10-ADV Advance Notice of Reportable Events

ADVANCE NOTICE OF REPORTABLE EVENTS
PBGC Form 10-ADV
Approved OMB #1212-0013
Expires xx/xx/xx
This form must be used by a contributing sponsor of a single-employer plan required to notify the
Pension Benefit Guaranty Corporation in advance that a reportable event will occur.
IDENTIFYING INFORMATION
Plan name:
EIN of contributing sponsor

___________

PN of plan ___

Name of contributing sponsor / name and title of individual to contact
Street address of contact
City, State, Zip
Telephone number and email address of contact
Name of plan administrator / name and title of individual to contact
Street address of contact
City, State, Zip
Telephone number and email address of contact
Effective date of the event or date event occurred if there is an extension:
REPORTABLE EVENTS - See instructions for descriptions of these events. Check all boxes that apply.
 Change in contributing sponsor or controlled group (29 CFR §4043.62)
 Liquidation (29 CFR §4043.63)
 Extraordinary dividend or stock redemption (29 CFR §4043.64)
Transfer of benefit liabilities (29 CFR §4043.65)
 Application for minimum funding waiver (29 CFR §4043.66)
 Loan default (29 CFR §4043.67)
 Insolvency or similar settlement (29 CFR §4043.68)

BRIEF DESCRIPTION - Briefly describe the pertinent facts relating to the event.

The following pages list additional information that must be submitted with this form, if not
included above.

2

ADDITIONAL INFORMATION REQUIRED FOR EACH EVENT
Additional Information Required for Each Event:
Change in Contributing Sponsor or Controlled Group
• Description of the plan’s old and new controlled group structures, including the name of each
controlled group member
• Name of each plan maintained by any member of the plan’s old and new controlled groups, its
contributing sponsor(s) and EIN/PN
• Financial information (see page 11 of the Form 10-ADV Instructions) and interim financial
statements of the plan’s contributing sponsor (both old and new in the case of a change in the
contributing sponsor) and any persons that will cease to be in the plan’s controlled group
• Actuarial information (see page 11 of the Form 10-ADV Instructions)
If a filer is unable with reasonable diligence to obtain any of the above information about a
controlled group other than the filer’s controlled group, the filer may instead file a statement to that
effect.
Liquidation
• Description of the plan’s controlled group structure before and after the liquidation, including the
name of each controlled group member
• Operational status of each controlled group member (in Chapter 7 proceedings, liquidating outside of
bankruptcy, on-going, etc.)
• Name of each plan maintained by any member of the plan’s controlled group, its contributing
sponsor(s) and EIN/PN
• Financial information for all controlled group members (see page 11 of the Form 10-ADV
Instructions)
• Actuarial information (see page 11 of the Form 10-ADV Instructions)
• If the plan sponsor is expected to cease or has ceased substantially all operations also provide:
– Date on which substantially all operations are expected to cease or have ceased
– Most recent pension plan document(s)
– Address of each controlled group member
– The Internal Revenue Service Determination Letter indicating the plan is a covered plan, if
applicable
Extraordinary Dividend or Stock Redemption
• Name and EIN of person making the distribution
• Date and amount of cash distribution(s) during fiscal year
• Description, fair market value, and date(s) of any non-cash distribution(s)
• Statement whether the recipient was a member of the plan’s controlled group
• Description of the plan’s controlled group structure, including the name and address of each
controlled group member
• Name of each plan maintained by any member of the plan's controlled group, its contributing
sponsor(s) and EIN/PN
• Financial information for all controlled group members (see page 11 of the Form 10-ADV
Instructions)
• Actuarial information (see page 11 of the Form 10-ADV Instructions)

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Transfer of Benefit Liabilities
• Description of the transferee’s old and new controlled group structures, including the name of each
controlled group member
• Name of each plan maintained by any member of the transferee’s old and new controlled group
structures, its contributing sponsor and EIN/PN of transferor plan and each transferee plan
• Explanation of the actuarial assumptions used in determining the value of benefit liabilities (and, if
appropriate, plan assets) transferred
• Estimate of the assets, liabilities, and number of participants whose benefits are transferred
• Financial statements of all members of the transferee’s new controlled group (see page 11 of the
Form 10-ADV Instructions)
• Actuarial information (see page 11 of the Form 10-ADV Instructions)
If a filer is unable with reasonable diligence to obtain any of the above information about a
controlled group other than the filer’s controlled group, the filer may instead file a statement to that
effect.
Application for Minimum Funding Waiver
• Copy of waiver application, with all attachments
Loan Default
• Copy of the relevant loan documents (e.g., promissory note, security agreement, loan agreement
amendments and waivers)
• Due date and amount of any missed payment
• Copy of any written notice of default, acceleration, forbearance, or loan agreement amendment or
waiver
• Description of any cross-defaults or anticipated cross-defaults
• Description of the plan’s controlled group structure, including the name of each controlled group
member
• Name of each plan maintained by any member of the plan's controlled group, its contributing
sponsor(s) and EIN/PN
• Financial statements for all controlled group members (see page 11 of the Form 10-ADV
Instructions)
• Actuarial information (see page 11 of the Form 10-ADV Instructions)
Insolvency or Similar Settlement
• Name, address and telephone number of any trustee, receiver or similar person
• Docket number of court filing and location of the court where any relevant proceeding was or will be
filed (if known)
• Description of the plan’s controlled group structure, including the name of each controlled group
member
• Name of each plan maintained by any member of the plan’s controlled group, its contributing
sponsor(s) and EIN/PN
• Actuarial information (see page 11 of the Form 10-ADV Instructions)

