US Internal Revenue Service: i5500cr--1992

8/14/2019 US Internal Revenue Service: i5500cr--1992

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Cat. No. 10958V

Section 1

Plan YearFile 1992 forms for plan years that startedin 1992. If the plan year differs from thecalendar year, fill in the fiscal year spacejust under the form title. For a short planyear, check box A(4) and see When ToFile on page 2.

A Change You Should NoteNew Schedule for 1992.Schedule F(Form 5500), Fringe Benefit Plan AnnualInformation Return, is a new Form 5500schedule designed to simplify the reportingrequirements of fringe benefit plans.

ReminderMany filers receive rejection notices forfailing to complete items 4, 6, and 26bproperly. 5500-R filers often fail tocomplete items 14 and 15b properly. Thereturn/report will also be consideredincomplete and penalties may be imposedif information required on a schedule is not

typed or printed on the appropriateschedule, such as the Schedule A (Form5500). See Schedules on page 6.Generally, a return/report must be filed foremployee welfare benefit plans whichprovide benefits wholly or partially througha Multiple Employer Welfare Arrangement(MEWA) as defined in ERISA section 3(40),unless otherwise exempt (see page 3).

In addition to filing this form with theIRS, plans covered by the Pension BenefitGuaranty Corporation (PBGC) terminationinsurance program must file their Annual

Premium Payment, PBGC Form 1, directlywith that agency.

Electronic Filing of Form 5500-C/R.Qualified tax return filers can file Form5500-C/R and related schedules viamagnetic media (magnetic tapes, floppydiskettes) or electronically. If the planadministrator files the employee plan returnelectronically or on magnetic media, he orshe must also file Form 8453-E, EmployeeBenefit Plan Declaration and Signature forElectronic/Magnetic Media Filing. This isthe declaration and signature form for theelectronic/magnetic media return. For more

information, see Pub. 1507, Procedures forElectronic/Magnetic Media Filing ofEmployee Benefit Plan Returns Forms5500, 5500-C/R, and 5500EZ for Plan Year1992.

How To Use This InstructionBookletThe instructions are divided into four mainsections.

Section 1 Page

Plan Year 1A Change You Should Note 1

Penalties 2

Who Must File 2

When To File 2

Extension of time To File 2

Where To File 2

Section 2

Kinds of Plans 2

Pension Benefit 2

Welfare Benefit 3

Fringe Benefit 3

Plans Excluded From Filing 3

Kinds of Filers 3

Single Employer 3

Controlled Group of Corporations,Group of Trades or BusinessesUnder Common Control, or anAffiliated Service Group 3

Multiemployer 3

Multiple-Employer CollectivelyBargained 4

Multiple-Employer (Other) 4

Investment Arrangements Filing DirectlyWith DOL 4

Common/Collective Trust andPooled Separate Account 4

Master Trust 4

103-12 Investment Entities 4

What To File 5

Forms 5

Items To Complete on Form5500-C 5

Items To Complete on Form5500-R 6

Schedules 6

Other Filings 7

Section 3

Final Return/Report 8

Signature and Date 8

Reproductions 8

Change in Plan Year 8

Amended Return/Report 8

How the Annual Return/ReportInformation May Be Used 8

Section 4

Informat ion at the Top of the Form 8

Line-By-Line Instructions 8

Page 1 8

Form 5500-R, Page 2 10

Form 5500-C, Page 3 Through 6 13

Codes for Principal Business Activityand Princ ipal Product or Service 19

Pension BenefitGuaranty Corporation

Department of LaborPension and WelfareBenefits Administration

Department of the TreasuryInternal Revenue Service

1992 Instructionsfor Form 5500-C/RReturn/ Report of Employee Benefit Plan(With fewer than 100 participants)(Code references are to the Internal Revenue Code. ERISA refers to theEmployee Retirement Income Security Act of 1974. )

Paperwork Reduction Act Notice.We ask for the information on this form to carry out thelaw as specified in ERISA and Code section 6039D. You are required to give us theinformation. We need it to determine whether the plan is operating according to the law.

The time needed to complete and file the forms listed below reflect the combinedrequirements of the Internal Revenue Service, Department of Labor, Pension Benefit GuarantyCorporation, and the Social Security Administration. These times will vary depending onindividual circumstances. The estimated average times are:

Copying,assembling, andsending the form

to the IRS

Learning aboutthe law or the

form Preparing the formRecordkeeping

32 min.10 hr., 35 min.7 hr., 29 min.Form 5500-C (Initial fi lers) 55 hr., 29 min.

Form 5500-C (All other filers) 32 min.10 hr., 26 min.7 hr., 29 min.45 hr., 41 min.

Schedule A (Form 5500) 16 min.1 hr., 42 min.28 min.17 hr., 28 min.

Schedule B (Form 5500) 3 hr., 16 min.2 hr., 35 min.34 hr., 12 min.

Schedule P (Form 5500) 33 min.30 min.1 hr., 55 min.

Schedule SSA (Form 5500) 19 min.12 min.6 hr., 42 min.

If you have comments concerning the accuracy of these time estimates or suggestions formaking these forms more simple, we would be happy to hear from you. You can write to boththe Internal Revenue Service, Washington, DC 20224, Attention: IRS Reports ClearanceOfficer, T:FP; and the Office of Management and Budget, Paperwork Reduction Project(1210-0016), Washington, DC 20503. DO NOT send your return to either of these offices.

Instead, see Where To File on page 2.

32 min.6 hr., 25 min.4 hr., 1 min.Form 5500-R (Init ial filers) 22 hr.

Form 5500-R (All other filers) 32 min.6 hr., 15 min.4 hr., 1 min.12 hr., 12 min.

Schedule E (Form 5500)(nonleveraged ESOP) 14 min.12 min.1 hr., 40 min.

Schedule E (Form 5500)(leveraged ESOP) 1 hr., 56 min.1 hr., 41 min.10 hr., 2 min.

Schedule F (Form 5500) 1 hr., 27 min. 46 min. 19 min.


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PenaltiesERISA and the Code provide for theassessment or imposition of penalties fornot giving complete information and notfiling statements and returns/reports.Certain penalties are administrative; that is,they may be imposed or assessed by oneof the governmental agencies delegated toadminister the collection of Form 5500series data. Others require a legalconviction.

Administrative Penalties

Listed below are various penalties for notmeeting the Form 5500 series filingrequirements. One or more of the followingfive penalties may be imposed or assessedin the event of incomplete filings and/orfilings received after the due date unless itis determined that your explanation forfailure to file properly is for reasonablecause:

1. A penalty of up to $1,000 a day foreach day a plan administrator fails orrefuses to file a complete return/report.See ERISA section 502(c)(2) and 29 CFR2560.502c-2.

2. A penalty of $25 a day (up to $15,000)for not filing returns for certain plans ofdeferred compensation, certain trusts andannuities, and bond purchase plans by thedue date(s). See Code section 6652(e).This penalty also applies to returnsrequired to be filed under Code section6039D.

3. A penalty of $1 a day (up to $5,000)for each participant for whom a registrationstatement (Schedule SSA (Form 5500)) isrequired but not filed. See Code section6652(d)(1).

4. A penalty of $1 a day (up to $1,000)for not filing a notification of change ofstatus of a plan. See Code section6652(d)(2).

5. A penalty of $1,000 for not filing anactuarial statement. See Code section6692.

Other Penalties1. Any individual who willfully violates

any provision of Part 1 of Title I of ERISAshall be fined not more than $5,000 orimprisoned not more than 1 year, or both.See ERISA section 501.

2. A penalty of up to $10,000, 5 yearsimprisonment, or both, for making anyfalse statement or representation of fact,knowing it to be false, or for knowinglyconcealing or not disclosing any factrequired by ERISA. See section 1027, Title18, U.S. Code, as amended by section 111

of ERISA.

Who Must FileAny administrator or sponsor of anemployee benefit plan subject to ERISAmust file information about each such planevery year (Code section 6058 and ERISAsections 104 and 4065). Every employermaintaining a specified fringe benefit planas described in Code section 6039D(except Code sections 79, 105, 106, and129 plans) is also required to file eachyear. The Internal Revenue Service (IRS),Department of Labor (DOL), and Pension

Benefit Guaranty Corporation (PBGC) haveconsolidated their returns and report formsto minimize the filing burden for planadministrators and employers. The charton page 5 gives a brief guide to the typeof return/report to be filed.

When To FileFile all required forms and schedules bythe last day of the 7th month after the planyear ends. For a short plan year, file theform and applicable schedules by the lastday of the 7th month after the short planyear ends. For purposes of thisreturn/report, the short plan year ends onthe date of the change in accountingperiod or upon the complete distribution ofthe assets of the plan. (Also see Section3.) If the current year Form 5500-C/R is notavailable before the due date of your shortplan year return/report, use the latest yearform available and change the date printedon the return/report to the current year.Also show the dates your short plan yearbegan and ended.

Extension of Time To File

A one time extension of time up to 212months may be granted for filing

returns/reports if Form 5558, Applicationfor Extension of Time To File CertainEmployee Plan Returns, is filed before thenormal due date (not including anyextensions) of the return/report.

