us internal revenue service: i5500--1992

8/14/2019 US Internal Revenue Service: i5500--1992

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Cat. No. 13502B

Pension BenefitGuaranty Corporation

Department of LaborPension and WelfareBenefits Administration

Department of the TreasuryInternal Revenue Service

Instructions for Form 5500

Annual Return/ Report of Employee BenefitPlan (With 100 or more participants)

(Code references are to the Internal Revenue Code. ERISArefers to the Employee Retirement Income Security Act of 1974. )

Paperwork Reduction Act Notice.We ask for the information on this form to carry out thelaw as specified in ERISA and Code section 6039D. You are required to give us theinformation. We need it to determine whether the plan is operating according to the law.

The time needed to complete and file the forms listed below reflects the combinedrequirements of the Internal Revenue Service, Department of Labor, Pension Benefit GuarantyCorporation, and the Social Security Administration. These times will vary depending onindividual circumstances. The estimated average times are:

Copying,assembling, and

sendingthe form

to the IRS

Learning aboutthe law or the

form Preparing the formRecordkeeping

87 hr., 17 min. 48 min.13 hr., 28 min.8 hr., 51 min.Form 5500 (initial filers)

81 hr., 33 min. 48 min.13 hr., 22 min.8 hr., 51 min.Form 5500 (all other filers)

1 hr., 42 min.28 min.17 hr., 28 min. 16 min.Schedule A (Form 5500) 3 hr., 16 min.2 hr., 35 min.34 hr., 12 min.Schedule B (Form 5500)

23 min.18 min.5 hr., 16 min.Schedule C (Form 5500)

Schedule E (Form 5500)(non leveraged ESOP) 14 min.12 min.1 hr., 40 min.

Schedule E (Form 5500)(leveraged ESOP) 1 hr., 56 min.1 hr., 41 min.10 hr., 2 min.

1 hr., 55 min.Schedule P (Form 5500) 33 min.30 min.

6 hr., 42 min.Schedule SSA (Form 5500) 19 min.12 min.

If you have comments concerning the accuracy of these time estimates or suggestions formaking these forms more simple, we would be happy to hear from you. You can write to boththe Internal Revenue Service, Washington, DC 20224, Attention: IRS Reports ClearanceOfficer, T:FP; and the Office of Management and Budget, Paperwork Reduction Project(1210-0016), Washington, DC 20503. DO NOT send this form to either of these offices. Instead,see Where To File on page 2.

How To Use This InstructionBookletThe instructions are divided into four mainsections.

Section 1 Page

Who Must File 2

When To File 2

Extension of Time To File 2

Where To File 2

Section 2Kinds of Plans 2

Pension benefit 2

Welfare benefit 3

Fringe benefit 3

Plans Excluded From Filing 3

Kinds of Filers 3

Investment Arrangements FilingDirectly With DOL 4

What To File 5

Forms 5

Items To Complete on Form 5500 6

Schedules 6

Other Filings 6

Section 3

Section 4

General Information For All Filers 1

Schedule F (Form 5500)

Schedule G (Form 5500)

Final Return/Report 8

Signature and Date 8

Reproductions 8

Change in Plan Year 8

Amended Return/Report 8

How the Annual Return/Report InformationMay Be Used 8

Information at the Top of the Form 8

Line-By-Line Instructions 8

Codes for Principal Business Activity andPrincipal Product or Service 23

1 hr., 27 min. 19 min.46 min.

15 hr., 4 min. 21 min.6 min.

Section 1

General Information For AllFilersFile 1992 forms for plan years thatstarted in 1992. If the plan year differsfrom the calendar year, fill in the fiscalyear space just under the form title. Fora short plan year, see When To File onpage 2.

Changes You Should Note

Electronic Filing of Form 5500.Qualified tax return filers can file Form5500 and related schedules via magneticmedia (magnetic tapes, floppy diskettes)or electronically. If the plan administratorfiles the employee plan returnelectronically or on magnetic media, heor she must also file Form 8453-E,Employee Benefit Plan Declaration andSignature for Electronic/Magnetic MediaFiling. This is the declaration andsignature form for theelectronic/magnetic media return. Formore information, see Pub. 1507,

Procedures for Electronic/MagneticMedia Filing of Employee Benefit PlanReturns Forms 5500, 5500-C/R, and5500EZ for Plan Year 1992.

New Schedules for 1992. Fringe benefitplans must now complete the newSchedule F (Form 5500), Fringe BenefitPlan Annual Information Return.Schedule F is designed to simplify thereporting requirements of fringe benefitplans. Also, the new Schedule G (Form5500), Financial Schedules, is anoptional form for 1992. See theinstructions for item 27.

ReminderMany filers receive rejection notices forfailing to complete items 4 and 6properly. The return/report will also beconsidered incomplete and penaltiesmay be imposed if information requiredon a schedule is not typed or printed onthe appropriate schedule, such as theSchedule A (Form 5500). See Scheduleson page 6. An annual return/report mustbe filed for employee welfare benefitplans which provide benefits wholly or

partially through a Multiple EmployerWelfare Arrangement (MEWA) as definedin ERISA section 3(40), unless otherwiseexempt (see page 3).

In addition to filing this form with theIRS, plans covered by the PensionBenefit Guaranty Corporation (PBGC)termination insurance program must filetheir Annual Premium Payment, PBGCForm 1, directly with that agency.

Penalties.ERISA and the Codeprovide for the assessment or impositionof penalties for not giving completeinformation and for not filing statements

and returns/reports. Certain penalties areadministrative; that is, they may beimposed or assessed by one of thegovernmental agencies delegated toadminister the collection of the Form5500 series data. Others require a legalconviction.

Administrative Penalties.Listed beloware various penalties for not meeting theForm 5500 series filing requirements.One or more of the following fivepenalties may be assessed or imposedin the event of incomplete filings or


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filings received after the due date unlessit is determined that your explanation forfailure to file properly is for reasonablecause:

1. A penalty of up to $1,000 a day foreach day a plan administrator fails orrefuses to file a complete return/report.See ERISA section 502(c)(2) and 29 CFR2560.502c-2.

2. A penalty of $25 a day (up to$15,000) for not filing returns for certainplans of deferred compensation, certain

trusts and annuities, and bond purchaseplans by the due date(s). See Codesection 6652(e). This penalty alsoapplies to returns required to be filedunder Code section 6039D.

3. A penalty of $1 a day (up to $5,000)for each participant for whom aregistration statement (Schedule SSA(Form 5500)) is required but not filed.See Code section 6652(d)(1).

4. A penalty of $1 a day (up to $1,000)for not filing a notification of change ofstatus of a plan. See Code section6652(d)(2).

5. A penalty of $1,000 for not filing an

actuarial statement. See Code section6692.

Other Penalties.

1. Any individual who willfully violatesany provision of Part 1 of Title I ofERISA shall be fined not more than$5,000 or imprisoned not more than 1year, or both. See ERISA section 501.

2. A penalty of up to $10,000, 5 yearsimprisonment, or both, for making anyfalse statement or representation of fact,knowing it to be false, or for knowinglyconcealing or not disclosing any factrequired by ERISA. See section 1027,Title 18, U.S. Code, as amended bysection 111 of ERISA.

Who Must FileAny administrator or sponsor of anemployee benefit plan subject to ERISAmust file information about each planevery year (Code section 6058 andERISA sections 104 and 4065). Everyemployer maintaining a specified fringebenefit plan as described in Codesection 6039D (except Code sections79, 105, 106 and 129 plans) is alsorequired to file each year. The InternalRevenue Service (IRS), Department ofLabor (DOL), and Pension BenefitGuaranty Corporation (PBGC) haveconsolidated their returns and reportforms to minimize the filing burden forplan administrators and employers. Thechart on page 5 gives a brief guide tothe type of return/report to be filed.

When To FileFile all required forms and schedules bythe last day of the 7th month after theplan year ends. For a short plan year, filethe form and applicable schedules bythe last day of the 7th month after the

short plan year ends. For purposes ofthis return/report, the short plan yearends on the date of the change inaccounting period or upon the completedistribution of the assets of the plan.(Also see Section 3.) If the current yearForm 5500 is not available before thedue date of your short plan yearreturn/report, use the latest year formavailable and change the date printed onthe return/report to the current year. Alsoshow the dates your short plan yearbegan and ended.

Extension of Time To File

A one time extension of time to file (upto 212 months) may be granted for filingreturns/reports if Form 5558, Applicationfor Extension of Time To File CertainEmployee Plan Returns, is filed beforethe normal due date (not including anyextensions) of the return/report.

Exception: Plans are automaticallygranted extensions of time to file Form5500 until the due date of the Federalincome tax return of the employer if allthe following conditions are met: (1) Theplan year and the employers tax year are

the same. (2) The employer has beengranted an extension of time to file itsFederal income tax return to a date laterthan the normal due date for filing theForm 5500. (3) A copy of the IRSextension of time to file the Federalincome tax return is attached to theForm 5500 filed with the IRS. Anextension granted by using thisexception CANNOT be extended furtherby filing a Form 5558.

Note: An extension of time to file thereturn/report does not operate as anextension of time to file the PBGCForm 1.

Where To FilePlease file the return/report with theInternal Revenue Service Centerindicated below. No street address isnecessary.

See page 7 for the filing address forinvestment arrangements filing directlywith DOL.

