Form 5310 - Application For Determination For Terminating Plan Page 4
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134
Form 5310 (Rev. 12-2013)
Page
4a
Name of plan (plan name cannot exceed 70 characters, including spaces):
b
c
Enter 3-digit plan number
Enter month on which the plan year ends (MM)
d
Enter plan’s original
e
Enter number of participants
effective date
If 100 or less, complete line 4f. Otherwise, go to line 5
Yes
No
Does the plan sponsor have no more than 100 employees who received at least $5,000 of compensation for
f
the preceding year?
If “Yes,” go to line 4g.
If “No,” go to line 5a(1).
g
Is at least one employee a non highly compensated employee?
5a (1)
Was this application filed in connection with a plan termination?
If “Yes,” attach copies of all actions taken to terminate the plan.
If “No,” do not submit this application.
(3) Date of board of directors
(2)
Proposed date of
action (or other
plan termination
documentation) formally
terminating the plan
b
Will plan assets be distributed as soon as administratively feasible?
c (1)
Will plan assets be, or have plan assets been, returned to the employer?
If “Yes,” complete lines 5c(2) and (3).
If “No,” go to line 6a.
(2)
Enter the estimated amount of plan assets to be returned to the employer .
.
.
.
.
.
.
▶
(3)
Has the employer established or does the employer intend to establish a Qualified Replacement Plan?
6a
Indicate the type of plan by entering the number from the list below.
(Use the lowest number from the list below applicable to the plan.)
1 – Pension Equity Plan (PEP)
5 – ESOP
9 – 401(k)
2 – cash balance conversion
6 – money purchase
10 – profit sharing plan
3 – cash balance (not converted)
7 – target benefit
4 – defined benefit but not cash balance
8 – stock bonus
5310
Form
(Rev. 12-2013)
11840Y12201304
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