Exception: Plans are automatically grantedextensions of time to file Form 5500-C/Runtil the due date of the Federal incometax return of the employer if all thefollowing conditions are met: (1) The planyear and the employers tax year are thesame. (2) The employer has been grantedan extension of time to file its Federalincome tax return to a date later than thenormal due date for filing the Form5500-C/R. (3) A copy of the IRS extensionof time to file the Federal income tax returnis attached to the Form 5500-C/R filed withthe IRS. An extension granted by using thisexception CANNOT be extended further byfiling a Form 5558.

Note: An extension of time to file thereturn/report does not operate as anextension of time to file the PBGCForm 1.

Where To FilePlease file the return/report with theInternal Revenue Service Center indicatedbelow. No street address is needed.

See page 7 for the filing address forinvestment arrangements filing directly with

DOL.If the principal officeof the plan sponsor

or the plan administratoris located in:

Use the followingInternal RevenueService Center

address

Connecticut, Delaware,District of Columbia,Foreign Address, Maine,Maryland, Massachusetts,New Hampshire, NewJersey, New York,Pennsylvania, Puerto Rico,Rhode Island, Vermont,Virginia

Holtsville, NY 00501

Alabama, Alaska, Arkansas,California, Florida, Georgia,Hawaii, Idaho, Louisiana,Mississippi, Nevada, NorthCarolina, Oregon, SouthCarolina, Tennessee,Washington

Atlanta, GA 39901

Arizona, Colorado, Illinois,Indiana, Iowa, Kansas,Kentucky, Michigan,Minnesota, Missouri,Montana, Nebraska, NewMexico, North Dakota,Ohio, Oklahoma, South

Dakota, Texas, Utah, WestVirginia, Wisconsin,Wyoming

Memphis, TN 37501

All Form 5500EZ filers Andover, MA 05501

Section 2

Kinds of PlansEmployee benefit plans include pensionbenefit plans and welfare benefit plans. Filethe applicable return/report for any of thefollowing plans.

Pension Benefit Plan

This is an employee pension benefit plancovered by ERISA. The return/report is duewhether or not the plan is qualified andeven if benefits no longer accrue,contributions were not made this plan year,or contributions are no longer made(frozen plan or wasting trust ). See FinalReturn/Report on page 8.

Pension benefit plans required to fileinclude defined benefit plans and definedcontribution plans (e.g., profit-sharing,stock bonus, money purchase plans, etc.).The following are among the pensionbenefit plans for which a return/reportmust be filed:

1. Annuity arrangements under Code

section 403(b)(1).2. Custodial account established underCode section 403(b)(7) for regulatedinvestment company stock.

3. Individual retirement accountestablished by an employer under Codesection 408(c).

4. Pension benefit plan maintainedoutside the United States primarily fornonresident aliens if the employer whomaintains the plan is:

a. A domestic employer, or

b. A foreign employer with incomederived from sources within the UnitedStates (including foreign subsidiaries ofdomestic employers) and deducts

contributions to the plan on its U.S.income tax return. See Plans ExcludedFrom Filing on page 3.

5. Church plans electing coverage underCode section 410(d).

6. A plan that covers residents of PuertoRico, the Virgin Islands, Guam, WakeIsland, or American Samoa. This includes aplan that elects to have the provisions ofsection 1022(i)(2) of ERISA apply.

See page 5 for Items To Complete onForm 5500-C and Items To Complete onForm 5500-R on page 6 for more


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information about what questions must becompleted by pension plans.

Welfare Benefit Plan

An employee welfare benefit plan iscovered by Part 1 of Title I of ERISA.Welfare plans provide benefits such asmedical, dental, life insurance,apprenticeship and training, scholarshipfunds, severance pay, disability, etc.

See page 5 for Items To Complete onForm 5500-C and Items To Complete onForm 5500-R on page 6. It contains more

information about what questions must becompleted for welfare benefit plans.

Fringe Benefit Plan

Group legal services plans described inCode section 120, cafeteria plansdescribed in Code section 125, andeducational assistance programs describedin Code section 127 are considered fringebenefit plans and generally are required tofile the annual information specified byCode section 6039D. However, Codesection 127 educational assistanceprograms that provide only job-relatedtraining that is deductible under Codesection 162 do not have to file Form

5500-C/R.Note: A fringe benefit plan may beassociated with one or more welfare plansas described above for which a Form5500-C/R may be required to be filed.

See Items To Complete on Form5500-C and Items To Complete on Form5500-R on pages 5 and 6 for moreinformation about how to complete thisform for a fringe benefit plan.

Plans Excluded From FilingThese exemptions do not apply to a fringebenefit plan required to file to satisfy therequirements of Code section 6039D.

Do not file a return/report for anemployee benefit plan that is any of thefollowing:

1. A welfare benefit plan which coversfewer than 100 participants as of thebeginning of the plan year and is:unfunded, fully insured, or a combinationof insured and unfunded.

a. An unfunded welfare benefit plan hasits benefits paid as needed directly fromthe general assets of the employer or theemployee organization that sponsors theplan.

Note: Plans that are NOT unfunded includethose plans that received employee (orformer employee) contributions during the

plan year and/or used a trust or separatelymaintained fund (including a Code section501(c)(9) trust) to hold plan assets or act asa conduit for the transfer of plan assetsduring the plan year.

b. A fully insured welfare benefit planhas its benefits provided exclusivelythrough insurance contracts or policies, thepremiums of which must be paid directlyby the employer or employee organizationfrom its general assets or partly from itsgeneral assets and partly fromcontributions by its employees or members

(which the employer or organizationforwards within 3 months of receipt).

The insurance contracts or policiesdiscussed above must be issued by aninsurance company or similar organization(such as Blue Cross, Blue Shield or ahealth maintenance organization) which isqualified to do business in any state.

c. A combination unfunded/insuredwelfare plan has its benefits providedpartially as an unfunded plan and partiallyas a fully insured plan. An example of sucha plan is a welfare plan which provides

medical benefits as in a above and lifeinsurance benefits as in b above.

See 29 CFR 2520.104-20.

Note: An employees beneficiaryassociation as used in Code section501(c)(9) should not be confused with theemployee organization or employer thatestablishes and maintains (i.e., sponsors)the welfare benefit plan.

2. An unfunded pension benefit plan oran unfunded or insured welfare benefitplan: (a) whose benefits go only to a selectgroup of management or highlycompensated employees, and (b) whichmeets the terms of Department of LaborRegulations 29 CFR 2520.104-23 (including

the requirement that a notificationstatement be filed with DOL) or 29 CFR2520.104-24.

3. Plans maintained only to comply withworkers compensation, unemploymentcompensation, or disability insurance laws.

4. An unfunded excess benefit plan.

5. A welfare benefit plan maintainedoutside the United States primarily forpersons substantially all of whom arenonresident aliens.

6. A pension benefit plan maintainedoutside the United States if it is a qualifiedforeign plan within the meaning of Codesection 404A(e) that does not qualify forthe treatment provided in Code section

402(c).7. An annuity arrangement described in

29 CFR 2510.3-2(f).

8. A simplified employee pension (SEP)described in Code section 408(k) whichconforms to the alternative method ofcompliance described in 29 CFR2520.104-48 or 29 CFR 104-49. A SEP is apension plan that meets certain minimumqualifications regarding eligibility andemployer contributions.

9. A church plan not electing coverageunder Code section 410(d) or agovernmental plan.

10. A welfare plan that participates in agroup insurance arrangement that files areturn/report Form 5500 on its behalf. Agroup insurance arrangement is anarrangement that provides benefits to theemployees of two or more unaffiliatedemployers (not in connection with amultiemployer plan or a multiple-employercollectively bargained plan), fully insuresone or more welfare plans of eachparticipating employer, and uses a trust (orother entity such as a trade association) asthe holder of the insurance contracts andthe conduit for payment of premiums tothe insurance company. For further details,see 29 CFR 2520.104-43.

11. An apprenticeship or training planmeeting all of the conditions specified in29 CFR 2520.104-22.

Kinds of FilersThe different types of plan entities that filethe form are described below. (Also seeinstructions for item 4 on page 9.)

1. Single-Employer Plan.If oneemployer or one employee organizationmaintains a plan, file a separatereturn/report for the plan. If the employer

or employee organization maintains morethan one such plan, file a separatereturn/report for each plan.

If a member of either a controlled groupof corporations, a group of trades orbusinesses under common control or anaffiliated service group maintains a planthat does not involve other groupmembers, file a separate return/report as asingle-employer plan.

If several employers participate in aprogram of benefits in which the fundsattributable to each employer are availableonly to pay benefits to that employersemployees, each employer must file aseparate return/report.

2. Plan For Controlled Group ofCorporations, Group of Trades orBusinesses Under Common Control, orAn Affiliated Service Group.Thesegroups are defined in Code sections414(b), (c), and (m), and are referred to ascontrolled groups.

If the benefits are payable to participantsfrom the plans total assets without regardto contributions by each participantsemployer, file one return/report for theplan. On the return/report for the plan,complete item 21 only for the controlledgroups employees.

Note: Employers who participate in apension plan of one of the groups listedabove but who are not members of thegroup must file a separate return/report.The return/report should be filed on Form5500-C/R regardless of the number ofparticipants. The years you are required tofile pages 1 and 3 through 6 as Form5500-C (seeWhat To Fileon page 5),complete only items 1 through 7a, 9, and21. The years you file pages 1 and 2 asForm 5500-R complete only items 1through 7a, 8a, and 8b. These participatingemployersmustenter code F on item 4 ofthe Form 5500-C/R.

