Department of the Treasury Department of Labor Pension Benefit information, see Pub. 1507, Procedures for
Internal Revenue Service Pension and Welfare Guaranty Corporation Electronic/Magnetic Media Filing of
Benefits Administration Employee Benefit Plan Returns Forms
5500, 5500-C/R, and 5500EZ for Plan Year
1992.
1992 Instructions How To Use This Instruction
for Form 5500-C/R Booklet
The instructions are divided into four main
Return/Report of Employee Benefit Plan sections.
(With fewer than 100 participants) Section 1 Page
Plan Year 1
( Code references are to the Internal Revenue Code. ERISA refers to the
A Change You Should Note 1
Employee Retirement Income Security Act of 1974. )
Penalties 2
Paperwork Reduction Act Notice.—We ask for the information on this form to carry out the Who Must File 2
law as specified in ERISA and Code section 6039D. You are required to give us the When To File 2
information. We need it to determine whether the plan is operating according to the law. Extension of time To File 2
The time needed to complete and file the forms listed below reflect the combined Where To File 2
requirements of the Internal Revenue Service, Department of Labor, Pension Benefit Guaranty
Corporation, and the Social Security Administration. These times will vary depending on Section 2
individual circumstances. The estimated average times are: Kinds of Plans 2
Copying, Pension Benefit 2
Learning about assembling, and
Welfare Benefit 3
the law or the sending the form
Recordkeeping form Preparing the form to the IRS Fringe Benefit 3
Form 5500-C (Initial filers) 55 hr., 29 min. 7 hr., 29 min. 10 hr., 35 min. 32 min. Plans Excluded From Filing 3
Form 5500-C (All other filers) 45 hr., 41 min. 7 hr., 29 min. 10 hr., 26 min. 32 min. Kinds of Filers 3
Form 5500-R (Initial filers) 22 hr. 4 hr., 1 min. 6 hr., 25 min. 32 min. Single Employer 3
Form 5500-R (All other filers) 12 hr., 12 min. 4 hr., 1 min. 6 hr., 15 min. 32 min. Controlled Group of Corporations,
Schedule A (Form 5500) 17 hr., 28 min. 28 min. 1 hr., 42 min. 16 min. Group of Trades or Businesses
Schedule B (Form 5500) 34 hr., 12 min. 2 hr., 35 min. 3 hr., 16 min. Under Common Control, or an
Schedule E (Form 5500) Affiliated Service Group 3
(nonleveraged ESOP) 1 hr., 40 min. 12 min. 14 min. Multiemployer 3
Schedule E (Form 5500)
(leveraged ESOP) 10 hr., 2 min. 1 hr., 41 min. 1 hr., 56 min. Multiple-Employer Collectively
Schedule F (Form 5500) 1 hr., 27 min. 46 min. 19 min. Bargained 4
Schedule P (Form 5500) 1 hr., 55 min. 30 min. 33 min. Multiple-Employer (Other) 4
Schedule SSA (Form 5500) 6 hr., 42 min. 12 min. 19 min. Investment Arrangements Filing Directly
If you have comments concerning the accuracy of these time estimates or suggestions for With DOL 4
making these forms more simple, we would be happy to hear from you. You can write to both Common/Collective Trust and
the Internal Revenue Service, Washington, DC 20224, Attention: IRS Reports Clearance Pooled Separate Account 4
Officer, T:FP; and the Office of Management and Budget, Paperwork Reduction Project Master Trust 4
(1210-0016), Washington, DC 20503. DO NOT send your return to either of these offices. 103-12 Investment Entities 4
Instead, see Where To File on page 2.
What To File 5
Forms 5
Section 1 typed or printed on the appropriate
schedule, such as the Schedule A (Form
Items To Complete on Form
5500-C 5
5500). See Schedules on page 6. Items To Complete on Form
Plan Year Generally, a return/report must be filed for 5500-R 6
File 1992 forms for plan years that started employee welfare benefit plans which Schedules 6
in 1992. If the plan year differs from the provide benefits wholly or partially through
a Multiple Employer Welfare Arrangement Other Filings 7
calendar year, fill in the fiscal year space
just under the form title. For a short plan (MEWA) as defined in ERISA section 3(40), Section 3
year, check box A(4) and see When To unless otherwise exempt (see page 3). Final Return/Report 8
File on page 2. In addition to filing this form with the Signature and Date 8
IRS, plans covered by the Pension Benefit
Reproductions 8
A Change You Should Note Guaranty Corporation (PBGC) termination
insurance program must file their Annual Change in Plan Year 8
New Schedule for 1992.—Schedule F Premium Payment, PBGC Form 1, directly Amended Return/Report 8
(Form 5500), Fringe Benefit Plan Annual with that agency. How the Annual Return/Report
Information Return, is a new Form 5500 Information May Be Used 8
schedule designed to simplify the reporting Electronic Filing of Form 5500-C/R.—
requirements of fringe benefit plans. Qualified tax return filers can file Form Section 4
5500-C/R and related schedules via Information at the Top of the Form 8
magnetic media (magnetic tapes, floppy
Reminder diskettes) or electronically. If the plan Line-By-Line Instructions 8
Many filers receive rejection notices for administrator files the employee plan return Page 1 8
failing to complete items 4, 6, and 26b electronically or on magnetic media, he or Form 5500-R, Page 2 10
properly. 5500-R filers often fail to she must also file Form 8453-E, Employee Form 5500-C, Page 3 Through 6 13
complete items 14 and 15b properly. The Benefit Plan Declaration and Signature for Codes for Principal Business Activity
return/report will also be considered Electronic/Magnetic Media Filing. This is and Principal Product or Service 19
incomplete and penalties may be imposed the declaration and signature form for the
if information required on a schedule is not electronic/magnetic media return. For more
Cat. No. 10958V
Penalties Benefit Guaranty Corporation (PBGC) have
Alabama, Alaska, Arkansas,
consolidated their returns and report forms California, Florida, Georgia,
ERISA and the Code provide for the to minimize the filing burden for plan Hawaii, Idaho, Louisiana,
assessment or imposition of penalties for administrators and employers. The chart Mississippi, Nevada, North Atlanta, GA 39901
not giving complete information and not on page 5 gives a brief guide to the type Carolina, Oregon, South
filing statements and returns/reports. of return/report to be filed. Carolina, Tennessee,
Certain penalties are administrative; that is, Washington
they may be imposed or assessed by one
of the governmental agencies delegated to
When To File Arizona, Colorado, Illinois,
Indiana, Iowa, Kansas,
administer the collection of Form 5500 File all required forms and schedules by Kentucky, Michigan,
series data. Others require a legal the last day of the 7th month after the plan Minnesota, Missouri,
conviction. year ends. For a short plan year, file the Montana, Nebraska, New
Memphis, TN 37501
form and applicable schedules by the last Mexico, North Dakota,
Administrative Penalties day of the 7th month after the short plan Ohio, Oklahoma, South
year ends. For purposes of this Dakota, Texas, Utah, West
Listed below are various penalties for not Virginia, Wisconsin,
meeting the Form 5500 series filing return/report, the short plan year ends on Wyoming
requirements. One or more of the following the date of the change in accounting
five penalties may be imposed or assessed period or upon the complete distribution of All Form 5500EZ filers Andover, MA 05501
in the event of incomplete filings and/or the assets of the plan. (Also see Section
filings received after the due date unless it 3.) If the current year Form 5500-C/R is not
is determined that your explanation for available before the due date of your short Section 2
failure to file properly is for reasonable plan year return/report, use the latest year
cause: form available and change the date printed Kinds of Plans
1. A penalty of up to $1,000 a day for on the return/report to the current year.
Also show the dates your short plan year Employee benefit plans include pension
each day a plan administrator fails or benefit plans and welfare benefit plans. File
refuses to file a complete return/report. began and ended.
the applicable return/report for any of the
See ERISA section 502(c)(2) and 29 CFR Extension of Time To File following plans.
2560.502c-2.
A one time extension of time up to 21⁄2
2. A penalty of $25 a day (up to $15,000)
months may be granted for filing Pension Benefit Plan
for not filing returns for certain plans of
returns/reports if Form 5558, Application This is an employee pension benefit plan
deferred compensation, certain trusts and
for Extension of Time To File Certain covered by ERISA. The return/report is due
annuities, and bond purchase plans by the
Employee Plan Returns, is filed before the whether or not the plan is qualified and
due date(s). See Code section 6652(e).
normal due date (not including any even if benefits no longer accrue,
This penalty also applies to returns
extensions) of the return/report. contributions were not made this plan year,
required to be filed under Code section
Exception: Plans are automatically granted or contributions are no longer made
6039D.
extensions of time to file Form 5500-C/R (“frozen plan” or “wasting trust”). See Final
3. A penalty of $1 a day (up to $5,000) Return/Report on page 8.
until the due date of the Federal income
for each participant for whom a registration
tax return of the employer if all the Pension benefit plans required to file
statement (Schedule SSA (Form 5500)) is
following conditions are met: (1) The plan include defined benefit plans and defined
required but not filed. See Code section
year and the employer’s tax year are the contribution plans (e.g., profit-sharing,
6652(d)(1).
same. (2) The employer has been granted stock bonus, money purchase plans, etc.).
4. A penalty of $1 a day (up to $1,000) an extension of time to file its Federal The following are among the pension
for not filing a notification of change of income tax return to a date later than the benefit plans for which a return/report
status of a plan. See Code section normal due date for filing the Form must be filed:
6652(d)(2). 5500-C/R. (3) A copy of the IRS extension 1. Annuity arrangements under Code
5. A penalty of $1,000 for not filing an of time to file the Federal income tax return section 403(b)(1).
actuarial statement. See Code section is attached to the Form 5500-C/R filed with 2. Custodial account established under
6692. the IRS. An extension granted by using this Code section 403(b)(7) for regulated
exception CANNOT be extended further by investment company stock.
Other Penalties filing a Form 5558.
1. Any individual who willfully violates 3. Individual retirement account
Note: An extension of time to file the established by an employer under Code
any provision of Part 1 of Title I of ERISA return/report does not operate as an
shall be fined not more than $5,000 or section 408(c).
extension of time to file the PBGC
imprisoned not more than 1 year, or both. 4. Pension benefit plan maintained
Form 1.
See ERISA section 501. outside the United States primarily for
2. A penalty of up to $10,000, 5 years nonresident aliens if the employer who
imprisonment, or both, for making any
Where To File maintains the plan is:
false statement or representation of fact, Please file the return/report with the a. A domestic employer, or
knowing it to be false, or for knowingly Internal Revenue Service Center indicated b. A foreign employer with income
concealing or not disclosing any fact below. No street address is needed. derived from sources within the United
required by ERISA. See section 1027, Title See page 7 for the filing address for States (including foreign subsidiaries of
18, U.S. Code, as amended by section 111 investment arrangements filing directly with domestic employers) and deducts
of ERISA. DOL. contributions to the plan on its U.S.
If the principal office Use the following income tax return. See Plans Excluded
of the plan sponsor Internal Revenue
Who Must File or the plan administrator Service Center
From Filing on page 3.
Any administrator or sponsor of an is located in: address 5. Church plans electing coverage under
employee benefit plan subject to ERISA Code section 410(d).
must file information about each such plan Connecticut, Delaware, 6. A plan that covers residents of Puerto
every year (Code section 6058 and ERISA District of Columbia, Rico, the Virgin Islands, Guam, Wake
sections 104 and 4065). Every employer Foreign Address, Maine, Island, or American Samoa. This includes a
maintaining a specified fringe benefit plan Maryland, Massachusetts, plan that elects to have the provisions of
as described in Code section 6039D New Hampshire, New Holtsville, NY 00501 section 1022(i)(2) of ERISA apply.
Jersey, New York,
(except Code sections 79, 105, 106, and Pennsylvania, Puerto Rico, See page 5 for Items To Complete on
129 plans) is also required to file each Rhode Island, Vermont, Form 5500-C and Items To Complete on
year. The Internal Revenue Service (IRS), Virginia Form 5500-R on page 6 for more
Department of Labor (DOL), and Pension
Page 2
information about what questions must be (which the employer or organization 11. An apprenticeship or training plan
completed by pension plans. forwards within 3 months of receipt). meeting all of the conditions specified in
The insurance contracts or policies 29 CFR 2520.104-22.
Welfare Benefit Plan discussed above must be issued by an
An employee welfare benefit plan is insurance company or similar organization Kinds of Filers
covered by Part 1 of Title I of ERISA. (such as Blue Cross, Blue Shield or a
Welfare plans provide benefits such as health maintenance organization) which is The different types of plan entities that file
medical, dental, life insurance, qualified to do business in any state. the form are described below. (Also see
apprenticeship and training, scholarship instructions for item 4 on page 9.)
c. A combination unfunded/insured
funds, severance pay, disability, etc. welfare plan has its benefits provided 1. Single-Employer Plan.—If one
See page 5 for Items To Complete on partially as an unfunded plan and partially employer or one employee organization
Form 5500-C and Items To Complete on as a fully insured plan. An example of such maintains a plan, file a separate
Form 5500-R on page 6. It contains more a plan is a welfare plan which provides return/report for the plan. If the employer
information about what questions must be medical benefits as in a above and life or employee organization maintains more
completed for welfare benefit plans. insurance benefits as in b above. than one such plan, file a separate
return/report for each plan.
See 29 CFR 2520.104-20.
Fringe Benefit Plan Note: An “employees’ beneficiary
If a member of either a controlled group
of corporations, a group of trades or
Group legal services plans described in association” as used in Code section businesses under common control or an
Code section 120, cafeteria plans 501(c)(9) should not be confused with the affiliated service group maintains a plan
described in Code section 125, and employee organization or employer that that does not involve other group
educational assistance programs described establishes and maintains (i.e., sponsors) members, file a separate return/report as a
in Code section 127 are considered fringe the welfare benefit plan. single-employer plan.
benefit plans and generally are required to 2. An unfunded pension benefit plan or
file the annual information specified by If several employers participate in a
an unfunded or insured welfare benefit program of benefits in which the funds
Code section 6039D. However, Code plan: (a) whose benefits go only to a select
section 127 educational assistance attributable to each employer are available
group of management or highly only to pay benefits to that employer’s
programs that provide only job-related compensated employees, and (b) which
training that is deductible under Code employees, each employer must file a
meets the terms of Department of Labor separate return/report.
section 162 do not have to file Form Regulations 29 CFR 2520.104-23 (including
5500-C/R. the requirement that a notification 2. Plan For Controlled Group of
Note: A fringe benefit plan may be statement be filed with DOL) or 29 CFR Corporations, Group of Trades or
associated with one or more welfare plans 2520.104-24. Businesses Under Common Control, or
as described above for which a Form An Affiliated Service Group.—These
3. Plans maintained only to comply with groups are defined in Code sections
5500-C/R may be required to be filed. workers’ compensation, unemployment 414(b), (c), and (m), and are referred to as
See Items To Complete on Form compensation, or disability insurance laws. controlled groups.
5500-C and Items To Complete on Form 4. An unfunded excess benefit plan.
