Fill - Free fillable Form 5305-SA SIMPLE Individual Retirement Custodial Account PDF form

Form 5305-SA

(Rev. April 2017)

Department of the Treasury

Internal Revenue Service

SIMPLE Individual Retirement Custodial Account

(Under section 408(p) of the Internal Revenue Code)

Do not file

with the Internal

Revenue Service

Name of participant Date of birth of participant

Address of participant

Check if transfer SIMPLE IRA .

▶

Check if amendment . . . .

▶

Name of custodian Address or principal place of business of custodian

The participant named above is establishing a savings incentive match plan for employees of small employers individual retirement account

(SIMPLE IRA) under sections 408(a) and 408(p) to provide for his or her retirement and for the support of his or her beneficiaries after death.

The custodian named above has given the participant the disclosure statement required by Regulations section 1.408-6.

The participant and the custodian make the following agreement.

Article I

The custodian will accept cash contributions made on behalf of the participant by the participant’s employer under the terms of a SIMPLE IRA plan

described in section 408(p). In addition, the custodian will accept transfers or rollovers from other SIMPLE IRAs of the participant and, after the 2-year

period of participation defined in section 72(t)(6), transfers or rollovers from any eligible retirement plan (as defined in section 402(c)(8)(B)) other than a

Roth IRA or a designated Roth account. No other contributions will be accepted by the custodian.

Article II

The participant’s interest in the balance in the custodial account is nonforfeitable.

Article III

1. No part of the custodial account funds may be invested in life insurance contracts, nor may the assets of the custodial account be

commingled with other property except in a common trust fund or common investment fund (within the meaning of section 408(a)(5)).

2. No part of the custodial account funds may be invested in collectibles (within the meaning of section 408(m)) except as otherwise permitted

by section 408(m)(3), which provides an exception for certain gold, silver, and platinum coins, coins issued under the laws of any state, and

certain bullion.

Article IV

1. Notwithstanding any provision of this agreement to the contrary, the distribution of the participant’s interest in the custodial account shall

be made in accordance with the following requirements and shall otherwise comply with section 408(a)(6) and the regulations thereunder, the

provisions of which are herein incorporated by reference.

2. The participant’s entire interest in the custodial account must be, or begin to be, distributed not later than the participant’s required

beginning date, April 1 following the calendar year in which the participant reaches age 70

/2. By that date, the participant may elect, in a

manner acceptable to the custodian, to have the balance in the custodial account distributed in:

(a) A single sum or

(b) Payments over a period not longer than the life of the participant or the joint lives of the participant and his or her designated beneficiary.

3. If the participant dies before his or her entire interest is distributed to him or her, the remaining interest will be distributed as follows.

(a) If the participant dies on or after the required beginning date and:

(i) The designated beneficiary is the participant’s surviving spouse, the remaining interest will be distributed over the surviving spouse’s life

expectancy as determined each year until such spouse’s death, or over the period in paragraph (a)(iii) below if longer. Any interest remaining

after the spouse’s death will be distributed over such spouse’s remaining life expectancy as determined in the year of the spouse’s death and

reduced by 1 for each subsequent year, or, if distributions are being made over the period in paragraph (a)(iii) below, over such period.

(ii) The designated beneficiary is not the participant’s surviving spouse, the remaining interest will be distributed over the beneficiary’s

remaining life expectancy as determined in the year following the death of the participant and reduced by 1 for each subsequent year, or over

the period in paragraph (a)(iii) below if longer.

(iii) There is no designated beneficiary, the remaining interest will be distributed over the remaining life expectancy of the participant as

determined in the year of the participant’s death and reduced by 1 for each subsequent year.

(b) If the participant dies before the required beginning date, the remaining interest will be distributed in accordance with paragraph (i) below or, if

elected or there is no designated beneficiary, in accordance with paragraph (ii) below.

(i) The remaining interest will be distributed in accordance with paragraphs (a)(i) and (a)(ii) above (but not over the period in paragraph (a)(iii),

even if longer), starting by the end of the calendar year following the year of the participant’s death. If, however, the designated beneficiary is

the participant’s surviving spouse, then this distribution is not required to begin before the end of the calendar year in which the participant

would have reached age 70

/2. But, in such case, if the participant’s surviving spouse dies before distributions are required to begin, then the

remaining interest will be distributed in accordance with paragraph (a)(ii) above (but not over the period in paragraph (a)(iii), even if longer), over such

spouse’s designated beneficiary’s life expectancy, or in accordance with paragraph (ii) below if there is no such designated beneficiary.

(ii) The remaining interest will be distributed by the end of the calendar year containing the fifth anniversary of the participant’s death.

4. If the participant dies before his or her entire interest has been distributed and if the designated beneficiary is not the participant’s surviving

spouse, no additional contributions may be accepted in the account.

5. The minimum amount that must be distributed each year, beginning with the year containing the participant’s required beginning date, is

known as the “required minimum distribution” and is determined as follows.

