002 Notice of Insolvency

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Notice of Insolvency
*Required fields
*Plan name: MEPD Test Pension plan
*EIN: 11-1111111

(ex. 33-3333333)

*PN: 002

(ex. 333)

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

Accountant

Plan Sponsor Information
*Plan sponsor name: UIVR Vftd Wjpko mf Poxmacxw
*Address: 2069 A Xiledz Kd

*City: Washington
*State:

DC

*Zip Code: 20005

(ex. 12345-1234)

*Telephone: 972-576-5841

(ex. 202-111-1111)

E-mail address: [email protected]

Ext. 6600
(ex. [email protected])

Fax:

(ex. 202-111-1111)

Plan Sponsor’s Duly Authorized Representative (if any)
First name: Ckwr
Last name: Ehm
Company: ABC Administrators
Title: Plan Administrator
Address: 1531 T Wm, Sy

City: Washington
State:

DC

Zip Code: 20005
Telephone:
E-mail address: [email protected]

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

Ext.
(ex. [email protected])

Fax:

*The Plan is/will be
insolvent under:

(ex. 202-111-1111)

Mass Withdrawal (Sec. 4281)
Ongoing/Critical Status (Sec. 4245)

*Insolvency year for which
2019
the notice is being filed:

(YYYY)

*The estimated amount of annual benefit payments under the plan (determined without regard to the
insolvency) for the insolvency year:
$ 89
*The estimated amount of the plan’s available resources for the insolvency year:
$ 456
*The estimated amount of the annual benefits guaranteed by PBGC for the insolvency year:
$ 123
*Estimated month of
05
insolvency:

(MM)

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Notice of Insolvency
Attached Documents
Click here for additional instructions.
Documents 1 - 3 are required for all filings.
Documents 4 and 5 are only required if they have not previously been submitted to PBGC.
Provide an explanation in the “Comments” box for any missing documents.
Comments:

File:
Document
Type:

No 4 or 5 document

Choose File No file chosen
- Select a document type Attach
Maximum file size is 25MB. It may take a minute or two to attach large files. Please click
only once. To send files larger than 25MB, please click on this link:
http://PBGC.leapfile.com, click "Secure Upload", enter the recipient's email address, and
follow the prompts. For additional assistance, please contact us at
[email protected] or 1-800-736-2444 (ext. 3993 or 6047). Local callers
may directly dial 202-326-4000 (ext. 3993 or 6047).

*Required documents
1. *Most recent actuarial valuation for the plan
File 1.docx

Delete

2. *Certification, signed by the plan sponsor (or duly authorized representative), that the notices of
insolvency have been given to all interested parties (defined in 29 CFR 4245.2) for critical status
plans or to participants and beneficiaries for plans terminated by mass withdrawal
File 2.docx

Delete

3. *Sample notice of insolvency given to all interested parties or to participants and beneficiaries
File 3.docx

Delete

4. Plan document (Including any amendments/restatements)
5. Most recent copy of the Schedule MB for the plan (if available, and only if the Schedule MB contains more
recent information than the most recent actuarial valuation)
6. Other

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Data Summary

Notice of Insolvency
MEPD Test Pension plan - 11-1111111/002

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Submit Filing

Plan Filing Information

Edit

Plan name:

MEPD Test Pension plan

EIN / PN:

11-1111111/002

Notice filer name:

Zjfh Xceu Rkgsy

Role of filer:

Accountant

Return to Home Page

Plan Sponsor Information
Name:

UIVR Vftd Wjpko mf Poxmacxw

Address:

2069 A Xiledz Kd Washington, DC 20005

Phone:

972-576-5841 x6600

Email:

[email protected]

Fax:

N/A

Plan Sponsor’s Duly Authorized Representative
Name:

Ckwr Ehm

Company:

ABC Administrators

Title:

Plan Administrator

Address:

1531 T Wm, Sy Washington, DC 20005

Phone:

N/A

Email:

[email protected]

Fax:

N/A

The Plan is/will be insolvent under:

Mass Withdrawal (Sec. 4281)

Insolvency year for which the notice is being filed:

2019

The estimated amount of annual benefit payments under
the plan (determined without regard to the insolvency) for $89.00
the insolvency year:
The estimated amount of the plan’s available resources
for the insolvency year:

$456.00

The estimated amount of the annual benefits guaranteed

$123.00

by PBGC for the insolvency year:
Estimated month of insolvency:

5

Attached Documents

Edit

Most recent actuarial valuation for the plan
Certification, signed by the plan sponsor (or duly authorized representative), that the notices of insolvency
have been given to all interested parties (defined in 29 CFR 4245.2) for critical status plans or to participants
and beneficiaries for plans terminated by mass withdrawal

Sample notice of insolvency given to all interested parties or to participants and beneficiaries
Plan document (Including any amendments/restatements)
Most recent copy of the Schedule MB for the plan (if available, and only if the Schedule MB contains more
recent information than the most recent actuarial valuation)
Other
Comments
No 4 or 5 document

CONFIDENTIAL

PBGC
Notice of Insolvency
Plan Filing Information
Plan name:

MEPD Test Pension plan

EIN/PN:

11-1111111/002

Notice filer name:

Zjfh Xceu Rkgsy

Role of filer:

Accountant

Plan Sponsor Information
Plan sponsor name:

UIVR Vftd Wjpko mf Poxmacxw

Address:

2069 A Xiledz Kd

City:

Washington

State:

DC

Zip:

20005

Telephone:

(972) 576-5841 Ext: 6600

E-mail:

[email protected]

Fax:

Plan Sponsor's Authorized Representative Information
First name:

Ckwr

Last name:

Ehm

Company:

ABC Administrators

Title:

Plan
Administrator

Address:

1531 T Wm, Sy

City:

Washington

State:

DC

Zip:

20005

Telephone:

Ext:

E-mail:

[email protected]

Fax:

Mass Withdrawal (Sec. 4281)
Ongoing/Critical Status (Sec. 4245)

The Plan is/will be insolvent
under:

2019

Estimated amount of annual
benefit payments under the plan
for the insolvency year:

$89.00

Estimated amount of the plan's
available resources for the
insolvency year:

$456.00

Estimated amount of annual
benefits guaranteed by PBGC
for the insolvency year:

$123.00

Estimated month of insolvency:

5

Insolvency year for which the
notice is being filed:

Submission status - Filing not yet submitted

CONFIDENTIAL

Attached Documents
Most recent actuarial valuation for the plan
Certification, signed by the plan sponsor (or duly authorized representative), that the notices of insolvency have
been given to all interested parties (defined in 29 CFR 4245.2) for critical status plans or to participants and
beneficiaries for plans terminated by mass withdrawal

Sample notice of insolvency given to all interested parties or to participants and beneficiaries
Plan document (Including any amendments/restatements)
Most recent copy of the Schedule MB for the plan (if available, and only if the Schedule MB contains more recent
information than the most recent actuarial valuation)
Other
Missing Information If required information has not been submitted, explain below.
No 4 or 5 document

Submission status - Filing not yet submitted
Go To Data Summary