5500-R on pages 5 and 6 for more If the benefits are payable to participants
5. A welfare benefit plan maintained from the plan’s total assets without regard
information about how to complete this outside the United States primarily for
form for a fringe benefit plan. to contributions by each participant’s
persons substantially all of whom are employer, file one return/report for the
nonresident aliens. plan. On the return/report for the plan,
Plans Excluded From Filing 6. A pension benefit plan maintained complete item 21 only for the controlled
These exemptions do not apply to a fringe outside the United States if it is a qualified group’s employees.
benefit plan required to file to satisfy the foreign plan within the meaning of Code Note: Employers who participate in a
requirements of Code section 6039D. section 404A(e) that does not qualify for pension plan of one of the groups listed
Do not file a return/report for an the treatment provided in Code section above but who are not members of the
employee benefit plan that is any of the 402(c). group must file a separate return/report.
following: 7. An annuity arrangement described in The return/report should be filed on Form
1. A welfare benefit plan which covers 29 CFR 2510.3-2(f). 5500-C/R regardless of the number of
fewer than 100 participants as of the 8. A simplified employee pension (SEP) participants. The years you are required to
beginning of the plan year and is: described in Code section 408(k) which file pages 1 and 3 through 6 as Form
unfunded, fully insured, or a combination conforms to the alternative method of 5500-C (see What To File on page 5),
of insured and unfunded. compliance described in 29 CFR complete only items 1 through 7a, 9, and
2520.104-48 or 29 CFR 104-49. A SEP is a 21. The years you file pages 1 and 2 as
a. An unfunded welfare benefit plan has
pension plan that meets certain minimum Form 5500-R complete only items 1
its benefits paid as needed directly from
qualifications regarding eligibility and through 7a, 8a, and 8b. These participating
the general assets of the employer or the
employer contributions. employers must enter code F on item 4 of
employee organization that sponsors the
9. A church plan not electing coverage the Form 5500-C/R.
plan.
under Code section 410(d) or a If several employers participate in a
Note: Plans that are NOT unfunded include
governmental plan. program of benefits in which the funds
those plans that received employee (or
10. A welfare plan that participates in a attributable to each employer are available
former employee) contributions during the
group insurance arrangement that files a only to pay benefits to that employer’s
plan year and/or used a trust or separately
return/report Form 5500 on its behalf. A employees, each employer must file a
maintained fund (including a Code section
group insurance arrangement is an separate return/report as a single employer
501(c)(9) trust) to hold plan assets or act as
arrangement that provides benefits to the plan.
a conduit for the transfer of plan assets
during the plan year. employees of two or more unaffiliated 3. Multiemployer Plan.—A
employers (not in connection with a multiemployer plan is a plan (1) to which
b. A fully insured welfare benefit plan
multiemployer plan or a multiple-employer more than one employer is required to
has its benefits provided exclusively
collectively bargained plan), fully insures contribute, (2) that is maintained pursuant
through insurance contracts or policies, the
one or more welfare plans of each to one or more collective-bargaining
premiums of which must be paid directly
participating employer, and uses a trust (or agreements, and (3) has not made the
by the employer or employee organization
other entity such as a trade association) as election under Code section 414(f)(5) and
from its general assets or partly from its
the holder of the insurance contracts and ERISA section 3(37)(E). File one
general assets and partly from
the conduit for payment of premiums to return/report for each plan. Contributing
contributions by its employees or members
the insurance company. For further details, employers do not file individually for these
see 29 CFR 2520.104-43.
Page 3
plans. See Code section 414 for more Common/Collective Trust and such employers are incorporated). See 29
information. CFR 2520.103-1(e).
Pooled Separate Account
4. Multiple-Employer-Collectively- For reporting purposes, the assets of a
Bargained Plan.—These plans involve Definition.—For reporting purposes, a master trust are considered to be held in
more than one employer, are collectively “common/collective trust” is a trust one or more “investment accounts.” A
bargained and collectively funded, and, if maintained by a bank, trust company, or master trust investment account may
covered by PBGC termination insurance, similar institution that is regulated, consist of a pool of assets or a single
have properly elected before September supervised, and subject to periodic asset.
27, 1981, not to be treated as examination by a state or Federal agency
Each pool of assets held in a master
multiemployer plans under Code section for the collective investment and
trust must be treated as a separate master
414(f)(5) or ERISA sections 3(37)(E) and reinvestment of assets contributed thereto
trust investment account if each plan that
4001(a)(3). File one return/report for each from employee benefit plans maintained by
has an interest in the pool has the same
such plan. Participating employers do not more than one employer or a controlled
fractional interest in each asset in the pool
file individually for these plans. group of corporations, as the term is used
as its fractional interest in the pool, and if
in Code section 1563. For reporting
Note: Filers described in Multiemployer each such plan may not dispose of its
purposes, a “pooled separate account” is
Plan or Multiple-Employer Collectively interest in any asset in the pool without
an account maintained by an insurance
Bargained Plan above complete item 21 disposing of its interest in the pool. A
carrier that is regulated, supervised, and
only if a plan: (1) benefits employees who master trust may also contain assets that
subject to periodic examination by a state
are not collectively-bargained unit are not held in such a pool. Each such
agency for the collective investment and
employees, or (2) only covers asset must be treated as a separate
reinvestment of assets contributed thereto
collectively-bargained unit employees and master trust investment account.
from employee benefit plans maintained by
2% or more of them are professionals. Financial information must generally be
more than one employer or controlled
5. Multiple-Employer Plan (Other).—A group of corporations, as the term is used provided to DOL with respect to each
multiple-employer plan (other) involves in Code section 1563. See 29 CFR master trust investment account as
more than one employer and is not one of sections 2520.103-3, 2520.103-4, specified on page 7.
the plans already described. File one 2520.103-5, and 2520.103-9. Additional information to be attached to
return/report for each plan. the Form 5500-C/R for plans
Note: For reporting purposes, a separate
Note: Each employer participating in a account that is not considered to be participating in master trusts.—A plan
defined contribution or defined benefit holding plan assets pursuant to 29 CFR participating in a master trust must
pension plan which is considered a 2510.3-101(h)(1)(iii), shall not constitute a complete the annual return/report and
multiple-employer plan (other) must file a pooled separate account. attach to it a schedule listing each master
Form 5500-C/R regardless of the number trust investment account in which the plan
Additional information to be attached to
of participants. For the years you are has an interest, indicating the plan’s name,
the Form 5500-C/R for plans
required to file pages 1 and 3 through 6 as EIN, and plan number and the name of the
participating in common/collective trusts
Form 5500-C, complete only items 1 master trust used in the master trust
and pooled separate accounts.—A plan
through 7a, 9, and 21. For the years you information filed with DOL (see page 7). In
participating in a common/collective trust
file pages 1 and 2 as Form 5500-R, tabular format, show the net value of the
or pooled separate account must complete
complete only items 1 through 7a, 8a, and plan’s interest in each investment account
the annual return/report in accordance with
8b. Each participating employer filing the at the beginning and end of the plan year,
the specific instructions and attach either:
Form 5500-C/R must enter code F in item and the net investment gain (or loss)
(1) the most recent statement of the assets
4, and use an appropriate number (001, allocated to the plan for the plan year from
and liabilities of any common/collective
002, etc.) in item 5c. the investment account.
trust or pooled separate account, or (2) a
Note: If a participating employer is also the certification that: (a) the statement of the Note: If a master trust investment account
sponsor of the multiple-employer plan assets and liabilities of the consists solely of one plan’s asset(s) during
(other), the plan number on the common/collective trust or pooled separate the reporting period, the plan may report
return/report filed for the plan should be account has been submitted directly to the(se) asset(s) either as an investment
333 and, if more than one plan, they DOL by the financial institution or account to be reported as part of the
should be consecutively numbered starting insurance carrier; (b) the plan has received master trust report filed directly with DOL
with 333. a copy of the statement; and (c) includes or as a plan asset(s) that is not part of the
If more than one employer participates in the EIN and other numbers used by the master trust (and therefore subject to all
the plan and the plan provides that each financial institution or insurance carrier to instructions pertaining to assets not held in
employer’s contributions are available to identify the trusts or accounts, and the a master trust).
pay benefits only for that employer’s name and address provided, in the direct
employees who are covered by the plan, filing made with DOL.
103-12 Investment Entities
one annual return/report must be filed for 29 CFR 2520.103-12 provides an
each participating employer. These filers Master Trust alternative method of reporting for plans
will be considered single employers and Definition.—For reporting purposes, a that invest in an entity (other than an
should complete the entire form. master trust is a trust for which a regulated investment arrangement filing with DOL as
financial institution (as defined below) described in Common/Collective Trust
Investment Arrangements serves as trustee or custodian (regardless and Pooled Separate Account or Master
of whether such institution exercises Trust above), the underlying assets of
Filing Directly With DOL discretionary authority or control with which include “plan assets” (within the
Some plans invest in certain trusts, respect to the management of assets held meaning of 29 CFR 2510.3-101) of two or
accounts, and other investment in the trust), and in which assets of more more plans that are not members of a
arrangements that may file information than one plan sponsored by a single “related group” of employee benefit plans.
concerning themselves and their employer or by a group of employers under For reporting purposes, a “related group”
relationship with employee benefit plans common control are held. consists of each group of two or more
directly with DOL (as specified on page 7). employee benefit plans (1) each of which
A “regulated financial institution” means
Plans participating in an investment receives 10% or more of its aggregate
a bank, trust company, or similar financial
arrangement as described in contributions from the same employer or
institution that is regulated, supervised,
Common/Collective Trust and Pooled from a member of the same controlled
and subject to periodic examination by a
Separate Account, Master Trust, and group of corporations (as determined
state or Federal agency. Common control
103-12 Investment Entities are required under Code section 1563(a), without regard
is determined on the basis of all relevant
to attach certain additional information to to Code section 1563(a)(4) thereof); or (2)
facts and circumstances (whether or not
the return/report filed with the IRS as each of which is either maintained by, or
specified below. maintained pursuant to a
Page 4
collective-bargaining agreement negotiated participants at the beginning of the plan employee benefit plan, the number of
by, the same employee organization or year. One-participant plans see Form participants should be calculated in the
affiliated employee organizations. For 5500EZ below. same manner as item 7 of the Form 5500
purposes of this paragraph, an “affiliate” of The Form 5500-C/R takes the place of or 5500-C/R but the calculation should be
an employee organization means any separate Forms 5500-C and 5500-R. The as of the beginning of the plan year. Also,
person controlling, controlled by, or under Form 5500-C/R has two checkboxes at the under the filing requirements explained
common control with such organization. top of page 1 to indicate that the form is above, if the number of plan participants
See 29 CFR 2520.103-12. being filed as a Form 5500-C or a Form increases to 100 or more, or decreases
For reporting purposes, the investment 5500-R. below 100, from one year to the next, you
entities described above with respect to Form 5500-C filers will check box (5) would generally have to file a different form
which the required information is filed indicating they are filing a Form 5500-C from that filed the previous year. However,
directly with DOL constitute “103-12 and complete pages 1 and 3 through 6. there is an exception to this rule. The filer
investment entities” (103-12 IEs). Form 5500-R filers will check box (6) may continue to file the same form filed
indicating they are filing a Form 5500-R, last year (i.e., Form 5500 or 5500-C/R),
even if the number of participants
What To File complete pages 1 and 2, and detach
changed, provided that at the beginning of
pages 3 through 6 before filing the
This section describes the different return/report. this plan year the plan had at least 80
categories of the Form 5500 series and the participants, but not more than 120.
You must check the box at the top of
related schedules and lists items to be
the Form 5500-C/R indicating that the form ● Form 5500EZ, Annual Return of
completed by different types of Form One-Participant (Owners and Their
5500-C/R filers. In addition, this section is a Form 5500-C for the first plan year,
the year for which the final return/report is Spouses) Pension Benefit Plan, should be
contains a description of the special filing filed by most one-participant plans.
requirements for plans that invest in certain due, and for plan years in which a Form
5500-R may not be filed as explained A one-participant plan is: (1) a pension
investment arrangements. For a brief guide benefit plan that covers only an individual
illustrating which forms and schedules are below.
You may check the box at the top of the or an individual and his or her spouse who
required by different types of plans and wholly own a trade or business, whether
filers, see the summary below. Form 5500-C/R indicating that the form is
a Form 5500-R unless: (a) this is the plan’s incorporated or unincorporated; or (2) a
Forms first plan year, (b) this is the plan year for pension benefit plan for a partnership that
which a final return/report is due, or (c) the covers only the partners or the partners
The following are the different forms in the and the partners’ spouses.
Form 5500-R has been filed for both of the
5500 series of forms. See Form 5500EZ and its instructions to
prior 2 plan years. If any of the preceding
● Form 5500, Annual Return/Report of three situations apply, you must file Form see if the plan meets the requirements for
Employee Benefit Plan, must be filed 5500-C and check box (5). filing the form.
annually for each plan with 100 or more ● Form 8822, Change of Address, may be
Any plan may choose not to file the
participants at the beginning of the plan used to notify the IRS if the plan’s mailing
Form 5500-R if the plan files the Form
year. address changes after the return/report
5500-C instead.
● Form 5500-C/R, Return/Report of has been filed.
Note: For purposes of determining whether
Employee Benefit Plan, must be filed for
to file Form 5500 or Form 5500-C/R for an
each pension benefit plan, welfare benefit
plan, and fringe benefit plan (unless
otherwise exempted) with fewer than 100
Summary of Filing Requirements for Employers and Plan Administrators
(File forms ONLY with IRS)
Type of plan What to file When to file
Most pension plans with only one participant or one participant and that participant’s spouse Form 5500EZ
Pension plan with fewer than 100 participants Form 5500-C/R
Pension plan with 100 or more participants Form 5500
Annuity under Code section 403(b)(1) or trust under Code section 408(c) Form 5500, 5500-C/R
Custodial account under Code section 403(b)(7) Form 5500, 5500-C/R File all
Welfare benefit plan with 100 or more participants Form 5500 required
forms and
Welfare benefit or fringe benefit plan with fewer than 100 participants (see plans excluded
Form 5500-C/R schedules
from filing on page 3)
for each
Financial statements, schedules, plan by the
Pension or welfare plan with 100 or more participants (see Form 5500 instructions) last day of
and accountant’s opinion
the 7th
Pension or welfare plan with benefits provided by an insurance company Schedule A (Form 5500) month after
Pension plan that requires actuarial information Schedule B (Form 5500) the plan
year ends.
Plan with 100 or more participants Schedule C (Form 5500)
Pension plan with ESOP benefits Schedule E (Form 5500)
Fringe benefit plan under Code section 6039D Schedule F (Form 5500)
Pension plan filing a registration statement identifying separated participants with deferred Schedule SSA
vested benefits from a pension plan (Form 5500)
Items To Complete on Form required to complete the entire form. Welfare benefit plans.—Welfare benefit
These are described below by type of plan. plans generally must complete the
5500-C (Form 5500-R filers see page 6.) Check the list of headings to see if your following items on the Form 5500-C: 1
Certain kinds of plans and certain kinds of plan is affected. through 6e; 7a; 8a, 8b, 8d, and 8e; 9a, 9b,
filers that must file Form 5500-C are not 5500-C filers do NOT complete page 2.
Page 5
9c, and 9f; 10a through 10d; 11 through primarily for nonresident aliens required to be “allocated” only if the insurance
14; and 26 through 28. file a Form 5500-C (see Who Must File on company or organization that issued the
Note: If one Form 5500-C is filed for both page 2) must only complete items 1 contract unconditionally guarantees, upon
a welfare benefit plan and a fringe benefit through 8c (enter code D in item 6c), 9 receipt of the required premium or
plan, complete Schedule F (Form 5500) in through 12, 15, and 16. consideration, to provide a retirement
addition to the items listed above for Plans of more than one employer.—All benefit of a specified amount, without
welfare benefit plans. plans of more than one employer (plans of adjustment for fluctuations in the market
Fringe benefit plans.—For a Form 5500-C a controlled group, multiemployer plans, value of the underlying assets of the
filed only because of Code section 6039D multiple-employer collectively bargained company or organization, to each
(i.e., for a fringe benefit plan) need plans, and multiple-employer plan (other)) participant, and each participant has a legal
complete only items 1 through 5, 6d and generally should complete all applicable right to such benefits that is legally
Schedule F (Form 5500). DO NOT file (welfare or pension) items on the form enforceable directly against the insurance
Schedules A, B, C, E, P, or SSA Form except for item 6f. Only single-employer company or organization.
(5500). pension plans must complete this item. 5. Nonqualified pension benefit plans
If the Form 5500-C/R is filed for both a maintained outside the United States.—
welfare benefit plan and a fringe benefit
Items To Complete on Form Nonqualified pension benefit plans
plan, complete the above items and those 5500-R maintained outside the United States
specified for Welfare benefit plans above. primarily for nonresident aliens required to
Certain kinds of plans and certain kinds of file a Form 5500-R need only complete
Pension plans.—In general, most pension filers that are required to submit Form items 1 through 8a and 11 through 15.
plans (defined benefit and defined 5500-R are not required to complete the
contribution) are required to complete all entire form. These are described below, by Schedules
items on the form. However, some items type of plan. Check the list of headings to
do not have to be completed by certain see if your plan is affected. Note: All attachments to Forms 5500 and
types of pension plans, as described 5500-C/R must include the name of the
Welfare benefit plans.—Welfare benefit
below. plan, the plan sponsor’s EIN, and plan
plans must complete the following items
number (PN) as found in items 5a, 1b, and
1. Plans exclusively using a tax on Form 5500-R: 1 through 6e; 7a; 8a and
5c, respectively.
deferred annuity arrangement under 8b; 9; 10; 11; and 13 through 15.
