Annual Return/Report of Employee Benefit Plan

Department of the Treasury
Internal Revenue Service

Department of Labor
Employee Benefits
Security Administration

Pension Benefit
Guaranty Corporation

20 11
Instructions for Form 5500-SF
Short Form Annual Return/Report of Small Employee Benefit Plan
Code section references are to the Internal Revenue
Code unless otherwise noted. ERISA refers to the
Employee Retirement Income Security Act of 1974.

Changes to Note

Authorized Service Provider Signatures. The instructions
have been updated to include the information in the EFAST2
Frequently Asked Questions explaining the circumstances
under which a service provider who manages the filing process
for the plan can get EFAST2 signing credentials and submit
the electronic Form 5500 for the plan.
Puerto Rico Plans. Reporting is clarified for certain Puerto
Rico plans. See the instructions to Line 9, Benefits Provided
Under Plan, on page 14.
Delinquent Contributions. The instructions for Line 10a have
been updated to advise that in the case of a plan with fewer
than 100 participants at the beginning of the plan year, any
amount deposited with such plan not later than the 7th
business day following the day on which such amount is
received by the employer (in the case of amounts that a
th
participant or beneficiary pays to an employer), or the 7
business day following the day on which such amount would
otherwise have been payable to the participant in cash (in the
case of amounts withheld by an employer from a participant’s
wages), shall be deemed to be contributed or repaid to such
plan on the earliest date on which such contributions or
participant loan repayments can reasonably be segregated
from the employer’s general assets. See 29 CFR 2510.3102(a)(2).
Schedule SB. The Schedule SB form and instructions have
been updated to reflect the provisions of the Preservation of
Access to Care for Medicare Beneficiaries and Pension Relief
Act of 2010 (PRA 2010). Additional changes have been made
to reflect changes under recent guidance, including final
regulations under certain portions of Code section 430
(sections 430(d), 430(f), 430(g), 430(h), and 430(i)) and Code
section 436 which were published in the Federal Register on
October 15, 2009. See the instructions to the Schedule SB for
more information.

Table of Contents
Page
EFAST2 Processing System ............................................. 1
How To Get Assistance .................................................... 1
General Instructions ....................................................... 2
Pension and Welfare Plans Required To File
Annual Return/Report............................................. 2
Plans Exempt from Filing ............................................. 3
Who May File ............................................................... 4
What To File ................................................................ 4
When To File ............................................................... 4
Extension of Time To File ............................................ 5

Delinquent Filer Voluntary Compliance (DFVC)
Program .................................................................. 5
Change in Plan Year .................................................... 5
Penalties ...................................................................... 5
How To File – Electronic Filing Requirement ............... 6
Signature and Date ...................................................... 7
Specific Instructions Only for “One-Participant
Plans” .................................................................... 7
Specific Line-by-Line Instructions ................................. 8
Part I – Annual Report Identification
Information.............................................................. 8
Part II – Basic Plan Information.................................... 9
Part III – Financial Information ................................... 12
Part IV – Plan Characteristics .................................... 14
Part V – Compliance Questions ................................. 14
Part VI – Pension Funding Compliance ..................... 17
Part VII – Plan Terminations and Transfers of
Assets ................................................................... 18
Paperwork Reduction Act Notice ..................................... 19
List of Plan Characteristics Codes................................... 20
Codes for Principal Business Activity .............................. 22
ERISA Compliance Quick Checklist ................................ 25
Index ............................................................................... 26

EFAST2 Processing System
Under the computerized ERISA Filing Acceptance System
(EFAST2), you must electronically file your 2011 Form
5500-SF, Short Form Annual Return/Report of Small
Employee Benefit Plan. You may file your 2011 Form
5500-SF online using EFAST2’s web-based filing system
or you may file through an EFAST2-approved vendor. You
cannot file a paper Form 5500-SF by mail or other delivery
service. For more information, see the instructions for
How To File – Electronic Filing Requirement on page 6
and the EFAST2 website at www.efast.dol.gov.

How To Get Assistance
If you need help completing this form, or have related
questions, call the EFAST2 Help Line at
1-866-GO-EFAST (1-866-463-3278) (toll free) or access
the EFAST2 or IRS websites. The EFAST2 Help Line is
available Monday through Friday from 8:00 am to 8:00
pm, Eastern Time.
You can access the EFAST2 website 24 hours a day,
7 days a week at www.efast.dol.gov to:
 File the Form 5500-SF or 5500 and any needed
schedules or attachments.
 Check on the status of a filing you submitted.
 View filings posted by EFAST2.
 Register for electronic credentials to sign or submit
filings.
 View forms and related instructions.

 Get information regarding EFAST2, including approved
software vendors.
 See answers to frequently asked questions about the
Form 5500-SF, the Form 5500 and its schedules, and
EFAST2.
 Access the main Employee Benefits Security
Administration (EBSA) and DOL websites for news,
regulations, and publications.
You can access the IRS website 24 hours a day, 7
days a week at www.irs.gov to:

pension plans covered by the PBGC have special additional
requirements, including filing premiums and reporting certain
transactions directly with that agency. See the PBGC’s
website at www.pbgc.gov/practitioners for information on
premium filings and reporting and disclosure requirements.
Note. The Form 5500-EZ generally is used by “oneparticipant plans” (as defined under Specific Instructions
Only for “One-Participant Plans” on page 7) that are not
subject to the requirements of section 104(a) of ERISA to
satisfy certain annual reporting and filing obligations
imposed by the Code. A “one-participant plan” may also be
eligible to file Form 5500-SF. See Specific Instructions Only
for “One-Participant Plans.” A “one-participant plan” that is
eligible to file Form 5500-SF may elect to file Form 5500-SF
electronically with EFAST2 rather than filing a Form 5500-EZ
on paper with the IRS. A “one-participant plan” that is not
eligible to file Form 5500-SF must file Form 5500-EZ on
paper with the IRS. For more information on filing with the
IRS, go to www.irs.gov or call 1-877-829-5500.

 View forms, instructions, and publications.
 See answers to frequently asked tax questions.
 Search publications online by topic or keyword.
 Send comments or request help by e-mail.
 Sign up to receive local and national tax news by email.
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).

Abbreviated filing requirements apply for oneparticipant plan filers who are eligible to file
Form 5500-SF. See Specific Instructions Only for
“One-Participant Plans” on page 7.

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

The Form 5500-SF must be filed electronically. See How To
File – Electronic Filing Requirement instructions on page 6
and the EFAST2 website at www.efast.dol.gov. Your Form
5500-SF entries will be initially screened electronically. Your
entries must satisfy this screening for your filing to be
received. Once received, your form may be subject to further
detailed review, and your filing may be rejected based upon
this further review.
ERISA and the Code provide for the assessment or
imposition of penalties for not submitting the required
information when due. See Penalties on page 5.

Plans required to file an annual return/report that are not
eligible to file the Form 5500-SF, must file a Form 5500,
Annual Return/Report of Employee Benefit Plan, with all
required schedules and attachments (Form 5500), or Form
5500-EZ, Annual Return of One-Participant (Owners and
Their Spouses) Retirement Plan.
To reduce the possibility of correspondence and penalties,
we remind filers that the Internal Revenue Service (IRS),
Department of Labor (DOL), and Pension Benefit Guaranty
Corporation (PBGC) have consolidated their annual
return/report forms to minimize the filing burden for
employee benefit plans. Administrators and sponsors of
employee benefit plans generally will satisfy their IRS and
DOL annual reporting requirements for the plan under
ERISA sections 104 and 4065 and Code sections 6058 and
6059 by filing either the Form 5500, Form 5500-SF, or Form
5500-EZ. Defined contribution and defined benefit pension
plans may have to file additional information with the IRS
including: Form 8955-SSA, Annual Registration Statement
Identifying Separated Participants with Deferred Vested
Benefits.; Form 5330, Return of Excise Taxes Related to
Employee Benefit Plans; Form 5310-A, Notice of Plan
Merger or Consolidation, Spinoff, or Transfer of Plan Assets
or Liabilities; Notice of Qualified Separate Lines of Business.
See www.irs.gov for more information. Defined benefit
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Annual returns/reports filed under Title I of ERISA must be
made available by plan administrators to plan participants
and beneficiaries and by the DOL to the public pursuant to
ERISA sections 104 and 106. Pursuant to Section 504 of
the Pension Protection Act of 2006 (PPA), this availability
for defined benefit pension plans must include the posting
of identification and basic plan information and actuarial
information (Form 5500-SF, Schedule SB or MB, and all
of the Schedule SB or MB attachments) 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 and later Forms 5500-SF, including actuarial
information, see www.dol.gov/ebsa. See
www.dol.gov/ebsa/actuarialsearch.html for 2008 and short
plan year 2009 actuarial information filed under the
previous paper-based system.

Pension and Welfare Plans
Required To File Annual
Return/Report
All pension benefit plans and welfare benefit plans covered
by ERISA must file a Form 5500 or Form 5500-SF for a
plan year unless they are eligible for a filing exemption.
General Instructions to Form 5500-SF

(See Code sections 6058 and 6059 and ERISA sections
104 and 4065). An annual return/report must be filed even
if the plan is not “tax qualified,” benefits no longer accrue,
contributions were not made during this plan year, or
contributions are no longer made. Pension benefit plans
required to file include both defined benefit plans and
defined contribution plans. Profit-sharing plans, stock
bonus plans, money purchase plans, 401(k) plans, Code
section 403(b) plans covered by Title I of ERISA, and IRA
plans established by an employer are among the pension
benefit plans for which an annual return/report must be
filed. Welfare benefit plans provide benefits such as
medical, dental, life insurance, apprenticeship and training,
scholarship funds, severance pay, disability, etc. Plans that
cover residents of Puerto Rico, the U.S. Virgin Islands,
Guam, Wake Island, or American Samoa also must file
unless they are eligible for a filing exemption. This includes
a plan that elects to have the provisions of section
1022(i)(2) of ERISA apply.
For more information about annual return/report filings
for Code section 403(b) plans covered by Title I of
ERISA, see Field Assistance Bulletins 2009-02 and 201001, available on the DOL website at www.dol.gov.

10. A governmental plan.
11. An unfunded pension benefit plan or an unfunded
or insured welfare benefit plan: (a) whose benefits go only
to a select group of management or highly compensated
employees, and (b) which meets the terms of 29 CFR
2520.104-23 (including the requirement that a registration
statement be timely filed with DOL) or 29 CFR 2520.10424.
12. A welfare benefit plan that covers fewer than 100
participants as of the beginning of the plan year and is
unfunded, fully insured, or a combination of insured and
unfunded. For this purpose:
a. An unfunded welfare benefit plan has its benefits
paid as needed directly from the general assets of the
employer or the employee organization that sponsors the
plan.
Note. Plans that are NOT unfunded include those plans
that received employee (or former employee)
contributions during the plan year and/or used a trust or
separately maintained fund (including a Code section
501(c)(9) trust) to hold plan assets or act as a conduit for
the transfer of plan assets during the plan year. A welfare
benefit plan with employee contributions that is associated
with a cafeteria plan under Code section 125 may be
treated for annual reporting purposes as an unfunded
welfare benefit plan if it meets the requirements of DOL
Technical Release 92-01, 57 Fed. Reg. 23272 (June 2,
1992) and 58 Fed. Reg. 45359 (Aug. 27, 1993). The mere
receipt of COBRA contributions or other after-tax
participant contributions (e.g., retiree contributions) by a
cafeteria plan would not by itself affect the availability of
the relief provided for cafeteria plans that otherwise meet
the requirements of DOL Technical Release 92-01. See
61 Fed. Reg. 41220, 41222-23 (Aug. 7, 1996).

