Form 5330 - Return Of Excise Taxes Related To Employee Benefit Plans Page 5

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5
Form 5330 (Rev. 4-2009)
Page
Name of Filer:
Filer’s identifying number:
Schedule C. Tax on Prohibited Transactions (Section 4975) Reported by the last day of the 7th month after the end of
the tax year of the employer (or other person who must file the return) (continued)
5 Complete the table below, if applicable, of other participating disqualified persons and description of correction
(see instructions).
(a)
(b)
(c)
(d)
(e)
Item no.
Name and address of
EIN or SSN
Description of correction
Date of
from line 2
disqualified person
correction
Schedule D. Tax on Failure to Meet Minimum Funding Standards (Section 4971(a)) Reported by the last day of the
7th month after the end of the employer’s tax year or 8
1
months after the last day of the plan year that ends within
2
the filer’s tax year
1
Aggregate unpaid required contributions (accumulated funding deficiency for multiemployer
1
plans) (see instructions)
2
Multiply line 1 by 10% (5% for multiemployer plans). Enter here and on Part I, line 8a
2
5330
Form
(Rev. 4-2009)

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