Annual Registration Statement Identifying Separated Participants with Deferred Vested Benefits

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Instructions for Form 5500

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Schedule SSA filed for the plan year in which he or she
separated from service or completed the first 1-year break in
service).

2007 Instructions for Schedule SSA
(Form 5500)
Annual Registration Statement
Identifying Separated Participants With
Deferred Vested Benefits

When NOT to Report a Participant
A participant is not required to be reported on Schedule SSA if,
before the date the Schedule SSA is required to be filed
(including any extension of time for filing), the participant:
1. Is paid some or all of the deferred vested retirement
benefit (see the Caution below), or
2. Returns to service covered by the plan and/or accrues
additional retirement benefits under the plan, or
3. Forfeits all the deferred vested retirement benefit.

General Instructions
Purpose of Schedule
Use Schedule SSA to report information concerning separated
participants with deferred vested benefit rights. Report
participants who:
• separated from your company during the plan year; or
• transferred into this plan during the plan year; or
• previously were reported under this plan but are no longer
entitled to those deferred vested benefits.
Also use Schedule SSA to correct information previously
reported concerning participants with deferred vested benefits.
The information on this schedule is given to the Social
Security Administration to provide to participants when they file
for Social Security benefits.
Note. Beginning with the 2004 Schedule SSA, report required
information regarding separated participants only on page 2 of
Schedule SSA. Use additional pages 2 when you need to report
information for more separated participants than one page 2
allows. Do not use attachments other than the page 2 Schedule
SSA.

If payment of the deferred vested retirement benefit
ceases before ALL of the benefit to which the
CAUTION participant is entitled is paid to the participant,
information relating to the deferred vested retirement benefit to
which the participant remains entitled shall be filed on the
Schedule SSA filed for the year following the last plan year
within which a portion of the benefit is paid to the participant.

!

Separation of a Re-Employed Employee
If the deferred vested benefit of a separated employee is
different from that previously reported, you may use code B
(see below) to report that employee’s total vested benefit.

Revising Prior Report
Use Schedule SSA to report revisions to pension information for
a participant you reported on a previous Schedule SSA. This
will ensure that SSA’s records are correct. This is important
since SSA provides Schedule SSA information that it has on file
to participants when they file for Social Security benefits. If this
information is not up-to-date, the participant may contact the
plan administrator to resolve the difference.
You do not need to report changes in the value of the
employees’ accounts, since that is likely to change. However,
you may report these changes if you want.

The Social Security Administration is revising its processing
of participant plan data to avoid inaccurate information in the
pension notice.

Who Must File
The plan administrator is responsible for filing Schedule SSA.
Plans that cover only owners and their spouses do not have to
file this schedule.
Check the Schedule SSA box on the Form 5500 (Part II, line
10a(4)) if a Schedule SSA is attached to the Form 5500.
Note. Government, church, or other plans that elect to file the
Schedule SSA voluntarily must check the appropriate box on
the schedule and complete lines 2 through 3c.

Transfer of a Participant to a New Plan
When a separated participant with deferred vested benefits is
transferred from the plan he or she was originally reported
under to a new plan,
1. The new plan administrator should complete a Schedule
SSA using:
• Entry Code C for line 4, box (a), when the original plan
information is available, or
• Entry Code A for line 4, box (a), when the original plan
information is not available.
2. The original plan administrator should complete a
Schedule SSA using Entry Code D for line 4, box (a).

When to Report a Separated Participant
In general, for a plan to which only one employer
contributes, a participant must be reported on Schedule SSA
if:
1. The participant separates from service covered by the
plan in a plan year, and
2. The participant is entitled to a deferred vested benefit
under the plan.

Where and How To File
File as an attachment to Form 5500.
Note. Government, church, or other plans that elect to
voluntarily file the Schedule SSA are not required to attach their
Schedule SSA to a Form 5500, but must check the appropriate
box on the schedule.