If the principal office ofthe plan sponsor or the

plan administrator islocated in

Use the followingInternal RevenueService Center

address

Connecticut, Delaware,

District of Columbia,Foreign Address, Maine,Maryland, Massachusetts,New Hampshire, NewJersey, New York,Pennsylvania, Puerto Rico,Rhode Island, Vermont,Virginia

Holtsville, NY 00501

Alabama, Alaska, Arkansas,California, Florida, Georgia,Hawaii, Idaho, Louisiana,Mississippi, Nevada, NorthCarolina, Oregon, SouthCarolina, Tennessee,Washington

Atlanta, GA 39901

Arizona, Colorado, Illinois,Indiana, Iowa, Kansas,Kentucky, Michigan,Minnesota, Missouri,Montana, Nebraska, NewMexico, North Dakota,Ohio, Oklahoma, South

Dakota, Texas, Utah, WestVirginia, Wisconsin,Wyoming

Memphis, TN 37501

All Form 5500EZ filers Andover, MA 05501

Section 2

Kinds of PlansEmployee benefit plans include pensionbenefit plans and welfare benefit plans.File the applicable return/report for anyof the following plans.

Pension Benefit Plan

This is an employee pension benefit plancovered by ERISA. The return/report isdue whether or not the plan is qualifiedand even if benefits no longer accrue,contributions were not made this planyear, or contributions are no longermade (frozen plan or wasting trust).See Final Return/Report on page 8.

Pension benefit plans required to fileinclude defined benefit plans anddefined contribution plans (e.g.,profit-sharing, stock bonus, moneypurchase plans, etc.). The following areamong the pension benefit plans forwhich a return/report must be filed:

1. Annuity arrangements under Codesection 403(b)(1).

2. Custodial account establishedunder Code section 403(b)(7) forregulated investment company stock.

3. Individual retirement accountestablished by an employer under Codesection 408(c).

4. Pension benefit plan maintainedoutside the United States primarily fornonresident aliens if the employer whomaintains the plan is:

a. a domestic employer, or

b. a foreign employer with incomederived from sources within the United

States (including foreign subsidiaries ofdomestic employers) and deductscontributions to the plan on its U.S.income tax return. See Plans ExcludedFrom Filing on page 3.

5. Church plans electing coverageunder Code section 410(d).

6. A plan that covers residents ofPuerto Rico, the Virgin Islands, Guam,Wake Island, or American Samoa. Thisincludes a plan that elects to have theprovisions of section 1022(i)(2) of ERISAapply.


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See Items To Complete on Form5500 on page 6 for more informationabout what questions must becompleted by pension plans.

Welfare Benefit Plan

This is an employee welfare benefit plancovered by Part 1 of Title I of ERISA.Welfare plans provide benefits such asmedical, dental, life insurance,apprenticeship and training, scholarshipfunds, severance pay, disability, etc.

See Items To Complete on Form5500 on page 6 for more informationabout what questions must becompleted for welfare benefit plans.

Fringe Benefit Plan

Group legal services plans described inCode section 120, cafeteria plansdescribed in Code section 125, andeducational assistance programsdescribed in Code section 127 areconsidered fringe benefit plans andgenerally are required to file the annualinformation specified by Code section6039D. However, Code section 127educational assistance programs, which

provide only job-related training that isdeductible under Code section 162, donot need to file Form 5500.

Note: A fringe benefit plan may beassociated with one or more welfareplans as described above for which aForm 5500 may be required to be filed.

See Items To Complete on Form5500 on page 6 for more informationabout how to complete this form for afringe benefit plan.

Plans Excluded From FilingThese exemptions do not apply to afringe benefit plan required to file tosatisfy the requirements of Code section6039D.

Do not file a return/report for anemployee benefit plan that is any of thefollowing:

1. A welfare benefit plan whichcovered fewer than 100 participants asof the beginning of the plan year and is:unfunded, fully insured, or a combinationof insured and unfunded.

a. An unfunded welfare benefit planhas its benefits paid as needed directlyfrom the general assets of the employeror the employee organization thatsponsors the plan.

Note: Plans that are NOT unfundedinclude those plans that receivedemployee (or former employee)contributions during the plan year and/orused a trust or separately maintainedfund (including a Code section 501(c)(9)trust) to hold plan assets or act as aconduit for the transfer of plan assetsduring the plan year.

b. A fully insured welfare benefit planhas its benefits provided exclusivelythrough insurance contracts or policies,the premiums of which must be paid

directly by the employer or employeeorganization from its general assets orpartly from its general assets and partlyfrom contributions by its employees ormembers (which the employer ororganization forwards within 3 months ofreceipt).

The insurance contracts or policiesdiscussed above must be issued by aninsurance company or similarorganization (such as Blue Cross, BlueShield or a health maintenance

organization) which is qualified to dobusiness in any state.

c. A combination unfunded/insuredwelfare plan has its benefits providedpartially as an unfunded plan andpartially as a fully insured plan. Anexample of such a plan is a welfare planwhich provides medical benefits as in aabove and life insurance benefits as in babove.

See 29 CFR 2520.104-20.

Note: An employees beneficiaryassociation as used in Code section501(c)(9) should not be confused withthe employee organization or employerthat establishes and maintains (i.e.,sponsors) the welfare benefit plan.

2. An unfunded pension benefit planor an unfunded or insured welfarebenefit plan: (a) whose benefits go onlyto a select group of management orhighly compensated employees, and(b) which meets the terms ofDepartment of Labor Regulations 29CFR 2520.104-23 (including therequirement that a notification statementbe filed with DOL) or 29 CFR2520.104-24.

3. Plans maintained only to complywith workers compensation,unemployment compensation, or

disability insurance laws.4. An unfunded excess benefit plan.

5. A welfare benefit plan maintainedoutside the United States primarily forpersons substantially all of whom arenonresident aliens.

6. A pension benefit plan maintainedoutside the United States if it is aqualified foreign plan within the meaningof Code section 404A(e) that does notqualify for the treatment provided inCode section 402(c).

7. An annuity arrangement describedin 29 CFR 2510.3-2(f).

8. A simplified employee pension

(SEP) described in Code section 408(k)which conforms to the alternativemethod of compliance described in 29CFR 2520.104-48 or 29 CFR2520.104-49. A SEP is a pension planthat meets certain minimumqualifications regarding eligibility andemployer contributions.

9. A church plan not electing coverageunder Code section 410(d) or agovernmental plan.

10. A welfare benefit plan thatparticipates in a group insurance

arrangement that files a return/reportForm 5500 on behalf of the welfarebenefit plan. See 29 CFR 2520.104-43.

11. An apprenticeship or training planmeeting all of the conditions specified in29 CFR 2520.104-22.

Kinds of FilersThe different types of plan entities thatfile the forms are described below. (Alsosee instructions for item 4 on page 9.)

Single-Employer PlanIf one employer or one employeeorganization maintains a plan, file aseparate return/report for the plan. If theemployer or employee organizationmaintains more than one such plan, filea separate return/report for each plan.

If a member of either a controlledgroup of corporations, a group of tradesor businesses under common control, oran affiliated service group maintains aplan that does not involve other groupmembers, file a separate return/report asa single-employer plan.

If several employers participate in a

program of benefits in which the fundsattributable to each employer areavailable only to pay benefits to thatemployers employees, each employermust file a separate return/report.

Plan for Controlled Group ofCorporations, Group of Trades orBusinesses Under CommonControl, or an Affiliated ServiceGroup

These groups are defined in Codesections 414(b), (c), and (m), and arereferred to as controlled groups.

If the benefits are payable to

participants from the plans total assetswithout regard to contributions by eachparticipants employer, file onereturn/report for the plan. On thereturn/report for the plan, complete item21 only for the controlled groupsemployees.

Note: Employers who participate in apension plan of one of the groups listedabove but who are not members of thegroup must file a separate return/report.The return/report should be filed onForm 5500-C/R regardless of thenumber of participants. The years youare required to file pages 1 and 3

through 6 as Form 5500-C, completeonly items 1 through 7a, 9, and 21. Theyears you file pages 1 and 2 as Form5500-R complete only items 1 through7a, 8a, and 8b. These participatingemployers must enter code F in item 4of the Form 5500-C/R.

If several employers participate in aprogram of benefits in which the fundsattributable to each employer areavailable only to pay benefits to thatemployers employees, each employermust file a separate return/report as asingle employer plan.


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Multiemployer Plan

A multiemployer plan is a plan (1) towhich more than one employer isrequired to contribute, (2) that ismaintained pursuant to one or morecollective-bargaining agreements, and(3) has not made the election underCode section 414(f)(5) and ERISAsection 3(37)(E). File one return/report foreach plan. Contributing employers donot file individually for these plans. SeeCode section 414 for more information.

Multiple-Employer-Collectively-Bargained Plan

These plans involve more than oneemployer; are collectively bargained andfunded; and, if covered by PBGCtermination insurance, have properlyelected before September 27, 1981, notto be treated as multiemployer plansunder Code section 414(f)(5) or ERISAsections 3(37)(E) and 4001(a)(3). File onereturn/report for each such plan.Participating employers do not fileindividually for these plans.

Note: Filers described inMultiemployer

PlanorMultiple-Employer-Collectively-Bargained Plan abovecomplete item 21 only if a plan:(1)benefits employees who are notcollective bargaining unit employees, or(2)only covers collective bargaining unitemployees and 2% or more of them areprofessionals.

