Form 5500-EZ Paper Submissions

2021

Instructions for

Form 5500-EZ

Department of the Treasury

Internal Revenue Service

Annual Return of A One-Participant

(Owners/Partners and Their Spouses) Retirement Plan or A Foreign Plan

Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form 5500-EZ and its instructions, such as legislation enacted after they were published, go to IRS.gov/Form5500EZ.

What's New

Extensions of Time. Part I, line B of Form has been revised to add checkboxes for plans filed under an extension of time using Form 5558, or automatic extension, or special extension.

Retroactively adopted plan permitted by SECURE Act section 201. New Checkbox E is added to Part I for a plan sponsor who adopted the plan in the 2021 plan year and treated the plan as being adopted and effective for the 2020 plan year pursuant to SECURE Act section 201.

Amended return. Clarifies in the instructions that you must submit the amended return electronically through EFAST2 if you previously filed electronically using either Form 5500-SF or Form 5500-EZ. You must submit the amended return using the paper Form 5500-EZ on the form year corresponding to the original year of filing with the IRS if you previously filed on a paper Form 5500-EZ.

Filing Tips

To reduce the possibility of correspondence and penalties, we remind filers of the following.

Filing Form 5500-EZ on paper with the IRS:

• ^{Use the online, fillable 2021 Form 5500-EZ on the IRS} website. Complete and download the form to your computer to print and sign before mailing.

• ^{Or, use the official printed paper Form 5500-EZ} obtained from the IRS. Complete the form by hand using only black or blue ink. Be sure to enter your information in the specific line fields provided; sign and date the form before mailing.

• ^{Or, use approved software, if available.}

• ^{Do not use felt tip pens or other writing instruments that} can cause signatures or data to bleed through to the other side of the paper. One-sided documents should have no markings on the blank side.

• ^{Do not use glue or other sticky substances on the paper. Paper should be clean.}

• ^{Do not submit extraneous information such as arrows or} notes on the form.

• ^{Mail Form 5500-EZ for plan year 2021 to the IRS office} in Ogden, Utah, to be processed. See Where To File in these instructions.

Filing Form 5500-EZ electronically using the EFAST2 filing system:

• ^{File online using EFAST2’s web-based filing system or}

• ^{File through an EFAST2-approved vendor.}

^{Detailed information on electronic filing is available on the EFAST2 website at www.efast.dol.gov.}

Phone Help

If you have questions and need help in completing this form, please call the IRS Help Desk at 877-829-5500. If you have questions concerning electronic filing under the EFAST2 filing system, call the EFAST2 Help Desk at 1-866-GO-EFAST (1-866-463-3278). These toll-free telephone services are available Monday through Friday.

How To Get Forms and Publications

You can find Form 5500-EZ and its instructions by visiting the IRS Internet website at IRS.gov/FormsPubs. You can also find and order other IRS forms and publications at IRS.gov/OrderForms.

Personal computer. You can access the IRS website 24 hours a day, 7 days a week at IRS.gov to:

• ^{View forms, instructions, and publications.}

• ^{See answers to frequently asked tax questions.}

• ^{Search publications online by topic or keyword.}

• ^{Send comments or request help by email.}

• ^{Sign up to receive local and national tax news by email.}

Photographs of Missing Children

The Internal Revenue Service is a proud partner with the National Center for Missing & Exploited Children® (NCMEC). Photographs of missing children selected by the Center may appear in instructions on pages that would otherwise be blank. You can help bring these children home by looking at the photographs and calling

1-800-THE-LOST (1-800-843-5678) if you recognize a child.

General Instructions

Purpose of Form

Form 5500-EZ is used by one-participant plans and foreign plans that are not subject to the requirements of section 104(a) of the Employee Retirement Income Security Act of 1974 (ERISA).

Note. A one-participant plan or a foreign plan (as defined under Who Must File Form 5500-EZ) cannot file an annual return on Form 5500, Annual Return/Report of Employee Benefit Plan, or Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan, regardless of whether the plan previously filed an annual return on Form 5500 or Form 5500-SF. Therefore, every one-participant plan or a foreign plan required to file an annual return must either file paper Form 5500-EZ with the IRS or electronically file Form 5500-EZ using the EFAST2 Filing System.

Who Must File Form 5500-EZ

You must file Form 5500-EZ for a retirement plan if the plan is a one-participant plan or a foreign plan that is required to file an annual return under section 6058(a).

A one-participant plan means a retirement plan (that is, a defined benefit pension plan or a defined contribution profit-sharing or money purchase pension plan), other than an Employee Stock Ownership Plan (ESOP), which:

1. Covers only you (or you and your spouse) and you (or you and your spouse) own the entire business (which may be incorporated or unincorporated); or

2. Covers only one or more partners (or partners and their spouses) in a business partnership (treating 2% shareholder of an S corporation, as defined in IRC §1372(b), as a partner); and

3. Does not provide benefits for anyone except you (or you and your spouse) or one or more partners (or partners and their spouses).

A one-participant plan must file an annual return unless the plan meets the conditions for not filing under Who Does Not Have To File Form 5500-EZ below.

A foreign plan means a pension plan that is maintained outside the United States primarily for nonresident aliens.

A foreign plan is required to file an annual return if the employer who maintains the plan is:

• ^{A domestic employer, or}

• ^{A foreign employer with income derived from sources} within the United States (including foreign subsidiaries of domestic employers) if contributions to the plan are deducted on its U.S. income tax return.

D o not file an annual return for a plan that is a qualified foreign plan within the meaning of section 404A(e) that does not qualify for the

treatment provided in section 402(d).

Note. If you are not eligible to file the Form 5500-EZ for a plan that is subject to the reporting requirements in section 104 of ERISA, you must electronically file Form 5500 or, if eligible, Form 5500-SF.

Who Does Not Have To File Form
5500-EZ

You do not have to file Form 5500-EZ for the 2021 plan year for a one-participant plan if the total of the plan's assets and the assets of all other one-participant plans maintained by the employer at the end of the 2021 plan year does not exceed $250,000, unless 2021 is the final plan year of the plan. For more information on final plan years, see Final Return, later.

Example. If a plan meets all the requirements for filing Form 5500-EZ and its total assets (either alone or in combination with one or more one-participant plans maintained by the employer) exceed $250,000 at the end of the 2021 plan year, Form 5500-EZ must be filed for each of the employer's one-participant plans including those with less than $250,000 in assets for the 2021 plan year.

Note. You should use the total plan assets as listed as of the end of the plan year on line 6a(2) of this form to determine whether the plan(s) assets exceed $250,000. If an employer maintains one or more one-participant plans, the total assets of all one-participant plans combined must be counted towards the amount of $250,000.

How To File

Paper forms for filing. The 2021 Form 5500-EZ may be filed on paper. File the official IRS printed Form 5500-EZ or the downloadable form found on the IRS website; or use approved software, if available.

You can complete the online, fillable 2021 Form 5500-EZ found on the IRS website and download it to your computer to print and sign before mailing to the address specified in these instructions. See Where To File.

You can obtain the official IRS printed 2021 Form 5500-EZ from the IRS to complete by hand with pen or typewriter using blue or black ink. Entries should not exceed the lines provided on the form. Abbreviate if necessary. Paper forms are available from the IRS as discussed earlier in How To Get Forms and Publications.

