Form 5330 - Return Of Excise Taxes Related To Employee Benefit Plans Page 2
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Form 5330 (Rev. 10-2003)
Page
DUE DATE: The taxes listed on this page are due by the last day of the 7th month after the end of the tax year of the filer.
Part II
Tax on Nondeductible Employer Contributions to Qualified Plans (Section 4972)
13a
Total contributions for your tax year to your qualified (under section 401(a), 403(a), or 408(k), or
408(p)) plan
b
Amount allowable as a deduction under section 404
c
Subtract line 13b from line 13a
d
Enter amount of any prior year nondeductible contributions made for years
beginning after 12/31/86
e
Amount of any prior year nondeductible contributions for years beginning
after 12/31/86 returned to you in this tax year or any prior tax year
f
Subtract line 13e from line 13d
g
Amount of line 13f carried forward and deductible in this tax year
h
Subtract line 13g from line 13f
i
Tentative taxable excess contributions. Add lines 13c and 13h
j
Nondeductible section 4972(c)(6) or (7) contributions exempt from excise tax
k
Taxable excess contributions. Subtract line 13j from line 13i
l Multiply line 13k by 10%. Enter here and on line 1
Part III
Tax on Excess Contributions to Section 403(b)(7)(A) Custodial Accounts (Section 4973(a)(3))
14
Total amount contributed for current year less rollovers (see page 3 of the instructions)
15
Amount excludable from gross income under section 403(b) (see page 3 of the instructions)
16
Current year excess contributions. Subtract line 15 from line 14; but not less than zero
17
Prior year excess contributions not previously eliminated. If zero, go to line 21
18
Contribution credit. If line 15 is more than line 14, enter the excess; otherwise, enter -0-
19
Total of all prior years’ distributions out of the account included in your gross income under section
72(e) and not previously used to reduce excess contributions
20
Adjusted prior years’ excess contributions. Subtract the total of lines 18 and 19 from line 17
21
Taxable excess contributions. Add lines 16 and 20
22
Excess contributions tax. Enter the lesser of 6% of line 21 or 6% of the value of your account as
of the last day of the year. Enter here and on line 2
Part IV
Tax on Disqualified Benefits for Funded Welfare Plan (Section 4976) (See page 4 of instructions)
23
If your welfare benefit fund has provided a disqualified benefit during your taxable year, enter the
amount of the disqualified benefit here and on line 3
Part V
Tax on Certain ESOP Dispositions (Sections 4978, 4978A, and 4978B)
24a
Enter your section 4978 or 4978A tax on dispositions of employer securities by employee stock
ownership plans and certain worker-owned cooperatives here and on line 4a (see page 4 of the
instructions)
Check the box to indicate whether the tax applies as a result of the application of
Section 664(g)
Section 4978A
Section 1042
b Enter your section 4978B tax on dispositions of employer securities to which section 133 applied
here and on line 4b
Part VI
Tax on Certain Prohibited Allocations of Qualified ESOP Securities (Section 4979A) (See page 5 of instructions)
25
Enter 50% of the prohibited allocation or the allocation described in section 664(g)(5)(A), here and
on line 5
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