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Part II – Basic Plan

Part III – Supplemental

mailing as timely filing/paying” rule for tax

returns and payments. The private

Information

delivery services include only the

following.

DRAFT AS OF

Lines 1a, 1b, and 1c. Enter the formal

Line 4a. Check “Yes” if the plan includes

Federal Express (FedEx): FedEx

name of the plan, the three-digit plan

a cash or deferred arrangement under

Priority Overnight, FedEx Standard

number (PN), and the date the plan first

which a covered employee may elect to

Overnight, FedEx 2Day, FedEx

became effective. This information must

have the employer either contribute an

International Priority, and FedEx

be the same as reported in Part II, lines

amount to the plan’s trust on behalf of the

International First.

1a, 1b, and 1c of the Form 5500, or Form

employee or to pay the employee directly

United Parcel Service (UPS): UPS Next

5500-SF. See the 2015 Instructions for

in cash or some other taxable benefit. A

Day Air, UPS Next Day Air Saver, UPS

Form 5500 or Form 5500-SF.

401(k) is a feature of a qualified

March 30, 2015

2nd Day Air, UPS 2nd Day Air A.M., UPS

profit-sharing plan that allows employees

Lines 2a, 2b, 2c, and 2d. Enter the plan

Worldwide Express Plus, and UPS

to contribute a portion of their wages to

sponsor’s name, address, the nine-digit

Worldwide Express.

individual accounts. The contributions go

employer identification number (EIN), the

into a 401(k) account, with the employee

Private delivery services should use the

plan sponsor’s telephone number, and the

often choosing the investments based on

following address.

six-digit business code. This information

options provided under the plan. In some

must be the same as reported in Part II,

plans, the employer also makes

Internal Revenue Service

lines 2a, 2b, 2c, and 2d of the Form 5500

contributions such as matching the

1973 Rulon White Blvd.

or Form 5500-SF. See the 2015

employee’s contributions up to a certain

Ogden, UT 84404

Instructions for Form 5500 or Form

percentage. SIMPLE and safe harbor

5500-SF.

401(k) plans have mandatory employer

Who Must Sign

Line 3a. Enter the name of trust. If a plan

contribution requirements.

uses more than one trust or custodial

The plan administrator or plan sponsor/

Line 4b. If line 4a is “Yes,” check the

employer must sign and date the paper

account for its fund, you should enter the

applicable testing method being used to

Form 5500-SUP for the 2015 filing.

primary trust or custodial account in which

satisfy the nondiscrimination requirements

the greatest dollar amount or largest

of section 401(k) and (m). A safe harbor

Penalties

percentage of the plan assets as of the

401(k) plan is similar to a traditional 401(k)

end of the plan year is held on this line.

If a filer fails to file the Form 5500-SUP

plan but, among other things, it must

For example, if a plan uses three different

when required to do so, the filer is deemed

provide for employer contributions that are

trusts, X, Y, and Z, with the percentages of

to have failed to file the return. Section

fully vested when made. These

plan assets, 35%, 45%, and 20%,

6652(e) imposes a penalty of $25 a day

contributions may be employer matching

respectively, trust Y that held the 45% of

(up to $15,000) for not filing returns in

contributions, limited to employees who

plan assets would be entered in line 4a.

connection with employee retirement

defer, or employer contributions made on

benefit plans by the required due date.

Line 3b. Enter the trust’s employer

behalf of all eligible employees, regardless

identification number (EIN) assigned to

of whether they make elective deferrals.

the employee benefit trust or custodial

The safe harbor 401(k) plan is not subject

Specific Instructions

account, if one has been issued to the

to the complex annual nondiscrimination

trust. The trust EIN should be used for

tests that apply to traditional 401(k) plans.

Part I – Annual Return

transactions conducted for the trust. If you

Check “Design-based safe harbor

Identification Information

do not have a trust EIN, enter the EIN you

method” if this is a safe harbor 401(k)

would use on Form 1099-R to report

plan, including a SIMPLE 401(k) plan

Line A. This information must be the

distributions from employee benefit plans

under sections 401(k)(11) and 401(m)

same as reported in Part I, B of the Form

and on Form 945 to report withheld

(10), a safe harbor 401(k) plan under

5500 or Form 5500-SF. See the 2015

amounts of income tax from those

sections 401(k)(12) and 401(m)(11), and a

Instructions for Form 5500 or 5500-SF.

payments.

safe harbor plan using automatic

contribution arrangements under sections

Line B. Enter the EFAST2

Do not use a social security number in

401(k)(13) and 401(m)(12). If the plan, by

Acknowledgement ID (30 characters). The

lieu of an EIN. Form 5500 and its

its terms, does not satisfy the safe harbor

Acknowledgement ID is a number created

attachments are open to public inspection,

method, it must satisfy the regular

by the EFAST2 system to acknowledge

and the contents are public information

nondiscrimination actual deferral

receipt of a filing that contains a unique

and are subject to publication on the

percentage (ADP)/actual contribution

Filing ID and filing data. The filing author

Internet. Because of privacy concerns, the

percentage (ACP) test.

received this ID when the Form 5500 or

inclusion of a social security number or

Form 5500-SF filing was submitted and

any portion thereof may result in the

Line 4c. If the ADP/ACP test was used to

processed through the EFAST2.

rejection of the filing.

satisfy nondiscrimination requirements

under section 401(k)(3), check “Yes” if an

A trust EIN can be obtained from the

Line C. This information must be the

election was made to use the current year

IRS by applying for one on Form SS-4,

same as reported in Part I, D of the Form

testing method under which the ADP test

Application for Employer Identification

5500 or Part I, C of the Form 5500-SF.

is performed by comparing the current

Number. See the instructions for line 2b

See the 2015 Instructions for Form 5500

plan year’s ADP for highly compensated

(Form 5500) for applying for an EIN. Also

or Form 5500-SF. Note that an extension

employees (HCEs) with the current plan

see the IRS EIN application link page for

of Form 5500 or Form 5500-SF will be

year’s (rather than the prior plan year)

further information.

treated as an extension of the Form

ADP for nonhighly compensated

5500-SUP. You are not required to file a

Lines 3c and 3d. Enter the name of the

employees (NHCEs). Note that the plan

separate Form 5558 for extension of time

trustee or custodian and the trustee’s or

must specify whether the prior year or the

to file this form.

custodian's telephone number.

current year testing method will be used in

the plan document.

Instructions for Form 5500-SUP

-2-

Instructions Draft For Form 5500-Sup - Annual Return Of Employee Benefit Plan Supplemental Information - 2015 Page 3

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