Schedule I (Form 5500) - Financial Information-Small Plan - 2016
Download a blank fillable Schedule I (Form 5500) - Financial Information-Small Plan - 2016 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Schedule I (Form 5500) - Financial Information-Small Plan - 2016 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
001
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
67
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
OMB No. 1210-0110
SCHEDULE I
Financial Information—Small Plan
(Form 5500)
2016
This schedule is required to be filed under section 104 of the Employee
Department of the Treasury
Retirement Income Security Act of 1974 (ERISA), and section 6058(a) of the
Internal Revenue Service
This Form is Open to Public
Internal Revenue Code (the Code).
Department of Labor
Inspection
Employee Benefits Security Administration
File as an attachment to Form 5500.
Pension Benefit Guaranty Corporation
For calendar plan year 2016 or fiscal plan year beginning
and ending
A
B
Name of plan
Three-digit
plan number (PN)
C
Plan sponsor’s name as shown on line 2a of Form 5500
D
Employer Identification Number (EIN)
Complete Schedule I if the plan covered fewer than 100 participants as of the beginning of the plan year. You may also complete Schedule I if you are filing as a
small plan under the 80-120 participant rule (see instructions). Complete Schedule H if reporting as a large plan or DFE.
Part I
Small Plan Financial Information
Report below the current value of assets and liabilities, income, expenses, transfers and changes in net assets during the plan year. Combine the value of plan
assets held in more than one trust. Do not enter the value of the portion of an insurance contract that guarantees during this plan year to pay a specific dollar
benefit at a future date. Include all income and expenses of the plan including any trust(s) or separately maintained fund(s) and any payments/receipts to/from
insurance carriers. Round off amounts to the nearest dollar.
1
Plan Assets and Liabilities:
(a) Beginning of Year
(b) End of Year
a
Total plan assets .........................................................................................
1a
b
Total plan liabilities ......................................................................................
1b
c
1c
Net plan assets (subtract line 1b from line 1a) ................................ .............
2
Income, Expenses, and Transfers for this Plan Year:
(a) Amount
(b) Total
a
Contributions received or receivable:
(1) Employers............................................................................................
2a(1)
(2) Participants ..........................................................................................
2a(2)
(3) Others (including rollovers) ................................................................ ..
2a(3)
b
Noncash contributions .................................................................................
2b
c
Other income ...............................................................................................
2c
d
Total income (add lines 2a(1), 2a(2), 2a(3), 2b, and 2c) ..............................
2d
e
Benefits paid (including direct rollovers) ......................................................
2e
f
Corrective distributions (see instructions) ....................................................
2f
g
Certain deemed distributions of participant loans
(see instructions) .........................................................................................
2g
h
Administrative service providers (salaries, fees, and
commissions) ..............................................................................................
2h
i
Other expenses ...........................................................................................
2i
j
Total expenses (add lines 2e, 2f, 2g, 2h, and 2i) ................................ ..........
2j
k
Net income (loss) (subtract line 2j from line 2d) ................................ ...........
2k
l
Transfers to (from) the plan (see instructions) ................................ .............
2l
3
Specific Assets: If the plan held assets at any time during the plan year in any of the following categories, check “Yes” and enter the current value of any assets
remaining in the plan as of the end of the plan year. Allocate the value of the plan’s interest in a commingled trust containing the assets of more than one plan on a
line-by-line basis unless the trust meets one of the specific exceptions described in the instructions.
Yes
No
Amount
a
Partnership/joint venture interests ................................................................................................ ..
3a
b
Employer real property ...................................................................................................................
3b
c
Real estate (other than employer real property) ..............................................................................
3c
d
Employer securities ........................................................................................................................
3d
e
Participant loans ............................................................................................................................
3e
f
Loans (other than to participants) ................................................................................................ ..
3f
g
Tangible personal property ................................................................................................ .............
3g
For Paperwork Reduction Act Notice, see the Instructions for Form 5500.
Schedule I (Form 5500) 2016
v. 160205
ADVERTISEMENT
0 votes
Related Articles
Related forms
Schedule Mb (form 5500) - Multiemployer Defined Benefit Plan And Certain Money Purchase Plan Actuarial Information - 2016
Financial
Schedule Mb (form 5500) - Multiemployer Defined Benefit Plan And Certain Money Purchase Plan Actuarial Information - 2012
Financial
Schedule Mb (form 5500) - Multiemployer Defined Benefit Plan And Certain Money Purchase Plan Actuarial Information - 2014
Financial
Related Categories
Parent category: Financial