This is archived information that pertains only to the 2006 Tax Year. If you
are looking for information for the current tax year, go to the Tax Prep Help Area.
Line 1a.
Enter the name, address, and telephone number of the plan sponsor/employer.
A plan sponsor means:
-
In the case of a plan that covers the employees of one employer, the employer;
-
In the case of a plan maintained by two or more employers (other than a plan sponsored by a group of entities required to
be combined under
section 414(b), (c), or (m)), the association, committee, joint board of trustees or other similar group of representatives
of those who established
or maintain the plan;
-
In the case of a plan sponsored by two or more entities required to be combined 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 name of the plan sponsor/employer should be the same name that was or will be used when the Form 5500 series annual
returns/reports are filed
for the plan.
Address.
Include the suite, room, or other unit number after the street address. If the Post Office does not deliver mail to
the street address and the plan
has a P.O. box, show the box number instead of the street address. This address should be the address of the sponsor/employer.
Line 1b.
Enter the 9-digit employer identification number (EIN) assigned to the plan sponsor/employer. This should be the same
EIN that was or will be used
when the Form 5500 series annual returns/reports are filed for the plan.
Do not use a social security number or the EIN of the trust. For a
multiple employer plan, the EIN should be the same EIN that was or will be used by the participating employer when Form 5500
is filed by the employer.
Use
Form SS-4, Application for Employer Identification Number, to apply for an EIN. Form SS-4 can be obtained at Social Security
Administration (SSA) offices or by calling 1-800-TAX-FORM.
The plan of a group of entities required to be combined under section 414(b), (c), or (m), whose sponsor is more than
one of the entities required
to be combined, should only enter the EIN of one of the sponsoring members. This EIN
must be used in all subsequent filings of
determination letter requests, and for filing annual returns/reports
unless there is a change of sponsor.
Line 1c.
Enter the two digits representing the month the employer's tax year ends. This is the employer whose EIN was entered
on line 1b.
Line 2.
The contact person will receive copies of all correspondence as authorized in a power of attorney, Form 2848, or other
written designation. Either
complete the contact's information on this line, or check the box and attach a Power of Attorney.
Line 3a.
Section 3001 of ERISA requires the applicant to provide evidence that each employee who qualifies as an interested
party has been notified of the
filing of this application. If "Yes" is checked, it means that each employee has been notified as required by regulations
under Section 7476 or this
is a one person plan. A copy of the notice is not required to be attached to this application. If "No" is checked or this
line is blank, the
application may be returned.
Rules defining "interested parties" and the form of notification are in Regulations section 1.7476-1. For an example
of an acceptable format, see
Rev. Proc. 2002-6.
Line 3c.
If you do not have a copy of the latest determination letter, or if no determination letter has ever been received
by the employer, submit copies
of the initial plan, or the latest plan for which you do have a determination letter, and any subsequent amendments and/or
restatements, including all
adoption agreements.
If you check "Yes," also
attach a statement explaining how the amendments affect or change this or any other plan of the employer.
Line 4b.
Enter the three-digit number, beginning with "001" and continuing in numerical order for each plan you adopt. (001-499).
This numbering will
differentiate your plans. The number assigned to a plan must not be changed or used for any other plan. This should be the
same number that was or
will be used when the Form 5500 series returns/reports are filed for the plan.
Line 4c.
Plan year means the calendar, policy, or fiscal year on which the records of the plan are kept.
Line 4e.
Enter the total number of participants. A participant means:
-
The total number of employees participating in the plan including employees under a section 401(k) qualified cash or deferred
arrangement
who are eligible but do not make elective deferrals,
-
Retirees and other former employees who have a nonforfeitable right to benefits under the plan, and
-
The beneficiary of a deceased employee who is receiving or will in the future receive benefits under the plan. Include one
beneficiary for
each deceased employee regardless of the number of individuals receiving benefits.
Example.
The payment of a deceased employee's benefit to three children is considered a payment to one beneficiary.
Line 5. Cash balance or similar plan.
For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (e.g.,
personal account plan, pension
equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit
as a life annuity
commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan
such as a single sum
distribution amount (e.g., 10 percent of final average pay times years of service, or the amount of the employee's hypothetical
account balance).
Line 6.
If the plan employer/sponsor is a member of a controlled group of corporations, trades or businesses under common
control, or an affiliated service
group, all employees of the group will be treated as employed by a single employer for purposes of certain qualification requirements.
