Form 5310 A PDF Details

When a business undergoes big changes like mergers, consolidations, or the transferring of plan assets or liabilities, the IRS needs to be informed using Form 5310-A. This form serves a crucial role in maintaining transparency and compliance with the Internal Revenue Code, specifically under section 6058(b). It requires detailed information including the name and details of the plan sponsor, types of plans involved, and the specifics of the transaction. Preparing this form with accuracy is paramount, as it needs to be filed in duplicate and the information entered will be processed by computers. Whether the plan in question falls under a defined benefit or a defined contribution category, additional documentation like an actuarial statement of valuation might be necessary to demonstrate compliance with certain sections of the code. Other critical details include the identification of any affiliated service groups or controlled groups of corporations the employer might be a part of, and explicitly stating the number of participants in the plan. The form also demands details on other plans involved in the transaction, emphasizing its importance in cases of restructuring. By declaring the information to be true, correct, and complete under penalties of perjury, the signer acknowledges the seriousness of the form’s content. The expiration date noted, alongside the OMB number, ensures that those filing are using the most current documentation required by the Department of the Treasury and the Internal Revenue Service.

QuestionAnswer
Form NameForm 5310 A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesConsolidation, MMDDYY, ERISA, OMB

Form Preview Example

Department of the Treasury Internal Revenue Service

Notice of M erger, Consolidation or Transfer

of Plan Assets or Liabilities

(Under section 6058(b) of the Internal Revenue Code)

File Form 5310- A in duplicate.

See the Who Must File instructions before filing this form.

OMB No. 1545-1225 Expires 4-30-94

For Agency Use Only

The information provided on this form will be read by computer. Therefore page 1 must be typed (except the signature). Please enter information exactly as requested and only in the space provided. Do not type in shaded areas.

1a

2

Name of plan sponsor (employer if single-employer plan)

 

 

 

 

1b

Employer identification number

 

 

 

 

 

 

 

 

 

Address (number, street, room, or suite no. (If a P.O. box, see page 1 of the instructions)

 

1c Employer’s tax year ends—N/A or (MM)

 

 

 

 

 

 

 

 

 

 

City

State

ZIP code

1d

Telephone number

 

 

 

 

 

 

 

 

(

)

 

Person to be contacted if more information is needed. (If same as 1a, leave blank.) (Complete even if Power of Attorney is attached):

Name

Address (number, street, room, or suite no. (If a P.O. box, see page 1 of the instructions)

City

State

 

ZIP code

Telephone number

 

 

 

 

 

 

 

(

)

3a Name of Plan (Plan name may not exceed 66 characters.):

b Enter plan number (3 digits)

 

d Enter date plan effective (MMDDYY)

c Enter date plan year ends (MMDD)

 

e Enter number of participants in plan

4a If this is a defined benefit plan, enter the appropriate number in box at left AND attach an actuarial statement of valuation showing compliance with the requirements of Code section 401(a)(12) and the regulations under section 414(l).

Enter 1

for unit benefit

Enter 3

for flat benefit

Enter 2

for fixed benefit

Enter 4

for other (specify)

bIf this is a defined contribution plan, enter the appropriate number in box at left AND attach an actuarial statement of valuation showing compliance with the requirements of Code section 401(a)(12) and the regulations under section 414(l).

Enter 1 for profit sharing

Enter 4 for target benefit

 

Enter 2 for stock bonus

Enter 5 for other (specify)

 

Enter 3 for money purchase

 

 

5a Is the employer a member of an affiliated service group?

 

 

Enter 1 if “ Yes”

Enter 2 if “ No”

Enter 3 if “Not Certain”

bIs the employer a member of a controlled group of corporations or a group of trades or businesses under common control?

Enter 1 if “ Yes”

Enter 2 if “ No”

6 Enter type of plan:

Enter 1 if governmental plan or church plan not subject to ERISA

Enter 2 if multiple employer plan (described in section 413(c)). Enter number of participating

 

 

employers

 

 

 

 

 

 

Enter 3 if other

 

 

7

Other plan(s) involved in transaction (see instructions):

 

 

a

Plan name

 

 

 

 

 

 

 

b

Name of employer

 

 

 

 

 

 

c

Employer Identification number

 

 

d Plan number (3 digits)

 

eDate of merger, consolidation or transfer (MMDDYY)

f Type of plan

. Enter the number to indicate type of plan: 1 defined benefit, 2 401(k) arrangement,

3 ESOP 4 money purchase, or

5 Other.

Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief it is true, correct, and complete. Both copies of this page must be signed.

