Form 14568-I - Model Vcp Compliance Statement Schedule 9 Limited Safe Harbor Correction By Plan Amendment Page 2

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Page 2

Plan name

EIN

Plan number

The resulting additional amount will be adjusted for earnings from the end of the plan year in which the failure

occurred through the date of the corrective contribution. The method for determining the earnings adjustment is as

follows (Attach additional pages as needed. Label the attachment “Section IA of Form 14568-I, Description of the

Proposed Method of Correction-Earnings” and include the plan name, Applicant’s EIN and plan number at the top of

each page).

Former employees affected by the failure (check one)

There are no former employees affected by the failure.

Affected former employees (or if deceased, their estate or known beneficiary) will be contacted and contributions

will be made to the plan on their behalf. To the extent that an affected former employee or beneficiary cannot be

located following a mailing to the last known address, the plan sponsor will take the actions specified below to

locate that employee or beneficiary.

After such actions are taken, if an affected employee or beneficiary is not found but is located at a later date, the

plan sponsor will make corrective contributions on behalf of the affected employee at that time.

B. Hardship Distribution Failure

Hardship distributions were made to participants under the plan even though the written terms of the plan did not

provide for any hardship distributions. All plan participants were entitled to request hardship distributions, and all

requests were evaluated in accordance with uniform eligibility standards, as described below.

14568-I

Catalog Number 66156F

Form

(Rev. 9-2017)

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