The separated participant must be reported no later than on
the Schedule SSA filed for the plan year following the plan year
in which separation occurred. However, you can report the
separation in the plan year in which it occurs, if you want to
report earlier. Do not report a participant more than once unless
you wish to revise or update a prior Schedule SSA (see
instructions for line 4, box (a), under codes B, C, or D).
In general, for a plan to which more than one employer
contributes, a participant must be reported on Schedule SSA
if:
1. The participant incurs two successive 1-year breaks in
service (as defined in the plan for vesting purposes), and
2. The participant is (or may be) entitled to a deferred
vested benefit under the plan.

!

CAUTION

Specific Instructions

• Complete all applicable fields on Schedule SSA.
• Please verify that the EIN and plan number being used on

the Form 5500 and this Schedule SSA are correct for this plan.
Line D. Enter the sponsor’s employer identification number
(EIN) shown on Form 5500, line 2b.
Line 2. If the Post Office does not deliver mail to the street
address and you have a P.O. box, enter the box number
instead of the street address.

The participant must be reported no later than on the
Schedule SSA filed for the plan year in which the participant
completed the second of the two consecutive 1-year breaks in
service. The participant may be reported earlier (i.e., on the
Instructions for Schedule SSA (Form 5500)

A penalty may be assessed if Schedule SSA (Form
5500) is not timely filed or critical information is not
furnished.

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Instructions for Form 5500

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Line 4, box (a).
list.

Type of Annuity Code
A A single sum
B Annuity payable over fixed number of years
C Life annuity
D Life annuity with period certain
E Cash refund life annuity
F Modified cash refund life annuity
G Joint and last survivor life annuity
M Other

Enter the appropriate code from the following

Code A — Use this code for a participant not previously
reported. Also complete boxes (b) through (h).
Code B — Use this code for a participant previously
reported under the plan number shown on this schedule to
modify some of the previously reported information. Enter all
the current information for boxes (b) through (h).
Code C — Use this code for a participant previously
reported under another plan number who will now be
receiving his/her future benefit from the plan reported on this
schedule. Also complete boxes (b), (c), (i), and (j).
Code D — Use this code for a participant previously
reported under the plan number shown on this schedule who
is no longer entitled to those deferred vested benefits. This
includes a participant who has begun receiving benefits, has
received a lump-sum payout, or has been transferred to
another plan. Also complete boxes (b) and (c).

Line 4, box (e). From the following list, select the code that
describes the benefit payment frequency during a 12-month
period.
Type of Payment Code
A Lump sum
B Annually
C Semiannually
D Quarterly
E Monthly
M Other
Line 4, box (f). For a defined benefit plan, enter the amount
of the periodic payment that a participant is entitled to receive
under line 4, box (f).
For a plan to which more than one employer contributes, if
the amount of the periodic payment cannot be accurately
determined because the plan administrator does not maintain
complete records of covered service, enter an estimated
amount.
Line 4, box (g). For a defined contribution plan, if the plan
states that a participant’s share of the fund will be determined
on the basis of units, enter the number of units credited to the
participant.
If, under the plan, participation is determined on the basis of
shares of stock of the employer, enter the number of shares
and add the letters ‘‘S’’ to indicate shares. A number without the
‘‘S’’ will be interpreted to mean units.
Line 4, box (h). For defined contribution plans, enter the
value of the participant’s account at the time of separation.
Line 4, boxes (i) and (j). Show the EIN and plan number of
the plan under which the participant was previously reported.
Signature. This form must be signed by the plan
administrator. If more than one Schedule SSA is filed for one
plan, only the initial page one should be signed.

Line 4, box (b). Enter the exact social security number (SSN)
of each participant listed. If the participant is a foreign national
employed outside the United States who does not have an
SSN, enter the word ‘‘FOREIGN.’’
Line 4, box (c). Enter each participant’s name exactly as it
appears on the participant’s social security card. Do not enter
periods; however, initials, if on the social security card, are
permitted. Space is available for the first eleven characters of
the participant’s first name, one for their middle initial, and the
first fifteen characters of their last name. If the participant does
not have a middle initial, leave the space for the middle initial
blank.
Line 4, box (d). From the following list, select the code that
describes the type of annuity that will be provided for the
participant. Enter the code that describes the type of annuity
that normally accrues under the plan at the time of the
participant’s separation from service covered by the plan (or for
a plan to which more than one employer contributes at the time
the participant incurs the second consecutive 1-year break in
service under the plan).

