Form 5310 - Application For Determination For Terminating Plan Page 7
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137
Form 5310 (Rev. 12-2013)
Page
(Line 11 continued)
Yes
No
Does this plan contain a qualified automatic contribution arrangement (QACA) within the meaning of section
c
401(k)(13)?
Does this plan contain an eligible automatic contribution arrangement (EACA) within the meaning of section
d
414(w)?
e
Does this plan have matching contributions within the meaning of section 401(m)?
If “Yes,” go to line 11f.
If “No,” go to line 11g.
f
Does this plan satisfy the section 401(m) safe harbor?
g
Does this plan have after-tax employee voluntary contributions (section 401(m))?
h
Does this plan utilize the permitted disparity rules of section 401(l)?
i
Is this plan part of an offset arrangement with any other plans?
If “Yes,” attach the required statement.
j
Is the plan part of an eligible combined plan arrangement within the meaning of section 414(x)?
If “Yes,” include the EIN and Plan # of the other plan.
EIN:
Plan #:
Yes
No
12
Has this plan been involved in a merger, consolidation, spinoff, termination re-establishment, or a transfer of
plan, assets or liabilities that was not considered under a previous DL?
If “Yes,” submit the required attachment.
13a
Was the plan amended or restated to change the plan type?
If “Yes,” go to line 13b.
If “No,” go to line 14.
b
Was the change considered in a prior DL?
If "No," attach a statement explaining the change.
14
Indicate the reason for termination by marking the letter from the list below:
a. Change in ownership by merger
b. Liquidation or dissolution of employer
c. Change in ownership
d. Adverse business conditions (attach an explanation).
e. Adoption of new plan. Enter type of new plan .
.
▶
f. Other (specify)
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5310
Form
(Rev. 12-2013)
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