Form 5500 Schedule A Instructions - Insurance Information - 2016 Page 3

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defined contribution plan that does not include substantial
Part IV – Provision of Information
restrictions to participants’ access to plan funds.
The insurance company, insurance service, or other similar
Important Reminder. Plans may treat multiple individual
organization is required under ERISA section 103(a)(2) to
annuity contracts, including Code section 403(b)(1) annuity
provide the plan administrator with the information needed to
contracts, issued by the same insurance company as a single
complete this return/report. If you do not receive this
group contract for reporting purposes on Schedule A.
information in a timely manner, contact the insurance
company, insurance service, or other similar organization.
Line 6a. The rate information called for here may be furnished
by attaching the appropriate schedules of current rates filed
Lines 11 and 12. If information is missing on Schedule A due
with the appropriate state insurance department or by
to a refusal by the insurance company, insurance service, or
providing a statement regarding the basis of the rates. Enter
other similar organization to provide information, check “Yes”
“see attached” if appropriate.
on line 11 and enter a description of the information not
provided on line 12. If you received all the information
Lines 7a through 7f. Report contracts with unallocated funds.
necessary to receive the Schedule A, check “No” and leave
Do not include portions of these contracts maintained in
line 12 blank.
separate accounts. Show deposit fund amounts rather than
experience credit records when both are maintained.
As noted above, the insurance company, insurance
service, or other similar organization is statutorily
Part III – Welfare Benefit Contract Information
required to provide you with all of the information
Line 8i. Report a stop-loss insurance policy that is an asset of
necessary to complete the Schedule A, but need not provide
the plan.
the information on a Schedule A itself.
Note. Employers sponsoring welfare plans may purchase a
stop-loss insurance policy with the employer as the insured to
help the employer manage its risk associated with its liabilities
under the plan. These employer contracts with premiums paid
exclusively out of the employer’s general assets without any
employee contributions generally are not plan assets and are
not reportable on Schedule A.
Instructions for Schedule A (Form 5500)
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