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

Department of the Treasury - Internal Revenue Service

Form 14568-B
(August 2016)

Model VCP Compliance Statement - Schedule 2:
Other Nonamender Failures and Failure to Adopt
a 403(b) Plan Timely

OMB Number
1545-1673

Include the plan name, Applicant’s EIN, and plan number on each page of the compliance statement, 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 Internal Revenue Code section
401(b) and the regulations thereunder:
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) 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.
The changes required by the 2005 Cumulative List (Notice 2005-101) for Cycle A individually designed plans.
The changes required by the 2006 Cumulative List (Notice 2007-3) 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.)
The changes required by the 2007 Cumulative List (Notice 2007-94) for Cycle C individually designed plans.
The changes required by the 2008 Cumulative List (Notice 2008-108) for Cycle D individually designed plans.
The changes required by the 2009 Cumulative List (Notice 2009-98) for Cycle E individually designed plans.
The changes required by the 2010 Cumulative List (Notice 2010-90) for Cycle A individually designed plans
and any eligible employer using a pre-approved defined contribution plan who failed to adopt the pre-approved
plan by 4/30/16, as required by Announcement 2014-16)
The changes required by the 2011 Cumulative List (Notice 2011-97) for Cycle B individually designed plans.
The changes required by the 2012 Cumulative List (Notice 2012-76) for Cycle C individually designed plans.
The changes required by the 2013 Cumulative List (Notice 2013-84) for Cycle D individually designed plans.
The changes required by the 2014 Cumulative List (Notice 2014-77) for Cycle E individually designed plans.
The changes required by the 2015 Cumulative List (Notice 2015-84) for Cycle A individually designed plans.

Catalog Number 66146J
www.irs.gov
For Paperwork Reduction Act information see current EPCRS Revenue Procedure.

Form 14568-B (Rev. 8-2016)

Page 2

Plan name

EIN

Plan number
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
Yes
No
the amendments?
Other (specify the late amender failure not listed above) (Attach additional pages as needed. Label the attachment
“Section 1A of Form 14568-B, Identification of Other Nonamender Failures” and include the plan name, Applicant’s
EIN and plan number at the top of each page.):

B. 403(b) Plans:
The plan sponsor did not timely adopt a written plan as required by the final Code section 403(b) regulations and
Notice 2009-3.

Section II - Description of Proposed Method of Correction
A. Qualified Plan. The Applicant indicated that the plan sponsor has adopted (or will adopt) amendments that satisfy
the requirements of all of the items checked in Section IA of this 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 VCP submission.
B. 403(b) Plan. Failure to adopt a written plan timely. The Applicant indicated that 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 VCP submission.

Section III - Change in Administrative Procedures
The Applicant indicated the plan sponsor has taken (or will take) 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
enclosed the following documents, as appropriate, with this VCP 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),
● For 403(b) plans, a copy of the signed and dated written 403(b) Plan.
Catalog Number 66146J

www.irs.gov

Form 14568-B (Rev. 8-2016)