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Note. Pre-approved plans that are

principal business is the performance of

qualification purposes with the plan for

management functions for another

which a DL has been requested.

submitting a determination request

organization, including the reason for

under 3, 4, 5, (as shown in line 3a) or a

9. A description of how the plan(s)

volume submitter multiple employer

performing the management function or

satisfies the coverage requirements of

plan will be reviewed as if it had been

service.

section 410(b) if the members (or

filed on Form 5307. An IRS review of

2. The identification of other

possible members) of the ASG are

the application will not consider

members (or possible members) of the

considered part of an ASG with the

changes in the qualification

ASG.

employer.

requirements subsequent to the 2004

3. A description of the nature of the

10. A copy of any ruling issued by the

Cumulative List. See Announcement

business of each member (or possible

national office on whether the employer

2008-23, 2008-14 I.R.B. 731.

member) of the ASG including the type

is an ASG; a copy of any prior DL that

Line 3f. If more than four

of organization (corporation,

considered the effect of section 414(m)

amendments, list amendments on a

partnership, etc.) and indicate whether

on the qualified status of the employer’s

separate piece of paper using the same

such member is a service organization

plan; and, if known, a copy of any such

format as shown on the form and label

or an organization whose principal

ruling or DL issued to any other

as an “attachment to #3f.” If a plan or

business is the performance of

member (or possible member) of the

amendment is proposed, enter 9/9/

management functions for the other

same ASG, accompanied by a

9999 for the signature date but include

group member(s).

statement as to whether the facts upon

the intended effective date.

which the ruling or DL was based have

4. The ownership interests between

changed.

Line 3g. If an amendment has more

the employer and the members (or

•

than one effective date, use the earliest

possible members) of the ASG

Enter 4 if you are not certain whether

effective date.

(including ownership interests as

or not you have leased employees,

described in section 414(m)(2)(B)(ii) or

attach the following information:

Line 3h. If you do not have a copy of

414(m)(6)(B)).

the latest DL, or if no DL has ever been

1. A description of the nature of the

received by the employer, include

5. A description of services

business of the recipient organization;

copies of the prior plan or adoption

performed for employers by the

2. A copy of the relevant leasing

agreement and all subsequent

members (or possible members) of the

agreement(s);

amendments and/or restatements with

ASG, or vice versa. Include the

3. A description of the function of all

the application request.

percentage of each member’s (or

leased employees in the trade or

possible member’s) gross receipts and

Line 3i. If 3h is “Yes,” enter the date of

business of the recipient organization

service receipts provided by such

the last DL. The number of

(including data as to whether all leased

services, if available, and data as to

amendments should include any

employees are performing services on

whether their services are a significant

proposed amendments being

a substantially full-time basis);

portion of the member’s business and

submitted.

4. A description of facts and

whether or not, as of December 13,

Line 3k. If the relationship with the

circumstances relevant to a

1980, it was unusual for the services to

pre-approved sponsor was terminated,

determination of whether such leased

be performed by employees of

please provide the date the relationship

employees’ services are performed

organizations in that service field in the

was terminated.

under primary direction or control of the

United States.

Line 3n. Section 3001 of the

recipient organization (including

6. A description of how the

Employee Retirement Income Security

whether the leased employees are

employer and the members (or possible

Act of 1974 (ERISA) requires that

required to comply with instructions of

members) of the ASG associate in

applicants subject to section 410

the recipient about when, where, and

performing services for other parties.

provide evidence that each employee

how to perform the services, whether

who qualifies as an interested party has

the services must be performed by

been notified of the filing of the

a. A description of management

particular persons, whether the leased

application. If “Yes” is checked, it

functions, if any, performed by the

employees are subject to the

means that each employee has been

employer for the members (or possible

supervision of the recipient, and

notified as required by Regulations

members) of the ASG, or received by

whether the leased employees must

section 1.7476-1, this is a one-person

the employer from any other members

perform services in the order or

plan, or the plan is not subject to

(or possible members) of the group

sequence set by the recipient); and

section 410. A copy of the notice is not

(including data as to whether such

5. If the recipient organization is

required to be attached. If “No” is

management functions are performed

relying on any qualified plan(s)

checked or this line is blank, your

on a regular and continuous basis) and

maintained by the employee leasing

application will be returned.

whether or not it is unusual for such

organization for purposes of

Rules defining “interested parties”

management functions to be performed

qualification of the recipient

by employees of organizations in the

and the form of notification are in

organization’s plan, a description of the

Regulations section 1.7476-1. For an

employer’s business field in the United

plan(s) (including a description of the

example of an acceptable format, see

States.

contributions or benefits provided for all

Rev. Proc. 2011-6.

b. If management functions are

leased employees that are for services

performed for the recipient

Line 3u. If the parent has made the

performed by the employer for the

organization, plan eligibility, and

election to use their EIN for determining

members (or possible members) of the

vesting).

your remedial amendment cycle under

ASG, describe what part of the

•

Rev. Proc. 2007-44 provide the name

employer’s business constitutes the

Enter 5 if this is a request for the

and EIN of the parent.

performance of management functions

effect a potential partial termination will

for the members (or possible members)

have on the plan’s qualification. The

Line 3w. Even if a ruling is not being

of the group (including the percentage

“effective date” means the date the

requested on Schedule Q, Demo 8,

of gross receipts derived from

partial termination occurred. Enter this

submit a copy of the pertinent plan

management activities as compared to

date on line 3c.

provisions regarding the offset.

the gross receipts from other activities).

•

Enter 6 if a DL is requested on the

Line 4a. Due to space restrictions this

8. A brief description of any other

termination of a multi-employer plan

field is limited to 70 characters,

plan maintained by the members (or

covered by PBGC insurance. Also enter

including spaces. Please complete this

possible members) of the ASG, if such

the date the termination is effective on

item with how the plan name should

other plan is designated as a unit for

line 3d.

read on the DL to the extent permitted.

-4-

Instructions For Form 5300 - Application For Determination For Employee Benefit Plan - Department Of Treasury Page 4

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