Form 5310 - Application For Determination For Terminating Plan Page 9
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139
Form 5310 (Rev. 12-2013)
Page
(Line 17 continued)
Yes
No
Will distributions be made in a form other than cash, annuity contracts, and/or readily tradable marketable
f (1)
securities?
If line 17f(1) is “Yes,” complete lines 17f(2) and (3) below and attach a statement explaining how assets
were valued and how assets will be allocated.
If line 17f(1) is "No," skip to line 17g.
(2)
Were all participants given the option of taking this type of distribution?
(3)
Which section of the plan allows for this type of distribution?
If this is a DB plan, attach copies of the Adjusted Funding Target Attainment Percentage (AFTAP) certification(s) and the
Schedule SB (Form 5500), Single-Employer Defined Benefit Plan Actuarial Information, for the year of termination and the
prior two plan years and answer lines 17g(1) through 17g(3). If this is not a single employer DB plan that must comply with
section 436, skip to line 17(h)(1).
g (1)
Did the participants receive the proper notification under ERISA 101j?
Were any accelerated distributions made in any year when the plan was subject to benefit restrictions under
(2)
section 436(d)?
If 17g(2) is “Yes,” attach a statement providing the date and amount of distribution and the application
of the limits including remaining and deferred amounts.
(3)
Was the plan amended to increase liability for benefits that would result in an AFTAP below 80%?
If this is a DB or money purchase plan, do you estimate there will be an unpaid minimum required contribution
h (1)
or an accumulated funding deficiency as of the end of the plan year during which the proposed termination
date occurs if no additional plan contributions are made and no additional funding waiver is granted?
If line 17h(1) is “Yes,” complete lines 17h(2) through 17h(4) below.
If line 17h(1) is “No,” skip to line 17i.
Yes
No
(2)
Is there an estimated accumulated funding deficiency? If “Yes,” enter here
▶
Was a Form 5330, Return of Excise Taxes Related to Employee Benefit Plans, filed regarding this funding
(3)
deficiency?
Was a funding waiver granted?
(4)
If line 17h(3) or h(4) is “Yes,” attach a copy of Form 5330 or the waiver ruling.
i (1)
Will or have any plan assets been returned to the employer?
Has the terminating plan been involved in a spinoff or other transfer of assets or liabilities subject to section
(2)
414(l), within 60 months preceding the proposed date of termination?
If “Yes,” attach a list and an explanation of the transaction(s) involved and complete lines 17i(3)
through 17i(5).
If “No,” go to line 17i(6).
Was notice filed with the IRS on Form 5310-A, Notice of Plan Merger or Consolidation, Spinoff, or Transfer of
(3)
Plan Assets or Liabilities; Notice of Qualified Separate Lines of Business?
5310
Form
(Rev. 12-2013)
11840Y12201309
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