Code section 403(b)(1).—These plans The various schedules to be attached to
Fringe benefit plans.—A Form 5500-R
must only complete items 1 through 5, 6b the return/report are listed below:
filed only because of Code section 6039D
(enter pension code 8), and 9. (i.e., for a fringe benefit plan) must ● Schedule A (Form 5500), Insurance
2. Plans exclusively using a custodial complete only items 1 through 6d, and Information, must be attached to Forms
account for regulated investment Schedule F (Form 5500). 5500 and 5500-C/R, if any benefits under
company stock under Code section the plan are provided by an insurance
Pension plans.—In general, most pension
403(b)(7).—These plans must only company, insurance service, or other
plans (defined benefit and defined
complete items 1 through 5, 6b (enter similar organization (such as Blue Cross,
contribution) are required to complete all
pension code 9), and 9. Blue Shield, or a health maintenance
items on the form. However, some items
organization). (This includes investments
3. Individual retirement account do not have to be completed by certain
with insurance companies such as
plan.—A pension plan utilizing individual types of pension plans, as described
guaranteed investment contracts (GICs).)
retirement accounts or annuities (as below.
described in Code section 408) as the sole Exceptions: 1. Schedule A (Form 5500) is
1. Plans exclusively using a tax
funding vehicle for providing benefits must not needed if the plan covers only: (a) an
deferred annuity arrangement under
only complete items 1 through 5, 6b (enter individual, or an individual and his or her
Code section 403(b)(1).—These plans
pension code 0), and 9. spouse, who wholly owns a trade or
must only complete items 1 through 5, 6b
business, whether incorporated or
4. Fully insured pension plan.—A (enter pension code 8), and 8.
unincorporated; or (b) a partner(s) in a
pension benefit plan providing benefits 2. Plans exclusively using a custodial partnership, or a partner(s) and his or her
exclusively through an insurance contract, account for regulated investment spouse.
or contracts that are fully guaranteed and company stock under Code section
that meets all of the conditions of 29 CFR 2. A Schedule A (Form 5500) is not
403(b)(7).—These plans must only
2520.104-44 need only complete items 1 required to be filed with the Form 5500 or
complete items 1 through 5, 6b (enter
through 26c. A pension plan that includes Form 5500-C/R if a Schedule A (Form
pension code 9), and 8.
both insurance contracts of the type 5500) is filed for the contract as part of the
3. Individual retirement account master trust or 103-12 IE information filed
described in 29 CFR 2520.104-44 as well plan.—A pension plan utilizing individual
as other assets should not include the directly with DOL.
retirement accounts or annuities (as
value of these contracts in item 27. Do not file a Schedule A (Form 5500)
described in Code section 408) as the sole
Note: For purposes of the annual with a Form 5500EZ.
funding vehicle for providing benefits must
return/report and the alternative method of only complete items 1 through 5, 6b (enter ● Schedule B (Form 5500), Actuarial
compliance set forth in 29 CFR pension code 0), and 8. Information, must be attached to Form
2520.104-44, a contract is considered to 5500, 5500-C/R, or 5500EZ for most
4. Fully insured pension plan.—A
be “allocated” only if the insurance defined benefit pension plans. See
pension benefit plan providing benefits
company or organization that issued the instructions for Schedule B.
exclusively through an insurance contract,
contract unconditionally guarantees, upon or contracts that are fully guaranteed, and ● Schedule E (Form 5500), ESOP Annual
receipt of the required premium or that meets all of the conditions of 29 CFR Information, must be attached to Form
consideration, to provide a retirement 2520.104-44 must only complete items 1 5500, 5500-C/R, or 5500EZ for all pension
benefit of a specified amount, without through 12, 14 (enter “0” in 14a and 14c), benefit plans with ESOP benefits. See the
adjustment for fluctuations in the market and 15a, 15b, and 15c. A pension plan instructions for Schedule E.
value of the underlying assets of the that includes both insurance contracts of ● Schedule F (Form 5500), Fringe Benefit
company or organization, to each the type described in 29 CFR 2520.104-44 Plan Annual Information Return, must be
participant, and each participant has a legal as well as other assets must complete all attached to page 1 of Form 5500 or
right to such benefits, which is legally applicable items on the Form 5500-R but 5500-C/R for all fringe benefit plans.
enforceable directly against the insurance limit its reporting in item 13 to those other ● Schedule SSA (Form 5500), Annual
company or organization. assets. Registration Statement Identifying
5. Nonqualified pension benefit plans Note: For purposes of the annual Separated Participants With Deferred
maintained outside the United States.— return/report and the alternative method of Vested Benefits, may be needed for
Nonqualified pension benefit plans compliance set forth in 29 CFR separated participants. See When To
maintained outside the United States 2520.104-44, a contract is considered to
Page 6
Report Separated Participants in the account to be reported as part of the comparing the current value of the
instructions for Schedule SSA. master trust report filed directly with DOL transaction at the transaction date with the
● Schedule P (Form 5500), Annual Return or as a plan asset(s) that is not part of the current value of the investment account
of Fiduciary of Employee Benefit Trust, master trust (and therefore subject to all assets at the beginning of the applicable
must be filed by any fiduciary (trustee or instructions pertaining to assets not held in fiscal year of the master trust.
custodian) of an organization that is a master trust). 103-12 IE information to be filed directly
qualified under Code section 401(a) and Each of the following statements and with DOL.—The information described
exempt from tax under Code section schedules must indicate the name of the below must be filed with the DOL by the
501(a) who wants to protect the master trust and the name of the master sponsor of the 103-12 IE no later than the
organization under the statute of limitations trust investment account. The information date on which the plan’s return/report is
provided in Code section 6501(a). You shall be filed with DOL by mailing it to: due before the plan administrator can elect
must enter the EIN of the trust on line 2b Master Trust the alternative method of reporting. While
of Schedule P. Pension and Welfare Benefits only one copy of the required information
File the Schedule P (Form 5500) as an Administration should be filed for the 103-12 IE, the
attachment to Form 5500, 5500-C/R, or U.S. Department of Labor, Room N5644 information is an integral part of the
5500EZ for the plan year in which the trust 200 Constitution Avenue, NW return/report of each plan electing the
year ends. Washington, DC 20210 alternative method of compliance. The
filing address is:
Other Filings 1. The name and fiscal year of the
master trust and the name and address of 103-12 Investment Entity
Certain investment arrangements for the master trustee. Pension and Welfare Benefits
employee benefit plans file financial 2. A list of all plans participating in the Administration
information directly with DOL. These master trust, showing each plan’s name, U.S. Department of Labor, Room N5644
arrangements include common/collective EIN, PN, and its percentage interest in 200 Constitution Avenue, NW
trusts, pooled separate accounts, master each master trust investment account as Washington, DC 20210
trusts, and 103-12 IEs. Definitions of these of the beginning and end of the fiscal year 1. The name, fiscal year, and EIN of the
investment arrangements may be found on of the master trust ending with or within 103-12 IE and the name and address of
page 4. Their DOL filing requirements are the plan year. the sponsor of the 103-12 IE. If more than
described below. one 103-12 IE is covered by the same EIN,
3. A Schedule A (Form 5500) for each
Common/collective trust and pooled insurance or annuity contract held in the they shall be sequentially numbered as
separate account information to be filed master trust. follows: 99-1234567 Entity No. 1.
directly with DOL.—Financial institutions 2. A list of all plans participating in the
4. A statement, in the same format as
and insurance carriers filing the statement 103-12 IE, showing each plan’s name, EIN,
Part I of Schedule C (Form 5500), for each
of the assets and liabilities of a PN, and its percentage interest in the
master trust investment account showing
common/collective trust or pooled separate 103-12 IE as of the beginning and end of
amounts of compensation paid during the
account should identify the trust or the fiscal year of the 103-12 IE ending with
fiscal year of the master trust ending with
account by providing the EIN of the trust or within the plan year.
or within the plan year to persons
or account, or (if more than one trust or 3. A Schedule A (Form 5500) for each
providing services with respect to the
account is covered by the same EIN) both insurance or annuity contract held in the
investment account and subtracted from
the EIN and any additional number 103-12 IE.
the gross income of the investment
assigned by the financial institution or
account in determining the net increase 4. A statement, in the same format as
insurance carrier (such as: 99-1234567
(decrease) in net assets of the investment Part I of Schedule C (Form 5500), for the
Trust No. 1); and a list of all plans
account. 103-12 IE showing amounts of
participating in the trust or account,
5. A statement for each master trust compensation paid during the fiscal year of
identified by the plan number, EIN, and
investment account showing the assets the 103-12 IE ending with or within the
name of the plan sponsor. The direct filing
and liabilities of the investment account at plan year to persons providing services to
should be addressed to:
the beginning and end of the fiscal year of the 103-12 IE.
Common/Collective Trust (OR) the master trust ending with or within the 5. A statement showing the assets and
Pooled Separate Account plan year, grouped in the same categories liabilities at the beginning and end of the
Pension and Welfare Benefits as those specified in item 31 of Form fiscal year of the 103-12 IE ending with or
Administration 5500. within the plan year, grouped in the same
U.S. Department of Labor, Room N5644 categories as those specified in item 31 of
6. A statement for each master trust
200 Constitution Avenue, NW Form 5500.
investment account showing the income
Washington, DC 20210
and expenses, changes in net assets, and 6. A statement showing the income and
Master trust information to be filed net increase (decrease) in net assets of expenses, changes in net assets, and net
directly with DOL.—The following each such investment account during the increase (decrease) in net assets during
information with respect to a master trust fiscal year of the master trust ending with the fiscal year of the 103-12 IE ending with
must be filed with DOL by the plan or within the plan year, in the categories or within the plan year, grouped in the
administrator or by a designee, such as the specified in item 32 of Form 5500. In place categories specified in item 32 of Form
administrator of another plan participating of item 32a, show the total of all transfers 5500. In place of item 32a, show the total
in the master trust or the financial of assets into the investment account by of all transfers of assets into the 103-12 IE
institution serving as trustee of the master participating plans. In place of item 32j, by participating plans. In place of item 32j,
trust, no later than the date on which the show the total of all transfers of assets out show the total of all transfers of assets out
plan’s return/report is due. While only one of the investment account by participating of the 103-12 IE by participating plans.
copy of the required information should be plans. 7. Schedules, in the format set forth in
filed for all plans participating in the master
7. Schedules, in the format set forth in the instructions for item 27 of Form 5500
trust, the information is an integral part of
the instructions for item 27 of Form 5500, (except item 27d) with respect to the 103-
the return/report of each participating plan,
of the following items with respect to each 12 IE for the fiscal year of the 103-12 IE
and the plan’s return/report will not be
master trust investment account for the ending with or within the plan year.
deemed complete unless all the
fiscal year of the master trust ending with Substitute the term “103-12 IE” for the
information is filed within the prescribed
or within the plan year: assets held for word “plan” when completing the
time.
investment, nonexempt party-in-interest schedules.
Note: If a master trust investment account transactions, defaulted or uncollectible 8. A report of an independent qualified
consists solely of one plan’s asset(s) during loans and leases, and 5% transactions public accountant regarding the above
the reporting period, the plan may report involving assets in the investment account. items and other books and records of the
the(se) asset(s) either as an investment The 5% figure shall be determined by
Page 7
103-12 IE that meets the requirements of granted an automatic approval for a Information at the Top of the
29 CFR 2520.103-1(b)(5). change in plan year if all the following
criteria are met: Form
1. No plan year exceeds 12 months. First Line at the top of the form—
Section 3 2. The change will not delay the time Complete the space for dates when:
when the plan otherwise would have been (1) the 12-month plan year is not a
Final Return/Report required to conform to the requirements of calendar year, or (2) the plan year is less
If all assets under the plan (including any statute, regulation, or published than 12 months (a short plan year).
insurance/annuity contracts) have been position of the IRS. A. Check box (1) if this is the first filing
distributed to the participants and 3. The trust, if any, retains its exempt for this plan. Do not check this box if you
beneficiaries or distributed to another plan status for the short period required to have ever filed for this plan even if it was
(and when all liabilities for which benefits effect the change, as well as for the on a different form (Form 5500 vs. Form
may be paid under a welfare benefit plan taxable year immediately preceding the 5500-C or Form 5500-R).
have been satisfied), check the “final short period. Check box (2) if you have already filed
return/report” box at the top of the Form 4. All actions necessary to implement for the 1992 plan year and are now
5500-C filed for such plan. The year of the change in plan year, including plan submitting an amended return/report to
complete distribution is the last year a amendment and a resolution of the board correct errors and/or omissions on the
return/report must be filed for the plan. For of directors (if applicable), have been taken previously filed return/report.
purposes of this paragraph, a complete on or before the last day of the short Check box (3) if the plan no longer exists
distribution will occur in the year in which period. to provide benefits. See Section 3 on this
the assets of a terminated plan are brought 5. No change in plan year has been page for instructions concerning the
under the control of PBGC. made for any of the preceding plan years. requirement to file a final return/report.
For a defined benefit plan covered by 6. In the case of a defined benefit plan, Check box (4) if this form is being filed
PBGC, a PBGC Form 1 must be filed and deductions are taken in accordance with for a period of less than 12 months and
a premium must be paid until the end of section 5 of Rev. Proc. 87-27. show the dates at the top.
the plan year in which the assets are Check box (5) if you are filing a Form
distributed or brought under the control of For the first return/report that is filed
following the change in plan year, check 5500-C. If you check this box, complete
PBGC. pages 1 and 3 through 6.
the box on line C at the top of the form.
Filing the return/report marked “Final Check box (6) if you are filing a Form
return” and indicating that the plan 5500-R. If you check this box, complete
terminated satisfies the notification Amended Return/Report only pages 1 and 2.
requirement of Code section 6057(b)(3). If you file an amended return/report, check B. Check this box if you make any
box A(2) “an amended return/report” at the changes to the preprinted information on
Signature and Date top of the form. When filing an amended page 1. Changes should be highlighted or
return, be sure to answer all questions and entered in red ink, if possible.
The plan administrator must sign and date put a circle around the item numbers that
all returns/reports filed. The name of the C. Check this box if the plan year has
have been amended.
individual who signed as plan administrator been changed since the last return/report
must be typed or printed clearly on the line was filed.
under the signature line. In addition, the How the Annual D. Check this box if you filed for an
employer must sign a return/report filed for Return/Report Information extension of time to file this form. Attach a
a single-employer plan or a plan required copy of the approved Form 5558 or a copy
to file only because of Code section 6039D May Be Used of the employer’s extension of time to file
(i.e., for a fringe benefit plan). All Form 5500 series return/reports will be the income tax return if you are using the
When a joint employer-union board of subjected to a computerized review. It is, exception in Extension of Time to File on
trustees or committee is the plan sponsor therefore, in the filer’s best interest that the page 2 of these instructions.
or plan administrator, at least one responses accurately reflect the
employer representative and one union circumstances they were designed to Line-By-Line Instructions
representative must sign and date the report. Annual reports filed under Title I of
return/report. ERISA must be made available by plan The numbers of the following
administrators to plan participants and by instructions are the same as the item
Participating employers in a
the Department of Labor to the public numbers on the return/report.
multiple-employer plan (other), who are
required to file Form 5500-C/R are required pursuant to ERISA section 104.
Page 1
to sign the return/report. The plan
Check the preprinted information in 1
administrator need not sign the Form
5500-C/R filed by the participating
Section 4 through 6d for accuracy and
employer. Important: Answer all items on the Form completeness. Cross out any incorrect
5500-C/R with respect to the plan year, information and enter the correct
unless otherwise explicitly stated in the information. Add any incomplete
Reproductions item-by-item instructions or on the form information in red ink, if possible.