Multiple-Employer Plan (Other)

A multiple-employer plan (other) involvesmore than one employer and is not oneof the plans already described. File onereturn/report for each plan.

Note: Each employer participating in adefined contribution or defined benefit

pension planwhich is considered amultiple-employer plan (other) must file aForm 5500-C/R regardless of thenumber of participants. For the yearsyou are required to file pages 1 and 3through 6 as Form 5500-C, completeonly items 1 through 7a, 9, and 21. Forthe years you file pages 1 and 2 as Form5500-R, complete only items 1 through7a, 8a, and 8b. Each participatingemployer filing the Form 5500-C/Rmustenter code F in item 4 and use anappropr iate number (001, 002, etc. ) initem 5c.

Note: If a participating employer is also

the sponsor of the multiple-employerplan (other), the plan number on thereturn/report filed for the plan should be333 and, if more than one plan, theyshould be consecutively numberedstarting with 333.

If more than one employer participatesin the plan and the plan provides thateach employers contributions areavailable to pay benefits only for thatemployers employees who are coveredby the plan, one annual return/reportmust be filed for each participating

employer. These filers will be consideredsingle employers and should completethe entire form.

Group Insurance Arrangement

This arrangement provides benefits tothe employees of two or moreunaffiliated employers (not in connectionwith a multiemployer plan or a multiple-employer-collectively-bargained plan),fully insures one or more welfare plansof each participating employer, and uses

a trust (or other entity such as a tradeassociation) as the holder of theinsurance contracts and the conduit forpayment of premiums to the insurancecompany.

Do not file a separate return/report fora welfare benefit plan that is part of agroup insurance arrangement if aconsolidated return/report for all theplans in the arrangement was filed bythe trust or other entity according to 29CFR 2520.104-43. Form 5500 is requiredby 29 CFR 2520.103-2 to be part of theconsolidated report.

Investment ArrangementsFiling Directly With DOLSome plans invest in certain trusts,accounts, and other investmentarrangements which may file informationconcerning themselves and theirrelationship with employee benefit plansdirectly with DOL (as specified on pages6 and 7). Plans participating in aninvestment arrangement as described inCommon/Collective Trust and PooledSeparate Account, Master Trust, and103-12 Investment Entities below arerequired to attach certain additionalinformation to the return/report filed withthe IRS as specified below.

Common/Collective Trust andPooled Separate Account

Definition.For reporting purposes, acommon/collective trust is a trustmaintained by a bank, trust company, orsimilar institution which is regulated,supervised, and subject to periodicexamination by a state or Federalagency for the collective investment andreinvestment of assets contributedthereto from employee benefit plansmaintained by more than one employeror a controlled group of corporations, asthe term is used in Code section 1563.

For reporting purposes, a pooledseparate account is an accountmaintained by an insurance carrier whichis regulated, supervised, and subject toperiodic examination by a state agencyfor the collective investment andreinvestment of assets contributedthereto from employee benefit plansmaintained by more than one employeror controlled group of corporations, asthe term is used in Code section 1563.See 29 CFR sections 2520.103-3,2520.103-4, 2520.103-5, and2520.103-9.

Note: For reporting purposes, a separateaccount which is not considered to beholding plan assets pursuant to 29 CFR2510.3-101(h)(1)(iii) shall not constitute apooled separate account.

Additional information required to beattached to the Form 5500 for plansparticipating in common/collectivetrusts and pooled separateaccounts.A plan participating in acommon/collective trust or pooledseparate account must complete the

annual return/report and attach either:(1) the most recent statement of theassets and liabilities of anycommon/collective trust or pooledseparate account, or (2) a certificationthat: (a) the statement of the assets andliabilities of the common/collective trustor pooled separate account has beensubmitted directly to DOL by thefinancial institution or insurance carrier;(b) the plan has received a copy of thestatement; and (c) includes the EIN andother numbers used by the financialinstitution or insurance carrier to identifythe trusts or accounts, and the nameand address provided in the direct filing

made with DOL.

Master Trust

Definition.For reporting purposes, amaster trust is a trust for which aregulated financial institution (as definedbelow) serves as trustee or custodian(regardless of whether such institutionexercises discretionary authority orcontrol with respect to the managementof assets held in the trust), and in whichassets of more than one plan sponsoredby a single employer or by a group ofemployers under common control areheld.

A regulated financial institutionmeans a bank, trust company, or similarfinancial institution which is regulated,supervised, and subject to periodicexamination by a state or Federalagency. Common control is determinedon the basis of all relevant facts andcircumstances (whether or not suchemployers are incorporated). See 29CFR 2520.103-1(e).

For reporting purposes, the assets ofa master trust are considered to be heldin one or more investment accounts. Amaster trust investment account mayconsist of a pool of assets or a singleasset.

Each pool of assets held in a mastertrust must be treated as a separatemaster trust investment account if eachplan which has an interest in the poolhas the same fractional interest in eachasset in the pool as its fractional interestin the pool, and if each such plan maynot dispose of its interest in any asset inthe pool without disposing of its interestin the pool. A master trust may alsocontain assets which are not held insuch a pool. Each such asset must be


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treated as a separate master trustinvestment account.

Financial information must generallybe provided for each master trustinvestment account as specified onpage 7.

Additional information required to beattached to the Form 5500 for plansparticipating in master trusts.A planparticipating in a master trust mustcomplete the annual return/report andattach a schedule listing each mastertrust investment account in which theplan has an interest indicating the plansname, EIN, and plan number and thename of the master trust used in themaster trust information filed with DOL(see page 7). In tabular format, show thenet value of the plans interest in eachinvestment account at the beginning andend of the plan year, and the netinvestment gain (or loss) allocated to theplan for the plan year from theinvestment account (see instructions foritems 31c(11) through (15) on page 20).

Note: If a master trust investmentaccount consists solely of one plansasset(s) during the reporting period, theplan may report the(se) asset(s) either asan investment account to be reported aspart of the master trust report fileddirectly with DOL or as a plan asset(s)which is not part of the master trust (and

therefore subject to all instructionspertaining to assets not held in a mastertrust).

103-12 Investment Entities

29 CFR 2520.103-12 provides analternative method of reporting for planswhich invest in an entity (other than aninvestment arrangement filing with DOLas described on page 4 inCommon/Collective Trust and PooledSeparate Accounts or Master Trust),the underlying assets of which include

plan assets (within the meaning of 29CFR 2510.3-101) of two or more plans

which are not members of a relatedgroup of employee benefit plans. Forreporting purposes, a related groupconsists of each group of two or moreemployee benefit plans (1) each ofwhich receives 10% or more of itsaggregate contributions from the sameemployer or from a member of the samecontrolled group of corporations (asdetermined under Code section 1563(a),without regard to Code section1563(a)(4) thereof); or (2) each of whichis either maintained by, or maintainedpursuant to a collective-bargainingagreement negotiated by the sameemployee organization or affiliated

employee organizations. For purposes ofthis paragraph, an affiliate of anemployee organization means anyperson controlling, controlled by, orunder common control with suchorganization. See 29 CFR 2520.103-12.

For reporting purposes, the investmententities described above with respect towhich the required information is fileddirectly with DOL constitute 103-12investment entities (103-12 IEs).

What To FileThis section describes the differentcategories of the Form 5500 series and

the related schedules and also listsitems to be completed by different typesof Form 5500 filers. In addition, thissection contains a description of thespecial filing requirements for planswhich invest in certain investmentarrangements. For a brief guideillustrating which forms and schedulesare required by different types of plansand filers, see the summary above.

Forms

The following are the different forms in

the 5500 series of forms. Form 5500, Annual Return/Report ofEmployee Benefit Plan, must be filedannually for each plan with 100 or moreparticipants at the beginning of the planyear.

Form 5500-C/R, Return/Report ofEmployee Benefit Plan, must be filed foreach pension benefit plan, welfarebenefit plan, and fringe benefit plan(unless otherwise exempted) with fewerthan 100 participants at the beginning ofthe plan year (one-participant plans seeForm 5500EZ below).

Note: For purposes of determining

whether to file Form 5500 or Form5500-C/R for an employee benefit plan,the number of participants should becalculated in the same manner as item 7of the Form 5500 or 5500-C/R but thecalculation should be as of thebeginningof the plan year. Also, underthe filing requirements explained above,if the number of plan participantsincreases to 100 or more, or decreasesbelow 100, from one year to the next,you would generally have to file adifferent form from that filed theprevious year. However, there is anexception to this rule. The filer maycontinue to file the same form filed last

year (i.e., Form 5500 or 5500-C/R), evenif the number of participants changed,provided that at the beginning of thisplan year the plan had at least 80participants, but not more than 120.

Form 5500EZ, Annual Return ofOne-Participant (Owners and TheirSpouses) Pension Benefit Plan, shouldbe filed by most one-participant plans.

A one-participant plan is: (1) apension benefit plan that covers only anindividual or an individual and his or herspouse who wholly own a trade or

Summary of Filing Requirements for Employers and Plan Administrators(File forms ONLY with IRS)

Type of plan What to file When to file

File allrequired

forms andschedules

for eachplan by thelast day of

the 7thmonth after

the planyear ends.