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Form 10-ADV Instructions
Advance Notice of Reportable Events
PAPERWORK REDUCTION ACT NOTICE
PBGC needs this information, which is required to be filed under Employee Retirement Income Security
Act (ERISA) §4043 and 29 CFR Part 4043, Subparts A and C, so that it can take action to protect
participants and the termination insurance program under Title IV of ERISA in appropriate cases.
Information provided to PBGC pursuant to ERISA §4043 is confidential to the extent provided by the
Freedom of Information Act, the Privacy Act, and ERISA §4043(f). PBGC estimates that it will take an
average of 5.3 hours and $790 to comply with these requirements. If you have any comments concerning
the accuracy of this estimate or suggestions for improving PBGC Form 10-ADV, please send your comments to the Pension Benefit Guaranty Corporation, Regulatory Affairs Group, Office of the General
Counsel, 1200 K Street, NW, Washington, DC 20005-4026. This collection of information has been
approved by the Office of Management and Budget (OMB) under control number 1212-0013. An agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information unless
it displays a currently valid OMB control number.
Table of Contents
Part I - General Instructions

6

Part II - Definitions

10

Part III - Specific Instructions

11

A. Change in Contributing Sponsor
or Controlled Group
B. Liquidation
C. Extraordinary Dividend or
Stock Redemption
D. Transfer of Benefit Liabilities
E. Application for Minimum
Funding Waiver
F. Loan Default
G. Insolvency or Similar Settlement

13
14
15
15
17
17
18

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PART I – GENERAL INSTRUCTIONS
Section 4043(b) of the Employee Retirement Income Security Act (ERISA) requires that certain
contributing sponsors notify PBGC at least 30 days before the effective date of certain “reportable
events.” PBGC’s regulation on Reportable Events (29 CFR Part 4043, Subparts A and C) describes in
detail each reportable event and any applicable extension or waiver provisions. The reportable events for
which advance reporting is required are:
A.
B.
C.
D.
E.
F.
G.

Change in contributing sponsor or controlled group
Liquidation of contributing sponsor or controlled group member
Extraordinary dividend or stock redemption
Transfer of benefit liabilities
Application for minimum funding waiver
Loan default
Insolvency or similar settlement

Part III of these instructions summarizes the rules for each event.
The rules in the Reportable Events regulation apply only to reportable events involving single-employer
plans (which include multiple-employer plans) covered by title IV of ERISA. In these instructions, “plan”
always means such a plan.
What’s New
PBGC recently amended and updated its reportable events regulation. See __ FR __ (_______ __,
201_). In connection with the amendments, the Form 10-ADV instructions and Form 10-ADV have been
changed; the key changes include:
•
•
•
•
•

•
•
•
•
•

Elimination of some filing extensions
A revised advance reporting threshold test to conform to the PPA 2006 funding rules and PBGC’s
new variable-rate premium rules
A requirement that filers use PBGC forms to file reportable events notices and that the notice be filed
electronically
Elimination of the “partial electronic filing” provision whereby certain basic information could be
submitted on time electronically and followed up within 1 business day with the remaining required
information
A requirement for certain events that filers submit the most recent month-end statement of the market
value of plan assets, the most recent actuarial valuation report that contains or is supplemented with
all the items of information described in § 4010.8(a)(11) of PBGC’s regulation on Annual Financial
and Actuarial Information Reporting (29 CFR part 4010), and a statement of any material changes in
plan liabilities since the actuarial valuation report
A requirement for certain events that filers submit financial statements, including for all controlled
group members where specified, to the extent not publicly available
Excluding bankruptcies under the Bankruptcy Code from reporting and reduced reporting for other
insolvency events
A requirement that filers submit financial statements for all controlled group members to the extent
not publicly available for loan defaults or extraordinary distributions or stock redemptions
A requirement that filers submit financial statements for both the transferor controlled group and
transferee controlled group for the benefit-liability-transfer event
A limitation on the scope of the benefit-liability-transfer event to exclude cashouts and annuitizations
6