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Instructions for Schedule SSA (Form 5500)

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Instructions for Form 5500

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OMB Control Numbers
Agency
OMB Number
Employee Benefits Security Administration . . . . . 1210 – 0110
1210 – 0089
Internal Revenue Service . . . . . . . . . . . . . . . . . 1545 – 1610

Agency
OMB Number
Pension Benefit Guaranty Corporation . . . . . . . . . 1212 – 0057
Social Security Administration . . . . . . . . . . . . . . . 0960 – 0606

Paperwork Reduction Act Notice
We ask for the information on this form to carry out the law as specified in ERISA and Code sections 6047(e), 6057(b), and 6058(a).
You are required to give us the information. We need it to determine whether the plan is operating according to the law.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the
form displays a valid OMB control number. Books and records relating to a form or its instructions must be retained as long as their
contents may become material in the administration of the Internal Revenue Code or are required to be maintained pursuant to Title
I or IV of ERISA. Generally, the Form 5500 return/reports are open to public inspection. However, Schedules E and SSA (Form
5500) are confidential, as required by Code section 6103.
The time needed to complete and file the forms listed below reflects the combined requirements of the Internal Revenue Service,
Department of Labor, Pension Benefit Guaranty Corporation, and the Social Security Administration. These times will vary
depending on individual circumstances. The estimated average times are:

Pension Plans
Large
Form 5500
Schedule A
Schedule B
Schedule C
Schedule D
Schedule E
Schedule G
Schedule H
Schedule I
Schedule R
Schedule SSA

1 hr., 43 min.
2 hr., 41 min.
7 hr., 56 min.
2 hr., 22 min.
1 hr., 39 min.
3 hr., 18 min.
11 hr., 29 min.
7 hr., 12 min.
1 hr., 36 min.
6 hr., 25 min.

Welfare Plans
Small*
1 hr., 17 min.
2 hr., 44 min.
7 hr., 55 min.
20 min.
3 hr., 18 min.

Large

Small*

1 hr., 45 min.
3 hr., 30 min.

1 hr., 14 min.
2 hr., 36 min.

3 hr., 8 min.
1 hr., 52 min.

20 min.

11 hr.
8 hr.
1 hr., 57 min.
1 hr., 3 min.
1 hr., 42 min.

1 hr., 48 min.

*In 2007, certain small plans have a simplified reporting alternative, as described in the instructions, which allows eligible filers to complete fewer schedules
and line items on certain schedules. We have assumed for purposes of assessing the paperwork burden that not all filers will use the simplified reporting
method because this method of filing is optional. For eligible plans that choose to use the simplified reporting option, the burden of filing will be smaller than the
table indicates, because this option allows eligible plans to fill out fewer line items and schedules.

If you have comments concerning the accuracy of these time estimates or suggestions for making these forms simpler, we would be
happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP,
1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send any of these forms or schedules to this address. Instead, see
Where To File on page 5.

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Page 58 of 62

Instructions for Form 5500

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Forms 5500 and 5500-EZ
Codes for Principal Business
Activity

This list of principal business activities and their
associated codes is designed to classify an
enterprise by the type of activity in which it is

engaged. These principal activity codes are based
on the North American Industry Classification
System.

