Appendix F, Schedule 5 Plan Loan Failures (Qualified Plans And 403(B) Plans)

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APPENDIX F, SCHEDULE 5
Plan Loan Failures
(Qualified Plans and 403(b) Plans)
Plan Name: __________________________________ EIN: _______________ Plan #: _____
(Please include the plan name, EIN, and plan number information on each page of the submission.)
PART I. IDENTIFICATION OF FAILURE
The plan identified above did not comply with the requirements of § 72(p)(2) of the Internal Revenue Code. (Note:
The conditions of § 72(p)(2) must be satisfied for a participant loan to be exempt from being treated as a distribution
to the participant under § 72(p)(1).) The failure occurred for the following reason(s) (check applicable boxes and
provide the information requested):
A. The loan(s) exceeded the limit under § 72(p)(2)(A)
Number of participants affected
Total number of
Plan Year
loans issued that violated §
72(p)(2)(A)
B. Loan terms did not satisfy the limits on the duration of the loan under § 72(p)(2)(B)
Number of participants affected
Total number of loans issued that
Plan Year
violated
§ 72(p)(2)(B)
1

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