SFA 204-B SFA Template 4B

Special Financial Assistance by PBGC

Template 4B v20220701p.xlsx

Application for Special Financial Assistance

OMB: 1212-0074

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Overview

Template 4B Instructions
4B-1 SFA Ben Pmts
4B-2 SFA Details .4(a)(2)(ii)
4B-3 SFA Exhaustion


Sheet 1: Template 4B Instructions

TEMPLATE 4B












v20220701p
SFA Determination - under the "present value method" for MPRA plans




























File name: Template 4B Plan Name, where "Plan Name" is an abbreviated version of the plan name.
If submitting additional information due to a merger under § 4262.4(f)(1)(ii): Template 4B Plan Name Merged, where "Plan Name Merged" is an abbreviated version of the plan name for the separate plan involved in the merger.
If submitting additional information due to certain events with limitations under § 4262.4(f)(1)(i): Template 4B Plan Name Add, where "Plan Name" is an abbreviated version of the plan name.
If submitting a supplemented application under § 4262.4(g)(6): Template 4B Supp Plan Name, where "Plan Name" is an abbreviated version of the plan name.
Instructions for Addendum D of the Instructions for Filing Requirements for Multiemployer Plans Applying for Special Financial Assistance:

IFR filers submitting a supplemented application should see Addendum C for more information.













MPRA plans using the "increasing assets method" should see Addendum D for more information.



























For MPRA plans, provide information used to determine the amount of SFA under the "present value method" described in § 4262.4(a)(2)(ii), if that amount is the greatest amount calculated under § 4262.4(a)(2).

The information to be provided is:
NOTE: All items below are provided on Sheet '4B-2 SFA Details .4(a)(2)(ii)' unless otherwise indicated.
a. The amount of SFA calculated using the "present value method", determined as a lump sum as of the SFA measurement date.
b. For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA coverage period"):

i. Identify the benefit payments described in § 4262.4(b)(1) (including any benefits that were restored under 26 CFR 1.432(e)(9)-(1)(e)(3) and excluding the payments in b.ii. below), separately for current retirees and beneficiaries, current terminated vested participants not yet in pay status, current active participants, and new entrants; and total benefit payments paid or expected to be paid. For each participant group except new entrants: benefit payments after reinstatement (excluding the payments in b.ii. below), the reduced benefit payments under the approved benefit suspension, and the difference due to the reinstatement of benefits.
[Sheet: 4B-1 SFA Ben Pmts]

Total difference in benefit payments due to reinstatement.

ii. Separately identify the make-up payments described in § 4262.4(b)(1) attributable to the reinstatement of benefits under § 4262.15 that were previously suspended through the SFA measurement date.
[Also see applicable examples in Section C, Item (4)e.iii. of the SFA instructions.]
c. The present value as of the SFA measurement date using the SFA interest rate required under § 4262.4(e)(2), of the total difference in benefit payments due to reinstatement provided in b.i. and the make-up payments provided in b.ii. above.















Additional instructions for each individual worksheet:




























Sheet













4B-1 SFA Determination - Benefit Payments for the "present value method" for MPRA plans












On this sheet, you will provide:
--Basic plan information (plan name, EIN/PN, SFA measurement date), and
--Year-by-year deterministic projection of benefit payments.

For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA coverage period"), identify benefit payments described in § 4262.4(b)(1) for current retirees and beneficiaries, current terminated vested participants not yet in pay status, currently active participants, and new entrants. On this Sheet 4B-1, show all benefit payments as positive amounts.

The benefit payments in Columns (1), (4), (7), (10), and (13) of this Sheet 4B-1 should match the benefit payments in Sheet 4A-2 of Template 4A used to determine the SFA amount under the "basic method".

The benefit payments in Columns (1), (4), (7), and (13) of this Sheet 4B-1 projection should reflect prospective reinstatement of benefits assuming such reinstatements commence as of the SFA measurement date. If the plan restored or partially restored benefits under 26 CFR 1.432(e)(9)-1(e)(3) before the SFA measurement date, the benefit payments in this Sheet 4B-1 should reflect fully restored prospective benefits.

The benefit payments in Columns (2), (5), (8), and (14) of this Sheet 4B-1 projection should reflect the reduced benefit payments under the approved benefit suspension, before any reinstatement.

The amounts in Columns (3), (6), (9), and (15) should reflect the difference in projected benefit payments due to the reinstatement.

