Form 14568-A - Model Vcp Compliance Statement - Schedule 1: Interim Nonamender Failures Page 2
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Plan name
EIN
Plan number
(3) The Applicant has indicated that the plan sponsor did not timely adopt amendments for the following:
(List each statutory, regulatory, or other requirement for which the Plan was not timely amended, and specify for each
such requirement the published cumulative list in which such requirement appears and the location of the corrective
amendment in the documents included with the VCP submission (for example, by amendment number and paragraph
number, or in the case of a restated plan, by page and section number). Do not use a general statement referring only
to a cumulative list or statute. For instance, the following description would not be acceptable: “All interim amendments
associated with the 20XX cumulative list [or the Pension Protection Act of 2006 (PPA)] were not timely adopted.”)
(Attach additional pages as needed. Label the attachment “Form 14568-A, Section 1(3) Identification of Interim
Nonamender Failures” and include the plan name, Applicant’s EIN and plan number on each page.)
Section II - Description of Proposed Method of Correction
The plan sponsor has adopted amendments reflecting the items listed in Section I (3) of this Schedule 1. These
amendments are effective retroactive to the effective dates of the specific provisions contained in the amendments. The
signed and dated amendments have been enclosed with this VCP submission.
Section III - Change in Administrative Procedures
The Applicant has taken (or will take) the following step(s) to ensure that the failure(s) will not recur:
Section IV - Enclosures
In addition to the applicable items listed on the Procedural Requirements Checklist for Form 8950, the plan sponsor
encloses copies of the signed and dated amendments used to correct the failure(s) identified in Section I (3) of this
Schedule 1 with this VCP submission.
14568-A
Catalog Number 66144N
Form
(Rev. 8-2016)
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