Fillable Form MP-300: Plan Information for Employer identification number/plan (Pension Benefit Guaranty Corporation)

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Form MP-300: Plan Information for Employer identification number/plan (Pension Benefit Guaranty Corporation)

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The Form MP-300: Plan Information for Employer identification number/plan (Pension Benefit Guaranty Corporation) form is 3 pages long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Pension Benefit Guaranty Corporation

BROWSE PENSION BENEFIT GUARANTY CORPORATION (DC) FORMS

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Missing Participants Program
Plan Information for
Small Professional Service DB Plans
Form MP-300
Approved OMB 1212-0069
Expires 1/31/2021
□ Amended Filing
Part I — General Information
1 Plan information
a Plan name___________________________________________________________________________
b
Employer identification number/plan number _ _ -_ _ _ _ _ _ _/_ _ _
c
8-digit PBGC Case # _ _ _ _ _ _ _ _
d Plan contact
(1) Name __________________________
(2) Company ___________________________________
(3) Street address ___________________________________________________________________________
(4) City_____________________________ (5) State _____ (6) Zip __________
(7) Telephone _ _ _ -_ _ _ - _ _ _ _ ext _ _ _ _ _ _ (8) email ___________________________________
e Is plan electing to be a transferring plan or a notifying plan? (check applicable box) Transferring □□ Notifying
2 Number of Missing Distributees
(Notifying plans may omit breakdown)
(1)
Benefit transfer amounts
$250 or less
(2)
Benefit transfer amounts
more than $250
Total
________ ________ ________
3 Benefit determination date (BDD) _ _ _ _ _ _ _ _
4 Commercial locator service(s) used (if any) ___________________________________________________________
5 Amended filings only - Did the original filing contain information on anyone who is no longer considered
missing (i.e., has anyone been removed from the applicable Schedule B)? (a
ttachment required if “Yes”)
Yes
□
□
No
Part II — Additional Information for Transferring Plans
6 Amounts owed to PBGC for missing distributees reported in this filing
a Aggregate benefit transfer amount as of BDD [sum of item 3 from all Schedules B] _____________
b Administrative fee [$35 x number reported in column (2) of item 2] _____________
c Aggregate late payment charge [sum of item 5b from all Schedules B] _____________
d Total [item 6a + item 6b + item 6c] _____________
7 Reconciliation (amended filings only)
a Amounts previously paid in conjunction with prior Forms MP-300 for this plan _____________
b Underpayment/(overpayment) [item 6d – item 7a] _____________
8 Payment method Pay.gov □ Other electronic funds transfer □□ Paper check
Part III — Plan Administrator Certification
9 Certification of plan administrator – The plan administrator must sign and complete this item.
I certify that to the best of my knowledge and belief that all the information in this filing is true, correct and complete and
has been determined in accordance with PBGC's Missing Participants regulations and instructions, including the diligent
search requirements of 29 CFR § 4050.304
.
Name of person signing: First name _______________ Last name _____________________________
_________________________________
_ _ _ -_ _ _ - _ _ _ _ ext _ _ _ _ _ _
email
Telephone
___________________________________________
_______________
Signature
Date
Clear Form
0
$ 0.00
$ 0.00
Individual Information - Notifying Plans
Schedule A
(Form MP-300)
Approved OMB 1212-0069
Expires 1/31/2021
This Schedule A is # _______ of __________ (insert total # of Schedules A included in this filing)
Part I — Plan/Financial Institution Information
1 Plan sponsor information
a Plan name_________________________________________________________________________________
b Employer identification number/plan number _ _ -_ _ _ _ _ _ _/_ _ _
c 8-digit PBGC Case # _ _ _ _ _ _ _ _
2 Financial institution information
a Financial institution name ___________________________________________
b Financial institution contact information
(1) Name ___________________ (2) Telephone _ _ _ -_ _ _ - _ _ _ _ (3) email __________________
c Financial institution address
(1) Street address _________________________________________________________________
(2) City_______________________________
(3) State ____
(4) Zip _________
Part II — Individual Information
Complete items 3-4 for each missing individual whose benefit was transferred to a financial institution that you are reporting to
PBGC. Use additional schedules as needed.
3 Missing distributee information
a Identifying information
(1) Name (last, first, middle) _______________________________ (2) Date of birth _ _ _ _ _ _ _ _