If several employers participate in aprogram of benefits in which the fundsattributable to each employer are availableonly to pay benefits to that employers

employees, each employer must file aseparate return/report as a single employerplan.

3. Multiemployer Plan.Amultiemployer plan is a plan (1) to whichmore than one employer is required tocontribute, (2) that is maintained pursuantto one or more collective-bargainingagreements, and (3) has not made theelection under Code section 414(f)(5) andERISA section 3(37)(E). File onereturn/report for each plan. Contributingemployers do not file individually for these


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plans. See Code section 414 for moreinformation.

4. Multiple-Employer-Collectively-Bargained Plan.These plans involvemore than one employer, are collectivelybargained and collectively funded, and, ifcovered by PBGC termination insurance,have properly elected before September27, 1981, not to be treated asmultiemployer plans under Code section414(f)(5) or ERISA sections 3(37)(E) and4001(a)(3). File one return/report for eachsuch plan. Participating employers do not

file individually for these plans.Note: Filers described inMultiemployerPlanorMultiple-Employer CollectivelyBargained Planabove complete item 21only if a plan:(1)benefits employees whoare not collectively-bargained unitemployees, or(2)only coverscollectively-bargained unit employees and2% or more of them are professionals.

5. Multiple-Employer Plan (Other).Amultiple-employer plan (other) involvesmore than one employer and is not one ofthe plans already described. File onereturn/report for each plan.

Note: Each employer participating in adefined contribution or defined benefit

pension planwhich is considered amultiple-employer plan (other) must file aForm 5500-C/R regardless of the numberof participants. For the years you arerequired to file pages 1 and 3 through 6 asForm 5500-C, complete only items 1through 7a, 9, and 21. For the years youfile pages 1 and 2 as Form 5500-R,complete only items 1 through 7a, 8a, and8b. Each participating employer filing theForm 5500-C/Rmustenter code F in item4, and use an appropriate number (001,002, etc.) in item 5c.

Note: If a participating employer is also thesponsor of the multiple-employer plan(other), the plan number on thereturn/report filed for the plan should be333 and, if more than one plan, theyshould be consecutively numbered startingwith 333.

If more than one employer participates inthe plan and the plan provides that eachemployers contributions are available topay benefits only for that employersemployees who are covered by the plan,one annual return/report must be filed foreach participating employer. These filerswill be considered single employers andshould complete the entire form.

Investment ArrangementsFiling Directly With DOLSome plans invest in certain trusts,accounts, and other investmentarrangements that may file informationconcerning themselves and theirrelationship with employee benefit plansdirectly with DOL (as specified on page 7).Plans participating in an investmentarrangement as described inCommon/Collective Trust and PooledSeparate Account, Master Trust, and103-12 Investment Entities are requiredto attach certain additional information tothe return/report filed with the IRS asspecified below.

Common/Collective Trust andPooled Separate Account

Definition.For reporting purposes, acommon/collective trust is a trustmaintained by a bank, trust company, orsimilar institution that is regulated,supervised, and subject to periodicexamination by a state or Federal agencyfor the collective investment andreinvestment of assets contributed theretofrom employee benefit plans maintained bymore than one employer or a controlled

group of corporations, as the term is usedin Code section 1563. For reportingpurposes, a pooled separate account isan account maintained by an insurancecarrier that is regulated, supervised, andsubject to periodic examination by a stateagency for the collective investment andreinvestment of assets contributed theretofrom employee benefit plans maintained bymore than one employer or controlledgroup of corporations, as the term is usedin Code section 1563. See 29 CFRsections 2520.103-3, 2520.103-4,2520.103-5, and 2520.103-9.

Note: For reporting purposes, a separateaccount that is not considered to beholding plan assets pursuant to 29 CFR

2510.3-101(h)(1)(iii), shall not constitute apooled separate account.

Additional information to be attached tothe Form 5500-C/R for plansparticipating in common/collective trustsand pooled separate accounts.A planparticipating in a common/collective trustor pooled separate account must completethe annual return/report in accordance withthe specific instructions and attach either:(1) the most recent statement of the assetsand liabilities of any common/collectivetrust or pooled separate account, or (2) acertification that: (a) the statement of theassets and liabilities of thecommon/collective trust or pooled separate

account has been submitted directly toDOL by the financial institution orinsurance carrier; (b) the plan has receiveda copy of the statement; and (c) includesthe EIN and other numbers used by thefinancial institution or insurance carrier toidentify the trusts or accounts, and thename and address provided, in the directfiling made with DOL.

Master Trust

Definition.For reporting purposes, amaster trust is a trust for which a regulatedfinancial institution (as defined below)serves as trustee or custodian (regardlessof whether such institution exercisesdiscretionary authority or control withrespect to the management of assets heldin the trust), and in which assets of morethan one plan sponsored by a singleemployer or by a group of employers undercommon control are held.

A regulated financial institution meansa bank, trust company, or similar financialinstitution that is regulated, supervised,and subject to periodic examination by astate or Federal agency. Common controlis determined on the basis of all relevantfacts and circumstances (whether or not

such employers are incorporated). See 29CFR 2520.103-1(e).

For reporting purposes, the assets of amaster trust are considered to be held inone or more investment accounts. Amaster trust investment account mayconsist of a pool of assets or a singleasset.

Each pool of assets held in a mastertrust must be treated as a separate mastertrust investment account if each plan thathas an interest in the pool has the samefractional interest in each asset in the pool

as its fractional interest in the pool, and ifeach such plan may not dispose of itsinterest in any asset in the pool withoutdisposing of its interest in the pool. Amaster trust may also contain assets thatare not held in such a pool. Each suchasset must be treated as a separatemaster trust investment account.

Financial information must generally beprovided to DOL with respect to eachmaster trust investment account asspecified on page 7.

Additional information to be attached tothe Form 5500-C/R for plansparticipating in master trusts.A planparticipating in a master trust must

complete the annual return/report andattach to it a schedule listing each mastertrust investment account in which the planhas an interest, indicating the plans name,EIN, and plan number and the name of themaster trust used in the master trustinformation filed with DOL (see page 7). Intabular format, show the net value of theplans interest in each investment accountat the beginning and end of the plan year,and the net investment gain (or loss)allocated to the plan for the plan year fromthe investment account.

Note: If a master trust investment accountconsists solely of one plans asset(s) duringthe reporting period, the plan may reportthe(se) asset(s) either as an investmentaccount to be reported as part of themaster trust report filed directly with DOLor as a plan asset(s) that is not part of themaster trust (and therefore subject to allinstructions pertaining to assets not held ina master trust).

103-12 Investment Entities

29 CFR 2520.103-12 provides analternative method of reporting for plansthat invest in an entity (other than aninvestment arrangement filing with DOL asdescribed in Common/Collective Trustand Pooled Separate Account or MasterTrust above), the underlying assets ofwhich include plan assets (within the

meaning of 29 CFR 2510.3-101) of two ormore plans that are not members of arelated group of employee benefit plans.For reporting purposes, a related groupconsists of each group of two or moreemployee benefit plans (1) each of whichreceives 10% or more of its aggregatecontributions from the same employer orfrom a member of the same controlledgroup of corporations (as determinedunder Code section 1563(a), without regardto Code section 1563(a)(4) thereof); or (2)each of which is either maintained by, ormaintained pursuant to a


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collective-bargaining agreement negotiatedby, the same employee organization oraffiliated employee organizations. Forpurposes of this paragraph, an affiliate ofan employee organization means anyperson controlling, controlled by, or undercommon control with such organization.See 29 CFR 2520.103-12.

For reporting purposes, the investmententities described above with respect towhich the required information is fileddirectly with DOL constitute 103-12investment entities (103-12 IEs).

What To FileThis section describes the differentcategories of the Form 5500 series and therelated schedules and lists items to becompleted by d ifferent types of Form5500-C/R filers. In addition, this sectioncontains a description of the special filingrequirements for plans that invest in certaininvestment arrangements. For a brief guideillustrating which forms and schedules arerequired by different types of plans andfilers, see the summary below.

Forms

The following are the different forms in the5500 series of forms.

Form 5500, Annual Return/Report ofEmployee Benefit Plan, must be filedannually for each plan with 100 or moreparticipants at the beginning of the planyear.

Form 5500-C/R, Return/Report ofEmployee Benefit Plan, must be filed foreach pension benefit plan, welfare benefitplan, and fringe benefit plan (unlessotherwise exempted) with fewer than 100

participants at the beginning of the planyear. One-participant plans see Form5500EZ below.

The Form 5500-C/R takes the place ofseparate Forms 5500-C and 5500-R. TheForm 5500-C/R has two checkboxes at thetop of page 1 to indicate that the form isbeing filed as a Form 5500-C or a Form5500-R.

Form 5500-C filers will check box (5)indicating they are filing a Form 5500-Cand complete pages 1 and 3 through 6.Form 5500-R filers will check box (6)

indicating they are filing a Form 5500-R,complete pages 1 and 2, and detachpages 3 through 6 before filing thereturn/report.

You must check the box at the top ofthe Form 5500-C/R indicating that the formis a Form 5500-C for the first plan year,the year for which the final return/report isdue, and for plan years in which a Form5500-R may not be filed as explainedbelow.

