2024 Form 5500-EZ

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 Part I  Annual Return Identification Information                                                                                                                    



For the calendar plan year 2024 or fiscal plan year beginning (MM/DD/YYYY)	                                    and ending
 A
This return is:
(1) 
the first return filed for the plan;
(3) 
the final return filed for the plan;


(2) 
an amended return;
(4) 
a short plan year return (less than 12 months)
B



 Check box if filing under

Form 5558

automatic extension




special extension (enter description) ____________________________________________________
C
If this return is for a foreign plan, check this box (see instructions)	.    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .

D
If this return is for the IRS Late Filer Penalty Relief Program, check this box (Must be filed on a paper Form with the IRS. See instructions)	.    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .

E	
If this is a retroactively adopted plan permitted by SECURE Act section 201, check here	.    .    .    .    .    .    .    .    .    .    .    .    

 Part II  Basic Plan Information — enter all requested information.	

1a	Name of plan
1b  Three-digit
plan number (PN)


1c  Date plan first became effective (MM/DD/YYYY)
2a
Employer’s name
 2b  Employer Identification Number (EIN)
(Do not enter your Social Security Number)

Trade name of business (if different from name of employer)



 2c  Employer’s telephone number

In care of name



2d  Business code (see instructions)

Mailing address (room, apt., suite no. and street, or P.O. box)





City or town, state or province, country, and ZIP or foreign postal code (if foreign, see instructions)

3a
Plan administrator’s name (If same as employer, enter “Same”)
3b  Administrator’s EIN

In care of name
3c  Administrator’s telephone number

Mailing address (room, apt., suite no. and street, or P.O. box)


City or town, state or province, country, and ZIP or foreign postal code (if foreign, see instructions)

4    If the employer’s name, the employer’s EIN, and/or the plan name has changed since the   last return filed for this plan, enter the employer’s name and EIN, the plan name, and the plan number for the last return in the appropriate space provided.
a    Employer’s name


4b  EIN
4c    Plan name
4d  PN
5a(1) Total number of participants at the beginning of the plan year    .   .   .   .   .   .   .   .   .      a(2) Total number of active participants at the beginning of the plan year  .  .   .   .   .   .   .            b(1) Total number of participants at the end of the plan year    .   .   .   .   .   .   .   .   .   .   .         b(2) Total number of active participants at the end of the plan year    .    .    .    .    .    .    .    .    c    Number of participants who terminated employment during the plan year with accrued 		benefits that were less than 100% vested   .    .    .    .    .    .    .    .    .    .    .    .    .    .    . 
5a(1) 


5a(2)


5b(1)


5b(2)


5c

 Part III  Financial Information	



(1) Beginning of year
(2) End of year
6a

Total plan assets .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .
6a


b

Total plan liabilities  .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .
6b


c

Net plan assets (subtract line 6b from 6a .   .   .   .   .   .   .   .   .   .   .   .
6c


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 5500-EZ.	Cat. No. 63263R	Form 5500-EZ (2024)
 Part III  (Continued)
























7
Contributions received or receivable from:



















Amount

a

Employers    .    .    .    .    .    .    .    .    .  .

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7a


b

Participants   .    .    .    .    .    .    .    .    .  .

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7b


c

Others (including rollovers)   .    .    .    .   .

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7c

 Part IV  Plan Characteristics

8	Enter the applicable two-character feature codes from the List of Plan Characteristics Codes in the instructions.



 Part V  Compliance and Funding Questions

Yes
No
Amount
    9 During the plan year, did the plan have any participant loans?
If “Yes,” enter amount as of year end .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .
    10 Is this a defined benefit plan that is subject to minimum funding requirements?
If “Yes,” complete Schedule SB (Form 5500) and line 10a below. (See instructions.)
9









10



a	Enter the unpaid minimum required contributions for all years from Schedule SB (Form 5500), line 40 .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .

10a

11	Is this a defined contribution plan subject to the minimum funding requirements
	of section 412 of the Code? .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .





11



If “Yes,” complete lines 11a or 11b, 11c, 11d, and 11e below, as applicable.
    a If a waiver of the minimum funding standard for a prior year is being amortized in this plan    year, enter the month, day, and year (MM/DD/YYYY) of the letter ruling granting the waiver   (see instructions)    .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .
    b Enter the minimum required contribution for this plan year .   .    .    .    .    .    .    .    .    .    .  .   . 
    c Enter the amount contributed by the employer to the plan for this plan year   .   .    .    .    .   .   . 
    d Subtract the amount in line 11c from the amount in line 11b. Enter the result (enter a minus sign 
to the left of a negative amount)   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .



11a


11b


11c





11d


Yes
No
N/A
e	Will the minimum funding amount reported on line 11d be met by the funding  deadline? .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .   .
11e



12	If the plan sponsor is an adopter of a pre-approved plan that received a favorable IRS Opinion Letter, enter the date of the Opinion Letter __/__/____ (MM/DD/YYYY) and the Opinion Letter serial number__________.




Caution: A penalty for the late or incomplete filing of this return will be assessed unless reasonable cause is established.

Under penalties of perjury, I declare that I have examined this return including, if applicable, any related Schedule MB (Form 5500) or Schedule SB (Form 5500) signed by an enrolled actuary, and, to the best of my knowledge and belief, it is true, correct, and complete.
Sign
Here	 	   	   	
Signature of employer or plan administrator	Date	Type or print name of individual signing as employer or
plan administrator
Form 5500-EZ (2024)