US Internal Revenue Service: i5500cr--1993

8/14/2019 US Internal Revenue Service: i5500cr--1993

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Cat. No. 10958V

Section 1

A Change To Note for 1994

The Revenue Reconciliation Act of 1993 (TitleXIII of OBRA 93) amended Code section401(a)(17) to reduce the maximum amount ofannual compensation that may be taken intoaccount under a qualified plan to $150,000for benefits accruing in plan years beginningon or after January 1, 1994. See Act Section13212 for the different effective dates and thetransition rules.

Plan Year

File 1993 forms for plan years that started in1993. If the plan year differs from thecalendar year, fill in the fiscal year space justunder the form title. For a short plan year,check box A(4) and see When To File onpage 2.

Reminders

Most qualified plans must be amended bythe end of the 1994 plan year for severalrecent changes in the law. See IRS Notice92-36, 1992-2 C.B. 364 and Rev. Proc.93-39, 1993-31 I.R.B. 7, for more specificinformation.

Many filers receive rejection notices forfailing to complete items 4, 6, and 26bproperly. Form 5500-R filers often fail tocomplete items 14 and 15b properly. Thereturn/report will also be consideredincomplete and penalties may be assessed ifinformation required on a schedule is nottyped or printed on the appropriate schedule,such as the Schedule A (Form 5500). SeeSchedules on page 6. Generally, areturn/report must be filed for employeewelfare benefit plans that provide benefitswholly or partially through a MultipleEmployer Welfare Arrangement (MEWA) as

defined in ERISA section 3(40), unlessotherwise exempt (see page 3).

In addition to filing this form with the IRS,plans covered by the Pension BenefitGuaranty Corporation (PBGC) terminationinsurance program must file their AnnualPremium Payment, PBGC Form 1, directlywith that agency.

Electronic Filing of Form 5500-C/R

Form 5500-C/R and the related schedulescan be filed via magnetic media (magnetictapes, floppy diskettes) or electronically. If theplan administrator files the return/report

electronically or on magnetic media, he orshe must also file Form 8453-E, EmployeeBenefit Plan Declaration and Signature forElectronic/Magnetic Media Filing. This is thedeclaration and signature form for theelectronic/magnetic media return. For moreinformation, get Pub. 1507, Procedures forElectronic/Magnetic Media Filing of EmployeeBenefit Plan Returns Forms 5500, 5500-C/R,and 5500-EZ for Plan Year 1993.

How To Use This InstructionBooklet

The instructions are divided into four mainsections.

Section 1 Page

A Change To Note for 1994 1

Plan Year 1

Electronic Filing of Form 5500-C/R 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 2

Fringe Benefit 3

Plans Excluded From Filing 3

Kinds of Filers 3

Single Employer 3

Controlled Group of Corporations, Groupof Trades or Businesses Under CommonControl, or an Affiliated Service Group 3

Multiemployer 3

Multiple-Employer-CollectivelyBargained 3

Multiple-Employer (Other) 3

Investment Arrangements Filing Directly WithDOL 4

Common/Collective Trust andPooled Separate Account 4

Master Trust 4

103-12 Investment Entities 4

What To File 4

Forms 4

Items To Complete on Form 5500-C 5

Items To Complete on Form 5500-R 6

Schedules 6

Other Filings 6

Section 3

Final Return/Report 7

Signature and Date 7

Reproductions 7Change in Plan Year 7

Amended Return/Report 7

How the Annual Return/ReportInformation May Be Used 7

Section 4

Information at the Top of the Form 8

Line-By-Line Instructions 8

Form 5500-R, Page 2 10

Form 5500-C, Pages 3 through 6 12

Codes for Principal Business Activityand Principal Product or Service 19

Pension BenefitGuaranty Corporation

Department of LaborPension and WelfareBenefits Administration

Department of the TreasuryInternal Revenue Service

1993 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.11 hr.7 hr., 53 min.Form 5500-C (Initial fi lers) 55 hr., 14 min.

Form 5500-C (All other filers) 32 min.10 hr., 51 min.7 hr., 53 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., 41 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, Attention: Reports Clearance Officer, PC:FP, Washington, DC20224; 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) 13 min.12 min.1 hr., 12 min.

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

Schedule F (Form 5500) 2 hr., 52 min. 24 min. 28 min.


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Penalties

ERISA and the Code provide for theassessment or imposition of penalties for notgiving complete information and not filingstatements and returns/reports. Certainpenalties are administrative (i.e., they may beimposed or assessed by one of thegovernmental agencies delegated toadminister the collection of Form 5500 seriesdata). Others require a legal conviction.

Administrative Penalties

Listed below are various penalties for not

meeting the Form 5500 series filingrequirements. One or more of the followingfive penalties may be imposed or assessed inthe event of incomplete filings or filingsreceived after the due date unless it isdetermined that your explanation for failure tofile properly is for reasonable cause:

1. A penalty of up to $1,000 a day for eachday a plan administrator fails or refuses to filea complete return/report. See ERISA section502(c)(2) and 29 CFR 2560.502c-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). Thispenalty also applies to returns required to befiled under Code section 6039D.

3. A penalty of $1 a day (up to $5,000) foreach 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) fornot filing a notification of change of status ofa plan. See Code section 6652(d)(2).

5. A penalty of $1,000 for not filing anactuarial statement. See Code section 6692.

Other Penalties

1. Any individual who willfully violates anyprovision of Part 1 of Title I of ERISA shall befined not more than $5,000 or imprisoned not

more than 1 year, or both. See ERISA section501.

2. A penalty of up to $10,000, 5 yearsimprisonment, or both, may be imposed formaking any false statement or representationof fact, knowing it to be false, or forknowingly concealing or not disclosing anyfact required by ERISA. See section 1027,Title 18, U.S. Code, as amended by section111 of ERISA.

Who Must File

Any administrator or sponsor of an employeebenefit plan subject to ERISA must fileinformation about each such plan every year(Code section 6058 and ERISA sections 104and 4065). Every employer maintaining aspecified fringe benefit plan as described inCode section 6039D (except Code sections79, 105, 106, 120, and 129 plans) is alsorequired to file each year. The InternalRevenue Service (IRS), Department of Labor(DOL), and Pension Benefit GuarantyCorporation (PBGC) have consolidated theirreturns and report forms to minimize the filingburden for plan administrators and employers.The chart on page 5 gives a brief guide to thetype of return/report to be filed.

When To File

File all required forms and schedules by thelast day of the 7th month after the plan yearends. For a short plan year, file the form andapplicable schedules by the last day of the7th month after the short plan year ends. Forpurposes of this return/report, the short planyear ends on the date of the change inaccounting period or upon the completedistribution of the assets of the plan. (Alsosee Section 3.) If the current year Form5500-C/R is not available before the due dateof your short plan year return/report, use the

latest year form available and change thedate printed on the return/report to thecurrent year. Also show the dates your shortplan year began and ended.

Extension of Time To File

A one-time extension of time up to 212months may be granted for filingreturns/reports if Form 5558, Application forExtension of Time To File Certain EmployeePlan Returns, is filed before the normal duedate (not including any extensions) of thereturn/report.