Plans Exempt From Filing
Under regulations and applicable guidance, some pension
benefit plans and many welfare benefit plans with fewer
than 100 participants are exempt from filing an annual
return/report. Do not file a Form 5500-SF for an employee
benefit plan that is any of the following:
1. An unfunded excess benefit plan. See ERISA section
4(b)(5).
2. A pension benefit plan maintained outside the United
States primarily for the benefit of persons substantially all
of whom are nonresident aliens. However, certain foreign
plans are required to file the Form 5500-EZ with the IRS.
See the instructions to the Form 5500-EZ for the filing
requirements. For more information, go to www.irs.gov/ep
or call 1-877-829-5500.
3. An annuity or custodial account arrangement under
Code section 403(b)(1) or (7) not established or maintained
by an employer as described in DOL Regulations 29 CFR
2510.3-2(f).
4. A simplified employee pension (SEP) described in
Code section 408(k) that conforms to the alternative
method of compliance described in 29 CFR 2520.104-48
or 29 CFR 104-49. A SEP is a pension plan that meets
certain minimum qualifications regarding eligibility and
employer contributions.
5. A Savings Incentive Match Plan for Employees of
Small Employers (SIMPLE) that involves SIMPLE IRAs
under Code section 408(p).
6. A church pension benefit plan not electing coverage
under Code section 410(d).
7. An unfunded dues financed pension benefit plan
that meets the alternative method of compliance provided
by 29 CFR 2520.104-27.
8. An individual retirement account or annuity not
considered a pension plan under 29 CFR 2510.3-2(d).
9. A “one-participant plan,” as defined on page 7.
However, certain one-participant plans are required to file
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 EFAST2. See page 7.
General Instructions to Form 5500-SF

b. A fully insured welfare benefit plan has its benefits
provided exclusively through insurance contracts or
policies, the premiums of which must be paid directly to
the insurance carrier by the employer or employee
organization from its general assets or partly from its
general assets and partly from contributions by its
employees or members (which the employer or employee
organization forwards within 3 months of receipt). The
insurance contracts or policies discussed above must be
issued by an insurance company or similar organization
(such as Blue Cross, Blue Shield or a health maintenance
organization) that is qualified to do business in any state.
c. A combination unfunded/insured welfare benefit plan
has its benefits provided partially as an unfunded plan and
partially as a fully insured plan. An example of such a plan
is a welfare benefit plan that provides medical benefits as
in “a” above and life insurance benefits as in “b” above.
See 29 CFR 2520.104-20.
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).
13. Plans maintained only to comply with workers’
compensation, unemployment compensation, or disability
insurance laws.
14. A welfare benefit plan maintained outside the
United States primarily for persons substantially all of
whom are nonresident aliens.
15. A church welfare benefit plan under ERISA section
3(33).
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16. An unfunded dues financed welfare benefit plan
that meets the alternative method of compliance provided
by 29 CFR 2520.104-26.
17. A welfare benefit plan that participates in a group
insurance arrangement that files a return/report on its
behalf under 29 CFR 2520.104-43. A group insurance
arrangement generally is an arrangement that provides
benefits to the employees of two or more unaffiliated
employers (not in connection with a multiemployer plan or
a collectively bargained multiple-employer plan), fully
insures one or more welfare benefit plans of each
participating employer, uses a trust (or other entity such
as a trade association) as the holder of the insurance
contracts, and uses a trust as the conduit for payment of
premiums to the insurance company.
18. An apprenticeship or training plan meeting all of
the conditions specified in 29 CFR 2520.104-22.
For more information on plans that are exempt from filing
an annual return/report, call the EFAST2 Help Line at 1866-GO-EFAST (1-866-463-3278). For one-participant
plan filers, see the Instructions for Form 5500-EZ or call
the IRS Help Line at 1-877-829-5500.

Who May File Form 5500-SF
If your plan is required to file an annual return/report, you
may file the Form 5500-SF instead of the Form 5500 only
if you meet all of the eligibility conditions listed below.
1. The plan (a) covered fewer than 100 participants at
the beginning of the plan year 2011, or (b) under 29 CFR
2520.103-1(d) was eligible to and filed as a small plan for
plan year 2010 and did not cover more than 120
participants at the beginning of plan year 2011 (see
instructions for line 5 on counting the number of
participants);
2. The plan did not hold any employer securities at any
time during the plan year;
3. At all times during the plan year, the plan was 100%
invested in certain secure, easy to value assets that meet
the definition of “eligible plan assets” (see the instructions
for line 6a), such as mutual fund shares, investment
contracts with insurance companies and banks valued at
least annually, publicly traded securities held by a
registered broker dealer, cash and cash equivalents, and
plan loans to participants;
4. The plan is eligible for the waiver of the annual
examination and report of an independent qualified public
accountant (IQPA) under 29 CFR 2520.104-46 (but not by
reason of enhanced bonding), which requirement
includes, among others, giving certain disclosures and
supporting documents to participants and beneficiaries
regarding the plan’s investments (see instructions for line
6b); and
5. The plan is not a multiemployer plan.
Note. Employee Stock Ownership Plans (ESOPs) and
Direct Filing Entities (DFEs) may not file the Form 5500SF.
Note. One-participant plans should follow the Specific
Instructions Only for “One-Participant Plans” in place of
the instructions 1–5 above to see if Form 5500-SF may be
filed instead of Form 5500-EZ.

What To File
Plans required to file an annual return/report that meet all
of the conditions for filing the Form 5500-SF may
complete and file the Form 5500-SF in accordance with its
instructions. Single-employer defined benefit pension
plans using the Form 5500-SF must also file the Schedule
SB (Form 5500), Single-Employer Defined Benefit Plan
Actuarial Information, and its required attachments.
Money purchase plans amortizing a funding waiver using
the Form 5500-SF must also file the Schedule MB (Form
5500), Multiemployer Defined Benefit Plan and Certain
Money Purchase Plan Actuarial Information, and its
required attachments. For information about Schedule SB
and Schedule MB, see the 2011 Instructions for Form
5500, Annual Return/Report of Employee Benefit Plan.
One-participant plans see Specific Instructions Only for
“One-Participant Plans.”
Eligible Combined Plans. The Pension Protection Act of
2006 (PPA) established rules for a new type of pension
plan, an “eligible combined plan,” effective for plan years
beginning after December 31, 2009. See Code section
414(x) and ERISA section 210(e). An eligible combined
plan consists of a defined benefit plan and a defined
contribution plan that includes a qualified cash or deferred
arrangement under Code section 401(k), with the assets
of the two plans held in a single trust, but clearly identified
and allocated between the plans. The eligible combined
plan design is available only to employers that employed
an average of at least two, but not more than 500
employees, on each business day during the calendar
year preceding the plan year as of which the eligible
combined plan is established and that employs at least
two employees on the first day of the plan year. Because
an eligible combined plan includes both a defined benefit
plan and a defined contribution plan, the Form 5500-SF
filed for the plan must include all the information,
schedules, and attachments that would be required for
either a defined benefit plan (such as a Schedule SB) or a
defined contribution plan.

When To File
File the 2011 Form 5500-SF for plan years that began in
2011. The form, and any required schedules and
attachments, must be filed by the last day of the 7th
calendar month after the end of the plan year (not to
exceed 12 months in length) that began in 2011.
Short Years. For a plan year of less than 12 months
(short plan year), file the form and applicable schedules
by the last day of the 7th calendar month after the short
plan year ends or by the extended due date, if filing under
an authorized extension of time. Fill in the short plan year
beginning and ending dates in the space provided and
check the appropriate box in Part I, line B, of the Form
5500-SF. For purposes of this return/report, a short plan
year ends on the date of the change in accounting period
or upon the complete distribution of assets of the plan.
Also see the instructions for Final Return/Report to
determine if “the final return/report” box in line B should be
checked.
Notes. (1) If the filing due date falls on a Saturday,
Sunday, or Federal holiday, the return/report may be filed

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General Instructions to Form 5500-SF

on the next day that is not a Saturday, Sunday, or Federal
holiday. (2) If the 2012 Form 5500 is not available before
the plan or DFE filing, use the 2011 Form 5500 and enter
the 2012 fiscal year beginning and ending dates on the
line provided at the top of the form.

complying with their DOL annual reporting obligations. If
the Form 5500-SF is being filed under the DFVC Program,
check the appropriate box on Form 5500-SF, Part I, line C
to indicate that the Form 5500-SF is being filed under the
DFVC Program. See www.efast.dol.gov for additional
information.
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.

Extension of Time To File
Using Form 5558
If filing under an extension of time based on the filing of an
IRS Form 5558, Application for Extension of Time To File
Certain Employee Plan Returns, check the appropriate box
on the Form 5500-SF, Part I, line C. A one-time extension
of time to file the Form 5500-SF (up to 2 ½ months) may be
obtained by filing Form 5558 on or before the normal due
date (not including any extensions) of the return/report.
You must file the Form 5558 with the Department of
Treasury, Internal Revenue Service Center, Ogden, UT
84201-0045. Approved copies of the Form 5558 will not be
returned to the filer. A copy of the completed extension
request must be retained with the plan’s records.

Change in Plan Year
Generally, only defined benefit pension plans need to get
approval for a change in plan year. See Code section
412(d)(1). However, under Rev. Proc. 87-27, 1987-1 C.B.
769, these pension plans may be eligible for automatic
approval of a change in plan year.
If a change in plan year for a pension or a welfare
benefit plan creates a short plan year, file the form and
applicable schedules by the last day of the 7th calendar
month after the short plan year ends or by the extended
due date, if filing under an authorized extension of time.
Fill in the short plan year beginning and ending dates in
the space provided in Part I and check the appropriate
box in Part I, line B of the Form 5500-SF. For purposes of
this return/report, the short plan year ends on the date of
the change in accounting period or upon the complete
distribution of assets of the plan. Also, see the instructions
for Final Return/Report to determine if “final return/report”
in line B should be checked.

Using Extension of Time To File Federal
Income Tax Return
An automatic extension of time to file Form 5500-SF until
the due date of the federal income tax return of the
employer will be granted if all of the following conditions
are met: (1) the plan year and the employer’s tax year are
the same; (2) the employer has been granted an
extension of time to file its federal income tax return to a
date later than the normal due date for filing the Form
5500-SF; and (3) a copy of the application for extension of
time to file the federal income tax return is maintained with
the filer’s records. An extension of time granted by using
this automatic extension procedure CANNOT be extended
further by filing an IRS Form 5558, nor can it be extended
beyond a total of 9 ½ months beyond the close of the plan
year.

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

Notes. (1) If the filing due date falls on a Saturday,
Sunday, or Federal holiday, the return/report may be filed
on the next day that is not a Saturday, Sunday, or Federal
holiday. (2) If the 2012 Form 5500 is not available before
the plan or DFE filing is due, use the 2011 Form 5500 and
enter the 2012 fiscal year beginning and ending dates on
the line provided at the top of the form.

Other Extensions of Time
The IRS, DOL, and PBGC may announce special
extensions of time under certain circumstances, such as
extensions for Presidentially-declared disasters or for
service in, or in support of, the Armed Forces of the
United States in a combat zone. See www.irs.gov,
www.efast.dol.gov, and www.pbgc.gov/practitioners for
announcements regarding such special extensions. If you
are relying on one of these announced special extensions,
check the appropriate box on the Form 5500-SF, Part I,
line C, and enter a description of the announced authority
for the extension.

