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

Form 5500 (1998)

Page

Yes

Welfare Plans Go To Line 25 On This Page.

22a

22a Is it or was it ever intended that this plan qualify under Code section 401(a)? If “Yes,” complete lines 22b and 22c

Enter the date of the most recent IRS determination letter

Month

Year

c Is a determination letter request pending with the IRS?

23a Does the plan hold any assets that have a fair market value that is not readily determinable on an established market?

23a

(If “Yes,” complete line 23b) (See instructions)

b Were all the assets referred to in line 23a valued for the 1998 plan year by an independent third-party appraiser?

If line 23b is “No,” enter the value of the assets that were not valued by an independent third-party appraiser for the

1998 plan year.

d Enter the most recent date the assets on line 23c were valued by an independent third-party appraiser. (If more than

one asset, see instructions.)

Month

Day

Year

(If this plan does not have ESOP features leave line 23e blank and go to line 24.)

e If dividends paid on employer securities held by the ESOP were used to make payments

on ESOP loans, enter the amount of the dividends used to make the payments

23e

Does the employer/sponsor listed on line 1a of this form maintain other qualified pension benefit plans?

If “Yes,” enter the total number of plans, including this plan

25a

Did any person who rendered services to the plan receive directly or indirectly $5,000 or more in compensation from

25a

the plan during the plan year (except for employees of the plan who were paid less than $1,000 in each month)?

If “Yes,” complete Part I of Schedule C (Form 5500).

Did the plan have any trustees who must be listed in Part II of Schedule C (Form 5500)?

Has there been a termination in the appointment of any person listed on line 25d below?

If line 25c is “Yes,” check the appropriate box(es), answer lines 25e and 25f, and complete Part III of Schedule C (Form 5500):

(1)

Accountant

(2)

Enrolled actuary

(3)

Insurance carrier

(4)

Custodian

(5)

Administrator

(6)

Investment manager

(7)

Trustee

e Have there been any outstanding material disputes or matters of disagreement concerning the above termination?

If an accountant or enrolled actuary has been terminated during the plan year, has the terminated accountant/actuary

been provided a copy of the explanation required by Part III of Schedule C (Form 5500) with a notice advising them of

their opportunity to submit comments on the explanation directly to the DOL?

Enter the number of Schedules C (Form 5500) that are attached. If none, enter -0-

26a

Is this plan exempt from the requirement to engage an independent qualified public accountant? (see instructions)

If line 26a is “No,” attach the accountant’s opinion to this return/report and check the appropriate box. This opinion is:

(1)

Unqualified

(2)

Qualified/disclaimer per Department of Labor Regulations 29 CFR 2520.103-8 and/or 2520.103-12(d)

(3)

Qualified/disclaimer other

(4)

Adverse

(5)

Other (explain)

If line 26a is “No,” does the accountant’s report, including the financial statements and/or notes required to be attached to this

return/report disclose (1) errors or irregularities; (2) illegal acts; (3) material internal control weaknesses; (4) a loss contingency indicating

that assets are impaired or a liability incurred; (5) significant real estate or other transactions in which the plan and (A) the sponsor,

(B) the plan administrator, (C) the employer(s), or (D) the employee organization(s) are jointly involved; (6) that the plan has participated

in any related party transactions; or (7) any unusual or infrequent events or transactions occurring subsequent to the plan year end

that might significantly affect the usefulness of the financial statements in assessing the plan’s present or future ability to pay benefits?

If line 26c is “Yes,” provide the total amount involved in such disclosure

If line 26a is “No,” complete the following questions. (You may NOT use “N/A” in response to lines 27a through 27i):

If line 27a, 27b, 27c, 27d, 27e, or 27f is checked “Yes,” schedules of these items in the format set forth in the instructions

are required to be attached to this return/report. Schedule G (Form 5500) may be used as specified in the instructions.

During the plan year:

27a

Did the plan have assets held for investment?

b Were any loans by the plan or fixed income obligations due the plan in default as of the close of the plan year or classified

during the year as uncollectible?

c Were any leases to which the plan was a party in default or classified during the year as uncollectible?

d Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets?

e Do the notes to the financial statements accompanying the accountant’s opinion disclose any nonexempt transactions

with parties-in-interest?

Did the plan engage in any nonexempt transactions with parties-in-interest not reported on line 27e?

g Did the plan hold qualifying employer securities that are not publicly traded?

h Did the plan purchase or receive any nonpublicly traded securities that were not appraised in writing by an unrelated

third party within 3 months prior to their receipt?

Did any person manage plan assets who had a financial interest worth more than 10% in any party providing services

to the plan or receive anything of value from any party providing services to the plan?

Form 5500 - Annual Return/report Of Employee Benefit Plan - 1998 Page 4

Related Articles

Related forms

Related Categories