Form 5307 - Application For Determination For Adopters Of Master Or Prototype Or Volume Submitter Plans Page 4

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Form 5307 (Rev. 3-2008)

Page

(continued)

Yes

Is this a section 412(i) plan?

Has this plan been involved in a merger? (If “Yes,” see instructions)

Has the plan been amended or restated to change the type of plan? (If “Yes,” see instructions)

Do you maintain any other qualified plan(s) under section 401(a)?

If “Yes,” attach required statement per instructions.

If “No,” skip to line 9d.

Do you maintain another plan of the same type (i.e. both this plan and the other plan are defined contribution

plans or both are defined benefit plans) that covers non-key employees who are also covered under this plan?

If “Yes,” when the plan is top-heavy, do the non-key employees covered under both plans receive the required

top-heavy minimum contribution or benefit under: (See instructions)

(1) This plan, or

(2) The other plan?

If this is a defined contribution plan, do you maintain a defined benefit plan (or if this is a defined benefit plan,

do you maintain a defined contribution plan) that covers non-key employees who are also covered under this

plan? If “Yes,” when the plan is top-heavy, do non-key employees covered under both plans receive:

(See instructions)

(1) The top-heavy minimum benefit under the defined plan,

(2) At least a 5% minimum contribution under the defined contribution plan,

(3) The minimum benefit offset by benefits provided by the defined contribution plan, or

(4) Benefits under both plans that, using a comparability analysis, are at least equal to the minimum benefit?

Does the plan prevent the possibility that the section 415 limitations will be exceeded for any employee who

is (or was) a participant in this plan and any other plan of the employer?

5307

Form

(Rev. 3-2008)

*11832Y03200804*

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