Administrative Penalties
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 and

Delinquent Filer Voluntary
Compliance (DFVC) Program
The DFVC Program facilitates voluntary compliance by
plan administrators who are delinquent in filing annual
return/report forms under Title I of ERISA by permitting
administrators to pay reduced civil penalties for voluntarily
General Instructions to Form 5500-SF

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accurate annual return/report. See ERISA section
502(c)(2) and 29 CFR 2560.502c-2.
2. A penalty of $25 a day (up to $15,000) for not filing
the annual return/report for certain plans of deferred
compensation, trusts and annuities, and bond purchase
plans by the due date(s). See Code section 6652(e).
3. A penalty of $1,000 for not filing an actuarial
statement (Schedule MB (Form 5500) or Schedule SB
(Form 5500)) required by the applicable instructions. See
Code section 6692.

attach, as required, any applicable schedules and
attachments.
 Do not enter “N/A” or “Not Applicable” on the Form
5500-SF or Schedules SB (Form 5500) and MB (Form
5500) unless specifically permitted. “Yes” or “No”
questions on the form and schedules cannot be left
blank, unless specifically permitted. Answer “Yes” or
“No,” but not both.
 Use the correct employer identification number (EIN)
and plan number (PN) for the plan.
You should check your return/report for errors before
signing or submitting it to EFAST2. Your filing software or,
if you are using it, the EFAST2 web-based filing system
will allow you to check your return/report for errors. If, after
reasonable attempts to correct your filing to eliminate any
identified problem or problems, you are unable to address
them, or you believe that you are receiving the message
in error, call the EFAST2 Help Line at 1-866-GO-EFAST
(1-866-463-3278) or contact the service provider you used
to help prepare and file your annual return/report.

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

How To File – Electronic Filing
Requirement
Under the computerized ERISA Filing Acceptance System
(EFAST2), you must file your 2011 Form 5500-SF
electronically. You may file your 2011 Form 5500-SF
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 (1-866-4633278). The EFAST2 Help Line is available Monday
through Friday from 8:00 am to 8:00 pm, Eastern Time.
Annual returns/reports filed under Title I of ERISA,
including those filed using the Form 5500-SF, must
be made available by the plan administrators to
plan participants and beneficiaries and by the DOL to the
public pursuant to ERISA sections 104 and 106. Even
though the Form 5500-SF must be filed electronically, the
plan administrator must keep a copy of the Form 5500-SF,
including schedules and attachments, with all required
signatures on file as part of the plan’s records, and must
make a paper copy available on request to participants,
beneficiaries, and the DOL as required by section 104 of
ERISA and 29 CFR 2520.103-1. Filers may use electronic
media for record maintenance and retention, so long as
they meet the applicable requirements.
Generally, questions on the Form 5500-SF relate to
the plan year entered at the top of the first page of the
form. Therefore, answer all questions on the 2011 Form
5500-SF with respect to the 2011 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-SF unless
otherwise specified. Also complete and electronically

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. 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 the system by
calling the EFAST2 Help Line at 1-866-GO-EFAST (1866-463-3278) and using the automated telephone
system.
To reduce the possibility of correspondence and
penalties from the DOL, IRS, and/or PBGC, you should do
the following: (1) Before submitting your return/report to
EFAST2, check it for errors, and (2) after you have
submitted it to EFAST2, verify that you have received a
filing status of “Filing_Received” and attempt to correct
and resolve any errors or warnings listed in the status
report.
Note. Even after being received by the EFAST2 system,
your return/report filing may be subject to further detailed
review by DOL, IRS, and/or PBGC, and your filing may be
deemed deficient based upon this further review. See
Penalties on page 5.
The Form 5500-SF, Schedules SB (Form 5500) and
MB (Form 5500), and any attachments that are filed under
ERISA are open to public inspection, and the contents are
public information subject to publication on the Internet.
Do not enter social security numbers in response
to questions asking for an employer identification

-6-

General Instructions to Form 5500-SF

option, see EFAST2 All-Electronic Filing System FAQs at
www.dol.gov/ebsa/faqs/faq-EFAST2.html.

number (EIN). Because of privacy concerns, the inclusion
of a social security number on the Form 5500-SF or on a
schedule or attachment that is open to public inspection
may result in the rejection of the filing. If you discover a
filing disclosed on the EFAST2 website that contains a
social security number, immediately call the EFAST2 Help
Line at 1-866-GO-EFAST (1-866-463-3278).
Do not attach a copy of the annual registration statement
identifying separated participants with deferred vested
benefits, or a previous year’s Schedule SSA (Form 5500)
to your 2011 Form 5500-SF annual return/report. The
annual registration statement must be filed directly with
the IRS and cannot be attached to a Form 5500-SF
submission with EFAST2.

Service providers should consider implications of
IRS tax return preparer rules.
Note. The Code permits either the plan
sponsor/employer or the administrator to sign the filing.
Therefore, in the case of a Form 5500-SF filed for a “oneparticipant plan” not subject to Title I of ERISA that is filing
a Form 5500-SF with EFAST2 in lieu of filing a Form
5500-EZ on paper with the IRS (see Specific Instructions
Only for “One-Participant Plans”), either may sign.
However, any other Form 5500-SF that is not
electronically signed by the plan administrator will be
subject to rejection and civil penalties under Title I of
ERISA.

Employers without an employer identification number
(EIN) must apply to the IRS for one as soon as possible.
The EBSA does not issue EINs. To apply for an EIN from
the IRS:
 Mail or fax Form SS-4, Application for Employer
Identification Number, obtained by calling 1-800-TAXFORM (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.)

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

Signature and Date

Specific Instructions Only for
“One-Participant Plans”

For purposes of Title I of ERISA, the plan administrator is
required to file the Form 5500 or 5500-SF. Thus, the plan
administrator or, if the plan administrator is an entity, a
person authorized to sign on behalf of the plan
administrator must electronically sign the Form 5500 or
5500-SF submitted to EFAST2. If the plan administrator
does not sign a filing, the filing status will indicate that
there is an error with your filing, and your filing will be
subject to further review, correspondence, rejection, and
civil penalties.

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

Authorized Service Provider Signatures. If the plan
administrator elects to have a service provider who
manages the filing process for the plan get EFAST2
signing credentials and submit the electronic Form 5500SF for the plan: 1) the service provider must receive
specific written authorization from the plan administrator to
submit the plan’s electronic filing; 2) the plan administrator
must manually sign a paper copy of the electronically
completed Form 5500-SF, and the service provider must
include a PDF copy of the first two pages of the manually
signed Form 5500-SF as an attachment to the electronic
Form 5500-SF submitted to EFAST2; 3) the service
provider must communicate to the plan administrator any
inquiries received from EFAST2, DOL, IRS or PBGC
regarding the filing; 4) the service provider must
communicate to the plan administrator that, by electing to
use this option, the image of the plan administrator’s
manual signature will be included with the rest of the
return/report posted by the Labor Department on the
Internet for public disclosure; and 5) the plan administrator
must keep the manually signed copy of the Form 5500SF, with all required schedules, as part of the plan’s
records. For more information on the electronic signature
General Instructions to Form 5500-SF

-7-

Conditions for Filing. One-participant plan filers that meet the
following conditions are eligible to file a Form 5500-SF.
1. The plan is a “one-participant plan.” This means either:
a. The plan only covers you (or you and your spouse)
and you (or you and your spouse) own the entire business
(which may be incorporated or unincorporated) or
b. The plan only covers one or more partners (or
partner(s) and spouse(s)) in a business partnership.
2. The plan does not provide benefits for anyone except you,
or you and your spouse, or one or more partners and their
spouses.
3. The plan covered fewer than 100 participants at the
beginning of the plan year.
If you do not meet ALL the conditions listed above, you are
not a one-participant plan filer who is eligible to file Form
5500-SF instead of Form 5500-EZ. You must file a paper
Form 5500-EZ with the IRS if you meet the first two
conditions but do not meet the third condition.
Eligible one-participant plans need complete only the
following questions on the Form 5500-SF:







Part I, lines A, B, and C;
Part II, lines 1a–5b;
Part III, lines 7a–c, and 8a;
Part IV, line 9a;
Part V, line 10g; and
Part VI, lines 11–12e.

Schedule MB (Form 5500). If a money purchase defined
contribution plan (including a target benefit plan) has
received a waiver of the minimum funding standard, and the
waiver is currently being amortized, complete lines 3, 9, and
10 of Schedule MB (Form 5500). See the Instructions for
Schedule MB in the Instructions for Form 5500. Oneparticipant plans, however, do not attach Schedule MB to the
Form 5500-SF. Instead, one-participant plans must keep the
completed Schedule MB in accordance with the applicable
records retention requirements.
Schedule SB (Form 5500). One-participant plans do not
attach Schedule SB (Form 5500) to the Form 5500-SF.
Instead, one-participant plans must keep the completed
Schedule SB that is signed by the plan actuary in
accordance with the applicable records retention
requirements. Actuaries of one-participant plans that are
defined benefit plans subject to the minimum funding
standards for this plan year, must complete Schedule SB
(Form 5500) and forward the completed and signed
Schedule SB to the plan administrator no later than the filing
due date. See the Instructions for Schedule SB in the
Instructions for Form 5500.
Filing Form 5500-EZ with the IRS. If you are filing a paper
form, you must file the Form 5500-EZ with the IRS using the
following address: Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201-0027. You may
order the paper Form 5500-EZ and its instructions by calling
1-800-TAX-FORM (1-800-829-3676) or visiting the IRS
website at www.irs.gov/formspubs/.
Filing an amendment. If you are filing an amendment for
a “one-participant plan” that filed a Form 5500-SF
electronically, you may submit the amendment either
electronically using the Form 5500-SF with EFAST2 or on
paper using the Form 5500-EZ with the IRS. If you are
filing an amendment for a “one-participant plan” that
-8-

previously filed on a paper Form 5500-EZ, you must
submit the amendment using the paper Form 5500-EZ
with the IRS.

