Form 14568-B - Model Vcp Compliance Statement Schedule 2 Other Nonamender Failures And Failure To Adopt A 403(B) Plan Timely Page 2

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Plan name
EIN
Plan number
Other (specify the late amender failure not listed above) (Attach additional pages as needed. Label the attachment
“Section 1A of Form 14568-B, Identification of Other Nonamender Failures” and include the plan name, Applicant’s
EIN and plan number at the top of each page.):
B. 403(b) Plans:
The plan sponsor did not timely adopt a written plan as required by the final IRC Section 403(b) regulations and
Notice 2009-3.
Section II - Description of Proposed Method of Correction
A. Qualified Plan. The Applicant (or the plan sponsor) adopted amendments that satisfy the requirements of all the
items checked in Section IA of this Form 14568-B, retroactively to the effective dates of the specific provisions
contained in the amendments. Copies of the signed and dated amendments and restated plan documents (where
applicable) are enclosed with this VCP submission.
B. 403(b) Plan. Failure to adopt a written plan timely. The Applicant (or the plan sponsor) adopted a written plan
retroactive to the later of the effective date of the final 403(b) regulations or the initial effective date of the plan. A copy
of the signed and dated 403(b) plan is enclosed with this VCP submission.
Section III - Change in Administrative Procedures
The Applicant indicated the plan sponsor 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
enclosed the following documents, as appropriate, with this VCP submission:
● Copies of all signed and dated amendments used to correct the failures,
● A copy of the plan document in effect prior to any of the amendments used to correct the failures,
● A copy of the most recent determination letter issued with respect to the plan (if applicable),
● For 403(b) plans, a copy of the signed and dated written 403(b) plan.
14568-B
Catalog Number 66146J
Form
(Rev. 9-2017)

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