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Form 5330 Return Of Excise Taxes Related To Employee Benefit Plans 5330 - Official Federal Forms
| Form 5330 Return Of Excise Taxes Related To Employee Benefit Plans Form. This is a national form and can be used in Department Of Treasury . |
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Form 5330 Name of filer (see instructions) (Rev. April 2009) Department of the Treasury Internal Revenue Service Return of Excise Taxes Related to Employee Benefit Plans (Under sections 4965, 4971, 4972, 4973(a)(3), 4975, 4976, 4977, 4978, 4979, 4979A, 4980, and 4980F of the Internal Revenue Code) OMB No. 1545-0575 Filer tax year beginning A , and ending , B Filer's identifying number (see instructions) Employer identification number (EIN) Number, street, and room or suite no. (If a P.O. box or foreign address, see instructions) Social security number (SSN) City or town, state, and ZIP code E Plan sponsor's EIN C Name of plan D Name and address of plan sponsor F Plan year ending (MM/DD/YYYY) H If this is an amended return, check here G Plan number Part I Taxes. You can only complete one section of Part I for each Form 5330 filed (see instructions). FOR IRS USE ONLY Section A. Taxes that are reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) 1 Section 4972 tax on nondeductible contributions to qualified plans (from Schedule A, line 12) Section 4973(a)(3) tax on excess contributions to section 403(b)(7)(A) custodial accounts (from Schedule B, line 12) 161 1 2 164 2 3a 3b 4 5a 5b 6 3a Section 4975(a) tax on prohibited transactions (from Schedule C, line 3) b Section 4975(b) tax on failure to correct prohibited transactions 4 Section 4976 tax on disqualified benefits for funded welfare plans 159 224 200 5a Section 4978 tax on ESOP dispositions b The tax on line 5a is a result of the application of: 6 7 209 Sec. 664(g) Sec. 1042 203 Section 4979A tax on certain prohibited allocations of qualified ESOP securities Total Section A taxes. Add lines 1 through 6. Enter here and on Part II, line 17 7 Section B. Taxes that are reported by the last day of the 7th month after the end of the employer's tax year or 8 1/2 months after the last day of the plan year that ends within the filer's tax year 163 8a 8a Section 4971(a) tax on failure to meet minimum funding standards (from Schedule D, line 2) 225 8b b Section 4971(b) tax for failure to correct minimum funding standards 9a Section 4971(f)(1) tax on failure to pay liquidity shortfall (from Schedule E, line 4) b Section 4971(f)(2) tax for failure to correct liquidity shortfall 226 227 9a 9b 10a Section 4971(g)(2) tax on failure to comply with a funding improvement or rehabilitation 450 10a plan (see instructions) b Section 4971(g)(3) tax on failure to meet requirements for plans in endangered or critical status (from Schedule F, line 1c) 451 10b c Section 4971(g)(4) tax on failure to adopt rehabilitation plan (from Schedule F, line 2d) 452 10c Section B1. Tax that is reported by the last day of the 7th month after the end of the calendar year in which the excess fringe benefits were paid to the employer's employees 11 12 13 Section 4977 tax on excess fringe benefits (from Schedule G, line 4) 201 11 Total Section B taxes. Add lines 8a through 11. Enter here and on Part II, line 17 12 Section C. Tax that is reported by the last day of the 15th month after the end of the plan year Section 4979 tax on excess contributions to certain plans (from Schedule H, line 2). Enter here and on Part II, line 17 Cat. No. 11870M 205 13 Form For Privacy Act and Paperwork Reduction Act Notice, see instructions. 5330 (Rev. 4-2009) Form 5330 (Rev. 4-2009) Page 2 Name of Filer: Filer's identifying number: Section D. Tax that is reported by the last day of the month following the month in which the reversion occurred 14 Section 4980 tax on reversion of qualified plan assets to an employer (from Schedule I, line 3). Enter here and on Part II, line 17 204 14 Section E. Tax that is reported by the last day of the month following the month in which the failure occurred 15 Section 4980F tax on failure to provide notice of significant reduction in future accruals (from Schedule J, line 5). Enter here and on Part II, line 17 228 15 Section F. Taxes reported on or before the 15th day of the 5th month following the close of the entity manager's taxable year during which the plan became a party to a prohibited tax shelter transaction 16 Section 4965 tax on prohibited tax shelter transactions for entity managers (from Schedule K, line 2). Enter here and on Part II, line 17 237 16 Part II 17 18 19 Tax Due 17 18 Enter the amount from Part I, line 7, 12, 13, 14, 15, or 16 (whichever is applicable) Enter amount of tax paid with Form 5558 or any other tax paid prior to filing this return Tax due. Subtract line 18 from line 17. If the result is greater than zero, enter here, and attach check or money order payable to "United States Treasury." Write your name, identifying number, plan number, and "Form 5330, Section(s) " on your payment 19 Sign Here Paid Preparer's Use Only Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code Date Telephone number Check if self-employed EIN Phone no. ( Date Preparer's SSN or PTIN ) Form 5330 (Rev. 4-2009) Form 5330 (Rev. 4-2009) Page 3 Name of Filer: Filer's identifying number: Schedule A. Tax on Nondeductible Employer Contributions to Qualified Employer Plans (Section 4972) Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) 1 Total contributions for your tax year to your qualified employer plan (under section 401(a), 403(a), 408(k), or 408(p)) Amount allowable as a deduction under section 404 Subtract line 2 from line 1 Enter amount of any prior year nondeductible contributions made for years beginning after 12/31/86 Amount of any prior year nondeductible contributions for years beginning after 12/31/86 returned to you in this tax year for any prior tax year Subtract line 5 from line 4 Amount of line 6 carried forward and deductible in this tax year Subtract line 7 from line 6 Tentative taxable excess contributions. Add lines 3 and 8 Nondeductible section 4972(c)(6) or (7) contributions exempt from excise tax Taxable excess contributions. Subtract line 10 from line 9 1 2 3 4 5 6 7 8 9 10 11 2 3 4 5 6 7 8 9 10 11 12 Multiply line 11 by 10%
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