Original forms are preferable, but a clear itself. Therefore, your responses usually If you did not receive a Form 5500-C/R
reproduction of the completed form is apply to the year entered or printed at the with a preprinted page one, complete
acceptable. Sign the return/report after it is top of the first page of the form. “Yes” or items 1 through 6d as follows:
reproduced. All signatures must be original. “No” questions must be marked either 1a. Enter the name and address of the
“Yes” or “No” but not both. “N/A” plan sponsor. If the Post Office does not
Change in Plan Year cannot be used to respond to a “Yes” or deliver mail to the street address and the
“No” question that is required to be sponsor has a P.O. box number, show the
Generally, only defined benefit pension answered by the filer as specified on
plans have to get prior approval for a box number instead of the street address.
page 5 under Items To Complete on If the plan covers only the employees of
change in plan year. (See Code section Form 5500-C or on page 6 under Items
412(c)(5).) Rev. Proc. 87-27, 1987-1 C.B. one employer, enter the employer’s name.
To Complete on Form 5500-R.
769, explains the procedure for automatic The term “plan sponsor” means—
approval of a change in plan year. A ● The employer, for an employee benefit
pension benefit plan that would ordinarily plan that a single employer established or
have to obtain approval for a change in maintains;
plan year under Code section 412(c)(5) is
Page 8
● The employee organization in the case of If the plan sponsor has no CUSIP issuer 5b. Enter the date the plan first became
a plan of an employee organization; or number, enter “N/A.” effective.
● The association, committee, joint board 2a. If the document constituting the plan 5c. Enter the 3-digit number the
of trustees, or other similar group of appoints or designates a plan administrator employer or plan administrator assigned to
representatives of the parties who other than the sponsor, enter the the plan. All welfare benefit plan numbers
establish or maintain the plan, if the plan is administrator’s name and address. If the and Code section 6039D plan numbers
established or maintained jointly by one or plan administrator is also the sponsor, start at 501. All other plans start at 001.
more employers and one or more enter “Same.” If “Same” is entered on 2a, Once you use a plan number, continue
employee organizations, or by two or more leave 2b and 2c blank. to use it for that plan on all future filings
employers. The term “administrator” means— with IRS, DOL and PBGC. Do not use it for
Include enough information in item 1a to ● The person or group of persons any other plan even if you terminated the
describe the sponsor adequately. For specified as the administrator by the first plan.
example, “Joint Board of Trustees of Local instrument under which the plan is 6a. Welfare Benefit Plan Codes.—
187 Machinists” rather than just “Joint operated; Check this box and enter every code from
Board of Trustees.” ● The plan sponsor/employer if an the list below that describes the welfare
1b. Enter the nine-digit employer administrator is not so designated; or benefit plan for which this return/report is
identification number (EIN) assigned to the ● Any other person prescribed by being filed. Example: If your plan provides
plan sponsor/employer (e.g., 00-1234567). regulations of the Secretary of Labor if an health insurance, life insurance, dental
Employers and plan administrators who administrator is not designated and a plan insurance and eye examinations, the four
do not have an EIN should apply for one sponsor cannot be identified. codes A, B, D, and E should be entered. If
on Form SS-4, Application for Employer your plan has a benefit not described by
2b. A plan administrator must have an one of the codes, enter “Z” and write in a
Identification Number. Form SS-4 can be EIN for reporting purposes. Enter the plan
obtained at most IRS or Social Security description of this benefit in the space
administrator’s nine-digit EIN here. If the provided.
Administration (SSA) offices. Send Form plan administrator does not have an EIN,
SS-4 to the Internal Revenue Service apply for one as explained in 1b above.
Center where this Form 5500-C/R will be Type of Welfare Plan Code
filed. Employees of an employer are not plan Health (other than dental or vision) A
administrators unless so designated in the Life insurance B
A plan of a controlled group of plan document, even though they engage Supplemental unemployment C
corporations whose sponsor is more than in administrative functions of the plan. If an Dental D
one of the members of the controlled employee of the employer is designated as Vision E
group should enter only the EIN of one of the plan administrator, that employee must Temporary disability (accident and
the sponsoring members. This EIN must be get an EIN. sickness) F
used in all subsequent filings of the annual Prepaid legal G
returns/reports for the controlled group 3. If the plan administrator’s/sponsor’s Long-term disability H
unless there is a change in the sponsor. name, address, and EIN have changed Severance pay I
since the last return/report was filed for Apprenticeship and training J
If the plan sponsor is a group of this plan, enter the plan administrator’s/
individuals, get a single EIN for the group. Scholarship (funded) K
sponsor’s name, address, and EIN as it Death benefits (other than life ins.) L
When you apply for a number, enter on appeared on the last return/report filed for
line 1 of Form SS-4 the name of the group, Taft-Hartley Financial Assistance
this plan. for Employee Housing Expenses P
such as “Joint Board of Trustees of the
Local 187 Machinists’ Retirement Plan.” 3c. Indicate if the change in the Other (specify on page 1) Z
sponsor’s name, address, and EIN is only 6b. Pension Benefit Plan Codes.—
Note: Although EINs for funds (trusts or a change in sponsorship. “Change in Check this box and enter the codes from
custodial accounts) associated with plans sponsorship” means the plan’s sponsor the list below that describe the type of
are generally not required to be furnished has been changed but no assets or benefits for which the Form 5500-C/R is
on the Form 5500 series returns/reports, liabilities have been transferred to another being filed.
the IRS will issue EINs for such funds for plan(s), the plan has not terminated or
other reporting purposes. EINs may be Note: Filers who previously used code 7
merged with any other plan, and so forth. must enter the applicable code below. A
obtained by filing Form SS-4 as explained Therefore, the plan is now the
above. pension plan must be either a defined
responsibility of the new sponsor whose benefit or a defined contribution plan.
Plan sponsors should use the trust EIN name is entered in item 1a of this
described in the Note above when opening return/report. Type of Pension Benefit Plan Code
a bank account or conducting other 4. Plan Entity Code.—From the Defined benefit 1
transactions for a trust that requires an following list of plan entities choose the
EIN. one that describes your plan entity and Defined Contribution
1d. From the list of business codes on Profit-sharing 2
enter that code in item 4.
pages 19 and 20, enter the one that best Stock bonus 3
describes the nature of the employer’s Entity Code Target Benefit 4
business. If more than one employer is Single-employer plan A Other money purchase 5
involved, enter the business code for the Plan of controlled group of corporations Other (specify on page 1) 6
main business activity. or common control employers B
Multiemployer plan C Other
1e. Plans entering entity Code A or B in Defined benefit plan with benefits
Multiple-employer-collectively-
item 4 must enter the first six digits of the bargained plan D based partly on balance of separate
CUSIP (Committee on Uniform Securities account of participant (Code section
Multiple-employer plan (other) E
Identification Procedures) number, “issuer 414(k)) 7
A return of an employer described in the Note to
number,” if one has been assigned to the Annuity arrangement of certain
Kinds of Filers 2 and 5 F
exempt organizations (Code section
plan sponsor for purposes of issuing 5a. Enter the formal name of the plan or 403(b)(1)) 8
corporate securities. CUSIP issuer enough information to identify the plan. Custodial account for regulated
numbers are assigned to corporations and This name should not exceed 70 investment company stock (Code
other entities which issue public securities characters. If the present plan name section 403(b)(7)) 9
listed on stock exchanges or traded over exceeds 70 characters and spaces, try to Pension plan utilizing individual
the counter. The CUSIP issuer number is abbreviate it. retirement accounts or annuities
the first six digits of the number assigned (described in Code section 408) as
to the individual securities that are traded. the sole funding vehicle for
providing benefits 0
Page 9
6c. Pension Plan Feature Codes.— election by employees to defer part of their heavy, include distributions made in the
Enter the code(s) from the list below that compensation or receive these amounts in 5-year period ending on the determination
describes the pension plan features. cash. date. However, do not take into account
● Enter code H if the plan is top-heavy. A accrued benefits for an individual who has
Type of Pension Plan Features (see “top-heavy plan” is a plan that during any not performed services for the employer
description and codes below) Code plan year is: during the 5-year period ending on the
Employee Stock Ownership Plan (ESOP) A determination date.
Leveraged ESOP B a. Any defined benefit plan if, as of the
determination date, the present value of A qualified plan must limit the annual
Participant-Directed account plan C
Pension Plan maintained outside the USA D the cumulative accrued benefits under the compensation of each employee taken into
Plan covering Self-Employed individuals E plan for key employees exceeds 60% of account for this year to $228,860 adjusted
Affiliated Service Group (Code Section 414(m)(2)) F the present value of the cumulative annually for the cost of living. The family
401(k) Plan—(Plan containing a cash or deferred accrued benefits under the plan for all members (spouse and lineal descendents
arrangement) G employees; and under age 19) of 5% owners or one of the
Top-Heavy plan (for 1984 or b. Any defined contribution plan if, as of 10 most highly compensated employees
subsequent plan year) H the determination date, the aggregate of are treated as a single employee. Qualified
Plan with Permitted Disparity Provisions—(See Code the accounts of key employees under the plans must comply with this requirement in
sections 401(a)(5) and 401(l)) I
plan exceeds 60% of the aggregate of the operation even if the plan has not yet been
Master plan J amended to comply with the Tax Reform
accounts of all employees under the plan.
Prototype plan K Act of 1986.
Regional Prototype plan L Each plan of an employer included in a
required aggregation group is to be treated 6d. Fringe Benefit Plan.—Complete only
● If you enter code A or B, you must page 1 (items 1 through 5 and 6d) AND
complete Schedule E (Form 5500) and as a top-heavy plan if such group is a top-
heavy group. See definitions of required Schedule F (Form 5500) for a Form
attach it to the Form 5500-C/R you file for 5500-C/R filed only because of Code
this plan. aggregation and top-heavy groups below.
section 6039D. See pages 5 and 6 for
● Enter code B for a leveraged ESOP if A “key employee” is any participant in additional instructions on Items To
the plan acquires employer securities with an employer plan who at any time during Complete on Form 5500-C and Items To
borrowed money or other debt-financing the plan year, or any of the 4 preceding Complete on Form 5500-R for a fringe
techniques. years, is: benefit plan.
● Enter code C for a pension plan that a. An officer of the employer having an Form 5500-C filers see pages 13
provides for individual accounts and annual compensation greater than 50% of through 18 for instructions for items 6e
permits a participant or beneficiary to $112,221, the defined benefit dollar through 28.
exercise independent control over the limitation for 1992 under Code section
assets in his or her account (see ERISA 415(b)(1)(A),
section 404(c)). b. One of the 10 employees having Form 5500-R, Page 2
● Enter code D for a pension benefit plan annual compensation from the employer 7. The definition of “participant” in the
maintained outside the United States greater than $30,000, the defined instructions below is only for purposes of
primarily for nonresident aliens. See Kinds contribution dollar limitation under Code item 7 of this form.
of Filers on page 3 for more information. section 415(c)(1)(A) and owning (or
considered as owning within the meaning For welfare plans, the number of
● Enter code F for a plan of an Affiliated of Code section 318) the largest interests participants should be determined by
Service Group. In general, Code section in the employer, reference to 29 CFR 2510.3-3(d).
414(m)(2) defines an affiliated service group Dependents are considered to be neither
as a first service organization (FSO) that c. A 5% owner of the employer, or participants nor beneficiaries. For pension
has: d. A 1% owner of the employer having benefit plans, “alternate payees” entitled to
1. A service organization (A-ORG) that is an annual compensation from the employer benefits under a qualified domestic
a shareholder or partner in the FSO and of more than $150,000. relations order are not to be counted as
that regularly performs services for the In determining whether an individual is participants for this item.
FSO, or is regularly associated with the an officer of the employer, no more than “Participant” means any individual who
FSO in performing services for third 50 employees, or, if less, the greater of 3 is included in one of the categories below.
persons, and/or employees or 10% of the employees, are a. Active participants include any
2. Any other organization (B-ORG) if: to be treated as officers. See Code section individuals who are currently in
416(i) and T-12 of Income Tax Regulations employment covered by a plan and who
a. A significant portion of the business of section 1.416-1. A key employee will not
that organization consists of performing are earning or retaining credited service
include any officer or employee of a under a plan. This category includes any
services for the FSO or A-ORG of a type governmental plan under Code section
historically performed by employees in the individuals who are: (A) currently below the
414(d). integration level in a plan that is integrated
service field of the FSO or A-ORG, and
A “required aggregation group” consists with social security, and/or (B) eligible to
b. 10% or more of the interest of the of:
B-ORG is held by persons who are highly elect to have the employer make payments
compensated employees of the FSO or a. Each plan of the employer in which a to a Code section 401(k) qualified cash or
A-ORG. key employee is or was a participant, and deferred arrangement. Active participants
b. Each other plan of the employer that also include any nonvested individuals who
An affiliated service group also includes are earning or retaining credited service
a group consisting of an organization enables a plan to meet the requirements
for nondiscrimination in contributions or under a plan. This category does not
whose principal business is performing include nonvested former employees who
management functions for another benefits under Code section 401(a)(4), or
the participation requirements under Code have incurred the break in service period
organization (or one organization and other specified in the plan.
related organizations) on a regular and section 410.
continuing basis, and the organization for A “top heavy group” is an aggregation b. Inactive participants receiving benefits
which such functions are so performed by group if, as of the determination date, the are any individuals who are retired or
the organization. For a plan maintained by sum of the present value of the cumulative separated from employment covered by
more than one employer, check “Yes” if accrued benefits for key employees under the plan and who are receiving benefits
any such employer is a member of an all defined benefit plans included in such under the plan. This includes former
affiliated service group. group and the aggregate of the accounts employees who are receiving group health
of key employees under all defined continuation coverage benefits pursuant to
● Enter code G for a cash or deferred Part 6 of ERISA and who are covered by
arrangement described under Code section contribution plans in such group exceeds
60% of a similar sum determined for all the employee welfare benefit plan. This
401(k) that is part of a qualified defined category does not include any individual to
contribution plan that provides for an employees. To determine if a plan is top
whom an insurance company has made an
Page 10
irrevocable commitment to pay all the insurance company (or similar nearest dollar. “Current value” means fair
benefits to which the individual is entitled organization). If information is missing on market value where available. Otherwise, it
under the plan. Schedule A (Form 5500) due to a refusal to means the fair value as determined in good
c. Inactive participants entitled to future provide this information, note this on faith under the terms of the plan by a
benefits are individuals who are retired or Schedule A. If there is no Schedule(s) A trustee or a named fiduciary, assuming an
separated from employment covered by attached, enter “0”. orderly liquidation at the time of the
the plan and who are entitled to begin 11a(1). Check “Yes,” if an amendment to determination.
receiving benefits under the plan in the the plan was adopted in this plan year, If the assets of two or more plans are
future. This category does not include any regardless of the effective date of the maintained in one trust, such as when an
individual to whom an insurance company amendment. employer has two plans funded through a
has made an irrevocable commitment to 11a(2). Enter the month and year of the single trust (except investment
pay all the benefits to which the individual most recent plan amendment even if it is in arrangements filing directly with DOL),
is entitled under the plan. a plan year prior to the plan year for which complete items 13 and 14 by entering the
d. Deceased participants are any this return/report is filed. plan’s allocable part of each line item.
deceased individuals who have one or 11b. Check “Yes” only if the accrued If assets of one plan are maintained in
more beneficiaries who are receiving or are benefits were retroactively reduced. For two or more trust funds, report the
entitled to receive benefits under the plan. example, a plan provides a benefit of 2% combined financial information in items 13
This category does not include an for each year of service, but the plan is and 14. Fully insured defined benefit or
individual if an insurance company has amended to change the benefit to 11⁄2% a defined contribution pension plans meeting
made an irrevocable commitment to pay all year for all years of service under the plan. the conditions of 29 CFR 2520.104-44
the benefits to which the beneficiaries of Do not check “Yes” if accrued benefits need not complete item 13.
that individual are entitled under the plan. were retroactively reduced solely to the For purposes of the annual return/report
7b. Enter the number of participants extent permitted under a model and the alternative method of compliance
included in item 7a(2) who have account amendment provided in IRS Notice 88-131, set forth in 29 CFR 2520.104-44, a
balances. For example, for a Code section 1988-2 C.B. 546. contract is considered to be “allocated”
401(k) plan, the number entered in item 7b 11c. Check “Yes” only if an amendment only if the insurance company or
should be the number of participants changed the information previously organization that issued the contract
counted in item 7a(2) who have made a provided to participants by the summary unconditionally guarantees, upon receipt of
contribution to the plan during this plan plan description or summary description of the required premium or consideration, to
year or any prior plan year. modifications. provide a retirement benefit of a specified
7c(1). If “Yes,” file Schedule SSA (Form amount, without adjustment for fluctuations
11d. A revised summary plan description in the market value of the underlying
5500) as an attachment to Form 5500-R. or summary description of modifications
Plan administrators: Code section 6057(e) assets of the company or organization, to
must be filed with DOL and distributed to each participant, and each participant has
provides that the plan administrator must all plan participants and pension plan
give each participant a statement showing a legal right to such benefits that is legally
beneficiaries no later than 210 days after enforceable directly against the insurance
the same information reported on Schedule the close of the plan year in which the
SSA for that participant. company or organization.
amendment(s) was adopted. If the material
8a. Check “Yes,” if the plan was was distributed and filed since the Total plan assets at the beginning of the
terminated or if the plan was merged or amendments were adopted (even if after plan year plus item 14c (net income (loss))
consolidated into another plan. Enter year the end of the plan year), check “Yes” to must equal the total plan assets at the end
of termination if applicable. item 11d. of the plan year.
