Form 5307 - Application For Determination For Adopters Of Master Or Prototype Or Volume Submitter Plans Page 6

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6
Form 5307 (Rev. 3-2008)
Page
11e (continued)
(4) Number of employees excluded because employed by other qualified separate lines of business
(QSLOBs)
(5) Number of employees excluded because they were nonresident aliens with no earned income
from sources within the United States
f Total statutory and regulatory exclusions (add lines 11e(1) through 11e(5))
g Nonexcludable employees (subtract line 11f from line 11d)
h Number of nonexcludable employees on line 11g who are highly compensated employees (HCEs)
i Number of nonexcludable HCEs on line 11h benefiting under the plan
j Number of nonexcludable employees who are nonhighly compensated employees (NHCEs)
(subtract line 11h from 11g)
k Number of nonexcludable NHCEs on line 11j benefiting under the plan
l Ratio percentage (See instructions)
m Enter the ratio percentage for the following, if applicable:
(1) Section 401(k) part of the plan
(2) Section 401(m) part of the plan
Yes
No
Are the results on line 11l or 11m based on the aggregated coverage of more than one plan? If “Yes,” attach a
n
statement listing the names, plan numbers, EINs, and benefit/allocation formula of the other plans. All aggregated
plans should be filed concurrently.
o
If the plan satisfied coverage using one of the special requirements of Regulations section 1.410(b)-2(b)(5), (6), or (7) enter the
letter from the list below that identifies the special rule.
A = 1.410(b)-2(b)(5) - No NHCEs employed
B = 1.410(b)-2(b)(6) - No HCEs benefit
C = 1.410(b)-2(b)(7) - Collectively bargained only
5307
Form
(Rev. 3-2008)
*11832Y03200806*

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