Exception. Plans are automatically grantedextensions of time to file Form 5500-C/R untilthe due date of the Federal income tax returnof the employer if all the following conditions

are met: (1) The plan year and the employerstax year are the same; (2) The employer hasbeen granted an extension of time to file itsFederal income tax return to a date later thanthe normal due date for filing the Form5500-C/R; (3) A copy of the IRS extension oftime to file the Federal income tax return isattached to the Form 5500-C/R filed with theIRS. 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 File

File the return/report with the InternalRevenue Service Center indicated below. Nostreet address is needed.

See pages 6 and 7 for the filing address forinvestment arrangements filing directly withDOL.

If the principal officeof the plan sponsor

or the plan administratoris located in:

Use the followingInternal RevenueService Center

address

Connecticut, Delaware,District of Columbia, ForeignAddress, Maine, Maryland,Massachusetts, NewHampshire, New Jersey, NewYork, 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, West Virginia,Wisconsin, Wyoming

Memphis, TN 37501

All Form 5500-EZ filers Andover, MA 05501

Section 2

Kinds of Plans

Employee 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 and evenif benefits no longer accrue, contributionswere not made this plan year, or contributionsare no longer made (frozen plan or wastingtrust). See Final Return/Report on page 7.

Pension benefit plans required to fileinclude defined benefit plans and definedcontribution plans (e.g., profit-sharing, stock

bonus, money purchase plans, etc.). Thefollowing are among the pension benefit plansfor which a return/report must be filed:

1. Annuity arrangements under Codesection 403(b)(1).

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

3. Individual retirement account establishedby an employer under Code section 408(c).

4. Pension benefit plan maintained outsidethe United States primarily for nonresidentaliens if the employer who maintains the planis:

a. A domestic employer, or

b. A foreign employer with income derived

from sources within the United States(including foreign subsidiaries of domesticemployers) and deducts contributions to theplan on its U.S. income tax return. See PlansExcluded From 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, Wake Island,or American Samoa. This includes a plan thatelects to have the provisions of section1022(i)(2) of ERISA apply.

See Items To Complete on Form 5500-Con page 5 and Items To Complete on Form5500-R on page 6 for more information aboutwhat questions must be completed by

pension plans.

Welfare Benefit Plan

An employee welfare benefit plan is coveredby Part 1 of Title I of ERISA. Welfare plansprovide benefits such as medical, dental, lifeinsurance, apprenticeship and training,scholarship funds, severance pay, disability,etc.

See Items To Complete on Form 5500-Con page 5 and Items To Complete on Form5500-R on page 6. It contains moreinformation about what questions must becompleted for welfare benefit plans.


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Fringe Benefit Plan

Cafeteria plans described in Code section125 and educational assistance programsdescribed in Code section 127 are consideredfringe benefit plans and generally are requiredto file the annual information specified byCode section 6039D. However, Code section127 educational assistance programs thatprovide only job-related training that isdeductible under Code section 162 do nothave to file Form 5500-C/R.

Note: A fringe benefit plan may be associatedwith one or more welfare plans as described

above for which a Form 5500-C/R may berequired to be filed.

See Items To Complete on Form 5500-Cand Items To Complete on Form 5500-R onpages 5 and 6 for more information abouthow to complete this form for a fringe benefitplan.

Plans Excluded From Filing

These 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 an employeebenefit plan that is any of the following:

1. A welfare benefit plan which coversfewer than 100 participants as of the

beginning of the plan year and is: unfunded,fully insured, or a combination of insured andunfunded.

a. An unfunded welfare benefit plan has itsbenefits paid as needed directly from thegeneral assets of the employer or theemployee organization that sponsors the plan.

Note: Plans that are NOT unfunded includethose plans that received employee (or formeremployee) contributions during the plan yearand/or used a trust or separately maintainedfund (including a Code section 501(c)(9) trust)to hold plan assets or act as a conduit for thetransfer of plan assets during the plan year.

b. A fully insured welfare benefit plan hasits benefits provided exclusively through

insurance contracts or policies, the premiumsof which must be paid directly by theemployer or employee organization from itsgeneral assets or partly from its generalassets and partly from contributions by itsemployees or members (which the employeror organization forwards within 3 months ofreceipt).

The insurance contracts or policiesdiscussed above must be issued by aninsurance company or similar organization(such as Blue Cross, Blue Shield or a healthmaintenance organization) which is qualifiedto do business in any state.

c. A combination unfunded/insured welfareplan has its benefits provided partially as anunfunded plan and partially as a fully insured

plan. An example of such a plan is a welfareplan which provides medical benefits as in aabove and life insurance benefits as in babove.

See 29 CFR 2520.104-20 and the DOLTechnical Release 92-01.

Note: An employees beneficiary associationas used in Code section 501(c)(9) should notbe confused with the employee organizationor employer that establishes and maintains(i.e., sponsors) the welfare benefit plan.

2. An unfunded pension benefit plan or anunfunded or insured welfare benefit plan: (a)

whose benefits go only to a select group ofmanagement or highly compensatedemployees, and (b) which meets the terms ofDepartment of Labor Regulations 29 CFR2520.104-23 (including the requirement that anotification statement be filed with DOL) or 29CFR 2520.104-24.

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

4. An unfunded excess benefit plan.

5. A welfare benefit plan maintained outsidethe United States primarily for persons

substantially all of whom are nonresidentaliens.

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 for thetreatment provided in Code sect ion 402(e)(5).

7. An annuity arrangement described in 29CFR 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 CFR 2520.104-48or 29 CFR 104-49. A SEP is a pension planthat meets certain minimum qualificationsregarding eligibility and employer

contributions.9. A church plan not electing coverage

under Code section 410(d) or a governmentalplan.

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 insures oneor more welfare plans of each participatingemployer, and uses a trust (or other entitysuch as a trade association) as the holder ofthe insurance contracts and the conduit forpayment of premiums to the insurancecompany. For further details, see 29 CFR2520.104-43.

11. An apprenticeship or training planmeeting all of the conditions specified in 29CFR 2520.104-22.

Kinds of Filers

The different types of plan entities that file theform are described below. (Also seeinstructions for item 4 on page 8.)

1. Single-Employer Plan

If one employer or one employee organizationmaintains a plan, file a separate return/reportfor the plan. If the employer or employee

organization maintains more than one suchplan, file a separate return/report for eachplan.

If a member of a controlled group ofcorporations, a group of trades or businessesunder common control or an affiliated servicegroup maintains a plan that does not involveother group members, file a separatereturn/report as a single-employer plan.

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.

2. Plan for Controlled Group ofCorporations, Group of Trades orBusinesses Under Common Control, or AnAffiliated Service Group

These groups 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 regard tocontributions by each participants employer,

file one return/report for the plan. On thereturn/report for the plan, complete item 21only for the controlled groups employees.

Note: Employers who participate in a pensionplan of one of the groups listed above butwho are not members of the group must file aseparate return/report. The return/reportshould be filed on Form 5500-C/R regardlessof the number of participants. The years youare required to file pages 1 and 3 through 6as Form 5500-C (seeWhat To Fileon page4), complete only items 1 through 7a, 9, and21. The years you file pages 1 and 2 as Form5500-R, complete only items 1 through 7a,8a, and 8b. These participating employersmustenter code F on item 4 of the Form5500-C/R.

