Form 5300, Application for Determination for Employee Benefit Plan, Schedule Q (Form 5300), Elective Determination Requests

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Page 1 of 7 Instructions for Form 5300

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Cumulative Changes Copy for OMB.

CUMULATIVE CHANGES SINCE FIRST APPROVAL
PACKAGE

Instructions for Form 5300

Department of the Treasury
Internal Revenue Service

(Rev. February 2011)
Application for Determination for Employee Benefit Plan
Section references are to the Internal
Revenue Code unless otherwise noted.

What’s New for 2011
The form and the instructions have
g
changes.
g
Some of the
undergone
changes
g were made because of the
changes
g required
q
byy Rev. Proc.
2007-44,, 2007-28,, I.R.B. 54 available
g
_
at www.irs.gov/irb/2007-28_IRB/index.
html. Review these documents before
completing the application.
Lines 13 and 14 must be
p
completed
to indicate whether or not a
ruling is being requested for:
g
g the
1. a determination regarding
p
g test under Regulations
ratio percentage
( ) ( )( )
section 1.410(b)-2(b)(2);
2. a determination regarding
g
g one of
the special
requirements
under
p
q
Regulations
section 1.410(b)-2(b)(5),
g
(6), or (7),
( ) or
g
g the
3. a determination regarding
g
nondiscrimination designed-based
safe
harbors of section 401(a)(4).
p
(
),
Complete
Schedule Q (Form
5300),
q
Elective Determination Requests,
if you
p of a
want to broaden the scope
q
ga
determination letter byy requesting
y
p
determination that your
plan
satisfies
q
q
certain qualification
requirements
g to minimum participation,
p
p
,
relating
g , and nondiscrimination.
coverage,
Schedule Q is no longer mandatory.
Disclosure Request by Taxpayer.
The Tax Reform Act of 1976 permits a
taxpayer to request the IRS to disclose
and discuss the taxpayer’s return and/
or return information with any person(s)
the taxpayer designates in a written
request. Use Form 2848, Power of
Attorney and Declaration of
Representative, and/or Form 8821, Tax
Information Authorization, for this
purpose.
Public Inspection. Form 5300 is open
to public inspection if there are more
than 25 plan participants. The total
number of participants must be shown
on line 4e. See the instructions for line
4e for a definition of participant.

General Instructions
Purpose of Form
File Form 5300 to request a
determination letter from the IRS for the
initial qualification of a defined benefit
or a defined contribution plan and the
exempt status of any related trust. See

Type of Determination Letter
Requested later for more information.
Note. The application should be filed
in accordance with Rev. Proc. 2007-44.
File Form 5307, Application for
Determination for Master or Prototype
or Volume Submitter Plans, instead of
Form 5300 if this is a Master and
Prototype (M&P) or volume submitter
plan. However, use Form 5300 instead
of Form 5307 if you are also requesting
a determination on affiliated service
group status, leased employee status,
or a partial termination.

Deleted reference to
Form 6046, now obsolete.

multiemployer or multiple-employer
plan (a plan maintained by more than
one employer considering all employers
combined under section 414(b), (c), or
(m) as one employer).
• Employer, plan
p
sponsor,
p
or plan
administratorr to request a
determination letter for compliance with
the applicable requirements of a foreign
situs trust for the taxability of
beneficiaries (section 402(c)) and
deductions for employer
p
contributions
(section 401(a)(4)).
Note. This application will be
processed in accordance with Rev.
Proc. 2007-44.

Type of Plan
A Defined Contribution Plan (DCP) is
a plan that provides an individual
account for each participant and for
benefits based only:
1. On the amount contributed to the
participant’s account, and
2. Any income, expenses, gains and
losses, and any forfeiture of accounts
of other participants that may be
allocated to the participant’s account.
A Defined Benefit Plan (DBP) is any
plan that is not a DCP.
Note. A qualified plan must satisfy
section 401(a) including, but not limited
to, participation, vesting,
nondiscriminatory contributions or
benefits, distributions, and contribution
and benefit limitations.

Who May File
This form may be filed by any:
• Employer, including a sole
proprietor, partnership, plan sponsor, or
a plan administrator that has adopted
an individually designed plan to request
a determination letter on:
1. Initial qualification of a plan;
2. Qualification of an entire plan as
amended;
3. Partial termination of a plan;
4. Affiliated Service Group (ASG)
status (section 414(m)); or
5. Leased employee status (section
414(n)).
• Plan sponsor or plan administrator
to request a determination letter for a
plan maintained by an employer that is
part of a controlled group of
corporations (section 414(b)), or trades
or businesses under common control
(section 414(c)), or an ASG (section
414(m)).
• Plan sponsor or plan administrator
to request a determination letter for a
Cat. No. 10932P

Who May
y Not File
This form may not be filed by an
adopter
ad p of:
• A collectivelyy bargained
g
plan,
p
where
a Form 5307 is applicable,
pp
, or
• A master or pprototype
yp p
plan where the
applicant
pp
is not requesting
q
ga
determination on ASG status, leased
employee
p y status,, or a partial
p
termination (instead, file Form 5307).

