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.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103.

The time needed to complete and file the form is listed below and will vary depending on individual circumstances. The estimated average time is:

	Recordkeeping	Learning about the law or the form	Preparing, copying, assembling, and sending the form to the IRS
Part I	1 hr., 26 min.	1 hr., 35 min.	1 hr., 41 min.
Part II	3 hr., 50 min.	12 min.	16 min.
Part III	4 hr., 32 min.	35 min.	42 min.

If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Tax Forms Committee, Western Area Distribution Center, Rancho Cordova, CA 95743-0001.

DO NOT send the form to this address. Instead, see Where To File on page 3.

Change To Note

Due to the centralization of the Employee Plans determination process all Form 5310-A notices should be filed with the Internal Revenue Service, P.O. Box 192, Covington, KY 41012-0192. See Where To File on page 3.

Purpose of Form

Form 5310-A is used by employers to give notice of:

• A plan merger or consolidation which is the combining of two or more plans into a single plan.
• A plan spinoff which is the splitting of a single plan into two or more spinoff plans.
• A plan transfer of plan assets or liabilities to another plan which is the splitting off of a portion of the assets or liabilities of the transferor plan and the concurrent acquisition or assumption of these split-off assets or liabilities by the transferee plan.
• Qualified separate lines of business (QSLOBs).

Note:   An IRS determination letter will not be issued when a Form 5310-A is filed.

General Instructions

Form 5310-A is screened for completeness. Incomplete notices will be returned. Here are some tips to help you complete the form correctly.

1. N/A (not applicable) is accepted as a response only for line 1c.
2. If an item requests a numeric response, you must enter a number.

The IRS may, at its discretion, require additional information any time it is deemed necessary.

Who Must File

• Pension plan, profit-sharing plan, or other deferred compensation plan. - Any sponsor or plan administrator of a pension, profit-sharing, or other deferred compensation plan (except a multiemployer plan covered by PBGC insurance) should file this form for a plan merger or consolidation, a spinoff, or a transfer of plan assets or liabilities to another plan. See section 6058(b). This form must be filed for each plan with a separate employer identification and plan number if that plan is involved in a merger or transfer of plan assets or liabilities. This includes plans that were not in existence before the plan merger and plans that cease to exist after the plan merger. In the case of a plan spinoff, file Form 5310-A only for the plan in existence prior to the spinoff.
• Qualified separate lines of business. - The employer must file notice that it elects to be treated as operating QSLOBs or that it either modifies or revokes a previously filed notice. Only one notice per employer, within the meaning of Code sections 414(b), (c), and (m), is required.

Examples

Example One - Initial Notice

Employer A is composed of four separate corporations that are treated as one employer within the meaning of Section 414(b). Employer A treats each corporation as a separate line of business. The 1995 testing year is the first year for which Employer A elects to be treated as operating QSLOBs for the purpose of section 410(b) (see When To File for a definition of testing year). Employer A must file Form 5310-A and provide information on each of the four QSLOBs on or before the notification date for the 1995 testing year (see When To File for a definition of notification date). If the notice is not timely filed, Employer A is not treated as operating QSLOBs for purposes of the coverage rules for the 1995 testing year (see Part III).

Example Two - Modification

The facts are the same as in Example One. During the 1996 testing year, Employer A sold QSLOB four. Also, assume that Employer A timely filed Form 5310-A for the 1995 testing year. For the 1996 testing year, Employer A intends to treat QSLOBs one and two as a single QSLOB. Employer A must modify its initial notice by filing Form 5310-A on or before the notification date for the 1996 testing year, including a revised list of QSLOBs for line 10 of the form. If Employer A does not timely provide a new notice, the initial notice filed for the 1995 testing year will be treated as the only notice filed for the 1996 testing year (see Part III).

