Form 5500 Schedule A Instructions - Insurance Information - 2002


Lines A, B, C, and D. This information should be the same as
2002 Instructions for Schedule A
reported in Part II of the Form 5500 to which this Schedule A is
attached. You may abbreviate the plan name (if necessary) to
(Form 5500)
fit in the space provided.
Insurance Information
Part I - Information Concerning Insurance Contract
Coverage, Fees, and Commissions
General Instructions
Line 1(c). Enter the code number assigned by the National
Association of Insurance Commissioners (NAIC) to the
Who Must File
insurance company. If none has been assigned, enter zeros
(-0-) in the spaces provided.
Schedule A, Insurance Information, must be attached to the
Form 5500 filed for every defined benefit pension plan, defined
Line 1(d). If individual policies with the same carrier are
contribution pension plan, and welfare benefit plan if any
grouped as a unit for purposes of this report, and the group
benefits under the plan are provided by an insurance company,
does not have one identification number, you may use the
insurance service, or other similar organization (such as Blue
contract or identification number of one of the individual
Cross, Blue Shield, or a health maintenance organization). This
contracts provided this number is used consistently to report
includes investments with insurance companies such as
these contracts as a group and the plan administrator maintains
guaranteed investment contracts (GICs).
the records necessary to disclose all the individual contract
numbers in the group upon request. Use separate Schedules A
For example, if Form 5500 line 9a(1), 9a(2), 9b(1), or 9b(2)
to report individual contracts that cannot be grouped as a unit.
is checked, indicating that either the plan funding arrangement
or plan benefit arrangement includes an account, policy, or
Line 1(e). Since plan coverage may fluctuate during the year,
the administrator should estimate the number of persons that
contract with an insurance company (or similar organization), at
least one Schedule A (Form 5500) would be required to be
were covered by the contract at the end of the policy or contract
attached to the Form 5500 filed for a pension or welfare plan to
year. Where contracts covering individual employees are
grouped, compute entries as of the end of the plan year.
provide information concerning the contract year ending with or
within the plan year.
Lines 1(f) and (g). Enter the beginning and ending dates of the
policy year for the contract identified in 1(d). Enter ‘‘N/A’’ in 1(f)
In addition, Schedules A must be attached to a Form 5500
if separate contracts covering individual employees are
filed for GIAs, MTIAs, and 103-12 IEs for each insurance or
annuity contract held in the MTIA, or 103-12 IE or by the GIA.
See the Form 5500 instructions for specific requirements for
Line 2. List all persons in descending order by the amount of
GIAs, MTIAs, and 103-12 IEs.
commissions and fees paid. Additional pages may be
necessary. You can get additional hand print pages by calling
Do not file Schedule A if: (1) the contract is an Administrative
1-800-TAX-FORM (1-800-829-3676) and requesting additional
Services Only (ASO) contract; (2) the Form 5500 is being filed
for a plan participating in a MTIA or 103-12 IE for which a Form
5500 is being filed that reports the contract on a Schedule A
Totals. Enter the total of all commissions and fees paid to
filed with the MTIA or 103-12 IE Form 5500; or (3) the Form
persons listed on line 2.
5500 is being filed for a plan that covers only: (A) an individual
Complete a separate item (elements (a) through (e)) for
or an individual and his or her spouse who wholly own a trade
each person. Enter the name and address of the person
or business, whether incorporated or unincorporated; or
identified in element (a) and complete elements (b) through (e)
(B) partners, or partners and one or more of the partners’
for each person as specified below.
spouses in a partnership.
Element (b). Report all sales commissions regardless of the
Check the Schedule A box on the Form 5500 (Part II, line
identity of the recipient. Do not report override commissions,
10b(3)), and enter the number attached in the space provided if
salaries, bonuses, etc., paid to a general agent or manager for
one or more Schedules A are attached to the Form 5500.
managing an agency, or for performing other administrative
Important Reminder. The insurance company (or similar
organization) is required to provide the plan administrator with
Element (c). Fees to be reported represent payments by
the information needed to complete the return/report, pursuant
insurance carriers to agents, brokers and other persons for
to ERISA section 103(a)(2). If you do not receive this
items other than commissions (e.g., service fees, consulting
information in a timely manner, contact the insurance company
fees, and finders fees). Fees paid by insurance carriers to
(or similar organization). If information is missing on Schedule A
persons other than agents and brokers should be reported
(Form 5500) due to a refusal to provide information, note this on
here, not in Parts II and III on Schedule A as acquisition costs,
the Schedule A.
administrative charges, etc. For plans, GIAs, MTIAs and 103-12
IEs required to file Part I of Schedule C, fees paid by employee
Specific Instructions
benefit plans or these DFEs to agents, brokers, and other
Information entered on Schedule A (Form 5500) should pertain
persons are also to be reported on Schedule C (Form 5500),
to the insurance contract or policy year ending with or within the
unless the only compensation in relation to the plan or DFE
plan year (for reporting purposes, a year cannot exceed 12
consists of insurance fees and commissions listed on the
Schedule A.
Example. If an insurance contract year begins on July 1 and
For purposes of line 2, commissions and fees include
ends on June 30, and the plan year begins on January 1, and
amounts paid by an insurance company on the basis of
ends on December 31, the information on the Schedule A
the aggregate value (e.g., policy amounts, premiums) of
attached to the 2002 Form 5500 should be for the insurance
contracts or policies (or classes thereof) placed or retained. The
contract year ending on June 30, 2002.
amount (or pro rata share of the total) of such commissions or
Exception. If the insurance company maintains records on the
fees attributable to the contract or policy placed with or retained
basis of a plan year rather than a policy or contract year, the
by the plan must be reported in element (b) or (c), as
information entered on Schedule A (Form 5500) may pertain to
the plan year instead of the policy or contract year.
Include only the contracts issued to or held by the plan, GIA,
MTIA or 103-12 IE for which the Form 5500 is being filed.
Instructions for Schedule A (Form 5500)


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