•

Making revisions to accommodate statutory changes made by the Pension Protection Act of 2006
(“PPA 2006”)
Post-Event Reporting Rule
Section 4043(a) of ERISA requires that the plan administrator and each contributing sponsor
notify PBGC within 30 days after the occurrence of certain reportable events. If an advance
notice is filed (using Form 10-ADV), no post-event notice (using Form 10) is required.
Form 10-ADV and the rules described in these instructions do not apply to post-event
reporting. See the Form 10 package and 29 CFR Part 4043, Subparts A and B, for further
information about post-event reporting.

Contributing Sponsors Subject to Advance Reporting
Certain contributing sponsors are required to notify PBGC at least 30 days before the effective date of
certain reportable events unless a waiver or extension applies (29 CFR §4043.61(a)).
A contributing sponsor of a plan is subject to the advance reporting requirement for a reportable event if:
(1) on the due date for the reportable event notice, neither the contributing sponsor nor any member of
the plan’s controlled group to which the event relates is a person subject to the reporting requirements
of section 13 or 15(d) of the Securities Exchange Act of 1934 or a subsidiary (as defined for purposes
of the Securities Exchange Act of 1934) of a person subject to such reporting requirements; and
(2) the plans maintained (on the due date for the reportable event notice) by the contributing sponsor and
members of the contributing sponsor’s controlled group, disregarding plans with no unfunded vested
benefits, have —
(i) aggregate unfunded vested benefits of more than $50 million; and
(ii) an aggregate value of plan assets that is less than 90 percent of the aggregate premium funding
target.
The unfunded vested benefits, value of plan assets, and premium funding targets are those determined for
premium purposes for the plan year preceding the effective date of the event.
Who Must Notify PBGC
Each contributing sponsor subject to advance reporting must notify PBGC that a reportable event will
occur using the PBGC Form 10-ADV. If there is a change in contributing sponsor, the reporting
obligation applies to the contributing sponsor(s) on the date the advance notice is due.
A single occurrence (such as a controlled group break-up) may be a reportable event for more than one
plan in the controlled group. In that case, the advance reporting requirement applies to each contributing
sponsor of each plan. Any filing will be deemed to be a filing by all persons required to notify PBGC.
Special Rule for Terminating Plans: The fact that a plan is terminating does not excuse a failure to timely
file a required reportable event notice. However, the notice is waived if the deadline for filing notice is on
or after the date on which (1) all of the plan’s assets (other than any excess assets) are distributed
pursuant to a standard termination under 29 CFR Part 4041 or (2) a trustee is appointed for the plan
under ERISA §4042(c).
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Reporting Waivers
Advance notice is automatically waived for certain reportable events in certain circumstances (see Part III
of these instructions). Advance reporting is waived for any occurrence that is reportable as more than one
reportable event only if the requirements for a waiver for each reportable event are met.
What to File
A contributing sponsor must use the PBGC Form 10-ADV to file an advance reportable event notice with
PBGC, and include with the Form 10-ADV both general information and event-specific information.
General information required is listed at the start of Part III of the instructions, and specific information is
listed under “Required Attachments” for each reportable event described in Part III and on the Form 10ADV.
If any required information has previously been submitted to PBGC, the filer may refer to the previous
submission instead of resubmitting the information.
If the same occurrence is reportable as more than one reportable event, separate notices may be filed
separately or together, or a single notice may be filed covering all of the events. If a single notice is filed,
the notice must include all the required information for each event. (See also “When to File.”)
Notices for two or more events may be submitted together.
PBGC may require that a contributing sponsor submit additional relevant information within 7 days after
the date of PBGC’s written request. PBGC may shorten this 7-day period where it determines that the
interests of PBGC or participants may be prejudiced by a delay in receipt of the information.
Note: Any non-public information submitted to PBGC as part of a reportable event notice shall not be
made public, except as may be relevant to any administrative or judicial action or proceeding or for
disclosure to either body of Congress.
Information on Controlled Group Structure
The requirement to submit a description of a plan’s controlled group may be satisfied by submitting an
organization chart or other diagram if it includes or is supplemented with names and addresses of all
members of the plan’s controlled group. The description or chart may exclude de minimis 5-percent
segments and foreign entities other than foreign parents.
When To File
In general, an advance notice of a reportable event must be filed no later than 30 days before the effective
date of the reportable event. PBGC has extended the deadline for some events in certain specified
circumstances (see Part III of these instructions).
PBGC may, upon review of an advance notice, shorten the notice period to allow for an earlier effective
date.
If the same occurrence is reportable as two or more reportable events with different filing deadlines, and a
separate notice is filed for each event, the notice for each event must be filed by the deadline for that
event. If the notices are filed together, or if a single notice is filed for all the events, the filing must be
made by the earliest filing deadline.
8