Attach a
statement showing in detail:
-
All members of the group,
-
Their relationship to the plan sponsor,
-
The type(s) of plan(s) each member has, and
-
Plans common to all members.
Note.
If you want to apply for a determination letter to determine if you are a member of an affiliated service group, do not file
this form. File Form
5300.
Line 7.
Attach copies of records of all actions taken to terminate the plan, such as board of directors' resolutions.
Line 7b.
Assets must be distributed as soon as administratively feasible after the date of termination. See Rev. Rul. 89-87,
1989-2 C.B. 81.
Line 7c.
Check "No" only if you are certain that there will be no reversion of plan assets to the employer.
Line 10d.
If you checked adverse business conditions as the reason for filing for termination, attach an explanation detailing
the conditions that require
termination of the plan.
Line 13.
Complete this line to indicate how the plan satisfied section 410(b). Complete lines 13a through 13n if the plan satisfied
the ratio percentage
test for the year of termination. Complete line 13o if the plan satisfied the average benefit test for the year of termination.
Complete line 13p if
the plan satisfied coverage using one of the special requirements of Regulations section 1.410(b)-2(b)(5), (6), or (7). Plans
that use the qualified
separate lines of business rules of section 414(r) must attach Demo 1. See Guidelines for Demonstrations.
Line 13a.
If the plan is disaggregated into two or more separate plans that are other than profit sharing and/or section(s)
401(k) and/or 401(m) plan(s),
complete lines 13b through 13o with respect to each disaggregated portion of the plan. Attach additional schedules as necessary
to identify the other
disaggregated portions of the plan and to provide the requested coverage information, in the same format as line 13, separately
with respect to the
other portions of the plan, or to otherwise show that the other portions of the plan separately satisfy section 410(b).
Example.
If this plan benefits the employees of more than one qualified separate line of business (QSLOB), the portion of the plan
benefiting the employees
of each QSLOB is treated as a separate plan maintained by that QSLOB and must separately satisfy section 410(b) unless the
employer-wide plan testing
rule in Regulations section 1.414(r)-1(c)(2)(ii) applies.
Section(s) 401(k) and/or 401(m) plan(s) must complete line 13(l) for the portion of the plan that is not a section 401(k)
or a 401(m) plan. Also
complete line 13(m)(1) to report the ratio percentage for the section 401(k) portion of the plan and line 13(m)(2) to report
the ratio percentage for
the section 401(m) portion of the plan.
Line 13c.
If, for purposes of satisfying the minimum coverage requirements of section 410(b), you are applying the daily testing
option in Regulations
section 1.410(b)-8(a)(2) or the quarterly testing option in Regulations section 1.410(b)-8(a)(3), or, if you are using single-day
"snapshot" testing
as permitted under section 3 of Rev. Proc. 93-42, 1993-2 C.B. 540, enter the most recent eight-digit date (MMDDYYYY) for which
the coverage data is
submitted. If you are applying the annual testing option in Regulations section 1.410(b)-8(a)(4), enter the year for which
the coverage data is
submitted.
Line 13d.
Include all employees of all entities combined under section 414(b), (c), (m), or (o). Also include all self-employed
individuals, common law
employees, and leased employees as defined in section 414(n) of any of the entities above, other than those excluded by section
414(n)(5). Certain
other individuals may also be required to be counted as employees. See the definition of employee in Regulations section 1.410(b)-9.
Also see
Regulations section 1.410(b)-6(i), which may permit the employer to exclude certain former nonhighly compensated employees.
Note.
This note applies only to plans that include a qualified cash or deferred arrangement under section 401(k) or employee or matching
contributions under section 401(m).
If there are any contributions under the plan that are not subject to the special rule for section 401(k) plans and section
401(m) plans in
Regulations section 1.401(a)(4)-1(b)(2)(ii)(B) (such as nonelective contributions), complete lines 13e through 13k with respect
to the portion of the
plan that includes these contributions and enter the ratio percentage for this portion of the plan on line 13l.
Otherwise, complete lines 13e through 13k with respect to the section 401(k) part of the plan (or the section 401(m) plan
if there is no section
401(k) arrangement) and leave line 13l blank. In all cases, enter the ratio percentages for the section 401(k) and the section
401(m) parts of the
plan, as applicable, on line 13m. These percentages should be based on the actual nonexcludables in the sections 401(k) and
401(m) portions,
respectively. It is suggested that these calculations be submitted with the application, but this is optional.
