5
Form 5300 (Rev. 12-2013)
Page
4a
Name of plan (plan name cannot exceed 70 characters, including spaces):
b
c
Enter 3-digit plan number
Enter the month on which the plan year ends (MM)
d
Enter plan’s original
e
Enter number of participants
effective date
If 100 or less, complete line 4f. Otherwise, go to line 5a.
Yes
No
Does the plan sponsor have no more than 100 employees who received at least $5,000 of compensation for
f
the preceding year?
If “Yes,” go to line 4g.
If “No,” go to line 5a.
g
Is at least one employee a non highly compensated employee?
5a
Indicate the type of plan by entering the number from the list below.
(Use the lowest number from the list below applicable to the plan.)
1 – Pension Equity Plan (PEP)
5 – ESOP
9 – 401(k)
2 – cash balance conversion
6 – money purchase
10 – profit sharing plan
3 – cash balance (not converted)
7 – target benefit
4 – defined benefit but not cash balance
8 – stock bonus
Yes
No
If the response to 5a was “1,” “2,” “3,” “4,” “6,” or “7,” was the plan’s normal retirement age below 62 any time
b (1)
after 5/22/07?
If “Yes,” go to line 5b(2).
If “No,” go to line 5c(1).
Has the employer (or trustees, if this is a multiemployer plan) made a good faith determination that the plan’s
(2)
normal retirement age is not lower than an age that reasonably represents the typical retirement age for the
industry in which the covered workforce is employed? If “Yes,” attach required statement. Governmental plans
see instructions.
c (1)
If the response to 5a was “5,” mark the box to indicate whether the plan sponsor is an S Corporation or a C Corporation.
C Corp.
S Corp.
If there has been a change to the corporate status from C to S or S to C (election/revocation), provide
(2)
the effective date of such change.
Yes
No
Is the plan sponsor a member of an ASG, controlled group of corporations, or a group of trades or businesses
6a (1)
under common control within the meaning of section 414(b) or (c)?
If “Yes,” attach the required statement.
Is the plan sponsor a foreign entity or is the plan sponsor a member of an ASG, controlled group of
(2)
corporations, or a group of trades or businesses under common control within the meaning of section 414(b)
or (c) that includes a foreign entity?
b
Is this a governmental plan under section 414(d)?
c (1)
Is this a church plan under section 414(e)?
If “Yes,” go to line 6c(2).
If “No,” go to line 6d.
5300
Form
(Rev. 12-2013)
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