In computing any period of time, the day of the event from which the period of time begins to run is not
included. The last day of the period is included, unless it is a weekend or Federal holiday, in which case
the period runs until the end of the next regular business day.
Note: There is no longer a special “partial electronic filing” provision whereby a filer could submit
certain required information within 1 business day after the filing deadline. Now, all required
information must be submitted by the filing deadline.
How To File
All required information must now be filed electronically (see 29 CFR § 4043.5) by the due date, which
can be done by e-mail at [email protected]. Notices must be filed using the Form 10-ADV that
is posted on PBGC’s web site. You may not submit your filing using a paper form unless you request and
receive an exemption from e-filing.
If you want to e-mail materials totaling more than 10 megabytes, please use LeapFILE. Enter
“pbgc.leapfile.com” in your Internet browser, click on “secure upload,” enter
“[email protected]” in the “Recipient Email” field, and attach the files.
Note: PBGC may waive electronic filing for voluminous paper documents to relieve filers of the need to
scan them, or for other reasons, upon request pursuant to 29 CFR § 4043.4(d) (case-by-case waivers).
Filing Date
The date when advance notice of a reportable event (or additional information required by PBGC) is
considered to have been filed is the date the notice is received by PBGC at [email protected].
See 29 CFR § 4000.29.
Effect of Failure to File
If a notice (or any other required information) under ERISA §4043 is not provided within the specified
time limit, PBGC may assess against each contributing sponsor required to provide the notice a separate
penalty under ERISA §4071 of up to $1,100 a day for each day for which the notice or other information
is overdue. PBGC will generally assess the full $1,100 a day penalty for failure to give advance notice
(see 29 CFR Part 4071 and PBGC’s Statement of Policy on Assessment of Penalties for Failure to
Provide Required Information (60 FR 36837, July 18, 1995)). PBGC may pursue any other equitable or
legal remedies available to it under the law.
For Questions, Problems, Copies of Forms
If you have questions or problems regarding reportable events, contact:
Pension Benefit Guaranty Corporation
Corporate Finance and Restructuring Department
1200 K Street, NW
Washington, DC 20005-4026
Telephone: 202-326-4000
Email: [email protected]
TTY/TDD users may call the Federal Relay Service toll-free at 1-800-877-8339 and ask to be connected
to 202-326-4000.

9

Copies of Form 10-ADV and instructions may be obtained from PBGC’s website
at http://www.pbgc.gov/prac/forms.html.

PART II - DEFINITIONS
Benefit Liabilities means the benefits of participants and their beneficiaries under the plan (within the
meaning of section 401(a)(2) of the Code).
Code means the Internal Revenue Code of 1986, as amended.
Contributing sponsor means a person that is a contributing sponsor as defined in ERISA §4001(a)(13).
Controlled group means, in connection with any person, a group consisting of that person and all other
persons under common control with that person (generally 80 percent ownership; see 29 CFR Part
4001.3). Any reference to a plan’s controlled group means all contributing sponsors of the plan and all
members of each contributing sponsor’s controlled group.
De minimis 5-percent segment means, in connection with a plan’s controlled group, one or more entities
that in the aggregate have for a fiscal year:
1. Revenue not exceeding 5 percent of the controlled group's revenue;
2. Annual operating income not exceeding the greater of:
a. 5 percent of the controlled group’s annual operating income, or
b. $5 million; and
3. Net tangible assets at the end of the fiscal year(s) not exceeding the greater of:
a. 5 percent of the controlled group’s net tangible assets at the end of the fiscal year(s), or
b. $5 million.
EIN/PN means the nine-digit employer identification number assigned by the Internal Revenue Service
to a person and the three-digit plan number assigned to a plan. The EIN/PN reported should be the
EIN/PN most recently reported for a PBGC premium filing (if applicable). If the plan has never made a
PBGC premium filing, enter the EIN assigned to the contributing sponsor by the IRS for income tax
purposes and the PN assigned by the contributing sponsor
Foreign entity means a member of a controlled group that:
1. Is not a contributing sponsor of a plan;
2. Is not organized under the laws of (or, if an individual, is not a domiciliary of) any State of the United
States, the District of Columbia, Puerto Rico, the Virgin Islands, American Samoa, Guam, and Wake
Island; and
3. For the fiscal year that includes the effective date of the reportable event, meets one of the following
tests:
a. Is not required to file any United States federal income tax form;
b. Has no income reportable on any United States federal income tax form other than passive
income not exceeding $1,000; or
c. Does not own substantial assets in the United States (disregarding stock of a member of the
plan’s controlled group) and is not required to file any quarterly United States tax return for
employee withholding.
10

