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See the instructions for Form 990-T for

Line 5a. Check the applicable testing

Line 6a. Check “Yes” if a plan has timely

more details.

method below used to satisfy the

adopted the amendments for all required

DRAFT AS OF

minimum coverage requirements under

tax law changes. Check “N/A” if it is a

Line 9. Plans that check “Yes” must

section 410(b). A plan satisfies the “ratio

newly established plan. In order to be a

enter amounts of any distributions made

percentage test” of section 410(b)(1)(B)

qualified plan and to retain tax

prior to attainment of retirement, death,

with respect to employees if the

advantages, a pension plan must be

disability, and severance of employment

percentage of the employer’s NHCEs who

timely amended for all required tax law

or termination of the plan. These amounts

benefit under the plan divided by the

changes and operate in accordance with

would include any distribution allowed

percentage of HCEs who benefit under

the plan document. The IRS generally

under a profit sharing plan after a fixed

March 30, 2015

the plan is at least 70% (percentages are

establishes a deadline by which plan

number of years. See Regulations section

calculated to the nearest hundredth). For

amendments that reflect tax law changes

1.401-1(b)(1)(ii). This includes any

example, if Employer Y has 100

must be adopted. See

Rev. Proc.

hardship distributions under section

employees, of which 30 are HCEs and 70

2007-44, 2007-28 I.R.B.

54, for more

401(k)(2)(B)(i)(IV) or any distribution

are NHCEs, and Employer Y maintains a

information.

allowed under the terms of the plan upon

pension Plan A that benefits 15 of the 30

attainment of age 62 under a money

Line 6b. Enter the date of the last plan

HCEs (that is, 50% of the HCEs) and 25 of

purchase plan or defined benefit plan for

amendment or restatement for the

the 70 NHCEs (that is, 35.71% of all

plan years beginning after December 31,

required law changes, and enter the

NHCEs), then the ratio percentage of

2006.

applicable Code indicating the law

71.42% (35.71% / 50%) is greater than

changes below.

Preparer Information

70%. Thus, Plan A satisfies the minimum

coverage requirement as required under

Enter the preparer’s name (including the

section 410(b)(1). The average benefit

Tax Law

Code

firm’s name, if applicable), address, and

test is a two-part test. First, the plan must

telephone number of the Form 5500 or

Pension Protection Act

satisfy the nondiscriminatory classification

of 2006 (PPA 06)

Form 5500-SF related to this filing. A

test. Second, the plan must satisfy the

preparer is any person who prepares an

Economic Growth and

average benefit percentage test. See

annual return/report for compensation, or

Tax Relief

Regulations sections 1.410(b)-4 and

who employs one or more persons to

Reconciliation Act of

1.410(b)-5 for more information.

2001 (EGTRRA)

prepare the return for compensation. If the

person who prepared the annual return/

Note. (1) If this is not a tax-qualified plan,

GATT, USERRA,

report is not the plan sponsor or employer

you may skip questions 5a and 5b. (2)

SBJPA, and TRA

named in line 2a, or the plan administrator

(GUST)

Under a special rule in Regulations

named in line 3a (of Form 5500 or Form

section 1.410(b)-2(b)(5), if the employer

5500-SF), name the person on this line. If

has no NHCEs, the plan will be deemed to

there are several people who prepared

satisfy the coverage tests of section

Line 6c. If a plan sponsor or an employer

this form, please name the person who is

410(b). Also, under Regulations section

adopted a pre-approved plan that includes

primarily responsible for the preparation of

a master and prototype plan (M&P), or a

1.410(b)-2(b)(6), if no HCEs benefit under

the annual return/report.

the plan, the minimum coverage

volume submitter plan, enter the date of

requirements under section 410(b) will be

opinion or advisory letter issued by the

Privacy Act and Paperwork Reduction

deemed satisfied. Also, under Regulations

IRS and the corresponding serial number

Act Notice. We ask for the information on

section 1.410(b)-2(b)(7), the minimum

listed on that favorable letter.

this form to carry out the Internal Revenue

coverage requirements under section

Line 6d. If the plan is an individually

laws of the United States. This form is

410(b) are also satisfied if the plan

designed plan and received a favorable

required to be filed under section 6058(a).

benefits solely collectively bargained

determination letter from the IRS, enter the

Section 6109 requires you to provide your

employees. See Regulations sections

date of the most recent determination

identification number. If you fail to provide

1.410(b)-2(b)(5), (6) and 1.410(b)-8(b).

letter. Leave this line blank if this individual

this information in a timely manner or if

Line 5b. Check “Yes” if this plan was

designed plan never received a favorable

you provide false or fraudulent

permissively aggregated with another plan

determination letter.

information, you may be subject to

to satisfy the requirements under sections

penalties. Section 6104(b) makes the

Line 7. Check “Yes” if a plan is in a U.S.

410(b) and 401(a)(4). Generally, each

information contained in this form publicly

territory, including Puerto Rico (if no

single plan must separately satisfy the

available. Therefore, the information will

election under ERISA section 1022(i)(2)

coverage and nondiscrimination

be given to anyone who asks for it and

has been made), American Samoa,

requirements. However, an employer may

may be given to the PBGC for the

Guam, the Commonwealth of the Northern

designate two or more separate plans as a

administration of ERISA, the Department

Mariana Islands, or the U.S. Virgin Islands.

single plan for purposes of applying the

of Justice for civil and criminal litigation,

Line 8. Plans that check “Yes” must

ratio percentage test of Regulations

and cities, states, the District of Columbia,

section 1.410(b)-2(b)(2) or the

enter any amount of unrelated business

and U.S. commonwealths and

nondiscretionary classification test of

taxable income as a result of gross

possessions for use in administering their

income derived from any trade or

Regulations section 1.401(b)-4. Two or

tax laws. The IRS may also disclose this

business regularly carried on and not

more plans that are permissively

information to other countries under a

substantially related to the plan’s exempt

aggregated and treated as a single plan

treaty, to federal and state agencies to

for purposes of the minimum coverage

purpose under section 512. Form 990-T,

enforce federal non-tax criminal laws, and

test of section 410(b) must also be treated

Exempt Organization Business Income

to federal law enforcement and

Tax Return, is required for any gross

as a single plan for purpose of the

intelligence agencies to combat terrorism.

income of $1,000 or more generated by an

nondiscrimination test under section

You are not required to provide the

401(a)(4). See Regulations sections

employee’s trust. Form 990-T must be

information requested on a form that is

1.410(b)-7 and 1.401(a)(4)-(9) for more

filed by the 15th day of the 4th month

subject to the Paperwork Reduction Act

information.

following the end of the trust’s tax year.

unless the form displays a valid OMB

Instructions for Form 5500-SUP

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Instructions Draft For Form 5500-Sup - Annual Return Of Employee Benefit Plan Supplemental Information - 2015 Page 4

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