Notice of Failure to Make Required Contributions

Form 200 Instructions

NOTICE OF FAILURE TO MAKE REQUIRED CONTRIBUTIONS

The Form 200 is used to notify the Pension Benefit Guaranty Corporation of a failure to make required contributions to a single-employer plan that is covered under ERISA §4021 and whose FTAP is less than 100% if the total of unpaid balances, including interest, exceeds $1 million (see ERISA section 303(k)(4)(A) and Code section §430(k)(4)(A)). For questions regarding this form, contact (202) 326-4070 or [email protected].

Table of Contents	Page
Introduction	2
General Instructions	4
Definitions	6
Specific Instructions	6
General Plan Information	6
Plan Funding Information	7
Additional Information to be Filed	7
Actuarial Information	8
Certifications	9
Appendix – Example of Calculation Concerning Failure to Make Required Funding Payments	A-1

INTRODUCTION

ERISA §303(k) and Code §430(k) provide that a lien arises in certain cases where there is a failure to make required contributions to a single- employer plan covered under ERISA §4021 whose funding target attainment percentage (as defined in ERISA §303(d) and Code §430(d)(2)) is less than

100 percent. The lien arises, in favor of the plan, upon all property and rights to property (whether real or personal) belonging to the person or persons who are liable for required contributions (i.e., a contributing sponsor and each member of the controlled group of which that contributing sponsor is a member) if:

1. any person fails to make a required contribution payment when due, and

2. the unpaid balance of the payment (including interest), when added to the aggregate unpaid balance of all preceding such payments for which payment was not made when due (including interest), exceeds $1 million.

Any lien imposed for failure to make required contributions may be perfected and enforced only by PBGC or, at its direction, by the plan’s contributing sponsor or any member of the contributing sponsor’s controlled group. ERISA

§303(k)(4)(A) and Code §430(k)(4)(A) require that PBGC be notified whenever there is a failure to make a required payment and the total of unpaid balances (including interest) exceeds $1 million. Notice must be provided within 10 days of the due date for the required payment.

To comply with this notification require- ment, PBGC regulations (29 CFR 4043.81) require that a contributing sponsor and, if that contributing sponsor is a member of a parent-subsidiary controlled group, the “ultimate parent,” file Form 200 whenever such a failure occurs.

Note: PBGC’s decision not to require (at this time) controlled group members other than contributing sponsors and ultimate parents to file Form 200 does not in any way limit the joint-

and-several liability of each controlled group member for required payments (whether the controlled group of which a contributing sponsor is a member is a “parent-subsidiary,” “brother-sister,” or “combined” group), the imposition of the lien on all assets of each controlled group member, or the ability of PBGC to take all appropriate steps to perfect and enforce the lien.

PBGC has restricted Form 200 to information generally needed in its decision-making regarding enforcement of a lien imposed by ERISA §303(k) and Code §430(k). If PBGC concludes that it needs additional information in a particular case, it will notify (in writing) the person required to supplement the Form 200 and specify the date by which the additional information must be submitted.

What’s New

The Form 200 instructions and Form 200 have been changed as follows:

• Added the amount of required payment that resulted in the requirement to notify PBGC (this is in addition to the already required due date of required payment that resulted in the requirement to notify PBGC).

• PBGC also intends to no longer accept electronic filing by email as of October 1, 2021. PBGC’s e-filing portal, available for reportable events filings since 2016, offers a secure application for submitting Form 200 information. The e-filing portal allows filers to:

• Review filings and generate a list of omissions and inconsistencies prior to submission to ensure that filings are complete.

• 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 e-certifications.

• Review prior filings submitted via the e-filing portal.

The portal can be accessed using the following address: efilingportal.pbgc.gov.

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Notification of future changes to any forms and instructions may be found under “What’s New” on the Employers & Practitioners page at www.pbgc.gov/whatsnew.

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GENERAL INSTRUCTIONS

Who Must File

Form 200 must be filed by (1) a contributing sponsor and (2) if a contributing sponsor is a member of a “parent-subsidiary” controlled group, the ultimate parent of such group. However, if a timely and complete Form 200 is properly filed by either a contributing sponsor or the ultimate parent, PBGC will deem the other to have so filed. (As noted in the “Introduction,” each other member of any controlled group of which a contributing sponsor is a member also is jointly and severally liable for required payments, and PBGC may enforce the statutory lien imposed on its assets.)