Most pension plans with only one participant or one participant and that participants spouse

Pension plan with fewer than 100 participants

Pension plan with 100 or more participants

Annuity under Code section 403(b)(1) or trust under Code section 408(c)

Custodial account under Code section 403(b)(7)

Welfare benefit plan with 100 or more participants

Welfare benefit plan with fewer than 100 participants (see exceptions on page 3 of these instructions)

Pension or welfare plan with 100 or more participants (see instructions for item 26)

Pension or welfare plan with benefits provided by an insurance company

Pension plan that requires actuarial information

Pension or welfare plan with 100 or more participants

Pension plan with ESOP benefits

Pension plan filing a registration statement identifying separated participants with deferredvested benefits from a pension plan

Form 5500EZ

Form 5500-C/R

Form 5500

Form 5500 or Form 5500-C/R

Financial statements, schedules,and accountants opinion

Schedule A (Form 5500)

Schedule B (Form 5500)

Schedule C (Form 5500)

Schedule E (Form 5500)

Schedule SSA(Form 5500)

Form 5500 or Form 5500-C/R

Form 5500

Form 5500-C/R

Fringe benefit plan under Code section 6039D Schedule F (Form 5500)

Financial Schedules for item 27 Schedule G (Form 5500)


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business, whether incorporated orunincorporated; or (2) a pension benefitplan for a partnership that covers onlythe partners or the partners and thepartners spouses.

See Form 5500EZ and its instructionsto see if the plan meets therequirements for filing the form.

Form 8822, Change of Address, maybe used to notify the IRS if the plansmailing address changes after thereturn/report has been filed.

Items To Complete on Form 5500

Certain kinds of plans and certain kindsof filers that must file an annual Form5500 are not required to complete theentire form. These are described below,by type of plan. Check the list ofheadings to see if your plan is affected.

Welfare benefit plans.Welfare benefitplans generally must complete thefollowing items on the Form 5500: 1through 6e, 7a(4), 7b, 7c, and 7d; 8a,8b, 8d, and 8e; 9a, 9b, 9c, and 9f; 10athrough 10d; 11 through 14; 25 through29; and 31 through 33.

Note: If one Form 5500 is filed for botha welfare plan and a fringe benefit plan,complete Schedule F (Form 5500) inaddition to the items listed above forwelfare plans.

Fringe benefit plans.For a Form 5500filed only for a fringe benefit plandescribed in Code sections 120, 125,and 127, complete only items 1 through5, 6d, and Schedule F (Form 5500). DONOT file Schedules A, B, C, E, P, or SSA(Form 5500).

If Form 5500 is filed for both a welfarebenefit plan and a fringe benefit plan,complete the above items and thosespecified for Welfare benefit plans

above.Pension plans.In general, mostpension plans (defined benefit anddefined contribution) are required tocomplete all items on the form.However, some items do not have to becompleted by certain types of pensionplans, as described below.

1. Plans exclusively using a taxdeferred annuity arrangement underCode section 403(b)(1).These plans(see Who Must File on page 2) mustonly complete items 1 through 5, 6b(enter pension code 8), and 9.

2. Plans exclusively using a custodial

account for regulated investmentcompany stock under Code section403(b)(7).These plans must onlycomplete items 1 through 5, 6b (enterpension code 9), and 9.

3. Individual retirement accountplan.A pension plan utilizing individualretirement accounts or annuities (asdescribed in Code section 408) as thesole funding vehicle for providingbenefits must only complete items 1through 5, 6b (enter pension code 0),and 9.

4. Fully insured pension plan.Apension benefit plan providing benefitsexclusively through an insurancecontract, or contracts which are fullyguaranteed and that meets all of theconditions of 29 CFR 2520.104-44 needonly complete items 1 through 26, 29,and 30.

A pension plan including bothinsurance contracts of the typedescribed in 29 CFR 2520.104-44 aswell as other assets should limit its

reporting in items 31 and 32 to thoseother assets.

Note: For purposes of the annual return/report and the alternative method ofcompliance set forth in 29 CFR2520.104-44, a contract is considered tobe allocated only if the insurancecompany or organization that issued thecontract unconditionally guarantees,upon receipt of the required premium orconsideration, to provide a retirementbenefit of a specified amount. Thisamount must be provided withoutadjustment for fluctuations in the marketvalue of the underlying assets of thecompany or organization, to each

participant, and each participant has alegal right to such benefits, which islegally enforceable directly against theinsurance company or organization.

5. Nonqualified pension benefit plansmaintained outside the UnitedStates.Nonqualified pension benefitplans maintained outside the UnitedStates primarily for nonresident aliensrequired to file a return/report (see WhoMust File on page 2) must onlycomplete items 1 through 8c (enter codeD in item 6c), 9 through 12, 15 and 16.

Plans of more than one employer.Allplans of more than one employer (plans

of a controlled group, multiemployerplans, multiple-employer collectivelybargained plans, and multiple-employerplan (other)) generally must complete allapplicable (welfare or pension) items onthe form except for item 6f. Onlysingle-employer pension plans mustcomplete item 6f.

Schedules

Note: All attachments to Forms 5500and 5500-C/R must include the name ofthe plan, the plan sponsors EIN, andplan number (PN) as found in items 5a,1b, and 5c, respectively.

The various schedules to attach to the

return/report are listed below: Schedule A (Form 5500), InsuranceInformation, must be attached to Form5500 or 5500-C/R, if any benefits underthe plan are provided by an insurancecompany, insurance service, or othersimilar organization (such as Blue Cross,Blue Shield, or a health maintenanceorganization). (This includes investmentswith insurance companies such asguaranteed investment contracts (GICs).)

Exceptions: (1)Schedule A (Form 5500)is not needed if the plan covers only: (a)

an individual, or an individual and his orher spouse, who wholly owns a trade orbusiness, whether incorporated orunincorporated; or (b) a partner(s) in apartnership, or a partner(s) and his or herspouse.

(2)A Schedule A (Form 5500) is notrequired to be filed with the Form 5500or Form 5500-C/R if a Schedule A (Form5500) is filed for the contract as part ofthe master trust or 103-12 IE informationfiled directly with DOL.

Do not file a Schedule A (Form 5500)with a Form 5500EZ.

Schedule B (Form 5500), ActuarialInformation, must be attached to Form5500, 5500-C/R, or 5500EZ for mostdefined benefit pension plans. See theinstructions for Schedule B.

Schedule C (Form 5500), ServiceProvider and Trustee Information, mustbe attached to Form 5500. See item 25and the instructions for Schedule C.

Schedule E (Form 5500), ESOPAnnual Information, must be attached toForm 5500, 5500-C/R, or 5500EZ for allpension benefit plans with ESOP

benefits. See the instructions forSchedule E.

Schedule F (Form 5500), FringeBenefit Plan Annual Information Return,must be attached to page 1 of Form5500 or 5500-C/R for all fringe benefitplans.

Schedule G (Form 5500), FinancialSchedules, may be attached to Form5500 when a Yes is checked for anyitem in 27a through 27f. The Schedule Gis optional for 1992 (you may use theschedules specified in the instructionsfor item 27 instead); however, for planyears beginning in 1993, you arerequired to report this information on the

Schedule G (Form 5500). Schedule SSA (Form 5500), AnnualRegistration Statement IdentifyingSeparated Participants With DeferredVested Benefits, may be needed forseparated participants. See When ToReport Separated Participants in theinstructions for Schedule SSA.

Schedule P (Form 5500), AnnualReturn of Fiduciary of Employee BenefitTrust, must be filed by any fiduciary(trustee or custodian) of an organizationthat is qualified under Code section401(a) and exempt from tax under Codesection 501(a) who wants to protect the

organization under the statute oflimitations provided in Code section6501(a). You must enter the EIN of thetrust on line 2b of Schedule P.

File the Schedule P (Form 5500) as anattachment to Form 5500, 5500-C/R, or5500EZ for the plan year in which thetrust year ends.

Other Filings

Certain investment arrangements foremployee benefit plans file financialinformation directly with DOL. These


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arrangements include common/collectivetrusts, pooled separate accounts, mastertrusts, and 103-12 IEs. Definitions ofthese investment arrangements may befound on page 4. Their DOL filingrequirements are described below.

Common/collective trust and pooledseparate account information to befiled directly with DOL.Financialinstitutions and insurance carriers filingthe statement of the assets and liabilitiesof a common/collective trust or pooled

separate account should identify thetrust or account by providing the EIN ofthe trust or account, or (if more than onetrust or account is covered by the sameEIN) both the EIN and any additionalnumber assigned by the financialinstitution or insurance carrier (such as:99-1234567 Trust No. 1); and a list of allplans participating in the trust oraccount, identified by the plan number,EIN, and name of the plan sponsor. Thedirect filing should be addressed to:

Common/Collective Trust (OR)Pooled Separate AccountPension and Welfare BenefitsAdministration

U.S. Department of Labor, Room N5644200 Constitution Avenue, NWWashington, DC 20210

Master trust information to be fileddirectly with DOL.The followinginformation with respect to a mastertrust must be filed with DOL by the planadministrator or by a designee, such asthe administrator of another planparticipating in the master trust or thefinancial institution serving as trustee ofthe master trust, no later than the dateon which the plans return/report is due.While only one copy of the requiredinformation should be filed for all plansparticipating in the master trust, theinformation is an integral part of thereturn/report of each participating plan,and the plans return/report will not bedeemed complete unless all theinformation is filed within the prescribedtime.

