Reportable Events

Form 10 Instructions
POST-EVENT NOTICE
OF REPORTABLE EVENTS
The Form 10 is used by a plan administrator or contributing sponsor of a single-employer plan when notifying
the Pension Benefit Guaranty Corporation that a reportable event has occurred. For questions regarding this
form, contact (202) 326-4070 or [email protected].

Table of Contents

Page

Part I - General Instructions

2

Part II - Definitions

5

Part III - Specific Instructions
A. Active Participant Reduction
B. Failure to Make Required Minimum
Funding Payments
C. Inability to Pay Benefits When Due
D. Distribution to a Substantial Owner
E. Change in Contributing Sponsor or
Controlled Group
F. Liquidation
G. Extraordinary Dividend or Stock Redemption
H. Transfer of Benefit Liabilities
I. Application for Minimum Funding Waiver
J. Loan Default
K. Insolvency or Similar Settlement

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8
9
10
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15
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Form 10 Instructions
PART I – GENERAL INSTRUCTIONS

The web-based application walks the filer through
various screens, prompting the filer to answer
questions and enter required information. The
application allows filers to, among other things:
– Save a partially completed filing;
– Modify information any time prior to
submission;
– Pre-populate a filing with data from a
previously submitted filing;
– Route the filing as needed to facilitate ecertifications; and
– Review prior filings submitted via the e-filing
portal.
The portal can be accessed using the following
address: efilingportal.pbgc.gov.
• Instructions were revised to provide the types
of additional information PBGC may request of
filers liquidating or in an insolvency or similar
settlement.
Notification of future changes to any forms and instructions may be found under “What’s New” on the
Practitioners Page at www.pbgc.gov.

Section 4043(a) of the Employee Retirement Income Security Act (ERISA) requires that plan
administrators and contributing sponsors notify
PBGC within 30 days after the occurrence of certain “reportable events.” PBGC’s regulation on
Reportable Events (29 CFR Part 4043, Subparts A
and B) describes in detail each reportable event and
any applicable extension or waiver provisions. The
reportable events are:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.

Active participant reduction
Failure to make required minimum
funding payments
Inability to pay benefits when due
Distribution to a substantial owner
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

Advance Reporting Rule for Non-Public
Companies
ERISA §4043(b) requires that certain contributing sponsors notify PBGC at least 30 days before
the effective date of certain reportable events. If
an event is subject to both post-event and
advance notice requirements, the notice filed

Part III of these instructions summarizes the rules
for each event.
The rules in the reportable events regulation ap- ply
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.

first satisfies both filing requirements.
The advance notice requirement applies only to nonpublic companies that:

What’s New

1. are members of a controlled group whose plans
(disregarding plans with no unfunded vested
benefits) have:
i. aggregate unfunded vested benefits of
more than $50 million and
ii. an aggregate funded vested benefit
percentage of less than 90 percent; and
2. are reporting about events relating to themselves or other non-public companies in the
controlled group.

The Form 10 instructions and the Form 10 have
changed. Key changes include:
•

•

Controlled
group,
company
financial
information, and plan actuarial information is
required to be submitted with all reportable event
filings.
PBGC's new e-filing portal offers a secure
application for submitting Form 10 information.
The application will review filings and generate
a list of omissions and inconsistencies prior to
submission to ensure that filings are complete.

Form 10 and the rules described in these instructions
do not apply to advance reporting. See the Form 102

Form 10 Instructions
Advance package and 29 CFR Part 4043, Subparts A
and C, for further information about advance
reporting.

Forms must be filed electronically. That can be
accomplished by:
1.
Emailing a completed form and any required
attachments to [email protected]; or
2. Using the 4043 module of PBGC's new e-filing
portal. The portal can be accessed using the
following address: efilingportal.pbgc.gov.

Who Must Notify PBGC
The plan administrator and each contributing sponsor of a plan for which a reportable event has occurred must file a post-event reportable event notice
with PBGC using the PBGC Form 10. If there is a
change in plan administrator or contributing sponsor,
the reporting obligation applies to the plan administrator or contributing sponsor(s) on the date the postevent notice is due.

To request an exemption from e-filing, submit a
request to [email protected].
If you are filing materials electronically that are larger
than 10 megabytes, please use LeapFILE. Enter
“pbgc.leapfile.com” in your Internet browser, click
on “secure upload,” enter “post-event.report@pbgc.
gov” in the “Recipient Email” field, and attach the
files.

