Pbgc Form 500 - Schedule Ea-S - Standard Termination Certification Of Sufficiency printable pdf download

Pbgc Form 500 - Schedule Ea-S - Standard Termination Certification Of Sufficiency

Schedule EA-S

z z

(PBGC Form 500)

Approved OMB 1212-0036

Expires 12/31/2000

Standard Termination

Certification of Sufficiency

Plan name

9 digit EIN

3 digit PN

PART I. CODE SECTION 412(i) PLANS

Is this plan a Code section 412(i) plan?

YES

If "No", the enrolled actuary must complete Part II and Part III. Do NOT complete item 2 or Part IV.

If "Yes", item 2 below and all of Part II must be completed, and either Part III or Part IV must be

completed and signed by the plan administrator or enrolled actuary, as appropriate.

Enter name (full official name of record) and address of the insurer

Name

Full Address

City

State

Zip Code

Telephone

Area Code

PART II. PLAN SUFFICIENCY

Proposed distribution date

MM/DD/YYYY

Is the value of plan assets projected to be sufficient as

YES

of the proposed distribution date to provide all plan

benefits? If "NO", the plan cannot terminate in a

standard termination.

Estimated value of plan assets as of the proposed

distribution date

Estimated value of plan benefits as of the proposed

distribution date

Estimated total amount of residual assets

Estimated amount of residual assets to be

distributed to the employer

Pbgc Form 500 - Schedule Ea-S - Standard Termination Certification Of Sufficiency