Foreign parent means a foreign entity that is a direct or indirect parent of a person that is a contributing
sponsor.
Notice date means the deadline (including extensions) for filing notice of a reportable event with PBGC.
Person means an individual, partnership, joint venture, corporation, mutual company, joint-stock
company, trust, estate, unincorporated organization, association, or employee organization.
Public company means a person subject to the reporting requirements of §13 or §15(d) of the Securities
Exchange Act of 1934 or a subsidiary (as defined for purposes of the Securities Exchange Act of 1934) of
a person subject to such reporting requirements.
Single-employer plan means any defined benefit plan (as defined in ERISA §3(35)) that is not a
multiemployer plan (as defined in ERISA §4001(a)(3)) and that is covered by title IV of ERISA.

PART III - SPECIFIC INSTRUCTIONS

General Information Required for All Reportable Events; see also each reportable event
listed below for event-specific information required:
•
•
•
•

•
•
•

The name of the plan
The name and address of the contributing sponsor(s) and the name, title, e-mail address, and phone
number of an individual whom PBGC should contact if it has questions about the filing
The name and address of the plan administrator and the name, title, e-mail address, and phone
number of an individual whom PBGC should contact if it has questions about the filing
The EIN/PN reported should be the EIN/PN most recently reported for a PBGC premium filing (if
applicable). If the plan has never made a PBGC premium filing, enter the EIN assigned to the
contributing sponsor by the IRS for income tax purposes and the PN assigned by the contributing
sponsor
Effective date of event or date event occurred if there is an extension
The type of event that occurred (indicated by marking the appropriate box)
A brief statement of the pertinent facts relating to the reportable event

Specific Information for Particular Events
Where a reportable event requires reporting financial information and/or actuarial information, please
include the following:
•

Financial information for all controlled group members (unless publicly available):
–
Audited financial statements for the most recent fiscal year (including balance sheet, income
statement, cash flow statement, and notes to the financial statements)
–
If audited financial statements are not available, unaudited financial statements for the most
recent fiscal year
–
If neither audited nor unaudited financial statements are available, copies of federal tax returns
for the most recent tax year

Note: If the above required financial information is publicly available, please indicate where the
financial statements can be obtained (SEC, company website, etc.).
11

•

Actuarial information:
– Copy of the most recent Actuarial Valuation Report that includes or is supplemented with all of
the items described in 29 CFR §4010.8(a)(11)*
– Statement of any material change in liabilities of the plan occurring after the date of the most
recent Actuarial Valuation Report
– Most recent month-end market value of plan assets
–

Contact name, number, and employer of the plan actuary if different from that listed on the most
recently filed Schedule SB to Form 5500

* The items described in 29 CFR §4010.8(a)(11) are:
o

o

o
o
o
o
o
o

o

o

o
o

The funding target calculated pursuant to ERISA section 303 without regard to subsection
303(i)(1), setting forth separately the value of the liabilities attributable to retirees and
beneficiaries receiving payment, terminated vested participants, and active participants (showing
vested and nonvested benefits separately;
A summary of the actuarial assumptions and methods used for purposes of ERISA section 303
and any changes in those assumptions and methods since the previous valuation and justifications
for any change; in the case of a plan that provides lump sums, other than de minimis lump sums,
the summary must include the assumptions on which participants are assumed to elect a lump
sum and how lump sums are valued;
The effective interest rate (as defined in ERISA section 303(h)(2)(A) and Code section
430(h)(2)(A));
The target normal cost calculated pursuant to ERISA section 303 without regard to subsection
303(i)(2) (and Code section 430 without regard to subsection 430(i)(2));
For the plan year and the four preceding plan years, a statement as to whether the plan was in atrisk status for that plan year;
In the case of a plan that is in at-risk status, the target normal cost calculated pursuant to ERISA
section 303 as if the plan has been in at-risk status for 5 consecutive years;
The value of the plan’s assets (reflecting any averaging method) as of the valuation date and the
fair market value of the plan’s assets as of the valuation date;
The funding standard carryover balance and the prefunding balance (maintained pursuant to
ERISA section 303(f)(1) and Code section 430(f)(1)) as of the beginning of the plan year and a
summary of any changes in such balances in the past year (e.g., amounts used to offset minimum
funding requirement, amounts reduced in accordance with any elections under ERISA section
303(f)(5) or Code section 430(f)(5), interest credited to such balances, and excess contributions
used to increase such balances);
A list of amortization bases (shortfall and waiver) under ERISA section 303 and Code section
430, including the year the base was established, the original amount, the installment amount, and
the remaining balance at the beginning of the plan year;
An age/service scatter for active participants including average compensation information for
pay-related plans and average account balance information for hybrid plans presented in a format
similar to that described in the instructions to Schedule SB of the Form 5500;
Expected disbursements (benefit payments and expenses) during the plan year; and
A summary of the principal eligibility and benefit provisions on which the valuation of the plan
was based (and any changes to those provisions since the previous valuation), along with
descriptions of any benefits not included in the valuation, any significant events that occurred
during the plan year, and the plan’s early retirement factors; in the case of a plan that provides
lump sums, other than de minimis lump sums, the summary must include information on how
annuity benefits are converted to lump sum amounts (for example, whether early retirement
subsidies are reflected).