Do not base the calculations on lines 13(m)(1) and (2) on the nonexcludable employees reported on line 13(g) unless all of
the disaggregated
plans (profit sharing, section 401(k), and section 401(m)) have the same nonexcludable employees with the same age and service
requirements.
Line 13e(1).
Enter the number of employees who are excluded because they have not attained the lowest minimum age and service requirements
for any employee
under this plan. If the employer is separately testing the portion of a plan that benefits otherwise excludable employees,
attach a separate schedule
describing which employees are treated as excludable employees on account of the minimum age and service requirements under
each separate portion of
the plan.
Line 13e(2).
Enter the number of employees who are excluded because they are collectively bargained employees as defined in Regulations
section
1.410(b)-6(d)(2), regardless of whether those employees benefit under the plan. For this purpose, an employee covered under
a Collective Bargaining
Agreement (CBA) is not considered a collectively bargained employee if more than 2% of the employees who are covered under
the agreement are
professional employees as defined in Regulations section 1.410(b)-9.
Line 13e(3).
Enter the number of employees who do not receive an allocation or accrue a benefit under the plan only because they
do not satisfy a minimum hours
of service requirement or a last-day-of-the-plan year requirement, provided they do not have more than 500 hours of service,
and they are not employed
on the last day of the plan year. Do not enter on this line any employees who have more than 500 hours of service, even if
they are not employed on
the last day of the plan year.
Line 13e(4).
If this plan benefits the employees of one QSLOB, enter on this line the number of employees of the employer's other
QSLOBs. This is not applicable
if the plan is tested under the special rule for employer-wide plans in Regulations section 1.414(r)-1(c)(2)(ii).
Line 13e(5).
Enter the number of employees who are nonresident aliens who receive no earned income (as defined in section 911(d)(2))
from the employer that
constitutes income from sources within the United States (as defined in section 861(a)(3)).
Line 13g.
Subtract the total of lines 13(e)(1) through 13(e)(5) as reported on line 13(f) from the total employees reported
on line 13(d). The result is the
number of "nonexcludable employees". These are the employees who cannot be excluded from the plan for statutory or regulatory
reasons and must be
considered in the calculation of the ratio percentage even though they might not "benefit" under the plan. If they meet the
age and service
requirements of section 410 and are not otherwise excludable employees, they must be included in this number.
Line 13h.
Enter the number of employees on line 13g who are highly compensated employees (HCEs) as defined in section 414(q).
Line 13i.
In general, an employee is treated as benefiting under the plan for coverage tests purposes only if the employee receives
an allocation of
contributions or forfeitures or accrues a benefit under the plan for the plan year. Certain other employees are treated as
benefiting if they fail to
receive an allocation of contributions and/or forfeitures, or to accrue a benefit, solely because they are subject to plan
provisions that uniformly
limit plan benefits, such as a provision for maximum years of service, maximum retirement benefits, application of offsets
or fresh start wear-away
formulas, or limits designed to satisfy section 415.
An employee is treated as benefiting under a plan to which elective contributions under section 401(k) or employee
contributions and matching
contributions under section 401(m) may be made if the employee is currently eligible to make such elective or employee contributions,
or to receive a
matching contribution, whether or not the employee actually makes or receives such contributions, (Regulations sections 1.401(k)-1(g)(4)
and
1.401(m)-1(f)(4)). However, do not apply this rule to determine if an employee is to be counted as benefiting for lines 13i
and 13k if, in accordance
with the note following the instruction for line 13d, the information provided in lines 13e through 13k relates to the portion
of the plan that is not
subject to the rule in Regulations section 1.401(a)(4)-1(b)(2)(ii)(B).
Line 13k.
See the instructions for line 13i for the meaning of "benefiting under the plan."
Line 13l.
To obtain the ratio percentage:
Step 1.
Divide the number on line 13k (nonexcludable NHCEs benefiting under the plan) by the number on line 13j (nonexcludable
NHCEs).
Step 2.
Divide the number on line 13i (nonexcludable HCEs benefiting under the plan) by the number on line 13h (nonexcludable
HCEs).
Step 3.
Divide the result from Step 1 by the result from Step 2.
Note.