Note: If a master trust investmentaccount consists solely of one plansasset(s) during the reporting period, theplan may report the(se) asset(s) either asan investment account to be reported aspart of the master trust report fileddirectly with DOL oras a plan asset(s)that is not part of the master trust (andtherefore subject to all instructions

pertaining to assets not held in a mastertrust).

Each of the following statements andschedules must indicate the name of themaster trust and the name of the mastertrust investment account. Theinformation shall be filed with DOL bymailing it to:

Master TrustPension and Welfare BenefitsAdministration

U.S. Department of Labor, Room N5644

200 Constitution Avenue, NWWashington, DC 20210

1. The name and fiscal year of themaster trust and the name and addressof the master trustee.

2. A list of all plans participating in themaster trust, showing each plans name,EIN, PN, and its percentage interest ineach master trust investment account asof the beginning and end of the fiscalyear of the master trust ending with orwithin the plan year.

3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in themaster trust.

4. A statement, in the same format asPart I of Schedule C (Form 5500), foreach master trust investment accountshowing amounts of compensation paidduring the fiscal year of the master trustending with or within the plan year topersons providing services with respectto the investment account andsubtracted from the gross income of theinvestment account in determining thenet increase (decrease) in net assets ofthe investment account.

5. A statement for each master trustinvestment account showing the assetsand liabilities of the investment accountat the beginning and end of the fiscalyear of the master trust ending with orwithin the plan year, grouped in thesame categories as those specified initem 31 of Form 5500.

6. A statement for each master trustinvestment account showing the incomeand expenses, changes in net assets,and net increase (decrease) in net assetsof each such investment account duringthe fiscal year of the master trust endingwith or within the plan year, in thecategories specified in item 32 of Form

5500. In place of item 32a, show thetotal of all transfers of assets into theinvestment account by participatingplans. In place of item 32j, show thetotal of all transfers of assets out of theinvestment account by participatingplans.

7. Schedules, in the format set forth inthe instructions for item 27 of Form5500, of the following items with respectto each master trust investment accountfor the fiscal year of the master trustending with or within the plan year:assets held for investment, nonexemptparty-in-interest transactions, defaultedor uncollectible loans and leases, and5% transactions involving assets in theinvestment account. The 5% figure shallbe determined by comparing the currentvalue of the transaction at thetransaction date with the current valueof the investment account assets at thebeginning of the applicable fiscal year ofthe master trust.

103-12 IE information to be fileddirectly with DOL.The informationdescribed below must be filed with theDOL by the sponsor of the 103-12 IE nolater than the date on which the plans

return/report is due before the planadministrator can elect the alternativemethod of reporting. While only onecopy of the required information shouldbe filed for the 103-12 IE, theinformation is an integral part of thereturn/report of each plan electing thealternative method of compliance. Thefiling address is:

103-12 Investment EntityPension and Welfare BenefitsAdministration

U.S. Department of Labor, Room N5644200 Constitution Avenue, NWWashington, DC 20210

1. The name, fiscal year, and EIN ofthe 103-12 IE and the name andaddress of the sponsor of the 103-12 IE.If more than one 103-12 IE is coveredby the same EIN, they shall besequentially numbered as follows:99-1234567 Entity No. 1.

2. A list of all plans participating in the103-12 IE, showing each plans name,EIN, PN, and its percentage interest inthe 103-12 IE as of the beginning andend of the fiscal year of the 103-12 IEending with or within the plan year.

3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in the103-12 IE.

4. A statement, in the same format asPart I of Schedule C (Form 5500), for the103-12 IE showing amounts ofcompensation paid during the fiscal yearof the 103-12 IE ending with or withinthe plan year to persons providingservices to the 103-12 IE.

5. A statement showing the assetsand liabilities at the beginning and endof the fiscal year of the 103-12 IE endingwith or within the plan year, grouped inthe same categories as those specified

in item 31 of Form 5500.6. A statement showing the income

and expenses, changes in net assets,and net increase (decrease) in net assetsduring the fiscal year of the 103-12 IEending with or within the plan year,grouped in the same categories as thosespecified in item 32 of Form 5500. Inplace of item 32a, show the total of alltransfers of assets into the 103-12 IE byparticipating plans. In place of item 32j,show the total of all transfers of assetsout of the 103-12 IE by participatingplans.

7. Schedules, in the format set forth in

the instructions for item 27 of Form5500 (except item 27d) with respect tothe 103-12 IE for the fiscal year of the103-12 IE ending with or within the planyear. Substitute the term 103-12 IE inplace of the word plan whencompleting the schedules.

8. A report of an independent qualifiedpublic accountant regarding the aboveitems and other books and records ofthe 103-12 IE that meets therequirements of 29 CFR2520.103-1(b)(5).


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Section 3

Final Return/ReportIf all assets under the plan (includinginsurance/annuity contracts) have beendistributed to the participants andbeneficiaries or distributed to anotherplan (and when all liabilities for whichbenefits may be paid under a welfarebenefit plan have been satisfied), checkthe final return/report box at the top ofthe form filed for such plan. The year ofcomplete distribution is the last year areturn/report must be filed for the plan.For purposes of this paragraph, acomplete distribution will occur in theyear in which the assets of a terminatedplan are brought under the control ofPBGC.

For a defined benefit plan covered byPBGC, a PBGC Form 1 must be filedand a premium must be paid until theend of the plan year in which the assetsare distributed or brought under thecontrol of PBGC.

Filing the return/report marked Finalreturn and indicating that the plan

terminated satisfies the notificationrequirement of Code section 6057(b)(3).

Signature and DateThe plan administrator must sign anddate all returns/reports filed. The nameof the individual who signed as planadministrator must be typed or printedclearly on the line under the signatureline. In addition, the employer must signa return/report filed for a single-employerplan or a plan required to file onlybecause of Code section 6039D (i.e., fora fringe benefit plan).

When a joint employer-union board of

trustees or committee is the plansponsor or plan administrator, at leastone employer representative and oneunion representative must sign and datethe return/report.

Participating employers in amultiple-employer plan (other), who arerequired to file Form 5500-C/R, arerequired to sign the return/report. Theplan administrator need not sign theForm 5500-C/R filed by the participatingemployer.

ReproductionsOriginal forms are preferable, but a clear

reproduction of the completed form isacceptable. Sign the return/report after itis reproduced. All signatures must beoriginal.

Change in Plan YearGenerally only defined benefit pensionplans need to get prior approval for achange in plan year. (See Code section412(c)(5).) Rev. Proc. 87-27, 1987-1 C.B.769 explains the procedure forautomatic approval of a change in plan

year. A pension benefit plan that wouldordinarily need to obtain approval for achange in plan year under Code section412(c)(5) is granted an automaticapproval for a change in plan year if allthe following criteria are met:

1. No plan year exceeds 12 months.

2. The change will not delay the timewhen the plan would otherwise havebeen required to conform to therequirements of any statute, regulation,or published position of the IRS.

3. The trust, if any, retains its exemptstatus for the short period required toeffect the change, as well as for thetaxable year immediately preceding theshort period.

4. All actions necessary to implementthe change in plan year, including planamendment and a resolution of theboard of directors (if applicable), havebeen taken on or before the last day ofthe short period.

5. No change in plan year has beenmade for any of the preceding planyears.

6. In the case of a defined benefit

plan, deductions are taken inaccordance with section 5 of Rev. Proc.87-27.

For the first return/report that is filedfollowing the change in plan year, checkthe box on line C at the top of the form.

Amended Return/ReportIf you file an amended return/report,check box A(2) an amendedreturn/report at the top of the form.When filing an amended return, be sureto answer all questions and put a circlearound the item numbers that have beenamended.

How The AnnualReturn/Report InformationMay Be UsedAll Form 5500 series return/reports willbe subjected to a computerized review.It is, therefore, in the filers best interestthat the responses accurately reflect thecircumstances they were designed toreport. Annual reports filed under Title Iof ERISA must be made available byplan administrators to plan participantsand by the Department of Labor to thepublic pursuant to ERISA section 104.

Section 4Important: Answer all items on theForm 5500 with respect to the plan year,unless otherwise explicitly stated in theitem-by-item instructions or on the formitself. Therefore, your responses usuallyapply to the year entered or printed atthe top of the first page of the form.Yes or No questions must be markedeither Yes or No, but not both. N/Acannot be used to respond to a Yes orNo question that is required to be

answered by the filer as specified onpage 6 under Items To Complete OnForm 5500.

Information at the Top of theFormFirst Line at the top of the formComplete the space for dates when:(1) the 12-month plan year is not acalendar year, or (2) the plan year is lessthan 12 months (a short plan year).

A. Check box (1) if this is the initialfiling for this plan. Do not check this boxif you have ever filed for this plan even ifit was on a different form (Form 5500 vs.Form 5500-C or Form 5500-R).

Check box (2) if you have already filedfor the 1992 plan year and are nowsubmitting an amended return/report tocorrect errors and/or omissions on thepreviously filed return/report.

Check box (3) if the plan no longerexists to provide benefits. See Section 3above for instructions concerning therequirement to file a final return/report.

Check box (4) if this form is being filedfor a period of less than 12 months andshow the dates at the top.

B. Check this box if you make anychanges to the preprinted information onpage 1. Changes should be highlightedor entered in red ink if possible.