Electronic filing. Effective for plan years beginning after 2019, a filer can file Form 5500-EZ electronically using the EFAST2 filing system. See EFAST2 Filing System in these instructions.

Mandatory electronic filing. A filer must file the Form 5500-EZ electronically using the EFAST2 Filing System instead of filing a paper Form 5500-EZ with the IRS if the filer is required to file at least 250 returns of any type with the IRS, including information returns (for example, Forms W-2 and Forms 1099), income tax returns, employment tax returns, and excise tax returns, during the calendar year that includes the first day of the applicable plan year. If a filer is required to file a Form 5500-EZ electronically but does not, the filer is considered to have not filed the form even if a paper Form 5500-EZ is submitted. See Treasury Regulations section 301.6058-2 for more information on mandatory electronic filing of employee retirement benefit plan returns. The IRS may waive the requirements to file Form 5500-EZ electronically in cases of undue economic hardship. For information on filing a request for a hardship waiver, see Rev. Proc. 2015-47, 2015-39 I.R.B. 419, available at https://www.irs.gov/irb/2015-39_IRB.

EFAST2 Filing System

A one-participant plan and a foreign plan can satisfy their filing obligation under the Code by filing Form 5500-EZ electronically under the EFAST2 filing system in place of filing Form 5500-EZ on paper with the IRS.

Under EFAST2, you must electronically file the 2021 Forms 5500 and 5500-SF using EFAST2's web-based filing system or you may file through an EFAST2-approved vendor. The 2021 Form 5500-EZ can also be electronically filed using the EFAST2 filing system or filed on paper with the IRS. For more information about electronic filing, see the EFAST2 website at www.efast.dol.gov. For telephone assistance, call the EFAST2 Help Desk at 1-866-GO-EFAST (1-866-463-3278). The EFAST2 Help Desk is available Monday through Friday.

Note (1). A filer must file Form 5500-EZ electronically instead of filing Form 5500-EZ on paper if the filer is required to file at least 250 returns of any type with the IRS during the calendar year. See How To File for more information.

Note (2). If a filer is not subject to the IRS mandatory electronic filing requirement under Treasury Regulations section 301.6058-2, a filer may elect to file Form 5500-EZ electronically using the EFAST2 filing system. Information filed on Form 5500-EZ is required to be made available to the public. However, the information for a one-participant plan or a foreign plan, whether filed electronically with EFAST2 or filed on paper, will not be published on the internet.

What To File

Plans required to file an annual return for one-participant (owners and their spouses) retirement plans or foreign plans may file Form 5500-EZ in accordance with its instructions. Filers of Form 5500-EZ are not required to file schedules or attachments related to Form 5500 with the 2021 Form 5500-EZ. However, you must collect and retain for your records completed Schedule MB (Form 5500), Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information, if applicable, and completed and signed Schedule SB (Form 5500), Single-Employer Defined Benefit Plan Actuarial Information, if applicable. Even though you do not have to file the Schedule MB (Form 5500) or Schedule SB (Form 5500) with the 2021 Form 5500-EZ, you are still required to both perform an annual valuation and maintain the funding records associated with plan funding in the same manner as a plan for which the applicable schedule must be filed.

Eligible combined plans. The Pension Protection Act of 2006 established rules for a new type of pension plan, an “eligible combined plan,” effective for plan years beginning after December 31, 2009. An eligible combined plan consists of a defined benefit plan and a defined contribution plan that includes a qualified cash or deferred arrangement under section 401(k). The assets of the two plans are held in a single trust, but clearly identified and allocated between plans. The eligible combined plan design is available only to employers that:

• ^{Employed an average of at least 2, but no more than} 500, employees on business days during the calendar year prior to the establishment of the eligible combined plan; and

• ^{Employ at least 2 employees on the first day of the plan} year that the plan is established.

Because an eligible combined plan includes both a defined benefit plan and a defined contribution plan, the Form 5500-EZ filed for the plan must include all the information that would be required for either a defined benefit plan or a defined contribution plan.

Note. The 2021 Schedule MB (Form 5500) and the 2021 Schedule SB (Form 5500) are available only electronically from the Department of Labor website at www.efast.dol.gov. You can complete the schedules online and print them out for your records. If you are a Form 5500-EZ filer, do not attempt to electronically file the Schedule MB or Schedule SB related to your 2021 Form 5500-EZ filing.

When To File

File the 2021 return for plan years that started in 2021. Form 5500-EZ must be filed by the last day of the 7th calendar month after the end of the plan year that began in 2021 (not to exceed 12 months in length).

Note. If the filing due date falls on a Saturday, Sunday, or legal holiday, the return may be filed on the next day that is not a Saturday, Sunday, or legal holiday.

Where To File

File the paper Form 5500-EZ at the following address:

Department of the Treasury Internal Revenue Service Ogden, UT 84201-0020

Private delivery services (PDSs). You can use certain private delivery services designated by the IRS to meet the “timely mailing as timely filing/paying” rule for tax returns and payments. Go to IRS.gov/PDS for the current list of designated services.

The PDS can tell you how to get written proof of the mailing date.

Private delivery services use the following address:

Internal Revenue Submission Processing Center 1973 Rulon White Blvd.

Ogden, UT 84201

Who Must Sign

The plan administrator or employer (owner) must sign and date paper Form 5500-EZ for the 2021 filing.

Penalties

Section 6652(e) imposes a penalty of $250 a day (up to a maximum penalty of $150,000 per plan year) for not filing returns in connection with pension, profit-sharing, etc., plans by the required due date.

Specific Instructions

Part I – Annual Return Identification Information

Enter the calendar or fiscal year beginning and ending dates of the plan year (not to exceed 12 months in length) for which you are reporting information. Express the date in numerical month, day, and year in the following order “MM/DD/YYYY” (for example, “01/01/2021”).

For a plan year of less than 12 months (short plan year), insert the short plan year beginning and ending dates on the line provided at the top of the form. For purposes of this form, the short plan year ends on the date of the change in accounting period or the complete distribution of the plan's assets.

First Return

Check box A(1) if this is the first filing for this plan. Do not check this box if you have ever filed for this plan, even if it was a different form (for example, Form 5500).

Amended Return

Check box A(2) if you are filing an amended Form 5500-EZ to correct errors and/or omissions in a previously filed annual return for the 2021 plan year. The amended Form 5500-EZ must conform to the requirements under the How To File section, earlier.

If you are filing an amended return for a one-participant plan or a foreign plan that originally filed electronically through EFAST2 using either Form 5500-SF or Form 5500-EZ, you must submit the amended return electronically with EFAST2. Use the 2019 Form 5500-SF for amending a 2019 return that was originally filed using the 2019 Form 5500-SF in place of the Form 5500-EZ; use the 2020 Form 5500-EZ for amending a filing originally filed using the 2020 Form 5500-EZ; and use the 2021 Form 5500-EZ for amending a current-year filing or any other year (see Note below). If you are filing an amended return for a one-participant plan or a foreign plan that was originally filed on a paper Form 5500-EZ with the IRS, you must submit the amended return using the paper Form 5500-EZ corresponding to the original year of the filing with the IRS.