Note: An authorized representative may file a reportable event notice on behalf of a plan administrator, a
contributing sponsor or both.

When to File
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
reporting requirement applies to the plan administrator and each contributing sponsor of each plan.
Any filing will be deemed to be a filing by all persons required to notify PBGC.

A reportable event notice must be filed within 30
days after a plan administrator or contributing sponsor knows or has reason to know that a reportable
event has occurred. 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.

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,
no notice is required if the deadline for filing notice

See 29 CFR § 4000.43 to determine how to compute
any period of time.

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 termination under 29 CFR Part 4041
or (2) a trustee is appointed for the plan under ERISA §4042(c).

Note: There is no longer a special “partial electronic
filing” provision whereby a filer could submit certain
required information within 2 business days after the
filing deadline. Now, all required information must be
submitted by the filing deadline.

Reporting Waivers
Automatic waivers are provided for certain reportable events in certain circumstances (see Part III of
these instructions for waivers by event type).

Notice Filing Date

Post-event 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.

The date a Form 10 is considered to have been filed is
the date the notice and all additional information is
submitted to PBGC at [email protected] or
the date submitted through PBGC’s e-filing portal. See
29 CFR § 4000.29.

How to File

What to File
3

Form 10 Instructions
A plan administrator or contributing sponsor must
include with the Form 10 certain specified information tailored to the particular event. This information
is listed on page 2 and 3 of the Form 10.

contributing sponsor required to provide the notice
(see 29 CFR Part 4071 and PBGC’s Statement of
Policy on Assessment of Penalties for Failure to
Provide Re- quired Information (60 FR 36837, July
18, 1995)). PBGC may pursue any other equitable or
legal remedies available to it under the law.

If any required information has previously been submitted to PBGC, the filer may refer to the previous
submission instead of resubmitting the information.

For Questions, Problems, Copies of Forms

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
(or an explanation for why any required information
is missing) for each event. Notices for two or more
events may be submitted together. (See also “When
to File.”)

If you have questions or problems regarding reportable events, contact:

PBGC may require that a plan administrator or contributing sponsor submit additional relevant information within 30 days after the date of PBGC’s writ- ten
request. PBGC may shorten this 30-day period where
it determines that the interests of PBGC or
participants may be prejudiced by a delay in receipt
of the information.

If you are having problems using the efiling portal,
contact PBGC at [email protected].

Pension Benefit Guaranty Corporation
Corporate Finance and Restructuring Department
1200 K Street, NW
Washington, DC 20005-4026
Telephone: 202-326-4070
Email: [email protected]

TTY/ASCII users may call the Federal Relay Service
toll-free at 1-800-877-8339 and ask to be connected
to 202-326-4070.
Copies of Form 10 and instructions may be obtained
from PBGC’s website at http://www.pbgc.gov/prac/
forms.html.

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 or any duly authorized committee or subcommittee of the Congress.
Information on Controlled Group Structure
To comply with any requirement that the reportable
event notice include a description of the plan’s controlled group structure (see page 2 of the Form 10),
the filer may submit a copy of an organization chart
or other diagram. The description or chart may
exclude de minimis 5-percent segments and foreign
entities other than foreign parents.
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 a penalty under
ERISA §4071 against each plan administrator and
4

Form 10 Instructions

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.

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).

Event year means the plan year in which a reportable event occurs.

Controlled group means, in connection with any
person, a group consisting of that person and all other
persons under common control with that per- son
(generally 80 percent ownership; see 29 CFR
§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.

Filing extension claimed means the specific filing
extension claimed under the relevant regulation and
reflected in the Notice Due Date.
Foreign entity means a member of a controlled
group that:
1. Is not a contributing sponsor of a plan;

Date of event means the date described in PBGC
regulations for the specific reportable event.

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 the Wake Island; and

De minimis 10-percent segment means, in connection with a plan’s controlled group, one or more entities that in the aggregate have for a fiscal year:

3. For the fiscal year that includes the date the
reportable event occurs, 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.

