Form 10 Notice PDF Details

In the complex landscape of pension regulation and oversight, the Pension Benefit Guaranty Corporation (PBGC) plays a critical role in ensuring the financial security of single-employer pension plans through mechanisms like the Form 10. This form, officially known as the "POST-EVENT NOTICE OF REPORTABLE EVENTS," serves as a tool for plan administrators or contributing sponsors to notify the PBGC about certain events that could signal financial instability or changes potentially affecting the sustainability of a pension plan. Events requiring notification include, but are not limited to, significant reductions in active participants, changes in the contributing sponsor or controlled group, failures to make required contributions, liquidation events, and situations of insolvency. Additionally, the form requests detailed information about the event, such as descriptions, numbers of participants affected, financial and actuarial data, and any subsequent actions taken by the plan's administrators. The PBGC Form 10, bearing the OMB approval number 1212-0013 and with an expiration date of November 30, 2018, embodies a comprehensive reporting requirement aimed at promoting transparency and early intervention possibilities for the PBGC, thereby helping to safeguard the retirement incomes of millions of Americans.

QuestionAnswer
Form NameForm 10 Notice
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namespension form reportable, pbgc form 10 advance, pbgc form 10 search, pension form 10 pdf

Form Preview Example

POST-EVENT NOTICE

OF REPORTABLE EVENTS

PBGC Form 10

Approved OMB #1212-0013 Expires 11/30/2018

This form may be used by a plan administrator or contributing sponsor of a single-employer plan when notifying the Pension Benefit Guaranty Corporation that a reportable event has occurred. For questions regarding this form, contact (202) 326-4070 or post-event.report@pbgc.gov

IDENTIFYING INFORMATION

Plan name

Name of filer

Street address of filer

City, State, Zip

EIN of contributing sponsor

Plan number

Filer is:

Plan administrator

 

 

Contributing sponsor

 

Name of authorized contact at filer

Title of contact

Email address of contact

Street address of contact

City, State, Zip

Telephone number of contact

Ext

REPORTABLE EVENTS

See instructions for descriptions of these events. Check all boxes that apply.

Active participant reduction

Change in contributing sponsor or controlled group

Failure to make required contributions under $1M

Liquidation

Inability to pay benefits when due

Extraordinary dividend or stock redemption

Distribution to a substantial owner

Application for minimum funding waiver

Transfer of benefit liabilities

Loan default

 

Insolvency or similar settlement

BRIEF DESCRIPTION

Briefly describe the pertinent facts relating to each event.

The next page lists additional information that must be submitted with this form, if not included above.

ADDITIONAL INFORMATION TO BE FILED

PBGC Form 10

Check box to indicate the item is attached. If not attached, explain on next page.

Active Participant Reduction

Single cause event - statement explaining the cause of the reduction (e.g., facility shutdown or sale, discontinued operations, winding down of the company, or reduction in force).

Attrition event - statement of factors involved in the attrition such as frozen plan, aging workforce or improved operational efficiencies that do not require replacing departing active participants

Number of active participants at the date the event occurs and at the beginning of the plan year in which the event occurred. If reporting two-year reduction, also include number at beginning of plan year two years prior to the plan year in which the event occurred.

Failure to Make Required Contributions

Due date and amount of the missed contribution

Due date and amount of the next payment due

Due date and amount of all contributions not timely made and not reported on the last Schedule SB filed

Date and amount of any contribution(s) made related to the missed contribution(s)

Reason contribution was not made by due date

Description of the plan's controlled group structure, including the name of each controlled group member

Name of each plan maintained by any member of the plan’s controlled group, its contributing sponsor(s) and

EIN/PN

Actuarial Information (see instructions)

Financial Information (see instructions)

Inability to Pay Benefits When Due

Date of any missed benefit payment and amount of benefits due

Next date on which the plan is expected to be unable to pay benefits, the amount of the projected shortfall, and the number of plan participants expected to be affected

Amount of the plan’s liquid assets at the end of the quarter, and the amount of its disbursements for the quarter

Name, address and phone number of plan trustee (and of any custodian)