Note. If you are electronically filing an amended Form 5500-EZ, you should use the current-year form 5500-EZ for amending any filing older than two years. However, if you are filing an amended Form 5500-EZ on paper, you must submit the amended return using the paper Form 5500-EZ corresponding to the original year of filing.

Short Plan Year

Check box A(4) if this form is filed for a period of less than 12 months. Show the dates at the top of the form.

For a short plan year, file a return by the last day of the 7th month following the end of the short plan year. Modify the heading of the form to show the beginning and ending dates of your short plan year and check box A(4) for a short plan year. If this is also the first or final return filed for the plan, check the appropriate box (box A(1) or A(3)).

Final Return

All one-participant plans and all foreign plans should file a return for their final plan year indicating that all assets have been distributed.

Check box A(3) if all assets under the plan(s) (including insurance/annuity contracts) have been distributed to the participants and beneficiaries or distributed or transferred to another plan. The final plan year is the year in which distribution of all plan assets is completed.

Extension of Time To File

Using Form 5558

If filing under an extension of time based on the filing of a Form 5558, Application for Extension of Time To File Certain Employee Plan Returns, do not attach Form 5558 to your Form 5500-EZ. Check the “Form 5558” box in Part I, line B. A one-time extension of time to file Form 5500-EZ (up to 2½ months) may be obtained by filing Form 5558 on or before the normal due date (not including any extensions) of the return. You must file Form 5558 with the IRS.

Approved copies of the Form 5558 will not be returned to the filer. A copy of the completed extension request must be retained with the plan's records.

See the instructions for Form 5558 and file it with the Department of the Treasury, Internal Revenue Service Center, Ogden, UT 84201-0045.

Note. Line A of the Form 5558 asks for “Name of filer, plan administrator, or plan sponsor.” The name of the plan sponsor is generally the same as the employer name for a one-participant plan.

Using Extension of Time To File Federal Income Tax Return

Filers are automatically granted an extension of time to file Form 5500-EZ until the extended due date of the federal income tax return of the employer (and are not required to file Form 5558) if all of the following conditions are met.

1. The plan year and the employer's tax year are the same;

2. The employer has been granted an extension of time to file its federal income tax return to a date later than the normal due date for filing the Form 5500-EZ; and

3. A copy of the application for extension of time to file the federal income tax return is retained with the plan's records.

Be sure to check the “automatic extension” box in Part I, line B, at the top of the form. An extension granted by using this automatic extension procedure cannot be extended further by filing a Form 5558, nor can it be extended beyond a total of 9½ months beyond the close of the plan year.

Other Extensions of Time

The IRS may announce special extensions of time under certain circumstances, such as extensions for Presidentially-declared disasters or for service in, or in support of, the Armed Forces of the United States in a combat zone. If you are relying on one of these announced special extensions, check the “special extension” box on the Form 5500-EZ, Part I, line B, and enter a description of the announced authority for the extension.

Foreign Plan

Check box C if the return is filed by a foreign plan. See

Who Must File Form 5500-EZ, earlier.

Late Filer Penalty Relief Program

Check box D only if you are filing a paper Form 5500-EZ with the IRS for the late filer penalty relief program. The delinquent return cannot be filed electronically through the EFAST2 System.

The IRS Late Filer Penalty Relief Program for late annual reporting for non-Title I retirement plans (one-participant plans and certain foreign plans) provides administrative relief to plan administrators and plan sponsors from the penalties otherwise applicable under sections 6652(e) and 6692 for failing to timely comply with the annual reporting requirements imposed under sections 6047(e), 6058, and 6059. Rev. Proc. 2015-32 requires that an applicant must submit a complete Form 5500-EZ for the delinquent plan year on paper with the IRS. The IRS delinquent return cannot be filed electronically through EFAST2 System.

An applicant under the program must print in red letters in the top margin above the Form 5500-EZ’s title on the first page of the return: “Delinquent Return Submitted under Rev. Proc. 2015-32, Eligible for Penalty Relief.” A filer who checks box D and submits the delinquent 2021 Form 5500-EZ under the program is not required to also mark the return as described in Rev. Proc. 2015-32. However, the return must still be marked as described in Rev. Proc. 2015-32 for delinquent returns for years that have no box D available. Please be aware that each submission under the program must include a completed paper copy of Form 14704 attached to the front of the oldest delinquent return in the submission. Form 14704 can be found at www.irs.gov/ pub/irs-pdf/f14704.pdf. See Rev. Proc. 2015-32, 2015-24 1063, for more information.

A plan Retroactively Adopted

Check box E for a retroactively adopted plan as permitted by SECURE Act section 201. Check this box if the plan sponsor adopted the plan during the 2021 plan year (i.e., by the due date, including extension, for filing the plan sponsor’s tax return for the 2020 taxable year) and elected to treat the plan as having been adopted before the 2021 plan year began (i.e., at the close as of the last day of the sponsor’s taxable year) as permitted by section 201 of the Setting Every Community Up for Retirement Enhancement Act of 2019 (SECURE Act). Plans in this situation are not required to file a 2020 Form 5500. However, if the plan is a defined benefit pension plan, the enrolled actuary must complete and sign the 2020 Schedule SB (Form 5500) in addition to the 2021 Schedule SB (Form 5500) and the plan sponsor must retain both Schedule SBs for its records. Please see Instructions for Schedule SB for more information.

Part II – Basic Plan Information

Line 1a. Enter the formal name of the plan.

Line 1b. Enter the three-digit plan number (PN) that the employer assigned to the plan. Plans should be numbered consecutively starting with 001. Once a plan number is used for a plan, it must be used as the plan number for all future filings of returns for the plan, and this number may not be used for any other plan even after the plan is terminated.

Line 1c. Enter the date the plan first became effective.

Line 2a. Each row is designed to contain specific information regarding the employer. Please limit your response to the information required in each row as specified below.

1. Enter in the first row the name of the employer.

2. Enter in the second row the trade name if different from the name entered in the first row.

3. Enter in the third row the in care of (“C/O”) name.

4. Enter in the fourth row the street address. A post office box number may be entered if the Post Office does not deliver mail to the employer's street address.

5. Enter in the fifth row the name of the city, the two character abbreviation of the U.S. state or possession and ZIP code.

Note. You can use Form 8822-B, Change of Address or Responsible Party — Business, to notify the IRS if you changed your business mailing address, your business location, or the identity of your responsible party.

Foreign address. For foreign addresses, enter the information in the order of the city or town, state or province, country, and ZIP or foreign postal code. Follow the country's practice in placing the postal code in the address. Do not abbreviate the country name.

Line 2b. Enter the employer's nine-digit employer identification number (EIN). For example, 00-1234567. Do not enter a social security number (SSN).

Employers without an EIN must apply for one as soon as possible. EINs are issued by the IRS. You can apply for an EIN:

• ^{Online — Go to the IRS website at IRS.gov/Businesses} and click on “Employer ID Numbers.” The EIN is issued immediately once the application information is validated.

• ^{By mailing or faxing Form SS-4, Application for} Employer Identification Number.