Note: An authorized representative may file a Form 200 on behalf of a contributing sponsor, a parent, or both.

Special Rule for Terminating Plans: The fact that a plan is in the process of terminating does not mean that a Form 200 notice need not be filed. However, a notice is waived if the deadline for filing the notice 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 or (2) a trustee is appointed for the plan under ERISA § 4042(c).

How to File

All required information must be filed using the Form 200 in accordance with the instructions posted on PBGC’s website (www.pbgc. gov). All filings should be submitted via email to [email protected] or filed through PBGC’s e- filing portal. To request an exemption from e- filing, send a request via email to [email protected].

Attaching files

Filers may attach electronic files to their submission. Examples of files that may be attached include, but are not limited to, actuarial valuation reports, financial statements, and organizational charts.

If you are filing materials electronically that are larger than 10 megabytes, please use Leap-FILE. Enter “pbgc.leapfile.com” in your Internet browser, click on “secure upload,” enter “[email protected]” in the “Recipient Email” field, and attach the files.

When to File

Form 200, including all required documentation and information, must be filed with PBGC no later than 10 days after the due date for the required payment.

Note: Form 200 must be filed each time there is a failure described in ERISA § 303(k)(1) and Code

§ 430(k)(1) and the total of unpaid balances of required payments (including interest) exceeds $1 million.

Notice Filing Date

The date a Form 200 is considered to have been filed is the date the notice and all additional required information is received by PBGC at [email protected] or the date received through PBGC’s e-filing portal. See 29 CFR § 4000.29.

Computation of time: In computing the 10-day period, the due date of the payment that resulted in the requirement to notify PBGC is not included. Form 200 is due 10 days thereafter unless that day is a Saturday, Sunday, or Federal holiday, in which case the 10-day period runs until the next day that is not a Saturday, Sunday, or Federal holiday. Information received on a weekend or Federal holiday or after 5:00 p.m. on a weekday is considered filed on the next regular business day.

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What to File

A contributing sponsor must use the PBGC Form 200 to file a notice of a failure to make required contributions. Certain individual items on the form call for additional information.

Attachments

If responding to an item requires the attachment of documentation or information, mark the attachment to identify the item to which it responds.

Previously Submitted Information

Because ERISA §303(k)(4)(A) and Code

§430(k)(4)(A) require that PBGC be notified each time there is a failure to make a required payment and the total of unpaid balances of required payments (including interest) exceeds $1 million, more than one filing may be required regarding the same plan, and at least some of the information included in a previous Form 200 filing may continue to be accurate and responsive at the time that a subsequent Form 200 must be filed. It also is possible that information submitted to PBGC in another context (e.g., in a distress termination filing pursuant to ERISA

§4041(c) or in a notice of a reportable event required by 29 CFR Part 4043) is responsive. A filer may respond to an item that calls for previously submitted documentation or other information by identifying the previous submission in which the response was provided.

Effect of Failure to Timely File

If a Form 200 (or other required information) is not provided within the specified time limit, PBGC may assess a penalty under ERISA §4071 against each person required to provide the Form 200 (see 29 CFR Part 4071 and PBGC’s Statement of Policy on Assessment of Penalties for Failure to Provide Required Information (60 FR 36837, July 18, 1995)). PBGC may pursue any other equitable or legal remedies available to it under the law.

For Questions or Problems Regarding Form 200

If you have questions or problems regarding Form 200 or these instructions, contact:

Pension Benefit Guaranty Corporation

Corporate Finance and Restructuring Department 1200 K Street, NW

Washington DC 20005-4026

Telephone: 202-326-4070 Email: [email protected]

If you are having problems using the e-filing portal, contact PBGC at [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 200 and instructions may be obtained from PBGC’s website at http://www.pbgc.gov/prac/ forms.

Reportable Event

A failure to make a required contribution may also be a reportable event under 29 CFR 4043.25(a). If with respect to such failure, a Form 200 is completed and submitted in accordance with 29 CFR 4043.81, the Form 200 filing is deemed to satisfy the reportable event requirement (see 29 CFR 4043.25(b)).

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 purposes of 29 CFR 4043.25(a). 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 confidentiality protection for reportable event notices under ERISA §4043(f).

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DEFINITIONS

As used in PBGC Form 200 and these instructions:

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).

Controlled group, for purposes of ERISA §303(k) and Code §430(k), means any group treated as a single employer under subsection (b), (c), (m), or

(o) of Code §414.

