Attention !!!
This form requires special handling. Procedures contained in Publication 1167 (Catalog #47013F), Substitute Printed, ComputerPrepared, and Computer-Generated Tax Forms and Schedules, or other Revenue Procedures which govern the distribution or reproduction of specialty products may apply.
Application for
Department of the Treasury Internal Revenue Service
Approval of Master or Prototype and Regional Prototype Defined Contribution Plan
OMB No. 1545-0169
This Form Is Open to Public Inspection
For IRS Use Only
File folder number
File This Form With the Internal Revenue Service
Section references are to the Internal Revenue Code unless otherwise noted.
The first page of this application is computer scannable. For the application to be processed, all entries on page one must be typed. No reproductions or substitutes for page one may be submitted. The answer to the multiple choice questions should be indicated by entering within the brackets the number that indicates your answer to the question. Complete every applicable item on this form. You may only answer “not applicable” (N/A) where an N/A answer is indicated as one of your options. Part I All Filers Complete This Part. See instructions before completing this form.
1 2 Enter amount of user fee submitted $ Approval requested:
File folder number Date of last letter issued
(1) Initial application (2) Amendment—Enter file folder number and date of last letter issued 3a Name of applicant Address (number, street, room or suite no.) (If a P.O. box, see the instructions.) City 3d Type of applicant (1) Sponsoring organization (4) Regional prototype sponsor 4 State ZIP code
3b Employer identification number of applicant
(2) Mass submitter sponsoring organization (5) Regional prototype mass submitter
3c Applicant’s telephone no. ( ) (3) Mass submitter nonsponsoring organization
Type of sponsoring organization (1) Bank (2) Trade or professional association (3) Insurance company (4) Nonbank trustee (attach a copy of authorization letter) (5) Regulated investment company, investment adviser or principal underwriter (6) Not applicable 5b Telephone number ( )
5a Name of person to be contacted 5c If a power of attorney is attached enter the number “1” in the brackets 6a Name of plan 6b Basic plan document number 7 Form of plan: c
Adoption agreement number (or Regional prototype plan number if applicable) (3) Master plan
(1) Prototype plan (2) Regional prototype plan Note: A master plan has only one trust or custodial account for all adopting employers. 8 Type of plan: (1) Money purchase (2) Target benefit (3) Profit-sharing (4) Profit-sharing/401(k) 9 Does the plan provide for permitted disparity in accordance with section 401(l)? 10 Filing status of plan (1) Standardized plan not paired (3) Nonstandardized plan
(1) Yes
(2) No
(2) Standardized plan paired (identify plan(s) paired with this plan by plan name and number on an attached sheet) (4) Nonstandardized safe harbor plan (1) Yes (2) No
11a Is this plan a replacement plan of any other plan(s) of the sponsoring organization? b If “Yes,” list the file folder number(s) of the plan(s) replaced below.
Reminder: A replacement plan must be of the same type as the plan(s) replaced.
Signature Required on Following Page
For Paperwork Reduction Act Notice, see the instructions.
Cat. No. 41676M
Form
4461
(Rev. 8-94)
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Application for
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(1) Initial application (2) Amendment—Enter file folder number and date of last letter issued 3a Name of applicant
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Approval requested:
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Address (number, street, room or suite no.) (If a P.O. box, see the instructions.)
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3b Employer identification number of applicant
City
State
ZIP code
3d Type of applicant (1) Sponsoring organization (4) Regional prototype sponsor 4
(2) Mass submitter sponsoring organization (5) Regional prototype mass submitter
3c Applicant’s telephone no. ( ) (3) Mass submitter nonsponsoring organization
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Type of sponsoring organization (1) Bank (2) Trade or professional association (3) Insurance company (4) Nonbank trustee (attach a copy of authorization letter) (5) Regulated investment company, investment adviser or principal underwriter (6) Not applicable 5b Telephone number ( )
5a Name of person to be contacted 5c If a power of attorney is attached enter the number “1” in the brackets 6a Name of plan
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6b Basic plan document number
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Adoption agreement number (or Regional prototype plan number if applicable)
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Form of plan:
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Filing status of plan (1) Standardized plan not paired (3) Nonstandardized plan
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(2) Standardized plan paired (identify plan(s) paired with this plan by plan name and number on an attached sheet) (4) Nonstandardized safe harbor plan (1) Yes (2) No
11a Is this plan a replacement plan of any other plan(s) of the sponsoring organization? b If “Yes,” list the file folder number(s) of the plan(s) replaced below.
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Reminder: A replacement plan must be of the same type as the plan(s) replaced.
Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief it is true, correct, and complete.
Signature
Title
Date Form
For Paperwork Reduction Act Notice, see the instructions.
4461
(Rev. 8-94)
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(1) Prototype plan (2) Regional prototype plan Note: A master plan has only one trust or custodial account for all adopting employers. 8 Type of plan: (1) Money purchase (2) Target benefit (3) Profit-sharing (4) Profit-sharing/401(k) 9 Does the plan provide for permitted disparity in accordance with section 401(l)?
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(2) No
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1
Department of the Treasury Internal Revenue Service
Approval of Master or Prototype and Regional Prototype Defined Contribution Plan
OMB No. 1545-0169
This Form Is Open to Public Inspection
For IRS Use Only
File folder number
File This Form With the Internal Revenue Service
Section references are to the Internal Revenue Code unless otherwise noted.
