Form 14568-C - Appendix C Part Ii Schedule 3 Seps And Sarseps Page 5
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Plan name
EIN
Plan number
Description of the Proposed Method of Correction (check all correction methods that apply)
Distribution of Excess Elective Deferrals (SARSEPs only)
The Plan Sponsor has effected (or will effect) a corrective distribution of the Excess Amounts, adjusted for Earnings through
the date of correction, to the affected participant(s). The Earnings adjustment will be based on the actual rates of return of the
participant’s SARSEP IRA account from the date(s) that the excess deferrals were made through the date of correction.
Affected participants were (or will be) informed that the corrective distribution of an Excess Amount is not eligible for favorable
tax treatment accorded to distributions from a SARSEP and, specifically, is not eligible for tax-free rollover.
The total corrective distribution (before adjusting for Earnings) for each affected year is as follows:
Year
Corrective Distribution
Number of Participants Affected
Distribution of Excess Employer Contributions
The Plan Sponsor has effected (or will effect) the return of excess employer contributions, adjusted for Earnings through the
date of correction, to the Plan Sponsor. The Earnings adjustment will be based on the actual rates of return of the SEP or
SARSEP from the date(s) that the excess employer contributions were made through the date of correction. The amount
returned to the Plan Sponsor is not includible in the gross income of the affected participant(s). The Plan Sponsor is not
entitled to a deduction for such excess employer contributions. The amount returned is reported on Form 1099-R as a
distribution issued to the affected participant(s), indicating the taxable amount as zero.
The amount to be returned to the Plan Sponsor (before adjusting for Earnings) for each affected year is as follows:
Year
Return of Excess Employer Contributions
Number of Participants Affected
Retention of Excess Amounts
Note: If this correction method is selected, an additional VCP fee is required. (See section 12.06(2) of Rev. Proc. 2013-12.)
The Excess Amounts (including Earnings) were retained in the SARSEP or SEP IRA accounts of the affected participants as
follows:
Year
Excess Amounts Retained
Number of Participants Affected
14568-C
Catalog Number 66147U
Form
(1-2014)
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