Due date means the date set forth in ERISA §303(j) and Code §430(j) for payment of a required installment and, in the case of a payment other than a required installment, the date such payment is required to be made under ERISA §303 and Code

§430.

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 should be the EIN/PN most recently reported for a PBGC premium filing (if applicable).

ERISA means the Employee Retirement Income Security Act of 1974, as amended.

IRS means the Internal Revenue Service.

Notice due date means the deadline for filing a Form 200 with PBGC.

Notice Filing Date means the date the Form 200 is received by PBGC.

Person means an individual, partnership, joint venture, corporation, mutual company, joint-stock company, trust, estate, unincorporated organization, association, or employee organization.

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Required installment means any of the four quarterly contribution payments required for each plan year by ERISA §303(j) and Code §430(j).

Required payment means a required installment or other payment required under ERISA §§ 302 and 303 and Code §§ 412 and 430 or as a result of a funding waiver.

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.

Ultimate Parent means the parent at the highest level in the chain of corporation and/or other organizations constituting a parent-subsidiary controlled group. (For example, if Corporation A owns all of the stock of Corporation B and Corporation C, and Corporation B owns all of the stock of Corporation X, the contributing sponsor, then the “ultimate parent” of Corporation X is Corporation A.)

SPECIFIC INSTRUCTIONS

General Plan Information

• Complete name of the plan as it appears on the plan document and the plan year commencement date

• 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.

• Name, address, telephone number, and email address of the individual or the board or other entity, if any, specifically designated as plan administrator by the terms of the plan or trust agreement. If none is so designated, enter the name, address, telephone number, and email address of the 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.

Plan Funding Information

Note: An enrolled actuary must certify that the information in this section is true, correct, and complete, and conforms to applicable regulatory requirements (see Certification section).

• Due date of required payment.

• Amount of the required payment.

• The total amount, as of the due date, of the

unpaid balance of the required payment and the aggregate unpaid balance of all preceding required payments for which payment was not made when due (i.e., include in this amount the unpaid balances, including interest, of all required payments for which payment was not made when due). See Appendix for an example of how to compute the total amount.

• Description of how the unpaid balance of required payments was determined. This description must include an attached spreadsheet that shows the details of the calculation (see Appendix for an example of how the required information may be shown).

Additional Information to be Filed

Additional information to be filed (check all boxes for information attached to form; see below for description of Actuarial Information required).

• Description of the plan’s controlled group structure (including the contributing sponsor and the ultimate parent of the controlled group), including the name, address, telephone number, and EIN of each controlled group member

• Location of real property owned by each controlled group member

• Name and address of the controlled group’s principal executive office

• Operational status of each controlled group member (in Chapter 7 proceedings, liquidating outside of bankruptcy, in Chapter 11 proceedings, on-going, etc.)

• Name, address, telephone number and EIN of

• each contributing sponsor of the plan

• Reason contribution was not made by due date

• Copy of any IRS letter(s) granting or modifying a funding waiver and/or extension of the amortization period

• Statement describing any pending request(s) for a funding waiver and/or extension of the amortization period

• Copies of audited financial statements (if available) or (if not) unaudited financial statements that were prepared for the contributing sponsor and each other controlled group member individually, including balance sheets, income statements, statements of cash flows,

• and notes to financial statements and annual reports. However, if financial statements were only prepared on a consolidated basis for more than one controlled group member, consolidated financial statements and consolidating financial statements (if available) and (if not) consolidating trial balances that identify each controlled group member individually may be attached instead. Copies of financial statements for the most recent three fiscal years available, and the most recent available interim financial statement, for each member of the plan’s controlled group, including the contributing sponsor and the ultimate parent

Also include an explanation of any information required to be filed but missing from the filing.

Note – Simplified Reporting: Most “Additional Information to be Filed” does not need to be submitted if the filer has not missed any required contribution (other than the missed contribution that triggered the Form 200 filing requirement) during

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the two-year period ending on the notice due date for the Form 200 and has made up the missed contribution by the notice due date. The only additional information required is the reason the contribution was not made by the due date. PBGC may also request evidence that the contribution has been made. The filer should note Simplified Reporting is being used in the missing information section of the filing.

