6
Form 5300 (Rev. 12-2013)
Page
(Line 6 continued)
Yes
No
Was an election made by the church to have participation, vesting, funding, etc. provisions apply in
(2)
accordance with section 410(d)?
d
Does this plan benefit any collectively bargained employees under Regulations section 1.410(b)-6(d)(2)?
e
Is this an insurance contract plan under section 412(e)(3)?
f
Is this a multiemployer plan under section 414(f)?
g
Is this a request for a ruling under section 401(h)?
h
Is this a request for ruling under section 420?
i (1)
Is this a multiple employer plan under section 413(c)?
If “Yes,” complete lines 6i(2) through 6i(5).
If “No,” go to line 7.
(2)
Enter the total number of participating employers.
(3)
Enter the number of participating employers submitting a Form 5300 concurrent with this application.
(4)
Enter the EIN of the employer submitting the controlling plan.
(5)
Enter the 3-digit plan number of the controlling plan.
7
Have interested parties been given the required notification of this application?
8
Is a separate DL application for this plan currently pending before the IRS?
Does this plan satisfy one of the design-based safe harbor requirements for contributions or benefits
9a
under Regulations section 1.401(a)(4)-2(b) or 3(b)?
If “Yes,” go to line 9b.
If “No,” go to line 10a.
Yes
No
b
Is this an election for a determination regarding a design-based safe harbor?
If “Yes,” complete lines 9c through 9e.
If “No,” go to line 10a.
c
Enter the letter (“A” - “E”) from the list below that identifies the safe harbor intended to be satisfied.
A = 1.401(a)(4)-2(b)(2) defined contribution (DC) plan with uniform allocation formula
B = 1.401(a)(4)-3(b)(3) unit credit defined benefit (DB) plan
C = 1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit DB fractional rule plan
D = 1.401(a)(4)-3(b)(4)(i)(C)(2) flat benefit DB plan
E = 1.401(a)(4)-3(b)(5) insurance contract plan
Does this plan satisfy one of the safe harbor definitions of compensation under Regulation sections
d
1.414(s)-1(c)(2) or (3)?
5300
Form
(Rev. 12-2013)
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