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purposes of 410(b) using a Schedule Q

they have not attained the lowest

coverage tests purposes only if the

and Demo 5.

minimum age and service requirements

employee receives an allocation of

for any employee under this plan. If the

contributions or forfeitures or accrues a

Line 13a. If answered “Yes,” you

employer is separately testing the

benefit under the plan for the plan year.

must complete lines 13b through 13n

portion of a plan that benefits otherwise

with respect to each disaggregated

excludable employees, attach a

Certain other employees are treated

portion of the plan. Attach additional

separate schedule describing which

as benefiting if they fail to receive an

schedules as necessary to identify the

employees are treated as excludable

allocation of contributions and/or

other disaggregated portions of the

employees on account of the minimum

forfeitures, or to accrue a benefit, solely

plan. Provide the requested coverage

age and service requirements under

because they are subject to plan

information, in the same format as line

each separate portion of the plan.

provisions that uniformly limit plan

13, separately with respect to the other

benefits, such as a provision for

Line 13e(2). Enter the number of

portions of the plan, or to otherwise

maximum years of service, maximum

employees who are excluded because

show that the other portions of the plan

retirement benefits, application of

they are collectively bargained

separately satisfy section 410(b).

offsets or fresh start wear-away

employees as defined in Regulations

formulas, or limits designed to satisfy

Example. If this plan benefits the

section 1.410(b)-6(d)(2), regardless of

section 415. An employee is treated as

employees of more than one qualified

whether those employees benefit under

benefiting under a plan to which

separate line of business (QSLOB), the

the plan. For this purpose, an employee

elective contributions under section

portion of the plan benefiting the

covered under a CBA is not considered

401(k) or employee contributions and

employees of each QSLOB is treated

a collectively bargained employee if

matching contributions under section

as a separate plan maintained by that

more than 2% of the employees who

401(m) may be made if the employee is

QSLOB and must separately satisfy

are covered under the agreement are

currently eligible to make such elective

section 410(b) unless the

professional employees as defined in

or employee contributions, or to receive

employer-wide plan testing rule in

Regulations section 1.410(b)-9.

Regulations section 1.414(r)-1(c)(2)(ii)

a matching contribution, whether or not

Line 13e(3). Enter the number of

applies.

the employee actually makes or

employees who do not receive an

receives such contributions

Note. If a determination is being

allocation or accrue a benefit under the

(Regulations section 1.401(k)-1(g)(4)

requested for a section 401(k) and/or

plan only because they do not satisfy a

and 1.401(m)-1(f)(4)). However, do not

401(m) plan, you must complete lines

minimum hours of service requirement

apply this rule to determine if an

13c-13l for the portion of the plan that is

or a last day of the plan year

employee is to be counted as benefiting

not a section 401(k) or a 401(m) plan.

requirement, provided they do not have

for the portion of the plan that is not a

Complete line 13m(1) to report the ratio

more than 500 hours of service, and

401(k) or 401(m) plan.

percentage for the section 401(k)

they are not employed on the last day

portion of the plan and line 13m(2) to

of the plan year.

Line 13k. See the instructions for line

report the ratio percentage for the

13i for the meaning of “benefiting under

section 401(m) portion of the plan.

Note. Do not enter on this line any

the plan.”

employees who have more than 500

Line 13c. If, for purposes of satisfying

hours of service, even if they are not

Line 13l. To obtain the ratio

the minimum coverage requirements of

employed on the last day of the plan

percentage:

section 410(b), you are applying the

year.

daily testing option in Regulations

Step 1. Divide the number on line

section 1.410(b)-8(a)(2) or the quarterly

Line 13e(4). If this plan benefits the

13k (nonexcludable NHCEs benefiting

testing option in Regulations section

employees of one QSLOB, enter on

under the plan) by the number on line

1.410(b)-8(a)(3), or, if you are using

this line the number of employees of

13j (nonexcludable NHCEs).

single-day “snapshot” testing as

the employer’s other QSLOBs. This is

permitted under section 3 of Rev. Proc.

Step 2. Divide the number on line

not applicable if the plan is tested under

93-42, 1993-2 C.B. 540, enter the most

the special rule for employer-wide plans

13i (nonexcludable HCEs benefiting

recent eight-digit date (MMDDYYYY)

in Regulations section

under the plan) by the number on line

for which the coverage data is

1.414(r)-1(c)(2)(ii).

13h (nonexcludable HCEs).

submitted. If you are applying the

Line 13e(5). Enter the number of

annual testing option in Regulations

Step 3. Divide the result from Step 1

section 1.410(b)-8(a)(4), enter the year

employees who are nonresident aliens

by the result from Step 2.

for which the coverage data is

who receive no earned income (as

Note. If the ratio percentage entered

submitted.

defined in section 911(d)(2)) from the

on line 13l and/or line 13m is less than

employer that constitutes income from

Line 13d. Include all employees of all

sources within the United States (as

70%, the plan does not satisfy the ratio

entities combined under sections

defined in section 861(a)(3)).

percentage test. In this case, the plan

414(b), (c), (m), or (o). Also include all

must satisfy the average benefit test. A

self-employed individuals, common law

Line 13g. “Nonexcludable employees”

determination regarding the average

employees, and leased employees as

are the employees who cannot be

benefit test can be requested using

defined in section 414(n) of any of the

excluded from the plan for statutory (for

Schedule Q.

entities above, other than those

example, age and service) or regulatory

excluded by section 414(n)(5). Certain

reasons and must be included even

Line 13m. To determine the ratio

individuals may also be required to be

though they might not benefit under the

percentages for the section 401(k) and

counted as employees. See the

plan.

all section 401(m) (matching and

definition of employee in Regulations

employee contribution) portions of the

Line 13h. Enter the number of

section 1.410(b)-9. Also see

plan, follow the steps described in the

nonexcludable employees on line 13g

Regulations section 1.410(b)-6(i), which

instructions for lines 13d through 13l,

who are highly compensated

may permit the employer to exclude

but treat an employee as benefiting

employees (HCEs) as defined in

certain former nonhighly compensated

under the rules for section 401(k) plans

section 414(q).

employees.

and section 401(m) plans described in

the instruction for line 13i.

Line 13e(1). Enter the number of

Line 13i. In general, an employee is

employees who are excluded because

treated as benefiting under the plan for

-6-

Instructions For Form 5300 - Application For Determination For Employee Benefit Plan - Department Of Treasury Page 6

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