Specific Line-by-Line Instructions
(Form 5500-SF)
Part I – Annual Report Identification
Information
Check only one of the line A box choices.
Line A – Box for Single-Employer Plan. Check this box if
the Form 5500-SF is filed for a single-employer plan. A
single-employer plan for purposes of the Form 5500-SF is an
employee benefit plan maintained by one employer or one
employee organization.
Note. A “controlled group” is generally considered one
employer for Form 5500 and Form 5500-SF reporting
purposes. A “controlled group” is a controlled group of
corporations under Code section 414(b), a group of trades or
businesses under common control under Code section
414(c), or an affiliated service group under Code section
414(m). A separate annual return/report with line A (singleemployer 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.
Line A – Box for Multiple-Employer Plan. Check this box if
the Form 5500-SF is being filed for a multiple-employer plan.
For purposes of the Form 5500-SF, a multiple-employer plan
is a plan that is maintained by more than one employer and
is not a single-employer plan or a multiemployer plan.
Multiple-employer plans can be collectively bargained and
collectively funded, but if covered by PBGC termination
insurance, they must have properly elected before
September 27, 1981, not to be treated as a multiemployer
plan under Code section 414(f)(5) or ERISA sections
3(37)(E) and 4001(a)(3), and have not revoked that election
or made an election to be treated as a multiemployer plan
under Code section 414(f)(6) or ERISA section 3(37)(G).
Participating employers do not file individually for multipleemployer plans.
Note. Do not check this box if all of the employers
maintaining the plan are members of the same controlled
group or affiliated service group under Code sections 414(b),
(c), or (m).
Multliemployer plans cannot use the Form 5500-SF
to satisfy their annual reporting obligations. They
must file the Form 5500. For these purposes, a
plan is a multiemployer plan if: (a) more than one employer
is required to contribute; (b) the plan is maintained pursuant
to one or more collective bargaining agreements between
one or more employee organizations and more than one
employer; (c) an election under Code section 414(f)(5) and
ERISA section 3(37)(E) has not been made; and (d) the plan
meets any other applicable conditions of 29 CFR 2510.3-37.
A plan that made a proper election under ERISA section
3(37)(G) and Code section 414(f)(6) on or before Aug. 17,
2007, is also a multiemployer plan.
Line A – Box for One-Participant Plan. Check this box if
the Form 5500-SF is being filed for a plan that is a “oneparticipant plan” (see page 7). Check the one-participant
General Instructions to Form 5500-SF

Line B – Box for Short Plan Year Return/Report.
Check this box if this Form 5500-SF is being filed for a
plan year period of less than 12 months. Provide the
dates in Part I, Plan Year Beginning and Ending.

plan box only for those plans that are submitting the Form
5500-SF in place of a Form 5500-EZ (on paper) to satisfy
the annual return/report filing obligations under the Code.
Plans checking the box for one-participant plan should not
check either the box for single-employer plan or the box for
multiple-employer plan. See Specific Instructions Only for
“One-Participant Plans.”

Line C – Box for Extension and DFVC Program.
Check the appropriate box here if:
 You filed for an extension of time to file this form with
the IRS using Form 5558, Application for Extension of
Time To File Certain Employee Plan Returns, and
maintain a copy of the Form 5558 with the filer’s records.

Line B – Box for First Return/Report. Check this box if an
annual return/report has not been previously filed for this
plan. For the purpose of completing this box, the Form 5500EZ is not considered an annual return/report.

 You are filing using the automatic extension of time to
file the Form 5500-SF return/report until the due date of
the federal income tax return of the employer and
maintain a copy of the employer’s extension of time to file
the income tax return with the plan’s records.

Line B – Box for Amended Return/Report. Check this box
if you have already filed for the 2011 plan year and are now
filing an amended return/report to correct errors and/or
omissions on the previously filed return/report.
Check the line B box for an “amended return/report”
if you filed a previous 2011 annual return/report that
was given a “Filing_Received,” “Filing_Error,” or
“Filing_Stopped” status by EFAST2. Do not check the line B
box for an “amended return/report” if your previous
submission attempts were not successfully received by
EFAST2 because of problems with the transmission of your
return/report. For more information, go to the EFAST2
website at www.efast.dol.gov or call the EFAST2 Help line at
1-866-GO-EFAST (1-866-463-3278).



 You are filing using a special extension of time to file
the Form 5500-SF annual return/report that has been
announced by the IRS, DOL, or PBGC. If you checked
that you are using a special extension of time, enter a
description of the extension of time in the space provided.

Part II – Basic Plan Information

If you need to file an amended return/report to correct
errors and/or omissions in a previously filed annual
return/report for the 2011 plan year AND you are eligible to
file the Form 5500-SF, you may use the Form 5500-SF even
if the original filing was a Form 5500. If you filed a Form
5500-SF, but determine that you were not eligible to file the
Form 5500-SF, you must use the Form 5500 or Form 5500EZ to amend your return/report.

Line 1a. Enter the formal name of the plan or enough
information to identify the plan. Abbreviate if necessary.
If an annual return/report has previously been filed on
behalf of the plan, regardless of the type of Form that
was filed (Form 5500, Form 5500-EZ, or Form 5500SF), use the same name or abbreviations that were
used on the prior filings. Once you use an abbreviation,
continue to use it for that plan on all future annual
return/report filings with the IRS, DOL, and PBGC. Do
not use the same name or abbreviation for any other
plan, even if the first plan is terminated.

Line B – Box for Final Return/Report. Check this box if
this is the final report for the plan. Only check this box if all
assets under the plan (including insurance/annuity contracts)
have been distributed to the participants and beneficiaries or
legally transferred to the control of another plan, and when
all liabilities for which benefits may be paid under a welfare
benefit plan have been satisfied. Do not mark the final
return/report box if you are reporting participants and/or
assets at the end of the plan year. If a trustee is appointed
for a terminated defined benefit plan pursuant to ERISA
section 4042, the last plan year for which a return/report
must be filed is the year in which the trustee is appointed.

Line 1b. Enter the three-digit plan or entity number (PN)
that the employer or plan administrator assigned to the
plan. This three-digit number, in conjunction with the
employer identification number (EIN) entered on line 2b,
is used by the IRS, DOL, and PBGC as a unique 12digit number to identify the plan.
Start at 001 for plans providing pension benefits.
Start at 501 for welfare plans. Do not use 888 or 999.

Examples:

Once you use a plan number, continue to use it for
that plan on all future filings with the IRS, DOL, and
PBGC. Do not use it for any other plan, even if the first
plan is terminated.

Mergers/Consolidations. A final return/report should be
filed for the plan year (12 months or less) that ends when all
plan assets were legally transferred to the control of another
plan.
Pension and Welfare Plans That Terminated Without
Distributing All Assets. If the plan was terminated but all
plan assets were not distributed, a return/report must be filed
for each year the plan has assets. The return/report must be
filed by the plan administrator, if designated, or by the
person or persons who actually control the plan’s assets/
property.

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

Assign PN

Codes are entered in line 9a

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

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

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



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).
General Instructions to Form 5500-SF

You are filing under the DFVC Program.

-9-



Exception. If 333 (or a higher number in a sequence
beginning with 333) was previously assigned to the plan, that
number may be entered on line 1b.
Line 1c. Enter the date the plan first became effective.
Line 2a. Limit your response to the information required in
each row as specified below:
1. Enter the plan sponsor’s (employer, if for a singleemployer plan) name, postal address (only use a P.O. Box
number if the Post Office does not deliver mail to the
employer’s street address), foreign routing code where
applicable, and “D/B/A” (doing business as) or trade name of
the employer if different from the employer’s name.
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.
Note. In the case of a multiple-employer plan, file only one
annual return/report for the plan. If an association or other
entity is not the sponsor, enter the name of a participating
employer as sponsor. For a plan of a controlled group of
corporations, the name of one of the sponsoring members
should be entered. In either case, the same name must be
used in all subsequent filings of the Form 5500 return/report
or Form 5500-SF for the multiple-employer plan or controlled
group (see instructions for line 4 concerning change in
sponsorship).
Line 2b. Enter the employer’s nine-digit employer
identification number (EIN). Do not use a social security
number (SSN). A Form 5500-SF that is filed under ERISA is
open to public inspection and the contents are public
information and are subject to publication on the Internet.
Because of privacy concerns, the inclusion of a social
security number on this line may result in the rejection of the
filing.
Employers without an EIN number must apply to the IRS
for one as soon as possible. The EBSA does not issue EINs.
To apply for an EIN from the IRS:
 Mail or fax Form SS-4, Application for Employer
Identification Number, obtained by calling 1-800-TAX-FORM
(1-800-829-3676) 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.)
A multiple-employer plan or plan of a controlled group of
corporations should use the EIN number of the sponsor
identified in line 2a. The EIN must be used in all subsequent
filings of the Form 5500-SF (or any subsequent Form 5500
-10-

or Form 5500-EZ in a year where the plan is not eligible to
file the Form 5500-SF) for these plans. (See instructions to
line 4 concerning change in EIN).
Note. EINs for funds (trusts or custodial accounts)
associated with plans are generally not required to be
furnished on the Form 5500-SF. The IRS, however, will
issue EINs for such funds for other reporting purposes.
EINs may be obtained as explained above. Plan
sponsors should use the trust EIN when opening a bank
account or conducting other transactions for a trust.
Line 2c. Enter the telephone number for the plan
sponsor. Use numbers only, including area code, and
do not include any special characters.
Line 2d. Enter the six-digit business code that best
describes the nature of the plan sponsor’s business
from the list of business codes on pages 22-24. 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. Limit your response to the information required
in each row as specified below:
1. Enter the name of the plan administrator unless the
administrator is the sponsor identified in line 2. If this is
the case, enter the word “same” on line 3a and leave
the remainder of line 3a and all of lines 3b and 3c blank.
If the administrator is not the plan sponsor, also enter on
line 3a the postal address (only use a P.O. Box number
if the Post Office does not deliver mail to the
administrator’s street address), and foreign routing code
where applicable.
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.
Plan administrator for this purpose means:
 The person or group of persons specified as the
administrator by the instrument under which the plan is
operated;
 The plan sponsor/employer if an administrator is not so
designated; or
 Any other person prescribed by applicable regulations
if an administrator is not designated and a plan sponsor
cannot be identified.
Line 3b. Enter the plan administrator’s nine-digit EIN. A
plan administrator must have an EIN for Form 5500-SF
reporting. If the plan administrator does not have an EIN, it
must apply to the IRS for one as explained in the
instructions for line 2b. One EIN should be entered for a
group of individuals who are, collectively, the plan
administrator.
Note. Employees of the plan sponsor who perform
administrative functions for the plan are generally not the
plan administrator unless specifically designated in the
plan document. If an employee of the plan sponsor is
designated as the plan administrator, that employee must
obtain an EIN.
General Instructions to Form 5500-SF

Line 3c. Enter the telephone number for the plan
administrator.
Line 4. If the plan sponsor’s name and/or EIN have
changed since the last annual return/report was filed for
this plan, enter the plan sponsor’s name, EIN, and the
plan number as it appeared on the last annual return/
report filed.

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.

Failure to indicate on line 4 that a plan sponsor
was previously identified by a different name or a
different employer identification number (EIN)
could result in correspondence from the DOL and the IRS.

For pension benefit plans, “alternate payees” entitled to
benefits under a qualified domestic relations order (QDRO)
are not to be counted as participants for this line.

