Form 5500 Schedule A Instructions - Insurance Information - 2002 Page 2


Element (e). Enter the most appropriate code.
benefit-responsive contract, i.e., it provides a liquidity guarantee
by a financially responsible third party of principal and
previously accrued interest for liquidations, transfers, loans, or
Code Type of Organization
hardship withdrawals initiated by plan participants exercising
Banking, Savings & Loan Association, Credit Union or
their rights to withdraw, borrow, or transfer funds under the
other similar financial institution
terms of a defined contribution plan that do not include
Trust Company
substantial restrictions to participants’ access to plan funds.
Insurance Agent or Broker
Line 5a. The rate information called for here may be furnished
Agent or Broker other than insurance
by attaching the appropriate schedules of current rates filed
Third party administrator
with the appropriate state insurance department or by providing
Investment Company/Mutual Fund
a statement regarding the basis of the rates. Enter “see
Investment Manager/Adviser
attached” if appropriate.
Labor Union
Foreign entity (e.g., an agent or broker, bank, insurance
Lines 6a through 6f. Report contracts with unallocated funds.
company, etc., not operating within the jurisdictional
Do not include portions of these contracts maintained in
separate accounts. Show deposit fund amounts rather than
boundaries of the United States)
experience credit records when both are maintained.
Part III - Welfare Benefit Contract Information
Part II - Investment and Annuity Contract Information
Line 7i. Report a stop-loss insurance policy that is an asset of
Line 3. Enter the current value of the plan’s interest at year end
the plan.
in the contract reported on line 6, e.g., deposit administration
(DA), immediate participation guarantee (IPG), or guaranteed
Note. Employers sponsoring welfare plans may purchase a
investment contracts (GIC).
stop loss insurance policy with the employer as the insured to
help the employer manage its risk associated with its liabilities
Exception. Contracts reported on line 6 need not be
under the plan. These employer contracts with premiums paid
included on line 3 if (1) the Schedule A is filed for a defined
exclusively out of the employer’s general assets without any
benefit pension plan and the contract was entered into before
employee contributions generally are not plan assets and are
March 20, 1992, or (2) the Schedule A is filed for a defined
not reportable on Schedule A.
contribution pension plan and the contract is a fully
Instructions for Schedule A (Form 5500)


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