Schedule I Form 5500 – Fill Out and Use This PDF

The Schedule I 5500 form is a crucial document required under the Employee Retirement Income Security Act of 1974 (ERISA) and section 6058(a) of the Internal Revenue Code for small plans with fewer than 100 participants at the beginning of the plan year. It serves as a comprehensive report detailing the financial information of small plans, including assets, liabilities, income, and expenses. To ensure compliance and proper management of employee retirement benefits, it is imperative for eligible plan sponsors to accurately complete and file this form.

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Schedule I Form 5500 PDF Details

In the realm of employee retirement plans, the meticulous task of reporting financial information holds paramount importance. At the heart of this endeavor, especially for smaller entities grappling with fewer resources, lies the Schedule I (Form 5500) – a document mandated by the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code. This critical form serves as a conduit for small plans, defined as those covering fewer than 100 participants at the start of the plan year, to articulate their financial condition, transactions, and compliance status to the Department of Labor, the Department of the Treasury, and the Pension Benefit Guaranty Corporation. The completion of Schedule I encompasses a comprehensive report on plan assets, liabilities, income, and expenses, culminating in a net income or loss calculation. It meticulously requires details on specific assets, cash vs. noncash contributions, and transfers affecting plan resources. Additionally, it probes into areas of compliance and potential areas of concern, such as timely contribution transmissions, transaction defaults, and fidelity bond coverage. With sections dedicated to scrutinizing participant contributions, loan defaults, and irregular transactions with interested parties, Schedule I demands transparency and accountability, aiming to safeguard the interests of participants and ensure the integrity of retirement plan operations.

Question	Answer
Form Name	Schedule I Form 5500
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	form 5500 sf, 2018 small, schedule, who files form 5500

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SCHEDULE I	Financial Information—Small Plan			OMB No. 1210-0110
SCHEDULE I	Financial Information—Small Plan
(Form 5500)				2018
Department of the Treasury	This schedule is required to be filed under section 104 of the Employee			2018
Department of the Treasury	Retirement Income Security Act of 1974 (ERISA), and section 6058(a) of the
Internal Revenue Service
	Internal Revenue Code (the Code).			This Form is Open to Public
Department of Labor	Internal Revenue Code (the Code).			This Form is Open to Public
Department of Labor				Inspection
Employee Benefits Security Administration	 File as an attachment to Form 5500.			Inspection
Employee Benefits Security Administration

Pension Benefit Guaranty Corporation
Pension Benefit Guaranty Corporation
For calendar plan year 2018 or fiscal plan year beginning		and ending
A Name of plan		B Three-digit
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI		plan number (PN)		001
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI

C Plan sponsor’s name as shown on line 2a of Form 5500		D Employer Identification Number (EIN)67
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI

Complete Schedule I if the plan covered fewer than 100 participants as of the beginning of the plan year. You may also complete Schedule I if you are filing as a small plan under the 80-120 participant rule (see instructions). Complete Schedule H if reporting as a large plan or DFE.

Part I Small Plan Financial Information

Report below the current value of assets and liabilities, income, expenses, transfers and changes in net assets during the plan year. Combine the value of plan assets held in more than one trust. Do not enter the value of the portion of an insurance contract that guarantees during this plan year to pay a specific dollar benefit at a future date. Include all income and expenses of the plan including any trust(s) or separately maintained fund(s) and any payments/receipts to/from insurance carriers. Round off amounts to the nearest dollar.

1	Plan Assets and Liabilities:			(a) Beginning of Year		(b) End of Year
1	Plan Assets and Liabilities:			(a) Beginning of Year		(b) End of Year
a	............................................................................Total plan assets		1a	-123456789012345	-123456789012345
b	.........................................................................Total plan liabilities		1b	-123456789012345	-123456789012345
c	Net plan assets (subtract line 1b from line 1a)		1c	-123456789012345	-123456789012345
c	Net plan assets (subtract line 1b from line 1a)		.............
2	Income, Expenses, and Transfers for this Plan Year:			(a) Amount		(b) Total
a	Contributions received or receivable:
a	Contributions received or receivable:
	(1)	...............................................................................Employers	2a(1)	-123456789012345
	(2)	.............................................................................Participants	2a(2)	-123456789012345
	(3)	.....................................................Others (including rollovers)	..2a(3)	-123456789012345
b
b	....................................................................Noncash contributions		2b	-123456789012345
c	..................................................................................Other income		2c	-123456789012345
d	.................Total income (add lines 2a(1), 2a(2), 2a(3), 2b, and 2c)		2d		-123456789012345
e	.........................................Benefits paid (including direct rollovers)		2e	-123456789012345
f	.......................................Corrective distributions (see instructions)		2f	-123456789012345
g	Certain deemed distributions of participant loans
	............................................................................(see instructions)		2g	-123456789012345
h	Administrative service providers (salaries, fees, and
	.................................................................................commissions)		2h	-123456789012345
i	..............................................................................Other expenses		2i	-123456789012345
j	.............................Total expenses (add lines 2e, 2f, 2g, 2h, and 2i)		..........2j		-123456789012345
k	Net income (loss) (subtract line 2j from line 2d)		...........2k		-123456789012345
k	Net income (loss) (subtract line 2j from line 2d)		...........2k		-123456789012345
l	Transfers to (from) the plan (see instructions)		.............2l		-123456789012345