Line 5. Enter in element (a) the total number of
participants at the beginning of the plan year. Enter in
element (b) the total number of participants at the end of
the plan year. Enter in element (c) the total number of
participants with account balances as of the end of the
plan year. Welfare benefit plans and defined benefit plans
do not complete element (c).
The description of “participant” in the following
instructions is only for purposes of these lines.
An individual becomes a participant covered under an
employee welfare benefit plan on the earliest of:
 The date designated by the plan as the date on which the
individual begins participation in the plan;
 The date on which the individual becomes eligible under
the plan for a benefit subject only to occurrence of the
contingency for which the benefit is provided; or
 The date on which the individual makes a contribution to
the plan, whether voluntary or mandatory.
See 29 CFR 2510.3-3(d)(1). This includes former
employees who are receiving group health continuation
coverage benefits pursuant to Part 6 of ERISA and who are
covered by the employee welfare benefit plan. Covered
dependents are not counted as participants. A child who is
an “alternate recipient” entitled to health benefits under a
qualified medical child support order (QMCSO) should not
be counted as a participant for line 5. An individual is not a
participant covered under an employee welfare plan on the
earliest date on which the individual (a) is ineligible to
receive any benefit under the plan even if the contingency
for which such benefit is provided should occur, and (b) is
not designated by the plan as a participant. See 29 CFR
2510.3-3(d)(2).
Before counting the number of participants,
especially in a welfare benefit plan, it is important to
determine whether the plan sponsor has
established one or more plans for Form 5500/Form 5500-SF
reporting purposes. As a matter of plan design, plan
sponsors can offer benefits through various structures or
combinations. For example, a plan sponsor could create (i)
one plan providing major medical benefits, dental benefits,
and vision benefits, (ii) two plans with one providing major
medical benefits and the other providing self-insured dental
and vision benefits; or (iii) three separate plans. You must
review the governing documents and actual operations to
determine whether welfare benefits are being provided under
a single plan or separate plans.
The fact that you have separate insurance policies for
each different welfare benefit does not necessarily mean that
you have separate plans. Some plan sponsors use a “wrap”
document to incorporate various benefits and insurance
policies into one comprehensive plan. In addition, whether a
General Instructions to Form 5500-SF

-11-

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.
Line 6. If your plan is required to file an annual return/
report, you may file the Form 5500-SF instead of the Form
5500 only if you meet all of the eligibility conditions listed
below.
1. The plan (a) covered fewer than 100 participants at
the beginning of the plan year 2011, or (b) under 29 CFR
2520.103-1(d) was eligible to and filed as a small plan for
plan year 2010 and did not cover more than 120
participants at the beginning of plan year 2011 (see
instructions for line 5 on counting the number of
participants);
2. The plan did not hold any employer securities at any
time during the plan year;
3. At all times during the plan year, the plan was 100%
invested in certain secure, easy to value assets such as
mutual fund shares, investment contracts with insurance

companies and banks valued at least annually, publicly
traded securities held by a registered broker dealer, cash
and cash equivalents, and plan loans to participants that
meet the definition of “eligible plan assts” (see the
instructions for line 6a);
4. The plan is eligible for the waiver of the annual
examination and report of an independent qualified public
accountant (IQPA) under 29 CFR 2520.104-46 (but not by
reason of enhanced bonding), which requirement includes,
among others, giving certain disclosures and supporting
documents to participants and beneficiaries regarding the
plan’s investments (see instructions for line 6b); and
5. The plan is not a multiemployer plan.
Special conditions for filing the Form 5500-SF apply to
“one-participant plans.” See Specific Instructions for “OneParticipant Plans” on page 7.
Line 6a – Eligible Plan Assets. To be eligible to file the
Form 5500-SF, all of the plan’s assets must be “eligible
plan assets.” Answer line 6a “Yes” or “No.” Do not leave
this question blank. If the answer to line 6a is “No” you
CANNOT file the Form 5500-SF and must file the Form
5500. See discussion under Who May File Form 5500SF.
For the purposes of this line, “eligible plan assets” are
assets that have a readily determinable fair market value
for purposes of this annual reporting requirement as
described in 29 CFR 2520.103-1(c)(2)(ii)(C), are not
employer securities, and are held or issued by one of the
following regulated financial institutions: a bank or similar
financial institution as defined in 29 CFR 2550.408b-4(c)
(for example, banks, trust companies, savings and loan
associations, domestic building and loan associations, and
credit unions); an insurance company qualified to do
business under the laws of a state; organizations
registered as broker-dealers under the Securities
Exchange Act of 1934; investment companies registered
under the Investment Company Act of 1940; or any other
organization authorized to act as a trustee for individual
retirement accounts under Code section 408. Examples of
assets that would qualify as eligible plan assets for this
annual reporting purpose are mutual fund shares,
investment contracts with insurance companies or banks
that provide the plan with valuation information at least
annually, publicly traded stock held by a registered broker
dealer, cash and cash equivalents held by a bank.
Participant loans meeting the requirements of ERISA
section 408(b)(1) are also “eligible plan assets” for this
purpose whether or not they have been deemed
distributed.
Line 6b. In addition to all of the plan’s assets being
eligible plan assets as defined in line 6a, to be eligible to
file the Form 5500-SF the plan also must be exempt from
the requirement to be audited annually by an independent
qualified public accountant (IQPA).
Welfare plans that cover fewer than 100 participants at
the beginning of the plan year are exempt from the annual
audit requirement.
A pension plan is exempt from the annual audit
requirement if it covered fewer than 100 participants at the
beginning of the plan year or under 29 CFR 2520.103-1(d)
was eligible to and filed as a small plan for plan year 2010
and did not cover more than 120 participants at the
beginning of plan year 2011 and meets the following three
requirements for the audit waiver under 29 CFR 2520.104-12-

46: (1) as the last day of the preceding plan year, at least
95% of a small pension plan’s assets were “qualifying plan
assets;” (2) the plan includes the required audit waiver
disclosure in the Summary Annual Report (SAR) furnished
to participants and beneficiaries, in accordance with 29
CFR 2520.104b-10. For defined benefit pension plans that
are required pursuant to section 101(f) of ERISA to furnish
an Annual Funding Notice (AFN), the administrator must
instead either provide the information to participants and
beneficiaries with the AFN or as a stand-alone notification
at the time an SAR would have been due and in
accordance with the rules for furnishing an SAR, although
such plans do not have to furnish an SAR; and (3) in
response to a request from any participant or beneficiary,
the plan administrator must furnish without charge copies
of statements from the regulated financial institutions
holding or issuing the plan’s “qualifying plan assets.”
In order to be eligible to file the Form 5500-SF, a
small pension plan must meet the audit waiver
conditions by virtue of having 95% or more of its
assets as “qualifying plan assets” in accordance with 29
CFR 2520.104-46(b)(1)(i)(A)(1). If the small plan satisfies
the conditions of the audit waiver by virtue of having an
enhanced fidelity bond under 29 CFR 2520.10446(b)(1)(i)(A)(2), the plan does not satisfy the conditions
for filing the Form 5500-SF and must file the Form 5500,
along with the appropriate schedules and attachments.
Also, although many “qualifying plan assets” for audit
waiver purposes will also be “eligible plan assets” as
described in the instructions for line 6a, the definitions are
not the same. If, as of the last day of the preceding plan
year, the plan was 100% invested in “eligible plan assets,”
the plan would satisfy the “qualifying plan asset” prong of
the audit waiver conditions. Holding all the plan’s
investments in “qualifying plan assets,” however, would
not necessarily satisfy the conditions for filing the Form
5500-SF. For example, real estate held by a bank as
trustee for a plan could be a qualifying plan asset for
purposes of the small pension plan audit waiver conditions
but it would not be an “eligible plan asset” for purposes of
the plan being eligible to file the Form 5500-SF because
real estate would not have a readily determinable fair
market value as described in 29 CFR 2520.1031(c)(2)(ii)(C).

Part III – Financial Information
Note. The cash, modified cash, or accrual basis may be
used for recognition of transactions in Parts I and II, as
long as you use one method consistently. Round off all
amounts reported on the Form 5500-SF to the nearest
dollar. Any other amounts are subject to rejection. Check
all subtotals and totals carefully.
Current value means fair market value where available.
Otherwise, it means the fair value as determined in good
faith under the terms of the plan by a trustee or named
fiduciary, assuming an orderly liquidation at the time of the
determination. See ERISA section 3(26).
Line 7 – Plan Assets and Liabilities. Amounts reported
on lines 7a, 7b, and 7c of the Form 5500-SF for the
beginning of the plan year must be the same as reported
for the end of the plan year for the corresponding lines on
the return/report for the preceding plan year. However, if
the Form 5500 was filed the previous year, the amounts
reported on the Form 5500-SF, lines 7a, column (a), 7b,
column (a), and 7c, column (a), should correspond to the
General Instructions to Form 5500-SF

amounts entered in lines 1a, column (b), 1b, column (b),
and 1c, column (b), of the 2010 Schedule I (Form 5500) or
the amounts entered in lines 1f, column (b), 1k, column
(b), and 1l, column (b), of Schedule H (Form 5500)
whichever schedule was filed.
Line 7a. Enter the total amount of plan assets at the
beginning of the plan year in column (a). Do not include
contributions designated for the 2011 plan year in column
(a).
Enter the total amount of plan assets at the end of the
plan year in column (b). Do not include in column (b) a
participant loan that has been deemed distributed during
the plan year under the provisions of Code section 72(p)
and Treasury Regulations section 1.72(p)-1 if both the
following circumstances apply: (1) Under the plan, the
participant loan is treated as a directed investment solely
of the participant’s individual account; and (2) As of the
end of the plan year, the participant is not continuing
repayment under the loan.
If the deemed distributed participant loan is included in
column (a) and both of these circumstances apply, include
the value of the loan as a deemed distribution on line 8e.
However, if either of these two circumstances does not
apply, the current value of the participant loan (including
interest accruing thereon after the deemed distribution)
should be included in column (b) without regard to the
occurrence of a deemed distribution.
After a participant loan that has been deemed
distributed is included in the amount reported on line 8e, it
is no longer to be reported as an asset on line 7a unless,
in a later year, the participant resumes repayment under
the loan. However, such a loan (including interest accruing
thereon after the deemed distribution) that has not been
repaid is still considered outstanding for purposes of
applying Code section 72(p)(2)(A) to determine the
maximum amount of subsequent loans. Also, the deemed
distribution is not treated as an actual distribution for other
purposes, such as the qualification requirements of Code
section 401, including, for example, the determination of
top-heavy status under Code section 416 and the vesting
requirements of Treasury Regulations section 1.411(a)7(d)(5). See Q&As 12 and 19 of Treasury Regulations
section 1.72(p)-1.
The entry on line 7a, column (b) (plan assets at end of
year) must include the current value of any participant loan
included as a deemed distribution in the amount reported
for any earlier year if, during the plan year, the participant
resumes repayment under the loan. In addition, the
amount to be entered on line 8e must be reduced by the
amount of the participant loan reported as a deemed
distribution for the earlier year.
Line 7b. Enter the total liabilities at the beginning and end of
the plan year. Liabilities to be entered here do not include the
value of future pension payments to participants. The amount
to be entered in line 7b for accrual basis filers includes, among
other things:
1. Benefit claims that have been processed and
approved for payment by the plan but have not been paid
(including all incurred but not reported (IBNR) welfare
benefit claims);
2. Accounts payable obligations owed by the plan that
were incurred in the normal operations of the plan but
have not been paid; and
3. Other liabilities such as acquisition indebtedness
and any other amount owed by the plan.
General Instructions to Form 5500-SF

-13-

Line 7c. Enter the net assets as of the beginning and end
of the plan year. (Subtract line 7b from 7a). Line 7c,
column (b), must equal the sum of line 7c, column (a), plus
lines 8i (net income (loss)) and 8j (transfers to (from) the
plan).
Line 8 – Income, Expenses, and Transfers for this Plan
Year.
Line 8a. Include the total cash contributions received
and/or (for accrual basis plans) due to be received.
Line 8a(1). Plans using the accrual basis of accounting
must not include contributions designated for years before
the 2011 plan year on line 8a(1).
Line 8a(2). For welfare plans, report all employee
contributions, including all elective contributions under a
cafeteria plan (Code section 125). For pension plans,
participant contributions, for purposes of this line item,
also include elective contributions under a qualified cash
or deferred arrangement (Code section 401(k)).
Line 8a(3). Enter the current value, at date contributed,
of all other contributions, including rollovers from other
plans.
Line 8b. Enter all other plan income for the plan year.
Do not include transfers from other plans that are
reported on line 8j. Examples of other income received
and/or receivable include:
1. Interest on investments (including money market
accounts, sweep accounts, etc.)
2. Dividends. (Accrual basis plans should include
dividends declared for all stock held by the plan even if
the dividends have not been received as of the end of
the plan year.)
3. Net gain or loss from the sale of assets.
4. Other income such as unrealized appreciation
(depreciation) in plan assets.
To compute this amount, subtract the current value
of all assets at the beginning of the year plus the cost of
any assets acquired during the plan year from the
current value of all assets at the end of the year minus
assets disposed of during the plan year.
Line 8c. Enter the total of all cash contributions (line
8a(1) through line 8a(3)) and other plan income (line 8b)
during the plan year. If entering a negative number,
enter a minus sign (“–”) to the left of the number.
Line 8d. Include (1) payments made (and for accrual
basis filers payments due) to or on behalf of participants
or beneficiaries in cash, securities, or other property
(including rollovers of an individual’s accrued benefit or
account balance). Include all eligible rollover
distributions as defined in Code section 401(a)(31)(D)
paid at the participant’s election to an eligible retirement
plan (including an IRA within the meaning of 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 as of the date of distribution.