The first page of this application is computer scannable. For the application to be processed, all entries on page one must be typed. No reproductions or substitutes for page one may be submitted. The answer to the multiple choice questions should be indicated by entering within the brackets the number that indicates your answer to the question. Complete every applicable item on this form. You may only answer “not applicable” (N/A) where an N/A answer is indicated as one of your options. Part I All Filers Complete This Part. See instructions before completing this form.
Enter amount of user fee submitted $
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File folder number
Date of last letter issued
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Form 4461 (Rev. 8-94)
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Procedural requirements: a If a power of attorney is needed, has one been submitted with this application? b If this is an initial request, have the following been submitted as required by instructions— (1) Adoption agreement? (2) Copy of plan? (3) Copy of trust indenture or custodial agreement? If this is a regional prototype plan, a cover letter requesting approval and stating that the sponsor can reasonably expect at least 30 clients whose principal place of business is located within the jurisdiction of not more than two regions of the Service where the application is being submitted? c Amended or restated plans: (1) If the amendment is not incorporated into the plan document, have the following been submitted? (a) A copy of the amendment? (b) A description of the amendment and its effect on the plan? (c) A working copy of the plan currently in effect (see specific instructions)? (2) (3) If the amendment is incorporated into the plan document, has a copy of the restated plan, with amendments highlighted been submitted? Will you advise those employers who cannot or do not adopt the amended or restated plan that they may not continue to participate under the master or prototype or regional prototype plan? (4)
Yes
No
d Is the plan and trust (or custodial agreement) patterned after and substantially the same as another plan and trust (or custodial agreement) on which a favorable letter has been received? (If “Yes,” see specific instructions.) e Mass submitter request: (1) If this is a master or prototype mass submitter request, have applications on behalf of 10 sponsoring organizations (9, if this is a mass submitter sponsoring organization) been submitted? If this is a flexible plan, answer (i) and (ii): (i) Have you bracketed and identified the optional provisions of the plan? (ii) (2) Have you included a copy of the written representation describing the choices available to sponsoring organizations and the coordination of optional provisions?
If this is a regional prototype mass submitter request has a cover letter certifying and identifying by name and address at least 50 sponsors that are expected to sponsor the identical plan been submitted? f Have you submitted the proper user fee? (Submit check or money order.) g If the sponsoring organization is a nonbank trustee, is a copy of the favorable ruling letter enclosed? Note: This application is designed to be used in conjunction with Rev. Proc. 89-9 and Rev. Proc. 89-13. A list of required modifications is also recommended for use and may be obtained by writing to the Internal Revenue Service, Employee Plans Technical and Actuarial Division, Washington, DC 20224, Attention: CP:E:EP:Q. In items 13 through 17 indicate the article or section and page number of the plan or trust where the following provisions are contained. All questions must be answered. If not applicable, check “N/A” column; otherwise complete the “Article or Section and Page Number” column. 13 Provisions applicable to all plans: a Definitions: Where does the plan define the following terms— (i) Year of service? (ii) Break in service? (iii) Hour of service under Department of Labor Regulations, including service with all employers aggregated under sections 414(b), (c), (m), or (o), and service of any individual considered an employee for purposes of this plan under section 414(n) or (o)? Elapsed time? Plan year? Compensation as defined in section 414(s) as limited by section 401(a)(17)? Earned income as defined in section 401(c)(2)? Disability? Employee as described in sections 414(b), (m), (n), or (o)? Leased employee as described in section 414(n) or (o)? Highly compensated employee as defined in section 414(q)?
N/A
Article or Section and Page Number
For IRS Use Only
(1) (2)
(iv) (v) (vi) (vii) (viii) (ix) (x) (xi)
(3) (4) (5) (6) (7) (8) (9) (10) (11)
Form 4461 (Rev. 8-94) Article or Section and Page Number
Page For IRS Use Only
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13a (continued) (xii) Owner-employee? (xiii) Self-employed individual? (xiv) Normal retirement age? (xv) Benefiting? (xvi) Straight life annuity? b Minimum participation standards: (1) (2) Are the requirements for participation under the plan determined without regard to maximum age? Will a new employee, otherwise eligible, participate on the earlier of the first day of the first plan year after meeting the minimum age and service requirements of section 410(a)(1) or 6 months after satisfying such requirements? Does the initial eligibility computation period begin with the date on which the employee first performs an hour of service, and do subsequent eligibility computation periods: (1) begin with the anniversary of such date, or (2) shift to the plan year in accordance with section 2530.202- 2(b) of the Department of Labor regulations? Is the computation period for determining a break in service the same as is used to compute a year of service for eligibility after the initial computation period? If all years of service are not counted for participation purposes, is the service not counted excludable under sections 410(a)(5)(B), (C), or (D)? Does this plan include the one-year hold-out rule? Will an employee otherwise eligible, who is in an ineligible class of employees, immediately participate on becoming a member of an eligible class? If this is a money purchase plan, are contributions on behalf of each participant determined under a definite formula? If this is a profit-sharing plan, are contributions allocated under a definite formula? If this is a target benefit plan, answer (i) and (ii), below. (i) Does the plan include a target benefit with permitted disparity? (ii) Does the plan provide for the calculation of employer contributions? Does the contribution or allocation formula provide for permitted disparity per section 401(l)? Does the plan continue to allocate contributions to participants without reduction in the rate of allocations on account of the attainment of any specified age? Are annual additions limited as required by section 415? Does the plan meet the requirements for aggregation under section 401(d)(1) relating to plans that benefit owner-employees? If the plan is fully insured or provides an insured preretirement death benefit, and there is a provision for purchasing additional contracts due to increases in compensation, will additional contracts be purchased when contributions are sufficient to purchase a policy with a face amount of $1,000 or a $10 additional monthly benefit? Does the plan require separate accounting for each employee’s accrued benefit?