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. If the amount of the most recent missed contribution is based on a calculation that is not reflected in the most recent Actuarial Valuation Report, also provide all of the information described below that supports the calculation:

• The funding target calculated pursuant to ERISA section 303 without regard to subsection 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 non-vested 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 ER- ISA section 303(h)(2)(A) and Code section

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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 off- set minimum funding requirement, amounts reduced in accordance with any elections un- der 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).

• 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.

• Copies of election letters relating to the application of carryover or prefunding balances to the contributions.

Certifications

Plan funding information and related explanation certification must be made by an enrolled actuary Contributing Sponsor or Parent

Certification must be made by an officer (or an individual of comparable authority in an unincorporated organization) of the contributing sponsor or ultimate parent that is filing the Form 200.

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APPENDIX

Example on How to Describe the Aggregate Unpaid Balance of Required Funding Payments

Assume the plan sponsor of a calendar-year plan:

• missed a required 2017 quarterly installment of $600,000 on January 15, 2018

• made a contribution of $200,000 on March 1, 2018

• missed a 2018 required quarterly installment of $500,000 on April 15, 2018

• missed a 2018 required quarterly installment of $500,000 on July 15, 2018

• missed the final 2017 required contribution of $150,000 on September 15, 2018

In addition, assume the effective interest rate for plan year 2017 was 8% and for plan year 2018 was 6%. Adding 5% (see ERISA §303(j)(3)(A)) to the effective interest rates for the periods of underpayment, the applicable interest rates for the missed quarterlies for the 2017 and 2018 plan years are 13% and 11%, respectively.

Aggregate Unpaid Balance of Required Contributions as of 7/15/2018

Date	Contribution Type	Applicable Plan Year	Applicable Interest Rate	Amount	Days until 07/15/2018	Interest Adjustment	Total
01/15/2018/Quarterly	Missed	2017	13%	$600,000	181	$37,488	$637,488
03/01/2018/Quarterly	Paid	2017	13%	-$200,000	136	-$9,318	-$209,318
04/15/2018/Quarterly	Missed	2018	11%	$500,000	91	$13,180	$513,180
07/15/2018/Quarterly	Missed	2018	11%	$500,000	0	$0	$500,000
Total				$1,400,000		$41,350	$1,441,350

Because the aggregate unpaid balance of required payments as of July 15, 2018 ($1,441,350) exceeds $1,000,000, a Form 200 filing is due on July 25, 2018 (10 days after the missed contribution, with weekend extension). The table shown above is an example of the data to be submitted with the Form 200 filing.

Aggregate Unpaid Balance of Required Contributions as of 9/15/2018

Date	Contribution Type	Applicable Plan Year	Applicable Interest Rate	Amount	Days until 07/15/2018	Interest Adjustment	Total
01/15/2018/Quarterly	Missed	2017	13%	$600,000	243	$50,861	$650,861
03/01/2018/Quarterly	Paid	2017	13%	-$200,000	198	-$13,709	-$213,709
04/15/2018/Quarterly	Missed	2018	11%	$500,000	153	$22,358	$522,358
07/15/2018/Quarterly	Missed	2018	11%	$500,000	62	$8,942	$508,942
09/15/2018/Final	Missed	2017	8%	$150,000	0	$0	$150,000
Total				$1,550,000		$68,452	$1,618,452

Because the aggregate unpaid balance of required payments as of September 15, 2018 ($1,618,452) exceeds

$1,000,000, an updated Form 200 filing is due on September 25, 2018 (10 days after the missed contribution, with weekend extension). The table shown above is an example of the data to be submitted with the Form 200 filing.

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PAPERWORK REDUCTION ACT NOTICE

PBGC needs this information, which is required to be filed under section 303(k)(4) of ERISA and section 430(k)(4) of the Internal Revenue Code (the Code) and 29 CFR Part 4043, Subparts A and D, to make decisions regarding enforcement of a lien imposed by section 303(k)(1) of ERISA and section 430(k)(1) of the Code. Information provided to PBGC is confidential to the extent provided in the Freedom of Information Act and the Privacy Act.

PBGC estimates that it will take an average of 1 hour and $725 to comply with the requirements described in these instructions. These figures are estimated averages that will vary depending on the nature and organizational structure of persons liable for plan contributions (in particular, whether the plan’s contributing sponsor is a member of a controlled group and, if so, the size of that group) and on the funding history of the plan.

If you have any comments concerning the accuracy of these time estimates or suggestions for improving the form or these instructions, please send your comments to the Pension Benefit Guaranty Corporation, Regula- tory 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 1212-0041. 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.