Line 8e. Include on this line all distributions paid during
the plan year of excess deferrals under Code section
402(g)(2)(A)(ii), excess contributions under 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 as well as
any attributable income that was also distributed.
For line 8e, also include in the total amount a
participant loan included in line 7a, column (a) that has
been deemed distributed during the plan year under the
provisions of Code section 72(p) and Treasury
Regulations section 1.72(p)-1 only if both of the
following circumstances apply:
1. Under the plan, the participant loan is treated as a
directed investment solely of the participant’s individual
account; and
2. As of the end of the plan year, the participant is
not continuing repayment under the loan.
If either of these circumstances does not apply, a
deemed distribution of a participant loan should not be
included in the total on line 8e. Instead, the current
value of the participant loan (including interest accruing
thereon after the deemed distribution) should be
included on lines 7a, column (b) (plan assets – end of
year), and 10g (participant loans – end of year), without
regard to the occurrence of a deemed distribution.
Note. The amount to be reported on line 8e must be
reduced if, during the plan year, a participant resumes
repayment under a participant loan reported as a
deemed distribution on line 2g of Schedule H or
Schedule I of a prior Form 5500 or line 8e of a prior
Form 5500-SF for any earlier year. The amount of the
required reduction is the amount of the participant loan
that was reported as a deemed distribution on such line
for any earlier year. If entering a negative number, enter
a minus sign (“–”) to the left of the number. The current
value of the participant loan must then be included on
line 7a, column (b) (plan assets – end of year).
Although certain participant loans deemed
distributed are to be reported on line 8e, and are not to
be reported on the Form 5500-SF or on the Schedule H
or Schedule I of the Form 5500 as an asset thereafter
(unless the participant resumes repayment under the
loan in a later year), they are still considered
outstanding loans and are not treated as actual
distributions for certain purposes. See Q&As 12 and 19
of Treasury Regulations section 1.72(p)-1.
Line 8f. The amount to be reported for expenses
involving administrative service providers (salaries, fees,
and commissions) 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; and
4. Fees and expenses for individual plan trustees,
including reimbursement for travel, seminars, and
meeting expenses.

Line 8g. Other expenses (paid and/or payable) include
other administrative and miscellaneous expenses paid
by or charged to the plan, including among others office
supplies and equipment, telephone, and postage.
Line 8h. Enter the total of all benefits paid or due
reported on lines 8d and 8e and all other plan expenses
reported on lines 8f and 8g during the year.
Line 8i. Subtract line 8h from line 8c.
Line 8j. Enter the net value of all assets transferred to
and from the plan during the plan year including those
resulting from mergers and spinoffs. A transfer of assets
or liabilities occurs when there is a reduction of assets
or liabilities with respect to one plan and the receipt of
these assets or the assumption of these liabilities by
another plan. Transfers out at the end of the year should
be reported as occurring during the plan year.
Note. A distribution of all or part of an individual
participant’s account balance that is reportable on Form
1099-R, Distributions From Pensions, Annuities,
Retirement or Profit-Sharing Plans, IRAs, Insurance
Contracts, etc., should not be included on line 8j but
must be included in benefit payments reported on line
8d. Do not submit IRS Form 1099-R with the Form
5500-SF.

Part IV – Plan Characteristics
Line 9. See the List of Plan Characteristics Codes on
pages 20 and 21.
Note. In the case of an eligible combined plan under
Code section 414(x) and ERISA section 210(e), the codes
entered in line 9a must include any codes applicable for
either the defined benefit pension features or the defined
contribution pension features of the plan.
For plan sponsors of Puerto Rico plans,
enter characteristic code 3C only if:
i.
ii.

only Puerto Rico residents participate,
the trust is exempt from income tax under the
laws of Puerto Rico, and
iii. the plan administrator has not made the
election under section 1022(i)(2), and,
therefore, the plan is not intended to qualify
under section 401(a) of the Internal Revenue
Code (U.S).

Part V – Compliance Questions
Line 10. Answer all lines either “Yes” or “No.” Do not leave
any answer blank unless otherwise directed. For lines 10a,
b, c, d, e, f, and g, if the answer is “Yes,” an amount must
be entered.
Note. “One-participant plans” should complete only
question 10g.
Line 10a. Amounts paid by a participant or beneficiary to
an employer and/or withheld by an employer for
contribution to the plan are participant contributions that
become plan assets as of the earliest date on which such
contributions can reasonably be segregated from the
employer’s general assets. See 29 CFR 2510.3-102. In
the case of a plan with fewer than 100 participants at the
beginning of the plan year, any amount deposited with
such plan not later than the 7th business day following the
-14-

General Instructions to Form 5500-SF

ERISA Technical Release 92-01; or (5) delinquent
participant contributions or delinquent loan repayments
reported on line 10a. You may indicate that an
application for an administrative exemption is pending. If
you are unsure whether a transaction is exempt or not,
you should consult either with a qualified public
accountant, legal counsel, or both. If the plan is a
qualified pension plan and a nonexempt prohibited
transaction occurred with respect to a disqualified
person, an IRS Form 5330 is required to be filed with
the IRS to pay the excise tax on the transaction.
Nonexempt transactions. Nonexempt transactions
with a party-in-interest include any direct or indirect:
A. Sale or exchange, or lease, of any property
between the plan and a party-in-interest.
B. Lending of money or other extension of credit
between the plan and a party-in-interest.
C. Furnishing of goods, services, or facilities
between the plan and a party-in-interest.
D. Transfer to, or use by or for the benefit of, a partyin-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.

day on which such amount is received by the employer (in
the case of amounts that a participant or beneficiary pays
to an employer), or the 7th business day following the day
on which such amount would otherwise have been
payable to the participant in cash (in the case of amounts
withheld by an employer from a participant’s wages), shall
be deemed to be contributed or repaid to such plan on the
earliest date on which such contributions or participant
loan repayments can reasonably be segregated from the
employer’s general assets. See 29 CFR 2510.3102(a)(2). 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 10a for the year in which the contributions
were delinquent and must be carried over and reported
again on line 10a for each subsequent year (or on line 4a
of Schedule H or I of the Form 5500 if not eligible to file
the Form 5500-SF in the subsequent year) until the year
after the violation has been fully corrected by payment of
the late contributions and reimbursement of the plan for
lost earnings or profits. If no participant contributions were
received or withheld by the employer during the plan year,
answer “No.”
An employer holding participant contributions
commingled with its general assets after the earliest date
on which such contributions can reasonably be
segregated from the employer’s general assets will have
engaged in a prohibited use of plan assets (see ERISA
section 406). If such a nonexempt prohibited transaction
occurred with respect to a disqualified person (see Code
section 4975(e)(2)), file IRS Form 5330, Return of Excise
Taxes Related to Employee Benefit Plans, with the IRS to
pay any applicable excise tax on the transaction.
Participant loan repayments paid to and/or withheld by
an employer for purposes of transmittal to the plan that
were not transmitted to the plan in a timely fashion must
be reported either on line 10a in accordance with the
reporting requirements that apply to delinquent participant
contributions or on line 10b. See Advisory Opinion 200202A, available at www.dol.gov/ebsa.
Applicants that satisfy both the DOL Voluntary Fiduciary
Correction Program (VFCP) and the conditions of
Prohibited Transaction Exemption (PTE) 2002-51 are
eligible for immediate relief from payment of certain
prohibited transaction excise taxes for certain corrected
transactions, and are also relieved from the requirement to
file the IRS Form 5330 with the IRS. For more information
on how to apply under the VFCP, the specific transactions
covered (which transactions include delinquent participant
contributions to pension and welfare plans), and acceptable
methods for correcting violations, see 71 Fed. Reg. 20261
(Apr. 19, 2006) and 71 Fed. Reg. 20135 (Apr. 19, 2006). All
delinquent participant contributions must be reported on
line 10a at least for the year in which they were delinquent
even if violations have been fully corrected by the close of
the plan year. Information about the VFCP is also available
on the Internet at www.dol.gov/ebsa.
Line 10b. Plans that check “Yes” must enter the
amount. Check “Yes” if any nonexempt transaction with
a party-in-interest occurred. Do not check “Yes” with
respect to transactions that are: (1) statutorily exempt
under Part 4 of Title I of ERISA; (2) administratively
exempt under ERISA section 408(a); (3) exempt under
Code sections 4975(c) or 4975(d); (4) the holding of
participant contributions in the employer’s general
assets for a welfare plan that meets the conditions of
General Instructions to Form 5500-SF

Party-in-Interest. For purposes of this form, partyin-interest is deemed to include a disqualified person.
See Code section 4975(e)(2). The term “party-ininterest” 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 which is an employer or
an employee organization described in C or D;
F. A relative of any individual described in A, B, C, or
E;
G. A corporation, partnership, or trust or estate of
which (or in which) 50% or more of:

-15-

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;

protect the plan from losses due to dishonest acts and
cannot be reported as fidelity bonds on line 10c.
Line 10d. Check “Yes” if the plan had suffered or
discovered any loss as a result of any dishonest or
fraudulent act(s) even if the loss was reimbursed by the
plan’s fidelity bond or from any other source. If “Yes” is
checked enter the full amount of the loss. If the full
amount of the loss has not yet been determined, provide
an estimate as determined in good faith by a plan
fiduciary. You must keep, in accordance with ERISA
section 107, records showing how the estimate was
determined.
Willful failure to report is a criminal offense. See
ERISA section 501.

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.