T he online application process is not yet available for plans with addresses in foreign countries. Foreign plans may not apply for an EIN online but must use one of the other methods to apply. However, foreign plans may call 267-941-1099 (not a toll-free number) to apply for an EIN. For more information, see the Instructions for Form SS-4.

Line 2c. Enter the employer's telephone number including the area code.

Line 2d. Enter the six-digit applicable code that best describes the nature of the plan sponsor's business from the list of principal business activity codes later in these instructions.

Line 3a. Each row is designed to contain specific information regarding the plan administrator. Please limit your response to the information required in each row of boxes as specified below.

1. Enter in the first row the name of the plan administrator unless the administrator is the employer identified in line 2a. If this is the case, enter the word “Same” on line 3a and leave the remainder of line 3a, and all of lines 3b and 3c, blank.

2. Enter in the second row any in care of (“C/O”) name.

3. Enter in the third row the street address. A post office box number may be entered if the Post Office does not deliver mail to the administrator's street address.

4. Enter in the fourth row the name of the city, the two-character abbreviation of the U.S. state or possession and ZIP code.

Foreign address. For foreign addresses, enter the information in the order of the city or town, state or province, country, and ZIP or foreign postal code. Follow the country's practice in placing the postal code in the address. Do not abbreviate the country name.

Line 3b. Enter the plan administrator's nine-digit EIN. A plan administrator must have an EIN for Form 5500-EZ reporting purposes. If the plan administrator does not have an EIN, apply for one as explained in the instructions for line 2b.

Line 3c. Enter the plan administrator's telephone number including the area code.

Lines 4a–4d. If the employer's name, the employer’s EIN, and/or the plan name has changed since the last return was filed for this plan, enter the employer's name and EIN, the plan name, and the plan number as it appeared on the last return filed for this plan.

Line 5a(1). Enter the total number of participants at the beginning of the plan year.

Line 5a(2). Enter the total number of active participants at the beginning of the plan year.

Line 5b(1). Enter the total number of participants at the end of the plan year.

Line 5b(2). Enter the total number of active participants at the end of the plan year.

“Participant” for purpose of lines 5a(1)–5b(2) means any individual who is included in one of the categories below.

1. Active participants (for example, any individuals who are currently in employment covered by the plan and who are earning or retaining credited service under the plan) including:

• ^{Any individuals who are eligible to elect to have the} employer make payments under a section 401(k) qualified

cash or deferred arrangement, and

• ^{Any nonvested individuals who are earning or retaining} credited service under the plan.

This category does not include (a) nonvested former employees who have incurred the break in service period specified in the plan or (b) former employees who have received a “cash-out” distribution or deemed distribution of their entire nonforfeitable accrued benefit.

2. Retired or separated participants receiving benefits (for example, individuals who are retired or separated from employment covered by the plan and who are receiving benefits under the plan). This category does not include any individual to whom an insurance company has made an irrevocable commitment to pay all the benefits to which the individual is entitled under the plan.

3. Other retired or separated participants entitled to future benefits (for example, any individuals who are retired or separated from employment covered by the plan and who are entitled to begin receiving benefits under the plan in the future). This category does not include any individual to whom an insurance company has made an irrevocable commitment to pay all the benefits to which the individual is entitled under the plan.

4. Deceased individuals who had one or more beneficiaries who are receiving or are entitled to receive benefits under the plan. This category does not include any individual to whom an insurance company has made an irrevocable commitment to pay all the benefits to which the beneficiaries of that individual are entitled under the plan.

Line 5c. Include any individual who terminated employment during this plan year, whether or not he or she (a) incurred a break in service, (b) received an irrevocable commitment from an insurance company to pay all the benefits to which he or she is entitled under the plan, and/or (c) received a cash distribution or deemed cash distribution of his or her nonforfeitable accrued benefit.

Part III – Financial Information

Note. The cash, modified cash, or accrual basis accounting methods may be used for recognition of transactions in Part III, as long as you use one method consistently. Amounts reported on lines 6a, 6b, and 6c for the beginning of the plan year must be the same as reported for the end of the plan year on the return for the preceding plan year. Use whole dollars only.

Line 6a. “Total plan assets” include rollovers and transfers received from other plans, unrealized gains and losses such as appreciation/depreciation in assets. It also includes specific assets held by the plan at any time during the plan year (for example, partnership/joint venture interests, employer real property, real estate (other than employer real property), employer securities, loans (participant and non-participant loans), and tangible personal property).

Enter the total amount of plan assets at the beginning of the plan year in column (1). Do not include contributions designated for the 2021 plan year in column (1). Enter the total amount of plan assets at the end of the plan year in column (2).

Line 6b. Liabilities include but are not limited to benefit claims payable, operating payables, acquisition indebtedness, and other liabilities. Do not include the value of future distributions that will be made to participants.

Lines 7a and 7b. Enter the total cash contributions received and/or receivable by the plan from employers and participants during the plan year.

Line 7c. Enter the amount of all other contributions including transfers or rollovers received from other plans valued on the date of contribution.

Part IV – Plan Characteristics

Line 8. Enter all applicable plan characteristics codes that applied during the reporting year from the List of Plan Characteristics Codes shown later that describe the characteristics of the plan being reported.

Note. In the case of an eligible combined plan under section 414(x) and ERISA section 210(e), the codes entered in the boxes on line 8 must include any codes applicable for either the defined benefit pension features or the defined contribution pension features of the plan.

Part V – Compliance and Funding Questions

Line 9. You must check “Yes” if the plan had any participant loans outstanding at any time during the plan year and enter the amount outstanding as of the end of the plan year.

Enter on this line all loans to participants, including residential mortgage loans that are subject to section 72(p). Include the sum of the value of the unpaid principal balances, plus accrued but unpaid interest, if any, for participant loans made under an individual account plan with investment experience segregated for each account made in accordance with 29 CFR 2550.408b-1 and which are secured solely by a portion of the participant's vested accrued benefit. When applicable, combine this amount with the current value of any other participant loans. Do not include a participant loan that has been deemed distributed.

Line 10. Check “Yes” if this plan is a defined benefit plan subject to the minimum funding standard requirements of section 412.

Line 10a. Enter the unpaid minimum required contribution for all years from line 40 of Schedule SB (Form 5500).

If the plan is a defined benefit plan, the enrolled actuary must complete and sign the 2021 Schedule SB (Form 5500) and forward it no later than the filing due date to the person responsible for filing Form 5500-EZ. The completed Schedule SB is subject to the records retention provisions of the Code. See the 2021 Instructions for Form 5500 for more information about Schedule SB.

Line 11a. If a waiver of the minimum funding standard for a prior year is being amortized in the current plan year, enter the month, day, and year (MM/DD/YYYY) the letter ruling was granted.

If a money purchase defined contribution plan (including a target benefit plan) has received a waiver of the minimum funding standard, and the waiver is currently being amortized, complete lines 3, 9, and 10 of

Schedule MB (Form 5500). See the Instructions for Schedule MB in the Instructions for Form 5500. Do not attach Schedule MB to the Form 5500-EZ. Instead, keep the completed Schedule MB in accordance with the applicable records retention requirements.