N/A
(12) (13) (14) (15) (16)
(17)
(18)
(3)
(19)
(4)
(20) (21) (22)
(5) (6) (7)
(23)
c Employer contributions: (1) (2) (3) (24) (25) (26), (27) (28) (29)
(4) (5)
(6) (7) (8)
(30) (31) (32)
(33) (34)
(9)
d Employee contributions: (1) If the plan permitted employee contributions: (i) (ii) For contributions made after 1986, does the plan comply with section 401(m)? Does the plan either provide for separate accounts for employer contributions and nondeductible employee contributions, or identify what portion of an account balance is attributable to employer contributions and nondeductible employee contributions according to section 411(c)(2)? (35)
(36)
Form 4461 (Rev. 8-94)
Page Article or Section and Page Number For IRS Use Only
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13d (continued)
N/A
(2)
Are all employeee contributions and earnings thereon nonforfeitable at all times? Does the plan prohibit deductible voluntary employee contributions for a tax year beginning after 1986? Are forfeitures used either to reduce employer contributions or to increase benefits according to a definite formula? If participants may withdraw employee contributions or the earnings on them, may the withdrawal be made without forfeiting vested benefits based on employer contributions? If benefits under the plan are forfeited when a participant or beneficiary cannot be located, does the plan provide for a reinstatement of the benefit if a claim is made?
(iii)
(37) (38)
e Forfeiture provisions: (1) (2) (39)
(40)
(3)
(41)
f Distribution provisions: (1) (i) If this is not a profit-sharing plan described in 6 below, does a married participant receive a qualified joint and survivor annuity (QJSA) and an unmarried participant a life annuity? Is the participant given an opportunity to make a Qualified Election to waive the QJSA in a manner which satisfies section 417(a)(2) during an election period beginning no later than 90 days before the annuity starting date? Does the plan provide that the spouse of a deceased participant will receive a qualified preretirement survivor annuity (QPSA) that requires payments not less than the amount specified in section 417(c)(2) in the event of death before the the annuity starting date? Is the participant given an opportunity to make a Qualified Election to waive the QPSA in a manner which satisfies section 417(a)(2) during election period beginning on the first day of the plan year in which the participant attains age 35 and ending on the date of the participant’s death?
(42)
(ii)
(42)
(2)
(i)
(42)
(ii)
(42)
(3)
Does the plan designate or enable the employer to elect the percentage (not less than 50% nor more than 100%) of the survivor annuity provided under the QJSA? Does the plan define annuity starting date in a manner that satisfies Q&A 10(b) of Regulations section 1.401(a)-20? (i) (ii) Does the plan provide for a written explanation of the QJSA in a manner which satisfies section 417(a)(3)(A)? Does the plan provide for a written explanation of the QPSA in a manner which satisfies section 417(a)(3)(B)?
(42) (42) (42) (42)
(4) (5)
(6)
If this is a profit-sharing plan which does not offer a life annuity form of payment, does the plan satisfy the conditions described in Q&A 3 of Regulations section 1.401(a)-20, including the requirement that the value of the participant’s vested account balance on the date of death be paid in full to the surviving spouse? If the plan permits distributions prior to 5 consecutive 1-year breaks in service (upon termination of employment, hardship distributions, change to an ineligible class, etc.), does the plan contain either (A) cashout, buy- back, or (B) separate account provisions required under Regulations sections 1.411(a)-7(d)(4) and (5)? If the vested account balance is greater than $3,500, is consent of the participant and spouse (if applicable) required when benefits are immediately distributable within the meaning of Regulations sections 1.411(a)-11 and 1.417(e)-1(b)(3)?
(42)
(7)
(43)
(8)
(44)
Form 4461 (Rev. 8-94)
Page Article or Section and Page Number For IRS Use Only
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13f
(continued)
N/A
(9) Do benefits under the plan begin, unless otherwise elected in writing, no later than the 60th day after the latest of the close of the plan year in which: (i) the participant attains the earlier of age 65 or the plan’s normal retirement age, (ii) the 10th anniversary of the year in which the participant began participation under the plan occurs, or (iii) the participant terminates his or her service with the employer? (10) If the plan contains an early retirement provision which requires or could require both a minimum age and service for eligibility, does a participant who meets the service requirement but separates from service before meeting the age requirement begin to receive benefits (unless otherwise elected) upon meeting the age requirement? (11) Are annuity contracts nontransferable when distributed? (12) Does the plan provide that the terms of any annuity contract purchased and distributed by the plan to a participant or spouse shall comply with the requirements of the plan? (13) Does the plan require, in accordance with section 401(a)(9) that: (i) (ii) Distributions be made beginning not later than the required beginning date? Payment of the participant’s interest be made at least as rapidly as under the method used prior to death, when the participant dies after distribution has started? Payment of the participant’s interest be made within 5 years of the participant’s death, unless one of the exceptions in sections 410(a) (9)(B)(iii) or (iv) applies, when payment of the participant’s interest has not begun prior to death?
