31)Please mark the box for the type of business that applies. If you are unsure, please speak to your corporate secretary, as this information must be accurate.
Subchapter S Corp
Limited Liability Corporation
Limited Liability Partnership
Government Entity or Church
State Agency, School, County, County Hospital, Municipality
ALL Participants in a Section 125 plan must be “employees.” “Employees” are defined by the regulations as to exclude self-employed Individuals. Partners, owners of a
Sole proprietorship and shareholders in a Subchapter S Corporation who owns more than2% of the stock of the corporation. However, partnerships, sole proprietorships
And Subchapter S Corporations are not prevented from sponsoring a Cafeteria Plan for the benefit of their common-law employees. (Example: If you are a 2% owner of a
Subchapter S Corporation, cannot Participate). Based on the above, please list owners that would not be eligible:
32) LIST OWNER(S) NAME: SOCIAL SECURITY NO:
Section 9. CONT. NON-DISCRIMINATION TESTING (Key, Top Paid Group and Highly Compensated Employees)
Directions: Please list employees that apply, give name, social security number and indicate the number(s) of the category items below that apply. List employees, shareholders and owners, as well as owner relatives that work for the company.
Please base your answers on the preceding calendar year (prior year) income.
1 - Officer(s) of the Company with greater than $170,000 *, as indexed, "Key Employees"
2 - Employees with 5% Ownership of the Employer -* "Key Employees"
3 - Employees with 1% Ownership of the Employer with income greater than $150,000 (not indexed) "Key Employees"
4 - Employees who are a spouse or dependent (and relationship) of any individual falling into the above categories, "Key Employees"
5 - Employee with 5% Shareholder stock or voting power (one any day of the year or the preceding year) * "Highly Compensated Employees and Key Employees"
6 - An Officer of the Company "Highly Compensated Employee"
7 - Employees with compensation of $120,000 or greater*, as indexed, "Highly Compensated Employees"
*Limits above are based on the IRS Indexed Contribution and Benefits Limits for qualified plans (IR 2004-122), as indexed.
Employees properly excluded under a plan’s eligibility may nevertheless have to be counted for purposes of the Code’s nondiscrimination tests. Excluding too many employees
could cause the plan to fail one or more of these tests. Many nondiscrimination issues can be avoided through plan design. SABC performs Eligibility Test, in which IRS requires
the plans eligibility be fair, consistent, and reasonable. Some employees may be excluded (on a uniform basis) because of their age, limited services, etc. SABC performs the
Utilization test, (sometimes called the concentration or contributions and benefits tests) where comparable benefits are utilized by a fair number of employees at all compensation levels and in all positions. This test includes the Key Employee Concentration Test and the Owner’s Test (To insure that Keys do not receive more than 25% of the total benefits under Code 125 plan) The Ownership and Key Test does not apply to collectively bargained plans, or officers or employees of governmental entities, but the highly compensated test does.
SABC MUST HAVE THE FOLLOWING INFORMATION FOR DOWNLOAD:
GENERAL EMPLOYEE CENSUS OF REQUIRED INFORMATION:
SOCIAL SECURITY NUMBER,
NAME: LAST,FIRST,MIDDLE INITIAL
DATE OF BIRTH:
DATE OF HIRE:
PAY FREQUENCY: (example Monthly)
(BY HOW EMPLOYEE IS PAID, MONTHLY, SEMI-MONTHLY, WEEKLY, BI-WEEKLY)
NUMBER OF DEUCTIONS: (12 ETC.)
GROSS PAY: (LIST AMOUNT BY HOW PAID, EXAMPLE MONTHLY, SEMI-MONTHLY, WEEKLY, BI-WEEKLY)
LOCATION NUMBER: IF YOU HAVE SEVERAL LOCATIONS, OR AS AN IDENTIFIER FOR A DIFFERENT DEPARTMENT OR CLASS. (PLEASE PROVIDE LIST OF LOCATIONS AND MATCHING ID NUMBER)
LIST INSURANCE PRODUCTS BY TYPE: Health, Dental, Vision, etc.
(List Amounts by how they are deducted.)
EXAMPLE: MONTHLY, SEMI-MONTHLY WEEKLY, BI-WEEKLY
(EXAMPLE) (Be sure to include amount of product, by how deducted)
HEALTH- $40.00 Bi Weekly (Only list portion paid by Employee)
Please provide name of the product carrier, i.e., Example STATE Health = Blue Cross/Blue Shield, and please indicate if products are not deducted the same way the
employees are paid. (Example: Employee paid 26 times a year, deductions are 24 times a year.)
Please send a copy of each insurance billing listed as a deduction, so SABC may determine cafeteria plan eligibility of the product.
When completing this form.
Please contact Valerie Givens, with SABC @ 601-856-9933,
She will help you go thru the form faster.