Form 001 Notice of Termination

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Notice of Termination
*Required fields
*Mass Withdrawal or
Plan Amendment?

Mass Withdrawal

Amendment

*Plan name: MEPD Test Pension Plan
*EIN: 11-1111111

(ex. 33-3333333)

*PN: 002

(ex. 333)

*Notice filer name: Zjfh Xceu Rkgsy
*Role of filer:

Accountant

*Date of termination of
4/16/2019
Plan (Freeze date):

(MM/DD/YYYY)

Plan Sponsor Information
*Plan sponsor name: Asdf jkl;

*Address: PBGC

*City: Washington
*State:

DC

*Zip Code: 20005
*Telephone: 972-576-5841

(ex. 12345-1234)
(ex. 202-111-1111)

E-mail address: [email protected]

(ex. [email protected])

Fax:

(ex. 202-111-1111)

Plan Sponsor’s Duly Authorized Representative (if any)
First name:
Last name:
Company:
Title:
Address:

City:
State:
Zip Code:

Ext.

- select a state (ex. 12345-1234)

Telephone:

Ext.

(ex. 202-111-1111)

E-mail address:

(ex. [email protected])

Fax:

(ex. 202-111-1111)

*Contact information for the person who will administer the plan after termination
Plan Sponsor

Duly Authorized Representative

Other

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Notice of Termination
Attached Documents
Click here for additional instructions.
All documents listed are required filings for plans terminated by mass withdrawal (information need
not be supplied if it duplicates information in the Form 5500, submitted with the notice). For plans
terminated by plan amendment, file a copy of the most recent Form 5500, including schedules.
Provide an explanation in the “Comments” box for any missing documents.
Comments: No Documents Entered

File:
Document
Type:

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only once. To send files larger than 25MB, please click on this link:
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follow the prompts. For additional assistance, please contact us at
[email protected] or 1-800-736-2444 (ext. 3993 or 6047). Local callers
may directly dial 202-326-4000 (ext. 3993 or 6047).

1. Notice of termination cover letter
2. Copy of plan document in effect 5 years before the date of termination and copies of any amendments
adopted after that date
3. Copy of trust agreement(s) authorizing Plan Sponsor to control and manage the operation and
administration of the Plan
4. Copy of most recent actuarial valuation for the Plan
5. A statement of material change in Plan assets or liabilities, occurring after either the actuarial valuation or
Form 5500 (submitted with this notice) was prepared
6. Complete copies of any letters of determination issued by the IRS relating to the establishment of the plan,
any letters of determination relating to the disqualification of the plan and any subsequent requalification, and
any letters of determination relating to the termination of the plan
7. A statement of Plan's ability to pay all benefits in pay status during the 12 months period following the date
of termination
8. If plan assets on hand are sufficient to satisfy all nonforfeitable benefits under the plan, and if the plan
sponsor intends to distribute such assets, a brief description of the proposed method of distributing the plan
assets
9. If plan assets on hand are not sufficient to satisfy all nonforfeitable benefits under the plan, the name and
address of any employer who contributed to the plan within 3 plan years before the date of termination

10. Copy of most recent Form 5500, including Schedules
11. Certification that information and documents submitted are true and correct
12. Other

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Data Summary

Notice of Termination
MEPD Test Pension Plan - 11-1111111/002

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Submit Filing

Plan Filing Information

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Mass Withdrawal or Plan Amendment?

Mass Withdrawal

Plan name:

MEPD Test Pension Plan

EIN / PN:

11-1111111/002

Notice filer name:

Zjfh Xceu Rkgsy

Role of filer:

Accountant

Date of termination of Plan (Freeze date):

4/16/2019

Return to Home Page

Plan Sponsor Information

Name:

Asdf jkl;

Address:

Pbgc Washington, DC 20005

Phone:

972-576-5841

Email:

[email protected]

Fax:

N/A

Plan Sponsor’s Duly Authorized Representative
Name:
Company:

N/A

Title:

N/A

Address:
Phone:

N/A

Email:

N/A

Fax:

N/A

Contact information for the person who will administer
the plan after termination:

Plan Sponsor

Attached Documents

Edit

Notice of termination cover letter
Copy of plan document in effect 5 years before the date of termination and copies of any amendments
adopted after that date
Copy of trust agreement(s) authorizing Plan Sponsor to control and manage the operation and administration
of the Plan
Copy of most recent actuarial valuation for the Plan
A statement of material change in plan assets or liabilities, occurring after either the actuarial valuation or
Form 5500 (submitted with this notice) was prepared
Complete copies of any letters of determination issued by the IRS relating to the establishment of the plan,
any letters of determination relating to the disqualification of the plan and any subsequent requalification, and any
letters of determination relating to the termination of the plan
A statement of Plan's ability to pay all benefits in pay status during the 12 months period following the date of
termination
If plan assets on hand are sufficient to satisfy all nonforfeitable benefits under the plan, and if the plan
sponsor intends to distribute such assets, a brief description of the proposed method of distributing the plan
assets
If plan assets on hand are not sufficient to satisfy all nonforfeitable benefits under the plan, the name and
address of any employer who contributed to the plan within 3 plan years before the date of termination

Copy of most recent Form 5500, including Schedules
Certification that information and documents submitted are true and correct
Other
Comments
No Documents Entered

CONFIDENTIAL

PBGC
Notice of Termination
Plan Filing Information
Plan name:

MEPD Test Pension Plan

EIN/PN:

11-1111111/002

Notice filer name:

Zjfh Xceu Rkgsy

Role of filer:

Accountant

Plan termination type:

Amendment

Mass Withdrawal

Date of termination of plan
(Freeze date):

16-APR-2019

Plan Sponsor Information
Plan sponsor name:

Asdf jkl;

Address:

Pbgc

City:

Washington

State:

DC

Zip:

20005

Telephone:

(972) 576-5841 Ext:

E-mail:

[email protected]

Fax:

Plan Sponsor's Authorized Representative Information
First name:

Last name:

Company:

Title:

Address:

City:

State:

Zip:

Telephone:

Ext:

E-mail:

Fax:

Contact information of the
person who will administer the
plan after termination:

Plan Sponsor

Duly Authorized Representative

Submission status - Filing not yet submitted

Other

CONFIDENTIAL

Attached Documents
Notice of termination cover letter
Copy of plan document in effect 5 years before the date of termination and copies of any amendments adopted
after that date
Copy of trust agreement(s) authorizing Plan Sponsor to control and manage the operation and administration of
the Plan
Copy of most recent actuarial valuation for the Plan
A statement of material change in Plan assets or liabilities, occurring after either the actuarial valuation or Form
5500 (submitted with this notice) was prepared
Complete copies of any letters of determination issued by the IRS relating to the establishment of the plan, any
letters of determination relating to the disqualification of the plan and any subsequent requalification, and any letters
of determination relating to the termination of the plan
A statement of Plan's ability to pay all benefits in pay status during the 12 months period following the date of
termination
If plan assets on hand are sufficient to satisfy all nonforfeitable benefits under the plan, and if the plan sponsor
intends to distribute such assets, a brief description of the proposed method of distributing the plan assets
If plan assets on hand are not sufficient to satisfy all nonforfeitable benefits under the plan, the name and address
of any employer who contributed to the plan within 3 plan years before the date of termination

Copy of most recent Form 5500, including Schedules
Certification that information and documents submitted are true and correct
Other
Missing Information If required information has not been submitted, explain below.
No Documents Entered

Submission status - Filing not yet submitted
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