(45)
(46) (47)
(48)
(49)
(49)
(iii)
(49)
Distributions, if not made in a single sum, will satisfy minimum distribution rules of section 401(a)(9) and the regulations thereunder, including the minimum distribution incidental benefit requirement of Proposed Regulations section 1.401(a)(9)-2? (14) Are optional forms of benefit: (i) Stated in the plan? Made available to employees in a manner that does not discriminate in favor of highly compensated employees? (iii) Not subject to employer discretion? (15) Does the plan provide for the direct rollover of an eligible rollover distribution to an eligible retirement plan? g Vesting provisions: (1) Is a computation period for vesting purposes specified in the plan? (2) (3) (4) Is the computation period for determining a break in service the same as is used to compute a year of service for vesting? Does the plan provide that an employee will be fully vested on reaching normal retirement age? If the plan contains vesting options, are they limited so that at all times they will provide a percentage of nonforfeitable rights which is not less than the percentage that would be provided under one of the options under section 411(a)(2)? If all years of service are not counted for vesting purposes, is the service not counted excludible under section 411(a)(4)? If the plan contains the vesting break in service rules, does the plan comply with section 411(a)(6)(B), (C), or (D), as applicable? Does a participant who has at least 3 years of service have a reasonable period of time after the adoption of an amendment which directly or indirectly affects the calculation of his or her nonforfeitable percentage (including a change to or from a top-heavy vesting schedule) to elect to have his or her nonforfeitable percentage computed without regard to the amendment? Does the plan provide protection against cutback of vested rights or rights to accrued benefits under sections 411(a)(10)(A) and 411(d)(6)? (ii)
(iv)
(49) (50) (50) (50) (51) (52) (52) (53)
(54) (55) (56, 57, 58)
(5) (6) (7)
(59) (60)
(8)
Form 4461 (Rev. 8-94) Article or Section and Page Number
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13
(continued) h Top-heavy: (1) If this plan is not designed to operate as if it were top-heavy at all times, does the plan define the following terms— (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) Key employee? Top-heavy plan? Top-heavy ratio (as defined in section 416(g))? Permissive aggregation group? Required aggregation group? Determination date? Valuation date? Present value?
N/A
(61) (61) (61) (61) (61) (61) (61) (61)
(2) Does the adoption agreement provide a section for the employer to specify the interest rate and mortality table used in determining the top- heavy ratio because of the required aggregation of multiple plans? (3) Does the plan provide that for the purpose of determining the top-heavy ratio, the accrual rate used will be that used to accrue benefits under all defined benefit plans of the employer, or where there is no such uniform rate, the slowest accrual rate permitted under section 411(b)(1)(C)? (4) Does the plan provide for a minimum contribution (determined without regard to social security) for each nonkey-employee participant, who has not separated from service at the end of the plan year, equal to the lesser of: (a) 3% of compensation, or (b) the highest contribution rate applicable to any key employee, including minimum contributions for nonkey employees who: (i) fail to complete 1,000 hours of service? (ii) fail to make mandatory contributions, or in the case of a cash or deferred arrangement, elective contributions to the plan?
(61)
(61)
(62) (62)
(5) Does the plan prohibit forfeitures of retired minimum contributions because of withdrawal of mandatory contributions described in section 411(a)(3)(B) or 411(a)(3)(D)? (6) Does the plan provide for vesting not less favorable than the vesting described in section 416(b)? i Death benefits: (1) If life insurance is provided, are premiums properly limited? (2) If ordinary life insurance contracts are purchased, will such contracts be either converted to cash or an annuity contract at or before retirement, or distributed to the participant? (3) Are insurance contracts owned and held by the trustee or custodian, if applicable, in accordance with the terms of the plan, including joint and survivor annuity requirements, if any? j Investment provisions: (1) Trust or custodial accounts: (i) (ii) Are assets valued at least annually, on a specified date, and at current fair market value? Are trust earnings and losses allocated on the basis of account balances?
(63) (64) (65)
(66)
(67)
(68) (68)
(2) If the plan provides for investment in insurance contracts, does it provide for the disposition of dividends and other credits? (3) If investments, including insurance contracts, may be earmarked, are such investments subject to the employee’s consent or purchased ratably where employee consent is not required? k Amendment and termination: (1) Is there a provision for the sponsor to amend the plan? (2) Is there a provision for the employer to amend the plan to satisfy sections 415 and 416 because of the required aggregation of multiple plans? (3) Does the plan prohibit adopting employers from amending other than elective provisions (except to the extent necessary to satisfy section 415 or 416 because of the required aggregation of multiple plans, or as permitted under the model CODA) unless the employer wants to cease participation in the plan?
(69)
(70) (71) (72)
(72)
Form 4461 (Rev. 8-94)
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13k (continued) (4) Is there a provision for the employer to amend the plan to add certain model amendments, published by the Internal Revenue Service, that specifically provide that their adoption will not cause the plan to be treated as individually designed? Are amounts credited to participants’ accounts nonforfeitable upon termination or partial termination of the plan? Under a profit-sharing plan, are the employees’ rights under the plan nonforfeitable upon complete discontinuance of contributions? Does the plan provide that after merger or consolidation with, or transfer of assets or liabilities to any other plan, benefits on a termination basis will be no less than before the merger, consolidation, or transfer?