(3) Social security number _ _ _-_ _-_ _ _ _
b Last-known address
(1) Street address__________________________________________________________________________
(2) City_____________________________ (3) State _____ (4) Zip _________
c Accrued benefit (enter amount and check applicable box) ___________ Monthly benefit □ □ Current value
d Account/certificate number ___________
4 Amended filing code — If this is an amended filing, enter the applicable code to indicate whether
information for this missing distributee has changed or is being reported for the first time
(see instructions).
_____
3 Missing distributee information
a Identifying information
(1) Name (last, first, middle) _______________________________ (2) Date of birth _ _ _ _ _ _ _ _
(3) Social security number _ _ _-_ _-_ _ _ _
b Last-known address
(1) Street address__________________________________________________________________________
(2) City_____________________________ (3) State _____ (4) Zip _________
c Accrued benefit (enter amount and check applicable box) ___________ □ Monthly benefit □ Current value
d Account/certificate number ___________
4 Amended filing code — If this is an amended filing, enter the applicable code to indicate whether
information for this missing distributee has changed or is being reported for the first time (see instructions).
_____
Click here to add another Sch A
Individual Information – Transferring Plans
Schedule B
(Form MP-300)
Approved OMB 1212-0069
Expires 1/31/2021
This Schedule B is # _______ of __________ (insert total # of Schedules B included in this filing)
Part I — Identifying Information
1 Plan information
a Plan name_________________________________________________________________________________
c 8-digit PBGC Case # _ _ _ _ _ _ _ _ b Employer identification number/plan number _ _ -_ _ _ _ _ _ _/_ _ _
d Benefit determination date (BDD) per Form MP-300 _ _ _ _ _ _ _ _
2 Missing distributee identifying information
a Missing distributee’s name (last, first, middle) ___________________________________________________
c Social Security Number _ _ _-_ _-_ _ _ _ b Date of birth _ _ _ _ _ _ _ _
d Last-known address
(1) Street address______________________________________________________________
(2) City_______________________________ (3) State _____ (4) Zip __________
e Other name(s) ever used (if known)___________________________________________________________
f Type of missing distributee □ Participant □ Beneficiary (See instructions re: required attachment)
g Has missing distributee received any benefit payments from this plan? (Attachment required if “Yes”) Yes □ □ No
h Is any portion of the benefit attributable to employee contributions? ( Attachment required if “Yes”) Yes □ □ No
i If this is an amended filing, enter the applicable code to indicate whether information for this missing
distributee has changed or is being reported for the first time
(see instructions).
_______
Part II – Amount owed to PBGC
3 Benefit transfer amount as of benefit determination date (BDD) ______________
4 Administrative fee (if item 3 > $250, enter $35, otherwise enter $0) ______________
5 Late payment charge
a Late payment (Portion of item 3 transferred, or to be transferred, more than 90 days after BDD)
______________
b Interest owed on late payment (If item 5a is $0, enter $0; otherwise, see instructions)
______________
Part III — Missing Participant Benefit Information
Complete this part only if “Participant” was checked in item 2f, “no” was checked in item 2g, and amount in item 3 exceeds $5,000
6 Lump sum eligibility – Was participant eligible to elect a lump sum?
□ Yes □ No
7 Normal retirement date*
_ _ _ _ _ _ _ _
8 Annuity information
a Monthly straight life annuity payable starting at Benefit Determination Date
Complete this item only if the participant is over age 55 and eligible to commence benefits at
the BDD and has not yet reached Normal Retirement Age.
______________
b Monthly straight life annuity payable that the participant is entitled to assuming payments commence at each
applicable age below. Enter N/A for ages/dates: (a) after the participant’s NRD*; (b) before the participant would have
been eligible to commence benefits had the plan not terminated; or (c) before BDD.
55 _____________ 58 ______________ 61 ______________ 64 _______________
56 _____________ 59 ______________ 62 ______________ 65 _______________
57 _____________ 60 ______________ 63 ______________ NRD* _____________
*Or if later, the date benefit accruals ceased.
Click here to add another Sch B
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Form MP-300: Plan Information for Employer identification numberplan (Pension Benefit Guaranty Corporation)

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Completed 26 January 2021

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