You may check the box at the top of theForm 5500-C/R indicating that the form isa Form 5500-R unless: (a) this is the plansfirst plan year, (b) this is the plan year forwhich a final return/report is due, or (c) the

Form 5500-R has been filed for both of theprior 2 plan years. If any of the precedingthree situations apply, you must file Form5500-C and check box (5).

Any plan may choose not to file theForm 5500-R if the plan files the Form5500-C instead.

Note: For purposes of determining whetherto file Form 5500 or Form 5500-C/R for an

employee benefit plan, the number ofparticipants should be calculated in thesame manner as item 7 of the Form 5500or 5500-C/R but the calculation should beas of thebeginningof the plan year. Also,under the filing requirements explainedabove, if the number of plan participantsincreases to 100 or more, or decreasesbelow 100, from one year to the next, youwould generally have to file a different formfrom that filed the previous year. However,there is an exception to this rule. The filermay continue to file the same form filed

last year (i.e., Form 5500 or 5500-C/R),even if the number of participantschanged, provided that at the beginning ofthis plan year the plan had at least 80participants, but not more than 120.

Form 5500EZ, Annual Return ofOne-Participant (Owners and TheirSpouses) Pension Benefit Plan, should befiled by most one-participant plans.

A one-participant plan is: (1) a pensionbenefit plan that covers only an individualor an individual and his or her spouse whowholly own a trade or business, whetherincorporated or unincorporated; or (2) apension benefit plan for a partnership thatcovers only the partners or the partners

and the partners spouses.See Form 5500EZ and its instructions tosee if the plan meets the requirements forfiling the form.

Form 8822, Change of Address, may beused to notify the IRS if the plans mailingaddress changes after the return/reporthas been filed.

Items To Complete on Form5500-C (Form 5500-R filers see page 6.)

Certain kinds of plans and certain kinds offilers that must file Form 5500-C are not

required to complete the entire form.These are described below by type of plan.Check the list of headings to see if yourplan is affected.

5500-C filers do NOT complete page 2.

Welfare benefit plans.Welfare benefitplans generally must complete thefollowing items on the Form 5500-C: 1through 6e; 7a; 8a, 8b, 8d, and 8e; 9a, 9b,

Summary of Filing Requirements for Employers and Plan Administrators(File forms ONLY with IRS)

When to fileWhat to fileType of planForm 5500EZMost pension plans with only one participant or one participant and that participants spouse

Form 5500-C/RPension plan with fewer than 100 participants

File allrequired

forms andschedulesfor each

plan by thelast day of

the 7thmonth after

the plan

year ends.

Form 5500Pension plan with 100 or more participants

Form 5500, 5500-C/RAnnuity under Code section 403(b)(1) or trust under Code section 408(c)

Form 5500, 5500-C/RCustodial account under Code section 403(b)(7)

Form 5500Welfare benefit plan with 100 or more participants

Form 5500-C/RWelfare benefit or fringe benefit plan with fewer than 100 participants (see plans excludedfrom filing on page 3)

Financial statements, schedules,and accountants opinion

Pension or welfare plan with 100 or more participants (see Form 5500 instructions)

Schedule A (Form 5500)Pension or welfare plan with benefits provided by an insurance company

Schedule B (Form 5500)Pension plan that requires actuarial information

Schedule C (Form 5500)Plan with 100 or more participants

Schedule SSA(Form 5500)

Pension plan filing a registration statement identifying separated participants with deferredvested benefits from a pension plan

Pension plan with ESOP benefits Schedule E (Form 5500)

Fringe benefit plan under Code section 6039D Schedule F (Form 5500)


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9c, and 9f; 10a through 10d; 11 through14; and 26 through 28.

Note: If one Form 5500-C is filed for botha welfare benefit plan and a fringe benefitplan, complete Schedule F (Form 5500) inaddition to the items listed above forwelfare benefit plans.

Fringe benefit plans.For a Form 5500-Cfiled only because of Code section 6039D(i.e., for a fringe benefit plan) needcomplete only items 1 through 5, 6d andSchedule F (Form 5500). DO NOT fileSchedules A, B, C, E, P, or SSA Form

(5500).If the Form 5500-C/R is filed for both a

welfare benefit plan and a fringe benefitplan, complete the above items and thosespecified for Welfare benefit plans above.

Pension plans.In general, most pensionplans (defined benefit and definedcontribution) are required to complete allitems on the form. However, some itemsdo not have to be completed by certaintypes of pension plans, as describedbelow.

1. Plans exclusively using a taxdeferred annuity arrangement underCode section 403(b)(1).These plansmust only complete items 1 through 5, 6b

(enter pension code 8), and 9.2. Plans exclusively using a custodial

account for regulated investmentcompany stock under Code section403(b)(7).These plans must onlycomplete items 1 through 5, 6b (enterpension code 9), and 9.

3. Individual retirement accountplan.A pension plan utilizing individualretirement accounts or annuities (asdescribed in Code section 408) as the solefunding vehicle for providing benefits mustonly complete items 1 through 5, 6b (enterpension code 0), and 9.

4. Fully insured pension plan.Apension benefit plan providing benefits

exclusively through an insurance contract,or contracts that are fully guaranteed andthat meets all of the conditions of 29 CFR2520.104-44 need only complete items 1through 26c. A pension plan that includesboth insurance contracts of the typedescribed in 29 CFR 2520.104-44 as wellas other assets should not include thevalue of these contracts in item 27.

Note: For purposes of the annualreturn/report and the alternative method ofcompliance set forth in 29 CFR2520.104-44, a contract is considered tobe allocated only if the insurancecompany or organization that issued thecontract unconditionally guarantees, upon

receipt of the required premium orconsideration, to provide a retirementbenefit of a specified amount, withoutadjustment for fluctuations in the marketvalue of the underlying assets of thecompany or organization, to eachparticipant, and each participant has a legalright to such benefits, which is legallyenforceable directly against the insurancecompany or organization.

5. Nonqualified pension benefit plansmaintained outside the United States.Nonqualified pension benefit plansmaintained outside the United States

primarily for nonresident aliens required tofile a Form 5500-C (see Who Must File onpage 2) must only complete items 1through 8c (enter code D in item 6c), 9through 12, 15, and 16.

Plans of more than one employer.Allplans of more than one employer (plans ofa controlled group, multiemployer plans,multiple-employer collectively bargainedplans, and multiple-employer plan (other))generally should complete all applicable(welfare or pension) items on the formexcept for item 6f. Only single-employer

pension plans must complete this item.

Items To Complete on Form5500-R

Certain kinds of plans and certain kinds offilers that are required to submit Form5500-R are not required to complete theentire form. These are described below, bytype of plan. Check the list of headings tosee if your plan is affected.

Welfare benefit plans.Welfare benefitplans must complete the following itemson Form 5500-R: 1 through 6e; 7a; 8a and8b; 9; 10; 11; and 13 through 15.

Fringe benefit plans.A Form 5500-Rfiled only because of Code section 6039D

(i.e., for a fringe benefit plan) mustcomplete only items 1 through 6d, andSchedule F (Form 5500).

Pension plans.In general, most pensionplans (defined benefit and definedcontribution) are required to complete allitems on the form. However, some itemsdo not have to be completed by certaintypes of pension plans, as describedbelow.

1. Plans exclusively using a taxdeferred annuity arrangement underCode section 403(b)(1).These plansmust only complete items 1 through 5, 6b(enter pension code 8), and 8.

2. Plans exclusively using a custodial

account for regulated investmentcompany stock under Code section403(b)(7).These plans must onlycomplete items 1 through 5, 6b (enterpension code 9), and 8.

3. Individual retirement accountplan.A pension plan utilizing individualretirement accounts or annuities (asdescribed in Code section 408) as the solefunding vehicle for providing benefits mustonly complete items 1 through 5, 6b (enterpension code 0), and 8.

4. Fully insured pension plan.Apension benefit plan providing benefitsexclusively through an insurance contract,or contracts that are fully guaranteed, and

that meets all of the conditions of 29 CFR2520.104-44 must only complete items 1through 12, 14 (enter 0 in 14a and 14c),and 15a, 15b, and 15c. A pension planthat includes both insurance contracts ofthe type described in 29 CFR 2520.104-44as well as other assets must complete allapplicable items on the Form 5500-R butlimit its reporting in item 13 to those otherassets.

Note: For purposes of the annualreturn/report and the alternative method ofcompliance set forth in 29 CFR2520.104-44, a contract is considered to

be allocated only if the insurancecompany or organization that issued thecontract unconditionally guarantees, uponreceipt of the required premium orconsideration, to provide a retirementbenefit of a specified amount, withoutadjustment for fluctuations in the marketvalue of the underlying assets of thecompany or organization, to eachparticipant, and each participant has a legalright to such benefits that is legallyenforceable directly against the insurancecompany or organization.

5. Nonqualified pension benefit plansmaintained outside the United States.Nonqualified pension benefit plansmaintained outside the United Statesprimarily for nonresident aliens required tofile a Form 5500-R need only completeitems 1 through 8a and 11 through 15.

Schedules

Note: All attachments to Forms 5500 and5500-C/R must include the name of theplan, the plan sponsors EIN, and plannumber (PN) as found in items 5a, 1b, and5c, respectively.