N/A
(72) (73) (74)
(5) (6) (7)
(75)
l
Miscellaneous plan provisions: (1) (2) (3) (4) (5) (6) Does the plan prohibit the assignment or alienation of benefits except as provided by sections 401(a)(13) and 414(p)? Do loans to plan participants satisfy the requirements of section 4975(d)(1) and the joint and survivor requirements, if any? Does the plan provide that corpus or income may not be diverted for purposes other than the exclusive benefit of employees or their beneficiaries? If a nontrusteed plan, do insurance contracts provide for refunds or credits for the exclusive benefit of the participants? Does the plan provide that if the employer’s plan does not attain or retain qualification, the employer can no longer participate under the plan? If this is a master plan: (i) (ii) Is only a single funding medium available for use by all adopting employers? Does the plan provide that funds held in the master trust on behalf of an adopting employer will be removed as soon as administratively feasible if the employer’s plan does not attain or retain qualified status? (76) (77) (78) (79) (80)
(81)
(82)
(7)
Does the plan provide that if the employer maintains a plan of the predecessor employer, service with the predecessor employer is counted as service with the employer? Does the adoption agreement contain the sponsoring organizations’s or representative’s name, address, and telephone number for the purpose of answering employer’s inquiries? Does the adopting agreement contain a cautionary statement to the effect that the failure to properly fill out the adoption agreement may result in disqualification of the plan? Does the adoption agreement contain a statement which provides that the sponsoring organization will inform the adopting employer of any amendments made to the plan or of the discontinuance or abandonment of the plan? Complete This Part If You Are Filing for a Standardized Plan
(83)
(8)
(85)
(9)
(85)
(10)
(85)
Part II
14
With respect to this standardized plan: a Does the plan cover all employees (including individuals required to be considered employees according to section 414(n) or (o) and employees of other members of groups aggregated under section 414(b), (c), (m) or (o)) other than employees who may be excluded under section 410(a)(1) or (b)(3)? b Are the eligibility requirements not more favorable for highly compensated employees as defined in section 414(q) than for other employees? c Does the contribution formula satisfy the safe harbor requirements of Regulations section 1.401(a)(4)-2(b)(2)? d Does the adoption agreement contain, in close proximity to the employer’s signature line, a statement that the employer, in order to obtain or retain reliance, must obtain a determination letter if the employer ever has maintained any other plan (including a welfare benefit plan) other than a specifically designated paired plan?
(86) (87) (88)
(89)
Form 4461 (Rev. 8-94) N/A Article or Section and Page Number
Page For IRS Use Only
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Part III
15
Complete This Part If You Are Filing for a Paired Plan
With respect to this paired plan: a If this plan is paired with another defined contribution plan, does the plan provide the appropriate defined contribution minimum? b Master or Prototype Plans only: Is this plan paired with a defined benefit plan? Yes No (90)
If ‘‘Yes,’’ answer 14 on Form 4461A. c If the plan provides for permitted disparity in accordance with section 401(1), does the pairing language provide only one of the paired plans may provide for permitted disparity? Part IV Complete This Part If You Are Filing for a Nonstandardized Plan 16 With respect to this nonstandardized plan: a Does the plan meet the minimum age and service requirements of section 410(a)(1)? b Does the adoption agreement contain, in close proximity to the employer’s signature line, a statement that adopting employers may not rely on an opinion letter issued by the National Office, or notification letter issued by the key district office, with respect to the qualification of this plan unless they apply to the appropriate key district office for a determination letter? c Does the plan permit the employer the option to select total compensation? Part V Complete This Part If You Are Filing for a Profit-Sharing/401(k) Plan 17 With respect to this section 401(k) plan: a Is the effective date of the Coda no earlier than the first day of the Plan Year to which the Coda is adopted? b Is an employee’s eligibility to make elective deferrals conditioned on no more than one year of service or attainment of no more than age 21? c Does the plan provide for a reasonable period during which participants may once a year elect to commence elective deferrals d Is the participant’s elective deferral limited to the dollar limit in effect in section 402(g) in any tax year? e Will elective deferrals be distributed no later than April 15 to any participant who has excess elective deferrals for the preceding tax year? f Do the elective deferrals meet the nondiscrimination tests of section 401(a)(4) and section 401(k)(3)? g Does the plan provide for the distribution of excess contributions no later than the last day of the plan year, if such excess contributions were allocated to the previous plan year? h May a participant recharacterize an excess contribution? i Can the employer make matching contributions? j Are matching contributions subject to section 411(a)(2)? k Can the employer make qualified matching contributions? l Do employee contributions and matching contributions meet the ACP and ADP tests of section 401? m Are the excess aggregrate contributions distributed or forfeited before the close of the following plan year? n May the employer make qualified non-elective contributions? o Are the participant’s rights to his or her accrued benefit derived from employee contributions, qualified non-elective contributions, qualified matching contributions, and elective deferrals nonforfeitable? p Do distributions of elective deferrals, qualified non-elective contributions, qualified matching contributions, and income allocable to each comply with section 401(k)(2)(B)? q Does the plan permit hardship distributions of elective deferrals? r Can elective deferral or matching contributions be taken into account to satisfy the minimum top-heavy contribution requirements?
