Annual Information Return/Report of Employee Benefit Plan

Annual Information Return/Report of Employee Benefit Plan- SECURE Act

2021 Form 5500-EZ Instructions Clean

Annual Information Return/Report of Employee Benefit Plan

OMB: 1210-0170

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Shape1 2021

Instructions for

Form 5500-EZ


Department of the Treasury

Internal Revenue Service

Annual Return of A One-Participant

Shape7 Shape6 (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.


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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.Shape9

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.Shape10

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.

  1. 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.

  2. 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.

  3. 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.




Shape11

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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:


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Shape12



Shape13

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.



Shape14

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

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title2020 Form 5500-EZ Instructions 020320
SubjectInstructions for Form 5500-EZ, Annual Return of A One-Participant (Owners/Partners and Their Spouses) Retirement Plan or A For
AuthorW:CAR:MP:FP
File Modified0000-00-00
File Created2021-10-04

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