Fillable Form 5500 - Annual Return/report Of Employee Benefit Plan

Form 5500 (1998)

Page

Welfare Plans Do Not Complete Lines 15 Through 24. Go To Line 25 On Page 4.

Yes

15a

If this is a defined benefit plan subject to the minimum funding standards for this plan year, is Schedule B (Form 5500)

15a

required to be attached? (If this is a defined contribution plan leave blank.)

If this is a defined contribution plan (i.e., money purchase or target benefit), is it subject to the minimum funding standards?

(If a waiver was granted, see instructions.) (If this is a defined benefit plan, leave blank.)

If ‘‘Yes,’’ complete (1), (2), and (3) below:

b(1) $

(1)

Amount of employer contribution required for the plan year under Code section 412

b(2) $

(2)

Amount of contribution paid by the employer for the plan year

Enter date of last payment by employer

Month

Day

Year

(3)

If (1) is greater than (2), subtract (2) from (1) and enter the funding deficiency here;

otherwise, enter -0-. (If you have a funding deficiency, file Form 5330.)

b(3) $

Has the annual compensation of each participant taken into account under the current plan year been limited as required

by section 401(a)(17)? (See instructions.)

a(1)

17a

(1)

Did the plan distribute any annuity contracts this year? (See instructions.)

(2)

If (1) is “Yes,” did these contracts contain a requirement that the spouse consent before any distributions under

a(2)

the contract are made in a form other than a qualified joint and survivor annuity?

Did the plan make distributions or loans to married participants and beneficiaries without the required consent of the

participant’s spouse?

Upon plan amendment or termination, do the accrued benefits of every participant include the subsidized benefits that

the participant may become entitled to receive subsequent to the plan amendment or termination?

Is the plan administrator making an election under section 412(c)(8) for an amendment adopted after the end of the plan

year? (See instructions.)

If a change in the actuarial funding method was made for the plan year pursuant to a Revenue Procedure providing

automatic approval for the change, indicate whether the plan sponsor agrees to the change

Is the employer electing to compute minimum funding for the plan year using the Transition rule of Code section 412(l)(11)?

Check if you are applying the substantiation guidelines from Revenue Procedure 93-42, in completing lines 21a

through 21o (see instructions)

If you checked the box, enter the first day of the plan year for which data is being submitted

Month

Day

Year

Does the employer apply the separate line of business rules of Code section 414(r) when testing this plan for the coverage

21a

and discrimination tests of Code sections 410(b) and 401(a)(4)?

If line 21a is “Yes,” enter the total number of separate lines of business claimed by the employer

If more than one separate line of business, see instructions for additional information to attach.

Does the employer apply the mandatory disaggregation rules under Income Tax Regulations section 1.410(b)-7(c)?

If “Yes,” see instructions for additional information to attach.

In testing whether this plan satisfies the coverage and discrimination tests of Code sections 410(b) and 401(a), does the

employer aggregate plans?

Does the employer restructure the plan into component plans to satisfy the coverage and discrimination tests of Code

sections 410(b) and 401(a)(4)?

If you meet either of the following exceptions, check the applicable box to tell us which exception you meet and do

NOT complete the rest of question 21:

No highly compensated employee benefited under the plan at any time during the plan year;

(1)

(2)

This is a collectively bargained plan that benefits only collectively bargained employees, no more than 2%

of whom are professional employees.

Did any leased employee perform services for the employer at any time during the plan year?

Number

Enter the total number of employees of the employer. Employer includes entities aggregated with the employer under

Code section 414(b), (c), or (m). Include leased employees and self-employed individuals

Enter the total number of employees excludable because of: (1) failure to meet requirements for minimum age and years

of service; (2) collectively bargained employees; (3) nonresident aliens who receive no earned income from U.S. sources;

and (4) 500 hours of service/last day rule

Enter the number of nonexcludable employees. Subtract line 21i from line 21h

k Do 100% of the nonexcludable employees entered on line 21j benefit under the plan?

Yes

If line 21k is “Yes,” do NOT complete lines 21l through 21o.

Enter the number of nonexcludable employees (line 21j) who are highly compensated employees

Enter the number of nonexcludable employees (line 21j) who benefit under the plan

Enter the number of employees entered on line 21m who are highly compensated employees

o This plan satisfies the coverage requirements on the basis of (check one):

(1)

The average benefits test

(2)

The ratio percentage test—Enter percentage

Form 5500 - Annual Return/report Of Employee Benefit Plan - 1998 Page 3

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