(91)
(92)
(93) (94)
(I) (II) (III) (IV) (V) (VI)
(VII) (VIII) (IX) (X) (XI) (XII) (XIII) (XIV)
(XV)
(XVI) (XVII) (XVIII)
Form 4461 (Rev. 8-94)
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9
Paperwork Reduction Act Notice.—We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to determine whether you meet the legal requirements for plan approval. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is: Recordkeeping 44 hr., 29 min. Learning about the law or the form 6 hr., 36 min. Preparing the form 9 hr., 28 min. Copying, assembling, and sending the form to the IRS 32 min. If you have comments concerning the accuracy of these time estimates or suggestions for making this form more simple, we would be happy to hear from you. You can write to both the Internal Revenue Service, Attention: Reports Clearance Officer, PC:FP, Washington, DC 20224: and the Office of Management and Budget, Paperwork Reduction Project (1545-0169), Washington, DC 20503. DO NOT send this form to either of these offices. Instead, see Where To File below.
Who May File
Master or prototype plans.—Sponsoring organizations and mass submitters (see Definitions below). Regional prototype plan.—Sponsors and mass submitters (see Definitions below).
What To File
One copy of Form 4461 should be submitted for each separate adoption agreement. For initial approval, file this application and each applicable document listed in item 12(b). For approval of an amendment, file this application and a copy of each applicable document listed in item 12(c). Different parts of this form must be completed depending on the type of plan for which you want approval. Standardized plans.—If you want to receive an opinion letter or a notification letter on a standardized plan, complete Parts I and II. Paired plans.—If you want to receive an opinion letter or a notification letter on a paired plan, complete Parts I, II, and III. Nonstandardized plans.—If you want to receive an opinion letter or notification letter on a plan other than a standardized or paired plan, complete Parts I and IV. A nonstandardized safe harbor plan must meet the requirements of Rev. Proc. 1993-10, 93-1 C.B. 476, as modified by Rev. Proc. 93-39, 1993-2 C.B. 513. Regional prototype plans.—Complete Parts I through IV, as appropriate, whether you are filing with the National Office as a regional prototype mass submitter or with the key district office as a sponsor of a regional prototype plan. When filing with the key district office, Form 8717, User Fee for Employee Plan Determination Letter Request, should be submitted along with this application. To request a notification letter on behalf of a sponsor who adopts a mass submitter regional prototype plan, file Form 4461-B, Application for Approval of Master or Prototype Plan, or Regional Prototype Plan, Mass Submitter Adopting Sponsor, with the appropriate key district office. Multiple plans.—A sponsoring organization or sponsor may utilize one basic plan document for several plans. A sponsoring organization may, for example, use one basic plan document for a money purchase plan other than a target benefit plan, a target benefit plan, and a profit-sharing plan. A separate adoption agreement and completed application must be provided for each such defined contribution plan. In the case of a simultaneous submission, submit only one basic plan document. If the request is not simultaneous, separate basic plan documents must be submitted (but the number assigned to the basic plan document of a master or prototype plan remains the same). Paired plans must be submitted simultaneously. Paired plans are paired by the basic plan documents. Two defined contribution plans that are paired (a profit- sharing and a money purchase plan) must share one basic plan document.
General Instructions
Purpose of Form
Form 4461 is used to apply for initial approval of or for approval of an amendment to: ● A master or prototype defined contribution plan. ● A regional prototype defined contribution plan. The first page of this form is designed for use with optical scanning equipment and must be filed in its original form. No reproductions or substitutes of page 1 will be accepted. All entries on page 1 must be typed in black ink in either pica or elite, 10 or 12 characters to the inch. Be sure to submit a complete and accurate application. Complete every applicable line on the application. If an item does not apply, check the “N/A” box or enter “N/A” on the line. If your application is not complete, we will return it without processing it. The questions are designed so that, unless they are not applicable, the article or section and page numbers indicating the location in the plan of the provision should be entered in the appropriate column. Inadequate submissions.—We will return, without further action, plans that are not in substantial compliance with the qualification requirements or plans that are so deficient that they cannot be reviewed in a reasonable amount of time. A master or prototype plan will not be considered in substantial compliance if it omits any of the requirements of section 10.07 of Rev. Proc. 89-9, 1989-1 C.B. 780. A regional prototype plan will not be considered to be in substantial compliance if it omits any of the requirements of section 6.02 of Rev. Proc. 89-13, 1989-1 C.B. 801. Rev. Proc. 89-9 and Rev. Proc. 89-13 have been modified by the following: Rev. Proc. 90-17, 1990-1 C.B. 479, Rev. Proc. 90-21, 1990-1 C.B. 499, Rev. Proc. 90-41, 1991-2 C.B. 697, Rev. Proc. 92-41, 1992-1 C.B. 870, Rev. Proc. 93-9, 1993-1 C.B. 474, Rev. Proc. 93-12, 1993-1 C.B. 479, and Rev. Proc. 94-12, 1994-3 I.R.B. 14. Rev. Proc. 89-13 was also modified by Rev. Proc. 90-20, 1990-1 C.B. 495.
