Form 5330 - Return Of Excise Taxes Related To Employee Benefit Plans Page 3
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63
Form 5330 (Rev. 12-2013)
Page
Name of Filer:
Filer’s identifying number:
Schedule A. Tax on Nondeductible Employer Contributions to Qualified Employer Plans (Section 4972)
Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file
the return)
Total contributions for your tax year to your qualified employer plan (under section 401(a),
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403(a), 408(k), or 408(p)) .
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Amount allowable as a deduction under section 404
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Subtract line 2 from line 1
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Enter amount of any prior year nondeductible contributions made for
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years beginning after 12/31/86 .
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Amount of any prior year nondeductible contributions for years beginning
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after 12/31/86 returned to you in this tax year for any prior tax year .
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Subtract line 5 from line 4
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6
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Amount of line 6 carried forward and deductible in this tax year .
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Subtract line 7 from line 6
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Tentative taxable excess contributions. Add lines 3 and 8 .
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Nondeductible section 4972(c)(6) or (7) contributions exempt from excise tax
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Taxable excess contributions. Subtract line 10 from line 9 .
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Multiply line 11 by 10%. Enter here and on Part I, line 1
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Schedule B. Tax on Excess Contributions to Section 403(b)(7)(A) Custodial Accounts (Section 4973(a)(3))
Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file
the return)
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Total amount contributed for current year less rollovers (see instructions) .
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Amount excludable from gross income under section 403(b) (see instructions) .
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Current year excess contributions. Subtract line 2 from line 1. If zero or less, enter -0-
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Prior year excess contributions not previously eliminated. If zero, go to line 8
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Contribution credit. If line 2 is more than line 1, enter the excess; otherwise, enter -0- .
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Total of all prior years’ distributions out of the account included in your gross income under
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section 72(e) and not previously used to reduce excess contributions .
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Adjusted prior years’ excess contributions. Subtract the total of lines 5 and 6 from line 4
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Taxable excess contributions. Add lines 3 and 7 .
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Multiply line 8 by 6% .
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Enter the value of your account as of the last day of the year .
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Multiply line 10 by 6%
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Excess contributions tax. Enter the lesser of line 9 or line 11 here and on Part I, line 2 .
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5330
Form
(Rev. 12-2013)
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