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 as a single-employerplan.

3. Multiemployer Plan

A multiemployer plan is a plan (1) to whichmore than one employer is required tocontribute, (2) that is maintained pursuant toone or more collective-bargainingagreements, and (3) has not made theelection under Code section 414(f)(5) andERISA section 3(37)(E). File one return/reportfor each plan. Contributing employers do not

file individually for these plans. See Codesection 414 for more information.

4. Multiple-Employer-CollectivelyBargained Plan

A multiple-employer-collectively bargainedplan involves more than one employer, iscollectively bargained and collectively funded,and, if covered by PBGC terminationinsurance, had properly elected beforeSeptember 27, 1981, not to be treated as amultiemployer plan 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 fileindividually for these plans.

5. Multiple-Employer Plan (Other)A multiple-employer plan (other) involvesmore than one employer and is not one of theplans already described. File one return/reportfor each plan.

Note: Each employer participating in aqualified defined contribution or definedbenefit plan which is considered amultiple-employer plan (other) must file aForm 5500-C/R regardless of the number ofparticipants. For the years you are required tofile pages 1 and 3 through 6 as Form 5500-C,complete only items 1 through 7a, 9, and 21.For the years you file pages 1 and 2 as Form


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5500-R, complete only items 1 through 7a,8a, and 8b. Each participating employer filingthe Form 5500-C/Rmustenter code F initem 4, 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 the return/report filed forthe plan should be 333 and, if more than oneplan, they should be consecutively numberedstarting with 333.

If more than one employer participates inthe plan and the plan provides that each

employers contributions are available to paybenefits only for that employers employeeswho are covered by the plan, one annualreturn/report must be filed for eachparticipating employer. These filers will beconsidered single employers and shouldcomplete the entire form.

Investment Arrangements FilingDirectly With DOL

Some plans invest in certain trusts, accounts,and other investment arrangements that mayfile information concerning themselves andtheir relationship with employee benefit plansdirectly with DOL (as specified on page 6).Plans participating in an investmentarrangement as described in

Common/Collective Trust and PooledSeparate Account, Master Trust, and103-12 Investment Entities are required toattach certain additional information to thereturn/report filed with the IRS as specifiedbelow.

Common/Collective Trust and PooledSeparate 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 agency forthe collective investment and reinvestment ofassets contributed thereto from employee

benefit plans maintained by more than oneemployer or a controlled group ofcorporations, as the term is used in Codesection 1563. For reporting purposes, apooled separate account is an accountmaintained by an insurance carrier that isregulated, supervised, and subject to periodicexamination by a state agency for thecollective investment and reinvestment ofassets contributed thereto from employeebenefit plans maintained by more than oneemployer or controlled group of corporations,as the term is used in Code section 1563.See 29 CFR sections 2520.103-3,2520.103-4, 2520.103-5, and 2520.103-9.

Note: For reporting purposes, a separateaccount that is not considered to be holding

plan assets pursuant to 29 CFR2510.3-101(h)(1)(iii), shall not constitute apooled separate account.

Additional information to be attached tothe Form 5500-C/R for plans participatingin common/collective trusts and pooledseparate accounts.A plan participating in acommon/collective trust or pooled separateaccount must complete the annualreturn/report in accordance with the specificinstructions and attach either: (1) the mostrecent statement of the assets and liabilitiesof any common/collective trust or pooledseparate account, or (2) a certification that:

(a) the statement of the assets and liabilitiesof the common/collective trust or pooledseparate account has been submitted directlyto DOL by the financial institution orinsurance carrier; (b) the plan has received acopy of the statement; and (c) includes theEIN and other numbers used by the financialinstitution or insurance carrier to identify thetrusts or accounts, and the name andaddress provided, in the direct filing madewith DOL.

Master Trust

Definition.For reporting purposes, a mastertrust is a trust for which a regulated financialinstitution (as defined below) serves astrustee or custodian (regardless of whethersuch institution exercises discretionaryauthority or control with respect to themanagement of assets held in the trust), andin which assets of more than one plansponsored by a single employer or by a groupof employers under common control are held.

A regulated financial institution means abank, trust company, or similar financialinstitution that is regulated, supervised, andsubject to periodic examination by a state orFederal agency. Common control isdetermined on the basis of all relevant factsand circumstances (whether or not such

employers are incorporated). See 29 CFR2520.103-1(e).

For reporting purposes, the assets of amaster trust are considered to be held in oneor more investment accounts. A mastertrust investment account may consist of apool of assets or a single asset.

Each pool of assets held in a master trustmust be treated as a separate master trustinvestment account if each plan that has aninterest in the pool has the same fractionalinterest in each asset in the pool as itsfractional interest in the pool, and if eachsuch plan may not dispose of its interest inany asset in the pool without disposing of itsinterest in the pool. A master trust may alsocontain assets that are not held in such a

pool. Each such asset must be treated as aseparate master trust investment account.

Financial information must generally beprovided to DOL with respect to each mastertrust investment account as specified onpage 6.

Additional information to be attached tothe Form 5500-C/R for plans participatingin master trusts.A plan participating in amaster trust must complete the annualreturn/report and attach to it a schedulelisting each master trust investment accountin which the plan has an interest, indicatingthe plans name, EIN, and plan number andthe name of the master trust used in themaster trust information filed with DOL (see

page 6). In tabular format, show the net valueof the plans interest in each investmentaccount at the beginning and end of the planyear, 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 the mastertrust report filed directly with DOL or as aplan asset(s) that is not part of the mastertrust (and therefore subject to all instructions

pertaining to assets not held in a mastertrust).

103-12 Investment Entities

29 CFR 2520.103-12 provides an alternativemethod of reporting for plans that invest in anentity (other than an investment arrangementfiling with DOL as described inCommon/Collective Trust and PooledSeparate Account or Master Trust above),the underlying assets of which include planassets (within the meaning of 29 CFR2510.3-101) of two or more plans that are notmembers of a related group of employeebenefit plans. For reporting purposes, arelated group consists of each group of twoor more employee benefit plans (1) each ofwhich receives 10% or more of its aggregatecontributions from the same employer or froma member of the same controlled group ofcorporations (as determined under Codesection 1563(a), without regard to Codesection 1563(a)(4)); or (2) each of which iseither maintained by, or maintained pursuantto a collective-bargaining agreementnegotiated by, the same employeeorganization or affiliated employeeorganizations. For purposes of this paragraph,an affiliate of an employee organizationmeans any person controlling, controlled by,or under common control with suchorganization. See 29 CFR 2520.103-12.

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

What To File

This section describes the different categoriesof the Form 5500 series and the relatedschedules and lists items to be completed bydifferent types of Form 5500-C/R filers. Inaddition, this section contains a description ofthe special filing requirements for plans thatinvest in certain investment arrangements.For a brief guide illustrating which forms and

schedules are required by different types ofplans and filers, see the summary on page 5.

Forms

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

Form 5500, Annual Return/Report ofEmployee Benefit Plan, must be filed annuallyfor each plan with 100 or more participants atthe beginning of the plan year.