Signature ▶

Title

▶

Date ▶

For Paperwork Reduction Act Notice, see page 1 of the instructions.

Cat. No. 12783Y

Form 5310- A (5-91)

vv

5/91

vv

 

5310-A

 

Department of the Treasury Internal Revenue Service

Notice of M erger, Consolidation or Transfer

of Plan Assets or Liabilities

(Under section 6058(b) of the Internal Revenue Code)

File Form 5310- A in duplicate.

See the Who Must File instructions before filing this form.

OMB No. 1545-1225 Expires 4-30-94

For Agency Use Only

The information provided on this form will be read by computer. Therefore page 1 must be typed (except the signature). Please enter information exactly as requested and only in the space provided. Do not type in shaded areas.

1a Name of plan sponsor (employer if single-employer plan)

1b Employer identification number

2

3a

4a

v

 

 

 

 

 

 

 

v

v

 

v

Address (number, street, room, or suite no. (If a P.O. box, see page 1 of the instructions)

1c Employer’s tax year ends—N/A or (MM)

v

 

 

 

 

 

 

 

v

 

 

 

City

 

 

State

 

 

ZIP code

1d

Telephone number

v

 

v

v

 

v

v

 

v

(

)

 

Person to be contacted if more information is needed. (If same as 1a, leave blank.)

 

 

 

 

(Complete even if Power of Attorney is attached):

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

v

 

 

 

 

 

 

 

 

 

 

v

Address (number, street, room, or suite no. (If a P.O. box, see page 1 of the instructions)

 

 

 

 

v

 

 

 

 

 

 

 

 

 

 

v

City

 

 

State

 

 

ZIP code

 

Telephone number

v

 

v

v

 

v

v

 

v

(

)

 

Name of Plan (Plan name may not exceed 66 characters.):

v

 

 

 

 

 

 

 

 

v

v

v

b

Enter plan number (3 digits)

 

 

 

d

Enter date plan effective (MMDDYY)

v

v

c

Enter date plan year ends (MMDD)

v

 

v

e

Enter number of participants in plan

If this is a defined benefit plan, enter the appropriate number in box at left AND attach an actuarial statement of valuation showing compliance with the requirements of Code section 401(a)(12) and the regulations under section 414(l).

v

v

Enter 1 for unit benefit

Enter 3 for flat benefit

Enter 2 for fixed benefit

Enter 4 for other (specify)

bIf this is a defined contribution plan, enter the appropriate number in box at left AND attach an actuarial statement of valuation showing compliance with the requirements of Code section 401(a)(12) and the regulations under section 414(l).

v

v

Enter 1 for profit sharing

Enter 4 for target benefit

Enter 2 for stock bonus

Enter 5 for other (specify)

Enter 3 for money purchase

5a Is the employer a member of an affiliated service group?

v

v

Enter 1 if “ Yes”

Enter 2 if “ No”

Enter 3 if “ Not Certain”

bIs the employer a member of a controlled group of corporations or a group of trades or businesses under common control?

v

v

6Enter type of plan:

Enter 1 if “ Yes”

Enter 2 if “ No”

v

v

Enter 1 if governmental plan or church plan not subject to ERISA

 

 

Enter 2 if multiple employer plan (described in section 413(c)). Enter number of participating

 

 

employers

 

 

Enter 3 if other

7Other plan(s) involved in transaction (see instructions):

a

Plan name

v

 

 

 

 

 

 

 

 

 

 

v

b

Name of employer

v

 

 

 

 

 

 

 

 

v

c

Employer Identification number

v

 

 

 

v

d Plan number (3 digits) v

 

v

e

Date of merger, consolidation or transfer (MMDDYY)

v

 

v

 

 

 

f

Type of plan

v

 

v

. Enter the number to indicate type of plan:

1 defined benefit, 2 401(k) arrangement,

 

3 ESOP 4 money purchase, or

5 Other.

 

 

 

 

 

 

Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief it is true, correct, and complete. Both copies of this page must be signed.

Signature ▶

Title

▶

Date ▶

For Paperwork Reduction Act Notice, see page 1 of the instructions.

Cat. No. 12783Y

Form 5310- A (5-91)

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