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Form 5307 Application For Determination For Adopters Of Master Or Prototype Or Volumne Submitter Plans 5307 - Official Federal Forms
| Form 5307 Application For Determination For Adopters Of Master Or Prototype Or Volumne Submitter Plans Form. This is a national form and can be used in Department Of Treasury . |
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FILLABLE FIELD DATA SHOULD PRINT BLACK, NOT BLUE Form (Rev. March 2008) 5307 Department of the Treasury Internal Revenue Service Application for Determination for Adopters of Master or Prototype or Volume Submitter Plans (Under sections 401(a) and 501(a) of the Internal Revenue Code) OMB No. 1545-0202 For IRS Use Only Review the Procedural Requirements Checklist before submitting this application. 1a Number Assigned under Section 6.19 of Revenue Procedure 2007-6 - 1b Name of plan sponsor (employer if single-employer plan) 1c Address of plan sponsor (if a P.O. Box, see instructions) 1d City 1e State 1f Zip Code 1g Country 1k Employer's tax year end (MM) 1h Employer identification number 1i Telephone number 1j Fax number 2a Person to contact if more information is needed. (See instructions) (If a Power of Attorney is attached, check box and do not complete this line.) Contact person's name 2b Contact person's address 2c City 2d State 2e Zip Code 2f Telephone number 2g Fax number If more space is needed for any item, attach additional sheets the same size as this form. Identify each additional sheet with the plan sponsor's name and EIN and identify each item. Under penalties of perjury, I declare that I have examined this application, including accompanying statements and schedules, and to the best of my knowledge and belief, it is true, correct, and complete. SIGN HERE Date Type or print name Type or print title For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11832Y Form 5307 (Rev. 3-2008) *11832Y03200801* Form 5307 (Rev. 3-2008) Page 2 3a Determination requested for (enter applicable number in box) 1 - Initial Qualification 2 - Request after Initial Qualification 3 - Standardized Plans (See instructions) b c d If line 3a is 1, please enter the date the plan was signed Enter number of amendments included Enter the date the amendment(s) reflected in 3c were signed (If more than 4 see instructions) (i) (ii) (iii) (iv) e Enter the date the amendment(s) were effective (If more than 4 see instructions) (i) Yes No Has the plan received a determination letter? If "No," submit copies of all prior plan(s) and/or adoption agreement(s). (ii) (iii) (iv) f g h i j k l m n If 3f is "Yes," enter the date of the latest letter (See instructions) Enter the number of amendments since the last determination letter Have interested parties been given the required notification of this application? (See instructions) Does the plan have a cash or deferred arrangement (section 401(k))? Does the plan have matching contributions (section 401(m))? Does the plan have after-tax employee voluntary contributions (section 401(m))? Does the plan utilize the permitted disparity rules of section 401(l) when allocating contributions or benefits? Is this plan an offset arrangement with any other plans? (If "Yes," attach a separate statement providing the name, EIN, and plan type of the other plan that is part of the arrangement. See instructions) Form 5307 (Rev. 3-2008) *11832Y03200802* Form 5307 (Rev. 3-2008) Page 3 4a Name of plan (If plan name exceeds 70 characters, including spaces, see instructions): b Enter 3-digit plan number (See instructions) d Enter plan's original effective date e Enter number of participants (See instructions) 5 Indicate type of plan by entering the number from the list below: 1 -- profit sharing and/or 401(k) 2 -- money purchase 3 -- target benefit Yes 6a b No c Enter month plan year ends 4 -- defined benefit but not cash balance (See instructions) 5 -- 401(k) safe harbor Is the employer a member of an affiliated service group? Is the employer a member of a controlled group of corporations or a group of trades or businesses under common control? If 6a and/or 6b is "Yes," see instructions. 7a(1) Is this a master or prototype plan? a(2) If "Yes," Date of Opinion letter a(3) Serial Number b(1) Is this a volume submitter plan? b(2) If "Yes," Date of Advisory letter b(3) Serial Number c d 8a b c d Are there modifications to the volume submitter plan or are there addenda to the adoption agreement? Are there any "Other" boxes selected in the adoption agreement? (See instructions) Is this a governmental plan? If "Yes," is the plan a state level plan? Is this a nonelecting church plan? Is this a collectively bargained plan? (See Regulations section 1.410(b)-9) Form 5307 (Rev. 3-2008) *11832Y03200803* Form 5307 (Rev. 3-2008) Page 4 8 (continued) Yes No e f g 9a Is this a section 412(i) plan? Has this plan been involved in a merger? (If "Yes," see instructions) Has the plan been amended or restated to change the type of plan? (If "Yes," see instructions) Do you maintain any other qualified plan(s) under section 401(a)? If "Yes," attach required statement per instructions. If "No," skip to line 9d. b Do you maintain another plan of the same type (i.e. both this plan and the other plan are defined contribution plans or both are defined benefit plans) that covers non-key employees who are also covered under this plan? If "Yes," when the plan is top-heavy, do the non-key employees covered under both plans receive the required top-heavy minimum contribution or benefit under: (See instructions) (1) This plan, or (2) The other plan? c If this is a defined contribution plan, do you maintain a defined benefit plan (or if this is a defined benefit plan, do you maintain a defined contribution plan) that covers non-key employees who are also covered under this plan? If "Yes," when the plan is top-heavy, do non-key employees covered under both plans receive: (See instructions) (1) The top-heavy minimum benefit under the defined plan, (2) At least a 5% minimum contribution under the defined contribution plan, (3) The minimum benefit offset by benefits provided by the defined contribution plan, or (4) Benefits under both plans that, using a comparability analysis, are at least equal to the minimum benefit? Does the plan prevent the possibility that the section 415 limitations will be exceeded for any employee who is (or was) a participant in this plan and any other plan of the employer? d Form 5307 (Rev. 3-2008) *11832Y03200804* Form 5307 (Rev. 3-2008) Page 5 Yes 10a No Does any amendment to the plan reduce or eliminate any section 411(d)(6) protected benefit including an amendment adopted after September 6, 2000, to eliminate the joint and survivor annuity form of benefit? (See instructions) Are trust earnings and losses allocated on the basis of account balances in a defined contribut
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