Where To File
File Form 5300 at the address indicated
below:
Internal Revenue Service
P.O. Box 12192
Covington, KY 41012-0192
Requests shipped by express mail or
a delivery service should be sent to:
Internal Revenue Service
201 West Rivercenter Blvd.
Attn: Extracting Stop 312
Covington, KY 41011
Private Delivery Services. In addition
to the United States mail, you can use
certain private delivery services
designated by the IRS to meet the
“timely mailing as timely filing/paying”
rule for tax returns and payments. The
list of designated private delivery
services includes only the following:
Delete:
• Airborne Express (Airborne):
Overnight Air Express Service, Next
Afternoon Service, Second Day
Service.
• DHL Express (DHL): DHL Same Day
Service.
• Federal Express (FedEx): FedEx
Priority Overnight, FedEx Standard
Overnight,
g , FedEx 2Day,
y, FedEx
International Priority, FedEx
International First.

Page 2 of 7 Instructions for Form 5300

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• United Parcel Service (UPS): UPS
Next Day Air, UPS Next Day Air Saver,
UPS 2nd Day Air, UPS 2nd Day Air
A.M., UPS Worldwide Express Plus,
and UPS Worldwide Express.
The private delivery service can tell
you how to get written proof of the
mailing date.

How To Complete the
Application
Applications are screened for
completeness. The application must be
signed by the employer, plan
administrator, or authorized
representative.
Note. Stamped signatures
are not
g
acceptable;
p
; see Rev. Proc. 2011-4,,
2011-1 I.R.B. 123 available at ww
www.irs.
ww.iirs.
gov/irb/2011-01_IRB/index.html.
ov/irb/2011-01_IRB/index.html.
Incomplete applications may be
returned to the applicant. For this
reason, it is important that an
appropriate response be entered for
each item. In completing the
application, pay careful attention to the
following:
• N/A (not applicable) is accepted as a
response only if an N/A block is
provided.
• If a number is requested, a number
must be entered.
• If an item provides a choice of boxes
to check, check only one box unless
instructed otherwise.
• If an item provides a box to check,
written responses are not acceptable.
• Governmental plans and non-electing
church plans do not have to complete
lines 10 and 12a.
• The application
pp
has formatted fields
that will limit the number of characters
entered per field.
• All data input
p will need to be entered
in Courier 10 point font.
• Alpha
p characters should be entered
in capital letters.
• Enter spaces
p
between any
y words.
Spaces do count as characters.
• All date fields are entered as an
eight-digit field (MMDDYYYY).
• Rev. Proc. 2007-44 requires
q
ap
plan
restatement and the IRS may,
y at its
discretion,, require
q
additional
information any
y time it is deemed
necessary.
y See section 7.05 of Rev
Rev.
v.
Proc. 2011-6,, 2011-1 I.R.B. 195
available at www.irs.gov/irb/
g
2011-01_IRB/index.html
/
Note. Rev. Proc.. 2011-6 publishes the
guidance under which the
determination letter program is
administered. It is updated annually and
can be found in the Internal Revenue
Bulletin (I.R.B.). Example: Rev. Proc.
2011-6 superseded Rev. Proc. 2010-6.

Partial Termination Worksheet

Year Year

Year of partial termination

Year

1 Participants employed:
a Number at beginning of plan year
b Number added during the plan year
c Total, add lines a and b
d Number dropped during the plan
year
e Number at end of plan year,
subtract d from c
f Total number of participants in this
plan separated from service without
full vesting
2 Present value (as of month
day during the year of

/

/

a Plan assets
b Accrued benefits
c Vested benefits
3 Submit a description of the actions that may have resulted (or might result) in a
partial termination. Include an explanation of how the plan meets the requirements of
section 411(d)(3).

What To File
ote. Payments
y
for sanction fees,,
No
Note.
fees, etc. should be
p
compliance
submitted on separate checks.
1. A check for the appropriate user
fee, if applicable, and Form 8717, User
Fee for Employee Plan Determination,
Opinion, and Advisory Letter Request.
Please submit a separate check for
each application. Make checks payable
to the “United States Treasury.”
2. A completed
p
Form 5300, which
consists of pages 1 – 11.
3. Schedule Q ((Form 5300),
), if any
elective determinations are being
q
, and any
y additional
requested,
schedules or demonstrations required
by these instructions or byy the
by
instructions for Schedule Q.
4. A copy
py of the p
plan’s last
determination letter.
5. A copy of the plan and all
required attachments and statements.
py of all amendments,,
6. A copy
g a copy
py of the Good Faith
including
Economic Growth and Tax Relief
(
Reconciliation Act of 2001 (EGTRRA)
amendments and all interim
amendments.
7. Anyy other information or material
required by the Service.
8. A copy
py of any
y compliance
p
g agreements
g
statement or closing
entered into in regards to this plan.
q
(See the Procedural Requirements
hecklistt on Form 5300 to ensure
Ch
Ch
your submitted package is
that y
complete.)

-2-

Type of Determination
Letter Requested
Initial Qualification
For initial qualification of a plan file
one copy of all instruments that make
up the plan.

Entire Plan as Amended
When requesting a determination letter
on the entire plan as amended after
initial qualification file:
1. One copy of the restated plan
and trust plus all amendments made to
date;
2. One copy of the latest
determination letter, including caveats;
and
3. A statement explaining how any
amendments made since the last
determination letter affect this or any
other plan of the employer.

