Instructions For Form 5310 (Rev. 2013) (Page 5 of 6) in pdf

this would not constitute a partial

3. Administrator's identification

d. an investment fund managed by

termination.

number(s),

an investment manager within the

meaning of section (3)(38) of ERISA for

4. Plan number(s),

Line 17b. The accrued benefits of a

a multiemployer plan.

plan participant may not be reduced on

5. An explanation of the

3. The terms of the plan state that

plan termination. A plan amendment

transaction(s) including:

the plan is a one-participant retirement

(including an amendment terminating a

a. The amount(s) of any

plan as defined in section 401(a)(35)(E)

plan) that effectively eliminates or

reversion(s),

(iv).

reduces an early retirement benefit or a

b. The date(s) of termination, and

retirement type subsidy for benefits

4. The plan is an ESOP, described

c. The reason(s) for termination.

attributable to pre-amendment service is

in section 4975(e)(7), that does not hold

treated as reducing the accrued benefit

any amounts subject to sections 401(k)

Line 17j(1). For this question only,

of a participant if subsequent to

or (m) and is separate from any other

“single-sum distribution” will mean a

termination the participant could satisfy

plan of the employer.

single payment of the value of a

the conditions necessary to receive

participant's benefits or a series of

Line 19b. Enter the amount of

such benefits. See section 411(d)(6),

payments that do not provide

forfeitures for each of the plan years on

Regulations section 1.411(d)-3 and

substantially equal payments (either

the chart. If these forfeitures resulted

Rev. Rul. 85-6, 1985-1 C.B. 133.

alone or in conjunction with other benefit

from a cashout for a year not listed on

Line 17c. Regulations section

payments) over the life of the

line 19, attach a statement indicating the

1.401(a)-20, Q&A-2 provides, in part,

participant.

year of the cashout.

that the requirements of sections 401(a)

Line 17m. Attach a statement for each

Line 19c. Enter the amount of transfers

(11) and 417 apply to the payments

plan that includes the following

and rollovers received from qualified

under annuity contracts, not to the

information:

plans (under section 401(a) and/or

distributions of annuity contracts.

conduit IRAs) for each of the plan years

1. Name of plan,

Line 17e. Answer “Yes” if any plan

entered. Submit proof that any rollovers

2. Type of plan,

assets were contributed in the form of,

or asset transfers received were from a

or invested in, obligations or property of

3. Form of plan (standardized,

qualified plan or IRA (for example, DL

the employer (including any entity

non-standardized, VS, or individually

and timely interim amendments).

related to the employer under section

designed),

Line 21. Complete the statement

414(b) or 414(c)).

4. Plan number,

showing the estimated fair market value

Line 17g. Section 436 requires the

5. Vesting schedule, and

of the plan assets and liabilities as of the

calculation of the Adjusted Funding

proposed date of termination or the

6. Whether the plan has received a

Target Attainment Percentage (AFTAP)

latest valuation date.

DL or an application for a letter is

to determine whether the plan is subject

pending with IRS.

Include and clearly identify all

to limits on plan amendments, lump sum

liabilities (other than liabilities for benefit

distributions, or benefit accruals. Attach

Line 17n. Applicable DC plans are

payments due after the date of plan

copies of the AFTAP certification. If the

required to contain the participant

termination) that are unpaid as of the

employer has filed for bankruptcy,

diversification rights under section

proposed termination date or that are

please provide the type and date of the

401(a)(35). In general, an applicable DC

paid or payable from plan assets after

bankruptcy filing.

plan means any DC plan that holds

the proposed date of plan termination

publicly traded employer securities. DC

Line 17i. All plan liabilities must be

under the provisions of the plan.

plans are required to have plan

satisfied before assets can revert to the

Liabilities include expenses, fees,

language reflecting the section 401(a)

employer upon termination of the plan.

other administrative costs, and benefit

(35) rights, with exceptions including the

All liabilities will not be satisfied if the

payments due and not paid before the

following:

value of retirement-type subsidies are

proposed termination date or latest

not provided participants who, after the

1. The terms of the plan do not

valuation date.

date of the proposed termination, satisfy

permit any investments in employer

certain pre-termination conditions

Line 21c(4). Include investment

securities.

necessary to receive such benefits. See

securities issued by a corporate entity at

2. The terms of the plan provide that

section 401(a)(2) and Regulations

a stated interest rate repayable on a

the plan may invest in employer

section 1.401-2(a)(1). The annuity

particular future date such as most

securities, but only if these securities

contracts purchased must be

bonds, debentures, convertible

are held indirectly as part of a broader

guaranteed for each participant.

debentures, commercial paper, and

fund that is:

However, in order to maintain

zero coupon bonds. Do not include debt

a. a regulated investment company

qualification of a continuing pension

securities of governmental units or

described in section 851(a),

plan, the contracts covering

municipalities.

participants’ accrued benefits in the plan

b. a common or collective trust fund

Line 21c(7)(A). Include the current

must not be distributed except in

or pooled investment fund maintained

value of real property owned by the plan

accordance with Regulations section

by a bank or trust company supervised

which produces income from rentals,

1.401-1(b)(1)(i).

by a State or a Federal agency,

etc. Do not include this property in

c. a pooled investment fund of an

Line 17i(2). If the answer to this item is

line 21e (building equipment, and other

insurance company that is qualified to

“Yes,” attach a list that includes the:

property used in plan operations).

do business in a State, or

1. Name(s) of the plan sponsor(s),

2. Employer or sponsor(s) EIN(s),

-5-

Instructions For Form 5310 (Rev. 2013) Page 5

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