Form 14568-E - Appendix C Part Ii Schedule 5 - Plan Loan Failures (Qualified Plans And 403(B) Plans) Page 2
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Plan name
EIN
Plan number
Section II - Eligibility for Use of Appendix C, Schedule 5
Yes
No
A.
Is any affected participant either a key employee (as defined in § 416(i)(1)) or an owner-employee (as defined in §
401(c)(3))?
If “Yes,” proceed to Section II B.
If “No,” skip Section II B and proceed to Section II C.
Yes
No
B.
Is the purpose of this request limited to permitting the Plan Sponsor to report the loan as a deemed distribution in
the year of correction instead of the year of the failure?
If “Yes,” complete Section III and then proceed directly to Section IV D. (Sections IV A, B, and C do not apply.)
If “No,” STOP - do NOT use this schedule. Any request for relief should be made by filing a detailed written
attachment describing the relief requested and the reasons why such relief should be granted.
Yes
No
C.
Will correction be completed before the maximum period for repayment of the loan (pursuant to § 72(p)(2)(B)) has
expired? (Note: The maximum period is determined from the original date of the loan. Generally, this period is five
years from the original date of the loan, except for home loans as described in § 72(p)(2)(B)(ii).)
If ”Yes,” and the Plan Sponsor wants relief from reporting the loan as a deemed distribution, complete Section III
and then answer applicable questions in Sections IV A through IV C.
If “No,” complete Section III and then proceed to Section IV D.
Section III - Explanation of How and Why the Plan Loan Failures Occurred
Section IV - Description of Proposed Method of Correction
If the Plan Sponsor is requesting relief from reporting loans as deemed distributions,then complete Sections IV A, B, or C, as
applicable.
If the Plan Sponsor is only requesting postponement of reporting loans as deemed distributions on Form 1099-R, then proceed directly
to Section IV D.
A. Correction for loans in excess of § 72(p)(2)(A)
Any participant affected by this failure will make a corrective repayment to the plan. After repaying the excess of the loan amount
over the maximum loan amount under § 72(p)(2)(A) (the “excess loan amount”), the remaining balance of the loan will be repaid
over the remaining period of the original loan (not beyond the period permitted under § 72(p)(2)(B), determined from the original
date of the loan) in a manner that complies with the frequency and level payment requirements of § 72(p)(2)(C). The excess loan
amount that will be repaid by the participant is determined based on how previously made payments have been applied to the loan.
The previous loan payments were applied as follows (check applicable box, and complete necessary information)
Prior loan payments were made in accordance with an amortization schedule that complied with the requirements of § 72(p)(2)
(B) relating to the terms of the loan and § 72(p)(2)(C) relating to frequency, and level loan payments. For the purpose of
determining the excess loan amount and the remaining outstanding amount of the loan to be repaid over the remaining period
of the loan, the previously made loan payments will be applied as follows (check box that applies)
1. Solely to reduce the portion of the loan that did not exceed the maximum loan amount under § 72(p)(2)(A). Result: The
corrective repayment would equal the excess loan amount plus interest thereon.
14568-E
Catalog Number 66149Q
Form
(1-2014)
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