12

A. Change in Contributing Sponsor or Controlled Group
(see 29 CFR §4043.62)
Definition of Event - A reportable event occurs for a plan when there is a transaction that results, or will
result, in one or more persons ceasing to be members of the plan’s controlled group.
For this purpose, a transaction includes, but is not limited to, a legally binding agreement, whether or not
written, to transfer ownership, an actual transfer of ownership, and an actual change in ownership that
occurs as a matter of law or through the exercise or lapse of pre-existing rights. Whether an agreement is
legally binding is to be determined without regard to any conditions in the agreement.
Note: This event does not include a transaction that will result solely in a reorganization involving a
mere change in identity, form, or place of organization, however effected.
Examples - The following examples assume a waiver does not apply.
Controlled Group Breakup
Facts: Plan A’s controlled group consists of Company A (its contributing sponsor), Company B (which
maintains Plan B), and Company C. As a result of a transaction, the controlled group will break into two
separate controlled groups -- one segment consisting of Company A and the other segment consisting of
Companies B and C.
Reporting: Both Company A (Plan A’s contributing sponsor) and the plan administrator of Plan A are
required to report that Companies B and C will leave Plan A’s controlled group. Company B (Plan B’s
contributing sponsor) and the plan administrator of Plan B are required to report that Company A will
leave Plan B’s controlled group. Company C is not required to report because it is not a contributing
sponsor or a plan administrator.
Change in Contributing Sponsor
Facts: Plan Q is maintained by Company Q. Company Q enters into a binding contract to sell a portion of
its assets and to transfer employees participating in Plan Q, along with Plan Q, to Company R, which is
not a member of Company Q's controlled group. There will be no change in the structure of Company Q's
controlled group. On the effective date of the sale, Company R will become the contributing sponsor of
Plan Q.
Reporting: A reportable event occurs on the date of the transaction (i.e., the binding contract) because, as
a result of the transaction, Company Q (and any other member of its controlled group) will cease to be a
member of Plan Q’s controlled group. If, on the 30th day after Company Q and Company R enter into the
binding contract, the change in the contributing sponsor has not yet become effective, Company Q has the
reporting obligation. If the change in the contributing sponsor has become effective by the 30th day,
Company R has the reporting obligation.
Reporting Waivers - Reporting of this event is waived if:
Small and mid-size plans: with respect to a change of contributing sponsor, the transferred plan has fewer
than 500 participants.
De minimis 5-percent segment: The person or persons that will cease to be members of the plan’s
controlled group represent a de minimis 5-percent segment of the plan’s old controlled group for the most
recent fiscal year(s) ending on or before the effective date of the reportable event.
13

Additional Required Information:
• Description of the plan’s old and new controlled group structures, including the name of each
controlled group member
• Name of each plan maintained by any member of the plan’s old and new controlled groups, its
contributing sponsor(s) and EIN/PN
• Financial information (see page 11 of these Instructions) and interim financial statements of the
plan’s contributing sponsor (both old and new in the case of a change in the contributing sponsor) and
any persons that will cease to be in the plan’s controlled group
• Actuarial information (see page 11 of these Instructions)
If a filer is unable with reasonable diligence to obtain any of the following information about a
controlled group other than the filer’s controlled group, the filer may instead file a statement to that
effect.