8b. If the plan was terminated and all 12a. Check “Yes,” if this is a pension Note: Plan income includes contributions
assets were not distributed, file a plan subject to minimum funding standards to the plan and plan expenses include total
return/report for each year the plan has that has experienced a funding deficiency. benefits paid.
assets. In that case, the return/report must If item 12a is checked “Yes,” and item 6b 13a. Enter the total plan assets at the
be filed by the plan administrator, if indicates this is a defined benefit pension beginning and end of the plan year. Plan
designated, or by the person or persons plan, complete and attach Schedule B assets may include, among other things:
who actually control the plan’s property. (Form 5500) to this form. All defined 1. Cash, including both interest and
If all assets were used to buy individual benefit plans are subject to minimum noninterest bearing. This includes all cash
annuity contracts and the contracts were funding standards, except fully insured on hand or in a financial institution
distributed to the participants, check plans, church plans, governmental plans, including money market funds.
“Yes.” and certain other plans covered by Code 2. Receivables, including all
If all the plan assets were legally section 412(h). Code section 412 describes contributions due to the plan from the
transferred to the control of another plan the minimum funding standards applicable employer and participants, income earned,
or brought under control of PBGC, check to defined contribution plans qualified but not yet received by the plan, and
“Yes.” under Code section 401(a) or 403(a). A receivables from any other source.
9. Check “Yes,” if either the funding deficiency occurs if the amount of 3. Investments including securities
contributions to the plan or the benefits required employer contribution for the plan (stocks, bonds, U.S. Government
paid by the plan are subject to the year exceeds the actual contribution paid obligations, municipal obligations, etc.);
collective-bargaining process, even if the by the employer for the plan year. If the real property (land, buildings, gold,
plan is not established and administered answer to this question is “No” or “Not furniture, equipment, etc.); loans
by a joint board of trustees. Check “Yes” Applicable,” check “No,” and go to item (mortgages, promissory notes, etc.); and all
even if only some of those covered by the 13. other investments (certificates of deposit,
plan are members of a 12b. If item 12a is checked “Yes,” this repurchase agreements, land contracts,
collective-bargaining unit that negotiates item must be answered. If a funding units of participation in common/collective
benefit levels on its own behalf. The deficiency occurs, Form 5330 must be filed trusts and pooled separate accounts,
benefit schedules do not have to be with the IRS to pay the excise tax on the shares of registered investment companies
identical for all employees under the plan. amount of the deficiency. (mutual funds), interests in master trusts
10. The insurance company (or similar Caution: There is a penalty for not filing and 103-12 IEs, etc.).
organization) that provides benefits is Form 5330 on time. Plans holding units of participation in
required to provide the plan administrator 13 and 14. Use either the cash, modified common/collective trusts and/or pooled
with the information needed to complete accrual, or accrual basis for recognition of separate accounts must attach to the Form
the return/report, pursuant to ERISA transactions in items 13 and 14, as long as 5500-R either the statement of assets and
section 103(a)(2). If you do not receive this one method is used consistently. Round liabilities of the common/collective trust
information in a timely manner, contact the off all amounts in items 13 and 14 to the and/or pooled separate account or the
Page 11
required certification. For details, see 29 value is not available) on the date the others. Section 412 of ERISA and the
CFR sections 2520.103-3, 2520.103-4, property was distributed. regulations found at 29 CFR 2580 provide
2520.103-5, and 2520.103-9. 2. Payments to insurance carriers and the bonding requirements including the
Plans in a master trust must include the similar organizations (including Blue Cross, definition of “handling” (29 CFR
value of the plan’s interest in the master Blue Shield, and health maintenance 2580.412-6), the permissible forms of
trust, which is the sum of the net values of organizations). bonds (29 CFR 2580.412-10), the amount
the plan’s interest in all of the master trust 3. Payments to provide benefits for such of the bond (29 CFR 2580, Subpart C), and
investment accounts. The net values of things as legal services, day care services, certain exemptions such as the exemption
such interests are obtained by multiplying training and apprenticeship services. for unfunded plans, certain banks and
the plan’s percentage interest in each insurance companies (ERISA section 412)
4. Administrative expenses including: and the exemption allowing plan officials to
master trust investment account by the net
assets of the investment account (total a. Salaries to employees of the plan. purchase bonds from surety companies
assets minus total liabilities) at the b. Expenses for accounting, actuarial, authorized by the Secretary of the Treasury
beginning and end of the plan year. legal, and investment services. as acceptable reinsurers on Federal bonds
13b. Enter the total liabilities at the c. Fees and expenses for trustees (29 CFR 2580.412-23).
beginning and end of the plan year. including reimbursement for travel, Check “Yes” only if the plan itself (as
Liabilities to be entered here do not seminars, and meeting expenses. opposed to the plan sponsor or
include the value of future pension d. Fees paid for valuations and administrator) is a named insured under a
payments to plan participants; however, appraisals. fidelity bond covering plan officials and if
the amount to be entered in item 13b for 14c. Enter the net income (loss). the plan is protected as described in 29
accrual basis filers includes, among other Subtract item 14b from item 14a. If the CFR 2580.412-18.
things: result is a negative number, enter it in Plans are permitted under certain
1. Benefit claims that have been parentheses. conditions to purchase fiduciary liability
processed but have not been paid, 14d. Enter the total contributions insurance. These policies do not protect
2. Accounts payable obligations owed by received, for accrual basis plans, the plan from dishonest acts and are not
the plan that were incurred in the normal contributions due to be received, from the bonds that should be reported in
operations of the plan but have not been employer, participants and/or any other item 15.
paid, source. These contributions are to be 15c. If item 15a is answered “Yes,” item
3. Other liabilities such as acquisition included in the amount of income entered 15c must be answered. Check item 15c
indebtedness and any other amount owed on item 14a. “Yes” if the plan has suffered or
by the plan. 14e. Include: (1) payments made (and discovered any loss as the result of a
for accrual basis filers payments due) to dishonest or fraudulent act(s). If “Yes,”
13c. Enter the net assets as of the enter the full amount of the loss. If the full
beginning and end of the plan year. participants or beneficiaries in cash,
securities, or other property; (2) payments amount of the loss has not yet been
Subtract item 13b from item 13a. determined, provide and disclose that the
14a. Enter all plan income during the to insurance companies and similar
organizations such as Blue Cross, Blue figure is an estimate, such as
year. Plan income received and/or “Approximately $1,000.”
receivable may include, among other Shield, and health maintenance
organizations for the provision of plan Note: Willful failure to report is a criminal
things: offense. See ERISA section 501.
benefits (e.g., paid-up annuities, accident
1. Interest on investments (including insurance, health insurance, vision care, 15d. For purposes of item 15, the term
money market funds, sweep accounts, dental coverage, etc.); (3) payments made “employer” includes affiliates of the
STIF accounts, etc.). to other organizations or individuals employer. In determining the five most
2. Dividends. (Accrual basis plans should providing benefits. Generally, the payments highly paid employees, use all
include dividends declared for all stock discussed in (3) are made to individual compensation paid including cash,
held by the plan even if the dividends have providers of welfare benefits such as legal bonuses, and noncash payments (e.g., the
not been received as of the end of the plan services, day care services, and training use of a car). A fiduciary is a person with
year.) and apprenticeship services. If securities or respect to a plan to the extent: (1) he or
3. Rents from income-producing other property are distributed to plan she exercises any discretionary authority or
property owned by the plan. participants or beneficiaries, include the discretionary control with respect to the
4. Royalties. fair market value (or a good-faith estimate management of such plan or exercises any
5. All contributions including securities or if fair market value is not available) on the authority or control over the management
other noncash property contributed to the date of distribution. These benefits are to or disposition of its assets, (2) he or she
plan. be included in the amount of the expenses renders investment advice for a fee or
entered in item 14b. other compensation, direct or indirect, with
6. Net gain or loss from the sale of
15. Check “Yes” or “No.” “N/A” may not respect to any moneys or other property of
assets.
be used as an answer. A “Yes” answer such plan, or has any authority or
7. Other income such as unrealized requires the total amount to be entered in responsibility to do so, or (3) he or she has
appreciation (depreciation) in plan assets. the amount column. Round off all amounts any discretionary authority or discretionary
To compute this amount subtract the to the nearest dollar. responsibility in the administration of such
current value of all assets at the beginning plan.
of the year plus the cost of any assets 15a. Check “Yes” and indicate the
aggregate amount of coverage available for Relatives include spouses, siblings,
acquired during the plan year from the
all claims if every plan official who handles ancestors, lineal descendents (e.g.,
current value of all assets at the end of the
plan funds is covered by a bond. children, grandchildren, etc.), and spouses
year minus assets disposed of during the
Otherwise, check “No.” Generally, every of lineal descendents. If item 15d is
plan year. A negative figure should be
plan official of an employee benefit plan answered “Yes,” enter the total amount of
placed in parentheses.
who “handles” funds or other property of these transactions.
14b. Enter all the expenses of the plan such plan must be bonded. A plan 15e. See item 15d above for the
during the year. Expenses (paid and/or administrator, officer, or employee shall be definitions of the parties involved. If item
payable) may include, among others: deemed to be “handling” funds or other 15e is answered “Yes,” enter the total
1. Direct payments made to participants property of a plan, so as to require amount of the transactions.
or beneficiaries in cash, securities, or other bonding, whenever his or her duties or 15f. An “employer security” is a security
property. If the securities or other property activities with respect to given funds are issued by an employer (including affiliates)
are distributed to plan participants or such that there is a risk that such funds of employees covered by the plan. These
beneficiaries, include the fair market value could be lost in the event of fraud or may include common stocks, preferred
(or a good-faith estimate if fair market dishonesty on the part of such person, stocks, bonds, zero coupon bonds,
acting either alone or in collusion with
Page 12
debentures, convertible debentures, notes, 2. Any series of transactions with, or in enter the value of the security as
and commercial paper. conjunction with, the same person, established by the plan.
Employer real property is any real involving property other than securities, 15o. You must check “Yes,” if any
property (and related personal property) which amount in the aggregate within the benefits were not timely paid or not paid in
owned by the plan and leased to the plan year (regardless of the category of full.
employer of employees covered by the asset and the gain or loss on any 16a. If you are uncertain if the plan is
plan. This may include land, warehouses, transaction) to more than 20% of the covered under the PBGC termination
office buildings, etc. If item 15f is checked current value of plan assets; insurance program, check the box “Not
“Yes,” enter the total amount of employer 3. Any transaction within the plan year determined,” contact the PBGC, and
securities and/or employer real property involving securities of the same issue if request a coverage determination. Welfare
held or acquired. within the plan year any series of and fringe benefit plans do not complete
15g. Generally, a loan requires that both transactions with respect to such securities this item.
the principal and interest be paid amount in the aggregate to more than
according to a pre-established repayment 20% of the current value of the plan Form 5500-R Filers Stop Here.
schedule. If the principal and/or interest assets; or
has not been paid in accordance with the 4. Any transaction within the plan year
original repayment schedule and the period with respect to securities with, or in Form 5500-C, Pages 3 Through 6
for repayment of the principal and/or conjunction with, a person if any prior or (Pages 3 through 6, items 6e through 28
interest has been extended, or the loan subsequent single transaction within the are completed for Form 5500-C filers only.)
has been renegotiated after the original plan year with such person, with respect to 6e. See pages 4 and 5 for definitions
repayment schedule has not been met, securities, exceeds 20% of the current and other information pertaining to master
check “Yes” and enter the total amount of value of plan assets. The 20% figure is trusts, 103-12 investment entities,
the delinquent loan. Otherwise, check determined by comparing the current value common/collective trusts and pooled
“No.” of the transaction at the transaction date separate accounts, and the instructions for
15i. Check “Yes” for obligations where with the current value of the plan assets at items 26 through 28 for specific reporting
the required payments have not been the beginning of the plan year. See 29 CFR requirements for plans which utilize these
made by the due date. With respect to 2520.103-6 and read “20%” whenever entities.
notes and loans, the due date, payment “5%” appears in the regulation. 6e(1). In the space provided in line 6e,
amount, and conditions for default are If the assets of two or more plans are enter the name of the trust and financial
usually contained in the note or loan maintained in one trust, the plan’s institution. Also enter the city and state
document. Defaults can occur at any time allocable portion of the transactions of the where the trust is maintained. (See Master
for those obligations that require periodic trust shall be combined with the other Trust on page 4 for instructions.)
repayment. Generally, loans and fixed transactions of the plan, if any, to 6e(2). In the space provided in line 6e,
income obligations are considered determine which transactions (or series of enter the name and address of the 103-12
uncollectible when payment has not been transactions) are reportable (20%) IE. (See page 7.)
made and there is little probability that transactions.
6f. For single-employer pension plans
payment will be made. A loan by the plan Exception. For investments in enter the date the employer’s tax year
is in default when the borrower is unable common/collective trusts, pooled separate ends. For example, if the tax year is a
to pay the obligation upon maturity. A fixed accounts, 103-12 IEs, and registered calendar year, enter December 31, 1992.
income obligation has a fixed maturity date investment companies, determine the 20% For all plans with more than one employer,
at a specified interest rate. If item 15i is figure by comparing the transaction date enter “N/A.”
checked “Yes,” enter the total amount of value of the acquisition and/or disposition
loans by the plan or fixed income 6g and 6h. A defined benefit plan is
of units of participation or shares in the
obligations that are uncollectible or in generally either subject to the minimum
entity with the current value of the plan
default as of the plan year end. funding requirements under Code section
assets at the beginning of the plan year.
412 or is a fully insured plan that is exempt
15j. Consider all fiduciaries and parties Check “No” if all plan funds are held in a
from the minimum funding requirements
providing services to the plan, including: master trust. Do not include individual
under Code section 412(i). However, a plan
(1) persons who are fiduciaries by reason transactions of common/collective trusts,
is considered a 412(i) plan whether or not
of their relationship to a master trust pooled separate accounts, 103-12 IEs, and
all or part of the plan is trusteed or a
investment account or 103-12 IE in which registered investment companies.
noninsured top-heavy side fund is
the plan has an interest or the assets in If item 15l is answered “Yes,” enter the maintained. All such plans must check
such an investment account or 103-12 IE; amount. their 412(i) status in item 6g. Check box 6h
and (2) parties providing services rendered 15m. Check “No” if the plan received all if any part of the plan that was formerly
with respect to assets held in master trusts of its contributions in cash. Generally, as it subject to the minimum funding
and 103-12 IEs. relates to this question, an appraisal by an requirements under section 412 for either
See item 15d above for the definition of unrelated third party is an evaluation of the of the prior two plan years has become
fiduciary. value of the asset contributed prepared by exempt under section 412(i).
