14568-B Appendix C Part II Schedule 2 Nonamender Failures (other

Department of the Treasury - Internal Revenue Service

Form 14568-B
(January 2014)

Appendix C Part II Schedule 2
Nonamender Failures (other than those to which
Schedule 1 applies) and Failure to Adopt a 403(b)
Plan Timely

OMB Number
1545-1673

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

EIN

Plan number

Section I - Identification of Failures
A. Qualified Plans: The plan identified above was not amended to comply with the applicable provisions of the following legislative and
regulatory requirements by the applicable deadlines in accordance with § 401(b) and the regulations thereunder:
The Employee Retirement Income Security Act of 1974 (ERISA)
The Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)
The Deficit Reduction Act of 1984 (DEFRA)
The Retirement Equity Act of 1984 (REA)
The Tax Reform Act of 1986 (TRA ’86)
The Unemployment Compensation Amendments of 1992 (UCA)
The Omnibus Budget Reconciliation Act of 1993 (OBRA)
GUST (includes The Uruguay Round Agreements Act, the Uniformed Services Employment and Reemployment Rights Act of
1994, the Small Business Job Protection Act of 1996, the Taxpayer Relief Act of 1997, the Internal Revenue Service
Restructuring and Reform Act of 1998, and the Community Renewal Tax Relief Act of 2000)
The changes required by the Cumulative List for the plan’s last on-cycle year:
The changes required by the 2004 Cumulative List (Notice 2004-84, 2004-2 C.B. 1030) for an eligible employer using a preapproved defined contribution plan who failed to adopt the pre-approved plan by 4/30/10, as required by Announcement
2008-23, 2008-1 C.B. 731.
The changes required by the 2005 Cumulative List (Notice 2005-101, 2005-2 C.B. 1219) for Cycle A individually designed
plans.
The changes required by the 2006 Cumulative List (Notice 2007-3, 2007-1 C.B. 255) for Cycle B individually designed
plans, and any eligible employer using a pre-approved defined benefit plan who failed to adopt the pre-approved plan by
4/30/12, as required by Announcement 2010-20, 2010-15 I.R.B. 551.)
The changes required by the 2007 Cumulative List (Notice 2007-94, 2007-2 C.B. 1179) for Cycle C individually designed
plans.
The changes required by the 2008 Cumulative List (Notice 2008-108, 2008-50 I.R.B. 1275) for Cycle D individually
designed plans.
The changes required by the 2009 Cumulative List (Notice 2009-98, 2009-52 I.R.B. 974) for Cycle E individually designed
plans.
The changes required by the 2010 Cumulative List (Notice 2010-90, 2010-52 I.R.B. 909) for Cycle A individually designed
plans.
The changes required by the 2011 Cumulative List (Notice 2011-97, 2011-52 I.R.B. 923) for Cycle B individually designed
plans.
The changes required by the 2012 Cumulative List (Notice 2012-76, 2012-52 I.R.B. 775) for Cycle C individually designed
plans.
Amendments required as a condition for a favorable determination letter. If this item was selected answer the following
questions by checking the applicable boxes:
Is this the sole failure for the VCP submission?

Yes

No

Were the amendments signed within three months of the expiration of the remedial amendment period for adopting the
amendments?
Yes
No
Catalog Number 66146J
www.irs.gov
For Paperwork Reduction Act information see Revenue Procedure 2013-12.

Form 14568-B (1-2014)

Page 2
Plan name

EIN

Plan number

Other (specify the legal requirement and applicable Cumulative List):

B. 403(b) Plans:
The Plan Sponsor did not timely adopt a written plan as required by the final 403(b) regulations and Notice 2009-3, 2009-2
I.R.B. 250.

Section II - Description of Proposed Method of Correction
A. Qualified Plan. The Plan Sponsor has adopted (or will adopt) amendments that satisfy the requirements of all of the items
checked in Section IA of this Appendix C Part II, Schedule 2, retroactively to the effective dates of the specific provisions contained
in the amendments. The amendments and restated plan documents (where applicable) are enclosed with this submission.
B. 403(b) Plan. Failure to adopt a written plan timely. The Plan Sponsor has adopted a written plan retroactive to the later of the
effective date of the final 403(b) regulations or the initial effective date of the plan. A copy of the signed and dated 403(b) plan is
enclosed with this submission.

Section III - Change in Administrative Procedures
The Plan Sponsor has taken the following step(s) to ensure that the failure(s) 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 documents, as appropriate, with this submission:
● Copies of all amendments used to correct the failure(s), either as adopted or in proposed form,
● A copy of the plan document in effect prior to any of the amendments used to correct the failure(s),
● A copy of the most recent determination letter issued with respect to the plan (if applicable),
● If required by Section 6.05 of Rev. Proc. 2013-12, a determination letter application (Form 5300, 5307, or 5310 along with Form
8717 and the applicable user fee payment made payable to the U.S. Treasury), or
● For 403(b) plans, a copy of the signed and dated 403(b) Plan document.
Catalog Number 66146J

www.irs.gov

Form 14568-B (1-2014)