1. Revenue not exceeding 10 percent of the controlled group’s revenue;
2. Annual operating income not exceeding the
greater of:
a. 10 percent of the controlled group’s annual
operating income,
b. $5 million; and
3. Net tangible assets at the end of the fiscal year(s)
not exceeding the greater of:
a. 10 percent of the controlled group’s net tangible assets at the end of the fiscal year(s), or
b. $5 million.

Foreign parent means a foreign entity that is a direct
or indirect parent of a person that is a contributing
sponsor of a plan.

De minimis 5-percent segment has the same meaning as a de minimis 10-percent segment, except that
“5%” is substituted for “10%” each time it appears.
5

ties 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.

Low-default-risk means the contributing sponsor
of a plan or the highest U.S parent of a contributing
sponsor has adequate capacity to meet its obligations
in full and on time as evidenced by satisfying either
(A) the first two or (B) any four of the following seven criteria:

1 Earnings

before interest, taxes, depreciation, and
amortization.

1. The probability that the company will default on
its financial obligations is not more than 4 percent over the next five years or not more than 0.4
percent over the next year, in either case determined on the basis of widely available financial
information on the company’s credit quality.
2. The company’s secured debt (with some exceptions) does not exceed 10 percent of its total asset
value.
3. The company’s ratio of total debt to EBITDA1 is
3.0 or less.
4. The company’s ratio of retained earnings to total
assets is 0.25 or more.
5. The company has positive net income for the two
most recent completed fiscal years.
6. The company has not experienced any loan default event in the past two years regardless of
whether reporting was waived.
7. The sponsor has not experienced a missed contribution event in the past two years unless reporting was waived.

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.
Variable-rate premium means the portion of the
single-employer premium based on a plan’s
unfunded vested benefits.
U.S. entity means entity subject to the personal jurisdiction of the U.S. district court.
Well-funded plan safe harbor means that a plan is
in the well-funded plan safe harbor for an event year
if no variable-rate premium was required to be paid
for the plan under parts 4006 and 4007 of this chapter
for the plan year preceding the event year.
PART III - SPECIFIC INSTRUCTIONS
General Information Required for All Reportable
Events; see also each reportable event listed below
for event-specific information required:

Notice due date means the deadline (including
extensions) for filing notice of a reportable event
with PBGC. If no extension is claimed, the notice
due date is 30 days after the date of event.

•
•

Notice filing date means the date the notice of a
reportable event is submitted to PBGC.

•

Participant has the meaning set forth in §4006.6 of
PBGC’s regulation on Premium Rates (29 CFR Part
4006).

•

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 Securi-

•
14

The name of the plan
The name and address of the filer and whether the
filer is the plan administrator or contributing
sponsor
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
The type of event that occurred (indicated by
marking the appropriate box)
A brief statement of the pertinent facts relating to

•

•

the reportable event
Additional information to be filed for each type
of event (check all boxes for information
attached to form)
An explanation of any information required to be
filed but missing from the filing

•
•
•

The date of event, notice due date, and notice
filing date
A brief statement describing the reason for late
filing or attrition event extension claimed
Certification by individual submitting the form

–

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

–

Financial Information - Where a reportable event
requires reporting financial information, please
include the following for all controlled group
members (unless publicly available):

–

•

Audited financial statements for the most re- cent
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
web- site, etc.).

–

•

•

–

–

Actuarial Information - Where a reportable event
requires reporting actuarial information, please
include the following for each plan maintained by
any member of the plan’s controlled group:
•

Copy of the most recent Actuarial Valuation
Report that includes or is supplemented with all
of the items described below:

–

– The funding target calculated pursuant to ERISA
15

section 303 without regard to sub- section
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
at-risk 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).
•

•

•
•

1. Single-cause event. On the date in a plan

If you are reporting a failure to make a required
contribution and the amount of the missed contribution is based on a calculation that is not reflected in the most recent Actuarial Valuation Report,
you must also provide all of the information listed above that supports the calculation.
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, telephone number, and employer of
the plan actuary if different from that listed on the
most recently filed Schedule SB to Form 5500

A. Active Participant Reduction
(see 29 CFR §4043.23)
Definition of Event - A reportable event occurs
when the number of active participants under a plan
is reduced to less than:

14

year

participants at the beginning of the next plan
year.

