Form 5310 - Application For Determination For Terminating Plan Page 10
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1310
Form 5310 (Rev. 12-2013)
Page
(Line 17 continued)
Yes
No
Are the accrued benefits of all participants, in the other plan(s) included in line 17i(2), fully vested and
(4)
nonforfeitable as of the date of termination?
Have cash distributions or guaranteed annuity contracts been provided for all accrued benefits, as of the date
(5)
of this plan termination, of all participants in the other plan(s) included in line 17i(2)?
Have cash distributions or guaranteed annuity contracts been provided for all accrued benefits of all
(6)
participants in this plan?
If “Yes,” attach a statement providing the dates and amounts of these cash distributions or purchase of
annuity contracts.
If this is a DB plan, is it intended, or is it a fact, that any or all of the participants in the terminating plan will be
(7)
covered by a new or existing DB plan of the employer?
If “Yes,” go to line 17i(8).
If “No,” go to line 17i(9).
Does the new or existing transferee plan which received plan assets give full prior service credit for vesting
(8)
and benefit entitlement purposes?
Did the employer previously receive a reversion of assets upon termination of a DB plan in the past 15 years?
(9)
If “Yes,” attach an explanation.
Did any plan participant during the current plan year or in the 5 prior plan years receive a single-sum
j (1)
distribution or have an annuity contract purchased by the plan from an insurance company on his behalf?
(2)
If line 17j(1) is “Yes,” state the largest amount distributed or applied to purchase an annuity contract.
Does the value of plan assets at termination exceed the present value of the plan’s liabilities within the
k (1)
meaning of section 401(a)(2)?
If “Yes,” complete line 17k(2).
If “No,” skip to line 17l.
(2)
Is the excess value the result of a change in the plan provisions other than the termination of the plan?
If the plan has been top-heavy, have top-heavy minimum benefits accrued or minimum contributions been
l
made for non-key employees?
m
Do you maintain any other qualified plan under section 401(a)?
If “Yes,” attach required statement.
Yes
No
N/A
n (1)
For DC plans—Is this an applicable DC plan as defined in Regulations section 1.401(a)(35)-1(f)(2)?
If this is an applicable DC plan enter the section of the plan that contains the diversification language.
(2)
If the plan satisfies one of the exceptions noted in line 17n of the instructions, enter the relevant section(s)
(3)
of the plan.
5310
Form
(Rev. 12-2013)
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