Form 14568-E - Model Vcp Compliance Statement Schedule 5 Plan Loan Failures (Qualified Plans And 403(B) Plans) Page 4

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Page 4
Plan name
EIN
Plan number
B. Correction for loans with terms that: (i) provided for a repayment period that exceeded the period permitted
under IRC Section 72(p)(2)(B) and/or (ii) provided for payments that did not provide for substantially level
amortization with payments not less frequently than quarterly, as provided under IRC Section 72(p)(2)(C):
(check the box that applies)
1. The loan balance will be reamortized with payments made on a substantially level basis (per IRC Section
72(p)(2)(C)), made at least quarterly.
2. The reamortized loan balance will be paid over a remaining period that does not extend beyond five years
from the date of the original loan. If original loan was a home loan described in IRC Section 72(p)(2)(B)(ii)
the reamortized loan balance will be paid over the remaining period of the original loan (per IRC Section
72(p)(2)(B)).
C. Correction for defaulted loans with terms that complied with the requirements of IRC Sections 72(p)(2)(A), (B)
and (C): (check the box that applies)
1. A lump sum repayment will be made to the plan in an amount equal to the additional repayments that the
affected participant would have made to the plan if there had been no failure to repay the plan, plus interest
accrued on the missed repayments.
2. The outstanding balance of the loan, including accrued interest, will be reamortized over a remaining period
that does not extend beyond five years from the date of the original loan. If the original loan was a home loan
described in IRC Section 72(p)(2)(B)(ii) the reamortized loan balance will be paid over the remaining period of
the original loan.
3. The Applicant will use a combination of the methods described in #1 and #2 above, as follows:
Determination of Interest Accrued on Missed Repayments (check the box that applies)
{insert rate}
Plan loan rate
{insert rate}
Rate of return of investments under plan
Note: This option may only be used if the rate of investment return under the plan equals or exceeds the plan loan
rate.
The interest rate for missed payments was determined as follows:
The additional unpaid interest (
will be
has been
(check one)) paid by the: (check the box that applies)
Plan sponsor
Affected participants
(Note: Irrespective of the plan sponsor’s election to have the affected participants pay the unpaid interest, the IRS
may, based on the facts and circumstances, determine that the plan sponsor should pay all or a portion of the
additional unpaid interest. If the IRS makes this determination, the plan sponsor will be requested to revise this
submission.)
14568-E
Catalog Number 66149Q
Form
(Rev. 9-2017)

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