15k. Include as a single security all an individual or firm who knows how to Note: All defined benefit plans subject to
securities of the same issue. An example judge the value of the asset and does not the minimum funding requirements under
of a single issue is a certificate of deposit have an ongoing relationship with the plan Code section 412 must complete item 15a
issued by the XYZ Bank on July 1, 1992, or plan fiduciaries except for preparing the and attach Schedule B (Form 5500). Also
which matures on June 30, 1993, and appraisal. If item 15m is checked “Yes,” complete item 15a and attach Schedule B
yields 6.5%. For the purposes of item 15k, enter the value of the asset as established (Form 5500) for all 412(i) plans where all
do not check “Yes” for securities issued by by the plan. premiums for the plan year required under
the U.S. Government or its agencies. If 15n. Nonpublicly traded securities are section 412(i) have not been paid before
item 15k is checked “Yes,” enter the total. generally held by few people and not lapse of any insurance contract under the
15l. In determining the 20% figure, traded on a stock exchange. Generally, as plan and/or where a noninsured top-heavy
subtract the current value of plan assets it relates to this question, an appraisal by side fund is maintained.
held in any master trust or 103-12 IE from an unrelated third party is an evaluation of 7. The description of “participant” in the
the current value of the plan’s total assets the value of the security prepared by an instructions below is only for purposes of
at the beginning of the plan year. Check individual or firm who knows how to judge item 7 of this form.
“Yes,” if the plan had: the value of the security and does not
For welfare plans, the number of
1. A single transaction within the plan have an ongoing relationship with the plan
participants should be determined by
year in excess of 20% of the current value or plan fiduciaries except for preparing the
reference to 29 CFR 2510.3-3(d).
of the plan assets; appraisal. If item 15n is answered “Yes,”
Dependents are considered to be neither
Page 13
participants nor beneficiaries. For pension 7d(1). If “Yes,” file Schedule SSA (Form 10a. If this plan was merged or
benefit plans, “alternate payees” entitled to 5500) as an attachment to the Form consolidated into another plan(s), or plan
benefits under a qualified domestic 5500-C. Plan administrators: Code assets or liabilities were transferred to
relations order are not to be counted as section 6057(e) provides that the plan another plan(s), indicate which other plan
participants for this item. administrator must give each participant a or plans were involved.
“Participant” means any individual who statement showing the same information 10c. Enter the EIN of the sponsor
is included in one of the categories below. for that participant as is reported on (employer, if for a single-employer plan) of
a. Active participants include any Schedule SSA. the other plan.
individuals who are currently in 8a. Check “Yes” if an amendment to the 10e. Pension benefit plans must file
employment covered by a plan and who plan was adopted, regardless of the Form 5310-A, Notice of Merger,
are earning or retaining credited service effective date of the amendment. Consolidation or Transfer of Plan Assets or
under a plan. This category includes any 8b. Enter the date the most recent Liabilities, at least 30 days before any plan
individuals who are: (1) currently below the amendment was adopted regardless of the merger or consolidation or any transfer of
integration level in a plan that is integrated date of the amendent or the effective date plan assets or liabilities to another plan.
with social security, and/or (2) eligible to of the amendment. Caution: There is a penalty for not filing
elect to have the employer make payments 8c. Check “Yes” only if the accrued Form 5310-A on time.
to a Code section 401(k) qualified cash or benefits were retroactively reduced. For 11. Funding Arrangement.—Enter the
deferred arrangement. Active participants example, a plan provides a benefit of 2% code for the funding arrangement used
also include any nonvested individuals who for each year of service, but the plan is by the plan for the plan year from the list
are earning or retaining credited service amended to change the benefit to 11⁄2% a below.
under a plan. This category does not year for all years of service under the plan.
include nonvested former employees who The “funding arrangement” is the
Do not check “Yes,” if accrued benefits method used during the plan year for the
have incurred the break in service period were retroactively reduced solely to the
specified in the plan. receipt, holding, investment, and
extent permitted under a model transmittal of plan assets prior to the time
For determining if active participants are amendment provided in IRS Notice 88-131, the plan actually provides the benefits
fully vested, partially vested, or nonvested, 1988-2 C.B. 546. promised under the plan. For purposes of
consider vesting in employer contributions 8d. Check “Yes” only if an amendment items 11 and 12, the term “trust” includes
only. changed the information previously any fund or account that receives, holds,
b. Inactive participants receiving benefits provided to participants by the summary transmits, or invests plan assets other than
are any individuals who are retired or plan description or summary description of an account or policy of an insurance
separated from employment covered by modifications. company.
the plan and who are receiving benefits 8e. A revised summary plan description Note: An employee benefit plan that enters
under the plan. This includes former or summary description of modifications code 2, 3, or 5 in item 11 and/or 12 must
employees who are receiving group health must be filed with DOL and distributed to attach a Schedule A (Form 5500),
continuation coverage benefits pursuant to all participants and pension plan Insurance Information, to provide
Part 6 of ERISA and who are covered by beneficiaries no later than 210 days after information pertaining to each contract
the employee welfare benefit plan. This the close of the plan year, in which the year ending with or within the plan year.
category does not include any individual to amendment(s) was adopted. If the material See the Schedule A (Form 5500)
whom an insurance company has made an was distributed and filed since the instructions.
irrevocable commitment to pay all the amendments were adopted (even if after
benefits to which the individual is entitled Plan Funding
the end of the plan year), check item 8e
under the plan. Arrangement Codes
“Yes.” Trust 1
c. Inactive participants entitled to future 9a. Check “Yes” if the plan was Trust and insurance 2
benefits are individuals who are retired or terminated or if the plan was merged or Insurance 3
separated from employment covered by consolidated into another plan. Enter year Exclusively from general assets
the plan and who are entitled to begin of termination if applicable. of sponsor (unfunded) 4
receiving benefits under the plan in the 9b. If the plan was terminated but all Partially insured and partially
future. This category does not include any plan assets were not distributed, a from general assets of sponsor 5
individual to whom an insurance company return/report must be filed for each year Other 6
has made an irrevocable commitment to the plan has assets. In that case, the 12. Benefit arrangement.—Enter the
pay all the benefits to which the individual return/report must be filed by the plan code for the benefit arrangement used by
is entitled under the plan. administrator, if designated, or by the the plan for the plan year from the list
d. Deceased participants are any person or persons who actually control the below.
deceased individuals who have one or plan’s property. The “benefit arrangement” is the method
more beneficiaries who are receiving or are If all plan assets were used to buy by which benefits were actually provided
entitled to receive benefits under the plan. individual annuity contracts and the by the plan during the plan year to
This category does not include an contracts were distributed to the participants. For example, if all participants
individual if an insurance company has participants, check “Yes.” If all the plan received their benefits from a trust (as
made an irrevocable commitment to pay all assets were legally transferred to another defined in 11 above), the plan’s benefit
the benefits to which the beneficiaries of plan or brought under the control of arrangement code would be “1.” If some
that individual are entitled under the plan. PBGC, check “Yes.” benefits come from a trust and some come
7b. Enter the number of participants Do not check “Yes” for a welfare benefit from an insurance company, the code
included in item 7a(2) (total participants at plan that is still liable to pay benefits for would be “2.” If all benefits were paid from
the end of the plan year) who have claims that were incurred prior to the an account or policy of an insurance
account balances. For example, for a Code termination date but not yet paid. See 29 company, the code would be “3.”
section 401(k) plan, the number entered in CFR 2520.104b-2(g)(2)(ii). Plan Benefit
item 7b should be the number of Arrangement Codes
participants counted in item 7a(2) who 9h. The Code provides for a
nondeductible excise tax on a reversion of Trust 1
have made a contribution to the plan Trust and insurance 2
during this plan year or any prior plan year. assets from a qualified plan.
Insurance 3
7c. Include any participant who 9i. The employer must report the Exclusively from general assets
terminated employment during this plan reversion by filing Form 5330 and pay any of sponsor (unfunded) 4
year, whether or not the participant applicable tax. The tax will not be imposed Partially insured and partially
incurred a break in service. upon employers who are tax-exempt from general assets of sponsor 5
entities under Code section 501(a). See the Other 6
instructions for Form 5330.
Page 14
13. Check “Yes” if either the required. The following is a partial listing of The Tax Reform Act of 1986 provides
contributions to the plan or the benefits circumstances where spousal consent is that a participant’s previously accrued
paid by the plan are subject to the not required: benefit will not be reduced merely because
collective-bargaining process, even if the 1. The participant is not married and no of the reduction in dollar limits or increases
plan is not established and administered former spouse is required to be treated as in required periods of participation. The
by a joint board of trustees. Check “Yes” a current spouse under a qualified transitional rule applies to an individual
even if only some of those covered by the domestic relations order issued by a court. who was a participant prior to January 1,
plan are members of a 2. The participant’s nonforfeitable 1987, in a plan in existence on May 5,
collective-bargaining unit that negotiates accrued benefit in the plan does not have 1986. If this participant’s current accrued
benefit levels on its own behalf. The a present value of more than $3,500 at the benefit exceeds the dollar limit under the
benefit schedules need not be identical for time of distribution. Tax Reform Act of 1986, but complies with
all employees under the plan. prior law, then the applicable dollar limit for
3. The benefit is paid in the form of a the participant is equal to the current
14. If either the funding arrangement qualified joint and survivor annuity (i.e., an
code (item 11) and/or the benefit accrued benefit. The term “current accrued
annuity for the life of the participant with a benefit” is defined as the participant’s
arrangement code (item 12) is 2, 3, or 5, at survivor annuity for the life of the spouse
least one Schedule A (Form 5500) must be accrued benefit as of the close of the last
that is not less than 50% of (and is not limitation year beginning before January 1,
attached to the Form 5500-C filed for greater than 100% of) the amount of the
pension and welfare plans to provide 1987, and expressed as an annual benefit.
annuity that is payable during the joint lives To compute the defined benefit fraction,
information concerning the contract year of the participant and the spouse). See
ending with or within the plan year. The the current accrued benefit would replace
Code section 417(b). the dollar limit otherwise used in the
insurance company (or similar organization)
that provides benefits is required to 4. The payout is from a profit-sharing or denominator of the fraction. The current
provide the plan administrator with the stock bonus plan that pays the spouse the accrued benefit is also reflected in the
information needed to complete the participant’s full account balance upon the numerator of the defined benefit fraction.
return/report, pursuant to ERISA section participant’s death, an annuity payment is 20. Employees must begin to receive
103(a)(2). If you do not receive this not elected by the participant, and the minimum distributions pursuant to Code
information in a timely manner, contact the profit-sharing or stock bonus plan is not a section 401(a)(9) by April 1 of the calendar
insurance company (or similar transferee plan with respect to the year following the calendar year in which
organization). If information is missing on participant (i.e., had not received a transfer they attain age 701⁄2. Once begun, minimal
Schedule A (Form 5500) due to a refusal to from a plan that was subject to the distributions must continue each calendar
provide this information, note this on the consent requirements with respect to the year. If your plan was required to make
Schedule A. If there is no Schedule(s) A participant). distributions and did not, check, “No.” If
attached, enter “0.” 5. The participant had no service under your plan made the required distributions,
15b. If a waived funding deficiency is the plan after August 22, 1984. check “Yes.” If no distributions were
being amortized in the current plan year, 17d. A plan may not eliminate a required, enter “N/A.”
do not complete (1), (2), and (3), but subsidized benefit or a retirement option 21. An employer may complete item 21
complete 1, 2, 3, 7, and 9 of Schedule B by plan amendment or plan termination. based upon a reasonable, good faith
(Form 5500). An enrolled actuary does not 18. If distributions were not made in interpretation of Code sections 410(b),
have to sign Schedule B under these accordance with the joint and survivor 401(a)(4), and other related Code sections,
circumstances. annuity rules of Code sections 411(a)(11) that differs from the regulations under such
15b(3). File Form 5330 with the IRS to and 417(e) answer “No.” If distributions did Code sections. Check the box in 21(i) if
pay the excise tax on the funding comply with Code sections 411(a)(11) and you are applying a reasonable, good faith
deficiency. 417(e), answer “Yes.” If no distributions interpretation that differs from the
Caution: There is a penalty for not filing were made, enter “N/A.” regulations under such Code sections. You
Form 5330 on time. 19. The maximum annual benefit may, but need not, attach an explanation
provided under a defined benefit plan may of the areas in item 21 in which such a
17a(1). Check “Yes,” if the plan reasonable, good faith interpretation is
distributed any annuity contracts. Check not exceed the lesser of $112,221 or
100% of average annual compensation. being applied.
“Yes” even if the plan was terminated.
However, if benefits begin before the social Announcement 92-81, 1992-22 I.R.B. 56,
17a(2). If “Yes” was checked for item security retirement age, the $112,221 limit issues in proposed form, a revenue
17a(1), the annuity contract must provide must be reduced as described in IRS procedure designed to reduce the
that all distributions from it will meet the Notice 87-21, 1987-1 C.B. 458. administrative burdens of substantiating
participant and spousal consent compliance with the requirements of the
requirements of Code section 417. In addition, the dollar limitations will be
reduced for participants with fewer than 10 nondiscrimination provisions. The proposed
However, consent is not needed for the revenue procedure sets forth new
distributions of the contract itself. If the years of participation in a defined benefit
plan (i.e., a 10% reduction for each year guidelines with respect to: (1) the quality of
contracts contained the Code section 417 data used in substantiating compliance,
requirements, check “Yes.” under 10 years of participation).
For defined contribution plans, Code (2) the timing of nondiscrimination testing,
17b. In general, distributions must be (3) the identification of highly compensated
made in the form of a qualified joint and section 415 now provides that the dollar
limit on annual additions to a qualified plan employees, and (4) the testing cycle of a
survivor annuity for life or a qualified plan. Section 7 of the proposed revenue
preretirement survivor annuity. A qualified may not exceed the greater of $30,000 or
25% of the defined benefit dollar limit for procedure permits employers to rely on the
joint and survivor annuity for a participant substantiation guidelines contained in the
who is not married is an annuity for the life such limitation year. The limitation for
defined contribution plans under Code procedure while they are proposed.
of the participant. Check “Yes” if Employers may use these substantiation
distributions in other forms were made, section 415(c)(1)(A) remains at $30,000 for
1992 since the law provides that it shall guidelines in completing item 21. Check
even if such distributions were permissible the box in 21(ii) if you are relying on the
(e.g., because consent was obtained or not be changed until the Code section
415(b)(1)(A) limit ($112,221 for 1992) for substantiation guidelines of announcement
was not needed). 92-81 in completing item 21. An employer
defined benefit plans exceeds $120,000.
17c. Generally, within the 90 days prior using both a reasonable, good faith
to the date of any benefit payment or the Annual additions to a defined
interpretation that differs from the
date a loan was made to a participant, you contribution plan will, for years beginning
regulations and the substantiation
must get the spouse’s consent to the after December 31, 1986, include 100% of
guidelines should check the box in both
payment of the benefit or the use of the all after-tax employee contributions. For
21(i) and 21(ii). In addition, enter the first
accrued benefit to make the loan. participants in plans of tax-exempt
day of the plan year for which the
However, there are some circumstances organizations, the pre-Tax Reform Act
where obtaining this spousal consent is not limits remain in effect.