The various schedules to be attached tothe return/report are listed below:

Schedule A (Form 5500), InsuranceInformation, must be attached to Forms5500 and 5500-C/R, if any benefits underthe plan are provided by an insurancecompany, insurance service, or othersimilar organization (such as Blue Cross,Blue Shield, or a health maintenanceorganization). (This includes investmentswith insurance companies such asguaranteed investment contracts (GICs).)

Exceptions: 1. Schedule A (Form 5500) isnot needed if the plan covers only: (a) anindividual, or an individual and his or herspouse, who wholly owns a trade orbusiness, whether incorporated orunincorporated; or (b) a partner(s) in a

partnership, or a partner(s) and his or herspouse.

2. A Schedule A (Form 5500) is notrequired to be filed with the Form 5500 orForm 5500-C/R if a Schedule A (Form5500) is filed for the contract as part of themaster trust or 103-12 IE information fileddirectly with DOL.

Do not file a Schedule A (Form 5500)with a Form 5500EZ.

Schedule B (Form 5500), ActuarialInformation, must be attached to Form5500, 5500-C/R, or 5500EZ for mostdefined benefit pension plans. Seeinstructions for Schedule B.

Schedule E (Form 5500), ESOP Annual

Information, must be attached to Form5500, 5500-C/R, or 5500EZ for all pensionbenefit plans with ESOP benefits. See theinstructions for Schedule E.

Schedule F (Form 5500), Fringe BenefitPlan Annual Information Return, must beattached to page 1 of Form 5500 or5500-C/R for all fringe benefit plans.

Schedule SSA (Form 5500), AnnualRegistration Statement IdentifyingSeparated Participants With DeferredVested Benefits, may be needed forseparated participants. See When To


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Report Separated Participants in theinstructions for Schedule SSA.

Schedule P (Form 5500), Annual Returnof Fiduciary of Employee Benefit Trust,must be filed by any fiduciary (trustee orcustodian) of an organization that isqualified under Code section 401(a) andexempt from tax under Code section501(a) who wants to protect theorganization under the statute of limitationsprovided in Code section 6501(a). Youmust enter the EIN of the trust on line 2bof Schedule P.

File the Schedule P (Form 5500) as anattachment to Form 5500, 5500-C/R, or5500EZ for the plan year in which the trustyear ends.

Other Filings

Certain investment arrangements foremployee benefit plans file financialinformation directly with DOL. Thesearrangements include common/collectivetrusts, pooled separate accounts, mastertrusts, and 103-12 IEs. Definitions of theseinvestment arrangements may be found onpage 4. Their DOL filing requirements aredescribed below.

Common/collective trust and pooled

separate account information to be fileddirectly with DOL.Financial institutionsand insurance carriers filing the statementof the assets and liabilities of acommon/collective trust or pooled separateaccount should identify the trust oraccount by providing the EIN of the trustor account, or (if more than one trust oraccount is covered by the same EIN) boththe EIN and any additional numberassigned by the financial institution orinsurance carrier (such as: 99-1234567Trust No. 1); and a list of all plansparticipating in the trust or account,identified by the plan number, EIN, andname of the plan sponsor. The direct filingshould be addressed to:

Common/Collective Trust (OR)Pooled Separate AccountPension and Welfare Benefits

AdministrationU.S. Department of Labor, Room N5644200 Constitution Avenue, NWWashington, DC 20210

Master trust information to be fileddirectly with DOL.The followinginformation with respect to a master trustmust be filed with DOL by the planadministrator or by a designee, such as theadministrator of another plan participatingin the master trust or the financialinstitution serving as trustee of the mastertrust, no later than the date on which theplans return/report is due. While only onecopy of the required information should befiled for all plans participating in the mastertrust, the information is an integral part ofthe return/report of each participating plan,and the plans return/report will not bedeemed complete unless all theinformation is filed within the prescribedtime.

Note: If a master trust investment accountconsists solely of one plans asset(s) duringthe reporting period, the plan may reportthe(se) asset(s) either as an investment

account to be reported as part of themaster trust report filed directly with DOLor as a plan asset(s) that is not part of themaster trust (and therefore subject to allinstructions pertaining to assets not held ina master trust).

Each of the following statements andschedules must indicate the name of themaster trust and the name of the mastertrust investment account. The informationshall be filed with DOL by mailing it to:

Master TrustPension and Welfare Benefits


1. The name and fiscal year of themaster trust and the name and address ofthe master trustee.

2. A list of all plans participating in themaster trust, showing each plans name,EIN, PN, and its percentage interest ineach master trust investment account asof the beginning and end of the fiscal yearof the master trust ending with or withinthe plan year.

3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in themaster trust.

4. A statement, in the same format asPart I of Schedule C (Form 5500), for eachmaster trust investment account showingamounts of compensation paid during thefiscal year of the master trust ending withor within the plan year to personsproviding services with respect to theinvestment account and subtracted fromthe gross income of the investmentaccount in determining the net increase(decrease) in net assets of the investmentaccount.

5. A statement for each master trustinvestment account showing the assetsand liabilities of the investment account at

the beginning and end of the fiscal year ofthe master trust ending with or within theplan year, grouped in the same categoriesas those specified in item 31 of Form5500.

6. A statement for each master trustinvestment account showing the incomeand expenses, changes in net assets, andnet increase (decrease) in net assets ofeach such investment account during thefiscal year of the master trust ending withor within the plan year, in the categoriesspecified in item 32 of Form 5500. In placeof item 32a, show the total of all transfersof assets into the investment account byparticipating plans. In place of item 32j,

show the total of all transfers of assets outof the investment account by participatingplans.

7. Schedules, in the format set forth inthe instructions for item 27 of Form 5500,of the following items with respect to eachmaster trust investment account for thefiscal year of the master trust ending withor within the plan year: assets held forinvestment, nonexempt party-in-interesttransactions, defaulted or uncollectibleloans and leases, and 5% transactionsinvolving assets in the investment account.The 5% figure shall be determined by

comparing the current value of thetransaction at the transaction date with thecurrent value of the investment accountassets at the beginning of the applicablefiscal year of the master trust.

103-12 IE information to be filed directlywith DOL.The information describedbelow must be filed with the DOL by thesponsor of the 103-12 IE no later than thedate on which the plans return/report isdue before the plan administrator can electthe alternative method of reporting. Whileonly one copy of the required information

should be filed for the 103-12 IE, theinformation is an integral part of thereturn/report of each plan electing thealternative method of compliance. Thefiling address is:

103-12 Investment EntityPension and Welfare Benefits


1. The name, fiscal year, and EIN of the103-12 IE and the name and address ofthe sponsor of the 103-12 IE. If more thanone 103-12 IE is covered by the same EIN,they shall be sequentially numbered as

follows: 99-1234567 Entity No. 1.2. A list of all plans participating in the

103-12 IE, showing each plans name, EIN,PN, and its percentage interest in the103-12 IE as of the beginning and end ofthe fiscal year of the 103-12 IE ending withor within the plan year.

3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in the103-12 IE.

4. A statement, in the same format asPart I of Schedule C (Form 5500), for the103-12 IE showing amounts ofcompensation paid during the fiscal year ofthe 103-12 IE ending with or within theplan year to persons providing services to

the 103-12 IE.5. A statement showing the assets and

liabilities at the beginning and end of thefiscal year of the 103-12 IE ending with orwithin the plan year, grouped in the samecategories as those specified in item 31 ofForm 5500.

6. A statement showing the income andexpenses, changes in net assets, and netincrease (decrease) in net assets duringthe fiscal year of the 103-12 IE ending withor within the plan year, grouped in thecategories specified in item 32 of Form5500. In place of item 32a, show the totalof all transfers of assets into the 103-12 IEby participating plans. In place of item 32j,

show the total of all transfers of assets outof the 103-12 IE by participating plans.

7. Schedules, in the format set forth inthe instructions for item 27 of Form 5500(except item 27d) with respect to the 103-12 IE for the fiscal year of the 103-12 IEending with or within the plan year.Substitute the term 103-12 IE for theword plan when completing theschedules.

8. A report of an independent qualifiedpublic accountant regarding the aboveitems and other books and records of the


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103-12 IE that meets the requirements of29 CFR 2520.103-1(b)(5).

Section 3

Final Return/ReportIf all assets under the plan (includinginsurance/annuity contracts) have beendistributed to the participants andbeneficiaries or distributed to another plan(and when all liabilities for which benefitsmay be paid under a welfare benefit plan

have been satisfied), check the finalreturn/report box at the top of the Form5500-C filed for such plan. The year ofcomplete distribution is the last year areturn/report must be filed for the plan. Forpurposes of this paragraph, a completedistribution will occur in the year in whichthe assets of a terminated plan are broughtunder the control of PBGC.

For a defined benefit plan covered byPBGC, a PBGC Form 1 must be filed anda premium must be paid until the end ofthe plan year in which the assets aredistributed or brought under the control ofPBGC.

Filing the return/report marked Final

return and indicating that the planterminated satisfies the notificationrequirement of Code section 6057(b)(3).

Signature and DateThe plan administrator must sign and dateall returns/reports filed. The name of theindividual who signed as plan administratormust be typed or printed clearly on the lineunder the signature line. In addition, theemployer must sign a return/report filed fora single-employer plan or a plan requiredto file only because of Code section 6039D(i.e., for a fringe benefit plan).

When a joint employer-union board oftrustees or committee is the plan sponsoror plan administrator, at least oneemployer representative and one unionrepresentative must sign and date thereturn/report.