If the ratio percentage entered on line 13l and/or line 13m is less than 70%, the plan does not satisfy the ratio percentage
test. In this case,
the plan must satisfy the average benefit test. A determination regarding the average benefit test can be requested on line
13o by submitting a Demo
5.
Line 13m.
See the Note following the instructions for line 13d. To determine the ratio percentages for the section 401(k) and
all section 401(m) (matching
and employee contribution) portions of the plan, follow the steps described in the instructions for lines 13d through 13l,
but treat an employee as
benefiting under the rules for section 401(k) plans and section 401(m) plans described in the instruction for line 13i.
Line 13o.
Plans that use the average benefit test to satisfy section 410(b) for the year of termination must attach a Demo 5
(see Guidelines for
Demonstrations) unless the plan has received a favorable determination regarding the average benefit test in the 3 years preceding
the date of
termination and the plan has not experienced a material change in the facts (including benefits provided and employee demographics)
on which the
determination was based.
Line 14.
Do not complete line 14 if line 13p is completed. Complete line 14 to indicate how the plan satisfied the requirements
of section 401(a)(4).
Complete this line as of the date entered in line 13c. If this plan has been disaggregated into separate plans or restructured
into component plans,
attach a Demo 4 indicating how each separate disaggregated plan or restructured component plan satisfies the nondiscrimination
in amount requirement
of Regulations section 1.401(a)(4)-1(b)(2).
If any restructured component plan or disaggregated plan relies on a non-design based safe harbor or a general test,
leave line 14c blank.
Line 14a.
Check "Yes" if the plan is intended to satisfy the permitted disparity requirements of section 401(I).
Line 14b.
To satisfy section 401(l), a plan must provide that the overall permitted disparity limits are not exceeded and specify
how employer-provided
contributions or benefits under the plan are adjusted, if necessary, to satisfy the overall permitted disparity limits. See
Regulations section
1.401(l)-5.
Line 14e.
Plans that use a non-design based safe harbor or a general test to satisfy section 401(a)(4) for the year of termination
must attach a Demo 6 (see
Guidelines for Demonstrations) unless: (1) the plan has received a favorable determination regarding the non-design based
safe harbor or general test
in the 3 years preceding the date of termination, and (2) the plan has not experienced a material change in the facts (including
benefits provided and
employee demographics) on which the determination was based.
Line 15a(4).
A dropped participant means any participant who has terminated employment even if their benefits have not been distributed.
Line 15a(6).
Enter the number of participants separated from vesting service with less than 100% vesting in their accrued benefit
or account balance.
Line 15b.
Attach a schedule with the following information for each participant who has separated from vesting service with less than 100%
vesting:
-
Name of participant,
-
Date of hire,
-
Date of termination,
-
Years of participation,
-
Vesting percentage,
-
Account balance/account benefit at the time of separation from service,
-
Amount of distribution,
-
Date of distribution, and
-
Reason for termination.
If there is a 20% reduction in participants, explain why this would not constitute a partial termination.
Line 17b.
Regulations section 1.401(a)-20, Q&A-2 provides, in part, that the requirements of sections 401(a)(11) and 417 apply
to the payments under
annuity contracts, not to the distributions of annuity contracts.
Line 17c.
The accrued benefits of a plan participant may not be reduced on plan termination. A plan amendment (including an
amendment terminating a plan)
that effectively eliminates or reduces an early retirement benefit or a retirement type subsidy for benefits attributable
to pre-amendment service is
treated as reducing the accrued benefit of a participant if subsequent to termination the participant could satisfy the conditions
necessary to
receive such benefits. See section 411(d)(6) and Regulations section 1.411(d)-3 and Rev. Rul. 85-6, 1985-1 C.B. 133.
Line 17d.
Answer "Yes" if any funds were contributed in the form of, or invested in, obligations or property of the employer
(including any entity related to
the employer under section 414(b) or 414(c)).
Line 17f.
If there is a contribution receivable that the employer intends to make by the required due date for section 412,
and no funding deficiency will
exist after the contribution is made, this line should be answered "No."
Line 17h(1).
Provide a description of the transaction(s) and attach a statement which must include the:
-
Name(s) of the sponsor(s) involved;
-
Employer identification number(s) of the sponsor(s);
-
Plan administrator's name(s) and EIN; and
-
Plan name(s) and plan numbers.
Line 17h(4)(A).
