Form 14568-C - Model Vcp Compliance Statement Schedule 3 Seps And Sarseps Page 4
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Plan name
EIN
Plan number
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 corrective
contributions will be made to their SARSEP IRA. 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 to the affected SARSEP IRA at that time.
D. Failure to provide eligible employees with the opportunity to make elective deferrals (SARSEPs only)
The plan did not provide employees who satisfied the applicable eligibility requirements with the opportunity to
make elective deferrals to the SARSEP. The failure occurred for the following plan year(s)
Description of the Proposed Method of Correction
The plan sponsor has contributed (or will contribute) additional amounts to the plan on behalf of each affected
employee. The corrective contribution will be made to compensate the affected employee(s) for the missed deferral
opportunity. The corrective contribution on behalf of each affected employee is equal to 50% of what the employee’s
deferral might have been had he or she been provided with the opportunity to make elective deferrals to the plan.
Since the employee’s deferral decision is not known, the deferral amount is estimated by determining the average of
the deferral percentages for the employee’s group (highly compensated or nonhighly compensated). (Example: NHCE
N was erroneously excluded from the plan. During the year of exclusion, N made $10,000 in compensation. The
average of the deferral percentages for other NHCEs who were provided with the opportunity to make elective
deferrals was 5%. N’s missed deferral is estimated to be 5% times $10,000 or $500. The required corrective
contribution on behalf of N, before adjusting for earnings, is 50% of $500 or $250.)
The total corrective contribution (before adjusting for earnings) on behalf of the affected NHCEs for each plan year is
Year
Corrective Contribution
14568-C
Catalog Number 66147U
Form
(Rev. 9-2017)
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