Form 5500 Schedule A Instructions - Insurance Information

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.

Other

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

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Instructions for Schedule A (Form 5500)

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

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