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Note.

be a determination regarding the

entities above, other than those

•

The plan and amendments submitted

average benefit test. Plans using the

excluded by section 414(n)(5). Certain

to verify that plans were qualified prior

qualified separate lines of business

individuals may also be required to be

to the merger are for information

rules of section 414(r) must file

counted as employees. See the

purposes only and will not be ruled on.

Schedule Q if a determination is

definition of employee in Regulations

•

If applicable, file Form 5310-A,

desired that the plan satisfies the

section 1.410(b)-9. Also see

Notice of Plan Merger or Consolidation,

gateway test of section 410(b)(5)(B) or

Regulations section 1.410(b)-6(i), which

Spinoff, or Transfer of Plan Assets or

the special requirements for

may permit the employer to exclude

Liabilities; Notice of Qualified Separate

employer-wide plans.

certain former nonhighly compensated

Lines of Business, 30 days prior to the

employees.

Line 11a. If a determination is being

merger, consolidation, or transfer of

requested and the plan is

Note. This note applies only to plans

assets or liabilities.

disaggregated into two or more

that include a qualified cash or deferred

separate plans that are other than

Line 8g. If the plan has been restated

arrangement under section 401(k) or

profit-sharing and/or sections 401(k)

to change the type of plan under

employee or matching contributions

and/or 401(m) plans, complete lines

Regulations section 1.401-1, answer

under section 401(m). If there are any

11c through 11l with respect to each

this question “Yes” and attach a

contributions under the plan that are

disaggregated portion of the plan.

statement explaining the change.

not subject to the special rule for

Attach additional schedules as

Line 9a. If “Yes” is checked, attach a

section 401(k) plans and section

necessary to identify the other

list for each plan, which includes the

401(m) plans in Regulations section

disaggregated portions of the plan.

following information:

1.401(a)(4)-1(b)(2)(ii)(B) (such as

Provide the requested coverage

nonelective contributions), complete

1. Name of plan,

information, in the same format as line

lines 11e through 11k with respect to

2. Type of plan,

11, separately with respect to the other

the portion of the plan that includes

3. Form of plan (standardized,

portions of the plan, or to otherwise

these contributions and enter the ratio

non-standardized, VS, or individually

show that the other portions of the plan

percentage for this portion of the plan

designed),

separately satisfy section 410(b).

on line 11l. Otherwise, complete lines

4. Plan number,

Example. If this plan benefits the

11e through 11k with respect to the

5. Vesting schedule,

employees of more than one qualified

section 401(k) part of the plan (or the

6. Whether the plan has received a

separate line of business (QSLOB), the

section 401(m) plan if there is no

determination letter or an application for

portion of the plan benefiting the

section 401(k) arrangement) and leave

a letter is pending with IRS.

employees of each QSLOB is treated

line 11l blank. In all cases, enter the

Also indicate if the plan is paired (if

as a separate plan maintained by that

ratio percentages for the section 401(k)

paired, indicate the letter serial number

QSLOB and must separately satisfy

and the section 401(m) parts of the

of the paired plan).

section 410(b) unless the

plan, as applicable, on line 11m. These

employer-wide plan testing rule in

percentages should be based on the

Lines 9b and 9c. See M-8, M-12, and

Regulations section 1.414(r)-1(c)(2)(ii)

actual nonexcludables in the 401(k) and

M-14 of Regulations section 1.416-1.

applies.

401(m) portions, respectively. It is

Line 10a. Section 411(d)(6) protected

suggested that these calculations be

If a determination is being requested

benefits include:

submitted with the application but this is

•

for a section 401(k) and/or 401(m) plan,

The accrued benefit of a participant

optional.

you must complete lines 11c through

as of the later of the amendment’s

11l for the portion of the plan that is not

adoption date or effective date; and

If the plan provides for

•

a section 401(k) or a 401(m) plan. Also

Any early retirement benefit,

nonelective profit-sharing

complete line 11m(1) to report the ratio

retirement-type subsidy, or optional

contributions, do not base the

CAUTION

percentage for the section 401(k)

form of benefit for benefits from service

calculations on lines 11m(1) and (2) on

portion of the plan and line 11m(2) to

before such amendment.

the nonexcludable employees reported

report the ratio percentage for the

If the answer is “Yes,” explain on an

on line 11g unless all of the

section 401(m) portion of the plan.

attachment how the amendment

disaggregated plans (profit-sharing,

Line 11c. If, for purposes of satisfying

satisfies one of the exceptions to the

401(k), and 401(m)) have the same

the minimum coverage requirements of

prohibition on reduction or elimination

nonexcludable employees with the

section 410(b), you are applying the

of section 411(d)(6) protected benefits.

same age and service requirements.

daily testing option in Regulations

Line 11e(1). Enter the number of

section 1.410(b)-8(a)(2) or the quarterly

Optional Ratio

employees who are excluded because

testing option in Regulations section

Percentage Test

they have not attained the lowest

1.410(b)-8(a)(3), or, if you are using

minimum age and service requirements

single-day ‘‘snapshot’’ testing as

Determination

for any employee under this plan. If the

permitted under section 3 of Rev. Proc.

employer is separately testing the

93-42, 1993-2 C.B. 540, enter the most

Line 11. This question may be used to

portion of a plan that benefits otherwise

recent eight-digit date (MMDDYYYY)

request an optional determination

excludable employees, attach a

for which the coverage data is

regarding the ratio percentage test

separate schedule describing which

submitted. If you are applying the

under Regulations section

employees are treated as excludable

annual testing option in Regulations

1.410(b)-2(b)(2). If ‘‘No’’ is checked and

employees on account of the minimum

section 1.410(b)-8(a)(4), enter the year

a request for a determination regarding

age and service requirements under

for which the coverage data is

the average benefit test is not made on

each separate portion of the plan.

submitted.

Schedule Q, the determination letter for

the plan will not be a determination

Line 11d. Include all employees of all

Line 11e(2). Enter the number of

regarding section 410(b). If ‘‘No’’ is

entities combined under sections

employees who are excluded because

checked but a request for a

414(b), (c), (m), or (o). Also include all

they are collectively bargained

determination regarding the average

self-employed individuals, common law

employees as defined in Regulations

benefit test is made on Schedule Q, the

employees, and leased employees as

section 1.410(b)-6(d)(2), regardless of

determination letter for the plan will also

defined in section 414(n) of any of the

whether those employees benefit under

-4-

Instructions For Form 5307 - Application For Determination For Adopters Of Master Or Prototype (M&p) Or Volume Submitter (Vs) Plans Page 4

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