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. This form is required to be filed under section 6058(a). Section 6109 requires you to provide your identification number. If you fail to provide this information in a timely manner or if you provide false or fraudulent information, you may be subject to penalties. Section 6104(b) makes the information contained in this form publicly available. Therefore, the information will be given to anyone who asks for it and may be given to the Pension Benefit Guaranty Corporation (PBGC) for administration of ERISA, the Department of Justice for civil and criminal litigation, and cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. We may also disclose this information to other countries under a treaty, to federal and state agencies to enforce federal non-tax criminal laws, and to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of the Internal Revenue Code. Generally, the Form 5500 series return/reports and some of the related schedules are open to public inspection.

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is:

Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 hr., 07 min.

Learning about the law or the form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 hr., 01min.

Preparing the form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 hr., 19 min.

Copying, assembling, and sending the form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 min.

If you have suggestions for making this form simpler, we would be happy to hear from you. You can send us comments from IRS.gov/FormComment. Or you can write to the Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form to this address. Instead, see Where To File, earlier.

2D	Offset plan – Plan benefits are subject to offset for retirement benefits provided in another plan or arrangement of the employer.
2E	Profit-sharing plan.
2J	Section 401(k) feature – A cash or deferred arrangement described in section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
2K	Section 401(m) arrangement – Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contributions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if plan is a section 403(b)(1), 403(b)(7), or 408 arrangement/accounts annuities.
2R	Participant-directed brokerage accounts provided as an investment option under the plan.
2S	Plan provides for automatic enrollment in plan that has elective contributions deducted from payroll.
2T	Total or partial participant-directed account plan – Plan uses default investment account for participants who fail to direct assets in their account.
CODE	Other Pension Benefit Features
3A	Non-U.S. plan – Pension plan maintained outside the United States primarily for nonresident aliens.
3B	Plan covering self-employed individuals.
3C	Plan not intended to be qualified – A plan not intended to be qualified under section 401, 403, or 408.
3D	Pre-approved pension plan – A pre-approved pension plan under sections 401, 403(a), and 4975(e)(7) that is subject to a favorable opinion letter from the IRS.
3E	A one-participant plan that satisfies minimum coverage requirements of section 410(b) only when combined with another plan of the employer.
3F	Plan sponsor(s) received services of leased employees, as defined in section 414(n), during the plan year.
3H	Plan sponsor(s) is (are) a member(s) of a controlled group, or affiliated service group (section 414(b), (c), or (m)).
3J	U.S.-based plan that covers residents of Puerto Rico and is qualified under both section 401 and section 1165 of the Internal Revenue Code of Puerto Rico.

LIST OF PLAN CHARACTERISTICS CODES FOR

LINE 8

CODE	Defined Benefit Pension Features
1A	Benefits are primarily pay related.
1B	Benefits are primarily flat dollar (includes dollars per year of service).
1C	Cash balance or similar plan – Plan has a “cash balance” formula. For this purpose, a “cash balance” formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10% of final average pay times years of service, or the amount of the employee's hypothetical account balance).
1D	Floor-offset plan – Plan benefits are subject to offset for retirement benefits provided by an employer-sponsored defined contribution plan.
1E	Section 401(h) arrangement – Plan contains separate accounts under section 401(h) to provide employee health benefits.
1F	Section 414(k) arrangement – Benefits are based partly on the balance of the separate account of the participant (also include appropriate defined contribution pension feature codes).
1I	Frozen plan – As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
CODE	Defined Contribution Pension Features
2A	Age/Service Weighted or New Comparability or Similar Plan – Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New Comparability or Similar Plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the threshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
2B	Target benefit plan.
2C	Money purchase (other than target benefit) plan.