Make-up payments to be paid to restore previously suspended benefits should not be included in this Sheet 4B-1, and are separately shown in Sheet 4B-2.

Except for the first row in the projection exhibit, each row must include the full plan year of the indicated information up to the plan year ending in 2051. The first row in the projection period is for the period beginning on the SFA measurement date and ending on the last day of the plan year containing the SFA measurement date, so the first row may contain less than a full plan year of information. For all other periods, provide the full plan year of information up to the plan year ending in 2051.















4B-2 SFA Determination - Details for the "present value method" under § 4262.4(a)(2)(ii) for MPRA plans












On this sheet, you will provide:
--Basic plan information (plan name, EIN/PN, SFA measurement date, SFA interest rate),
--MPRA plan information,
--Year-by-year deterministic projection,
--Present values as of the SFA measurement date, using the SFA interest rate, and
--SFA Amount as of the SFA measurement date calculated under the "present value method".

For each plan year in the period beginning on the SFA measurement date and ending on the last day of the last plan year ending in 2051 (the "SFA coverage period"), provide each of the items requested in Columns (1) and (2). On this Sheet 4B-2, show all benefit payments as positive amounts.

Column (2) should show the make-up payments to be paid to restore the previously suspended benefits and should match the make-up payments in Column (5) of Sheet 4A-4 of Template 4A used to determine the SFA amount under the "basic method". These amounts should be determined as if such make-up payments are paid beginning as of the SFA measurement date. If the plan sponsor elects to pay these amounts as a lump sum, then the lump sum amount is assumed paid as of the SFA measurement date. If the plan sponsor elects to pay equal installments over 60 months, the first monthly payment is assumed paid on the first regular payment date on or after the SFA measurement date. See the examples in the SFA Instructions. If the make-up payments are paid over 60 months, each row in the projection should reflect the monthly payments for that period.

Provide the present values as of the SFA measurement date of each of the projections in Columns (1) and (2), using the SFA interest rate from Sheet 4A-1 of Template 4A. On this Sheet 4B-2, show the present values as positive amounts.

Except for the first row in the projection exhibit, each row must include the full plan year of the indicated information up to the plan year ending in 2051. The first row in the projection period is for the period beginning on the SFA measurement date and ending on the last day of the plan year containing the SFA measurement date, so the first row may contain less than a full plan year of information. For all other periods, provide the full plan year of information up to the plan year ending in 2051.















4B-3 SFA Exhaustion Year - Projected based on cash flows and formulas from Template 4A Sheet 4A-4, but with the SFA amount determined under the "present value method" described in § 4262.4(a)(2)(ii)
This sheet should use the cash flows and formulas in Sheet 4A-4 of Template 4A, and the SFA amount calculated under the "present value method" in Sheet 4B-2, to determine the projected SFA exhaustion year.















Version Updates (newest version at top)













Version Date updated










v20220701p 7/1/2022

Sheet 2: 4B-1 SFA Ben Pmts

TEMPLATE 4B - Sheet 4B-1












v20220701p
SFA Determination - Benefit Payments for the "present value method" for MPRA plans




























See Template 4B Instructions for Additional Instructions for Sheet 4B-1.

























PLAN INFORMATION













Abbreviated
Plan Name:












EIN:













PN:













SFA Measurement Date:






























On this Sheet, show all benefit payment amounts as positive amounts.


PROJECTED BENEFIT PAYMENTS for:


Current Retirees and Beneficiaries in Pay Status Current Terminated Vested Participants Current Active Participants New Entrants Total


(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (13) (14) (15)
SFA Measurement Date / Plan Year Start Date Plan Year End Date Benefit Payments after Reinstatement Reduced Benefit Payments under the Approved Suspension Difference in Benefit Payments due to Reinstatement
(1) - (2)
Benefit Payments after Reinstatement Reduced Benefit Payments under the Approved Suspension Difference in Benefit Payments due to Reinstatement
(4) - (5)
Benefit Payments after Reinstatement Reduced Benefit Payments under the Approved Suspension Difference in Benefit Payments due to Reinstatement
(7) - (8)
Projected Benefit Payments Benefit Payments after Reinstatement
(1) + (4) + (7) + (10)
Reduced Benefit Payments under the Approved Suspension
(2) + (5) + (8) + (10)
Difference in Benefit Payments due to Reinstatement
(13) - (14)

































































































































































































































































































































































































































































































Sheet 3: 4B-2 SFA Details .4(a)(2)(ii)

TEMPLATE 4B - Sheet 4B-2




v20220701p
SFA Determination - Details for the "present value method" under § 4262.4(a)(2)(ii) for MPRA plans












See Template 4B Instructions for Additional Instructions for Sheet 4B-2.