when, as a result of a single cause — such as a
reorganization, the discontinuance of an opera- tion,
a natural disaster, a mass layoff, or an early
retirement incentive program —the number of active
participants is reduced to less than 80 per- cent of the
number of active participants at the beginning of the
plan year in which the event oc- curred or less than
75 percent of the number of active participants at the
beginning of the plan year preceding the plan year in
which the event occurred.
2. Attrition event. On the last day of a plan year
if the number of active participants covered by
the plan at the end of such plan year is less
than 80 percent of the number of active
participants at the beginning of such plan year,
or less than 75 percent of the number of active
participants at the beginning of the plan year
preceding such plan year. The reduction may
be measured by using the number of active
participants on either the last day of the plan
year or the participant count date (as defined in
29 CFR part 4006.2) for the next plan year, but
in either case is considered to occur on the last
day of the plan year.

An active participant is a participant who (1) is
receiving compensation for work performed; (2)
is on paid or unpaid leave granted for a reason
other than a layoff; (3) is laid off from work for a
period of time that has lasted less than 30 days;
or (4) is absent from work due to a recurring reduction in employment that occurs at least annually. The employment relationship described in
this paragraph is between the participant and all
members of the plan’s controlled group.
Reporting Waivers - Reporting of this event is
waived if:
Small plan. The plan had 100 or fewer participants for
whom flat-rate premiums were payable for the plan
year preceding the event year.
Low-default-risk. Each contributing sponsor of the
plan and the highest level U.S. parent of each contributing sponsor are low-default-risk on the date of
the event.

To determine whether reporting is required for
an attrition event for a plan year, a potential
filer may disregard any cessations of active
participant status reported to PBGC for singlecause events during the plan year or preceding
plan year. See PBGC Technical Update 17-1
(September 15, 2017).

Special Note for Low-default risk waiver:
For reporting to be waived for an event to which
the safe harbor applies, both the contributing
sponsor and the highest level U.S. parent of the
contributing sponsor must satisfy the company
low-default-risk waiver.

For purposes of this reportable event:
Disregard a reduction in the number of active
participants to the extent that the reduction is
both (1) attributable to a substantial cessation of
operations under ERISA §4062(e) or to the
withdrawal of a substantial employer under
ERISA §4063(a), and (2) timely reported to
PBGC under ERISA §4063(a).

A company is to determine whether it qualifies for
the low-default-risk waiver once during an
annual financial reporting cycle (on a “financial
information date”). If it qualifies on that financial information date, its qualification remains in
place throughout a “waiver period” that ends 13
months later or on the next financial information date (if earlier)2. If it does not quali- fy,
its non-qualified status remains in place until the
next financial information date. The finan- cial
information date is the date annual financial
statements are filed with the SEC or the closing
date of the annual accounting cycle. If audited
financial information is not available, the date is

The number of active participants at the beginning of a plan year may be determined by using
the number of active participants at the end of
the previous plan year and the number of active
par- ticipants at the end of a plan year may be
deter- mined by using the number of active
15

confidentiality protection for reportable event
notices under ERISA §4043(f).

the date the company files its annual federal income tax returns or IRS Form 990. If an accountant’s audit or review report expresses a material
adverse view or qualification, the company will
not satisfy the low-default-risk standard for the
waiver.

Reporting Waivers - Reporting of this event is
waived if:
Small plan. With respect to a failure to make a required quarterly contribution under section 303(j)(3)
of ERISA or section 430(j)(3) of the Code (not an
annual catch-up payment) the plan had 100 or fewer
participants for whom flat-rate premiums were
payable for the plan year preceding the event year.

Thirteen months allows for some variation
from year to year on the date that annual financials
are reported.
2

Well-funded plan. The plan is in the well-funded
plan safe harbor for the event year.

Note: The small plan waiver does not apply to a minimum required payment due 8 ½ months after the end
of the plan year under section 303(j)(1) of ERISA or
section 430(j)(1) of the Code.

Public company. Any contributing sponsor of the
plan before the reduction is a public company and
the contributing sponsor timely files a SEC Form 8K disclosing the event under an item of the Form 8K other than under Item 2.02 (Results of Operations
and Financial Condition) or in financial statements
under Item 9.01 (Financial Statements and
Exhibits).

Made-up contribution. The missed contribution is
made by the 30th day after its due date.
Late funding balance election. If the failure to make a
timely required contribution is solely because of the
plan sponsor’s failure to timely make a funding
balance election.