C. Check this box if the plan year hasbeen changed since the lastreturn/report was filed.

D. Check this box if you filed for anextension of time to file this form. Attacha copy of the approved Form 5558 or acopy of the employers extension of timeto file the income tax return if you areusing the exception in Extension ofTime to File on page 2 of these

instructions.

Line-By-Line InstructionsThe numbers of the followinginstructions are the same as the itemnumbers on the return/report.

Page 1

Check the preprinted information for 1athrough 6d for accuracy andcompleteness. Cross out any incorrectinformation and enter the correctinformation. Add any incompleteinformation in red ink if possible.

If you did not receive a Form 5500with a preprinted page one, completeitems 1 through 6d as follows:

1a. Enter the name and address of theplan sponsor. If the plan covers only theemployees of one employer, enter theemployers name. If the Post Office doesnot deliver mail to the street addressand the sponsor has a P.O. box, showthe box number instead of the streetaddress.

The term plan sponsor means


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The employer, for an employee benefitplan that a single employer establishedor maintains;

The employee organization in the caseof a plan of an employee organization; or

The association, committee, jointboard of trustees, or other similar groupof representatives of the parties whoestablish or maintain the plan, if the planis established or maintained jointly byone or more employers and one or moreemployee organizations, or by two or

more employers.Include enough information in item

1(a) to describe the sponsor adequately.For example, Joint Board of Trustees ofLocal 187 Machinists rather than justJoint Board of Trustees.

For group insurance arrangements,enter the name of the trust or otherentity that holds the insurance contracts.In addition, attach a list of allparticipating employers and their EINs.

A group insurance arrangement is anarrangement which provides benefits tothe employees of two or moreunaffiliated employers (not in connection

with a multiemployer plan or amultiple-employer collectively bargainedplan), fully insures one or more welfareplans of each participating employer,and uses a trust (or other entity such asa trade association) as the holder of theinsurance contracts and the conduit forpayment of premiums to the insurancecompany.

1b. Enter the nine-digit employeridentification number (EIN) assigned tothe plan sponsor/employer. For example,00-1234567.

Employers and plan administratorswho do not have an EIN should applyfor one on Form SS-4, Application for

Employer Identification Number. FormSS-4 can be obtained at most IRS orSocial Security Administration (SSA)offices. Send Form SS-4 to the InternalRevenue Service Center where this Form5500 will be filed.

A plan of a controlled group ofcorporations whose sponsor is morethan one of the members of thecontrolled group should insert only theEIN of one of the sponsoring members.This EIN must be used in all subsequentfilings of the annual returns/reports forthe controlled group unless there is achange in the sponsor.

If the plan sponsor is a group ofindividuals, get a single EIN for thegroup. When you apply for a number,enter on line 1 of Form SS-4 the nameof the group, such as Joint Board ofTrustees of the Local 187 MachinistsRetirement Plan.

Note: Although EINs for funds (trusts orcustodial accounts) associated withplans are generally not required to befurnished on the Form 5500 seriesreturns/reports, the IRS will issue EINsfor such funds for other reporting

purposes. EINs may be obtained by filingForm SS-4 as explained above.

Plan sponsors should use the trustEIN described in the Note above whenopening a bank account or conductingother transactions for a trust thatrequires an EIN.

1d. From the list of business codes onpages 23 and 24, enter the one thatbest describes the nature of theemployers business. If more than oneemployer is involved, enter the business

code for the main business activity.1e. Plans entering entity code A or B

in item 4 must enter the first six digits ofthe CUSIP (Committee on UniformSecurities Identification Procedures)number, issuer number, if one hasbeen assigned to the plan sponsor forpurposes of issuing corporate securities.CUSIP issuer numbers are assigned tocorporations and other entities that issuepublic securities listed on stockexchanges or traded over the counter.The CUSIP issuer number is the first sixdigits of the number assigned to theindividual securities that are traded. Ifthe plan sponsor has no CUSIP issuer

number, enter N/A.2a. If the document constituting the

plan appoints or designates a planadministrator other than the sponsor,enter the administrators name andaddress. If the plan administrator is alsothe sponsor, enter Same. If filing as agroup insurance arrangement, enterSame. If Same is entered on 2a,leave items 2b and 2c blank.

The term administrator means

The person or group of personsspecified as the administrator by theinstrument under which the plan isoperated;

The plan sponsor/employer if anadministrator is not so designated; or

Any other person prescribed byregulations of the Secretary of Labor ifan administrator is not designated and aplan sponsor cannot be identified.

2b. A plan administrator must have anEIN for reporting purposes. Enter theplan administrators nine-digit EIN here.If the plan administrator does not havean EIN, apply for one as explained in 1babove.

Employees of an employer are notplan administrators unless so designatedin the plan document, even though they

engage in administrative functions of theplan. If an employee of the employer isdesignated as the plan administrator,that employee must get an EIN.

3. If the plan sponsors/administratorsname, address, and EIN have changedsince the last return/report was filed forthis plan, enter the plansponsors/administrators name, address,and EIN as it appeared on the lastreturn/report filed for this plan.

3c. Indicate if the change in 3a is onlya change in sponsorship. Change in

sponsorship means the plans sponsorhas been changed but no assets orliabilities have been transferred toanother plan(s), the plan has notterminated or merged with any otherplan, and so forth. Therefore, the plan isnow the responsibility of the newsponsor whose name is entered in item1a of this return/report.

4. Plan Entity Code.From thefollowing list of plan entities choose theone that describes your plan entity and

enter that code in item 4.Entity Code

Single-employer plan A

Plan of controlled group of corporationsor common control employers B

Multiemployer plan C

Multiple-employer-collectively-bargained plan D

Multiple-employer plan (other) E

Group insurance arrangement(of welfare plans) F

5a. Enter the formal name of the plan,group insurance arrangement, or enoughinformation to identify the plan. Thisname should not exceed 70 characters.If the present plan name exceeds 70

characters and spaces, try to abbreviateit.

5b. Enter the date the plan firstbecame effective.

5c. Enter the three-digit number theemployer or plan administrator assignedto the plan. All welfare benefit plannumbers and Code section 6039D plannumbers start at 501. All other plansstart at 001.

Once you use a plan number, continueto use it for that plan on all future filingswith the IRS, DOL, and PBGC. Do notuse it for any other plan even if youterminated the first plan.

6a. Welfare Benefit Plan Codes.Check this box and enter every codefrom the list below that describes thewelfare benefit plan for which thisreturn/report is being filed.

Example: If your plan provides healthinsurance, life insurance, dentalinsurance, and eye examinations, thefour codes A, B, D, and E should beentered. If your plan has a benefit notdescribed by one of the codes, enterZ and write in a description of thisbenefit in the space provided.

Type of Welfare Plan Code

Health (other than dental or vision) A

Life insurance BSupplemental unemployment C

Dental D

Vision E

Temporary disability (accident and sickness) F

Prepaid legal G

Long-term disability H

Severance pay I

Apprenticeship and training J

Scholarship (funded) K

Death benefits (other than life ins.) L

Taft-Hartley Financial Assistancefor Employee Housing Expenses P

Other (specify on page 1) Z


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Page 10

6b. Pension Benefit Plan Codes.Check this box and enter the codesfrom the list below that describe thetype of benefits for which the Form 5500is being filed.

Note: Filers who previously used code 7must enter the applicable code below. Apension plan must be either a definedbenefit or a defined contribution plan.

Type of Pension Benefit Plan Code

Defined benefit 1

Defined ContributionProfit-sharing 2

Stock bonus 3

Target Benefit 4

Other money purchase 5

Other (specify on page 1) 6

Other

Defined benefit plan with benefitsbased partly on balance of separateaccount of participant (Code section414(k)) 7

Annuity arrangement of certainexempt organizations (Code section403(b)(1)) 8

Custodial account for regulatedinvestment company stock (Codesection 403(b)(7)) 9

Pension plan utilizing individualretirement accounts or annuities(described in Code section 408) asthe sole funding vehicle forproviding benefits 0

6c. Pension Plan Feature Codes.Enter the code(s) from the list below thatdescribes the pension plan features.

Type of Pension Plan Feature Code(see descriptions and codes below)

Employee Stock Ownership Plan (ESOP) A

Leveraged ESOP B

Participant-Directed Account Plan C

Pension Plan maintained outside the USA D

Plan covering Self- Employed individuals E

Affiliated Service Group (Code section 414(m)(2)) F

401(k) Plan(Plan containing a cash or deferredarrangement) G

Top-Heavy plan (in 1984 or subsequent planyear) H

Plan with Permitted Disparity Provisions(See Codesections 401(a)(5) and 401(1) I

Master plan J

Prototype plan K

Regional Prototype plan L

If you enter code A or B, you mustcomplete Schedule E (Form 5500) andattach it to the Form 5500 you file forthis plan.

Enter code B for a leveraged ESOP ifthe plan acquires employer securitieswith borrowed money or otherdebt-financing techniques.

Enter code C for a pension plan thatprovides for individual accounts andpermits a participant or beneficiary toexercise independent control over theassets in his or her account (see ERISAsection 404(c)).

Enter Code D for a pension benefitplan maintained outside the UnitedStates primarily for nonresident aliens.See Kinds of Filers on page 3 for moreinformation.