Sponsors of regional prototype plans.—File Form 4461 with the key district office serving your geographic area. See Form 8717 for a list of key district offices. Sponsors of regional prototype plans must attach Form 8717 and the appropriate user fee when filing with a key district office. Signature.—The application must be signed by a partner or officer of the applicant who is authorized to sign, or other person authorized by a power of attorney. The power of attorney should be filed with the application. Disclosure requested by taxpayer.—The Tax Reform Act of 1976 permits a taxpayer to request the Service to disclose and discuss the return or return information with any person(s) the taxpayer designates in a written request. If you want to designate a person(s) to assist in an application for approval, you must provide the IRS office of jurisdiction with a written request that contains: ● The taxpayer’s name, address, employer identification number, and plan number(s). ● The name, address, social security number, and telephone number(s) of the person or persons whom you are authorizing to receive return information. ● A paragraph that clearly describes the return or return information that you authorize the IRS to disclose. ● An authorized signature (see above). As an alternative to providing the above statement, you may submit Form 2848, Power of Attorney and Declaration of Representative, may be submitted.
Definitions
Adoption agreement.—The portion of the plan containing all the options that the adopting employer may select. Each separate adoption agreement is treated as a separate plan and will receive its own opinion or notification letter. Basic plan document.—The portion of the plan containing all the nonelective provisions applicable to all adopting employers. No options (including blanks to be completed) may be provided in the basic plan document except for options in flexible plans. Favorable TEFRA opinion letter.—A favorable opinion letter issued by the national office after July 18, 1985. Flexible plan.—A plan submitted by a mass submitter which contains certain optional provisions as allowed by Rev. Proc. 89-9. Sponsoring organizations which adopt a flexible plan may include or delete any optional provision designated as such in the mass submitter’s plan. A flexible plan adopted by a sponsoring organization which differs from the mass submitter plan only because of the deletion of certain optional provisions will be treated as a word-for-word identical plan to the mass submitter plan. Mass submitter.—Any entity (whether or not such entity is a sponsoring organization) which submits applications for at least 10 sponsoring organizations that will sponsor a word-for-word identical Master or Prototype plan. A mass submitter which is a sponsoring organization may count as 1 of the 10 sponsoring organizations. Mass submitter regional prototype plan.—A plan that is made available to sponsors by a regional prototype mass submitter that would otherwise meet all of the requirements applicable to regional prototype plans. Master plan.—A form of plan that is made available by a sponsoring organization for adoption by employers for which a single funding medium (e.g., a trust or custodial account) is established, as part of the plan, for
Where To File
Master or prototype plan.—File the application with Internal Revenue Service, Assistant Commissioner (Employee Plans and Exempt Organizations), Attention: CP:E:EP:Q, P.O. Box 14073, Ben Franklin Station, Washington, DC 20224. Mass submitter of a regional prototype plan.—File the application with Internal Revenue Service, Assistant Commissioner (Employee Plans and Exempt Organizations), Attention: CP:E:EP:Q, P.O. Box 14073, Ben Franklin Station, Washington, DC 20224.
Form 4461 (Rev. 8-94)
Page
10
the joint use of all adopting employers. A master plan consists of an adoption agreement and a basic plan document. Paired plans.—A combination of either two or more defined contribution standardized plans or one or more defined contribution standardized plans and one defined benefit standardized plan, designed so that if any single plan or combination of plans is adopted by an employer, each plan in itself, or the plans together, will meet the anti-discrimination rules of section 401(a)(4), the contribution and benefit limitations of section 415, and the top-heavy provisions of section 416. Paired plans must have the same sponsoring organization and they must be submitted for initial approval at the same time. Each set of paired plans must be limited to two different basic plan documents; one for a defined benefit plan and one for a defined contribution plan. Only one of the paired plans an employer adopts may be integrated. Prototype plan.—A form of plan that is made available by a sponsoring organization for adoption by employers under which a separate funding medium is established for each adopting employer. A prototype plan consists of an adoption agreement and a basic plan document. Regional prototype plan.—A plan that is made available by a regional sponsor for adoption by employers, and which consists of an adoption agreement, a basic plan document and, except in the case where the basic plan document incorporates a trust or custodial account agreement the provisions of which are applicable to all adopting employers, a trust or custodial document. Regional prototype plan mass submitter.— Any person, whether or not such person is a sponsor, which can establish that, if it receives a favorable notification letter for a regional prototype plan it has submitted to the Service, there are at least 50 unaffiliated sponsors that will adopt the plan on a word-for- word identical basis. Replacement plan.—A plan submitted by a sponsoring organization which restates or amends a prior plan of that sponsoring organization which has a favorable TEFRA opinion letter as of the date the replacement plan is submitted. Except to the extent permitted under Regulations sections 1.401(a)-4 and 1.411(d)-4, a replacement plan must preserve all section 411(d)(6) protected benefits which were provided under the replaced plan, and must be the same type as the plan replaced (e.g., both plans are money purchase plans). The plan replaced can only be replaced by one basic plan document; but such replacement may contain additional adoption agreements. Sponsoring organization.—A bank (as defined in section 581), an insured credit union within the meaning of section 101(6) of the Federal Credit Union Act, a person that has been approved by the IRS in accordance with Regulations section 1.401-12(n) to act as a nonbank trustee, an insurance company, a regulated investment advisor that has an advisory contract with one or more regulated investment companies, or a principal underwriter that has a principal underwriting contract with one or more regulated investment companies. The term “sponsoring organization” also includes a trade or professional organization having characteristics similar to those described in section 501(c)(6) which markets its plan only to its members in their capacity as adopting employers. Sponsor.—A firm, other than a sponsoring organization, that: (1) has an established place of business in the United States where it is accessible during every business day, and (2)
either has at least 30 clients that have their principal place of business within the jurisdiction of not more than two regions of the Service and are expected to adopt the sponsor’s regional prototype plan, or has at least three clients that are expected to adopt a mass submitter regional prototype plan with respect to which a favorable notification letter has been issued to its sponsor. Standardized plan.—A plan which meets the specific requirements of Part II of this form.