3Specific Assets: If the plan held assets at any time during the plan year in any of the following categories, check “Yes” and enter the current value of any assets remaining in the plan as of the end of the plan year. Allocate the value of the plan’s interest in a commingled trust containing the assets of more than one plan on a line-by-line basis unless the trust meets one of the specific exceptions described in the instructions.

			Yes	No	Amount
a	Partnership/joint venture interests	3a ..			-123456789012345
b	Employer real property	3b			-123456789012345
.................................................................c Real estate (other than employer real property)		3c			-123456789012345
d	Employer securities	3d			-123456789012345
e	Participant loans	3e
f	Loans (other than to participants)	3f ..
g	Tangible personal property
g	Tangible personal property	3g

For Paperwork Reduction Act Notice, see the Instructions for Form 5500.					Schedule I (Form 5500) 2018
					v. 171027

	Schedule I (Form 5500) 2018	Page 2-

Part II Compliance Questions

4 During the plan year:

Yes

Amount

aWas there a failure to transmit to the plan any participant contributions within the time period described in 29 CFR 2510.3-102? Continue to answer “Yes” for any prior year failures until

fully corrected. (See instructions and DOL’s Voluntary Fiduciary Correction Program.)	4a	-123456789012345

b Were any loans by the plan or fixed income obligations due the plan in default as of the
close of plan year or classified during the year as uncollectible? Disregard participant loans
	4b
secured by the participant’s account balance	4b	-123456789012345

c Were any leases to which the plan was a party in default or classified during the year as
uncollectible?	4c	-123456789012345


d	Were there any nonexempt transactions with any party-in-interest? (Do not include
d
	transactions reported on line 4a.)	4d		-123456789012345
e	Was the plan covered by a fidelity bond?	4e	-123456789012345
f	Did the plan have a loss, whether or not reimbursed by the plan’s fidelity bond, that was
f			-123456789012345
	caused by fraud or dishonesty?	4f	-123456789012345

g	Did the plan hold any assets whose current value was neither readily determinable on an
	established market nor set by an independent third party appraiser?	4g	-123456789012345
h	Did the plan receive any noncash contributions whose value was neither readily
	determinable on an established market nor set by an independent third party appraiser?	4h	-123456789012345

i	Did the plan at any time hold 20% or more of its assets in any single security, debt,
i
	mortgage, parcel of real estate, or partnership/joint venture interest?	4i	-123456789012345
j
	Were all the plan assets either distributed to participants or beneficiaries, transferred to

	another plan, or brought under the control of the PBGC?	4j

kAre you claiming a waiver of the annual examination and report of an independent qualified

public accountant (IQPA) under 29 CFR 2520.104-46? If “No,” attach an IQPA’s report or
	4k
2520.104-50 statement. (See instructions on waiver eligibility and conditions.)

l Has the plan failed to provide any benefit when due under the plan?	4l	-123456789012345
m If this is an individual account plan, was there a blackout period? (See instructions and 29

CFR 2520.101-3.)	4m

	n If 4m was answered “Yes,” check the “Yes” box if you either provided the required notice or	4n
	one of the exceptions to providing the notice applied under 29 CFR 2520.101-3	4n

5a Has a resolution to terminate the plan been adopted during the plan year or any prior plan year?	X	Yes	X	No-
If “Yes,” enter the amount of any plan assets that reverted to the employer this year ____________________________________.

5b If, during this plan year, any assets or liabilities were transferred from this plan to another plan(s), identify the plan(s) to which assets or liabilities were transferred. (See instructions.)

5b(1) Name of plan(s)	5b(2) EIN(s)	5b(3) PN(s)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI	123456789	123

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI	123456789	123

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI	123456789	123

5c If the plan is a defined benefit plan, is it covered under the PBGC insurance program (See ERISA section 4021.)? ..... …X Yes X No X Not determined.

If “Yes” is checked, enter the My PAA confirmation number from the PBGC premium filing for this plan year_________________________. (See instructions.)

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3. Completing Schedule I Form, Page x, Part II Compliance Questions, b Were any loans by the plan or, close of plan year or classified, c Were any leases to which the, uncollectible c, d Were there any nonexempt, transactions reported on line a, e Was the plan covered by a, caused by fraud or dishonesty, g Did the plan hold any assets, established market nor set by an, h Did the plan receive any noncash, and determinable on an established is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

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Schedule I Form 5500 – Fill Out and Use This PDF

Schedule I Form 5500 PDF Details

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