PDF《5310》

5310 (Rev. 12-2013) Form

5310 (Rev. 12-2013) Page

4 4a Name of plan (plan name cannot exceed

70 characters, including spaces): b Enter 3-digit plan number c Enter month on which the plan year ends (MM) d Enter plan'

s original effective date e Enter number of participants If

100 or less, complete line 4f. Otherwise, go to line

5 Yes No f Does the plan sponsor have no more than

100 employees who received at least $5,000 of compensation for the preceding year? If Yes, go to line 4g. If No, go to line 5a(1). g Is at least one employee a non highly compensated employee? 5a (1) Was this application filed in connection with a plan termination? If Yes, attach copies of all actions taken to terminate the plan. If No, do not submit this application. (2) Proposed date of plan termination (3) Date of board of directors action (or other documentation) formally terminating the plan b Will plan assets be distributed as soon as administratively feasible? c (1) Will plan assets be, or have plan assets been, returned to the employer? If Yes, complete lines 5c(2) and (3). If No, go to line 6a. (2) Enter the estimated amount of plan assets to be returned to the employer (3) Has the employer established or does the employer intend to establish a Qualified Replacement Plan? 6a Indicate the type of plan by entering the number from the list below. (Use the lowest number from the list below applicable to the plan.)

1 C Pension Equity Plan (PEP)

2 C cash balance conversion

3 C cash balance (not converted)

4 C defined benefit but not cash balance

5 C ESOP

6 C money purchase

7 C target benefit

8 C stock bonus

9 C 401(k)

10 C profit sharing plan Form

5310 (Rev. 12-2013) Form

5310 (Rev. 12-2013) Page

5 (Line

6 continued) Yes No b (1) If the response to line 6a was 1, 2, 3, 4, 6, or 7, is the plan'

s normal retirement age below

62 at any time after 5/22/07? If Yes, go to line 6b(2). If No, go to line 6c(1). (2) Has the employer (or trustees, if this is a multiemployer plan) made a good faith determination that the plan'

s normal retirement age is not lower than an age that reasonably represents the typical retirement age for the industry in which the covered workforce is employed? If Yes, attach required statement. Governmental plans see instructions. c (1) If the response to line 6a was 5, mark the applicable box to indicate whether the plan sponsor is an S Corporation or a C Corporation. S Corp. C Corp. (2) If there has been a change to the corporate status (from S to C or C to S election/revocation), provide the effective date of such change. 7a (1) Is the plan sponsor a member of an affiliated service group (ASG), controlled group of corporations, or a group of trades or businesses under common control within the meaning of section 414(b) or (c)? If Yes, attach the required statement. (2) Is the plan sponsor a foreign entity or is the plan sponsor a member of an ASG, controlled group of corporations, or a group of trades or businesses under common control within the meaning of section 414(b) or (c) that includes a foreign entity? b Is this a governmental plan under section 414(d)? c (1) Is this a church plan under section 414(e)? If Yes, go to line 7c(2). If No, go to line 7d. (2) Was an election made by the church to have participation, vesting, funding, etc. provisions apply in accordance with section 410(d)? d Does this plan benefit any collectively bargained employees under Regulations section 1.410(b)-6(d)(2)? e Is this an insurance contract plan under section 412(e)(3)? f Is this a multiemployer plan under section 414(f)? g Is this a request for a ruling involving the termination of a plan with a section 401(h) feature? h (1) Is this a multiple employer plan under section 413(c)? If Yes, complete lines 7h(2) through 7h(5). If No, go to line 8a. (2) Enter the total number of participating employers. (3) Enter the number of participating employers submitting a Form