If an employee benefit plan deposit exceeds $250,000 in the aggregate, before an insurance determination can be made on the benefit plan deposit, an executed copy of the enclosed Declaration for Plan and Trust must be submitted along with a copy of:
The pages of the Trust appointing the trustees and showing the trustees’ signatures, and
Any one of:
The adoption agreement, or
The IRS determination letter for the Plan.
If the Plan and Trust are part of the same document, one copy of the complete document may be provided.
If the trustees named in the Trust are not the current trustees, please also attach to the Declaration for Plan and Trust the resolution appointing the current trustees.
If there is only one participant in the Plan, please indicate this on the Declaration for Plan and Trust. If there is more than one participant in the Plan, the following information must also be submitted:
If the Plan is a Defined Contribution Plan, please complete the enclosed Declaration for Defined Contribution Plan.
If the Plan is a Defined Benefit Plan, please have the enclosed Declaration for Defined Benefit Plan completed. A certified actuary must complete the Declaration for Defined Benefit Plan.
Questions 5 and 6 of the Declaration for Defined Benefit Planmust be answered if any of the following are applicable:
The account had more than $250,000 in it on the closing date;
There are other accounts for an employee benefit plan with the same sponsor at the defaulted institution; or
The present value of any one participant’s accrued benefit (including rollover, other voluntary participant contributions, and any other amounts held for the benefit of the participant) exceeds 95% of the total Plan assets on the closing date.
If the Plan is a Health or Welfare Plan (medical, dental, life insurance, etc., benefits), please complete the enclosed Declaration for Health and Welfare Plan.
FAILURE TO PROVIDE ALL OF THE INFORMATION REQUESTED WILL DELAY THE PAYMENT OF INSURANCE ON YOUR ACCOUNT.