Other Amendments

• Complex amendments. Use Form
5300, as described under Entire Plan
as Amended
d on this page, for complex
amendments, including amendments
with significant changes to plan benefits
or coverage.
deleted some text.
Note. Rev. Proc. 2007-44 requires
that all plan documents must be
restated for the current cumulative list.
• Partial Termination. For a partial
termination you must:
1. File the application form and the
appropriate documents and statements.
2. Attach a statement indicating if a
partial termination may have occurred
or might occur as a result of proposed
actions.

Page 3 of 7 Instructions for Form 5300

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3. Using the format in the Partial
Termination Worksheet above
above, submit a
schedule of information for the plan
year in which the partial (or potential
partial) termination began. Also, submit
a schedule for the next plan year, as
well as for the 2 prior plan years, to the
extent information is available.
If the plan has more than one benefit
computation formula, complete the
Partial Termination Worksheet. Also
attach a sheet showing the information
separately in the same format as lines
1a through 1f of the worksheet for each
benefit computation formula.
4. Submit a description of the
actions that may have resulted in a
partial termination.
5. Include an explanation of how the
plan meets the requirements of section
411(d)(3).
• Termination of Plan. If you are
terminating your plan, file Form 5310,
Application for Determination for
Terminating Plan, to request a
determination letter for the complete
termination of a DBP or a DCP. This
form should be filed to request a
determination letter involving the
complete termination of a
multi-employer plan covered by the
Pension Benefit Guaranty Corporation
(PBGC) insurance program.
In addition, include:
1. One copy of the plan;
2. One copy of the latest
determination letter;
3. A copy of all actions taken to
terminate the plan; and
4. If necessary, Form 6088,
Distributable Benefits From Employee
Pension Benefit Plans. Form 6088 is
required if the plan is a DBP or if the
plan is an underfunded DCP that
benefits non-collectively bargained
employees or more than 2% of the
employees who are covered under a
Collective Bargaining Agreement (CBA)
are professional employees. (See
Regulations section 1.410(b)-9 for
definitions.)
If you wish to stop benefit accruals
or stop making contributions to your
plan, and your plan trust will continue,
the plan will not be considered
terminated. If you want to receive a
determination letter, you must use Form
5300. Do not file Form 5310 if the plan
trust will continue.
Note. If a DBP is amended to become
a DCP, or if the merger of a DBP with a
DCP results solely in a DCP, the DBP
is considered terminated.

Specific Plans —
Additional Requirements
See the Procedural Requirements
Checksheet on Form 5300.
• For a determination on an ASG
status, submit:
1. A copy of the appropriate
documents, and

2. Statements listed in the
instructions for lines 3a and 6.
• For plans of controlled groups of
corporations or trades or businesses
under common control, submit the
statement specified in the instructions
for line 6.
• For multiple employer plans that do
not involve collective bargaining,
submit:
1. One application for the plan and
any additional required schedules or
demonstrations, and
2. Form 5300 (lines 1 through 8
only) for each employer who adopts the
plan (all employers in each ASG or
controlled group are considered one
employer). Form 5300 must be signed
by the respective employers.
Note. If the employer has no
employees, the taxpayer cannot submit
as the sponsor of the plan.
• For a governmental or
non-electing church plan, skip lines
10 and 12a. A non-electing church
plan is a plan for which an election
under section 410(d) has not been
made.
• For an Employee Stock Ownership
Plan (ESOP), attach Form 5309,
Application for Determination of
Employee Stock Ownership Plan.

Specific Instructions
Line 1a. If not applicable, leave blank.
Line 1b through
g 1g.
g Enter the name,,
address,, and telephone
number of the
p
plan sponsor/employer.
A plan sponsor means:
p
1. In the case of a plan
that covers
the employees
p y
of one employer, the
p y ;
employer;
2. In the case of a p
plan sponsored
p
by
y two or more entities required
q
to be
combined under sections 414(b),
( ), (c),
( ), or
((m),
), one of the members participating in
the p
plan;; or
3. In the case of a p
plan that covers
the employees
p y
and/or p
partner(s) of a
partnership, the partnership.
Notes.
N
• Line 1b is limited to 70 characters.
Enter a space
En
p
between all words.
• The name of the pplan sponsor/
p
employer
p y should be the same name
that was or will be used when the Form
5500,, Annual Return/Report
p of
Employee
p y Benefit Plan;; Form 5500-EZ,
p
Annual Return of One-Participant
(
p
)
(Owners
and Their Spouses)
Retirement Plan;; or Form 5500-SF,,
p of
Short Form Annual Return/Report
Small Employee Benefit Plan is filed for
the plan.
p
• Address should include the suite,,
room,, or other unit number after the
street address. If the Post Office does
not deliver mail to the street address
and the p
plan has a P.O. Box,, show
w the
box number instead of the street

-3-

!

