Form 5310 - Application For Determination For Terminating Plan Page 8
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138
Form 5310 (Rev. 12-2013)
Page
15
Last employer/sponsor contribution to the plan. Complete the following:
(a) Enter date
(b) Amount
(c) For plan year ending
Enter the total number of participants employed at any time during the plan year of termination and each of the 5 prior plan
16a
years on the schedule below. If all such participants were fully vested at all times during such years, do not complete lines
16a(1) through 16a(5), and instead enter “0” in line 6 of columns (i), (ii), (iii), (iv), (v) and (vi).
(i)
(ii)
(iii)
(iv)
(v)
(vi)
Enter Plan Year End
▶
a(1) Number at end of prior plan
year
a(2) Number added during the
plan year
a(3) Total. Add lines (1) and (2)
a(4) Number dropped during the
plan year
a(5) Number at end of plan year.
Subtract line (4) from line (3)
a(6) Total number of participants
in this plan separated from
vesting service during the
plan year without full vesting
Yes
No
b
Did line 16(a)(6) indicate that a participant separated without full vesting in the year of termination or any of the
past 5 years?
If “Yes,” attach a statement that provides the following information for each participant who had a
severance from employment without full vesting:
(1) Name of participant
(5) Years of vesting
(8) Amount of distribution
(2) Date of hire
(6) Vesting percentage
(9) Date of distribution
(7) Account balance or accrued benefit
(3) Date of termination
(10) Reason for termination
at the time of severance from
(4) Years of participation
employment
Note. Amounts in b(7) and b(8) should not include elective deferrals.
17
Miscellaneous:
Yes
No
a
As a result of the termination, are accrued benefits or account balances nonforfeitable as required under
section 411(d)(3)?
b
Do any amendments or actions that were not considered in a prior DL eliminate or reduce any section 411(d)(6)
protected benefits? If “Yes,” attach required statement.
c
If annuity contracts are distributed on plan termination, are the applicable consent, present value, waiver and
other rights and benefits protected by sections 401(a)(11) and 417 included in the annuity contracts?
d
Do the accrued benefits for each participant upon termination include the subsidized benefits that the
participant may become entitled to receive subsequent to the termination? Answer “No” if the plan does not
include subsidized benefits.
Were any plan assets contributed in the form of, or invested in, obligations or property of the employer
e
including any controlled group of corporations or group of trades or businesses under common control?
If “Yes,” attach a statement explaining how assets were valued.
5310
Form
(Rev. 12-2013)
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