PLAN INFORMATION





Abbreviated
Plan Name:




EIN:





PN:





MPRA Plan?
Meets the definition of a MPRA plan described in § 4262.4(a)(3)?

If a MPRA Plan, which method yields the greatest amount of SFA?
MPRA increasing assets method described in § 4262.4(a)(2)(i).
MPRA present value method described in § 4262.4(a)(2)(ii).


SFA Measurement Date:





SFA Amount as of the SFA Measurement Date under the method calculated in this Sheet:
Per § 4262.4(a)(2)(ii), the present value of benefits paid and expected to be paid by the plan during the SFA coverage period attributable to the reinstatement of benefits and makeup payments under § 4262.15(a)(1) and (2), and any restoration of benefits under 26 CFR 1.432(e)(9)-1(e)(3), calculated using the SFA interest rate.
[Sum of PV of (1) + PV of (2) below]
SFA Interest Rate:














PRESENT VALUE as of the SFA Measurement Date of Projected Amounts for:




PV of (1) PV of (2)




Difference in Benefit Payments due to Reinstatement Make-up Payments Attributable to Reinstatement of Benefits Suspended through the SFA Measurement Date


















On this Sheet, show all benefit payment amounts as positive amounts.




(1) (2)


SFA Measurement Date / Plan Year Start Date Plan Year End Date Difference in Benefit Payments due to Reinstatement (should match total from Sheet 4B-1) Make-up Payments Attributable to Reinstatement of Benefits Suspended through the SFA Measurement Date



































































































































































































































Sheet 4: 4B-3 SFA Exhaustion

TEMPLATE 4B - Sheet 4B-3











v20220701p
SFA Exhaustion Year - Projected based on cash flows and formulas from Template 4A Sheet 4A-4, but with the SFA amount calculated under the "present value method" described in § 4262.4(a)(2)(ii)


























See Template 4B Instructions for Additional Instructions for Sheet 4B-3.























PLAN INFORMATION












Abbreviated
Plan Name:











EIN:












PN:












MPRA Plan?
Meets the definition of a MPRA plan described in § 4262.4(a)(3)?








If a MPRA Plan, which method yields the greatest amount of SFA?
MPRA increasing assets method described in § 4262.4(a)(2)(i).
MPRA present value method described in § 4262.4(a)(2)(ii).









SFA Measurement Date:












Fair Market Value of Assets as of the SFA Measurement Date:












SFA Amount as of the SFA Measurement Date under the method calculated in Sheet 4B-2:












Projected SFA exhaustion year:
Only required on this sheet if the requested amount of SFA is based on the "present value method".
Plan Year Start Date of the plan year in which the sum of annual projected benefit payments and administrative expenses for the year exceeds the beginning-of-year projected SFA assets.







Non-SFA Interest Rate:












SFA Interest Rate:




























On this Sheet, show payments INTO the plan as positive amounts, and payments OUT of the plan as negative amounts.


(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
SFA Measurement Date / Plan Year Start Date Plan Year End Date Contributions Withdrawal Liability Payments Other Payments to Plan (excluding financial assistance and SFA) Benefit Payments (should match total from Sheet 4A-2) Make-up Payments Attributable to Reinstatement of Benefits Suspended through the SFA Measurement Date Administrative Expenses (excluding amount owed PBGC under 4261 of ERISA; should match total from Sheet 4A-3) Benefit Payments (from (4) and (5)) and Administrative Expenses (from (6)) Paid from SFA Assets SFA Investment Income Based on SFA Interest Rate Projected SFA Assets at End of Plan Year
(prior year assets +
(7) + (8))
Benefit Payments (from (4) and (5)) and Administrative Expenses (from (6)) Paid from Non-SFA Assets Non-SFA Investment Income Based on Non-SFA Interest Rate Projected Non-SFA Assets at End of Plan Year
(prior year assets +
(1) + (2) + (3) +
(10) + (11))
































































































































































































































































































































































































































































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