CAUTION

address. The address should be the
address of the sponsor/employer.
Line 1h. Enter the 9-digit
g employer
p y
identification number ((EIN)) assigned
g
to
the plan
p
sponsor/employer.
p
p y This should
be the same EIN that was or will be
used when the Form 5500 series
annual returns/reports
p
are filed for the
plan. For a multiple
p
p employer
p y p
plan,, the
EIN should be the same EIN that was
or will be used by
y the p
participating
p
g
employer
p y when Form 5500 is filed by
the employer.
Do nott use a social security
number or the EIN of the trust.
The p
plan sponsor/employer
p
p y must
have an EIN. A plan
p
sponsor/employer
p
p
without an EIN can apply
w
pp y for one.
• Online — Generally,
y, a p
plan sponsor/
p
employer
p y can receive an EIN byy
Internet and use it immediately
y to file a
return. Go to the IRS website at www.
irs.gov/businesses/small
g
l and click on
Employer
Em
p y ID Numbers (EINs).
• Byy telephone
p
— Call
1-800-TAX-FORM ((829-4933).
1
)
• Byy mail or fax — Send in a completed
p
Form SS-4,, Application
pp
for Employer
p y
Identification Number, to apply for an
EIN.
Note. Form SS-4 can also be obtained
at Social Security Administration (SSA)
offices.
The p
plan of a group
g p of entities
required
q
to be combined under section
414(b),
( ), (c),
( ), or (m),
( ), whose sponsor
p
is
more than one of the entities required
q
to be combined,, should onlyy enter the
EIN of one of the sponsoring
p
g members.
This EIN must be used in all
subsequent
q
filings
g of determination
letter requests,
q
, and for filing
g annual
returns/reports
p
unless there is a change
of sponsor.
deleted Note, same note
3
digits3a
Line 1k. Enter the two under
representing
p
g the month the employer’s
p y
tax year
y
ends. This is the employer
p y
whose EIN was entered on line 1h.
Line 2. The contact person will receive
copies of all correspondence as
authorized in a Power of Attorney and
Declaration of Representative, Form
2848, or Tax Information Authorization,
Form 8821. Either complete the
contact’s information on this line, or
check the box and attach a completed
Form 2848 or Form 8821.
Line 3a. Enter the number(s) that
corresponds to the request(s) being
made.
• Enter 1 if the IRS has not issued a
determination letter for this plan.
p
Enter
the number of subsequent
q
amendments
signed
g
after the initial p
plan on line 3e.
Enter the date(s)
( ) the amendment(s)
(
was signed
g
along
g with date(s)
( ) the
amendment(s) was effective on lines 3f
and 3g.
• Enter 2 if the IRS has previously
issued a determination letter for this
plan. Enter the date(s) the

Page 4 of 7 Instructions for Form 5300

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amendment(s) was signed along with
the date(s)
( ) the amendment(s)
( was
effective on lines 3f and 3g.
Note.
• If amendments are substantial,, see
section 7.04 of Rev. Proc. 2011-6.
• Enter 3 if requesting a letter
concerning the effect of section 414(m),
a change in the ASG membership or if
you are not certain that you are a
member of an ASG, attach the
following information:
1. A description of the nature of the
business of the employer. Specifically
state whether it is a service
organization or an organization whose
principal business is the performance of
management functions for another
organization, including the reason for
performing the management function or
service.
2. The identification of other
members (or possible members) of the
ASG.
3. A description of the nature of the
business of each member (or possible
member) of the ASG including the type
of organization (corporation,
partnership, etc.) and indicate whether
such member is a service organization
or an organization whose principal
business is the performance of
management functions for the other
group member(s).
4. The ownership interests between
the employer and the members (or
possible members) of the ASG
(including ownership interests as
described in section 414(m)(2)(B)(ii) or
414(m)(6)(B)).
5. A description of services
performed for employers by the
members (or possible members) of the
ASG, or vice versa. Include the
percentage of each member’s (or
possible member’s) gross receipts and
service receipts provided by such
services, if available, and data as to
whether their services are a significant
portion of the member’s business and
whether or not, as of December 13,
1980, it was unusual for the services to
be performed by employees of
organizations in that service field in the
United States.
6. A description of how the
employer and the members (or possible
members) of the ASG associate in
performing services for other parties.
7.
a. A description of management
functions, if any, performed by the
employer for the members (or possible
members) of the ASG, or received by
the employer from any other members
(or possible members) of the group
(including data as to whether such
management functions are performed
on a regular and continuous basis) and
whether or not it is unusual for such
management functions to be performed
by employees of organizations in the
employer’s business field in the United
States.

b. If management functions are
performed by the employer for the
members (or possible members) of the
ASG, describe what part of the
employer’s business constitutes the
performance of management functions
for the members (or possible members)
of the group (including the percentage
of gross receipts derived from
management activities as compared to
the gross receipts from other activities).
8. A brief description of any other
plan maintained by the members (or
possible members) of the ASG, if such
other plan is designated as a unit for
qualification purposes with the plan for
which a determination letter has been
requested.
9. A description of how the plan(s)
satisfies the coverage requirements of
section 410(b) if the members (or
possible members) of the ASG are
considered part of an ASG with the
employer.
10. A copy of any ruling issued by the
national office on whether the employer
is an ASG; a copy of any prior
determination letter that considered the
effect of section 414(m) on the qualified
status of the employer’s plan; and, if
known, a copy of any such ruling or
determination letter issued to any other
member (or possible member) of the
same ASG, accompanied by a
statement as to whether the facts upon
which the ruling or determination letter
was based have changed.
• Enter 4 if you are not certain whether
or not you have leased employees,
attach the following information:
1. A description of the nature of the
business of the recipient organization;
2. A copy of the relevant leasing
agreement(s);
3. A description of the function of all
leased employees in the trade or
business of the recipient organization
(including data as to whether all leased
employees are performing services on
a substantially full-time basis);
4. A description of facts and
circumstances relevant to a
determination of whether such leased
employees’ services are performed
under primary direction or control by the
recipient organization (including
whether the leased employees are
required to comply with instructions of
the recipient about when, where, and
how to perform the services, whether
the services must be performed by
particular persons, whether the leased
employees are subject to the
supervision of the recipient, and
whether the leased employees must
perform services in the order or
sequence set by the recipient); and
5. If the recipient organization is
relying on any qualified plan(s)
maintained by the employee leasing
organization for purposes of
qualification of the recipient
organization’s plan, a description of the
plan(s) (including a description of the

