Pbgc Form 601 - Distress Termination Notice Single-Employer Plan Termination printable pdf download

Pbgc Form 601 - Distress Termination Notice Single-Employer Plan Termination

PBGC Form 601

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Approved OMB 1212-0036

Expires 12/31/2000

Distress Termination Notice

Single-Employer Plan Termination

PART I. IDENTIFYING INFORMATION

Plan name

Contributing sponsor

Employer identification and plan numbers

9 digit EIN

3 digit PN

PBGC case number

PART II. SPECIFIC PLAN INFORMATION

Proposed termination date

MM/DD/YYYY

Proposed termination date stated in notice of

MM/DD/YYYY

intent to terminate (if different from 5a)

Earliest date notices of intent to terminate

MM/DD/YYYY

issued to affected parties

Latest date notices of intent to terminate

MM/DD/YYYY

issued

Does each contributing sponsor and each member

YES

of a contributing sponsor's controlled group meet

one of the distress tests described in ERISA

§ 4041(c)(2)(B) and 29 CFR § 4041.41(c)?

Attach a statement identifying each contributing sponsor

and each controlled group member and the distress test

met by each. Also attach the information to demonstrate

that each contributing sponsor and controlled group

member meets the distress test(s) identified.

Has a formal challenge to the termination been initiated

YES

N/A

under an existing collective bargaining agreement?

If "Yes", attach a copy of the formal challenge and a

statement describing the challenge.

Pbgc Form 601 - Distress Termination Notice Single-Employer Plan Termination