Form 14568-C - Model Vcp Compliance Statement Schedule 3 Seps And Sarseps Page 5

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Page 5
Plan name
EIN
Plan number
The corrective contribution made on behalf of each affected employee will also be adjusted for earnings. Earnings will
be calculated from the date(s) that the contribution(s) should have been made through the date of the corrective
contribution. The corrective contribution (adjusted for earnings) will be made to each affected employee’s SARSEP
IRA. If an affected employee does not have a SARSEP IRA, a SARSEP IRA will be established for that employee.
Earnings will be calculated on the basis of one of the following methods (check one)
Actual investment results of the affected employee’s SARSEP IRA.
The interest rate incorporated in the VFCP Online Calculator, since the actual earnings of the affected employee’s
IRA cannot be ascertained.
Actual investment results for years in which data is available, or the rate incorporated in the VFCP Online
Calculator for years in which the actual earnings of the affected employee’s IRA cannot be ascertained. The
VFCP Online Calculator was or will be used for the following year(s)
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.
E. Excess Amounts Contributed
The plan sponsor contributed excess amounts to the plan on behalf of participants as follows (check boxes that apply)
Amounts were contributed in excess of the benefit the participants were entitled to under the plan.
SARSEP only: Elective deferrals were contributed to the SARSEP in excess of the limitation under the terms of
the SARSEP (such as, the lesser of 25% of compensation or the applicable limit under IRC Section 402(g)).
The total of the excess amounts for each affected plan year was
Year
Excess Amounts
Number of Participants Affected
Excess amounts of $100 or less.
For one or more participants, the total excess amount (employer contributions and/or elective deferrals before
adjusting for earnings) is $100 or less. The excess amount will not be distributed.
14568-C
Catalog Number 66147U
Form
(Rev. 9-2017)

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