Enter code F for a plan of an AffiliatedService Group. In general, Code section414(m)(2) defines an affiliated servicegroup as a first service organization(FSO) that has:

1. A service organization (A-ORG) thatis a shareholder or partner in the FSOand that regularly performs services forthe FSO, or is regularly associated withthe FSO in performing services for thirdpersons, and/or

2. Any other organization (B-ORG) if:

a. A significant portion of the businessof that organization consists ofperforming services for the FSO orA-ORG of a type historically performedby employees in the service field of theFSO or A-ORG, and

b. 10% or more of the interest of theB-ORG is held by persons who arehighly compensated employees of theFSO or A-ORG.

An affiliated service group alsoincludes a group consisting of anorganization whose principal business isperforming management functions foranother organization (or one organization

and other related organizations) on aregular and continuing basis, and theorganization for which such functionsare so performed by the organization.For a plan maintained by more than oneemployer, check Yes if any suchemployer is a member of an affiliatedservice group.

Enter Code G for a cash or deferredarrangement described under Codesection 401(k) that is part of a qualifieddefined contribution plan that providesfor an election by employees to deferpart of their compensation or receivethese amounts in cash.

Enter Code H if the plan is top heavy.

A top-heavy plan is a plan that duringany plan year is:

a. Any defined benefit plan if, as ofthe determination date, the presentvalue of the cumulative accrued benefitsunder the plan for key employeesexceeds 60% of the present value of thecumulative accrued benefits under theplan for all employees; and

b. Any defined contribution plan if, asof the determination date, the aggregateof the accounts of key employees underthe plan exceeds 60% of the aggregateof the accounts of all employees underthe plan.

Each plan of an employer included ina required aggregation group must betreated as a top-heavy plan if suchgroup is a top-heavy group. Seedefinitions of required aggregation groupand top-heavy group, below.

A key employee is any participant inan employer plan who at any time duringthe plan year, or any of the 4 precedingyears, is:

a. An officer of the employer havingan annual compensation greater than50% of $112,221, the defined benefit

dollar limitation for 1992 under Codesection 415(b)(1)(A),

b. One of the 10 employees havingannual compensation from the employergreater than $30,000, the definedcontribution dollar limitation for 1992under Code section 415(c)(1)(A) andowning (or considered as owning withinthe meaning of Code section 318) thelargest interests in the employer,

c. A 5% owner of the employer, or

d. A 1% owner of the employer having

an annual compensation from theemployer of more than $150,000.

In determining whether an individual isan officer of the employer, no more than50 employees, or, if less, the greater of 3employees or 10% of the employees,are to be treated as officers. See Codesection 416(i) and T-12 of Regulationssection 1.416-1. A key employee will notinclude any officer or employee of agovernmental plan under Code section414(d).

A required aggregation groupconsists of:

a. Each plan of the employer in which

a key employee is or was a participant,and

b. Each other plan of the employerwhich enables a plan to meet therequirements for nondiscrimination incontributions or benefits under Codesection 401(a)(4), or the participationrequirements under Code section 410.

A top-heavy group is an aggregationgroup if, as of the determination date,the sum of the present value of thecumulative accrued benefits for keyemployees under all defined benefitplans included in such group and theaggregate of the accounts of keyemployees under all defined contributionplans in such group exceeds 60% of asimilar sum determined for allemployees. To determine if a plan istop-heavy, include distributions made inthe 5-year period ending on thedetermination date. However, do nottake into account accrued benefits foran individual who hasnt performedservices for the employer during the5-year period ending on thedetermination date.

A qualified plan must limit the annualcompensation of each employee takeninto account for this year to $228,860adjusted annually for the cost of living.

The family members (spouse and linealdescendents under age 19) of 5%owners or one of the 10 most highlycompensated employees are treated asa single employee. Qualified plans mustcomply with this requirement inoperation even if the plan has not yetbeen amended to comply with the TaxReform Act of 1986.

6d. Fringe Benefit Plan.Completeonly page 1 (items 1 through 5 and 6d)AND Schedule F (Form 5500) for a Form5500 filed only because of Code section


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6039D. Check this box and see page 6for additional instructions on Items ToComplete on Form 5500 for a fringebenefit plan.

6e. See pages 4 through 7 fordefinitions and other informationpertaining to master trusts, 103-12investment entities, common/collectivetrusts and pooled separate accounts.Also see the instructions for items 25through 32 for specific reportingrequirements for plans which utilize

these entities.6e(1). In the space provided in line 6e,enter the name of the trust and financialinstitution. Also enter the city and statewhere the trust is maintained. (SeeMaster Trust on page 4 for moreinformation.)

6e(2). In the space provided in line 6e,enter the name and address of the103-12 IE. (See pages 6 and 7 for103-12 IE instructions.)

6f. For single-employer pension plans,enter the date the employers tax yearends. For example, if the tax year is acalendar year, enter 12-31-92. For allplans with more than one employer,enter N/A.

6g and 6h. A defined benefit plan isgenerally either subject to the minimumfunding requirements under section 412or is a fully insured plan that is exemptfrom the minimum funding requirementsunder section 412(i). However, a plan isconsidered a 412(i) plan whether or notall or part of the plan is trusteed or anoninsured top-heavy side fund ismaintained. All such plans must checktheir 412(i) status in item 6g. Check box6h if any part of the plan that wasformerly subject to the minimum fundingrequirements under section 412 for

either of the prior two plan years hasbecome exempt under section 412(i).

Note. All defined benefit plans subject tothe minimum funding requirementsunder Section 412 must complete item15a and attach Schedule B (Form 5500).Also complete item 15a and attachSchedule B (Form 5500) for all 412(i)plans where all premiums for the planyear required under section 412(i) havenot been paid before lapse of anyinsurance contract under the plan and/orwhere a noninsured top-heavy side fundis maintained.

7. The description of participant inthe instructions below is only forpurposes of item 7 of this form.

For welfare plans, the number ofparticipants should be determined byreference to 29 CFR 2510.3-3(d).Dependents are considered to be neitherparticipants nor beneficiaries. Forpension benefit plans, alternatepayees entitled to benefits under aqualified domestic relations order are notto be counted as participants for thisitem.

Participant means any individualwho is included in one of the categoriesbelow.

7a. Active participants include anyindividuals who are currently inemployment covered by a plan and whoare earning or retaining credited serviceunder a plan. This category includes anyindividuals who are: (1) currently belowthe integration level in a plan that isintegrated with social security, and/or(2) eligible to elect to have the employer

make payments to a Code section401(k) qualified cash or deferredarrangement. Active participants alsoinclude any nonvested individuals whoare earning or retaining credited serviceunder a plan. This category does notinclude nonvested former employeeswho have incurred the break in serviceperiod specified in the plan.

For determining if active participantsare fully vested, partially vested, ornonvested, consider vesting in employercontributions only.

7b. Inactive participants receivingbenefits are any individuals who areretired or separated from employment

covered by the plan and who arereceiving benefits under the plan. Thisincludes former employees who arereceiving group health continuationcoverage benefits pursuant to Part 6 ofERISA who are covered by the employeewelfare benefit plan. This category doesnot include any individual to whom aninsurance company has made anirrevocable commitment to pay all thebenefits to which the individual isentitled under the plan.

7c. Inactive participants entitled tofuture benefits are individuals who areretired or separated from employment

covered by the plan and who areentitled to begin receiving benefits underthe plan in the future. This categorydoes not include any individual to whoman insurance company has made anirrevocable commitment to pay all thebenefits to which the individual isentitled under the plan.

7e. Deceased participants are anydeceased individuals who had one ormore beneficiaries who are receiving orare entitled to receive benefits under theplan. This category does not include anindividual if an insurance company hasmade an irrevocable commitment to payall the benefits to which the beneficiaries

of that individual are entitled under theplan.

7g. Enter the number of participantsincluded in line 7f who have accountbalances at the end of the plan year. Forexample, for a Code section 401(k) plan,the number entered on line 7g should bethe number of participants counted inline 7f who have made a contribution tothe plan during this plan year or anyprior plan year.

7h. Include any participant whoterminated employment during this plan

year, whether or not the participantincurred a break in service.

7i(1). If Yes, file Schedule SSA (Form5500) as an attachment to Form 5500.Plan administrators: Code section6057(e) provides that the planadministrator must give each participanta statement showing the sameinformation reported on Schedule SSAfor that participant.

8a. Check Yes if an amendment tothe plan was adopted regardless of the

effective date of the amendment.8b. Enter the date the most recent

amendment was adopted regardless ofthe date of the amendment or theeffective date of the amendment.

8c. Check Yes only if the accruedbenefits were retroactively reduced. Forexample, a plan provides a benefit of2% for each year of service, but theplan is amended to change the benefitto 112% a year for all years of serviceunder the plan. Do not check Yes ifaccrued benefits were retroactivelyreduced solely to the extent permittedunder a model amendment provided inIRS Notice 88-131, 1988-2 C.B. 546.

8d. Check Yes only if an amendmentchanged the information previouslyprovided to participants by the summaryplan description or summary descriptionof modifications.

8e. A revised summary plandescription or summary description ofmodifications must be filed with the DOLand distributed to all participants andpension plan beneficiaries no later than210 days after the close of the plan yearin which the amendment(s) wasadopted. If the material was distributedand filed since the amendments wereadopted (even if after the end of the

plan year), check Yes to item 8e.9a. Check Yes if the plan was

terminated or if the plan was merged orconsolidated into another plan. Enter theyear of termination if applicable.