Form 5500-C/R, Return/Report ofEmployee Benefit Plan, must be filed for eachpension benefit plan, welfare benefit plan,and fringe benefit plan (unless otherwiseexempted) with fewer than 100 participants atthe beginning of the plan year.One-participant plans see Form 5500-EZ on

page 5.The Form 5500-C/R takes the place of

separate 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-C andcomplete pages 1 and 3 through 6. Form5500-R filers will check box (6) indicating theyare filing a Form 5500-R, complete pages 1and 2, and detach pages 3 through 6 beforefiling the return/report.


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You must check the box at the top of theForm 5500-C/R indicating that the form is aForm 5500-C for the first plan year, the yearfor which the final return/report is due, andfor plan years in which a Form 5500-R maynot be filed as explained below.

You may check the box at the top of theForm 5500-C/R indicating that the form is aForm 5500-R unless: (a) this is the plans firstplan year, (b) this is the plan year for which afinal return/report is due, or (c) the Form5500-R has been filed for both of the prior 2plan years. If any of the preceding three

situations apply, you must file Form 5500-Cand check box (5).

Any plan may choose not to file the Form5500-R if the plan files the Form 5500-Cinstead.

Note: To determine whether to file Form 5500or Form 5500-C/R for an employee benefitplan, calculate the number of participants inthe same manner as item 7 of the Form 5500or 5500-C/R but the calculation should be asof thebeginningof the plan year. Also, underthe filing requirements explained above, if thenumber of plan participants increases to 100or more, or decreases below 100, from 1 yearto the next, you would generally have to file adifferent form from that filed the previousyear. However, there is an exception to this

rule. The filer may continue to file the sameform filed last year (i.e., Form 5500 or5500-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 5500-EZ, Annual Return ofOne-Participant (Owners and Their Spouses)Pension Benefit Plan, should be filed by mostone-participant plans.

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

covers only the partners or the partners andthe partners spouses.

See Form 5500-EZ 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/report hasbeen filed.

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

Certain kinds of plans and certain kinds offilers that must file Form 5500-C are notrequired to complete the entire form. These

are described below by type of plan. Checkthe list of headings to see if your plan isaffected.

Form 5500-C filers do not completepage 2.

Welfare benefit plans.Welfare benefit plansgenerally must complete the following itemson the Form 5500-C: 1 through 6a; 6e; 7a;8a, 8b, 8d, and 8e; 9a, 9b, 9c, and 9f; 10athrough 10d; 11 through 14; and 26 through28.

Note: If one Form 5500-C is filed for both awelfare benefit plan and a fringe benefit plan,check 6d and complete Schedule F (Form5500) in addition to the items listed above forwelfare benefit plans.

Fringe benefit plans.For a Form 5500-Cfiled only for a fringe benefit plan described inCode sections 125 and 127, complete onlyitems 1 through 5, 6d, and Schedule F (Form5500). Do not file any other schedules.

If the Form 5500-C/R is filed for both awelfare benefit plan and a fringe benefit plan,complete the above items, all applicableschedules, and the items specified forWelfare benefit plans above.

Pension plans.In general, most pensionplans (defined benefit and definedcontribution) are required to complete allitems on the form. However, some items donot have to be completed by certain types ofpension plans, as described below.

1. Plans exclusively using a tax deferredannuity arrangement under Code section

403(b)(1).These plans need only completeitems 1 through 5, 6b (enter pension code 8),and 9.

2. Plans exclusively using a custodialaccount for regulated investment companystock under Code section 403(b)(7).Theseplans need only complete items 1 through 5,6b (enter pension code 9), and 9.

3. Individual retirement account plan.Apension plan utilizing individual retirementaccounts or annuities (as described in Codesection 408) as the sole funding vehicle forproviding benefits need only complete items 1

through 5, 6b (enter pension code 0), and 9.4. Fully insured pension plan.A pension

benefit plan providing benefits exclusivelythrough an insurance contract, or contractsthat are fully guaranteed and that meets all ofthe conditions of 29 CFR 2520.104-44 needonly complete items 1 through 26c. A pensionplan that includes both insurance contracts ofthe type described in 29 CFR 2520.104-44 aswell as 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 CFR 2520.104-44,a contract is considered to be allocatedonly if the insurance company or organizationthat issued the contract unconditionallyguarantees, upon receipt of the requiredpremium or consideration, to provide aretirement benefit of a specified amount,without adjustment for fluctuations in themarket value of the underlying assets of thecompany or organization, to each participant,and each participant has a legal right to suchbenefits, which is legally enforceable directlyagainst the insurance company ororganization.

5. Nonqualified pension benefit plansmaintained outside the United States.Nonqualified pension benefit plans maintainedoutside the United States primarily fornonresident aliens required to file a Form5500-C (see Who Must File on page 2) must

only complete items 1 through 8c (enter codeD in item 6c), 9 through 12, 15, and 16.

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

When to fileWhat to fileType of plan

Form 5500-EZMost 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 planyear 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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Plans of more than one employer.Allplans of more than one employer (plans of acontrolled group, multiemployer plans,multiple-employer-collectively bargainedplans, and multiple-employer plan (other))generally should complete all applicable(welfare or pension) items on the form exceptfor item 6f. Only single-employer pensionplans must complete this item. Multiemployerplans and multiple-employer-collectivelybargained plans need not complete 7c onpage 3.

Items To Complete on Form 5500-R

Certain kinds of plans and certain kinds offilers that are required to submit Form 5500-Rare not required to complete the entire form.These are described below, by type of plan.Check the list of headings to see if your planis affected.

Welfare benefit plans.Welfare benefit plansmust complete the following items on Form5500-R: 1 through 6a; 6e; 7a; 8a and 8b; 9;10; 11; and 13 through 15.

Fringe benefit plans.A Form 5500-R filedonly for a fringe benefit plan described inCode sections 125 and 127 must completeonly items 1 through 6d, and Schedule F(Form 5500). Do not file any other schedules.

Pension plans.In general, most pension

plans (defined benefit and definedcontribution) are required to complete allitems on the form. However, some items donot have to be completed by certain types ofpension plans, as described below.

1. Plans exclusively using a tax deferredannuity arrangement under Code section403(b)(1).These plans must only completeitems 1 through 5, 6b (enter pension code 8),and 8.

2. Plans exclusively using a custodialaccount for regulated investment companystock under Code section 403(b)(7).Theseplans must only complete items 1 through 5,6b (enter pension code 9), and 8.

3. Individual retirement account plan.A

pension plan utilizing individual retirementaccounts or annuities (as described in Codesection 408) as the sole funding vehicle forproviding benefits must only complete items 1through 5, 6b (enter pension code 0), and 8.

4. Fully insured pension plan.A pensionbenefit plan providing benefits exclusivelythrough an insurance contract, or contractsthat are fully guaranteed, and that meets allof the conditions of 29 CFR 2520.104-44must only complete items 1 through 12, 14(enter 0 in 14a and 14c), and 15a, 15b, and15c. A pension plan that includes bothinsurance contracts of the type described in29 CFR 2520.104-44 as well as other assetsmust complete all applicable items on theForm 5500-R but limit its reporting in item 13

to those other assets.