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

Applicants that satisfy the VFCP
requirements and the conditions of PTE
2002-51 (see the instructions for line 10a)
are eligible for immediate relief from
payment of certain prohibited transaction excise taxes
for certain corrected transactions and the requirement to
file the Form 5330 with the IRS. For more information,
see 71 Fed. Reg. 20261 (Apr. 19, 2006) and 71 Fed.
Reg. 20135 (Apr. 19, 2006). When the conditions of
PTE 2002-51 have been satisfied, the corrected
transactions should be treated as exempt under Code
section 4975(c) for the purposes of answering line 10b.
Line 10c. Plans that check “Yes” must enter the
aggregate amount of fidelity bond coverage for all
claims. Check “Yes” only if the plan itself (as opposed to
the plan sponsor or administrator) is a named insured
under a fidelity bond that is from an approved surety
covering plan officials and that protects the plan from
losses due to fraud or dishonesty as described in 29
CFR Part 2580. Generally, every plan official of an
employee benefit plan who “handles” funds or other
property of such plan must be bonded. Generally, a
person shall be deemed to be “handling” funds or other
property of a plan, so as to require bonding, whenever
his or her duties or activities with respect to given funds
are such that there is a risk that such funds could be lost
in the event of fraud or dishonesty on the part of such
person, acting either alone or in collusion with others.
Section 412 of ERISA and 29 CFR Part 2580 describe
the bonding requirements, including the definition of
“handling” (29 CFR 2580.412-6), the permissible forms
of bonds (29 CFR 2580.412-10), the amount of the bond
(29 CFR Part 2580, Subpart C), and certain exemptions
such as the exemption for 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 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

-16-

General Instructions to Form 5500-SF

Line 10f. You must check “Yes” if any benefits due under
the plan were not timely paid or not paid in full. Include in
this amount the total of any outstanding amounts that were
not paid when due in previous years that have continued
to remain unpaid.
Line 10g. You must check “Yes” if the plan had any
participant loans outstanding at any time during the plan
year and enter the amount outstanding as of the end of
the plan year. If no participant loans are outstanding as of
the end of the plan year, enter “0”.
Line 10h. Code section 401(k) and other individual
account pension plans must complete line 10h. Other filers
should leave line 10h blank. Check “Yes” if there was a
“blackout period.” A blackout period is a temporary
suspension of more than three consecutive business days
during which participants or beneficiaries of a 401(k) or
other individual account pension plan were unable, or
were limited or restricted in their ability, to direct or
diversify assets credited to their accounts, obtain loans
from the plan, or obtain distributions from the plan. A
“blackout period” generally does not include a temporary
suspension of the right of participants and beneficiaries to
direct or diversify assets credited to their accounts, obtain
loans from the plan, or obtain distributions from the plan if
the temporary suspension is: (1) part of the regularly
scheduled operations of the plan that has been disclosed
to participants and beneficiaries; (2) due to a qualified
domestic relations order (QDRO) or because of a pending
determination as to whether a domestic relations order is a
QDRO; (3) due to an action or a failure to take action by
an individual participant or because of an action or claim
by someone other than the plan regarding a participant’s
individual account; or (4) by application of federal
securities laws. For more information, see the DOL’s
regulation at 29 CFR 2520.101-3 (available at
www.dol.gov/ebsa).
Line 10i. Code section 401(k) and other individual account
pension plans who answered “Yes” to line 10h must
complete line 10i. Other filers should leave line 10i blank.
If there was a blackout period, did you provide the
required notice not less than 30 days nor more than 60
days in advance of restricting the rights of participants and
beneficiaries to change their plan investments, obtain
loans from the plan, or obtain distributions from the plan?
If so, check “Yes.” See 29 CFR 2520.101-3 for specific
notice requirements and for exceptions from the notice
requirement. Also, answer “Yes” if one of the exceptions to
the notice requirement under 29 CFR 2520.101-3 applies.

include compensation provided by the insurer incidental to
the sale or renewal of a policy, such as finders’ fees,
insurance brokerage commissions and fees, or similar
fees.
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).
Reporting is not required for occasional gifts or meals
of insubstantial value which are tax deductible for federal
income tax purposes by the person providing the gift or
meal and would not be taxable income to the recipient. For
this exemption to be available, the gift or gratuity must be
both occasional and insubstantial. For this exemption to
apply, the gift must be valued at less than $50, the
aggregate value of gifts from one source in a calendar
year must be less than $100, but gifts with a value of less
than $10 do not need to be counted toward the $100
annual limit. If the $100 aggregate value limit is exceeded,
then the aggregate value of all the gifts will be reportable.
For this purpose, 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.
Gifts from multiple employees of one service provider
should be treated as originating from a single source when
calculating whether the $100 threshold applies. On the
other hand, in applying the threshold to an occasional gift
received from one source by multiple employees of a
single service provider, the amount received by each
employee should be separately determined in applying the
$50 and $100 thresholds. For example, if six employees of
a broker attend a business conference put on by an
insurer designed to educate and explain the insurer’s
products for employee benefit plans, and the insurer
provides, at no cost to the attendees, refreshments valued
at $20 per individual, the gratuities would not be reportable
on this line even though the total cost of the refreshments
for all the employees would be $120.
These thresholds are for purposes of line 10e
reporting. Filers are cautioned that the payment or receipt
of gifts and gratuities of any amount by plan fiduciaries
may violate ERISA and give rise to civil liabilities and
criminal penalties.
Important Reminder. The insurance company,
insurance service, or other similar organization is required
under ERISA section 103(a)(2) to provide the plan
administrator with the information needed to complete this
return/report. Your insurance company must provide you
with the information you need to answer this question. If
your insurance company, insurance service, or other
similar organization does not automatically send you this
information, you should make a written request for the
information. If you have difficulty getting the information
from your insurance company, contact the nearest office
of the DOL’s Employee Benefits Security Administration.

General Instructions to Form 5500-SF

Part VI – Pension Funding Compliance
Complete Part VI only if the plan is subject to the minimum
funding requirements of Code section 412 or ERISA
section 302.
All qualified defined benefit and defined contribution
plans are subject to the minimum funding requirements of
Code section 412 unless they are described in the
exceptions listed under 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.
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).
-17-

The employer or plan administrator of a singleemployer or multiple-employer defined benefit plan that is
subject to the minimum funding requirements must file the
Schedule SB (Form 5500) as an attachment to the Form
5500-SF. The employer or plan administrator of a money
purchase plan that is currently amortizing a waiver of the
minimum funding requirements must complete lines 3, 9,
and 10 of the Schedule MB (Form 5500) and file it as an
attachment to the Form 5500-SF.
Line 11. If “Yes” is checked, attach a completed and
signed Schedule SB (Form 5500). See the instructions for
the Schedule SB in the Instructions for Form 5500. If this
is a defined contribution pension plan, leave blank.
Line 12. Check the “Yes” box if the plan is a defined
contribution plan subject to the minimum funding
requirements of Code section 412 and ERISA section 302.
Those money purchase plans (including target benefit
plans) that are amortizing a waiver of the minimum funding
standard for a prior year should fill out line 12a and then
skip to line 13. Those defined contribution plans answering
“Yes” to the line 12 question that do not fill out line 12a
should fill out lines 12b-12e.
Line 12a. If a money purchase defined contribution plan
(including a target benefit plan) has received a waiver of
the minimum funding standard, and the waiver is currently
being amortized, complete lines 3, 9, and 10 of Schedule
MB (Form 5500). See instructions for Schedule MB in the
Instructions for Form 5500. The Schedule MB for a money
purchase defined contribution plan does not need to be
signed by an enrolled actuary.
Line 12b. 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 12c. Include all contributions for the plan year made
not later than 8 ½ months after the end of the plan year.
Show only contributions actually made to the plan by the
date the form is filed. For example, do not include
receivable contributions for this purpose
Line 12d. If the minimum required contribution exceeds
the contributions for the plan year made not later than 8 ½
months after the end of the plan year, the excess is an
accumulated funding deficiency for the plan year. File IRS
Form 5330, Return of Excise Taxes Related to Employee
Benefit Plans, with the IRS to pay the excise tax on the
deficiency. There is a penalty for not filing Form 5330 on
time.
Line 12e. Check “Yes” if the minimum required
contribution remaining in line 12d will be made not later
than 8 ½ 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.

employer. If “Yes” is checked, enter the amount of plan
assets that reverted to the employer during the plan year
in connection with the implementation of such termination.
Enter “0” if no reversion occurred during the current plan
year.
A Form 5500 or a Form 5500-SF must be filed
for each year the plan has assets, and, for a
welfare benefit plan, if the plan is still liable to pay benefits
for claims incurred before the termination date, but not yet
paid. See 29 CFR 2520.104b-2(g)(2)(ii).
Line 13b. Check “Yes” if all of the plan assets (including
insurance/annuity contracts) were distributed to the
participants and beneficiaries, legally transferred to the
control of another plan, or brought under the control of the
PBGC.
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 2520.104b2(g)(2)(ii).
Line 13c. Enter information concerning assets and/or
liabilities transferred from this plan to another plan(s)
(including spinoffs) during the plan year. A transfer of
assets or liabilities occurs when there is a reduction of
assets or liabilities with respect to one plan and the receipt
of these assets or the assumption of these liabilities by
another plan. Enter the name, EIN, and PN of the
transferee plan(s) involved on lines 13c(1), c(2), and c(3).
Do not use a social security number in place of an EIN
or include an attachment that contains visible social
security numbers. The Form 5500-SF is open to public
inspection, and the contents are public information and are
subject to publication on the Internet. Because of privacy
concerns, the inclusion of a social security number on this
Form 5500-SF may result in the rejection of the filing.
Note. A distribution of all or part of an individual
participant’s account balance that is reportable on Form
1099-R should not be included on line 13c. Do not submit
Form 1099-R with the Form 5500-SF.
IRS Form 5310-A, Notice of Plan Merger or
Consolidation, Spinoff, or Transfer of Plan
Assets or Liabilities; Notice of Qualified Separate Lines of
Business, must be filed at least 30 days before any plan
merger or consolidation or any transfer of plan assets or
liabilities to another plan. There is a penalty for not filing
IRS Form 5310-A on time. In addition, a transfer of benefit
liabilities involving a plan covered by PBGC insurance
may be reportable to the PBGC. See PBGC Form 10,
Post-Event Notice of Reportable Event, and PBGC Form
10-Advance, Advance Notice of Reportable Event (see the
“Reportable Events and Large Unpaid Contributions”
section of the Practitioners page on PBGC’s website,
which is available at www.pbgc.gov/practitioners).

Part VII – Plan Terminations and Transfers
of Assets
Line 13a. Check “Yes” if a resolution to terminate the plan
was adopted during this or any prior plan year, unless the
termination was revoked and no assets reverted to the
-18-

General Instructions to Form 5500-SF

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

Paperwork Reduction Act Notice
We ask for the information on this form to carry out the law as specified in ERISA and in Code sections 6058(a) and 6059(a).
You are required to give us the information. We need it to determine whether the plan is operating according to the law.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Books and records relating to a form or its instructions must be retained as long as
their contents may become material in the administration of the Internal Revenue Code or are required to be maintained
pursuant to Title I or IV of ERISA. The Form 5500-SF return/reports are open to public inspection and are subject to publication
on the Internet.
The time needed to complete and file the Form 5500-SF and the Schedules SB (Form 5500) and MB (Form 5500) shown in
the list below reflects the combined requirements of the Internal Revenue Service, Department of Labor, and Pension Benefit
Guaranty Corporation. These times will vary depending on individual circumstances. The estimated average times are:
Form

Pension Plans

Welfare Plans

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

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

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

If you have comments concerning the accuracy of these time estimates or suggestions for making these forms simpler, we
would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form or these schedules
to this address. The form and schedules must be filed electronically. See How To File – Electronic Filing Requirement.

General Instructions to Form 5500-SF

-19-

LIST OF PLAN CHARACTERISTICS CODES FOR LINES 9a AND 9b

CODE

Defined Benefit Pension Features

1A

Benefits are primarily pay related.

1B

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

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).

1D

Floor-offset plan – Plan benefits are subject 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).

1G

Covered by PBGC – Plan is covered under the PBGC
insurance program (see ERISA section 4021).

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.

1I

CODE
2A

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).

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).
Target benefit plan.

2C

Money purchase (other than target benefit).

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

2E

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.

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.

2H

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

2J

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.