Extension of Reporting Deadline - For an attrition
event, the notice date is extended until the premium
due date for the plan year following the event year.

C. Inability to Pay Benefits When Due
(see 29 CFR §4043.26)

B. Failure to Make Required
Minimum Funding Payment
(see 29 CFR §4043.25)

Definition of Event - A reportable event occurs when a
plan is currently unable, or projected to be unable, to
pay benefits.

Definition of Event - A reportable event occurs
when a contribution required under ERISA §302
and §303 or Code §412 and §430 is not made by the
due date for the payment or any other contribution
required as a condition of a funding waiver is not
made when due.

A plan is currently unable to pay benefits if the plan
fails to provide any participant or beneficiary the full
benefits to which the person is entitled under the terms
of the plan, at the time the benefit is due and in the form
in which it is due.

Note: If a contributing sponsor or controlled group
member files a complete Form 200 with PBGC
within 10 days of the due date of the payment in
accordance with 29 CFR §4043.81, the Form 200
filing satisfies the notice requirement for this event.
However, Form 10 may also be filed if desired.
Choosing to rely on Form 200 to satisfy the Form
10 filing requirement does not make the Form 200 a
reportable event filing under ERISA §4043 and
does not give the Form 200 filing the benefit of the

Note: This does not include a failure or inability to
pay benefits caused solely by a limitation under Code
§ 436 and ERISA § 206(g) (dealing with fund- ingbased limits on benefits and benefit accruals under
single-employer plans); the need to verify the person’s
eligibility for benefits; the inability to locate the
person; or any other administrative delay, if the delay
is for less than the shorter of two months or two full
benefit payment periods.
14

A plan is projected to be unable to pay benefits when,
as of the last day of any quarter of a plan year, the
plan’s liquid assets are less than two times the
amount of the disbursements from the plan for such
quarter. Liquid assets and disbursements from the
plan are defined in ERISA §303(j)(4)(E) and Code
§430(j)(4)(E).

5. Either (i) The sum of the values of all distributions to
any one substantial owner within the one-year
period ending with the date of the distribution
is more than one percent of the end-of-year total amount of the plan’s assets (as required to
be reported on Schedule H or I to Form 5500)
for each of the two plan years immediately
preceding the event year, or

Reporting Waiver - Plan is subject to liquidity
shortfall rules: Reporting of this event is waived
if the event occurs during a plan year for which the
plan is subject to the liquidity shortfall rules in ERISA §303(j)(4) and Code §430(j)(4) because it is described in ERISA §303(g)(2)(B) and Code §430(g)
(2)(B).

(ii) The sum of the values of all distributions to
all substantial owners within the one-year
period ending with the date of the distribution is
more than five percent of the end-of-year to- tal
amount of the plan’s assets (as required to be
reported on Schedule H or I to Form 5500) for
each of the two plan years immediately
preceding the event year.

D. Distribution to a Substantial Owner
(see 29 CFR §4043.27)
A substantial owner (see ERISA §4021(d)) is an
individual who owns (or owned within the
preceding 60 months):

Value of the Distribution - The value of a distribution to a substantial owner is determined as of the date
of distribution and is the sum of:

1. The entire interest in an unincorporated trade or
business;

1. The cash amounts actually received by the
substantial owner, determined as of the date of
receipt;

2. Directly or indirectly, more than 10 percent of
the capital or profits interest in a partnership; or

2. The purchase price of any irrevocable commitment, determined as of the date on which the
obligation to provide benefits passes from the
plan to the insurer; and

3. Directly or indirectly, more than 10 percent of
the voting stock or the total stock of a corporation.

3. The fair market value of any other assets distributed, determined as of the date when the plan
relinquishes control over the assets transferred
directly or indirectly to the substantial owner.

Definition of Event - A reportable event occurs for
a plan when:
1. There is a distribution to a substantial owner of
a contributing sponsor;

Date of Distribution - The date of distribution to a
substantial owner of a cash distribution is the date it
is received by the substantial owner. The date of
distribution to a substantial owner of an irrevocable
commitment is the date on which the obligation to
provide benefits passes from the plan to the insurer.
The date of any other distribution to a substantial
owner is the date when the plan relinquishes control
over the assets transferred directly or indirectly to the
substantial owner.