-4-

contributions or benefits provided for all
leased employees that are for services
performed for the recipient
organization, plan eligibility, and
vesting).
• Enter 5 if this is a request for the
effect a potential partial termination will
have on the p
plan’s qualification. The
“effective date” means the date the
p
partial termination occurred. Enter this
date on line 3c.
• Enter 6 if a determination letter is
requested on the termination of a multiemployer plan covered by PBGC
insurance. Also enter the date the
termination is effective
e on line 3d.
Note. Pre-approved
pp
p
plans that are
submitting
g a determination request
q
under 3,, 4,, 5,, ((as shown in line 3a)) or a
volume submitter multiple
p employer
p y
plan will be reviewed as if it had been
p
filed on Form 5307. An IRS review of
the application
pp
will not consider
changes
g in the q
qualification
requirements
q
subsequent
q
to the 2004
Cumulative List. See Announcement
2008-23, 2008-14, I.R.B. 731.
Line 3f. If more than four deleted line 3b, 3c.
amendments,, list amendments on a
separate
p
p
piece of p
paper
p using
g the same
format as shown on the form and label
as an “attachment to #3f.” If a p
plan or
amendment is p
proposed,
p
, enter 9/9/
9999 for the signature
g
date but include
the intended effective date.
Line 3g.
g If an amendment has more
than one effective date, use the earliest
effective date.
Line 3h. If yyou do not have a copy
py of
the latest determination letter,, or if no
determination letter has ever been
received byy the employer,
p y , include
copies
p
of the p
prior p
plan or adoption
p
agreement
g
and all subsequent
q
amendments and/or restatements with
the application request.
Line 3i. If 3h is “Yes,”
, enter the date of
the last determination letter. The
number of amendments should include
any
yp
proposed
p
amendments being
submitted.
Line 3m. If the relationship
p with the
pre-approved
p
pp
sponsor
p
was terminated,,
please p
p
provide the date the relationship
was terminated.
Line 3n. Section 3001 of the
Employee
p y Retirement Income Security
Act of 1974 (ERISA)
(
) requires
q
that
applicants
pp
subject
j
to section 410
provide evidence that each employee
p
p y
who q
qualifies as an interested p
party has
been notified of the filing
g of the
application.
pp
If “Yes” is checked,, it
means that each employee
p y has been
notified as required
q
byy Regulations
g
section 1.7476-1,, this is a one-person
p
plan,, or the plan
p
p
is not subject
j
to
section 410. A copy
py of the notice is not
required
q
to be attached. If “No” is
checked or this line is blank, your
application will be returned.
Rules defining
g “interested p
parties”
and the form of notification are in