9b. If the plan was terminated but allplan assets were not distributed, areturn/report must be filed for each yearthe plan has assets. In that case, thereturn/report must be filed by the planadministrator, if designated, or by theperson or persons who actually controlthe plans property.

If all plan assets were used to buyindividual annuity contracts and the

contracts were distributed to theparticipants, check Yes.

If all the plan assets were legallytransferred to the control of another planor brought under the control of PBGC,check Yes.

Do not check Yes for a welfarebenefit plan that is still liable to paybenefits for claims that were incurredprior to the termination date, but not yetpaid. See 29 CFR 2520.104b-2(g)(2)(ii).


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9h. The Code provides for anondeductible excise tax on a reversionof assets from a qualified plan.

9i. The employer must report thereversion by filing Form 5330 and payany applicable tax. The tax will not beimposed on employers who aretax-exempt entities under Code section501(a). See the instructions for Form5330.

10a. If this plan was merged orconsolidated into another plan(s), or plan

assets or liabilities were transferred toanother plan(s), indicate which otherplan or plans were involved.

10c. Enter the EIN of the sponsor(employer, if for a single-employer plan)of the other plan.

10e. Pension benefit plans must fileForm 5310-A, Notice of Merger,Consolidation, or Transfer of Plan Assetsor Liabilities, at least 30 days before anyplan merger or consolidation or anytransfer of plan assets or liabilities toanother plan.

Caution: There is a penalty for not filingForm 5310-A on time.

11. Funding Arrangement.Enter thecode for the funding arrangement usedby the plan for the plan year from the listbelow.

The funding arrangement is themethod used during the plan year forthe receipt, holding, investment, andtransmittal of plan assets prior to thetime the plan actually provides thebenefits promised under the plan. Forpurposes of items 11 and 12, the termtrust includes any fund or accountwhich receives, holds, transmits, orinvests plan assets other than anaccount or policy of an insurancecompany.

Note: An employee benefit plan thatenters code 2, 3, or 5 in item 11 and/or12 must attach aSchedule A (Form5500), Insurance Information, to provideinformation pertaining to each contractyear ending with or within the plan year.See the instructions for Schedule A(Form 5500).

Plan FundingArrangement

Codes

Trust 1

Trust and insurance 2

Insurance 3

Exclusively from general assetsof sponsor (unfunded) 4

Partially insured and partiallyfrom general assets of sponsor 5

Other 6

12. Benefit Arrangement.Enter thecode for the benefit arrangement usedby the plan for the plan year from the listbelow.

The benefit arrangement is themethod by which benefits were actuallyprovided during the plan year toparticipants by the plan. For example, ifall participants received their benefitsfrom a trust (as defined in 11 above) the

plans benefit arrangement code wouldbe 1. If some benefits come from atrust and some come from an insurancecompany, the code would be 2. If allbenefits were paid from an account orpolicy of an insurance company, thecode would be 3.

Plan BenefitArrangement

Codes

Trust 1

Trust and insurance 2

Insurance 3

Exclusively from general assetsof sponsor (unfunded) 4

Partially insured and partiallyfrom general assets of sponsor 5

Other 6

13a. Enter Yes if either thecontributions to the plan or the benefitspaid by the plan are subject to thecollective bargaining process, even if theplan is not established and administeredby a joint board of trustees. Enter Yeseven if only some of those covered bythe plan are members of a collectivebargaining unit that negotiates benefitlevels on its own behalf. The benefitschedules do not have to be identical for

all employees under the plan.13b. All plans that entered code C or

D on line 4 must enter the six-digit LMnumber to identify each sponsoringlabor organization that is a party to thecollective bargaining agreement. Otherplans that are maintained pursuant tocollective bargaining agreements shouldenter the appropriate LM number, ifavailable. The LM number is thesix-digit Labor-Management file numberentered by the sponsoring labororganization in item 1 of the Form LM-2or LM-3 (Labor Organization AnnualReport) filed with the Department of

Labor. Accordingly, the LM number(s)should be readily available from thesponsoring labor organization(s). If allsponsoring labor organizations LMnumbers cannot be entered in thespaces provided in item 13b on theform, enter the additional LM numberson a supplemental sheet to accompanythe Form 5500.

14. If either the funding arrangementcode (item 11) and/or the benefitarrangement code (item 12) is 2, 3, or 5,at least one Schedule A (Form 5500)must be attached to the Form 5500 filedfor pension and welfare plans to provideinformation concerning the contract year

ending with or within the plan year. Theinsurance company (or similarorganization) that provides benefits isrequired to provide the planadministrator with the informationneeded to complete the return/report,pursuant to ERISA section 103 (a)(2). Ifyou do not receive this information in atimely manner, contact the insurancecompany (or similar organization). Ifinformation is missing on Schedule A(Form 5500) due to a refusal to providethis information, note this on the

Schedule A. If there is no Schedule(s) Aattached, enter 0.

15b. If a waived funding deficiency isbeing amortized in the current plan year,do not complete (1), (2), and (3), butcomplete items 1, 2, 3, 7, and 9 ofSchedule B (Form 5500). An enrolledactuary does not have to sign ScheduleB under these circumstances.

15b(3). File Form 5330 with the IRS topay the excise tax on any fundingdeficiency. Caution: There is a penalty

for not filing Form 5330 on time.17a(1). Check Yes if the plan

distributed any annuity contracts. CheckYes even if the plan was terminated.

17a(2). If Yes was checked for item17a(1), the annuity contract mustprovide that all distributions from it willmeet the participant and spousalconsent requirements of Code section417. However, consent is not needed forthe distribution of the contract itself. Ifthe contracts contained the Codesection 417 requirements, check Yes.

17b. In general, distributions must bemade in the form of a qualified joint and

survivor annuity for life or a qualifiedpreretirement survivor annuity. Aqualified joint and survivor annuity for aparticipant who is not married is anannuity for the life of the participant.Check Yes if distributions in otherforms were made, even if thosedistributions were permissible (e.g.,because consent was obtained or wasnot required).

17c. Generally, within the 90 daysprior to the date of any benefit paymentor the date a loan was made to aparticipant, you must get the spousesconsent to the payment of the benefit orthe use of the accrued benefit to make

the loan. However, there are somecircumstances where obtaining thisspousal consent is not required. Thefollowing is a partial list ofcircumstances when spousal consent isnot required:

1. The participant is not married andno former spouse is required to betreated as a current spouse under aqualified domestic relations order issuedby a court.

2. The participants nonforfeitableaccrued benefit in the plan does nothave a present value of more than$3,500 at the time of distribution.

3. The benefit is paid in the form of aqualified joint and survivor annuity (i.e.,an annuity for the life of the participantwith a survivor annuity for the life of thespouse that is not less than 50% of, andis not greater than 100% of, the amountof the annuity that is payable during the

joint lives of the participant and thespouse). See Code section 417(b).

4. The payout is from a profit-sharingor stock bonus plan that pays thespouse the participants full accountbalance upon the participants death, an


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annuity payment is not elected by theparticipant, and the profit-sharing orstock bonus plan is not a transferee planwith respect to the participant (i.e., hadnot received a transfer from a plan thatwas subject to the consent requirementswith respect to the participant).

5. The participant had no serviceunder the plan after August 22, 1984.

17d. A plan may not eliminate asubsidized benefit or a retirement optionby plan amendment or plan termination.

18. If distributions were not made inaccordance with the joint and survivorannuity rules of Code sections 411(a)(11)and 417(e), answer No. If distributionsdid comply with Code sections411(a)(11) and 417(e), answer Yes. Ifno distributions were made, enter N/A.

19. The maximum annual benefit thatmay be provided under a defined benefitplan may not exceed the lesser of$112,221 or 100% of average annualcompensation. However, if benefitsbegin before the social securityretirement age, the $112,221 limit mustbe reduced as described in IRS Notice87-21, 1987-1 C.B. 458.

In addition, the dollar limitations willbe reduced for participants with fewerthan 10 years of participation in adefined benefit plan (i.e., a 10%reduction for each year under 10 yearsof participation).

For defined contribution plans, Codesection 415 now provides that the dollarlimit on annual additions to a qualifiedplan may not exceed the greater of$30,000 or 25% of the defined benefitdollar limit for such limitation year. Thelimitation for defined contributions plansunder section 415(c)(1)(A) remains at$30,000 for 1992 since the law provides

that it shall not be changed until thesection 415(b)(1)(A) limit ($112,221 for1992) for defined benefit plans exceeds$120,000.

Annual additions to a definedcontribution plan will, for yearsbeginning after December 31, 1986,include 100% of all after-tax employeecontributions. For participantsparticipating in plans of tax-exemptorganizations, the pre-Tax Reform Actlimits remain in effect.

The Tax Reform Act of 1986 providesthat a participants previously accruedbenefit wont be reduced merely

because of the reduction in dollar limitsor increases in required periods ofparticipation. The transitional rule appliesto an individual who was a participantprior to January 1, 1987, in a plan inexistence on May 5, 1986. If thisparticipants current accrued benefitexceeds the dollar limit under the TaxReform Act of 1986, but complies withprior law, then the applicable dollar limitfor the participant is equal to the currentaccrued benefit. The term currentaccrued benefit is defined as theparticipants accrued benefit as of the

close of the last limitation year beginningbefore Janua

us internal revenue service: i5500--1992

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