2. The total of all distributions to the substantial
owner within the one-year period ending with
the date of such distribution exceeds $10,000;
3. The distribution is for a reason other than the
substantial owner’s death; and
4. Immediately after the distribution, the plan has
unfunded nonforfeitable benefits.
15

The determination of whether a participant is (or has
been in the preceding 60 months) a substantial owner is made on the date when there has been a distribution that would be reportable under this section if
made to a substantial owner.

K other than under Item 2.02 (Results of Operations
and Financial Condition) or in financial statements
under Item 9.01 (Financial Statements and Exhibits).
Note: In the case of an annuity for a substantial owner,
a filing that satisfies the requirements of this section
with respect to any payment under the annuity and that
discloses the period, the amount of the payment, and
the duration of the annuity satisfies the requirements
of this section with respect to all subse- quent payments
under the annuity.

Reporting Waivers - Reporting of this event is
waived if:
Low-default-risk. Each contributing sponsor of the
plan and the highest level U.S. parent of each contributing sponsor are low-default-risk on the date of
the event.

Thirteen months allows for some variation
from year to year on the date that annual financials
are reported.
3

Special Note for Low-default risk waiver:
For reporting to be waived for an event to which
the safe harbor applies, both the contributing
sponsor and the highest level U.S. parent of the
contributing sponsor must satisfy the company lowdefault-risk waiver.

E. Change in Contributing Sponsor or
Controlled Group
(see 29 CFR §4043.29)
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.

A company is to determine whether it qualifies for
the low-default-risk waiver once during an annual
fi- nancial reporting cycle (on a “financial
information date”). If it qualifies on that financial
information date, its qualification remains in place
throughout a “waiver period” that ends 13 months
later or on the next financial information date (if
earlier).3 If it does not qualify, its non-qualified
status remains in place until the next financial
information date. The financial information date is
the date annual finan- cial statements are filed with
the SEC or the closing date of the annual
accounting cycle. If audited fi- nancial information
is not available, the date is the date the company
files its annual federal income tax returns or IRS
Form 990. If an accountant’s audit or review report
expresses a material adverse view or qualification,
the company will not satisfy the low- default-risk
standard for the waiver.

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.

Well-funded plan. The plan is in the well-funded
plan safe harbor for the event year.

Controlled Group Breakup

Public company. Any contributing sponsor of the
plan before the transaction is a public company and
the contributing sponsor timely files a SEC Form 8K disclosing the event under an item of the Form 8-

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
14

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.

the date the reportable event occurs;
Foreign entity. Each person that will cease to be a
member of the plan’s controlled group is a foreign
entity other than a foreign parent; or

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

Small plan. The plan had 100 or fewer participants
for whom flat-rate premiums were payable for the
plan year preceding the event year.
Low-default-risk. Each contributing sponsor of

the

plan and the highest level U.S. parent of each con- tributing
sponsor are low-default-risk on the date of the event.

not required to report because it is not a contributing
sponsor or a plan administrator.

Special Note for Low-default risk waiver:

Change in Contributing Sponsor

For reporting to be waived for an event to which the
safe harbor applies, both the contributing sponsor and
the highest level U.S. parent of the contributing
sponsor must satisfy the company low-default-risk safe
harbor.

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 Compa- ny Q’s controlled group. On
the effective date of the sale, Company R will
become the contributing spon- sor of Plan Q.

A company is to determine whether it qualifies for the
low-default-risk safe harbor once during an annual
financial reporting cycle (on a “financial information
date”). If it qualifies on that financial information
date, its qualification remains in place throughout a
“safe harbor period” that ends 13 months later or on
the next financial information date (if earlier).4 If it
does not qualify, its non-qualified status remains in
place until the next financial information date. The
financial information date is the date annual financial statements are filed with the SEC or the closing
date of the annual accounting cycle. If audited financial information is not available, the date is the
date the company files its annual federal income tax
returns or IRS Form 990. If an accountant’s audit or
review report expresses a material adverse view or
qualification, the company will not satisfy the lowdefault-risk standard for the safe harbor.

Reporting: A reportable event occurs on the date
of the transaction (i.e., the date the binding contract
was executed) 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 con- trolled group. The event is not
reported before the notice date. 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 be- come effective, Company Q
has the reporting obli- gation. If the change in the
contributing sponsor has become effective by the
30th day, Company R has the reporting obligation.