Note: For purposes of the annualreturn/report and the alternative method ofcompliance set forth in 29 CFR 2520.104-44,a contract is considered to be allocatedonly if the insurance company or organizationthat issued the contract unconditionallyguarantees, upon receipt of the requiredpremium or consideration, to provide aretirement benefit of a specified amount,without adjustment for fluctuations in themarket value of the underlying assets of thecompany or organization, to each participant,and each participant has a legal right to such

benefits that is legally enforceable directlyagainst the insurance company ororganization.

5. Nonqualified pension benefit plansmaintained outside the United States.Nonqualified pension benefit plans maintainedoutside the United States primarily fornonresident aliens required to file a Form5500-R must only complete items 1 through8a (enter code D in item 6c), and 11 through15.

Schedules

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

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

Schedule A (Form 5500), InsuranceInformation, must be attached to Forms 5500and 5500-C/R, if any benefits under the planare provided by an insurance company,insurance service, or other similarorganization (such as Blue Cross, Blue Shield,or a health maintenance organization). (Thisincludes investments with insurancecompanies such as guaranteed investmentcontracts (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 or business,whether incorporated or unincorporated; or (b)a partner(s) in a partnership, or a partner(s)and his or her spouse. (2)A Schedule A(Form 5500) is not required to be filed withthe Form 5500 or Form 5500-C/R if aSchedule A (Form 5500) is filed for thecontract as part of the master trust or 103-12IE information filed directly with DOL.

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

Schedule B (Form 5500), ActuarialInformation, must be attached to Form 5500,5500-C/R, or 5500-EZ for most defined

benefit pension plans. See instructions forSchedule B.

Schedule E (Form 5500), ESOP AnnualInformation, must be attached to Form 5500,5500-C/R, or 5500-EZ for all pension benefitplans 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 Identifying SeparatedParticipants With Deferred Vested Benefits,may be needed for separated participants.See When To Report a Separated

Participant in the instructions for ScheduleSSA.

Schedule P (Form 5500), Annual Return ofFiduciary of Employee Benefit Trust, may befiled by any fiduciary (trustee or custodian) ofan organization that is qualified under Codesection 401(a) and exempt from tax underCode section 501(a) who wants to protect theorganization under the statute of limitationsprovided in Code section 6501(a).

File the Schedule P (Form 5500) as anattachment to Form 5500, 5500-C/R, or5500-EZ 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 pooledseparate account information to be fileddirectly with DOL.Financial institutions and

insurance carriers filing the statement of theassets and liabilities of a common/collectivetrust or pooled separate account shouldidentify the trust or account by providing theEIN of the trust or account, or (if more thanone trust or account is covered by the sameEIN) both the EIN and any additional numberassigned by the financial institution orinsurance carrier (such as: 99-1234567 TrustNo. 1); and a list of all plans participating inthe trust or account, identified by the plannumber, EIN, and name of the plan sponsor.The direct filing should 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 filed directlywith DOL.The following information withrespect to a master trust must be filed withDOL by the plan administrator or by adesignee, such as the administrator ofanother plan participating in the master trustor the financial institution serving as trusteeof the master trust, no later than the date onwhich the plans return/report is due. Whileonly one copy of the required informationshould be filed for all plans participating inthe master trust, the information is an integralpart of the return/report of each participating

plan, and the plans return/report will not bedeemed complete unless all the information isfiled within the prescribed time.

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 the mastertrust report filed directly with DOL or as aplan asset(s) that is not part of the mastertrust (and therefore subject to all instructionspertaining to assets not held in a mastertrust).

Each of the following statements andschedules must indicate the name of themaster trust and the name of the master trustinvestment account. The information shall be

filed with DOL by mailing it to:

Master TrustPension and Welfare Benefits


1. The name and fiscal year of the mastertrust and the name and address of the mastertrustee.

2. A list of all plans participating in themaster trust, showing each plans name, EIN,PN, and its percentage interest in each


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master trust investment account as of thebeginning and end of the fiscal year of themaster trust ending with or within the planyear.

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

4. A statement, in the same format as Part Iof Schedule C (Form 5500), for each mastertrust investment account showing amounts ofcompensation paid during the fiscal year ofthe master trust ending with or within theplan year to persons providing services with

respect to the investment account andsubtracted from the gross income of theinvestment account in determining the netincrease (decrease) in net assets of theinvestment account.

5. A statement for each master trustinvestment account showing the assets andliabilities of the investment account at thebeginning and end of the fiscal year of themaster trust ending with or within the planyear, grouped in the same categories asthose specified in item 31 of Form 5500.

6. A statement for each master trustinvestment account showing the income andexpenses, changes in net assets, and netincrease (decrease) in net assets of eachsuch investment account during the fiscalyear of the master trust ending with or withinthe plan year, in the categories specified initem 32 of Form 5500. In place of item 32a,show the total of all transfers of assets intothe investment account by participating plans.In place of item 32j, show the total of alltransfers of assets out of the investmentaccount by participating plans.

7. Schedules, in the format set forth in theinstructions for item 27 of Form 5500, of thefollowing items with respect to each mastertrust investment account for the fiscal year ofthe master trust ending with or within theplan year: assets held for investment,nonexempt party-in-interest transactions,defaulted or uncollectible loans and leases,

and 5% transactions involving assets in theinvestment account. The 5% figure shall bedetermined by comparing the current value ofthe transaction at the transaction date withthe current 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 described belowmust be filed with DOL by the sponsor of the103-12 IE no later than the date on which theplans return/report is due before the planadministrator can elect the alternative methodof reporting. While only one copy of therequired information should be filed for the103-12 IE, the information is an integral partof the return/report of each plan electing the

alternative method of compliance. The filingaddress is:

103-12 Investment EntityPension and Welfare Benefits


1. The name, fiscal year, and EIN of the103-12 IE and the name and address of thesponsor of the 103-12 IE. If more than one103-12 IE is covered by the same EIN, theyshall be sequentially numbered as follows:99-1234567 Entity No. 1.

2. A list of all plans participating in the103-12 IE, showing each plans name, EIN,PN, and its percentage interest in the 103-12IE as of the beginning and end of the fiscalyear of the 103-12 IE ending with or withinthe 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 as Part Iof Schedule C (Form 5500), for the 103-12 IEshowing amounts of compensation paidduring the fiscal year of the 103-12 IE ending

with or within the plan year to personsproviding services to the 103-12 IE.

5. A statement showing the assets andliabilities 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 during thefiscal year of the 103-12 IE ending with orwithin the plan year, grouped in thecategories specified in item 32 of Form 5500.In place of item 32a, show the total of alltransfers of assets into the 103-12 IE byparticipating plans. In place of item 32j, showthe total of all transfers of assets out of the103-12 IE by participating plans.

7. Schedules, in the format set forth in theinstructions for item 27 of Form 5500 (exceptitem 27d) with respect to the 103-12 IE forthe fiscal year of the 103-12 IE ending with orwithin the plan year. Substitute the term103-12 IE for the word plan whencompleting the schedules.

8. A report of an independent qualifiedpublic accountant regarding the above itemsand other books and records of the 103-12 IEthat meets the requirements of 29 CFR2520.103-1(b)(5).

Section 3

Final Return/Report

If 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 benefits maybe paid under a welfare benefit plan havebeen satisfied), check the final return/reportbox at the top of the Form 5500-C filed forsuch plan. The year of complete distributionis the last year a return/report must be filedfor the plan. For purposes of this paragraph,a complete distribution will occur in the yearin which the assets of a terminated plan arebrought under the control of PBGC.

