MP-200 Template MP-200 Template

Missing participants

form-mp200_OMB.xlsx

OMB: 1212-0069

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Schedule A
Schedule B
Removed via Amendment


Sheet 1: Instructions








Instructions for Completing Excel Template
Schedule B Individual data for Transferring Plans - Attachment to Form MP-200


Review the Form MP-200 Instructions before entering data. https://www.pbgc.gov/sites/default/files/form-mp200-instructions.pdf
COLOR CODE KEY
Use these color indicators when reviewing your filing spreadsheet to insure you have included all the necessary data and descriptions.
2) Enter the PBGC case number assigned to your plan and case name in the heading of the applicable tab.


3) Use the appropriate schedule as a guide while filling out this spreadsheet.

4) Overwrite the sample data in each tab and populate the applicable tab for:


- Notifying PBGC of transfer to Financial Institution: Schedule A; or


- Transferring Funds to PBGC: Schedule B


- Missing Distributees Removed via Amendment

5) The item number on the schedule corresponds to the applicable section or question on the Form MP-200

6) Save your spreadsheet as "Form 200 Excel Attachment_12345600" where "12345600" is the applicable case number of your plan.
7) Feel free to add a row at the bottom totaling amounts, counting participants, etc., but please insert a blank row between the individual data and any "total" row you want to add.






Tips for Schedule B

a) See Color Coding tips to help understand when additional data or an attachment is required.




b) See Definitions of Qualified and Non-Qualified Roth Transfers to determine if Post-Tax Roth transfers are Qualified.
TAB


c) Uncashed checks should be transferred to PBGC without any reduction for tax withholdings.
Removed via Amendment
Use this Tab for participants that were removed from the Plan Via Amendment, why they were removed and any benefit amount in 8a if a copy of the form is not available.
d) If the administrative fee gets paid out of participant funds, record the amount net of the fee.




e) If the plan has Other non-taxable benefits, include a description/plan provisions




f) If the Missing Distributee is a Beneficiary, list the beneficiary's information and include an attachment, or use the Beneficiary tab, to include the originating Participant and why the beneficiary is due money





Sheet 2: Schedule A


Schedule A individual data for Notifying Plans - Attachment to Form MP-200



















See instructions for detailed information about data to be entered, including information about which items may be left blank



















Case Number 12345600


















Case Name ABC


















Part I - Financial Institution Information
Part II - Individual Information
Financial institution information Financial institution address
Missing distributee's name

Last-known address Account information Amended Filing Code
Name Contact Name Contact Telephone Contact Email Street City State Zip
Last First Middle Date of birth Social security number (enter without dashes) Street City State Zip Account number Account balance transferred Use "Removed via Amendment" tab below if needed
2(a) 2b(1) 2b(2) 2b(3) 2c(1) 2c(2) 2c(3) 2c(4)
3a(1) 3a(1) 3a(1) 3a(2)
3b(1) 3b(2) 3b(3) 3b(4) 3c(1) 3c(2) 4
First National Bank Sarah Parker (888) 555-2222 [email protected] 502 Mockingbird Street Atlanta GA 30301
White Betty E 5/5/1955 111111111 123 Robin Hwy Ave City1 DE 42345 1111111111 $25,000.00

First National Bank Sarah Parker 8885552222 [email protected] 502 Mockingbird Street Atlanta GA 30301
Yellow Joseph F 6/6/1965 222222222 123 Blackbird Rd City2 WV 52345 2222222222 $10,000.00

First National Bank Sarah Parker 8885552222 [email protected] 502 Mockingbird Street Atlanta GA 30301
Black Polly G 7/7/1970 333333333 123 Eagle St City3 DE 62345 3333333333 $2,500.00


Sheet 3: Schedule B


Schedule B Individual data for Transferring Plans - Attachment to Form MP-200






















































































































































































































































































































































































































































































































































See instructions for detailed information about data to be entered, including information about which items may be left blank










