Form 14568-I - Appendix C Part Ii Schedule 9 Correction By Plan Amendment (In Accordance With Appendix B)

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Department of the Treasury - Internal Revenue Service
Appendix C Part II Schedule 9
14568-I
Form
OMB Number
Correction by Plan Amendment
1545-1673
(January 2014)
(in accordance with Appendix B)
Please include the plan name, Applicant’s EIN, and plan number information on each page of the submission
Plan name
EIN
Plan number
Section I - Identification of Failure(s) and Proposed Method(s) of Correction
The following failure(s) occurred with respect to the plan identified above (check failure(s) that apply)
A. § 401(a)(17) Failure in a Defined Contribution Plan (check as applicable)
Contributions
Forfeitures
were allocated on the basis of compensation in excess of the limit under § 401(a)(17) as provided below:
Enter the plan years in which the failure occurred, the amount of the allocations in excess of § 401(a)(17) made for each plan year
(including Earnings), and the number of participants affected by the failure for each plan year:
Plan Year
Amounts Allocated in Excess of § 401(a)(17)
Number of Participants Affected
Description of Proposed Method of Correction:
An additional amount has been (or will be) contributed to the plan on behalf of each of the employees who received an allocation
for the year of the failure (excluding each employee for whom there was a § 401(a)(17) failure). The amount contributed for an
employee is equal to the employee's plan compensation for the year of the failure multiplied by a fraction, the numerator of which is
the improperly allocated amount made on behalf of the employee with the largest improperly allocated amount, and the
denominator of which is the limit under § 401(a)(17) applicable to the year of the failure. In addition, the plan will be retroactively
amended to reflect the increased contribution and allocation percentages for the plan’s participants.
Enter the plan years in which the failure occurred, the fraction used to determine the additional amount allocated to employees
other than those for whom there was a § 401(a)(17) failure, and the total required contribution (before adjusting for Earnings) for
each plan year in which the failure occurred:
Fraction Used to Determine the
Total Required Contribution
Plan Year
Additional Amount Allocated
(Before Adjusting for Earnings)
14568-I
Catalog Number 66156F
Form
(1-2014)
For Paperwork Reduction Act information see Revenue Procedure 2013-12.

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