Page 5 of 7 Instructions for Form 5300

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Regulations
g
section 1.7476-1. For an
example
p of an acceptable format, see
Rev. Proc. 2011-6.
p
Line 3u. If the parent
has made the
g
election to use their EIN for determining
y
y
your
remedial amendment cycle
under
p
Rev. Proc. 2007-44 provide
the name
and EIN of the parent.
Line 3w. Even if a ruling
g is not being
requested
on Schedule Q,, Demo 8,
q
submit a copy
plan
py of the pertinent
p
p
provisions regarding the offset.
p
Line 4a. Due to space
restrictions this
field is limited to 70 characters,,
g spaces.
p
p
including
Please complete
this
p
item with how the plan
name should
read on the determination letter to the
p
extent permitted.
Due to this restriction,
p
p in mind that “Employees”
p y
please
keep
and “Trust” are not needed and will be
left off if space does not permit.
Line 4b. Enter the three-digit number,
beginning with ‘‘001’’ and continuing in
numerical order for each plan you
adopt (001-499). The numbering will
differentiate your plans. The number
assigned to a plan cannot be changed
or used for any other plan. This should
be the same number that was or will be
used when the Form 5500, Form
5500-EZ, or Form 5500-SF is filed for
the plan.
Line 4c. Plan year
means the
y
calendar,, policy,
on which
p y, or fiscal year
y
the records of the plan
are kept.
p
p Enter
the two-digit
g month (mm) on which the
plan year ends.
Line 4e. Enter the total number of
participants. A participant means:
1. The total number of employees
participating in the plan including
employees under a section 401(k)
qualified cash or deferred arrangement
who are eligible but do not make
elective deferrals,
2. Retirees and other former
employees who have a nonforfeitable
right to benefits under the plan, and
3. The beneficiary of a deceased
employee who is receiving or will in the
future receive benefits under the plan.
Include one beneficiary for each
deceased employee regardless of the
number of individuals receiving
benefits.
Example. Payment of a deceased
employee’s benefit to three children is
considered a payment to one
beneficiary.
Line 5.
• Cash balance plan. 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).
ac
)
• For an ESOP. If the pplan contains
the loan language
g g for a leveraged
g
ESOP,, then the application
pp
should be
marked as such,, even though
g in
operation
p
the plan has not utilized this
provision.
Lines 6a and 6b. If the employer is a
member of a controlled group of
corporations, trades or businesses
under common control, or an ASG, all
employees of the group will be treated
as employed by a single employer for
purposes of certain qualification
requirements. Attach a statement which
provides the following in detail:
1. All members of the group;
2. The relationship of each member
to the plan sponsor;
3. The type(s) of plan(s) maintained
by each employer;
4. Plans common to all members;
and
5. If the member of the controlled
group is a foreign entity.
Line 6c. If the election to use Cycle
y
A
under Rev. Proc. 2007-44 was made
submit a copy
py of the signed
g
and dated
election. Include a copy
py of the
controlled g
group
p election with each
submission of that controlled group.
Note. If you want to apply for a
determination letter to determine if you
are a member of an ASG,, leave this
line blank and enter “3” on line 3a and
attach the information p
per the
instructions for this
s item. deleted line 7e
plan has been involved
Line 7f. If the p
in a merger,
g , attach a statement which
provides the following:
1. Name of the p
plan(s)
( ) involved;
2. Type
yp of p
plan(s)
( ) involved;;
3. Date(s)
( ) of merger(s);
g ( ); and
4. Verification that each plan
p
involved was qualified
q
at the time of
merger
g (copy
( py of prior
p
DL,, if any,
y,
otherwise p
provide a signed
g
and dated
copy
py of most recent restatement and
subsequent amendments)
amendments).
Notes.
N
• The pplan and amendments submitted
to verify
y that p
plans were q
qualified prior
to the merger
g are for information
purposes
pu
p
only
y and will not be ruled on.
• If applicable,
pp
, file Form 5310-A,,
Notice of Plan Merger
g or Consolidation,
Spinoff
p
or Transfer of Plan Assets or
Liabilities;; Notice of Qualified Separate
p
Line of Business,, 30 days
y prior
p
to the
merger,
g , consolidation, or transfer of
assets or liabilities.
Line 7g.
has been restated
g If the plan
p
to change
under
g the type
yp of plan
p
Regulations
section 1.401-1,, answer
g
this question
“Yes” and attach a
q
statement explaining the change.
Line 7h. A multiple
is
p employer
p y plan
p
a plan maintained by more than one

-5-

employer,
p y , but which is NOT maintained
under a collective bargaining
g
g
agreement.
g
Under this plan
p
type,
yp ,
contributions from each employer
p y must
be available to pay
p y benefits of any
participant,
p
p , even if employed
p y byy
another employer.
p y Also,, enter the total
number of employers
p y
adopting
p g the p
plan.
Include a statement in each p
plan that
was submitted that includes the
sponsor
p
name(s)
( ) and EIN(s)
( ) of all the
cases that were submitted. See section
413(c).
Line 7i. Attach a statement indicating
g
the plan
p
sponsor
p
name and EIN of all
cases submitted with the lead plan.
Line 7k. A multi-employer
p y plan
p
((as
described in section 414(f))
( )) is one to
which more than one employer
p y is
required
q
to contribute and which is
maintained under one or more
collective bargaining
g
g agreements
g
between one or more employee
p y
organizations
g
and more than one
employer.
Line 7l . See Rev. Proc. 2011-6 and
the Appendix thereto.
Line 7m. A foreign
g trust is a trust that
was not created or organized
g
in the
United States. If yyou have a Puerto
Rican p
plan,, was the irrevocable election
in ERISA section 1022(i)
( ) made? If
“Yes,”
, p
provide the election or provide
p
the statement making
g the election with
the determination letter that the election
is made in accordance with ERISA
section 1022(i).
Line 8a. If “Yes” is checked, attach a
statement for each plan with the
following information:
1. Name of plan,
yp of p
2. Type
plan,,
3. Form of plan (standardized,
nonstandardized, volume submitter, or
individually designed),
4. Plan number,,
g schedule,, and
5. Vesting
6. Whether the p
plan has received a
determination letter or an application
p
for
a letter is pending with IRS.
Lines 8b and 8c. See M-8, M-12, and
M-14 of Regulations section 1.416-1.
Line 12a. Section 411(d)(6) protected
benefits include:
• The accrued benefit of a participant
as of the later of the amendment’s
adoption date or effective date; and
• Any early retirement benefit,
retirement-type subsidy, or optional
form of benefit for benefits from service
before such amendment.
, attach a statement which
If “Yes,”
provides how the amendment satisfies
one of the exceptions to the prohibition
on reduction or elimination of section
411(d)(6) protected benefits.
Line 13. This question may be used
to request a determination regarding
the ratio percentage test under
Regulations section 1.410(b)-2(b)(2).