B. Liquidation
(see 29 CFR §4043.63)
Definition of Event - A reportable event occurs for a plan when a member of the plan’s controlled group:
1. Is involved in any transaction to implement its complete liquidation (including liquidation into
another controlled group member);
2. Institutes or has instituted against it a proceeding to be dissolved or is dissolved, whichever occurs
first; or
3. Liquidates in a case under the Bankruptcy Code, or under any similar law.
Note: An event described above may also be reportable under Insolvency or Similar Settlement (see
Part III.G).
Reporting Waiver - De minimis 5-percent segment. Reporting of this event is waived if the person that
liquidates is a de minimis 5-percent segment of the plan’s controlled group for the most recent fiscal
year(s) ending on or before the effective date of the reportable event, and each plan that was maintained
by the liquidating member is maintained by another member of the plan’s controlled group.
Additional Required Information:
• Description of the plan’s controlled group structure before and after the liquidation, including the
name of each controlled group member
• Operational status of each controlled group member (in Chapter 7 proceedings, liquidating outside of
bankruptcy, on-going, etc.)
• Name of each plan maintained by any member of the plan’s controlled group, its contributing
sponsor(s) and EIN/PN
• Financial information for all controlled group members (see page 11 of these Instructions)
• Actuarial information (see page 11 of these Instructions)
• If the plan sponsor is expected to cease or has ceased substantially all operations also provide:
– Date on which substantially all operations are expected to cease or have ceased
– Most recent pension plan document(s)
– Address of each controlled group member
– The Internal Revenue Service Determination Letter indicating the plan is a covered plan

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C. Extraordinary Dividend or Stock Redemption
(see 29 CFR §4043.64)
ERISA Definition - The reportable event described below replaces the corresponding event for
extraordinary dividends and stock redemptions described in ERISA §4043(c)(11). Thus, reporting of any
event described under ERISA §4043(c)(11) is waived, unless the event would be reportable under this or
another reportable event.
Definition of Event - A reportable event occurs for a plan when any member of the plan’s controlled
group declares a dividend or redeems its own stock, and the amount or net value of the distribution, when
combined with other such distributions during the same fiscal year of the person, exceeds the person’s net
income before after-tax gain or loss on any sale of assets, as determined in accordance with generally
accepted accounting principles and practices, for the prior fiscal year. A distribution by a person to a
member of its controlled group is disregarded.
Determination Rules - For purposes of this event, the net value of a non-cash distribution is the fair
market value of assets transferred by the person making the distribution, reduced by the fair market value
of any liabilities assumed or consideration given by the recipient in connection with the distribution. Net
value determinations should be based on readily available fair market value(s) or independent appraisal(s)
performed within one year before the distribution is made. To the extent that fair market values are not
readily available and no such appraisals exist, the fair market value of an asset transferred in connection
with a distribution or a liability assumed by a recipient of a distribution is deemed to be equal to 200
percent of the book value of the asset or liability on the books of the person making the distribution.
Stock redeemed is deemed to have no value.
Reporting Waiver; de minimis 5-percent segment - Reporting is waived if the person making the
distribution is a de minimis 5-percent segment of the plan’s controlled group for the most recent fiscal
year(s) ending on or before the effective date of the reportable event.
Additional Required Information:
• Name and EIN of person making the distribution
• Date and amount of cash distribution(s) during fiscal year
• Description, fair market value, and date(s) of any non-cash distribution(s)
• Statement whether the recipient was a member of the plan’s controlled group
• Description of the plan’s controlled group structure, including the name and address of each
controlled group member
• Name of each plan maintained by any member of the plan's controlled group, its contributing
sponsor(s) and EIN/PN
• Financial information for all controlled group members (see page 11 of these Instructions)
• Actuarial information (see page 11 of these Instructions)
D. Transfer of Benefit Liabilities
(see 29 CFR §4043.65)
Definition of Event - A reportable event occurs for a plan when:
1. The plan makes a transfer of benefit liabilities to a person, or to a plan or plans maintained by a
person or persons, that are not members of the transferor plan’s controlled group; and
2. The amount of benefit liabilities transferred, in conjunction with other benefit liabilities transferred
during the 12-month period ending on the date of the transfer, is 3 percent or more of the plan’s total
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benefit liabilities. For this purpose, value both the benefit liabilities transferred and the plan’s total
benefit liabilities as of any one date in the plan year in which the transfer occurs, using actuarial
assumptions that comply with Code §414(l).
The date of a transfer of benefit liabilities shall be determined on the basis of the facts and
circumstances of the particular situation. For transfers subject to Code §414(l), the date determined in
accordance with that section and 26 CFR §1.414(l)-1(b)(11) will be considered the date of transfer.
Note: For purposes of this reportable event, the payment of a lump sum, or purchase of an irrevocable
commitment to provide an annuity, in satisfaction of benefit liabilities is not considered a transfer of
benefit liabilities.
Reporting Waivers - Reporting of this event is waived if:
Complete plan transfer: The transfer is a transfer of all of the transferor plan's benefit liabilities and
assets to one other plan.
Transfer of less than 3 percent of assets: The value of the assets being transferred —
(1) Equals the present value of the accrued benefits (whether or not vested) being transferred,
using actuarial assumptions that comply with section 414(l) of the Code; and
(2) In conjunction with other assets transferred during the same plan year, is less than 3 percent
of the assets of the transferor plan as of at least one day in that year.
Section 414(l) safe harbor: The benefit liabilities of 500 or fewer participants are transferred and the
transfer complies with section 414(l) of the Code using the actuarial assumptions prescribed for valuing
benefits in trusteed plans under 29 CFR §§4044.51-57.
Fully funded plans: The transfer complies with section 414(l) of the Code using reasonable actuarial
assumptions and, after the transfer, the transferor and transferee plans are fully funded as determined in
accordance with 29 CFR Parts 4044.51 through 4044.57 (dealing with valuation of benefits and assets in
trusteed terminating plans) and 29 CFR Part 4010.8(d)(1)(ii).
Additional Required Information:
• Description of the transferee’s old and new controlled group structures, including the name of each
controlled group member
• Name of each plan maintained by any member of the transferee’s old and new controlled group
structures, its contributing sponsor and EIN/PN of transferor plan and each transferee plan
• Explanation of the actuarial assumptions used in determining the value of benefit liabilities (and, if
appropriate, plan assets) transferred
• Estimate of the assets, liabilities, and number of participants whose benefits are transferred
• Financial statements of all members of the transferee’s new controlled group (see page 11 of these
Instructions)
• Actuarial information (see page 11 of these Instructions)
If a filer is unable with reasonable diligence to obtain any of the above information about a
controlled group other than the filer’s controlled group, the filer may instead file a statement to that
effect.