Forms 5500, 5500-SF, and 5500-EZ Codes for Principal Business Activity		This list of principal business activities and their associated codes is designed to classify an enterprise by the type of activity in which it is engaged.		These principal activity codes are based on the North American Industry Classification System.
Code	Code		Code		Code
Agriculture, Forestry, Fishing	Specialty Trade Contractors		Printing and Related Support		Computer and Electronic Product
and Hunting	238100 Foundation, Structure, &		Activities		Manufacturing
Crop Production	Building Exterior Contractors		323100 Printing & Related Support		334110 Computer & Peripheral
111100 Oilseed & Grain Farming	(including framing carpentry,		Activities		Equipment Mfg
111210 Vegetable & Melon Farming	masonry, glass, roofing, &		Petroleum and Coal Products		334200 Communications Equipment
(including potatoes & yams)	siding)		Manufacturing		Mfg
111300 Fruit & Tree Nut Farming	238210 Electrical Contractors		324110 Petroleum Refineries		334310 Audio & Video Equipment Mfg
111400 Greenhouse, Nursery, &	238220 Plumbing, Heating, &		(including integrated)		334410 Semiconductor & Other
Floriculture Production	Air-Conditioning Contractors		324120 Asphalt Paving, Roofing, &		Electronic Component Mfg
111900 Other Crop Farming	238290 Other Building Equipment		Saturated Materials Mfg		334500 Navigational, Measuring,
(including tobacco, cotton,	Contractors		324190 Other Petroleum & Coal		Electromedical, & Control
sugarcane, hay, peanut,	238300 Building Finishing		Products Mfg		Instruments Mfg
sugar beet, & all other crop	Contractors (including		Chemical Manufacturing		334610 Manufacturing & Reproducing
farming)	drywall, insulation, painting,		325100 Basic Chemical Mfg		Magnetic & Optical Media
Animal Production	wallcovering, flooring, tile, &		325200 Resin, Synthetic Rubber, &		Electrical Equipment, Appliance, and
112111 Beef Cattle Ranching &	finish carpentry)		Artificial & Synthetic Fibers &		Component Manufacturing
Farming	238900 Other Specialty Trade		Filaments Mfg		335100 Electric Lighting Equipment
112112 Cattle Feedlots	Contractors (including site		325300 Pesticide, Fertilizer, & Other		Mfg
112120 Dairy Cattle & Milk	preparation)		Agricultural Chemical Mfg		335200 Major Household Appliance Mfg
Production	Manufacturing		325410 Pharmaceutical & Medicine Mfg		335310 Electrical Equipment Mfg
112210 Hog & Pig Farming	Food Manufacturing		325500 Paint, Coating, & Adhesive Mfg		335900 Other Electrical Equipment &
112300 Poultry & Egg Production	311110 Animal Food Mfg		325600 Soap, Cleaning Compound, &		Component Mfg
112400 Sheep & Goat Farming	311200 Grain & Oilseed Milling		Toilet Preparation Mfg		Transportation Equipment
112510 Aquaculture (including	311300 Sugar & Confectionary		325900 Other Chemical Product &		Manufacturing
shellfish & finfish farms &	Product Mfg		Preparation Mfg		336100 Motor Vehicle Mfg
hatcheries)	311400 Fruit & Vegetable Preserving		Plastics and Rubber Products		336210 Motor Vehicle Body & Trailer
112900 Other Animal Production	& Specialty Food Mfg		Manufacturing		Mfg
Forestry and Logging	311500 Dairy Product Mfg		326100 Plastics Product Mfg		336300 Motor Vehicle Parts Mfg
113110 Timber Tract Operations	311610 Animal Slaughtering and		326200 Rubber Product Mfg		336410 Aerospace Product & Parts
113210 Forest Nurseries & Gathering	Processing		Nonmetallic Mineral Product		Mfg
of Forest Products	311710 Seafood Product Preparation		Manufacturing		336510 Railroad Rolling Stock Mfg
113310 Logging	& Packaging		327100 Clay Product & Refractory Mfg		336610 Ship & Boat Building
Fishing, Hunting and Trapping	311800 Bakeries, Tortilla & Dry Pasta		327210 Glass & Glass Product Mfg		336990 Other Transportation
114110 Fishing	Mfg		327300 Cement & Concrete Product Mfg		Equipment Mfg
114210 Hunting & Trapping	311900 Other Food Mfg (including		327400 Lime & Gypsum Product Mfg		Furniture and Related Product
Support Activities for Agriculture	coffee, tea, flavorings &		327900 Other Nonmetallic Mineral		Manufacturing
and Forestry	seasonings)		Product Mfg		337000 Furniture & Related Product
115110 Support Activities for Crop	Beverage and Tobacco Product		Primary Metal Manufacturing		Manufacturing
Production (including cotton	Manufacturing		331110 Iron & Steel Mills & Ferroalloy		Miscellaneous Manufacturing
ginning, soil preparation,	312110 Soft Drink & Ice Mfg		Mfg		339110 Medical Equipment &
planting, & cultivating)	312120 Breweries		331200 Steel Product Mfg from		Supplies Mfg
115210 Support Activities for Animal	312130 Wineries		Purchased Steel		339900 Other Miscellaneous Mfg
Production	312140 Distilleries		331310 Alumina & Aluminum		Wholesale Trade
115310 Support Activities for	312200 Tobacco Manufacturing		Production & Processing		Merchant Wholesalers, Durable
Forestry	Textile Mills and Textile Product		331400 Nonferrous Metal (except		Goods
Mining	Mills		Aluminum) Production &		423100 Motor Vehicle, & Motor
211120 Crude Petroleum Extraction	313000 Textile Mills		Processing		Vehicle Parts & Supplies
211130 Natural Gas Extraction	314000 Textile Product Mills		331500 Foundries		423200 Furniture & Home Furnishings
212110 Coal Mining	Apparel Manufacturing		Fabricated Metal Product		423300 Lumber & Other Construction
212200 Metal Ore Mining	315100 Apparel Knitting Mills		Manufacturing		Materials
212310 Stone Mining & Quarrying	315210 Cut & Sew Apparel		332110 Forging & Stamping		423400 Professional & Commercial
212320 Sand, Gravel, Clay, &	Contractors		332210 Cutlery & Handtool Mfg		Equipment & Supplies
Ceramic & Refractory	315220 Men’s & Boys’ Cut & Sew		332300 Architectural & Structural		423500 Metal & Mineral (except
Minerals Mining, & Quarrying	Apparel Mfg.		Metals Mfg		petroleum)
212390 Other Nonmetallic Mineral	315240 Women’s, Girls’ and Infants’		332400 Boiler, Tank, & Shipping		423600 Household Appliances and
Mining & Quarrying	Cut & Sew Apparel Mfg.		Container Mfg		Electrical & Electronic Goods
213110 Support Activities for Mining	315280 Other Cut & Sew Apparel Mfg		332510 Hardware Mfg		423700 Hardware, Plumbing, &
Utilities	315990 Apparel Accessories & Other		332610 Spring & Wire Product Mfg		Heating Equipment &
221100 Electric Power Generation,	Apparel Mfg		332700 Machine Shops; Turned		Supplies
Transmission & Distribution	Leather and Allied Product		Product; & Screw, Nut, & Bolt		423800 Machinery, Equipment, &
221210 Natural Gas Distribution	Manufacturing		Mfg		Supplies
221300 Water, Sewage & Other	316110 Leather & Hide Tanning, &		332810 Coating, Engraving, Heat		423910 Sporting & Recreational
Systems	Finishing		Treating, & Allied Activities		Goods & Supplies
221500 Combination Gas & Electric	316210 Footwear Mfg (including		332900 Other Fabricated Metal		423920 Toy, & Hobby Goods, &
Construction	rubber & plastics)		Product Mfg		Supplies
Construction of Buildings	316990 Other Leather & Allied		Machinery Manufacturing		423930 Recyclable Materials
236110 Residential Building	Product Mfg		333100 Agriculture, Construction, &		423940 Jewelry, Watch, Precious
Construction	Wood Product Manufacturing		Mining Machinery Mfg		Stone, & Precious Metals
236200 Nonresidential Building	321110 Sawmills & Wood		333200 Industrial Machinery Mfg		423990 Other Miscellaneous Durable
Construction	Preservation		333310 Commercial & Service		Goods
Heavy and Civil Engineering	321210 Veneer, Plywood, &		Industry Machinery Mfg		Merchant Wholesalers, Nondurable
Construction	Engineered Wood Product		333410 Ventilation, Heating,		Goods
237100 Utility System Construction	Mfg		Air-Conditioning, &		424100 Paper & Paper Products
237210 Land Subdivision	321900 Other Wood Product Mfg		Commercial Refrigeration		424210 Drugs & Druggists’ Sundries
237310 Highway, Street, & Bridge	Paper Manufacturing		Equipment Mfg		424300 Apparel, Piece Goods, &
Construction	322100 Pulp, Paper, & Paperboard		333510 Metalworking Machinery Mfg		Notions