Well-funded plan. The plan is in the well-funded plan
safe harbor for the event year.

Reporting Waivers - Reporting of this event is
waived if:

Public company. Any contributing sponsor of the plan
before the transaction is a public company and the
contributing sponsor timely files a SEC Form 8-K
disclosing the event under an item of the Form 8-K
other than under Item 2.02 (Results of Operations and

De minimis 10-percent segment. The person or persons that will cease to be members of the plan’s
controlled group represent a de minimis 10-percent segment of the plan’s old controlled group for
the most recent fiscal year(s) ending on or before
15

group expects to incur;
3. Timing of the expected liquidation of assets, distribution
of proceeds, and payment of expenses as detailed in #1 and
2; and
4. Details of any prior liquidation proceeds already
distributed since the controlled group made the decision to
liquidate, including the name of the creditor, amount, and
type of debt (secured or unsecured).

Financial Condition) or in financial statements under
Item 9.01 (Financial Statements and Exhibits).
F. Liquidation
(see 29 CFR §4043.30)

Thirteen months allows for some variation
from year to year on the date that annual financials
are reported.
4

G. Extraordinary Dividend
Redemption
(see 29 CFR §4043.31)

Definition of Event - A reportable event occurs for
a
plan when a member of the plan’s controlled group:

or

Stock

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.

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 Settlements (see
Part III.K).
Reporting Waivers - Reporting of this event is
waived if:

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 mak- ing the
distribution, reduced by the fair market val- ue 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 apprais- al(s)
performed within one year before the distribu- tion 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 con- nection
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.

De minimis 10-percent segment. The person or persons that liquidate do not include any contributing
sponsor of the plan and represent a de minimis 10percent segment of the plan’s controlled group for
the most recent fiscal year(s) ending on or be- fore
the date the reportable event occurs; or
Foreign entity. Each person that liquidates is a foreign entity other than a foreign parent.
Note: Additional Information — Under 29 CFR §
4043.3(d), and as noted above under “What to file,”
PBGC may request additional information. Items that
may be requested for this event include:
1. The estimated liquidation proceeds and the controlled
group’s anticipated allocation of those proceeds to its
creditors;
2. An itemized list of liquidation expenses the controlled

14

and the highest level U.S. parent of the contributing
sponsor must satisfy the company low-default-risk
safe harbor.

Reporting Waivers - Reporting of this event is
waived if:
De minimis 10-percent segment. The person making
the distribution is a de minimis 10-percent segment
of the plan’s controlled group for the most recent fiscal year(s) ending on or before the date the reportable event occurs;

A company is to determine whether it qualifies for the
low-default-risk safe harbor once during an annual
financial reporting cycle (on a “financial information
date”). If it qualifies on that financial information
date, its qualification remains in place throughout a
“safe harbor period” that ends 13 months later or on
the next financial information date (if earlier).5 If it
does not qualify, its non-qualified status remains in
place until the next financial information date. The
financial information date is the date annual financial statements are filed with the SEC or the closing
date of the annual accounting cycle. If audited financial information is not available, the date is the
date the company files its annual federal income tax
returns or IRS Form 990. If an accountant’s audit or
review report expresses a material adverse view or
qualification, the company will not satisfy the lowdefault-risk standard for the safe harbor.

Foreign entity. The person making the distribution is
a foreign entity other than a foreign parent;
Small plan. The plan had 100 or fewer participants
for whom flat-rate premiums were payable for the
plan year preceding the event year.
Low-default-risk. Each contributing sponsor of the
plan and the highest level U.S. parent of each contributing sponsor are low-default-risk on the date of
the event.
Special Note for Low-default risk waiver:

Well-funded plan. The plan is in the well-funded plan
safe harbor for the event year.

For reporting to be waived for an event to which the
safe harbor applies, both the contributing sponsor

Public company. Any contributing sponsor of the
plan before the transaction is a public company and
the contributing sponsor timely files a SEC Form 8-K
disclosing the event under an item of the Form 8-K
other than under Item 2.02 (Results of Operations
and Financial Condition) or in financial statements
under Item 9.01 (Financial Statements and Exhibits).

