14568-G Appendix C Part II Schedule 7 Failure to Distribute Elec

Department of the Treasury - Internal Revenue Service

Form 14568-G

Appendix C Part II Schedule 7

(January 2014)

Failure to Distribute Elective Deferrals in Excess
of the § 402(g) Limit

OMB Number
1545-1673

Please include the plan name, Applicant’s EIN, and plan number information on each page of the submission
Plan name

EIN

Plan number

Section I - Identification of Failure
Calendar Years (Year of Deferral)

Number of Participants Affected

Amount of Excess Deferrals Distributed (Excluding Earnings)

Section II - Description of the Proposed Method of Correction
The plan will distribute the excess deferral to the employee(s) and report the amount as taxable in the year of deferral and in the year
distributed. In accordance with Income Tax Regulations § 1.402(g)-1(e)(1)(ii), a distribution to a highly compensated employee is
included in the Average Deferral Percentage (ADP) test; however, a distribution to a nonhighly compensated employee is not included
in the ADP test.
For any distributions attributable to elective deferrals designated as Roth Contributions, all distributions will be reported as taxable in
the year distributed. Designated Roth contributions will have already been included in income in the year of deferral.
The excess deferral to be distributed will also be adjusted for Earnings. Earnings will be determined from the end of the year in which
the failure occurred through the year of correction. Earnings will be included in the distribution amount that is to be reported as taxable
in the year of distribution.

Section III - Change in Administrative Procedures
Please include an explanation of how and why the failures arose and a description of the measures that will be implemented to ensure
that the same failures will not recur.

Section IV - Enclosures
In addition to the applicable items listed on the Procedural Requirements Checklist for Form 8950, the Plan Sponsor encloses the
following with this submission:
Specific calculations for each affected employee or a representative sample of affected employees. (The sample calculations must be
sufficient to demonstrate each aspect of the correction method proposed)
Catalog Number 66151C
www.irs.gov
For Paperwork Reduction Act information see Revenue Procedure 2013-12.

Form 14568-G (1-2014)