Instructions For Schedule H (Form 5500) - Financial Information

beneficiaries; (2) due to a qualified domestic relations order

during the plan year. A transfer of assets or liabilities occurs

(QDRO) or because of a pending determination as to whether a

when there is a reduction of assets or liabilities with respect to

domestic relations order is a QDRO; (3) due to an action or a

one plan and the receipt of these assets or the assumption of

failure to take action by an individual participant or because of

these liabilities by another plan. Enter the name, EIN, and PN

an action or claim by someone other than the plan regarding a

for the transferee plan(s) involved on lines 5b(1), (2), and (3).

participant’s individual account; or (4) by application of federal

securities laws. For more information, see 29 CFR 2520.101-3

Do not use a social security number in lieu of an EIN or

(available at ).

include an attachment that contains visible social security

Line 4n. If there was a blackout period, did you provide the

numbers. The Schedule H is open to public inspection, and the

required notice not less than 30 days nor more than 60 days in

contents are public information and are subject to publication on

advance of restricting the rights of participants and beneficiaries

the Internet. Because of privacy concerns, the inclusion of a

to change their plan investments, obtain loans from the plan, or

social security number on this Schedule H or the inclusion of a

obtain distributions from the plan? If so, check “Yes.” See 29

visible social security number on an attachment may result in

CFR 2520.101-3 for specific notice requirements and for

the rejection of the filing.

exceptions from the notice requirement. Also, answer “Yes” if

one of the exceptions to the notice requirement under 29 CFR

Note. A distribution of all or part of an individual participant’s

2520.101-3 applies.

account balance that is reportable on Form 1099-R should not

Line 5a. Check ‘‘Yes’’ if a resolution to terminate the plan was

be included on line 5b. Do not submit Form 1099-R with the

adopted during this or any prior plan year, unless the

Form 5500.

termination was revoked and no assets reverted to the

employer. If ‘‘Yes’’ is checked, enter the amount of plan assets

IRS Form 5310-A, Notice of Plan Merger or

that reverted to the employer during the plan year in connection

Consolidation, Spinoff, or Transfer of Plan Assets or

with the implementation of such termination. Enter ‘‘0’’ if no

Liabilities; Notice of Qualified Separate Lines of

CAUTION

reversion occurred during the current plan year.

Business, must be filed at least 30 days before any plan merger

A Form 5500 must be filed for each year the plan has

or consolidation or any transfer of plan assets or liabilities to

assets, and, for a welfare benefit plan, if the plan is still

another plan. There is a penalty for not filing IRS Form 5310-A

liable to pay benefits for claims incurred before the

CAUTION

on time. In addition, a transfer of benefit liabilities involving a

termination date, but not yet paid. See 29 CFR

plan covered by PBGC insurance may be reportable to the

2520.104b-2(g)(2)(ii).

PBGC. See PBGC Form 10, Post-Event Notice of Reportable

Line 5b. Enter information concerning assets and/or liabilities

Events, and PBGC Form 10-Advance, Advance Notice of

transferred from this plan to another plan(s) (including spinoffs)

Reportable Events.

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Instructions for Schedule H (Form 5500)

Instructions For Schedule H (Form 5500) - Financial Information - 2009 Page 9

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