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Get IRS 5330 2021-2024

G Plan number Taxes. You can only complete one section of Part I for each Form 5330 filed see instructions. For Privacy Act and Paperwork Reduction Act Notice see instructions. Cat. No. 11870M 10b 10c year in which the excess Rev. 12-2013 Form 5330 Rev. 12-2013 Page Name of Filer line 3. Form Rev. December 2013 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 Information about Form 5330 and its instructions is at www.irs.gov/form5330. Write your name identifying number plan number and Form 5330 Section s on your payment. Your Signature Print/Type preparer s name Firm s name Firm s address Preparer s signature Paid Preparer Use Only Sign Here 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. Filer tax year beginning A OMB No* 1545-0575 and ending Name of filer see instructions B Filer s identifying number Enter either the EIN or SSN but not both. See instructions. Number street and room or suite no. If a P. O. box or foreign address see instructions. Employer identification number EIN City or town state or province country and ZIP or foreign postal code Social security number SSN C Name of plan E Plan sponsor s EIN D Name and address of plan sponsor F Plan year ending MM/DD/YYYY H If this is an amended return check here Part I. 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 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. 3a Section 4975 a tax on prohibited transactions from Schedule C line 3. b Section 4975 b tax on failure to correct prohibited transactions. 5a Section 4978 tax on ESOP dispositions. b The tax on line 5a is a result of the application of. Sec* 664 g FOR IRS USE ONLY 3a 3b Sec* 1042 of synthetic equity. 5a 5b Total Section A taxes. Add lines 1 through 6. Enter here and on Part II line 17. after the last day of the plan year that ends within the filer s tax year 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. 8a 8b 9a 9b 10a see instructions. status from Schedule F line 1c. c Section 4971 g 4 tax on failure to adopt rehabilitation plan from Schedule F line 2d. Section B1. Tax that is reported by the last day of the 7th month after the end of the calendar fringe benefits were paid to the employer s employees here and on Part II line 17. Enter here and on Part II line 17. Section E* Tax that is reported by the last day of the month following the month in which the failure occurred Section 4980F tax on failure to provide notice of significant reduction in future accruals 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 Tax Due Enter the amount from Part I line 7 12 13 14 15 or 16 whichever is applicable.

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