237990 Other Heavy & Civil	Mills		333610 Engine, Turbine & Power		424400 Grocery & Related Products
Engineering Construction	322200 Converted Paper Product Mfg		Transmission Equipment Mfg		424500 Farm Product Raw Materials
			333900 Other General Purpose		424600 Chemical & Allied Products
			Machinery Mfg
Forms 5500, 5500-SF, and 5500-EZ Codes for Principal Business Activity (continued)
Code	Code		Code		Code
424700 Petroleum & Petroleum	448140 Family Clothing Stores		Support Activities for Transportation		Securities, Commodity Contracts,
Products	448150 Clothing Accessories Stores		488100 Support Activities for Air		and Other Financial Investments and
424800 Beer, Wine, & Distilled	448190 Other Clothing Stores		Transportation		Related Activities
Alcoholic Beverages	448210 Shoe Stores		488210 Support Activities for Rail		523110 Investment Banking &
424910 Farm Supplies	448310 Jewelry Stores		Transportation		Securities Dealing
424920 Book, Periodical, &	448320 Luggage & Leather Goods		488300 Support Activities for Water		523120 Securities Brokerage
Newspapers	Stores		Transportation		523130 Commodity Contracts Dealing
424930 Flower, Nursery Stock, &	Sporting Goods, Hobby, Book, and		488410 Motor Vehicle Towing		523140 Commodity Contracts
Florists’ Supplies	Music Stores		488490 Other Support Activities for		Brokerage
424940 Tobacco & Tobacco Products	451110 Sporting Goods Stores		Road Transportation		523210 Securities & Commodity
424950 Paint, Varnish, & Supplies	451120 Hobby, Toy, & Game Stores		488510 Freight Transportation		Exchanges
424990 Other Miscellaneous	451130 Sewing, Needlework, & Piece		Arrangement		523900 Other Financial Investment
Nondurable Goods	Goods Stores		488990 Other Support Activities for		Activities (including portfolio
Wholesale Electronic Markets and	451140 Musical Instrument &		Transportation		management & investment
Agents and Brokers	Supplies Stores		Couriers and Messengers		advice)
425110 Business to Business	451211 Book Stores		492110 Couriers		Insurance Carriers and Related
Electronic Markets	451212 News Dealers & Newsstands		492210 Local Messengers & Local		Activities
425120 Wholesale Trade Agents &	General Merchandise Stores		Delivery		524130 Reinsurance Carriers
Brokers	452200 Department Stores		Warehousing and Storage		524140 Direct Life, Health, & Medical
Retail Trade	452300 General Merchandise		493100 Warehousing & Storage		Insurance Carriers
Motor Vehicle and Parts Dealers	Stores incl. Warehouse Clubs &		(except lessors of		524150 Direct Insurance (except Life,
	Supercenters		miniwarehouses & self-storage		Health & Medical) Carriers
441110 New Car Dealers			units)		524210 Insurance Agencies &
441120 Used Car Dealers	Miscellaneous Store Retailers				Brokerages
441210 Recreational Vehicle Dealers	453110 Florists		Information		524290 Other Insurance Related
441222 Boat Dealers	453210 Office Supplies & Stationery		Publishing Industries (except Internet)		Activities (including third-
441228 Motorcycle, ATV, and All	Stores		511110 Newspaper Publishers		party administration of
Other Motor Vehicle Dealers	453220 Gift, Novelty, & Souvenir		511120 Periodical Publishers		Insurance and pension funds)
441300 Automotive Parts,	Stores		511130 Book Publishers		Funds, Trusts, and Other Financial
Accessories, & Tire Stores	453310 Used Merchandise Stores		511140 Directory & Mailing List		Vehicles
Furniture and Home Furnishings	453910 Pet & Pet Supplies Stores		Publishers		525100 Insurance & Employee
Stores	453920 Art Dealers		511190 Other Publishers		Benefit Funds
442110 Furniture Stores	453930 Manufactured (Mobile) Home		511210 Software Publishers		525910 Open-End Investment Funds
442210 Floor Covering Stores	Dealers		Motion Picture and Sound Recording		(Form 1120-RIC)
442291 Window Treatment Stores	453990 All Other Miscellaneous Store		Industries		525920 Trusts, Estates, & Agency
442299 All Other Home Furnishings	Retailers (including tobacco,		512100 Motion Picture & Video		Accounts
Stores	candle, & trophy shops)		Industries (except video rental)		525990 Other Financial Vehicles
Electronics and Appliance Stores	Nonstore Retailers		512200 Sound Recording Industries		(including mortgage REITs &
443141 Household Appliance Stores	454110 Electronic Shopping &		Broadcasting (except Internet)		closed-end investment funds)
443142 Electronics Stores (including	Mail-Order Houses		515100 Radio & Television		“Offices of Bank Holding Companies”
Audio, Video, Computer, and	454210 Vending Machine Operators		Broadcasting		and “Offices of Other Holding Companies”
Camera Stores)	454310 Fuel Dealers (including Heating		515210 Cable & Other Subscription		are located under Management
Building Material and Garden	Oil and Liquefied Petroleum)		Programming		of Companies (Holding Companies).
Equipment and Supplies Dealers	454390 Other Direct Selling		Telecommunications		Real Estate and Rental and
444110 Home Centers	Establishments (including		517000 Telecommunications		Leasing
444120 Paint & Wallpaper Stores	door-to-door retailing, frozen		(including paging, cellular,		Real Estate
	food plan providers, party		satellite, cable & other program		531110 Lessors of Residential
444130 Hardware Stores	plan merchandisers, &		distribution, resellers, other		Buildings & Dwellings
444190 Other Building Material	coffee-break service providers)		telecommunications, &		(including equity REITs)
Dealers	Transportation and		internet service providers)		531120 Lessors of Nonresidential
444200 Lawn & Garden Equipment &	Warehousing		Data Processing Services		Buildings (except
Supplies Stores	Air, Rail, and Water Transportation		518210 Data Processing, Hosting, &		Miniwarehouses) (including
Food and Beverage Stores	481000 Air Transportation		Related Services		equity REITs)
445110 Supermarkets and Other	482110 Rail Transportation		Other Information Services		531130 Lessors of Miniwarehouses &
Grocery (except	483000 Water Transportation		519100 Other Information Services		Self-Storage Units (including
Convenience) Stores	Truck Transportation		(including news syndicates,		equity REITs)
445120 Convenience Stores	484110 General Freight Trucking,		libraries, internet publishing &		531190 Lessors of Other Real Estate
445210 Meat Markets	Local		broadcasting)		Property (including equity
445220 Fish & Seafood Markets	484120 General Freight Trucking,		Finance and Insurance		REITs)
445230 Fruit & Vegetable Markets	Long-distance		Depository Credit Intermediation		531210 Offices of Real Estate Agents
445291 Baked Goods Stores	484200 Specialized Freight Trucking		522110 Commercial Banking		& Brokers
445292 Confectionery & Nut Stores	Transit and Ground Passenger		522120 Savings Institutions		531310 Real Estate Property
445299 All Other Specialty Food	Transportation		522130 Credit Unions		Managers
Stores	485110 Urban Transit Systems		522190 Other Depository Credit		531320 Offices of Real Estate
445310 Beer, Wine, & Liquor Stores	485210 Interurban & Rural Bus		Intermediation		Appraisers
Health and Personal Care Stores	Transportation		Nondepository Credit Intermediation		531390 Other Activities Related to
446110 Pharmacies & Drug Stores	485310 Taxi Service		522210 Credit Card Issuing		Real Estate
446120 Cosmetics, Beauty Supplies,	485320 Limousine Service		522220 Sales Financing		Rental and Leasing Services
& Perfume Stores	485410 School & Employee Bus		522291 Consumer Lending		532100 Automotive Equipment Rental &
446130 Optical Goods Stores	Transportation		522292 Real Estate Credit		Leasing
446190 Other Health & Personal	485510 Charter Bus Industry		(including mortgage bankers &		532210 Consumer Electronics &
Care Stores	485990 Other Transit & Ground		originators)		Appliances Rental
Gasoline Stations	Passenger Transportation		522293 International Trade Financing		532281 Formal Wear & Costume Rental
447100 Gasoline Stations (including	Pipeline Transportation		522294 Secondary Market Financing		532282 Video Tape & Disc Rental