Example Three - Revocation

The facts are the same as in Example Two. Assume that Employer A timely filed a new notice for the 1996 testing year. During 1997, Employer A elects not to treat itself as operating QSLOBs for the 1997 testing year. Employer A must revoke the last notice it filed (i.e. the notice for the 1996 testing year). Employer A must revoke the notice filed for the 1996 testing year by filing Form 5310-A for the 1997 testing year and indicating on line 8 of the 5310-A that it is revoking a previously filed notice and is no longer testing on a QSLOB basis. If such notice is not filed on or before the notification date for the 1997 testing year, the notice filed for the 1996 testing year will be treated as the only notice filed for the 1997 testing year (see Part III).

Exceptions From Filing Notice of Plan Merger or Consolidation, Spinoff, or Transfer of Plan Assets or Liabilities

Do not file Form 5310-A:

• For an eligible rollover distribution that is paid directly to an eligible retirement plan in a direct rollover as described in section 401(a)(31).
• If the plan merger or consolidation, spinoff, or transfer of plan assets or liabilities complies with Regulations section 1.414(l)-1(d), (h), (m), or (n)(2).

Generally, these requirements will be satisfied in the following four situations:

1. Two or more defined contribution plans are merged and all of the following conditions are met:
   1. The sum of the account balances in each plan prior to the merger equals the fair market value of the entire plan assets. Example: Neither plan has an outstanding section 412(d) waiver balance.
   2. The assets of each plan are combined to form the assets of the plan as merged.
   3. Immediately after the merger, each participant in the plan has an account balance equal to the sum of the account balances the participant had in the plans immediately prior to the merger.
2. There is a spinoff of a defined contribution plan and all of the following conditions are met:
   1. The sum of the account balances in the plan prior to the spinoff equals the fair market value of the entire plan assets. Example: The plan does not have an outstanding section 412(d) waiver balance.
   2. The sum of the account balances for each of the participants in the resulting plan(s) equal the account balances of the participants in the plan before the spinoff.
   3. The assets in each of the plans immediately after the spinoff equals the sum of the account balances for all participants in that plan. Example: The plan does not have an unallocated suspense account for an ESOP.
3. Two or more defined benefit plans are merged into one defined benefit plan and both of the following conditions are met:
   1. The total liabilities (the present value of benefits whether or not vested) that are merged into the larger plan involved in the merger are less than 3% of the assets of the larger plan. This condition must be satisfied on at least 1 day in the larger plan's plan year during which the merger occurs. All previous mergers (including transfers from another plan) occurring in the same plan year are taken into account in determining the percentage of assets described above. Example: Assume that a merger involving almost 3% of the assets of the larger plan occurs in the first month of the larger plan's plan year. In the fourth month of the larger plan's plan year a second merger occurs involving liabilities equal to 2% of the assets of the larger plan. The total of both mergers exceeds 3% of the assets of the larger plan. As a result of the second merger, both mergers must be reported on Form 5310-A. Enter the date of the second merger on line 5g.

      Also, mergers occurring in previous plan years are taken into account in determining the percentage of assets above if the series of mergers is, in substance, one transaction with the merger occurring during the current plan year.

      Aggregating mergers may cause a merger for which a Form 5310-A was not initially required to be filed to become reportable as a result of a subsequent merger. In this case, the merger(s) must be reported on the Form 5310-A filed for the subsequent merger.

   2. The provisions of the larger plan that allocate assets at the time of termination must provide that in the event of a spinoff or termination of the plan within 5 years following the merger, plan assets will be allocated first for the benefit of the participants in the other plan(s) to the extent of their benefits on a termination basis just prior to the merger.
4. There is a spinoff of a defined benefit plan into two or more defined benefit plans and both of the following conditions are met:
   1. For each plan that results from the spinoff, other than the spunoff plan with the greatest value of plan assets after the spinoff, the value of the assets spun off is not less than the present value of the benefits spun off (whether or not vested).
   2. The value of the assets spun off to all the resulting spunoff plans (other than the spunoff plan with the greatest value of plan assets after the spinoff) plus other assets previously spun off (including transfers to another plan) during the plan year in which the spinoff occurs is less than 3% of the assets of the plan before the spinoff as of at least 1 day in that plan's plan year. Example: Assume that a spinoff involving almost 3% of the assets of the plan occurs in the first month of the plan year. In the fourth month of the plan year a second spinoff occurs involving liabilities equal to 2% of the assets of the plan. The total of both spinoffs exceeds 3% of the plan assets. As a result of the second spinoff, Form 5310-A must be filed to report both spinoffs. Enter the date of the second spinoff on line 5g.