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E. Application for Minimum Funding Waiver
(see 29 CFR §4043.66)
Definition of Event - A reportable event occurs when an application for a minimum funding waiver is
submitted for a plan under ERISA §302(c) or Code §412(c).
Extension of Reporting Deadline - The notice date is extended until 10 days after the reportable event
occurs.
Additional Required Information:
• Copy of waiver application, with all attachments
F. Loan Default
(see 29 CFR §4043.67)
Definition of Event - A reportable event occurs for a plan when, with respect to a loan with an
outstanding balance of $10 million or more to a member of the plan’s controlled group:
1. There is an acceleration of payment or a default under the loan agreement; or
2. The lender waives or agrees to an amendment of any covenant in the loan agreement for the purpose
of avoiding a default.
Note – A default on a loan within a controlled group is not for that reason excluded from the reporting
requirement.
Additional Required Information:
• Copy of the relevant loan documents (e.g., promissory note, security agreement, loan agreement
amendments and waivers)
• Due date and amount of any missed payment
• Copy of any written notice of default, acceleration, forebearance, or loan agreement amendment or
waiver
• Description of any cross-defaults or anticipated cross-defaults
• Description of the plan’s controlled group structure, including the name of each controlled group
member
• Name of each plan maintained by any member of the plan's controlled group, its contributing
sponsor(s) and EIN/PN
• Financial statements for all controlled group members (see page 11 of these Instructions)
• Actuarial information (see page 11 of these Instructions)

17

G. Insolvency or Similar Settlement
(see 29 CFR §4043.68)
Definition of Event - A reportable event occurs with respect to a plan when any member of the plan’s
controlled group:
1. Commences, or has commenced against it, any insolvency proceeding (including, but not limited to,
the appointment of a receiver) , other than a bankruptcy case under the Bankruptcy Code;
2. Commences, or has commenced against it, a proceeding to effect a composition, extension, or
settlement with creditors;
3. Executes a general assignment for the benefit of creditors; or
4. Undertakes to effect any other nonjudicial composition, extension, or settlement with substantially all
its creditors.
Note: An event described above may also be reportable under Liquidation (see Part III.B).
Extension of Reporting Deadline – For a case or proceeding under 1 or 2 described in the definition of a
insolvency or similar event above, the notice date is extended until 10 days after the commencement of
the case or proceeding.
Additional Required Information:
• Name, address and telephone number of any trustee, receiver or similar person
• Docket number of court filing and location of the court where any relevant proceeding was or will be
filed (if known)
• Description of the plan’s controlled group structure, including the name of each controlled group
member
• Name of each plan maintained by any member of the plan’s controlled group, its contributing
sponsor(s) and EIN/PN
• Actuarial information (see page 11 of these Instructions)

18