Most recent pension plan document(s)

The Internal Revenue Service Determination Letter indicating the plan is a covered plan, if applicable

Description of the plan’s controlled group structure, including the name of each controlled group member

Actuarial Information (see instructions)

Financial Information (see instructions)

Distribution to a Substantial Owner

Name, address and phone number of person receiving the distribution(s)

Amount, form and date of each distribution

Reason for distribution

Transfer of Benefit Liabilities

Name, contributing sponsor, EIN/PN, and contact information of transferee plan(s)

Description of the transferor and transferee's controlled group structures, including the name of each controlled group member

Explanation of the actuarial assumptions used in determining the value of benefit liabilities (and, if appropriate, plan assets) transferred

Estimate of the assets, liabilities, and number of participants whose benefits are transferred (liabilities and participants should be broken down by status - active, term vested, and retirees)

Financial Information for the transferor and transferee's controlled group (see instructions)

Change in Contributing Sponsor or Controlled Group

Description of the plan’s old and new controlled group structures, including the name of each controlled group member

Name of each plan maintained by any member of the plan's old and new controlled groups, its contributing sponsor(s) and EIN/PN

Financial Information for the old and new controlled group (see instructions)

Liquidation

Description of the plan's controlled group structure before and after the liquidation, including the name of each controlled group member

Operational status of each controlled group member (in Chapter 7 proceedings, liquidating outside of bankruptcy, on-going, etc.)

Name of each plan maintained by any member of the plan's controlled group, its contributing sponsor(s) and

EIN/PN

Statement whether the recipient was a member of the plan’s controlled group

Actuarial Information (see instructions)

Financial Information (see instructions)

If the plan sponsor is expected to cease or has ceased substantially all operations also provide:

Date on which substantially all operations are expected to cease or have ceased

Most recent pension plan document(s)

Address of each controlled group member

The Internal Revenue Service Determination Letter indicating the plan is a covered plan, if applicable

Extraordinary Dividend or Stock Redemption

Name and EIN of person making the distribution

Date and amount of cash distribution(s) during fiscal year

Description, fair market value, and date or dates of any non-cash distributions

Statement whether the recipient was a member of the plan's controlled group

Financial Information (see instructions)

Application for Minimum Funding Waiver

Copy of waiver application, with all attachments

Minimum funding projections for the next 5 years (with and without the waiver) including all details supporting the calculations and all assumptions, to the extent not included in the waiver application

PBGC Form 10

Loan Default

Copy of the relevant loan documents (e.g., promissory note, security agreement, loan agreement amendments and waivers)

Due date and amount of any missed payment

Copy of any written notice of default or any notice of acceleration from lender, any notice of forbearance, or loan agreement amendment or waiver

Description of any cross-defaults or anticipated cross- defaults

Description of the plan's controlled group structure, including the name of each controlled group member

Actuarial Information (see instructions)

Financial Information (see instructions)

Insolvency or Similar Settlement

Name, address and phone number of any trustee, receiver or similar person

Docket number of court filing and location of the court where any relevant proceeding was or will be filed (if known)

Description of the plan’s controlled group structure, including the name of each controlled group member

Name of each plan maintained by any member of the plan’s controlled group, its contributing sponsor(s) and

EIN/PN

Actuarial Information (see instructions)

Financial Information (see instructions)

MISSING INFORMATION

If required information has not been submitted with this Form 10, explain below.

FILING INFORMATION

Date of Event

Notice Due Date

Notice Filing Date (if late, explain below)

REASON FOR LATE FILING OR ATTRITION EVENT EXTENTION CLAIMED

PBGC Form 10

If filing is late or an extension for an attrition event is claimed, explain below.

CERTIFICATION

I certify that, to the best of my knowledge and belief, the information submitted in this filing is true, correct, and complete. In making this certification, I recognize that knowingly and willfully making false, fictitious, or fraudulent statements to the PBGC is punishable under 18 U.S.C. § 1001.

Signature of Individual Submitting Form

Name and Title of Individual Submitting Form

 

 

 

Telephone Number of Individual Submitting Form

Employer of Individual Submitting Form