Spinoffs occurring in previous or subsequent plan years are taken into account in determining the percentage of assets spun off if such spinoffs are, in substance, one transaction with the spinoff occurring during the current plan year.

Aggregating spinoffs may cause a spinoff for which a Form 5310-A was not initially required to be filed, to become reportable as a result of a subsequent spinoff. In this case, report the spinoff(s) on the Form 5310-A filed for the subsequent spinoff. Enter the date of the subsequent spinoff on line 5g.

A transfer of plan assets or liabilities is considered a combination of separate plan spinoffs and mergers.

Do not file Form 5310-A for:

• The transferor plan in a transfer transaction if the assets transferred satisfy the spinoff conditions in 2 or 4 above.
• The transferee plan in a transfer transaction if the plan liabilities transferred satisfy the merger conditions in 1 or 3 above.

Thus, in some situations, the transferor plan may have to file Form 5310-A but not the transferee plan or, the transferee plan may have to file but not the transferor plan.

Examples:

Transfer of Plan Assets or Liabilities

Plans A, B, and C are separate plans within the meaning of section 414(l). A portion of the assets and liabilities of both Plan B and Plan C will be transferred to Plan A. None of the plans are excluded from filing under the exceptions from filing listed above. In this situation, three Forms 5310-A must be filed. Each of the plans must file a complete Form 5310-A; enter code 4 (notice of a transfer of plan assets or liabilities) as the reason for filing and complete all of Parts I and II of the form. For Plan A, line 5 of the form will show information regarding Plan B and an attached statement with the line 5 information for Plan C. Plan B and Plan C will each enter the information regarding Plan A on line 5.

Plan Merger

Plans A, B, and C are separate plans within the meaning of section 414(l). Plans A, B, and C are being merged. Assets and liabilities from each plan will be merged into Plan D, a new plan that was established for the purpose of effecting the merger. None of the plans are excluded from filing under the exceptions from filing above.

In this situation, four separate Forms 5310-A must be filed. Because Plan D is receiving assets from Plans A, B, and C, Plan D must file a complete Form 5310-A, enter code 2 (notice of a plan merger) as the reason for filing and complete all of Parts I and II of the form. Line 5 of the form will show information regarding Plan A and an attached statement with the line 5 information for Plans B and C. Plans A, B, and C are merging with Plan D. Plans A, B, and C will each file a separate Form 5310-A completed as follows: Enter code 2 as the reason for filing, complete all of Parts I and II, and enter the information regarding Plan D on line 5.

When To File

• File Form 5310-A at least 30 days prior to a plan merger or consolidation, spinoff, or transfer of plan assets or liabilities to another plan.
• If you are filing Form 5310-A to notify the IRS that the employer treats itself as operating QSLOBs or either modifies or revokes a previously filed notice, file Form 5310-A on or before the notification date for the testing year. The Notification Date for a testing year is the later of: (1) October 15 of the year following the testing year, or (2) the 15th day of the 10th month after the close of the plan year of the plan of the employer that begins earliest in the testing year. Testing Year means the calendar year.

Penalties

If you are filing Form 5310-A to report a plan merger or consolidation, spinoff, or transfer of plan assets or liabilities, there is a penalty for late filing. The penalty is $25 a day for each day the Form 5310-A is late (up to a maximum of $15,000). The form is late if it is not filed at least 30 days before the plan merger or consolidation, spinoff, or transfer of plan assets or liabilities.

Where To File

File this notice with the Internal Revenue Service, P.O. Box 192, Covington, KY 41012-0192.