For a defined benefit plan covered by

PBGC, a PBGC Form 1 must be filed and apremium must be paid until the end of theplan year in which the assets are distributedor brought under the control of PBGC.

Filing the return/report marked Finalreturn and indicating that the planterminated satisfies the notificationrequirement of Code section 6057(b)(3).

Signature and Date

The plan administrator must sign and date allreturns/reports filed. The name of theindividual who signed as plan administratormust be typed or printed clearly on the line

under the signature line. In addition, theemployer must sign a return/report filed for asingle-employer plan or a plan required to fileonly because of Code section 6039D (i.e., fora fringe benefit plan).

When a joint employer-union board oftrustees or committee is the plan sponsor orplan administrator, at least one employerrepresentative and one union representativemust sign and date the return/report.

Participating employers in amultiple-employer plan (other), who arerequired to file Form 5500-C/R are required to

sign the return/report. The plan administratorneed not sign the Form 5500-C/R filed by theparticipating employer.

Reproductions

Original forms are preferable, but a clearreproduction of the completed form isacceptable. Sign the return/report after it isreproduced. All signatures must be original.

Change in Plan Year

Generally, only defined benefit pension planshave to get prior approval for a change inplan year. (See Code section 412(c)(5).) Rev.Proc. 87-27, 1987-1 C.B. 769 explains theprocedure for automatic approval of a changein plan year. A pension benefit plan that

would ordinarily have to obtain approval for achange in plan year under Code section412(c)(5) is granted an automatic approval fora change in plan year if all the followingcriteria are met:

1. No plan year exceeds 12 months.

2. The change will not delay the time whenthe plan otherwise would have been requiredto conform to the requirements of anystatute, regulation, or published position ofthe IRS.

3. The trust, if any, retains its exemptstatus for the short period required to effectthe change, as well as for the taxable yearimmediately preceding the short period.

4. All actions necessary to implement the

change in plan year, including planamendment and a resolution of the board ofdirectors (if applicable), have been taken onor before the last day of the short period.

5. No change in plan year has been madefor 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, check thebox on line C at the top of the form.

Amended Return/Report

If you file an amended return/report, checkbox A(2) an amended return/report at the

top of the form. When filing an amendedreturn, answer all questions and circle theamended item numbers.

How the Annual Return/ReportInformation May Be Used

All Form 5500 series return/reports will besubjected to a computerized review. It is,therefore, in the filers best interest that theresponses accurately reflect thecircumstances they were designed to report.Annual reports filed under Title I of ERISAmust be made available by planadministrators to plan participants and by the


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Department of Labor to the public pursuantto 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 form itself.Therefore, your responses usually apply tothe year entered or printed at the top of thefirst page of the form. Yes or Noquestions must be marked either Yes orNo but not both. N/A cannot be used to

respond to a Yes or No question that isrequired to be answered by the filer asspecified on page 5 under Items ToComplete on Form 5500-C or on page 6under Items To Complete on Form 5500-R.

Information at the Top of the Form

On the first line at the top of the formcomplete the space for dates when: (1) the12-month plan year is not a calendar year, or(2) the plan year is less than 12 months (ashort plan year).

A. Check box (1) if this is the first filing forthis plan. Do not check this box if you haveever filed for this plan even if it was on adifferent form (Form 5500 vs. Form 5500-C orForm 5500-R).

Check box (2) if you have already filed forthe 1993 plan year and are now submitting anamended return/report to correct errorsand/or omissions on the previously filedreturn/report.

Check box (3) if the plan no longer exists toprovide benefits. See Section 3 on page 7 forinstructions concerning the requirement to filea final return/report.

Check box (4) if this form is being filed fora period of less than 12 months and showthe 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 Form

5500-R. If you check this box, complete onlypages 1 and 2.

B. Check this box if you make any changesto the preprinted information on page 1.Changes should be highlighted or entered inred ink, if possible.

C. Check this box if the plan year has beenchanged since the last return/report was 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 copy ofthe employers extension of time to file theincome tax return if you are using theexception in Extension of Time to File onpage 2 of these instructions.

Line-By-Line InstructionsCheck the preprinted information on page 1for 1a through 6d for accuracy andcompleteness. Cross out any incorrectinformation and enter the correct information.Add any incomplete information in red ink, ifpossible.

If you did not receive a Form 5500-C/Rwith a preprinted page 1, complete items 1through 6d as follows:

1a. Enter the name and address of the plansponsor. If the Post Office does not delivermail to the street address and the sponsorhas a P.O. box number, show the box

number instead of the street address. If theplan covers only the employees of oneemployer, enter the employers name.

The term plan sponsor means

The employer, for an employee benefit planthat a single employer established ormaintains;

The employee organization in the case of aplan of an employee organization; or

The association, committee, joint board oftrustees, or other similar group ofrepresentatives of the parties who establishor maintain the plan, if the plan is establishedor maintained jointly by one or moreemployers and one or more employeeorganizations, or by two or more employers.

Include enough information in item 1a todescribe the sponsor adequately. Forexample, Joint Board of Trustees of Local187 Machinists rather than just Joint Boardof Trustees.

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

Employers and plan administrators who donot have an EIN should apply for one onForm SS-4, Application for EmployerIdentification Number. Form SS-4 can beobtained at most IRS or Social Security

Administration (SSA) offices. Send Form SS-4to the Internal Revenue Service Center whereyou will file Form 5500-C/R.

A plan of a controlled group of corporationsshould use the EIN of one of the sponsoringmembers. This EIN must be used in allsubsequent filings of the annualreturns/reports for the controlled group.

If the plan sponsor is a group of individuals,get a single EIN for the group. When youapply for a number, enter on line 1 of FormSS-4 the name of the group, such as JointBoard of Trustees of the Local 187Machinists Retirement Plan.

Note: Although EINs for funds (trusts orcustodial accounts) associated with plans are

generally not required to be furnished on theForm 5500 series returns/reports, the IRS willissue EINs for such funds for other trustreporting purposes. EINs may be obtained byfiling Form SS-4 as explained above.

Plan sponsors should use the trust EINdescribed in the Note above when opening abank account or conducting othertransactions for a trust that requires an EIN.

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 issuer numbersare assigned to corporations and otherentities which issue public securities listed onstock exchanges or traded over the counter.The CUSIP issuer number is the first six digitsof the number assigned to the individualsecurities that are traded. If the plan sponsorhas no CUSIP issuer number, enter N/A.

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

The term administrator means

The person or group of persons specifiedas the administrator by the instrument underwhich the plan is operated;

The plan sponsor/employer if anadministrator is not so designated; or

Any other person prescribed by regulationsof the Secretary of Labor if an administrator isnot designated and a plan sponsor cannot beidentified.

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

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

3. If the plan administrators/sponsorsname, address, and EIN have changed sincethe last return/report was filed for this plan,enter the plan administrators/sponsorsname, address, and EIN as it appeared onthe last return/report filed for this plan.

3c. Indicate if the change in the sponsorsname, address, and EIN is only a change insponsorship. Change in sponsorship meansthe plans sponsor has been changed but noassets or liabilities have been transferred toanother plan(s), the plan has not terminatedor merged with any other plan. Therefore, theplan is now the responsibility of the newsponsor whose name is entered in item 1a ofthis return/report.