Page 6 of 7 Instructions for Form 5300

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Notes.
• If “No” is checked and a request for a
determination regarding the average
benefit test is not made on Schedule Q,
the determination letter for the plan will
not be a determination regarding
section 410(b).
• If “No” is checked but a request for a
determination regarding the average
benefit test is made on Schedule Q, the
determination letter for the plan will also
be a determination regarding the
average benefit test.
• Plans using the qualified separate
lines of business rules of section 414(r)
must file Schedule Q if a determination
is desired that the plan satisfies the
gateway test of section 410(b)(5)(B) or
the special requirements for employer
wide plans.
• If “Yes” and 13(l) is 70% or more,
then a request cannot be made for
purposes of 410(b) using a Schedule Q
and Demo 5.
Line 13a. If answered “Yes,” you
must complete lines 13b through 13n
with respect to each disaggregated
portion of the plan. Attach additional
schedules as necessary to identify the
other disaggregated portions of the
plan. Provide the requested coverage
information, in the same format as line
13, separately with respect to the other
portions of the plan, or to otherwise
show that the other portions of the plan
separately satisfy section 410(b).
Example. If this plan benefits the
employees of more than one qualified
separate line of business (QSLOB), the
portion of the plan benefiting the
employees of each QSLOB is treated
as a separate plan maintained by that
QSLOB and must separately satisfy
section 410(b) unless the
employer-wide plan testing rule in
Regulations section 1.414(r)-1(c)(2)(ii)
applies.
Note. If a determination is being
requested for a section 401(k) and/or
401(m)
( ) plan, you must complete lines
13c-13l for the portion of the plan that is
not a section 401(k) or a 401(m) plan.
Complete line 13m(1) to report the ratio
percentage for the section 401(k)
portion of the plan and line 13m(2) to
report the ratio percentage for the
section 401(m) portion of the plan.
Line 13c. If, for purposes of satisfying
the minimum coverage requirements of
section 410(b), you are applying the
daily testing option in Regulations
section 1.410(b)-8(a)(2) or the quarterly
testing option in Regulations section
1.410(b)-8(a)(3), or, if you are using
single-day “snapshot” testing as
permitted under section 3 of Rev. Proc.
93-42, 1993-2 C.B. 540, enter the most
recent eight-digit date (MMDDYYYY)
for which the coverage data is
submitted. If you are applying the
annual testing option in Regulations
section 1.410(b)-8(a)(4), enter the year
for which the coverage data is
submitted.

Line 13d. Include all employees of all
entities combined under sections
414(b), (c), (m), or (o). Also include all
self-employed individuals, common law
employees, and leased employees as
defined in section 414(n) of any of the
entities above, other than those
excluded by section 414(n)(5). Certain
individuals may also be required to be
counted as employees. See the
definition of employee in Regulations
section 1.410(b)-9. Also see
Regulations section 1.410(b)-6(i), which
may permit the employer to exclude
certain former nonhighly compensated
employees.
Line 13e(1). Enter the number of
employees who are excluded because
they have not attained the lowest
minimum age and service requirements
for any employee under this plan. If the
employer is separately testing the
portion of a plan that benefits otherwise
excludable employees, attach a
separate schedule describing which
employees are treated as excludable
employees on account of the minimum
age and service requirements under
each separate portion of the plan.
Line 13e(2). Enter the number of
employees who are excluded because
they are collectively bargained
employees as defined in Regulations
section 1.410(b)-6(d)(2), regardless of
whether those employees benefit under
the plan. For this purpose, an employee
covered under a CBA is not considered
a collectively bargained employee if
more than 2% of the employees who
are covered under the agreement are
professional employees as defined in
Regulations section 1.410(b)-9.
Line 13e(3). Enter the number of
employees who do not receive an
allocation or accrue a benefit under the
plan only because they do not satisfy a
minimum hours of service requirement
or a last day of the plan year
requirement, provided they do not have
more than 500 hours of service, and
they are not employed on the last day
of the plan year.
Note. Do not enter on this line anyy
employees
who have more than 500
p y
hours of service,, even if they
y are not
employed
p
on the last day of the plan
year.
Line 13e(4). If this plan benefits the
employees of one QSLOB, enter on
this line the number of employees of
the employer’s other QSLOBs. This is
not applicable if the plan is tested under
the special rule for employer-wide plans
in Regulations section
1.414(r)-1(c)(2)(ii).
Line 13e(5). Enter the number of
employees who are nonresident aliens
who receive no earned income (as
defined in section 911(d)(2)) from the
employer that constitutes income from
sources within the United States (as
defined in section 861(a)(3)).