Signature

In general, the employer or plan administrator must sign both copies of the 1st page of the form. For single employer plans the plan administrator and the employer are generally the same person. When the plan administrator is a joint employer - union board or committee, at least one employer representative and one union representative must sign. A Form 5310-A filed with the IRS by a representative on behalf of an employer or plan administrator must be accompanied by:

1. A power of attorney specifically authorizing such representation in this matter (you may use Form 2848, Power of Attorney and Declaration of Representative), or
2. A written declaration that the representative is a currently qualified attorney, certified public accountant, enrolled actuary, or is currently enrolled to practice before the IRS (include either the enrollment number or the expiration date of the enrollment card) and is authorized to represent the employer or plan administrator.

Specific Instructions

Reason for filing. -    Enter the appropriate code that describes the reason you are filing Form 5310-A.

Enter 1 for a notice of qualified separate lines of business.

Enter 2 for a notice of a plan merger or consolidation.

Enter 3 for a notice of a plan spinoff.

Enter 4 for a notice of a transfer of plan assets or liabilities to another plan.

Part I

Line 1a. -    Enter the name and address of the employer or plan sponsor. If the Post Office does not deliver mail to the street address and the sponsor has a P. O. box, show the box number instead of the street address. If the plan covers only the employees of one employer, enter the employer's name.

Plan Sponsor means:

• In the case of a plan that covers the employees of one employer, the employer;
• In the case of a plan sponsored by two or more entities required to be aggregated under section 414(b), (c), or (m), one of the members participating in the plan; or
• In the case of a plan that covers the employees and/or partner(s) of a partnership, the partnership.

The plan sponsor should be the same name used (or that will be used) when the Form 5500 series return/reports are filed for the plan.

Line 1b. -    Enter the nine-digit employer identification number (EIN) assigned to the employer or plan sponsor. This should be the same EIN that was used (or will be used) when the Form 5500 series returns/reports are filed for the plan. Do not use a social security number. An EIN may be secured by using Form SS-4, Application for Employer Identification Number, which may be obtained by calling 1-800-829-3676.

Enter only the EIN of one of the sponsoring members of the plan for a group of entities required to be aggregated under section 414(b), (c), or (m), whose sponsor is more than one of the entities required to be aggregated. This EIN must be used in all subsequent filings of determination letter requests for this plan. This is also the EIN used for filing annual returns/reports unless there is a change of sponsor.

Line 1c. -    Enter the month the tax year ends for the employer whose EIN you entered on line 1b.

Part II

Line 3a. -    Enter the name you designated for your plan.

Line 3b. -    Enter the three-digit number that the employer or plan administrator has assigned to the plan. This number should be the same as the three-digit number entered on the latest Form 5500, or Form 5500-C/R filed for this plan.

Lines 4a and 4b. -    Attach an actuarial statement of valuation showing compliance with section 414(l). The statement must (a) identify the type of transaction involved (e.g., merger or consolidation, spinoff, or transfer of assets or liabilities), and (b) provide information verifying compliance with the requirements of section 401(a)(12) and 414(l). This statement need not be signed by an actuary.

On line 4b, enter the code that describes your plan.

Enter 1 for a profit-sharing plan.

Enter 2 for a stock bonus plan.

Enter 3 for a money purchase plan.

Enter 4 for a target benefit plan.

Enter 5 for a profit-sharing/401(k) plan.

Enter 6 for an ESOP plan.

Enter 7 for other and specify the type of plan.

Line 5a. -    Enter the total number of plans, other than the plan named on line 3a, involved in this transaction.

Lines 5c through 5h. -    Complete lines 5c through 5h for the other plan(s) involved in the merger or consolidation, spinoff, or transfer of plan assets or liabilities with the plan named on line 3a. If there is more than one other plan, attach a separate statement showing the information requested for lines 5a through 5h. Example: Plans A, B, and C are merging with Plan D. Plan D would complete a Form 5310-A, reporting information about itself on line 3. Plan D would then complete the line 5 information for Plan A and attach two statements showing the line 5 information for Plans B and C. In addition, Plans A, B, and C must each file a separate Form 5310-A (see the example of a plan merger on page 3).