Page 15
coverage information is being submitted in nondiscrimination rules of Code section treated as benefiting even if they fail to
item 21. 401(a)(4) on an aggregated basis. Note that receive an allocation of contributions
In general, a plan must satisfy one of the a special aggregation rule applies for the and/or forfeitures, or to accrue a benefit
coverage tests on each day of the year purposes of computing the average benefit solely because the employee is subject to
being tested. However, if the plan satisfies percentage. See item 21o(1) below. If the plan provisions that limit plan benefits,
one of the tests on at least 1 day in each employer aggregates plans for the such as a provision for maximum years of
quarter of the year being tested, the plan purposes of the coverage and service, maximum retirement benefits, or
will be deemed to pass the coverage tests nondiscrimination tests (other than for the limits designed to satisfy Code section
for the entire year provided that the purpose of computing the average benefit 415. An employee is treated as benefiting
quarterly testing dates reasonably percentage), check this item “Yes,” and under a plan (or portion of a plan) that
represent the coverage of the plan over the complete the rest of item 21 for the plans provides for elective contributions under
entire plan year. Complete item 21 for the as aggregated. Code section 401(k) or after-tax employee
testing date selected by the employer 21e. Income Tax Regulations section contributions or matching contributions
(typically the last day of the plan year). For 1.401(a)(4)–9(c) allows an employer to under Code section 401(m) if the employee
an annual alternative testing option, see restructure a plan into component plans in is eligible to make elective contributions to
Income Tax Regulations section order to satisfy the coverage and the 401(k) plan or is eligible to make
1.410(b)-8(a)(4). discrimination tests. Check “Yes,” if the employee contributions or receive
Multiemployer plans (Code C in item 4) employer is satisfying the coverage and allocations of matching contributions to the
and multiple-employer collectively discrimination tests by restructuring the 401(m) plan.
bargained plans (Code D in item 4), need plan, and do not complete the rest of item 21o(1). A plan satisfies the average
not complete item 21. Multiple-employer 21. benefit test if it satisfies both the
plan (other) filers (Code E in item 4) are not 21f(1). Check this box if this plan nondiscriminatory classification test and
required to complete item 21. However, benefited no highly compensated the average benefit percentage test.
the participating employers in employees (within the meaning of Code A plan satisfies the nondiscriminatory
multiple-employer plan (other) pension section 414(q)). This box should be classification test if the plan benefits such
benefit plans are required to complete the checked for plans under which no employees as qualify under a classification
applicable questions in item 21 on the employee receives an allocation or accrues set up by the employer and found by the
Form 5500-C/R that they file. a benefit. See the instructions to item 21m Secretary not to be discriminatory in favor
21a. In general, if the employer operated for the definition of “benefiting”. of highly compensated employees. This
separate lines of business within the 21f(2). See Regulations section test takes into account all relevant facts
meaning of Code section 414(r) for a year, 1.410(b)-6(d)(2) for the definition of and circumstances, including: (1) the
the employer may apply the coverage and collectively bargained employee and difference between the coverage
nondiscrimination requirements separately Regulations section 1.410(b)-9 for the percentages of the highly compensated
with respect to employees in each definition of professional employee. employees and of the nonhighly
separate line of business. If item 21a is 21g. Check “Yes,” if any leased compensated employees, (2) the
“Yes,” complete items 21b through 21o for employee, within the meaning of Code percentage of total employees covered,
the separate line of business covered by section 414(n), performed services for the and (3) the difference between the
the plan as if the employees of the employer or any entity aggregated with the compensation of those employees covered
separate line of business were the sole employer under Code sections 414(b), (c), under the plan and those employees who
employees of the employer. If this plan or (m). are excluded from coverage under the
benefits employees in more than one plan. Under Income Tax Regulations
21h. Enter the total number of section 1.410(b)-4, a classification will be
separate line of business, complete item employees of the employer. Include all
21 for one of the lines of business and for deemed nondiscriminatory if the ratio in
self-employed individuals, common law item 21o(2) below is equal to or greater
each additional line of business covered by employees and leased employees, within
the plan submit an attachment completed than the safe harbor percentage. The safe
the meaning of Code section 414(n), of any harbor percentage is 50%, reduced by 3⁄4
in the same format as item 21. of the entities aggregated with the
21c. Certain single plans must be of a percentage point for each percentage
employer under Code sections 414(b), (c), point by which the nonhighly compensated
disaggregated into two or more separate or (m). If any employers are aggregated
plans. Each of the disaggregated parts of employee concentration percentage
under the family aggregation rules of exceeds 60%. The nonhighly compensated
the plan must then satisfy the coverage section 414(q)(6), for purposes of item 21,
requirements under Code section 410(b) as employee concentration percentage is the
treat the family group as a single employee percentage of all the employees of the
if it were a separate plan. Under the with aggregated compensation and
regulations, the following plans must be employer who are not highly compensated
benefits. employees.
disaggregated: (1) a plan that has a 21i. Enter the total number of excludable
section 401(k) provision (a qualified cash or In general, a plan satisfies the average
employees in the following categories: benefit percentage test if the actual benefit
deferred arrangement (CODA)) and a
provision that is not a 401(k) plan, (2) a 1. Employees who have not attained the percentage for nonhighly compensated
plan that has a section 401(m) provision minimum age and service requirements of employees is at least 70% of the actual
(employee and matching contributions) and the plan. benefit percentage for highly compensated
a provision that is not a 401(m) provision, 2. Collectively bargained employees. employees. All qualified plans (or parts of
(3) a plan that has an ESOP provision and 3. Nonresident aliens who receive no plans) of the employer, including ESOPs,
a provision that is not an ESOP, and (4) a U.S. source income. CODAs, and plans containing employee or
plan that benefits both collectively and 4. Employees who fail to benefit solely matching contributions (Code section
noncollectively bargained employees. because they fail to satisfy a minimum 401(k) or (m)) are aggregated in
If any of the above apply to your plan, hours of service or a last day requirement determining the actual benefit percentages.
complete item 21 for one of the under the plan. Do not aggregate plans that may not be
disaggregated plans and for each aggregated for the purposes of satisfying
21k. See the instructions for line 21m for
additional part of the plan that must be the ratio percentage test, other than
the definition of “benefiting”.
disaggregated, submit an attachment ESOPs and plans subject to Code section
21l. The definition of highly 401(k) or (m). In addition, all nonexcludable
completed in the same format as item 21. compensated employee is contained in employees, including those with no benefit
21d. Employers can satisfy coverage by Code section 414(q) and its regulations. under any qualified plan of the employer,
aggregating any qualified pension or 21m. In general, an employee is are included in determining the actual
profit-sharing plans that are not “benefiting” if he or she receives an benefit percentages.
mandatorily disaggregated under the rules allocation of contributions or forfeitures, or
for item 21c above. However, the 21o(2). In general, to compute the ratio
accrues a benefit under the plan for the divide the number of nonexcludable
aggregated plan must also satisfy the plan year. Certain other employees are
Page 16
employees who benefit under the plan and the plan from dishonest acts and are not the due date. With respect to notes and
are not highly compensated by the total bonds that should be reported in item 26. loans, the due date, payment amount and
number of nonexcludable nonhighly 26c. If item 26a is answered “Yes,” item conditions for default are usually contained
compensated employees; put this result in 26c must be answered. Check item 26c in the note or loan document. Defaults can
the numerator (top of the fraction). Divide “Yes,” if the plan has suffered or occur at any time for those obligations that
the number of nonexcludable employees discovered any loss as the result of a require periodic repayment. Generally,
who benefit under the plan and who are dishonest or fraudulent act(s). If “Yes,” loans and fixed income obligations are
highly compensated by the total number of enter the full amount of the loss. If the full considered uncollectible when payment
nonexcludable highly compensated amount of the loss has not yet been has not been made and there is little
employees; put this result in the determined, provide and disclose that the probability that payment will be made. A
denominator (bottom of the fraction). figure is an estimate, such as loan by the plan is in default when the
Divide the numerator by the denominator “Approximately $1,000.” borrower is unable to pay the obligation
and put the result on item 21o(2). Note: Willful failure to report is a criminal upon maturity. A fixed income obligation
22a. Check “Yes” if it is your intention offense. See ERISA section 501. has a fixed maturity date at a specified
that this plan qualify under Code section interest rate. If item 26i is checked “Yes,”
26d. For purposes of item 26, the term enter the total amount of loans by the plan
401(a). Otherwise, check “No” and go to “employer” includes affiliates of the
item 23a. or fixed income obligations that are
employer. In determining the five most uncollectible or in default as of the plan
22b. If item 22a is “Yes,” and you have highly paid employees, use all
received a determination letter from the year end.
compensation paid including cash,
IRS, enter the date of the most recent bonuses, and noncash payments (e.g., the 26j. Consider all fiduciaries and parties
determination letter received. use of a car). A fiduciary is a person with providing services to the plan, including:
22c. Check “Yes” if you have applied for respect to a plan to the extent: (1) he or (1) persons who are fiduciaries by reason
a determination letter from IRS but have she exercises any discretionary authority or of their relationship to a master trust
not received a reply. Otherwise, check discretionary control with respect to the investment account or 103-12 IE in which
“No.” management of such plan or exercises any the plan has an interest or the assets in
authority or control with respect to the such an investment account or 103-12 IE;
25a. If you are uncertain whether the and (2) parties providing services rendered
plan is covered under the PBGC management or disposition of its assets,
(2) he or she renders investment advice for with respect to assets held in master trusts
termination insurance program, check the and 103-12 IEs.
box “Not determined,” contact the PBGC, a fee or other compensation, direct or
and request a coverage determination. indirect, with respect to any monies or See item 26d above for the definition of
other property of such plan, or has any fiduciary.
26. Check “Yes” or “No.” “N/A” may
not be used as an answer. A “Yes” authority or responsibility to do so, or 26k. Include as a single security all
answer requires the total amount to be (3) he or she has any discretionary securities of the same issue. An example
entered in the amount column. Round off authority or discretionary responsibility in of a single issue is a certificate of deposit
all amounts to the nearest dollar. the administration of such plan. issued by XYZ Bank on July 1, 1992,
“Relatives” include spouses, siblings, which matures June 30, 1993, and yields
26a. Check “Yes” and indicate the 6.5%. For the purposes of item 26k, do
aggregate amount of coverage available for ancestors, lineal descendents (e.g.,
children, grandchildren, etc.), and spouses not check “Yes” for securities issued by
all claims if every plan official who handles the U.S. Government or its agencies. If
plan funds is covered by a bond. of lineal descendents. If item 26d is
answered “Yes,” enter the total amount of item 26k is checked “Yes,” enter the total.
Otherwise, check “No.” Generally, every
plan official of an employee benefit plan these transactions. 26l. In determining the 20% figure,
who “handles” funds or other property of 26e. See 26d above for the definitions of subtract the current value of plan assets
such plan must be bonded. A plan the parties involved. If item 26e is held in any master trust or 103-12 IE from
administrator, officer, or employee shall be answered “Yes,” enter the total amount of the current value of the plan’s total assets
deemed to be “handling” funds or other the transactions. at the beginning of the plan year. Check
property of a plan, so as to require 26f. An “employer security” is a security “Yes,” if the plan had:
bonding, whenever his or her duties or issued by an employer (including affiliates) 1. A single transaction within the plan
activities with respect to given funds are of employees covered by the plan. These year in excess of 20% of the current value
such that there is a risk that such funds may include common stocks, preferred of the plan assets;
could be lost in the event of fraud or stocks, bonds, zero coupon bonds, 2. Any series of transactions with (or in
dishonesty on the part of such person, debentures, convertible debentures, notes, conjunction with) the same person,
acting either alone or in collusion with and commercial paper. involving property other than securities,
others. Section 412 of ERISA and the Employer real property is any real that amount in the aggregate within the
regulations found at 29 CFR 2580 provide property (and related personal property) plan year (regardless of the category of
the bonding requirements including the owned by the plan and leased to the asset and the gain or loss on any
definition of “handling” (29 CFR employer of employees covered by the transaction) to more than 20% of the
2580.412-6), the permissible forms of plan. This may include land, warehouses, current value of plan assets;
bonds (29 CFR 2580.412-10), the amount office buildings, etc. If item 26f is checked 3. Any transaction within the plan year
of the bond (29 CFR 2580, Subpart C), and “Yes,” enter the total amount of employer involving securities of the same issue if
certain exemptions such as the exemption securities and/or employer real property within the plan year any series of
for unfunded plans, banks and insurance held or acquired. transactions with respect to such securities
companies (ERISA section 412) and the 26g. Generally, a loan requires that both amount in the aggregate to more than
exemption allowing plan officials to the principal and interest be paid 20% of the current value of the plan
purchase bonds from surety companies according to a pre-established repayment assets; or
authorized by the Secretary of the Treasury schedule. If the principal and/or interest 4. Any transaction within the plan year
as acceptable reinsurers on Federal bonds has not been paid in accordance with the with respect to securities with, or in
(29 CFR 2580.412-23). original repayment schedule and the period conjunction with, a person if any prior or
Check “Yes” only if the plan itself (as for repayment of the principal and/or subsequent single transaction within the
opposed to the plan sponsor or interest has been extended, or the loan plan year with such person, with respect to
administrator) is a named insured under a has been renegotiated after it has not met securities, exceeds 20% of the current
fidelity bond covering plan officials and if the original repayment schedule, check value of plan assets. The 20% figure is
the plan is protected as described in 29 “Yes,” and enter the total amount of the determined by comparing the current value
CFR 2580.412-18. delinquent loan. Otherwise, check “No.” of the transaction at the transaction date
Plans are permitted under certain 26i. Check “Yes” for obligations if the with the current value of the plan assets at
conditions to purchase fiduciary liability required payments have not been made by the beginning of the plan year. (See 29
insurance. These policies do not protect
Page 17
CFR 2520.103-6 and read “20%” on page 7), complete items 27 and 28 by contracts reported in item 27 that you
whenever “5%” appears in the regulation.) entering the plan’s allocable part of each used for line 6e of the Schedule A (Form
If the assets of two or more plans are line item. 5500) as long as the contract values are
maintained in one trust, the plan’s If assets of one plan are maintained in stated as of the beginning and end of the
allocable portion of the transactions of the two or more trust funds, report the plan year.
trust shall be combined with the other combined financial information in items 27 Liabilities include among other things:
transactions of the plan, if any, to and 28. 1. Benefit claims payable—claims that
determine which transactions (or series of Total plan assets at the beginning of the have been processed and approved for
transactions) are reportable (20%) plan year plus net income (loss) at the end payment but have not been paid.
transactions. of the plan year (28k) must equal the total 2. Accounts payable—obligations owed
Exception: For investments in plan assets at the end of the plan year. by the plan that were incurred in the
common/collective trusts, pooled separate A fully insured pension plan meeting the normal operations of the plan and have
accounts, 103-12 IEs, and registered conditions of 29 CFR 2520.104-44 need been approved for payment but not been
investment companies, determine the 20% not complete items 27 and 28. For more paid.
figure by comparing the transaction date details, see page 11 of the instructions 3. Other liabilities—such as acquisition
value of the acquisition and/or disposition under items 13 and 14. indebtedness and any other amount owed
of units of participation or shares in the 27. Plan assets may include, among by the plan.
entity with the current value of the plan other things:
assets at the beginning of the plan year. Liabilities do not include the value of
Check “No” if all plan funds are held in a a. Cash, both interest and noninterest future pension payments.
master trust. Do not include individual bearing. This includes all cash on hand or 27g. Enter total amount of claims that
transactions of common/collective trusts, in a financial institution including money have been processed and approved for
pooled separate accounts, 103-12 IEs, and market funds. payment directly from the trust but have
registered investment companies. b. All contributions due to the plan from not been paid. Do not include the value of
If item 26l is answered “Yes,” enter the the employer and participants, income future pension payments.
amount. earned, but not yet received by the plan, 27h. Acquisition indebtedness.—
and receivables from any other source. Acquisition indebtedness, for
26m. Check “No” if the plan received all
of its contributions in cash. Generally, for Note: Contributions designated for the debt-financed property other than real
this question, an appraisal by an unrelated 1992 plan year may not be included in property, means the outstanding amount of
third party is an evaluation of the value of column (a). the principal debt incurred:
the asset contributed prepared by an c. Investment securities (stocks, bonds, 1. By the organization in acquiring or
individual or firm who knows how to judge U. S. Government obligations, municipal improving the property;
the value of the asset and does not have obligations, etc.); real and personal 2. Before the acquisition or improvement
an ongoing relationship with the plan or property (land, buildings, gold, furniture, of the property if the debt was incurred
plan fiduciaries except for preparing the equipment, etc.); loans (mortgages, only to acquire or improve the property; or
appraisal. If item 26m is checked “Yes,” promissory notes, etc.); and all other 3. After the acquisition or improvement
enter the value of the asset as established investments (certificates of deposit, of the property if the debt was incurred
by the plan. repurchase agreements, land contracts, only to acquire or improve the property
26n. Nonpublicly traded securities are units of participation in common/collective and was reasonably foreseeable at the
generally held by few people and not trusts and pooled separate accounts, time of such acquisition or improvement.
traded on a stock exchange. Generally, for shares of registered investment companies
(mutual funds), interests in master trusts For further explanation, see Code
this question, an appraisal by an unrelated section 514(c).
third party is an evaluation of the value of and 103-12 IEs, etc.).