Code

Code

Code

Code

Agriculture, Forestry, Fishing
and Hunting

Specialty Trade Contractors
238100 Foundation, Structure, &
Building Exterior Contractors
(including framing carpentry,
masonry, glass, roofing, &
siding)
238210 Electrical Contractors
238220 Plumbing, Heating, &
Air-Conditioning Contractors
238290 Other Building Equipment
Contractors
238300 Building Finishing
Contractors (including
drywall, insulation, painting,
wallcovering, flooring, tile, &
finish carpentry)
238900 Other Specialty Trade
Contractors (including site
preparation)

Petroleum and Coal Products
Manufacturing
324110 Petroleum Refineries
(including integrated)
324120 Asphalt Paving, Roofing, &
Saturated Materials Mfg
324190 Other Petroleum & Coal
Products Mfg
Chemical Manufacturing
325100 Basic Chemical Mfg
325200 Resin, Synthetic Rubber, &
Artificial & Synthetic Fibers &
Filaments Mfg
325300 Pesticide, Fertilizer, & Other
Agricultural Chemical Mfg
325410 Pharmaceutical & Medicine
Mfg
325500 Paint, Coating, & Adhesive
Mfg
325600 Soap, Cleaning Compound, &
Toilet Preparation Mfg
325900 Other Chemical Product &
Preparation Mfg
Plastics and Rubber Products
Manufacturing
326100 Plastics Product Mfg
326200 Rubber Product Mfg
Nonmetallic Mineral Product
Manufacturing
327100 Clay Product & Refractory
Mfg
327210 Glass & Glass Product Mfg
327300 Cement & Concrete Product
Mfg
327400 Lime & Gypsum Product Mfg
327900 Other Nonmetallic Mineral
Product Mfg
Primary Metal Manufacturing
331110 Iron & Steel Mills & Ferroalloy
Mfg
331200 Steel Product Mfg from
Purchased Steel
331310 Alumina & Aluminum
Production & Processing
331400 Nonferrous Metal (except
Aluminum) Production &
Processing
331500 Foundries
Fabricated Metal Product
Manufacturing
332110 Forging & Stamping
332210 Cutlery & Handtool Mfg
332300 Architectural & Structural
Metals Mfg
332400 Boiler, Tank, & Shipping
Container Mfg
332510 Hardware Mfg
332610 Spring & Wire Product Mfg
332700 Machine Shops; Turned
Product; & Screw, Nut, & Bolt
Mfg
332810 Coating, Engraving, Heat
Treating, & Allied Activities
332900 Other Fabricated Metal
Product Mfg
Machinery Manufacturing
333100 Agriculture, Construction, &
Mining Machinery Mfg
333200 Industrial Machinery Mfg
333310 Commercial & Service
Industry Machinery Mfg
333410 Ventilation, Heating,
Air-Conditioning, &
Commercial Refrigeration
Equipment Mfg
333510 Metalworking Machinery Mfg
333610 Engine, Turbine & Power
Transmission Equipment Mfg
333900 Other General Purpose
Machinery Mfg

Computer and Electronic Product
Manufacturing
334110 Computer & Peripheral
Equipment Mfg
334200 Communications Equipment
Mfg
334310 Audio & Video Equipment
Mfg
334410 Semiconductor & Other
Electronic Component Mfg
334500 Navigational, Measuring,
Electromedical, & Control
Instruments Mfg
334610 Manufacturing & Reproducing
Magnetic & Optical Media
Electrical Equipment, Appliance, and
Component Manufacturing
335100 Electric Lighting Equipment
Mfg
335200 Household Appliance Mfg
335310 Electrical Equipment Mfg
335900 Other Electrical Equipment &
Component Mfg
Transportation Equipment
Manufacturing
336100 Motor Vehicle Mfg
336210 Motor Vehicle Body & Trailer
Mfg
336300 Motor Vehicle Parts Mfg
336410 Aerospace Product & Parts
Mfg
336510 Railroad Rolling Stock Mfg
336610 Ship & Boat Building
336990 Other Transportation
Equipment Mfg
Furniture and Related Product
Manufacturing
337000 Furniture & Related Product
Manufacturing
Miscellaneous Manufacturing
339110 Medical Equipment &
Supplies Mfg
339900 Other Miscellaneous
Manufacturing

