Form 5307 - Application For Determination For Adopters Of Modified Volume Submitter Plans Page 4
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64
Form 5307 (Rev. 6-2014)
Page
Yes
No
8 a
Is a separate DL application for this plan currently pending before the IRS?
b
Is this application being filed during the applicable two-year window announced by the Service?
9a
Does this plan satisfy one of the design-based safe harbor requirements for contributions or benefits under
Regulations section 1.401(a)(4)-2(b) or 3(b)?
If "Yes," go to line 9b.
If "No," go to line 10a.
b
Is this an election for a determination regarding a design-based safe harbor?
If "Yes," complete lines 9c through 9e.
If "No," go to line 10a.
c Enter the letter ("A" - "E") from the list below that identifies the safe harbor intended to be satisfied.
A = 1.401(a)(4)-2(b)(2) defined contribution (DC) plan with a uniform allocation formula
B = 1.401(a)(4)-3(b)(3) unit credit defined benefit (DB) plan
C = 1.401(a)(4)-3(b)(4)(i)(C)(1) unit credit DB fractional rule plan
D = 1.401(a)(4)-3(b)(4)(i)(C)(2) flat benefit DB plan
E = 1.401(a)(4)-3(b)(5) insurance contract plan
d
Does this plan satisfy one of the safe harbor definitions of compensation under Regulation sections
1.414(s)-1(c)(2) or (3)?
e List the plan sections that satisfy the design-based safe harbor (including, if applicable, the permitted disparity requirements).
10a
Does this plan have a cash or deferred arrangement (CODA)?
If "Yes," go to line 10b(1).
If "No," go to line 10e.
b(1)
Does the CODA satisfy a safe harbor?
If "Yes," go to line 10b(2).
If "No," go to line 10d.
b(2) Indicate by using the corresponding number from the instructions, the type of section 401(k) safe harbor that was satisfied.
1. 401(k)(12)(B)
2. 401(k)(12)(C)
3. 401(m)(11)(B)
Does this plan contain a qualified automatic contribution arrangement (QACA) within the meaning of
c
section 401(k)(13)?
Does this plan contain an eligible automatic contribution arrangement (EACA) within the meaning of
d
section 414(w)?
Does this plan have matching contributions within the meaning of section 401(m)?
e
If "Yes," go to line 10f.
If "No," go to line 10g.
Does this plan satisfy the section 401(m) safe harbor?
f
Does this plan have after-tax employee voluntary contributions within the meaning of section 401(m)?
g
11
Does this plan utilize the permitted disparity rules of section 401(l)?
Is this plan part of an offset arrangement with any other plans?
12
If "Yes," attach the required statement.
5307
Form
(Rev. 6-2014)
*11832Y06201404*
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