-6-

Line 13g.
g “Nonexcludable employees”
p y
are the employees
p y
who cannot be
excluded from the p
plan for statutoryy (for
(
example,
p , age
g and service)) or regulatory
g
reasons and must be included even
though
g they might not benefit under the
plan.
Line 13h. Enter the number of
nonexcludable employees on line 13g
who are highly compensated
employees (HCEs) as defined in
section 414(q).
Line 13i. In general, an employee is
treated as benefiting under the plan for
coverage tests purposes only if the
employee receives an allocation of
contributions or forfeitures or accrues a
benefit under the plan for the plan year.
Certain other employees are treated
as benefiting if they fail to receive an
allocation of contributions and/or
forfeitures, or to accrue a benefit, solely
because they are subject to plan
provisions that uniformly limit plan
benefits, such as a provision for
maximum years of service, maximum
retirement benefits, application of
offsets or fresh start wear-away
formulas, or limits designed to satisfy
section 415. An employee is treated as
benefiting under a plan to which
elective contributions under section
401(k) or employee contributions and
matching contributions under section
401(m) may be made if the employee is
currently eligible to make such elective
or employee contributions, or to receive
a matching contribution, whether or not
the employee actually makes or
receives such contributions
(Regulations section 1.401(k)-1(g)(4)
and 1.401(m)-1(f)(4)). However, do not
apply this rule to determine if an
employee
p y is to be counted as benefiting
for the p
portion of the p
plan that is not a
401(k) or 401(m) plan.
Line 13k. See the instructions for line
13i for the meaning of “benefiting under
the plan.”
Line 13l. To obtain the ratio
percentage:
Step 1. Divide the number on line
13k (nonexcludable NHCEs benefiting
under the plan) by the number on line
13j (nonexcludable NHCEs).
Step 2. Divide the number on line
13i (nonexcludable HCEs benefiting
under the plan) by the number on line
13h (nonexcludable HCEs).
Step 3. Divide the result from Step 1
by the result from Step 2.
Note. If the ratio p
percentage
g entered
on line 13l and/or line 13m is less than
70%,, the plan
p
does not satisfyy the ratio
percentage
p
g test. In this case,, the plan
p
must satisfy
y the average
g benefit test. A
determination regarding
g
g the average
g
benefit test can be requested using
Schedule Q.
Line 13m. To determine the ratio
percentages for the section 401(k) and
all section 401(m) (matching and

Page 7 of 7 Instructions for Form 5300

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employee contribution) portions of the
plan, follow the steps described in the
instructions for lines 13d through 13l,
but treat an employee as benefiting
under the rules for section 401(k) plans
and section 401(m) plans described in
the instruction for line 13i.

Design-Based
g
Nondiscrimination Safe
Harbors
Line 14. This q
question may
y be used
by
y certain p
plans to request
q
a
determination regarding
g
g the
design-based
g
safe harbor under section
401(a)(4).
Note. This item should be marked
“No” if:
• this is a section 401(k) and/or section
401(m) plan that does not contain a
provision for nonelective employer
contributions;
• any disaggregated plan relies on a
non-design based safe harbor or a
general test;
• this plan has been restructured into
component plans.
Line 14a. Check “Yes” if the plan is
intended to satisfy the permitted
disparity requirements of section 401(I).
Line 14b. To satisfy section 401(l), a
plan must provide that the overall
permitted disparity limits are not
exceeded and specify how

employer-provided contributions or
benefits under the plan are adjusted, if
necessary, to satisfy the overall
permitted disparity limits. See
Regulations section 1.401(l)-5.
Note. The p
plan will not satisfy
y the safe
harbor requirements
q
of 401(a)(4)
( )( if it
does not satisfy section 401(l).
Line 14c. This line provides a list of
the design-based nondiscrimination
safe-harbor regulations.

How To Get Forms,
Publications, and
Assistance
Internet. You can access the IRS
website 24 hours a day, 7 days a week
at IRS.gov
g to:
t
• Download forms, instructions, and
publications;
• Order IRS products on-line;
• Research your tax questions on-line;
• Search publications on-line by topic
or keyword; and
• Sign up to receive local and national
tax news by email.
DVD for Tax Products. You can order
Pub. 1796, IRS Tax Products DVD, and
obtain:
• Current year forms, instructions, and
publications;

• Prior year forms, instructions, and
publications;
• Tax Map: An electronic research tool
and finding aid;
• Tax Law frequently asked questions;
• Tax Topics from the IRS telephone
response system;
• Fill-in, print, and save features for
most tax forms;
• Internal Revenue Bulletins; and
• Toll-free and email technical support.
The DVD is released twice during
the year. The first release will be
shipped
pp at the beginning of January
2011 and the final release will be
shipped
pp at the beginning of March
2011.
Purchase the DVD from the National
Technical Information Service (NTIS) at
www.irs.gov/cdorders for $30 (no
handling fee), or call 1-877-CDFORMS
(1-877-233-6767) toll-free to buy the
DVD for $30 (plus a $6 handling fee).
Price is subject to change.
By phone and in person. You can
order forms and publications by calling
1-800-TAX-FORM (1-800-829-3676).
You can also get most forms and
publications at your local IRS office.
For questions regarding this form,
call the Employee Plans Customer
Service, toll-free, at 1-877-829-5500.

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal
Revenue laws of the United States. If you want to have your plan approved by the IRS, you are required to give us the
information. We need it to determine whether you meet the legal requirements for plan approval.
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 or records relating to a form or its instructions must be retained as long
as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return
information are confidential, as required by section 6103.
The time needed to complete and file this form will vary depending on individual circumstances. The estimated average
time is:
Form 5300
Sch. Q (Form 5300)

Recordkeeping

Learning about the law or the form

Preparing the form

Copying, assembling, and sending the form

41 hr., 7 min.
6 hr.,13 min.

7 hr., 54 min.
9 hr., 14 min.

13 hr., 34 min.
9 hr., 45 min.

1hr., 20 min.

If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we
would be happy to hear from you. You can write to the Tax Products Coordinating Committee, 1111 Constitution Ave., NW,
IR-6526, Washington, DC 20224
Do not send any of these forms or schedules to this address. Instead, see Where To File on page 1.

-7-