convenience stores with gas)	486000 Pipeline Transportation		522298 All Other Nondepository
Clothing and Clothing Accessories	Scenic & Sightseeing Transportation		Credit Intermediation
Stores	487000 Scenic & Sightseeing		Activities Related to Credit
448110 Men’s Clothing Stores	Transportation		Intermediation
448120 Women’s Clothing Stores			522300 Activities Related to Credit
448130 Children’s & Infants’ Clothing			Intermediation (including loan
Stores			brokers, check clearing, &
			money transmitting)
Forms 5500, 5500-SF, and 5500-EZ Codes for Principal Business Activity (continued)
Code	Code		Code		Code
532283 Home Health Equipment	Administrative and Support and		Medical and Diagnostic Laboratories		Other Services
Rental	Waste Management and		621510 Medical & Diagnostic		Repair and Maintenance
532284 Recreational Goods Rental	Remediation Services		Laboratories		811110 Automotive Mechanical, &
532289 All Other Consumer Goods	Administration and Support Services		Home Health Care Services		Electrical Repair &
Rental	561110 Office Administrative Services		621610 Home Health Care Services		Maintenance
532310 General Rental Centers	561210 Facilities Support Services		Other Ambulatory Health Care Services		811120 Automotive Body, Paint,
532400 Commercial & Industrial	561300 Employment Services		621900 Other Ambulatory Health Care		Interior, & Glass Repair
Machinery & Equipment	561410 Document Preparation Services		Services (including ambulance		811190 Other Automotive Repair &
Rental & Leasing	561420 Telephone Call Centers		services & blood & organ banks)		Maintenance (including oil
Lessors of Nonfinancial Intangible	561430 Business Service Centers		Hospitals		change & lubrication shops &
Assets (except copyrighted works)	(including private mail centers		622000 Hospitals		car washes)
533110 Lessors of Nonfinancial	& copy shops)		Nursing and Residential Care		811210 Electronic & Precision
Intangible Assets (except	561440 Collection Agencies		Facilities		Equipment Repair &
copyrighted works)	561450 Credit Bureaus		623000 Nursing & Residential Care		Maintenance
Professional, Scientific, and	561490 Other Business Support		Facilities		811310 Commercial & Industrial
Technical Services	Services (including		Social Assistance		Machinery & Equipment
Legal Services	repossession services, court		624100 Individual & Family Services		(except Automotive &
541110 Offices of Lawyers	reporting, & stenotype		624200 Community Food & Housing, &		Electronic) Repair &
541190 Other Legal Services	services)		Emergency & Other Relief		Maintenance
Accounting, Tax Preparation,	561500 Travel Arrangement &		Services		811410 Home & Garden Equipment &
Bookkeeping, and Payroll Services	Reservation Services		624310 Vocational Rehabilitation		Appliance Repair &
541211 Offices of Certified Public	561600 Investigation & Security		Services		Maintenance
Accountants	Services		624410 Child Day Care Services		811420 Reupholstery & Furniture
541213 Tax Preparation Services	561710 Exterminating & Pest Control		Arts, Entertainment, and		Repair
541214 Payroll Services	Services		Recreation		811430 Footwear & Leather Goods
541219 Other Accounting Services	561720 Janitorial Services		Performing Arts, Spectator Sports,		Repair
Architectural, Engineering, and	561730 Landscaping Services		and Related Industries		811490 Other Personal & Household
Related Services	561740 Carpet & Upholstery Cleaning		711100 Performing Arts Companies		Goods Repair & Maintenance
541310 Architectural Services	Services		711210 Spectator Sports (including		Personal and Laundry Services
541320 Landscape Architecture	561790 Other Services to Buildings &		sports clubs & racetracks)		812111 Barber Shops
Services	Dwellings		711300 Promoters of Performing Arts,		812112 Beauty Salons
541330 Engineering Services	561900 Other Support Services		Sports, & Similar Events		812113 Nail Salons
541340 Drafting Services	(including packaging &		711410 Agents & Managers for		812190 Other Personal Care
541350 Building Inspection Services	labeling services, & convention		Artists, Athletes, Entertainers, &		Services (including diet &
541360 Geophysical Surveying &	& trade show organizers)		Other Public Figures		weight reducing centers)
Mapping Services	Waste Management and		711510 Independent Artists, Writers, &		812210 Funeral Homes & Funeral
541370 Surveying & Mapping (except	Remediation Services		Performers		Services
Geophysical) Services	562000 Waste Management and		Museums, Historical Sites, and Similar		812220 Cemeteries & Crematories
541380 Testing Laboratories	Remediation Services		Institutions		812310 Coin-Operated Laundries &
Specialized Design Services	Educational Services		712100 Museums, Historical Sites, &		Drycleaners
541400 Specialized Design Services	611000 Educational Services		Similar Institutions		812320 Drycleaning & Laundry
(including interior, industrial,	(including schools, colleges,		Amusements, Gambling, and		Services (except
graphic, & fashion design)	& universities)		Recreation Industries		Coin-Operated)
Computer Systems Design and	Health Care and Social Assistance		713100 Amusement Parks & Arcades		812330 Linen & Uniform Supply
Related Services	Offices of Physicians and Dentists		713200 Gambling Industries		812910 Pet Care (except Veterinary)
541511 Custom Computer	621111 Offices of Physicians (except		713900 Other Amusement &		Services
Programming Services	mental health specialists)		Recreation Industries		812920 Photofinishing
541512 Computer Systems Design	621112 Offices of Physicians, Mental		(including golf courses, skiing		812930 Parking Lots & Garages
Services	Health Specialists		facilities, marinas, fitness		812990 All Other Personal Services
541513 Computer Facilities	621210 Offices of Dentists		centers, & bowling centers)		Religious, Grantmaking, Civic,
Management Services	Offices of Other Health Practitioners		Accommodation and Food Services		Professional, and Similar
541519 Other Computer Related	621310 Offices of Chiropractors		Accommodation		Organizations
Services	621320 Offices of Optometrists		721110 Hotels (except Casino Hotels) &		813000 Religious, Grantmaking,
Other Professional, Scientific, and	621330 Offices of Mental Health		Motels		Civic, Professional, & Similar
Technical Services	Practitioners (except		721120 Casino Hotels		Organizations (including
541600 Management, Scientific, &	Physicians)		721191 Bed & Breakfast Inns		condominium and
Technical Consulting Services	621340 Offices of Physical,		721199 All other Traveler		homeowners associations)
541700 Scientific Research &	Occupational & Speech		Accommodation		813930 Labor Unions and Similar
Development Services	Therapists, & Audiologists		721210 RV (Recreational Vehicle)		Labor Organizations
541800 Advertising & Related	621391 Offices of Podiatrists		Parks & Recreational Camps		921000 Governmental Instrumentality
Services	621399 Offices of all Other		721310 Rooming and Boarding Houses,		or Agency
541910 Marketing Research & Public	Miscellaneous Health		Dormitories, and Workers’
Opinion Polling	Practitioners		Camps
541920 Photographic Services	Outpatient Care Centers		Food Services and Drinking Places
541930 Translation & Interpretation	621410 Family Planning Centers		722300 Special Food Services
Services	621420 Outpatient Mental Health &		(including food service
541940 Veterinary Services	Substance Abuse Centers		contractors & caterers)
541990 All Other Professional,	621491 HMO Medical Centers		722410 Drinking Places (Alcoholic
Scientific, & Technical	621492 Kidney Dialysis Centers		Beverages)
Services	621493 Freestanding Ambulatory		722511 Full-Service Restaurants
Management of Companies	Surgical & Emergency Centers		722513 Limited-Service Restaurants
(Holding Companies)	621498 All Other Outpatient Care		722514 Cafeterias and Buffets
551111 Offices of Bank Holding	Centers		722515 Snack and Non-alcoholic
Companies			Beverage Bars
551112 Offices of Other Holding
Companies

Cat. No. 63264C