4. Plan Entity Code.From the followinglist of plan entities, choose the one thatdescribes your plan entity and enter thatcode in item 4.

Entity Code

Single-employer plan A

Plan of controlled group of corporationsor common control employers B

Multiemployer plan C

Multiple-employer-collectivelybargained plan D

Multiple-employer plan (other) E

A return of an employer described in theNotes to Kinds of Filers 2 and 5 onpage 3 F

5a. Enter the formal name of the plan orenough information to identify the plan. Thisname should not exceed 70 characters. If thepresent plan name exceeds 70 charactersand spaces, try to abbreviate it.

5b. Enter the date the plan first becameeffective.

5c. Enter the three-digit number theemployer or plan administrator assigned tothe plan. All welfare benefit plan numbers andCode section 6039D plan numbers start at501. All other plans start at 001.


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Once you use a plan number, continue touse it for that plan on all future filings withIRS, DOL and PBGC. Do not use it for anyother plan even if you terminated the firstplan.

6a. Welfare Benefit Plan Codes. Checkthis box and enter every code from the listbelow that describes the welfare benefit planfor which this return/report is being filed.Example. If your plan provides healthinsurance, life insurance, dental insuranceand eye examinations, the four codes A, B,D, and E should be entered. If your plan has

a benefit not described by one of the codes,enter Z and write in a description of thisbenefit in the space provided.

Type of Welfare Plan Code

Health (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 JScholarship (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. Checkthis box and enter the codes from the listbelow that describe the type of benefits forwhich the Form 5500-C/R is being filed.

Note: A pension plan must be either adefined benefit or a defined contribution plan.

Type of Pension Benefit Plan Code

Defined benefit 1

Defined ContributionProfit-sharing 2

Stock bonus 3

Target Benefit 4

Other money purchase 5

Other (specify on page 1) 6

Other

Defined benefit plan with benefitsbased 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

6c. Pension Plan Feature Codes. Enterthe code(s) from the list below that describesthe pension plan features.

Type of Pension Plan Features (seedescription and codes below) Code

Employee 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 section414(m)(2)) F

401(k) Plan(Plan containing a cash ordeferred arrangement) G

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

Plan with Permitted Disparity Provisions(See Code sections 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) and attachit to the Form 5500-C/R you file for this plan.

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

Enter code C for a pension plan thatprovides for individual accounts and permitsa participant or beneficiary to exerciseindependent control over the assets in his orher account (see ERISA section 404(c)).

Enter code D for a pension benefit planmaintained outside the United States primarilyfor nonresident aliens. See Kinds of Filers onpage 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) that has:

1. A service organization (A-ORG) that is ashareholder or partner in the FSO and thatregularly performs services for the FSO, or isregularly associated with the FSO inperforming services for third persons, 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 includes agroup consisting of an organization whoseprincipal business is performing managementfunctions for another organization (or oneorganization and other related organizations)on a regular and continuing basis, and theorganization for which such functions are soperformed by the organization.

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 electionby 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 of thecumulative accrued benefits under the planfor key employees exceeds 60% of thepresent value of the cumulative accruedbenefits under the plan for all employees; and

b. Any defined contribution plan if, as ofthe determination date, the aggregate of theaccounts of key employees under the planexceeds 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 treated as

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 in anemployer plan who at any time during theplan year, or any of the 4 preceding years, is:

a. An officer of the employer having anannual compensation greater than 50% of$115,641, the defined benefit dollar limitationfor 1993 under Code section 415(b)(1)(A),

b. One of the 10 employees having annualcompensation from the employer greater than$30,000, the defined contribution dollarlimitation under Code section 415(c)(1)(A) andowning (or considered as owning within themeaning of Code section 318) the largest

interests in the employer,c. A 5% owner of the employer, or

d. A 1% owner of the employer having anannual compensation from the employer ofmore than $150,000.

In determining whether an individual is anofficer of the employer, no more than 50employees, or, if less, the greater of 3employees or 10% of the employees, are tobe 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 consists of:

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 requirements fornondiscrimination in contributions or benefitsunder Code section 401(a)(4), or theparticipation 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 under alldefined benefit plans included in such groupand the aggregate of the accounts of keyemployees under all defined contributionplans in such group exceeds 60% of a similar

sum determined for all employees. Todetermine if a plan is top heavy, includedistributions made in the 5-year period endingon the determination date. However, do nottake into account accrued benefits for anindividual who has not performed services forthe employer during the 5-year period endingon the determination date.

A qualified plan must limit the annualcompensation of each employee taken intoaccount for this year to $235,840, adjustedannually for the cost of living. The familymembers (spouse and lineal descendentsunder age 19) of 5% owners or one of the 10most highly compensated employees are


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treated as a single employee. Qualified plansmay comply with this requirement inoperation even if the plan has not yet beenamended to comply with the Tax Reform Actof 1986.

6d. Fringe Benefit Plan.Complete onlypage 1 (items 1 through 5 and 6d) andSchedule F (Form 5500) for a Form 5500-C/Rfiled only because of Code section 6039D.See pages 5 and 6 for additional instructionson Items To Complete on Form 5500-C andItems To Complete on Form 5500-R for afringe benefit plan.

Form 5500-C filers, see pages 12 through18 for instructions for items 6e through 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). Dependentsare considered to be neither participants norbeneficiaries. For pension benefit plans,alternate payees entitled to benefits under aqualified domestic relations order are not tobe counted as participants for this item.

Participant means any individual who isincluded in one of the categories below.

a. Active participants include anyindividuals who are currently in employmentcovered by a plan and who are earning orretaining credited service under a plan. Thiscategory includes any individuals who are: (1)currently below the permitted disparity level ina plan that is integrated with social security,and/or (2) eligible to elect to have theemployer make payments to a Code section401(k) qualified cash or deferred arrangement.Active participants also include anynonvested individuals who are earning orretaining credited service under a plan. Thiscategory does not include nonvested formeremployees who have incurred the break in

service period specified in the plan.b. Inactive participants receiving benefits

are any individuals who are retired orseparated from employment covered by theplan and who are receiving benefits under theplan. This includes former employees who arereceiving group health continuation coveragebenefits pursuant to Part 6 of ERISA and whoare covered by the employee welfare benefitplan. This category does not include anyindividual to whom an insurance companyhas made an irrevocable commitment to payall the benefits to which the individual isentitled under the plan.

c. Inactive participants entitled to futurebenefits are individuals who are retired orseparated from employment covered by the

plan and who are entitled to begin receivingbenefits under the plan in the future. Thiscategory does not include any individual towhom an insurance company has made anirrevocable commitment to pay all thebenefits to which the individual is entitledunder the plan.

d. Deceased participants are any deceasedindividuals who have one or morebeneficiaries who are receiving or are entitledto receive benefits under the plan. Thiscategory does not include an individual if aninsurance company has made an irrevocablecommitment to pay all the benefits to which

the beneficiaries of that individual are entitledunder 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 participants countedin item 7a(2) who have made a contributionto the plan during this plan year or any priorplan year.