Cat. No. 23698C

Form 5305-SA (Rev. 4-2017)

Account number

Form 5305-SA (Rev. 4-2017)

Page 2

(a) The required minimum distribution under paragraph 2(b) for any year, beginning with the year the participant reaches age 70

/2, is the

participant’s account value at the close of business on December 31 of the preceding year divided by the distribution period in the uniform

lifetime table in Regulations section 1.401(a)(9)-9. However, if the participant’s designated beneficiary is his or her surviving spouse, the required

minimum distribution for a year shall not be more than the participant’s account value at the close of business on December 31 of the preceding

year divided by the number in the joint and last survivor table in Regulations section 1.401(a)(9)-9. The required minimum distribution for a year

under this paragraph (a) is determined using the participant’s (or, if applicable, the participant and spouse’s) attained age (or ages) in the year.

(b) The required minimum distribution under paragraphs 3(a) and 3(b)(i) for a year, beginning with the year following the year of the

participant’s death (or the year the participant would have reached age 70

/2, if applicable under paragraph 3(b)(i)) is the account value at the

close of business on December 31 of the preceding year divided by the life expectancy (in the single life table in Regulations section

1.401(a)(9)-9) of the individual specified in such paragraphs 3(a) and 3(b)(i).

/2 can be made as late as April 1 of the following year. The

required minimum distribution for any other year must be made by the end of such year.

6. The owner of two or more IRAs (other than Roth IRAs) may satisfy the minimum distribution requirements described above by taking from

one IRA the amount required to satisfy the requirement for another in accordance with the regulations under section 408(a)(6).

Article V

1. The participant agrees to provide the trustee with all information necessary to prepare any reports required by sections 408(i) and

408(l)(2) and Regulations sections 1.408-5 and 1.408-6.

2. The custodian agrees to submit to the Internal Revenue Service (IRS) and participant the reports prescribed by the IRS.

3. The custodian also agrees to provide the participant’s employer the summary description described in section 408(l)(2) unless this SIMPLE

IRA is a transfer SIMPLE IRA.

Article VI

Notwithstanding any other articles which may be added or incorporated, the provisions of Articles I through III and this sentence will be

controlling. Any additional articles inconsistent with sections 408(a) and 408(p) and the related regulations will be invalid.

Article VII

This agreement will be amended as necessary to comply with the provisions of the Code and the related regulations. Other amendments may

be made with the consent of the persons whose signatures appear below.

Article VIII

Article VIII may be used for any additional provisions. If no other provisions will be added, draw a line through this space. If provisions are

added, they must comply with applicable requirements of state law and the Internal Revenue Code and may not imply that they have been reviewed or

pre-approved by the IRS.

Participant’s signature Date

(If an individual other than the participant signs this form for the participant, indicate the individual’s relationship to the participant.)

Custodian’s signature Date

Witness’ signature

(Use only if signature of the participant or the custodian is required to be witnessed.)

Date

General Instructions

Section references are to the Internal

Revenue Code unless otherwise noted.

Purpose of Form

Form 5305-S is a model custodial account

agreement that meets the requirements of

sections 408(a) and 408(p). However, only

Articles I through VII have been reviewed by

the IRS. A SIMPLE individual retirement

account (SIMPLE IRA) is established after the

form is fully executed by both the individual

(participant) and the custodian. This account

must be created in the United States for the

exclusive benefit of the participant and his or

her beneficiaries.

Do not file Form 5305-S with the IRS.

Instead, keep it with your records.

For more information on SIMPLE IRAs,

including the required disclosures the

custodian must give the participant, see

Pub. 590-A, Contributions to Individual

Retirement Arrangements (IRAs); Pub. 590-B,

Distributions from Individual Retirement

Arrangements (IRAs); and Pub 560,

Retirement Plans for Small Business (SEP,

SIMPLE, and Qualified Plans).

Definitions

Participant. The participant is the person

who establishes the custodial account.

Custodian. The custodian must be a bank or

savings and loan association, as defined in

section 408(n), or any person who has the

approval of the IRS to act as custodian.

Transfer SIMPLE IRA

This SIMPLE IRA is a “transfer SIMPLE IRA”

if it is not the original recipient of

contributions under any SIMPLE IRA plan.

The summary description requirements of

section 408(l)(2) do not apply to transfer

SIMPLE IRAs.

Specific Instructions

Article IV. Distributions made under this

article may be made in a single sum, periodic

payment, or a combination of both. The

distribution option should be reviewed in the

year the participant reaches age 70

/2 to

ensure that the requirements of section

408(a)(6) have been met.

Article VIII. Article VIII and any that follow it

may incorporate additional provisions that are

agreed to by the participant and custodian to

complete the agreement. They may include,

for example, definitions, investment powers,

voting rights, exculpatory provisions,

amendment and termination, removal of the

custodian, custodian’s fees, state law

requirements, beginning date of distributions,

accepting only cash, treatment of excess

contributions, prohibited transactions with the

participant, etc. Attach additional pages if

necessary.

Form 5305-SA (Rev. 4-2017)

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