On line 5h, enter the code that describes the other plan.

Enter 1 for a defined benefit plan.

Enter 2 for a profit-sharing plan.

Enter 3 for a profit-sharing/401(k) plan.

Enter 4 for a stock bonus plan.

Enter 5 for an ESOP plan.

Enter 6 for a money purchase plan.

Enter 7 for a target benefit plan.

Enter 8 for other and specify the type of plan.

Part III - Qualified Separate Lines of Business

Rev. Proc. 93-40, 1993-2 C.B. 535, contains procedures relating to the notification requirements of section 414(r)(2)(B).

Notice given by an employer applies to all plans maintained by the employer for plan years beginning in the testing year. Once the notification date (see When To File on page 3), for a testing year has passed, the employer is deemed to have irrevocably elected to apply the specified section or sections of the Code on the basis of QSLOBs for all plan years beginning in the testing year.

In addition, after the notification date, notice cannot be modified, withdrawn or revoked, and will be treated as applying to subsequent testing years unless the employer takes timely action to provide new notice (see examples under Who Must File). Timely action will be deemed to have been taken any time prior to the notification date for any subsequent testing year.

Line 6. -    If you previously filed a notice of QSLOB for a testing year, enter the first testing year for which such notice applied on line 6b. Enter the date the notice was filed on line 6c. Also enter on line 6c the appropriate code number listed below that indicates the location where the prior notice was filed.

1. Northeast Key District Office (Brooklyn)
2. Southeast Key District Office (Baltimore)
3. Cincinnati Key District Office
4. Midstates Key District Office (Dallas)
5. Former Atlanta Key District Office
6. Western Key District Office (Los Angeles/Monterey Park)
7. Former Chicago Key District Office
8. Other

Line 7. -    Enter the first testing year for which this notice applies. See When To File on page 3 for the definition of Testing Year.

Line 8. -    Indicate whether you are filing this form to give notice that you are no longer testing on a QSLOB basis. If your answer to line 8 is yes complete line 9 and skip lines 10 and 11. Answer line 9 based on the previously filed notice that you are now revoking. If your answer to line 8 is no, complete lines 9 through 11. See Who Must File for an example of a revocation.

Line 9. -    Section 414(r) provides rules for determining whether an employer operates QSLOBs for purposes of applying sections 410(b) (relating to minimum coverage), 401(a)(26) (relating to minimum participation rules), and 129(d)(8) (relating to dependent care assistance programs). If you are treated as operating QSLOBs under section 414(r), you will be permitted to apply the aforementioned Code provisions separately for the employees in each QSLOB. Indicate, by checking, the appropriate boxes, which Code section(s) you are testing on a QSLOB basis. See instructions for line 8 to determine how to answer this question if you answered yes to line 8.

Line 10. -    Attach a list identifying the part or parts of the employer that make up each QSLOB of the employer. Your identification should include, for example, the type of business or industry in which the QSLOB is involved, the business unit (such as corporation, partnership, or division) the qualified line of business comprises, and the name (formal or informal) of the QSLOB.

Line 11. -    Enter the information requested on lines 11a through 11e. If there is more than one plan, attach a separate statement showing the information requested on lines 11a through 11e for each plan.

Line 11b. -    Enter the date of the determination letter, if any. Otherwise, leave blank.

Line 11c. -    If the plan is a master or prototype or regional prototype plan, enter the date of the letter and the serial number of the opinion or notification letter request, as applicable. If a letter has not been issued or requested for the plan, leave blank.

Line 11d. -    Enter the appropriate code number that indicates the location of the pending letter request, if any. See instructions for line 6c for a code list. If this question is not applicable, leave blank.

Line 11e. -    List the QSLOBs identified on line 10 that have employees benefiting under the plan on line 11e. If you need additional space to list the QSLOBs, use the area beneath line 11e.

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