7c(1). If Yes, file Schedule SSA (Form5500) as an attachment to Form 5500-R.Plan administrators: Code section 6057(e)

provides that the plan administrator must giveeach participant a statement showing thesame information reported on Schedule SSAfor that participant.

8a. Check Yes, if the plan was terminatedand enter the year of 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 befiled by the plan administrator, if designated,or by the person or persons who actuallycontrol the plans property.

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

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

9. Check Yes, if either the contributionsto the plan or the benefits paid by the planare subject to the collective-bargainingprocess, even if the plan is not establishedand administered by a joint board of trustees.Check Yes even if only some of thosecovered by the plan are members of acollective-bargaining unit that negotiatesbenefit levels on its own behalf. The benefitschedules do not have to be identical for allemployees under the plan.

10. The insurance company (or similarorganization) that provides benefits isrequired to provide the plan administratorwith the information needed to complete thereturn/report, pursuant to ERISA section103(a)(2). If you do not receive thisinformation in a timely manner, contact theinsurance company (or similar organization). Ifinformation is missing on Schedule A (Form5500) due to a refusal to provide thisinformation, note this on Schedule A. If thereis no Schedule(s) A attached, 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 in a

plan year prior to the plan year for which thisreturn/report is filed.

11b. Check Yes only if the accruedbenefits were retroactively reduced. Forexample, a plan provides a benefit of 2% foreach year of service, but the plan is amendedto change the benefit to 112% a year for allyears of service under the plan.

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

11c. Check Yes only if an amendmentchanged the information previously providedto participants by the summary plandescription or summary description ofmodifications.

11d. A revised summary plan description orsummary description of modifications mustbe filed with DOL and distributed to all planparticipants and pension plan beneficiaries nolater than 210 days after the close of the planyear in which the amendment(s) was adopted.If the material was distributed and filed sincethe amendments were adopted (even if after

the end of the plan year), check Yes to item11d.

12a. Check Yes, if this is a pension plansubject to minimum funding standards thathas experienced a funding deficiency. If item12a is checked Yes, and item 6b indicatesthis is a defined benefit pension plan,complete and attach Schedule B (Form 5500)and a Schedule of Active Participant Datato this form. This schedule, prepared by theenrolled actuary who prepared the ScheduleB, should show the distribution of activeparticipants by age and service groupingswith average compensation data.

Form 5500-R filers, use the instructionson page 14 (item 15a) to prepare theschedule of active participant data. Also

see the instructions for item 15a on page14 for a suggested format that can be usedto provide the information.

All defined benefit plans are subject tominimum funding standards, except fullyinsured plans, church plans, governmentalplans, and certain other plans covered byCode section 412(h). Code section 412describes the minimum funding standardsapplicable to defined contribution plansqualified under Code section 401(a) or 403(a).A funding deficiency occurs if the amount ofrequired employer contribution for the planyear exceeds the actual contribution paid bythe employer for the plan year. If the answerto this question is No or Not Applicable,check No, and go to item 13.

12b. If item 12a is checked Yes, this itemmust be answered. If a funding deficiencyoccurs, Form 5330 must be filed with the IRSto pay the excise tax on the amount of thedeficiency.

Caution: There is a penalty for not filing Form5330 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. Round offall amounts in items 13 and 14 to the nearestdollar. Current value means fair marketvalue where available. Otherwise, it meansthe fair value as determined in good faithunder the terms of the plan by a trustee or a

named fiduciary, assuming an orderlyliquidation at the time of the determination.

If the assets of two or more plans aremaintained in one trust, such as when anemployer has two plans funded through asingle trust (except investment arrangementsfiling directly with DOL), complete items 13and 14 by entering the plans allocable part ofeach line item.

If assets of one plan are maintained in twoor more trust funds, report the combinedfinancial information in items 13 and 14. Fullyinsured defined benefit or definedcontribution pension plans meeting the


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conditions of 29 CFR 2520.104-44 need notcomplete item 13.

For purposes of the annual return/reportand the alternative method of compliance setforth in 29 CFR 2520.104-44, a contract isconsidered to be allocated only if theinsurance company or organization thatissued the contract unconditionallyguarantees, upon receipt of the requiredpremium or consideration, to provide aretirement benefit of a specified amount,without adjustment for fluctuations in themarket value of the underlying assets of the

company or organization, to each participant,and each participant has a legal right to suchbenefits that is legally enforceable directlyagainst the insurance company ororganization.

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

Note: Plan income includes contributions tothe plan and plan expenses include totalbenefits paid.

13a. Enter the total plan assets at thebeginning and end of the plan year. Planassets may include, among other things:

1. Cash, including both interest and

noninterest bearing. This includes all cash onhand or in a financial institution includingmoney market funds.

2. Receivables, including all contributionsdue to the plan from the employer andparticipants, income earned, but not yetreceived by the plan, and receivables fromany other source.

3. Investments including securities (stocks,bonds, U.S. Government obligations,municipal obligations, etc.); real property(land, buildings, gold, furniture, equipment,etc.); loans (mortgages, promissory notes,etc.); and all other investments (certificates ofdeposit, repurchase agreements, landcontracts, units of participation incommon/collective trusts and pooled

separate accounts, shares of registeredinvestment companies (mutual funds),interests in master trusts and 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 therequired certification. For details, see 29 CFRsections 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 master trust,which is the sum of the net values of the

plans interest in all of the master trustinvestment accounts. The net values of suchinterests are obtained by multiplying theplans percentage interest in each mastertrust investment account by the net assets ofthe investment account (total assets minustotal liabilities) at the beginning and end ofthe plan year.

13b. Enter the total liabilities at thebeginning and end of the plan year. Liabilitiesto be entered here do not include the value offuture pension payments to plan participants;however, the amount to be entered in item

13b for accrual basis filers includes, amongother things:

1. Benefit claims that have been processedbut 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 acquisitionindebtedness and any other amount owed bythe plan.

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

14a. Enter all plan income during the year.Plan income received and/or receivable mayinclude, among other things:

1. Interest on investments (including moneymarket funds, sweep accounts, STIFaccounts, etc.).

2. Dividends. (Accrual basis plans shouldinclude dividends declared for all stock heldby the plan even if the dividends have notbeen received as of the end of the plan year.)

3. Rents from income-producing propertyowned by the plan.

4. Royalties.

5. All contributions including securities or

other noncash property contributed to theplan.

6. Net gain or loss from the sale of assets.

7. Other income such as unrealizedappreciation (depreciation) in plan assets. Tocompute this amount, subtract the currentvalue of all assets at the beginning of theyear plus the cost of any assets acquiredduring the plan year from the current value ofall assets at the end of the year minus assetsdisposed of during the plan year. A negativefigure should be placed 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 participants or

beneficiaries in cash, securities, or otherproperty. If the securities or other propertyare distributed to plan participants orbeneficiaries, include the fair market value (ora good-faith estimate if fair market value isnot available) on the date the property wasdistributed.

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 includingreimbursement for travel, seminars, andmeeting expenses.

d. Fees paid for valuations and appraisals.

14c. Enter the net income (loss). Subtractitem 14b from item 14a. If the result is anegative number, enter it in parentheses.

14d. Enter the total contributions received,for accrual basis plans, contributions due tobe recei

Documents

US Internal Revenue Service: i5500cr--1993