Plans holding units of participation in 27k. Column (b) must equal the sum of
the security prepared by an individual or column (a) plus item 28k.
firm who knows how to judge the value of common/collective trusts and/or pooled
separate accounts must attach to the 28a(1). If the plan is on the accrual
the security and does not have an ongoing
return/report either the statement of assets basis, enter the amount of contributions
relationship with the plan or plan
and liabilities of the common/collective received or accrued.
fiduciaries except for preparing the
appraisal. If item 26n is answered “Yes,” trust and/or pooled separate account or 28b. Show current value, at date
enter the value of the security as the certification discussed on page 4 of contributed, of securities or other noncash
established by the plan. these instructions. For details, see 29 CFR property contributed to the plan.
26o. You must check “Yes,” if any sections 2520.103-3, 2520.103-4, 28e. Other income includes unrealized
benefits were not timely paid or not paid in 2520.103-5, and 2520.103-9. appreciation (depreciation) in plan assets.
full. Plans in a master trust must include the To compute this amount subtract the
value of the plan’s interest in the master current value of all assets at the beginning
27 and 28. You can use either the cash,
trust that is the sum of the net values of of the year plus the cost of any assets
modified accrual, or accrual basis for
the plan’s interest in all of the master trust acquired during the plan year from the
recognition of transactions in items 27 and
investment accounts (see page 4 for the current value of all assets at the end of the
28, as long as you use one method
definition of master trust investment year minus assets disposed of during the
consistently.
account). The net values of such interests plan year. A negative figure should be
“Current value” means fair market value are obtained by multiplying the plan’s placed in parentheses.
where available. Otherwise, it means the percentage interest in each master trust 28g. If distributions include securities or
fair value as determined in good faith investment account by the net assets of other property, show the current value at
under the terms of the plan by a trustee or the investment account (total assets minus date distributed in this figure.
a named fiduciary, assuming an orderly total liabilities) at the beginning and end of
liquidation at the time of the determination. 28h. Report all administrative expenses
the plan year. paid by or charged to the plan, including
If the assets of two or more plans are 27c. Investments in securities of the U.S. those that were not subtracted from the
maintained in one trust, such as when an Government should be included in c(1). gross income of master trust investment
employer has two plans that are funded
You can use the same method for accounts and 103-12 IEs in determining
through a single trust (except investment
determining the value of the insurance their net investment gain(s) or loss(es).
arrangements filing with DOL as specified
Page 18
Code
Codes for Principal Business Activity Electrical and electronic machinery, equipment, and
and Principal Product or Service supplies:
3630 Household appliances.
These industry titles and definitions are based, in general, on the Enterprise Standard Industrial 3665 Radio, television, and communication
Classification System authorized by the Regulatory and Statistical Analysis Division, Office of equipment.
Information and Regulatory Affairs, Office of Management and Budget, to classify enterprises by type 3670 Electronic components and accessories.
of activity in which they are engaged. 3698 Other electric equipment.
Transportation equipment:
Code Code
3710 Motor vehicles and equipment.
AGRICULTURE, FORESTRY, AND FISHING Lumber and wood products:
3725 Aircraft, guided missiles, and parts.
0120 Field crop. 2415 Logging camps and logging contractors, 3730 Ship and boat building and repairing.
0150 Fruit, tree nut, and vegetable. sawmills, and planing mills. 3798 Other transportation equipment.
0180 Horticultural specialty. 2430 Millwork, plywood, and related products.
0230 Livestock. 2498 Other wood products, including wood Measuring and controlling instruments; photographic
0270 Animal specialty. buildings and mobile homes. and medical goods, watches and clocks:
Agricultural services and forestry: 2500 Furniture and fixtures.
Paper and allied products: 3815 Scientific instruments and measuring devices;
0740 Veterinary services. watches, and clocks.
0750 Animal services, except veterinary. 2625 Pulp, paper, and board mills. 3845 Optical, medical, and ophthalmic goods.
0780 Landscape and horticultural services. 2699 Other paper products. 3860 Photographic equipment and supplies.
0790 Other agricultural services. 3998 Other manufacturing products.
0800 Forestry. Printing, publishing, and allied industries:
Farms: 2710 Newspapers. TRANSPORTATION, COMMUNICATION,
2720 Periodicals. ELECTRIC, GAS, SANITARY SERVICES
Fishing, hunting, and trapping: 2735 Books, greeting cards, and miscellaneous Transportation:
0930 Commercial fishing, hatcheries, and preserves. publishing.
2799 Commercial and other printing, and printing 4000 Railroad transportation.
0970 Hunting, trapping, and game propagation.
trade services. Local and interurban passenger transit:
MINING Chemical and allied products: 4121 Taxicabs.
Metal mining: 2815 Industrial chemicals, plastics materials, and 4189 Other passenger transportation.
1010 Iron ores. synthetics. Trucking and warehousing:
1070 Copper, lead and zinc, gold and silver ores. 2830 Drugs.
1098 Other metal mining. 2840 Soap, cleaners, and toilet goods. 4210 Trucking, local and long distance.
1150 Coal mining. 2850 Paints and allied products. 4289 Public warehousing and trucking terminals.
2898 Agricultural and other chemical products.
Oil and gas extraction: Other transportation including transportation
Petroleum refining and related industries (including services:
1330 Crude petroleum, natural gas, and natural gas those integrated with extraction):
liquids. 4400 Water transportation.
1380 Oil and gas field services. 2910 Petroleum refining (including those integrated 4500 Transportation by air.
with extraction). 4600 Pipelines, except natural gas.
Nonmetallic minerals (except fuels) mining: 2998 Other petroleum and coal products. 4722 Passenger transportation arrangement.
1430 Dimension, crushed and broken stone; sand 4723 Freight transportation arrangement.
Rubber and misc. plastic products: 4799 Other transportation services.
and gravel.
1498 Other nonmetallic minerals, except fuels. 3050 Rubber products, plastic footwear, hose, and Communication:
belting.
CONSTRUCTION 3070 Miscellaneous plastic products. 4825 Telephone, telegraph, and other
communication services.
General building contractors and operative builders: Leather and leather products: 4830 Radio and television broadcasting.
1510 General building contractors. 3140 Footwear, except rubber. Electric, gas, and sanitary services:
1531 Operative builders. 3198 Other leather and leather products.
4910 Electric services.
Heavy construction contractors: Stone, clay, glass, and concrete products: 4920 Gas production and distribution.
1611 Highway and street construction. 3225 Glass products. 4930 Combination utility services.
1620 Heavy construction, except highway. 3240 Cement, hydraulic. 4990 Water supply and other sanitary services.
3270 Concrete, gypsum, and plaster products.
Special trade contractors: 3298 Other nonmetallic mineral products. WHOLESALE TRADE
1711 Plumbing, heating, and air conditioning. Primary metal industries: Durable:
1721 Painting, paperhanging, and decorating.
1731 Electrical work. 3370 Ferrous metal industries; miscellaneous 5010 Motor vehicles and automotive equipment.
1740 Masonry, stonework, and plastering. primary metal products. 5020 Furniture and home furnishings.
1750 Carpentering and flooring. 3380 Nonferrous metal industries. 5030 Lumber and construction materials.
1761 Roofing and sheet metal work. 5040 Sporting, recreational, photographic, and
Fabricated metal products, except machinery and hobby goods, toys, and supplies.
1771 Concrete work.
transportation equipment: 5050 Metals and minerals, except petroleum and
1781 Water well drilling.
1790 Miscellaneous special trade contractors. scrap.
3410 Metal cans and shipping containers.
5060 Electrical goods.
3428 Cutlery, hand tools, and hardware; screw
5070 Hardware, plumbing, and heating equipment.
MANUFACTURING machine products, bolts, and similar products.
5083 Farm machinery and equipment.
Food and kindred products: 3430 Plumbing and heating, except electric and
5089 Other machinery, equipment, and supplies.
warm air.
2010 Meat products. 5098 Other durable goods.
3440 Fabricated structural metal products.
2020 Dairy products. 3460 Metal forgings and stampings. Nondurable:
2030 Preserved fruits and vegetables. 3470 Coating, engraving, and allied services.
2040 Grain mill products. 3480 Ordnance and accessories, except vehicles 5110 Paper and paper products.
2050 Bakery products. and guided missiles. 5129 Drugs, drug proprietaries, and druggists’
2060 Sugar and confectionary products. 3490 Miscellaneous fabricated metal products. sundries.
2081 Malt liquors and malt. 5130 Apparel, piece goods, and notions.
2088 Alcoholic beverages, except malt liquors and Machinery, except electrical: 5140 Groceries and related products, except meats
malt. and meat products.
3520 Farm machinery.
2089 Bottled soft drinks and flavorings. 5147 Meats and meat products.
3530 Construction, mining and materials handling
2096 Other food and kindred products. 5150 Farm product raw materials.
machinery, and equipment.
2100 Tobacco manufacturers. 5160 Chemicals and allied products.
3540 Metalworking machinery.
5170 Petroleum and petroleum products.
Textile mill products: 3550 Special industry machinery, except
5180 Alcoholic beverages.
metalworking machinery.
2228 Weaving mills and textile finishing. 5190 Miscellaneous nondurable goods.
3560 General industrial machinery.
2250 Knitting mills. 3570 Office, computing, and accounting machines.
2298 Other textile mill products. 3598 Engines and turbines, service industry
Apparel and other textile products: machinery, and other machinery, except
electrical.
2315 Men’s and boys’ clothing.
2345 Women’s and children’s clothing.
2388 Hats, caps, millinery, fur goods, and other
apparel and accessories.
2390 Misc. fabricated textile products.
Page 19
Code Code Code
RETAIL TRADE FINANCE, INSURANCE, AND REAL ESTATE Automotive repair and services:
Building materials hardware, garden supply, and Banking: 7510 Automotive rentals and leasing, without
mobile home dealers: drivers.
6030 Mutual savings banks.
5211 Lumber and other building materials dealers. 6060 Banking holding companies. 7520 Automobile parking.
5231 Paint, glass, and wallpaper stores. 6090 Banks, except mutual savings banks and 7531 Automobile top and body repair shops.
5251 Hardware stores. bank holding companies. 7538 General automobile repair shops.
5261 Retail nurseries and garden stores. 7539 Other automobile repair shops.
5271 Mobile home dealers. Credit agencies other than banks: 7540 Automobile services, except repair.
General merchandise: 6120 Savings and loan associations. Miscellaneous repair services:
6140 Personal credit institutions.
5331 Variety stores. 6150 Business credit institutions. 7622 Radio and TV repair shops.
5398 Other general merchandise stores. 6199 Other credit agencies. 7628 Electrical repair shops, except radio and TV.
7641 Reupholstery and furniture repair.
Food stores: Security, commodity brokers, dealers, exchanges, 7680 Other miscellaneous repair shops.
and services:
5411 Grocery stores. Motion pictures:
5420 Meat and fish markets and freezer 6212 Security underwriting syndicates.
provisioners. 6218 Security brokers and dealers, except 7812 Motion picture production, distribution, and
5431 Fruit stores and vegetable markets. underwriting syndicates. services.
5441 Candy, nut, and confectionary stores. 6299 Commodity contracts brokers and dealers; 7830 Motion picture theaters.
5451 Dairy products stores. security and commodity exchanges; Amusement and recreation services:
5460 Retail bakeries. and allied services.
5490 Other food stores. 7920 Producers, orchestras, and entertainers.
Insurance: 7932 Billiard and pool establishments.
Automotive dealers and service stations: 7933 Bowling alleys.
6355 Life insurance.
5511 New car dealers (franchised). 6356 Mutual insurance, except life or marine and 7980 Other amusement and recreation services.
5521 Used car dealers. certain fire or flood insurance companies. Medical and health services:
5531 Auto and home supply stores. 6359 Other insurance companies.
5541 Gasoline service stations. 6411 Insurance agents, brokers, and services. 8011 Offices of physicians.
5551 Boat dealers. 8021 Offices of dentists.
5561 Recreational vehicle dealers. Real estate: 8031 Offices of osteopathic physicians.
5571 Motorcycle dealers. 6511 Real estate operators (except developers) 8041 Offices of chiropractors.
5599 Aircraft and other automotive dealers. and lessors of buildings. 8042 Offices of optometrists.
6516 Lessors of mining, oil, and similar property. 8048 Registered and practical nurses.
Apparel and accessory stores: 8050 Nursing and personal care facilities.
6518 Lessors of railroad property and other real
5611 Men’s and boys’ clothing and furnishings. property. 8060 Hospitals.
5621 Women’s ready-to-wear stores. 6531 Real estate agents, brokers, and managers. 8071 Medical laboratories.
5631 Women’s accessory and specialty stores. 6541 Title abstract offices. 8072 Dental laboratories.
5641 Children’s and infants’ wear stores. 6552 Subdividers and developers, except 8098 Other medical and health services.
5651 Family clothing stores. cemeteries. Other services:
5661 Shoe stores. 6553 Cemetery subdividers and developers.
5681 Furriers and fur shops. 6599 Other real estate. 8111 Legal services.
5699 Other apparel and accessory stores. 6611 Combined real estate, insurance, loans, and 8200 Educational services.
law offices. 8911 Engineering and architectural services.
Furniture, home furnishings, and equipment stores: 8932 Certified public accountants.
Holding and other investment companies: 8933 Other accounting, auditing, and
5712 Furniture stores.
5713 Floor covering stores. 6742 Regulated investment companies. bookkeeping services.
5714 Drapery, curtain, and upholstery stores. 6743 Real estate investment trusts. 8999 Other services, not elsewhere classified.
5719 Home furnishings, except appliances. 6744 Small business investment companies.
5722 Household appliance stores. 6749 Holding and other investment companies, TAX-EXEMPT ORGANIZATIONS
5732 Radio and television stores. except bank holding companies. 9002 Church plans making an election under
5733 Music stores. section 410(d) of the Internal
Eating and drinking places: SERVICES Revenue Code.
Hotels and other lodging places: 9319 Other tax-exempt organizations.
5812 Eating places. 9904 Governmental instrumentality or agency.
5813 Drinking places. 7012 Hotels.
7013 Motels, motor hotels, and tourist courts.
Miscellaneous retail stores: 7021 Rooming and boarding houses.
5912 Drug stores and proprietary stores. 7032 Sporting and recreational camps.
5921 Liquor stores. 7033 Trailer parks and camp sites.
5931 Used merchandise stores. 7041 Organizational hotels and lodging houses
5941 Sporting goods stores and bicycle shops. on a membership basis.
5942 Book stores. Personal services:
5943 Stationery stores.
5944 Jewelry stores. 7215 Coin-operated laundries and dry cleaning.
5945 Hobby, toy, and game shops. 7219 Other laundry, cleaning, and garment services.
5946 Camera and photographic supply stores. 7221 Photographic studios, portrait.
5947 Gift, novelty, and souvenir shops. 7231 Beauty shops.
5948 Luggage and leather goods stores. 7241 Barber shops.
5949 Sewing, needlework, and piece goods stores. 7251 Shoe repair and hat cleaning shops.
5961 Mail order houses. 7261 Funeral services and crematories.
5962 Merchandising machine operators. 7299 Miscellaneous personal services.
5963 Direct selling organizations. Business services:
5982 Fuel and ice dealers (except fuel oil and
bottle gas dealers). 7310 Advertising.
5983 Fuel oil dealers. 7340 Services to buildings.
5984 Liquefied petroleum gas (bottled gas). 7370 Computer and data processing services.
5992 Florists. 7392 Management, consulting, and public
5993 Cigar stores and stands. relations services.
5994 News dealers and newsstands. 7394 Equipment rental and leasing.
5996 Other miscellaneous retail stores. 7398 Other business services.
Page 20