Form 14568-B - Appendix C Part Ii Schedule 2 - Nonamender Failures (Other Than Those To Which Schedule 1 Applies) And Failure To Adopt A 403(B) Plan Timely Page 2

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Plan name
EIN
Plan number
Other (specify the legal requirement and applicable Cumulative List):
B. 403(b) Plans:
The Plan Sponsor did not timely adopt a written plan as required by the final 403(b) regulations and Notice 2009-3, 2009-2
I.R.B. 250.
Section II - Description of Proposed Method of Correction
A. Qualified Plan. The Plan Sponsor has adopted (or will adopt) amendments that satisfy the requirements of all of the items
checked in Section IA of this Appendix C Part II, Schedule 2, retroactively to the effective dates of the specific provisions contained
in the amendments. The amendments and restated plan documents (where applicable) are enclosed with this submission.
B. 403(b) Plan. Failure to adopt a written plan timely. The Plan Sponsor has adopted a written plan retroactive to the later of the
effective date of the final 403(b) regulations or the initial effective date of the plan. A copy of the signed and dated 403(b) plan is
enclosed with this submission.
Section III - Change in Administrative Procedures
The Plan Sponsor has taken the following step(s) to ensure that the failure(s) will not recur:
Section IV - Enclosures
In addition to the applicable items listed on the Procedural Requirements Checklist for Form 8950, the Plan Sponsor encloses the
following documents, as appropriate, with this submission:
● Copies of all amendments used to correct the failure(s), either as adopted or in proposed form,
● A copy of the plan document in effect prior to any of the amendments used to correct the failure(s),
● A copy of the most recent determination letter issued with respect to the plan (if applicable),
● If required by Section 6.05 of Rev. Proc. 2013-12, a determination letter application (Form 5300, 5307, or 5310 along with Form
8717 and the applicable user fee payment made payable to the U.S. Treasury), or
● For 403(b) plans, a copy of the signed and dated 403(b) Plan document.
14568-B
Catalog Number 66146J
Form
(1-2014)

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