Crop Production
111100 Oilseed & Grain Farming
111210 Vegetable & Melon Farming
(including potatoes & yams)
111300 Fruit & Tree Nut Farming
111400 Greenhouse, Nursery, &
Floriculture Production
111900 Other Crop Farming
(including tobacco, cotton,
sugarcane, hay, peanut,
sugar beet, & all other crop
farming)
Animal Production
112111 Beef Cattle Ranching &
Farming
112112 Cattle Feedlots
112120 Dairy Cattle & Milk
Production
112210 Hog & Pig Farming
112300 Poultry & Egg Production
112400 Sheep & Goat Farming
112510 Aquaculture (including
shellfish & finfish farms &
hatcheries)
112900 Other Animal Production
Forestry and Logging
113110 Timber Tract Operations
113210 Forest Nurseries & Gathering
of Forest Products
113310 Logging
Fishing, Hunting and Trapping
114110 Fishing
114210 Hunting & Trapping
Support Activities for Agriculture
and Forestry
115110 Support Activities for Crop
Production (including cotton
ginning, soil preparation,
planting, & cultivating)
115210 Support Activities for Animal
Production
115310 Support Activities For
Forestry

Mining
211110
212110
212200
212310
212320

Oil & Gas Extraction
Coal Mining
Metal Ore Mining
Stone Mining & Quarrying
Sand, Gravel, Clay, &
Ceramic & Refractory
Minerals Mining & Quarrying
212390 Other Nonmetallic Mineral
Mining & Quarrying
213110 Support Activities for Mining

Utilities
221100 Electric Power Generation,
Transmission & Distribution
221210 Natural Gas Distribution
221300 Water, Sewage, & Other
Systems
221500 Combination Gas & Electric

Construction
Construction of Buildings
236110 Residential Building
Construction
236200 Nonresidential Building
Construction
Heavy and Civil Engineering
Construction
237100 Utility System Construction
237210 Land Subdivision
237310 Highway, Street, & Bridge
Construction
237990 Other Heavy & Civil
Engineering Construction

Manufacturing
Food Manufacturing
311110 Animal Food Mfg
311200 Grain & Oilseed Milling
311300 Sugar & Confectionery
Product Mfg
311400 Fruit & Vegetable Preserving
& Specialty Food Mfg
311500 Dairy Product Mfg
311610 Animal Slaughtering and
Processing
311710 Seafood Product Preparation
& Packaging
311800 Bakeries & Tortilla Mfg
311900 Other Food Mfg (including
coffee, tea, flavorings &
seasonings)
Beverage and Tobacco Product
Manufacturing
312110 Soft Drink & Ice Mfg
312120 Breweries
312130 Wineries
312140 Distilleries
312200 Tobacco Manufacturing
Textile Mills and Textile Product
Mills
313000 Textile Mills
314000 Textile Product Mills
Apparel Manufacturing
315100 Apparel Knitting Mills
315210 Cut & Sew Apparel
Contractors
315220 Men’s & Boys’ Cut & Sew
Apparel Mfg
315230 Women’s & Girls’ Cut & Sew
Apparel Mfg
315290 Other Cut & Sew Apparel Mfg
315990 Apparel Accessories & Other
Apparel Mfg
Leather and Allied Product
Manufacturing
316110 Leather & Hide Tanning &
Finishing
316210 Footwear Mfg (including
rubber & plastics)
316990 Other Leather & Allied
Product Mfg
Wood Product Manufacturing
321110 Sawmills & Wood
Preservation
321210 Veneer, Plywood, &
Engineered Wood Product
Mfg
321900 Other Wood Product Mfg
Paper Manufacturing
322100 Pulp, Paper, & Paperboard
Mills
322200 Converted Paper Product Mfg
Printing and Related Support
Activities
323100 Printing & Related Support
Activities