COLOR CODE KEY



































































































































































































































































































































































































































































































































Case Number 33333300













































































































































































































































































































































































































































































































































Case Name Bus. Corp.













































































































































































































































































































































































































































































































































Part II - Individual Information
Part III - Transfer Amount
Part IV - Miscellaneous Information
Information if Missing Distributee is a Beneficiary (if answer in 2f is B= Beneficiary)
Non-US Source Income (If answer in 6 is Yes)













































































































































































































































































































































































































































































































Missing distributee's name

Last-known address
Type of distributee
P if Participant
B if Beneficiary

Transfer amount attributable to:
Is any portion of the benefit attributable to
Date of 1st Roth Contribution Beneficiary information Amended Filing Code



If there are Non-Qualified Roth Benefits If participant is deceased Participant's Last-known address


















































































































































































































































































































































































































































































































Last First Middle
Social security number





Pre-tax Contributions Post-tax contributions
non-US source income?
(Required only if part of transfer is non-qualified Roth in 4b) Beneficiary Election Form


(Use code from instructions for
Beneficiary's Relationship to Participant










Portion of Portion of Country of














































































































































































































































































































































































































































































































Date of birth (enter without dashes Street City State Zip Other name(s) ever used (if known) (If Beneficiary, Include information
Qualified Roth Transfers Non-qualified Roth transfers Other
(Include attachment if greater than $0)
Total Transfer Amount Enter "Yes" or "No"; if "Yes", include information
(yes or no, if yes include copy of form) Name Social Security Number Relationship each customer record)
Include copy of relevant document Participant SSN Participant Name Date of Birth, if participant Was the participant disabled? Date of Death Street City State Zip Country
benefit treated as benefit treated as non-US
Source
Income
Other comments



















































































AGE

























































































































































































































































































































































































































& ensure any lead zeroes are included)




in fields to the right)
Total Total Contributions Investment Earnings Total (auto calculated) Contributions Investment Earnings Total (auto calculated) Total (auto calculated) in "Non-US
Source Income" fields to the right


(enter without dashes)
Use "Removed via Amendment" tab below if needed
(QDRO, beneficiary election form, etc)

is still living







US Source Income non-US Source Income
















































































































































































































































































































































































































































































































2a
2b 2c 2d(1) 2d(2) 2d(3) 2d(4) 2e 2f

3 4a
4b

4c
5 6
7 8a 8b 8c 8d 9






























































































































































































































































































































































































































































































































White James E 7/8/1970 111111111 123 Robin Hwy Ave City1 DE 42345-1234
P
$500.00 $500.00 $100.00 $50.00 $150.00

$0.00 $1,150.00 yes
1/1/2018 no




surviving spouse 444444444 Joan White
No 1/1/2022 123 Robin Hwy Ave City1 DE 42345-1234 US
75% 25% Italy




















































































53.47
























































































































































































































































































































































































































Yellow Joe F 3/2/1964 222222222 123 Blackbird Rd City2 WV 52345
P
$300.00 $800.00 $0.00 $0.00 $0.00

$0.00 $1,100.00


yes Mary Yellow 777777777 daughter





































































































59.82
























































































































































































































































































































































































































Black Polly G 1/1/1960 003333333 123 Eagle St City3 DE 62345 Johnson B
$96.69
$0.00 $0.00 $0.00

$0.00 $96.69

1/1/2020 no




former spouse/AP 555555555 John Black


123 Main St City3 DE 62345 US
























































































63.99

























































































































































































































































































































































































































Sheet 4: Removed via Amendment


Removed via Amendment data - Attachment to Form MP-200





See instructions for detailed information about data to be entered, including information about which items may be left blank





Case Number 33333300





Case Name Bus. Corp.




Removed via Amendment








Last-known address

Distributee SSN Distributee Name Street City State Zip Reason Removed Amount Adjusted
123456789 A Smith 789 Main St City 1 VA 22151 Found and paid out $500.00
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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