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Form 5300 (Rev. 12-2013)
Page
Yes
No
16a
Does the plan sponsor maintain any other qualified plans under section 401(a)?
If “Yes,” attach required statement and complete lines 16b and 16c.
If “No,” go to line 17.
Does the plan sponsor maintain another plan of the same type (for example, both this plan and the other plan
b (1)
are DC plans or both are DB plans) that covers non-key employees who are also covered under this plan?
If “No,” go to line 16c(1).
If “Yes,” when the plan is top-heavy, do non-key employees covered under both plans receive the top-
heavy minimum contribution or benefit under:
(2)
This plan, or
(3)
The other plan?
If this is a DC plan, does the plan sponsor maintain a DB plan (or if this is a DB plan, does the plan
c (1)
sponsor maintain a DC plan) that covers non-key employees who are also covered under this plan?
If “No,” go to line 17.
If “Yes,” when the plan is top-heavy, do non-key employees covered under both plans receive:
(2)
The top-heavy minimum benefit under the DB plan,
(3)
At least a 5% minimum contribution under the DC plan,
(4)
The minimum benefit offset by benefits provided by the DC plan, or
(5)
Benefits under both plans, using a comparability analysis, at least equal to the minimum benefit.
17
Does any amendment to this plan reduce or eliminate any section 411(d)(6) protected benefit?
If “Yes,” attach the required statement.
Yes
No
NA
If this is a DC plan, are trust earnings and losses allocated on the basis of
18
account balances?
If “No,” attach a statement explaining how they are allocated.
Yes
No
Is any issue involving this plan currently pending or has any issue related to this plan been resolved during
19
the current RAC by:
(1) Internal Revenue Service,
(2) Department of Labor,
(3) PBGC,
(4) Any court (including bankruptcy), or
(5) The Voluntary Correction Program of the Employee Plans Compliance Resolution System.
If “Yes,” attach a statement with the contact person’s name (IRS Agent, DOL Investigator, etc.)
and telephone number.
5300
Form
(Rev. 12-2013)
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