2K

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

2L

Code section 403(b)(1) arrangement.

2M

Code section 403(b)(7) accounts.

2N

Code section 408 accounts and annuities.

2R

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

2S

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

2T

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

CODE

Defined Contribution Pension Features

2B

2D

-20-

Other Pension Benefit Features

3B

Plan covering self-employed individuals.

3C

Plan not intended to be qualified – A plan not intended to
be qualified under Code sections 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.

3E

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

3F

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

General Instructions to Form 5500-SF

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

3H

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

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.

CODE

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).

4G

Prepaid legal.

4H

Long-term disability.

4I

Severance pay.

4J

Apprenticeship and training.

General Instructions to Form 5500-SF

-21-

4K

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.

4S

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).

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.

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

Agriculture, Forestry, Fishing
and Hunting
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
Hog & Pig Farming
Poultry & Egg Production
Sheep & Goat Farming
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
112210
112300
112400
112510

115310

212390
213110

221210
221300
221500

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

Manufacturing
Food Manufacturing
311110 Animal Food Mfg
311200 Grain & Oilseed Milling
311300 Sugar & Confectionary
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

325410
325500
325600

Electrical Equipment Mfg
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 Mfg

331310

Wholesale Trade

331400

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

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

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

315990

Apparel Accessories & Other
Apparel Mfg
Leather and Allied Product
Manufacturing
316110 Leather & Hide Tanning &
Finishing
316210 Footwear Mfg (including

332510
332610
332700

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

332900

Electric Power Generation,
Transmission & Distribution
Natural Gas Distribution
Water, Sewage, & Other
Systems
Combination Gas & Electric

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

-22-

Code
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

Pharmaceutical & Medicine Mfg
Paint, Coating & Adhesive Mfg
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

312200 Tobacco Manufacturing
Textile Mills and Textile Product
Mills

Utilities
221100

Code
Printing and Related Support
Activities
323100 Printing & Related Support
Activities
Petroleum and Coal Products
Manufacturing

Production
Support Activities for
Forestry

Mining
211110
212110
212200
212310
212320

Code
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)

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

332810

Alumina & Aluminum
Production & Processing
Nonferrous Metal (except

335310
335900

Merchant Wholesalers, Durable
Goods
423100
423200
423300
423400
423500
423600
423700

Hardware Mfg
Spring & Wire Product Mfg
Machine Shops; Turned
Product; & Screw, Nut, & Bolt
Mfg
Coating, Engraving, Heat
Treating, & Allied Activities

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

423800
423910
423920

Motor Vehicle & Motor
Vehicle Parts & Supplies
Furniture & Home Furnishings
Lumber & Other Construction
Materials
Professional & Commercial
Equipment & Supplies
Metals & Minerals (except
Petroleum)
Electrical & Electronic Goods
Hardware, Plumbing &
Heating Equipment &
Supplies
Machinery, Equipment, &
Supplies
Sporting & Recreational
Goods & Supplies
Toy & Hobby Goods &

Supplies
Recyclable Materials
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
423930
423940

General Instructions to Form 5500-SF

Forms 5500, 5500-SF, and 5500-EZ Codes for Principal Business Activity (continued)
Code
424700

Code
448140
448150
448190
448210
448310
448320

Code
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

Code
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

Retail Trade

General Merchandise Stores
452110 Department Stores
452900 Other General Merchandise
Stores

493100

management & investment
advice)
Insurance Carriers and Related
Activities

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, &

Information

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
Motor Vehicle and Parts Dealers
441110 New Car Dealers
441120 Used Car Dealers
441210
441221
441222
441229

Recreational Vehicle Dealers
Motorcycle Dealers
Boat Dealers
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
445210
445220
445230
445291
445292
445299

Convenience Stores
Meat Markets
Fish & Seafood Markets
Fruit & Vegetable Markets
Baked Goods Stores
Confectionery & Nut Stores
All Other Specialty Food
Stores
445310 Beer, Wine, & Liquor Stores
Health and Personal Care Stores
446110 Pharmacies & Drug Stores
446120 Cosmetics, Beauty Supplies,
& Perfume Stores
446130 Optical Goods Stores
446190 Other Health & Personal
Care Stores
Gasoline Stations
447100 Gasoline Stations (including
convenience stores with gas)
Clothing and Clothing Accessories
Stores
448110 Men’s Clothing Stores
448120 Women’s Clothing Stores
448130 Children’s & Infants’ Clothing
Stores

Family Clothing Stores
Clothing Accessories Stores
Other Clothing Stores
Shoe Stores
Jewelry Stores
Luggage & Leather Goods
Stores
Sporting Goods, Hobby, Book, and
Music Stores
451110 Sporting Goods Stores
451120 Hobby, Toy, & Game Stores
451130 Sewing, Needlework, & Piece
Goods Stores
451140 Musical Instrument &
Supplies Stores
451211 Book Stores
451212 News Dealers & Newsstands
451220 Prerecorded Tape, Compact
Disc, & Record Stores

coffee-break service providers)

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

General Instructions to Form 5500-SF

Warehousing & Storage
(except lessors of
miniwarehouses & self-storage
units)

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

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 thirdparty 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).

518210

Real Estate and Rental and Leasing

Data Processing, Hosting, &

Related Services
Other Information Services
519100 Other Information Services
(including news syndicates,
libraries, internet publishing &
broadcasting)

Real Estate
531110 Lessors of Residential
Buildings & Dwellings
(including equity REITs)
531114 Cooperative Housing
(including equity REITs)

Finance and Insurance

531120

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

-23-

524140

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

Forms 5500, 5500-SF, and 5500-EZ Codes for Principal Business Activity (continued)
Code
532290

Code

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)

Professional, Scientific, and
Technical Services
Legal Services
541110 Offices of Lawyers
541190 Other Legal Services
Accounting, Tax Preparation,
Bookkeeping, and Payroll Services
541211 Offices of Certified Public
Accountants
541213 Tax Preparation Services
541214 Payroll Services
541219 Other Accounting Services

Administrative and Support and
Waste Management and
Remediation Services
Administration 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
561440
561450
561490

561500
561600

& copy shops)
Collection Agencies
Credit Bureaus
Other Business Support
Services (including
repossession services, court
reporting, & stenotype
services)
Travel Arrangement &
Reservation Services
Investigation & Security
Services

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

Arts, Entertainment, and
Recreation

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,

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 and
Remediation Services

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

graphic, & fashion design)
Computer System Design and
Related Services
541511 Custom Computer

Educational Services

712100

541512
541513
541519

Programming Services
Computer Systems Design
Services
Computer Facilities
Management Services
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

561710

Code
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

611000

Educational Services
(including schools, colleges,
& universities)

Health Care and Social Assistance
Offices of Physicians and Dentists
621111 Offices of Physicians (except
mental health specialists)
621112 Offices of Physicians, Mental
Health Specialists
621210 Offices of Dentists

Amusement Parks & Arcades
Gambling Industries
Other Amusement &
Recreation Industries
(including golf courses, skiing
facilities, marinas, fitness
centers, & bowling centers)

Accommodation and Food Services

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

Accommodation
721110 Hotels (except Casino Hotels) &
Motels
721120 Casino Hotels
721191 Bed & Breakfast Inns
721199 All other Traveler
Accommodation
721210 RV (Recreational Vehicle)

Opinion Polling
Photographic Services

621391
621399

721310

Translation & Interpretation
Services
Veterinary Services
All Other Professional,
Scientific, & Technical
Services

Miscellaneous Health
Practitioners
Outpatient Care Centers
621410 Family Planning Centers
621420 Outpatient Mental Health &
Substance Abuse Centers

Food Services and Drinking Places
722110 Full-Service Restaurants
722210 Limited-Service Eating Places
722300 Special Food Services
(including food service
contractors & caterers)

Management of Companies
(Holding Companies)

621491
621492

HMO Medical Centers
Kidney Dialysis Centers

722410

551111

621493

Freestanding Ambulatory
Surgical & Emergency Centers
All Other Outpatient Care
Centers

541920
541930
541940
541990

551112

Offices of Bank Holding
Companies
Offices of Other Holding
Companies

621498

Offices of Podiatrists
Offices of all Other

-24-

Other 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

811310

811410

811420

Electronic & Precision
Equipment Repair &
Maintenance
Commercial & Industrial
Machinery & Equipment
(except Automotive &
Electronic) Repair &
Maintenance
Home & Garden Equipment &
Appliance Repair &
Maintenance
Reupholstery & Furniture

Repair
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 &
811430

Museums, Historical Sites, &
Similar Institutions
Amusements, Gambling, and
Recreation Industries
713100
713200
713900

Code

Parks & Recreational Camps
Rooming & Boarding Houses

812320

Drycleaners
Drycleaning & Laundry
Services (except
Coin-Operated)

812330
812910

Linen & Uniform Supply
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, & Similar
Organizations (including
condominium and
homeowners associations)
813930 Labor Unions and Similar
Labor Organizations
921000

Governmental Instrumentality
or Agency

Drinking Places (Alcoholic
Beverages)

General Instructions to Form 5500-SF

ERISA COMPLIANCE QUICK CHECKLIST
Compliance with the Employee Retirement Income Security Act (ERISA) begins with knowing the rules. Plan administrators and
other plan officials can use this checklist as a quick diagnostic tool for assessing a plan’s compliance with certain important
ERISA rules; it is not a complete description of all ERISA’s rules and it is not a substitute for a comprehensive compliance
review. Use of this checklist is voluntary, and it is not be filed with your Form 5500-SF.
If you answer “No” to any of the questions below, you should review your plan’s operations because you may not be in
full compliance with ERISA’s requirements.
1.

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?

10. Did the plan pay participant benefits on time and in the correct amounts?
11. Did the plan give participants and beneficiaries 30 days advance notice before imposing a “blackout period” of at least
three consecutive business days during which participants or beneficiaries of a 401(k) or other individual account
pension plan were unable to change their plan investments, obtain loans from the plan, or obtain distributions from
the plan?
If you answer “Yes” to any of the questions below, you should review your plan’s operations because you may not be
in full compliance with ERISA’s requirements.
1.

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

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?

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.

General Instructions to Form 5500-SF

-25-

Index
A
Annual Report Identification
Information .......................... 8
B
Basic Plan Information ............ 9
C
Change in Plan Year ................ 5
Codes for Principal Business
Activity ............................... 22
Compliance Questions ........... 14
D
Delinquent Filer Voluntary
Compliance (DFVC)
Program................................ 5
E
EFAST2 Processing System .... 1
ERISA Compliance Quick
Checklist ............................ 25
Extension of Time To File ........ 5

F
Financial Information ............. 12
H
How To File – Electronic Filing
Requirement ........................ 6
How To Get Assistance .......... 1

Pension Funding
Compliance ........................ 17
Plan Assets and Liabilities ..... 13
Plan Characteristics Codes ... 20
Plan Terminations .................. 18
Plans Exempt From Filing........ 3

N
Nonexempt Transactions ....... 15

S
Signature and Date ................. 7
Specific Line-by-Line Instructions
(Form 5500-SF) ................... 8

O
One-Participant Plans .............. 7

T
Transfers of Assets ................ 18

P
Paperwork Reduction Act
Notice ................................. 19
Party-In-Interest .................... 15
Penalties:
Administrative ..................... 5
Other .................................... 6
Pension and Welfare Plans
Required To File Annual
Return/Report ...................... 2

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

-26-

General Instructions to Form 5500-SF