Participating employers in amultiple-employer plan (other), who arerequired to file Form 5500-C/R are requiredto sign the return/report. The planadministrator need not sign the Form5500-C/R filed by the participatingemployer.

ReproductionsOriginal forms are preferable, but a clearreproduction of the completed form is

acceptable. Sign the return/report after it isreproduced. All signatures must be original.

Change in Plan YearGenerally, only defined benefit pensionplans have to get prior approval for achange in plan year. (See Code section412(c)(5).) Rev. Proc. 87-27, 1987-1 C.B.769, explains the procedure for automaticapproval of a change in plan year. Apension benefit plan that would ordinarilyhave to obtain approval for a change inplan year under Code section 412(c)(5) is

granted an automatic approval for achange in plan year if all the followingcriteria are met:

1. No plan year exceeds 12 months.

2. The change will not delay the timewhen the plan otherwise would have beenrequired to conform to the requirements ofany statute, regulation, or publishedposition of the IRS.

3. The trust, if any, retains its exemptstatus for the short period required toeffect the change, as well as for thetaxable year immediately preceding theshort period.

4. All actions necessary to implementthe change in plan year, including planamendment and a resolution of the boardof directors (if applicable), have been takenon or before the last day of the shortperiod.

5. No change in plan year has beenmade for any of the preceding plan years.

6. In the case of a defined benefit plan,deductions are taken in accordance withsection 5 of Rev. Proc. 87-27.

For the first return/report that is filedfollowing the change in plan year, checkthe box on line C at the top of the form.

Amended Return/ReportIf you file an amended return/report, checkbox A(2) an amended return/report at thetop of the form. When filing an amendedreturn, be sure to answer all questions andput a circle around the item numbers thathave been amended.

How the AnnualReturn/Report InformationMay Be UsedAll Form 5500 series return/reports will besubjected to a computerized review. It is,therefore, in the filers best interest that the

responses accurately reflect thecircumstances they were designed toreport. Annual reports filed under Title I ofERISA must be made available by planadministrators to plan participants and bythe Department of Labor to the publicpursuant to ERISA section 104.

Section 4Important: Answer all items on the Form5500-C/R with respect to the plan year,unless otherwise explicitly stated in theitem-by-item instructions or on the formitself. Therefore, your responses usuallyapply to the year entered or printed at the

top of the first page of the form. Yes orNo questions must be marked eitherYes or No but not both. N/Acannot be used to respond to a Yes orNo question that is required to beanswered by the filer as specified onpage 5 under Items To Complete onForm 5500-C or on page 6 under ItemsTo Complete on Form 5500-R.

Information at the Top of theFormFirst Line at the top of the formComplete the space for dates when:(1) the 12-month plan year is not acalendar year, or (2) the plan year is lessthan 12 months (a short plan year).

A. Check box (1) if this is the first filingfor this plan. Do not check this box if youhave ever filed for this plan even if it wason a different form (Form 5500 vs. Form5500-C or Form 5500-R).

Check box (2) if you have already filedfor the 1992 plan year and are nowsubmitting an amended return/report tocorrect errors and/or omissions on thepreviously filed return/report.

Check box (3) if the plan no longer existsto provide benefits. See Section 3 on thispage for instructions concerning therequirement to file a final return/report.

Check box (4) if this form is being filedfor a period of less than 12 months andshow the dates at the top.

Check box (5) if you are filing a Form5500-C. If you check this box, completepages 1 and 3 through 6.

Check box (6) if you are filing a Form5500-R. If you check this box, completeonly pages 1 and 2.

B. Check this box if you make anychanges to the preprinted information onpage 1. Changes should be highlighted orentered in red ink, if possible.

C. Check this box if the plan year hasbeen changed since the last return/reportwas filed.

D. Check this box if you filed for anextension of time to file this form. Attach acopy of the approved Form 5558 or a copyof the employers extension of time to filethe income tax return if you are using theexception in Extension of Time to File onpage 2 of these instructions.

Line-By-Line InstructionsThe numbers of the followinginstructions are the same as the itemnumbers on the return/report.

Page 1

Check the preprinted information in 1through 6d for accuracy andcompleteness. Cross out any incorrectinformation and enter the correctinformation. Add any incompleteinformation in red ink, if possible.

If you did not receive a Form 5500-C/Rwith a preprinted page one, complete

items 1 through 6d as follows:1a. Enter the name and address of the

plan sponsor. If the Post Office does notdeliver mail to the street address and thesponsor has a P.O. box number, show thebox number instead of the street address.If the plan covers only the employees ofone employer, enter the employers name.

The term plan sponsor means

The employer, for an employee benefitplan that a single employer established ormaintains;


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The employee organization in the case ofa plan of an employee organization; or

The association, committee, joint boardof trustees, or other similar group ofrepresentatives of the parties whoestablish or maintain the plan, if the plan isestablished or maintained jointly by one ormore employers and one or moreemployee organizations, or by two or moreemployers.

Include enough information in item 1a todescribe the sponsor adequately. Forexample, Joint Board of Trustees of Local

187 Machinists rather than just JointBoard of Trustees.

1b. Enter the nine-digit employeridentification number (EIN) assigned to theplan sponsor/employer (e.g., 00-1234567).

Employers and plan administrators whodo not have an EIN should apply for oneon Form SS-4, Application for EmployerIdentification Number. Form SS-4 can beobtained at most IRS or Social SecurityAdministration (SSA) offices. Send FormSS-4 to the Internal Revenue ServiceCenter where this Form 5500-C/R will befiled.

A plan of a controlled group ofcorporations whose sponsor is more than

one of the members of the controlledgroup should enter only the EIN of one ofthe sponsoring members. This EIN must beused in all subsequent filings of the annualreturns/reports for the controlled groupunless there is a change in the sponsor.

If the plan sponsor is a group ofindividuals, get a single EIN for the group.When you apply for a number, enter online 1 of Form SS-4 the name of the group,such as Joint Board of Trustees of theLocal 187 Machinists Retirement Plan.

Note: Although EINs for funds (trusts orcustodial accounts) associated with plansare generally not required to be furnishedon the Form 5500 series returns/reports,

the IRS will issue EINs for such funds forother reporting purposes. EINs may beobtained by filing Form SS-4 as explainedabove.

Plan sponsors should use the trust EINdescribed in the Note above when openinga bank account or conducting othertransactions for a trust that requires anEIN.

1d. From the list of business codes onpages 19 and 20, enter the one that bestdescribes the nature of the employersbusiness. If more than one employer isinvolved, enter the business code for themain business activity.

1e. Plans entering entity Code A or B in

item 4 must enter the first six digits of theCUSIP (Committee on Uniform SecuritiesIdentification Procedures) number, issuernumber, if one has been assigned to theplan sponsor for purposes of issuingcorporate securities. CUSIP issuernumbers are assigned to corporations andother entities which issue public securitieslisted on stock exchanges or traded overthe counter. The CUSIP issuer number isthe first six digits of the number assignedto the individual securities that are traded.

If the plan sponsor has no CUSIP issuernumber, enter N/A.

2a. If the document constituting the planappoints or designates a plan administratorother than the sponsor, enter theadministrators name and address. If theplan administrator is also the sponsor,enter Same. If Same is entered on 2a,leave 2b and 2c blank.

The term administrator means

The person or group of personsspecified as the administrator by theinstrument under which the plan isoperated; The plan sponsor/employer if anadministrator is not so designated; or

Any other person prescribed byregulations of the Secretary of Labor if anadministrator is not designated and a plansponsor cannot be identified.

2b. A plan administrator must have anEIN for reporting purposes. Enter the planadministrators nine-digit EIN here. If theplan administrator does not have an EIN,apply for one as explained in 1b above.

Employees of an employer are not planadministrators unless so designated in theplan document, even though they engagein administrative functions of the plan. If anemployee of the employer is designated asthe plan administrator, that employee mustget an EIN.

3. If the p lan administrators/sponsorsname, address, and EIN have changedsince the last return/report was filed forthis plan, enter the plan administrators/sponsors name, address, and EIN as itappeared on the last return/report filed forthis plan.

3c. Indicate if the change in thesponsors name, address, and EIN is onlya change in sponsorship. Change insponsorship means the p lans sponsorhas been changed but no assets orliabilities have been transferred to another

plan(s), the plan has not terminated ormerged with any other plan, and so forth.Therefore, the plan is now theresponsibility of the new sponsor whosename is entered in item 1a of thisreturn/report.

4. Plan Entity Code.From thefollowing list of plan entities choose theone that describes your plan entity andenter that code in item 4.

Entity CodeSingle-employer plan A

Plan of controlled group of corporationsor common control employers B

Multiemployer plan C

Multiple-employer-collectively-

bargained plan DMultiple-employer plan (other) E

A return of an employer described in the Note toKinds of Filers 2 and 5 F

5a. Enter the formal name of the plan orenough information to identify the plan.This name should not exceed 70characters. If the present plan nameexceeds 70 characters and spaces, try toabbreviate it.

5b. Enter the date the plan first becameeffective.

5c. Enter the 3-digit number theemployer or plan administrator assigned tothe plan. All welfare benefit plan numbersand Code section 6039D plan numbersstart at 501. All other plans start at 001.

Once you use a plan number, continueto use it for that plan on all future filingswith IRS, DOL and PBGC. Do not use it forany other plan even if you terminated thefirst plan.