H. Transfer of Benefit Liabilities
(see 29 CFR §4043.32)
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
Thirteen months allows for some variation
from year to year on the date that annual financials
5

15

are reported.

14

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 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).

“safe harbor period” that ends 13 months later or on
the next financial information date (if earlier)6. If it
does not qualify, its non-qualified status remains in
place until the next financial information date. The
financial information date is the date annual financial statements are filed with the SEC or the closing
date of the annual accounting cycle. If audited financial information is not available, the date is the
date the company files its annual federal income tax
returns or IRS Form 990. If an accountant’s audit or
review report expresses a material adverse view or
qualification, the company will not satisfy the lowdefault-risk standard for the safe harbor.

The date of a transfer of benefit liabilities is 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
Code §414(l) and 26 CFR §1.414(l)-1(b)(11) will be
considered the date of transfer.

Well-funded plan. The plan is in the well-funded plan
safe harbor for the event year.
Public company. Any contributing sponsor of the
plan before the transaction is a public company and
the contributing sponsor timely files a SEC Form 8-K
disclosing the event under an item of the Form 8-K
other than under Item 2.02 (Results of Operations
and Financial Condition) or in financial statements
under Item 9.01 (Financial Statements and Exhibits).

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 is waived if:

I. Application for Minimum Funding Waiver
(see 29 CFR §4043.33)

Small plan. The plan had 100 or fewer participants
for whom flat-rate premiums were payable for the
plan year preceding the event year.

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).

Low-default-risk. Each contributing sponsor of the
plan and the highest level U.S. parent of each contributing sponsor are low-default-risk on the date of
the event.

J. Loan Default
(see 29 CFR §4043.34)

Special Note for Low-default risk waiver:
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:

For reporting to be waived for an event to which the
safe harbor applies, both the contributing sponsor
and the highest level U.S. parent of the contributing
sponsor must satisfy the company low-default-risk
safe harbor.

1. There is an acceleration of payment or a default
under the loan agreement; or

A company is to determine whether it qualifies for the
low-default-risk safe harbor once during an annual
financial reporting cycle (on a “financial information
date”). If it qualifies on that financial information
date, its qualification remains in place throughout a

2. The lender waives or agrees to an amendment of
any covenant in the loan agreement the effect of
Thirteen months allows for some variation
from year to year on the date that annual financials
are reported.
6

15

which is to cure or avoid a breach that would trigger a default.

De minimis 10-percent segment: The controlled
group member described above is not a contributing
sponsor of the plan and represents a de minimis 10percent segment of the plan’s controlled group for the
most recent fiscal year(s) ending on or before the date
the reportable event occurs.

Note – A default on a loan between controlled group
members is not excluded from the reporting requirement.
Reporting Waivers - Reporting of this event is
waived if:

Foreign entity: The controlled group member described above is a foreign entity other than a foreign
parent.

De minimis 10-percent segment. The debtor is not a
contributing sponsor of the plan and represents a de
minimis 10-percent segment of the plan’s controlled
group for the most recent fiscal year(s) ending on or
before the date the reportable event occurs.

Note: Additional Information —Under 29 CFR §
4043.3(d), and as noted above under “What to File,”
PBGC may request additional information for this
event. Items that may be requested include:
1. The estimated proceeds from the sale of assets and the
controlled group’s anticipated allocation of those proceeds
to its creditors;
2. An itemized list of asset sale expenses the controlled
group expects to incur;
3. Timing of the expected sale of assets, distribution of
proceeds, and payment of expenses as detailed in #1 and 2;
and
4. Details of any prior asset sale proceeds already
distributed since the reportable event date, including the
name of the creditor, amount, and of debt (secured or
unsecured).

Foreign entity. The debtor is a foreign entity other
than a foreign parent; or
K. Insolvency or Similar Settlement
(see 29 CFR §4043.35)
Definition of Event - A reportable event occurs with
respect to a plan when any member of the plan’s controlled group commences or has commenced against
it:
1. 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;
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.F).
Reporting Waivers - Reporting of this event is
waived if:
16

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 B, so that it can take action to protect participants and
the termination insurance program 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 3 hours and $745 to comply with these requirements. If you have any comments concerning the accuracy of this estimate or suggestions for improving this
form, 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 [pending]
and expires on XX,XXXX. 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.

15