All plan liabilities must be satisfied before assets can revert to the employer upon termination of the plan. All
liabilities will not be satisfied
if the value of retirement-type subsidies are not provided participants who, after the date of the proposed termination, satisfy
certain
pre-termination conditions necessary to receive such benefits. See section 401(a)(2), Regulations section 1.401-2(a)(1) and
Rev. Rul. 85-6.
Line 17h(4)(B).
The annuity contracts purchased must be guaranteed for each participant. However, in order to maintain qualification
of a continuing pension plan,
the contracts covering participants' accrued benefits in the plan must not be distributed except in accordance with Regulations
section
1.401-1(b)(1)(i).
Line 17h(7).
Answer "Yes" if your plan is a defined benefit plan and you intend that any or all of your participants will be covered
by a new or existing
defined benefit plan of the employer.
Line 17h(10).
If the answer to this item is "Yes," attach a list that includes the:
-
Name(s) of the plan sponsor(s),
-
Employer or sponsor's EINs,
-
Administrator's identification number(s),
-
Plan number(s), and
-
An explanation of the termination(s) including:
-
The amount(s) of the reversion(s),
-
The date(s) of termination, and
-
The reason(s) for termination.
Line 17j.
For this question only, "single-sum distribution" will mean a single payment of the value of a participant's benefits
or a series of payments that
do not provide substantially equal payments (either alone or in conjunction with other benefit payments) over the life of
the participant.
Line 17l.
Section 416 provides that plan participants in a top-heavy plan who are non-key employees must accrue a minimum benefit
or receive a minimum
contribution.
Line 17m.
If "Yes" is checked, attach a list for each plan with the following information:
-
Name of plan,
-
Type of plan,
-
Plan number, and
-
Indicate if another application is simultaneously being submitted with this application.
Line 18.
Complete this only for defined contribution plans. Enter the date of the current plan year and the prior 5 plan-years
in the columns indicated.
Line 18b.
Enter the amount of forfeitures for each of the plan years entered. If these forfeitures resulted from a cashout for
a year not listed on line 15a,
attach a statement indicating the year of the cashout.
Line 18c.
Enter the amount of transfers and rollovers received from qualified plans (under section 401(a) and/or conduit IRAs)
for each of the plan years
entered.
Line 19.
Check the box or boxes that indicate the form(s) of distribution of benefits for your plan upon termination. Submit
a statement that all
distributions have been or will be made in accordance with plan provisions and proper spousal consents will be secured, when
applicable.
Line 20.
Complete the statement showing the estimated fair market value of the plan assets and liabilities as of the proposed
date of termination or the
latest valuation date.
Include and clearly identify all liabilities (other than liabilities for benefit payments due after the date of plan
termination) that are unpaid
as of the proposed termination date or that are paid or payable from plan assets after the proposed date of plan termination
under the provisions of
the plan. Liabilities include expenses, fees, other administrative costs, and benefit payments due and not paid before the
proposed termination date
or latest valuation date.
Line 20c(4).
Include investment securities issued by a corporate entity at a stated interest rate repayable on a particular future
date such as most bonds,
debentures, convertible debentures, commercial paper and zero coupon bonds. Do not include debt securities of governmental
units or municipalities.
Line 20c(7)(A).
Include the current value of real property owned by the plan which produces income from rentals, etc. Do not include
this property in line 20e
(buildings and other property used in plan operations).
Line 20c(7)(B).
Include the current value of real property owned by the plan which is not producing income or used in plan operations.
Line 20c(9) and (10).
Attach a list regarding loans from the plan. Include the following information:
-
Name,
-
Dollar amount of each loan(s),
-
Date of loan,
-
Balance of the loan at the date of termination,
-
Account balance prior to the date of the loan,
-
Identify all disqualified persons as described by section 4975(f), and
-
Amortization and/or repayment schedule.
Line 20c(12).
Include allocated and unallocated contracts including plan-owned life insurance.
Line 20i.
"Acquisition indebtedness," for debt-financed property other than real property, means the outstanding amount of the
principal debt incurred:
-
By the organization in acquiring or improving the property;
-
Before the acquisition or improvement of the property if the debt was incurred only to acquire or improve the property; or
-
After the acquisition or improvement of the property if the debt was incurred only to acquire or improve the property and
was reasonably
foreseeable at the time of such acquisition or improvement. For more details, see section 514(c).