Line 10—Paired plans.—If the application is for a paired plan (see Definitions on page 9), attach a list showing the name(s) and three-digit adoption agreement number(s) (plan number for regional prototype plan) of the plan or plans designed to be paired with this plan. Initial requests for approval of paired plans must be submitted together. Line 11—Replacement plans.—If this application is for a replacement plan (see definition above), enter the file folder numbers of each plan being replaced. If more than three plans are being replaced, attach an additional sheet to the back of this application containing the information requested on line 11. Line 12—Procedural requirements.—A separate application must be submitted for each different plan/adoption agreement combination. Line 12c.—The applicant must submit, along with this application, either: (a) a copy of the amendment, a description of the amendment and its effect on the plan, and a working copy of the plan currently in effect, or (b) a copy of the amended plan in restated form with areas of change highlighted (a restated plan). If a restated plan is being submitted with this application, a copy of the amendment and a description of such amendment need not be submitted. The Internal Revenue Service may, at its discretion, require plan restatement any time it deems necessary. Line 12d.—If you checked “Yes,” submit a copy of such plan with language differences highlighted. Attach a cover letter which provides the name and file folder number of the plan (including the name and EIN of the sponsoring organization), a list of all plans written by the plan drafter which are substantially identical to the lead plan (including the information described above), a description of each place where the plan for which the application is being submitted is not word-for-word identical to the language of the lead plan (including an explanation of the purpose and effect of each difference), and a certification, made under penalty of perjury by the plan drafter, that the information describing where the plan language is not word-for-word identical is true and complete. Line 12e.—A master or prototype mass submitter must submit the applications of at least 10 sponsoring organizations which will sponsor a word-for-word identical master or prototype plan. A mass submitter which is a sponsoring organization may count as 1 of the 10 sponsoring organizations. A regional prototype mass submitter must submit a certification identifying by name and address at least 50 sponsors who are expected to sponsor the identical plan. The mass submitter must use Form 4461-B when submitting applications on behalf of its adopting sponsoring organizations. The regional prototype mass submitter should use Form 4461-B when submitting applications on behalf of its sponsor. National sponsoring organizations (see Definition above) must maintain a list of their adopting employers. For this purpose, an adopting employer is any employer that has adopted a master or prototype plan of the sponsoring organization which has a favorable TEFRA opinion letter.
Specific Instructions
Line 1.—All applications submitted must be accompanied by the appropriate user fee as determined from the schedule in Rev. Proc. 94-8, 1994-1 I.R.B. 176, when Form 4461 is filed with the National Office. When Form 4461 is filed with a key district office, attach Form 8717 and the appropriate user fee. Applications submitted without the proper user fee will not be processed and will be returned to the applicant. Line 2.—Enter a 1 if this application is for an initial approval. If the application is for an amended plan, enter a 2 and complete the boxes to the right of line 2. Line 3a.—Enter the name and address of the plan sponsor. If the Post Office does not deliver mail to the street address and the sponsor has a P.O. box number, show the P.O. box number instead of the street address. Line 4(5).—Investment advisor/principal underwriter must be contracted with a regulated investment company. See Sponsoring organization above. Line 4(6).—N/A may be indicated only if (3), (5), or (6) is indicated on line 3d. Line 5a.—If the person to be contacted is other than an employee of the applicant, please enclose an authorized power of attorney. See Disclosure requested by a Taxpayer on page 9. Line 6b.—For master and prototype plans only.— Enter the two-digit basic plan document number you have assigned to the basic plan document designed to accompany the adoption agreement for which you are requesting approval. All basic plan documents from one sponsoring organization which are the same (word-for-word) should use the same two-digit number on all applications. The first basic plan document submitted should be numbered “01,” the second, “02,” etc. Line 6c.—Master and prototype plans.—Enter the three-digit number you have assigned to the adoption agreement for which this application is submitted. Each different adoption agreement designed to accompany a single basic plan document should be given a different three-digit number beginning with “001.” For example, if the first basic plan document of a sponsoring organization has four separate adoption agreements, they should be numbered “001” through “004,” and four separate Forms 4461 should be submitted. Adoption agreements submitted with the second or any subsequent basic plan documents (that are not word-for-word identical to a previously submitted basic plan document) should be similarly numbered beginning with “001.” Regional Prototype Plans.—Enter the three digit plan number beginning with 001. See, Rev. Proc. 89-13, section 10.02. Line 9.—Indicate if this plan provides for permitted disparity in accordance with section 401(l) by entering the appropriate number. Cash or deferred arrangements may not be integrated.
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