . . . . . . . . . . . . . . . 9
Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Pension Benefit Plan Filing
Requirements . . . . . . . . . . . . . . . . . . . . . . . 8
Pension Schedules . . . . . . . . . . . . . . . . . . . . 7
Plan sponsor . . . . . . . . . . . . . . . . . . . . . . . . . 15
Pooled Separate Account (PSA) . . . . . . 10
Provision of Information . . . . . . . . . . . . . . . 21
AF
D
R
C
Change in Plan Year . . . . . . . . . . . . . . . . . . . 7
Changes To Note . . . . . . . . . . . . . . . . . . . . . . 1
Combination unfunded/insured welfare
plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Common/Collective Trust (CCT) . . . . . . 10
Group Insurance Arrangement
(GIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
T
80-120 Participant Rule . . . . . . . . . . . . . . . . 7
103-12 Investment Entity (103-12
IE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
-71-
■
| File Type | application/pdf |
| File Title | C:\Batch\Users\Pagersvc[DS]\I5500\I5500. |
| File Modified | 2009-09-15 |
| File Created | 2009-08-31 |