6a. Welfare Benefit Plan Codes.Check this box and enter every code fromthe list below that describes the welfarebenefit p lan for which this return/report isbeing filed. Example: If your plan provideshealth insurance, life insurance, dentalinsurance and eye examinations, the fourcodes A, B, D, and E should be entered. Ifyour plan has a benefit not described byone of the codes, enter Z and write in adescription of this benefit in the spaceprovided.

Type of Welfare Plan CodeHealth (other than dental or vision) A

Life insurance B

Supplemental unemployment C

Dental D

Vision E

Temporary disability (accident andsickness) F

Prepaid legal G

Long-term disability H

Severance pay I

Apprenticeship and training J

Scholarship (funded) K

Death benefits (other than life ins.) L

Taft-Hartley Financial Assistancefor Employee Housing Expenses P

Other (specify on page 1) Z

6b. Pension Benefit Plan Codes.Check this box and enter the codes fromthe list below that describe the type ofbenefits for which the Form 5500-C/R isbeing filed.

Note: Filers who previously used code 7must enter the applicable code below. Apension plan must be either a definedbenefit or a defined contribution plan.

Type of Pension Benefit Plan CodeDefined benefit 1

Defined ContributionProfit-sharing 2

Stock bonus 3

Target Benefit 4

Other money purchase 5

Other (specify on page 1) 6

OtherDefined benefit plan with benefits

based partly on balance of separateaccount of participant (Code section414(k)) 7

Annuity arrangement of certainexempt organizations (Code section403(b)(1)) 8

Custodial account for regulatedinvestment company stock (Codesection 403(b)(7)) 9

Pension plan utilizing individualretirement accounts or annuities(described in Code section 408) asthe sole funding vehicle forproviding benefits 0


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6c. Pension Plan Feature Codes.Enter the code(s) from the list below thatdescribes the pension plan features.

Type of Pension Plan Features (seedescription and codes below) CodeEmployee Stock Ownership Plan (ESOP) A

Leveraged ESOP B

Participant-Directed account plan C

Pension Plan maintained outside the USA D

Plan covering Self-Employed individuals E

Affiliated Service Group (Code Section 414(m)(2)) F

401(k) Plan(Plan containing a cash or deferredarrangement) G

Top-Heavy plan (for 1984 orsubsequent plan year) H

Plan with Permitted Disparity Provisions(See Codesections 401(a)(5) and 401(l)) I

Master plan J

Prototype plan K

Regional Prototype plan L

If you enter code A or B, you mustcomplete Schedule E (Form 5500) andattach it to the Form 5500-C/R you file forthis plan.

Enter code B for a leveraged ESOP ifthe plan acquires employer securities withborrowed money or other debt-financingtechniques.

Enter code C for a pension plan that

provides for individual accounts andpermits a participant or beneficiary toexercise independent control over theassets in his or her account (see ERISAsection 404(c)).

Enter code D for a pension benefit planmaintained outside the United Statesprimarily for nonresident aliens. See Kindsof Filers on page 3 for more information.

Enter code F for a plan of an AffiliatedService Group. In general, Code section414(m)(2) defines an affiliated service groupas a first service organization (FSO) thathas:

1. A service organization (A-ORG) that isa shareholder or partner in the FSO and

that regularly performs services for theFSO, or is regularly associated with theFSO in performing services for thirdpersons, and/or

2. Any other organization (B-ORG) if:

a. A significant portion of the business ofthat organization consists of performingservices for the FSO or A-ORG of a typehistorically performed by employees in theservice field of the FSO or A-ORG, and

b. 10% or more of the interest of theB-ORG is held by persons who are highlycompensated employees of the FSO orA-ORG.

An affiliated service group also includesa group consisting of an organization

whose principal business is performingmanagement functions for anotherorganization (or one organization and otherrelated organizations) on a regular andcontinuing basis, and the organization forwhich such functions are so performed bythe organization. For a plan maintained bymore than one employer, check Yes ifany such employer is a member of anaffiliated service group.

Enter code G for a cash or deferredarrangement described under Code section401(k) that is part of a qualified definedcontribution plan that provides for an

election by employees to defer part of theircompensation or receive these amounts incash.

Enter code H if the plan is top-heavy. Atop-heavy plan is a plan that during anyplan year is:

a. Any defined benefit plan if, as of thedetermination date, the present value ofthe cumulative accrued benefits under theplan for key employees exceeds 60% ofthe present value of the cumulativeaccrued benefits under the plan for allemployees; and

b. Any defined contribution plan if, as ofthe determination date, the aggregate ofthe accounts of key employees under theplan exceeds 60% of the aggregate of theaccounts of all employees under the plan.

Each plan of an employer included in arequired aggregation group is to be treatedas a top-heavy plan if such group is a top-heavy group. See definitions of requiredaggregation and top-heavy groups below.

A key employee is any participant inan employer plan who at any time duringthe plan year, or any of the 4 precedingyears, is:

a. An officer of the employer having anannual compensation greater than 50% of

$112,221, the defined benefit dollarlimitation for 1992 under Code section415(b)(1)(A),

b. One of the 10 employees havingannual compensation from the employergreater than $30,000, the definedcontribution dollar limitation under Codesection 415(c)(1)(A) and owning (orconsidered as owning within the meaningof Code section 318) the largest interestsin the employer,

c. A 5% owner of the employer, or

d. A 1% owner of the employer havingan annual compensation from the employerof more than $150,000.

In determining whether an individual isan officer of the employer, no more than50 employees, or, if less, the greater of 3employees or 10% of the employees, areto be treated as officers. See Code section416(i) and T-12 of Income Tax Regulationssection 1.416-1. A key employee will notinclude any officer or employee of agovernmental plan under Code section414(d).

A required aggregation group consistsof:

a. Each plan of the employer in which akey employee is or was a participant, and

b. Each other plan of the employer thatenables a plan to meet the requirementsfor nondiscrimination in contributions orbenefits under Code section 401(a)(4), orthe participation requirements under Codesection 410.

A top heavy group is an aggregationgroup if, as of the determination date, thesum of the present value of the cumulativeaccrued benefits for key employees underall defined benefit plans included in suchgroup and the aggregate of the accountsof key employees under all definedcontribution plans in such group exceeds60% of a similar sum determined for allemployees. To determine if a plan is top

heavy, include distributions made in the5-year period ending on the determinationdate. However, do not take into accountaccrued benefits for an individual who hasnot performed services for the employerduring the 5-year period ending on thedetermination date.

A qualified plan must limit the annualcompensation of each employee taken intoaccount for this year to $228,860 adjustedannually for the cost of living. The familymembers (spouse and lineal descendentsunder age 19) of 5% owners or one of the

10 most highly compensated employeesare treated as a single employee. Qualifiedplans must comply with this requirement inoperation even if the plan has not yet beenamended to comply with the Tax ReformAct of 1986.

6d. Fringe Benefit Plan.Complete onlypage 1 (items 1 through 5 and 6d) ANDSchedule F (Form 5500) for a Form5500-C/R filed only because of Codesection 6039D. See pages 5 and 6 foradditional instructions on Items ToComplete on Form 5500-C and Items ToComplete on Form 5500-R for a fringebenefit plan.

Form 5500-C filers see pages 13

through 18 for instructions for items 6ethrough 28.

Form 5500-R, Page 2

7. The definition of participant in theinstructions below is only for purposes ofitem 7 of this form.

For welfare plans, the number ofparticipants should be determined byreference to 29 CFR 2510.3-3(d).Dependents are considered to be neitherparticipants nor beneficiaries. For pensionbenefit plans, alternate payees entitled tobenefits under a qualified domesticrelations order are not to be counted asparticipants for this item.

Participant means any individual whois included in one of the categories below.

a. Active participants include anyindividuals who are currently inemployment covered by a plan and whoare earning or retaining credited serviceunder a plan. This category includes anyindividuals who are: (A) currently below theintegration level in a plan that is integratedwith social security, and/or (B) eligible toelect to have the employer make paymentsto a Code section 401(k) qualified cash ordeferred arrangement. Active participantsalso include any nonvested individuals whoare earning or retaining credited serviceunder a plan. This category does not

include nonvested former employees whohave incurred the break in service periodspecified in the plan.

b. Inactive participants receiving benefitsare any individuals who are retired orseparated from employment covered bythe plan and who are receiving benefitsunder the plan. This includes formeremployees who are receiving group healthcontinuation coverage benefits pursuant toPart 6 of ERISA and who are covered bythe employee welfare benefit plan. Thiscategory does not include any individual towhom an insurance company has made an


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irrevocable commitment to pay all thebenefits to which the individual is entitledunder the plan.

c. Inactive participants entitled to futurebenefits are individuals who are retired orseparated from employment covered bythe plan and who are entitled to beginreceiving benefits under the plan in thefuture. This category does not include anyindividual to whom an insurance companyhas made an irrevocable commitment topay all the benefits to which the individualis entitled under the plan.

d. Deceased participants are anydeceased individuals who have one ormore beneficiaries who are receiving or areentitled to receive benefits under the plan.This category does not include anindividual if an insurance company hasmade an irrevocable commitment to pay allthe benefits to which the beneficiaries ofthat individual are entitled under the plan.

7b. Enter the number of participantsincluded in item 7a(2) who have accountbalances. For example, for a Code section401(k) plan, the number entered in item 7bshould be the number of participantscounted in item 7a(2) who have made acontribution to the plan during this plan

year or any prior plan year.7c(1). If Yes, file Schedule SSA (Form

5500) as an attachment to Form 5500-R.Plan administrators: Code section 6057(e)provides that the plan administrator mustgive each participant a statement showingthe same information reported on ScheduleSSA for that participant.

8a. Check Yes, if the plan wasterminated or if the plan was merged orconsolidated into another plan. Enter yearof termination if applicable.

8b. If the plan was terminated and allassets were not distributed, file areturn/report for each year the plan hasassets. In that case, the return/report must

be filed by the plan administrator, ifdesignated, or by the person or personswho actually control the plans property.

If all assets were used to buy individualannuity contracts and the contracts weredistributed to the participants, checkYes.

If all the plan assets were legallytransferred to the control of another planor brought under control of PBGC, checkYes.

9. Check Yes, if either thecontributions to the plan or the benefitspaid by the plan are subject to thecollective-bargaining process, even if theplan is not established and administered

by a joint board of trustees. Check Yeseven if only some of those covered by theplan are members of acollective-bargaining unit that negotiatesbenefit levels on its own behalf. Thebenefit schedules do not have to beidentical for all employees under the plan.

10. The insurance company (or similarorganization) that provides benefits isrequired to provide the plan administratorwith the information needed to completethe return/report, pursuant to ERISAsection 103(a)(2). If you do not receive thisinformation in a timely manner, contact the

insurance company (or similarorganization). If information is missing onSchedule A (Form 5500) due to a refusal toprovide this information, note this onSchedule A. If there is no Schedule(s) Aattached, enter 0.

11a(1). Check Yes, if an amendment tothe plan was adopted in this plan year,regardless of the effective date of theamendment.

11a(2). Enter the month and year of themost recent plan amendment even if it is ina plan year prior to the plan year for which

this return/report is filed.11b. Check Yes only if the accrued

benefits were retroactively reduced. Forexample, a plan provides a benefit of 2%for each year of service, but the plan isamended to change the benefit to 112% ayear for all years of service under the plan.

Do not check Yes if accrued benefitswere retroactively reduced solely to theextent permitted under a modelamendment provided in IRS Notice 88-131,1988-2 C.B. 546.

11c. Check Yes only if an amendmentchanged the information previouslyprovided to participants by the summaryplan description or summary description of

modifications.11d. A revised summary plan description

or summary description of modificationsmust be filed with DOL and distributed toall plan participants and pension planbeneficiaries no later than 210 days afterthe close of the plan year in which theamendment(s) was adopted. If the materialwas distributed and filed since theamendments were adopted (even if afterthe end of the plan year), check Yes toitem 11d.

12a. Check Yes, if this is a pensionplan subject to minimum funding standardsthat has experienced a funding deficiency.If item 12a is checked Yes, and item 6b

indicates this is a defined benefit pensionplan, complete and attach Schedule B(Form 5500) to this form. All definedbenefit plans are subject to minimumfunding standards, except fully insuredplans, church plans, governmental plans,and certain other plans covered by Codesection 412(h). Code section 412 describesthe minimum funding standards applicableto defined contribution plans qualifiedunder Code section 401(a) or 403(a). Afunding deficiency occurs if the amount ofrequired employer contribution for the planyear exceeds the actual contribution paidby the employer for the plan year. If theanswer to this question is No or NotApplicable, check No, and go to item13.

12b. If item 12a is checked Yes, thisitem must be answered. If a fundingdeficiency occurs, Form 5330 must be filedwith the IRS to pay the excise tax on theamount of the deficiency.

Caution: There is a penalty for not filingForm 5330 on time.

13 and 14. Use either the cash, modifiedaccrual, or accrual basis for recognition oftransactions in items 13 and 14, as long asone method is used consistently. Roundoff all amounts in items 13 and 14 to the

nearest dollar. Current value means fairmarket value where available. Otherwise, itmeans the fair value as determined in goodfaith under the terms of the plan by atrustee or a named fiduciary, assuming anorderly liquidation at the time of thedetermination.

If the assets of two or more plans aremaintained in one trust, such as when anemployer has two plans funded through asingle trust (except investmentarrangements filing directly with DOL),complete items 13 and 14 by entering the

plans allocable part of each line item.If assets of one plan are maintained in

two or more trust funds, report thecombined financial information in items 13and 14. Fully insured defined benefit ordefined contribution pension plans meetingthe conditions of 29 CFR 2520.104-44need not complete item 13.

For purposes of the annual return/reportand the alternative method of complianceset forth in 29 CFR 2520.104-44, acontract is considered to be allocatedonly if the insurance company ororganization that issued the contractunconditionally guarantees, upon receipt ofthe required premium or consideration, to

provide a retirement benefit of a specifiedamount, without adjustment for fluctuationsin the market value of the underlyingassets of the company or organization, toeach participant, and each participant hasa legal right to such benefits that is legallyenforceable directly against the insurancecompany or organization.

Total plan assets at the beginning of theplan year plus item 14c (net income (loss))must equal the total plan assets at the endof the plan year.

Note: Plan income includes contributionsto the plan and plan expenses include totalbenefits paid.

13a. Enter the total plan assets at the

beginning and end of the plan year. Planassets may include, among other things:

1. Cash, including both interest andnoninterest bearing. This includes all cashon hand or in a financial institutionincluding money market funds.

2. Receivables, including allcontributions due to the plan from theemployer and participants, income earned,but not yet received by the plan, andreceivables from any other source.

3. Investments including securities(stocks, bonds, U.S. Governmentobligations, municipal obligations, etc.);real property (land, buildings, gold,furniture, equipment, etc.); loans

(mortgages, promissory notes, etc.); and allother investments (certificates of deposit,repurchase agreements, land contracts,units of participation in common/collectivetrusts and pooled separate accounts,shares of registered investment companies(mutual funds), interests in master trustsand 103-12 IEs, etc.).

Plans holding units of participation incommon/collective trusts and/or pooledseparate accounts must attach to the Form5500-R either the statement of assets andliabilities of the common/collective trustand/or pooled separate account or the


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required certification. For details, see 29CFR sections 2520.103-3, 2520.103-4,2520.103-5, and 2520.103-9.

Plans in a master trust must include thevalue of the plans interest in the mastertrust, which is the sum of the net values ofthe plans interest in all of the master trustinvestment accounts. The net values ofsuch interests are obtained by multiplyingthe plans percentage interest in eachmaster trust investment account by the netassets of the investment account (totalassets minus total liabilities) at the

beginning and end of the plan year.13b. Enter the total liabilities at the

beginning and end of the plan year.Liabilities to be entered here do notinclude the value of future pensionpayments to plan participants; however,the amount to be entered in item 13b foraccrual basis filers includes, among otherthings:

1. Benefit claims that have beenprocessed but have not been paid,

2. Accounts payable obligations owed bythe plan that were incurred in the normaloperations of the plan but have not beenpaid,

3. Other liabilities such as acquisition

indebtedness and any other amount owedby the plan.

13c. Enter the net assets as of thebeginning and end of the plan year.Subtract item 13b from item 13a.

14a. Enter all plan income during theyear. Plan income received and/orreceivable may include, among otherthings:

1. Interest on investments (includingmoney market funds, sweep accounts,STIF accounts, etc.).

2. Dividends. (Accrual basis plans shouldinclude dividends declared for all stockheld by the plan even if the dividends havenot been received as of the end of the plan

year.)3. Rents from income-producing

property owned by the plan.

4. Royalties.

5. All contributions including securities orother noncash property contributed to theplan.

6. Net gain or loss from the sale ofassets.

7. Other income such as unrealizedappreciation (depreciation) in plan assets.To compute this amount subtract thecurrent value of all assets at the beginningof the year plus the cost of any assetsacquired during the plan year from the

current value of all assets at the end of theyear minus assets disposed of during theplan year. A negative figure should beplaced in parentheses.

14b. Enter all the expenses of the planduring the year. Expenses (paid and/orpayable) may include, among others:

1. Direct payments made to participantsor beneficiaries in cash, securities, or otherproperty. If the securities or other propertyare distributed to plan participants orbeneficiaries, include the fair market value(or a good-faith estimate if fair market

value is not available) on the date theproperty was distributed.

2. Payments to insurance carriers andsimilar organizations (including Blue Cross,Blue Shield, and health maintenanceorganizations).

3. Payments to provide benefits for suchthings as legal services, day care services,training and apprenticeship services.

4. Administrative expenses including:

a. Salaries to employees of the plan.

b. Expenses for accounting, actuarial,

legal, and investment services.c. Fees and expenses for trustees

including reimbursement for travel,seminars, and meeting expenses.

d. Fees paid for valuations andappraisals.

14c. Enter the net income (loss).Subtract item 14b from item 14a. If theresult is a negative number, enter it inparentheses.

14d. Enter the total contributionsreceived, for accrual basis plans,contributions due to be received, from theemployer, participants and/or any othersource. These contributions are to beincluded in the amount of income entered

on item 14a.14e. Include: (1) payments made (and

for accrual basis filers payments due) toparticipants or beneficiaries in cash,securities, or other property; (2) paymentsto insurance companies and similarorganizati

Documents

US Internal Revenue Service: i5500cr--1992