-58-

Wholesale Trade
Merchant Wholesalers, Durable
Goods
423100 Motor Vehicle & Motor
Vehicle Parts & Supplies
423200 Furniture & Home
Furnishings
423300 Lumber & Other Construction
Materials
423400 Professional & Commercial
Equipment & Supplies
423500 Metals & Minerals (except
Petroleum)
423600 Electrical & Electronic Goods
423700 Hardware, Plumbing &
Heating Equipment &
Supplies
423800 Machinery, Equipment, &
Supplies
423910 Sporting & Recreational
Goods & Supplies
423920 Toy & Hobby Goods &
Supplies
423930 Recyclable Materials
423940 Jewelry, Watches, Precious
Stones, & Precious Metals
423990 Other Miscellaneous Durable
Goods
Merchant Wholesalers, Nondurable
Goods
424100 Paper & Paper Products
424210 Drugs & Druggists’ Sundries
424300 Apparel, Piece Goods, &
Notions
424400 Grocery & Related Products
424500 Farm Product Raw Materials
424600 Chemical & Allied Products

Page 59 of 62

Instructions for Form 5500

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Forms 5500 and 5500-EZ Codes for Principal Business Activity (continued)
Code

Code

Code

Code

424700 Petroleum & Petroleum
Products
424800 Beer, Wine, & Distilled
Alcoholic Beverages
424910 Farm Supplies
424920 Books, Periodicals, &
Newspapers
424930 Flower, Nursery Stock, &
Florists’ Supplies
424940 Tobacco & Tobacco Products
424950 Paint, Varnish, & Supplies
424990 Other Miscellaneous
Nondurable Goods
Wholesale Electronic Markets and
Agents and Brokers
425110 Business to Business
Electronic Markets
425120 Wholesale Trade Agents &
Brokers

448140
448150
448190
448210
448310
448320

Support Activities for Transportation
488100 Support Activities for Air
Transportation
488210 Support Activities for Rail
Transportation
488300 Support Activities for Water
Transportation
488410 Motor Vehicle Towing
488490 Other Support Activities for
Road Transportation
488510 Freight Transportation
Arrangement
488990 Other Support Activities for
Transportation
Couriers and Messengers
492110 Couriers
492210 Local Messengers & Local
Delivery
Warehousing and Storage
493100 Warehousing & Storage
(except lessors of
miniwarehouses &
self-storage units)

Activities Related to Credit
Intermediation
522300 Activities Related to Credit
Intermediation (including loan
brokers, check clearing, &
money transmitting)
Securities, Commodity Contracts,
and Other Financial Investments and
Related Activities
523110 Investment Banking &
Securities Dealing
523120 Securities Brokerage
523130 Commodity Contracts
Dealing
523140 Commodity Contracts
Brokerage
523210 Securities & Commodity
Exchanges
523900 Other Financial Investment
Activities (including portfolio
management & investment
advice)
Insurance Carriers and Related
Activities
524140 Direct Life, Health, & Medical
Insurance & Reinsurance
Carriers
524150 Direct Insurance &
Reinsurance (except Life,
Health & Medical) Carriers
524210 Insurance Agencies &
Brokerages
524290 Other Insurance Related
Activities (including
third-party administration of
insurance and pension funds)
Funds, Trusts, and Other Financial
Vehicles
525100 Insurance & Employee
Benefit Funds
525910 Open-End Investment Funds
(Form 1120-RIC)
525920 Trusts, Estates, & Agency
Accounts
525990 Other Financial Vehicles
(including mortgage REITs &
closed-end investment funds)
“Offices of Bank Holding Companies”
and “Offices of Other Holding
Companies” are located under
Management of Companies (Holding
Companies).

Retail Trade
Motor Vehicle and Parts Dealers
441110 New Car Dealers
441120 Used Car Dealers
441210 Recreational Vehicle Dealers
441221 Motorcycle Dealers
441222 Boat Dealers
441229 All Other Motor Vehicle
Dealers
441300 Automotive Parts,
Accessories, & Tire Stores
Furniture and Home Furnishings
Stores
442110 Furniture Stores
442210 Floor Covering Stores
442291 Window Treatment Stores
442299 All Other Home Furnishings
Stores
Electronics and Appliance Stores
443111 Household Appliance Stores
443112 Radio, Television, & Other
Electronics Stores
443120 Computer & Software Stores
443130 Camera & Photographic
Supplies Stores
Building Material and Garden
Equipment and Supplies Dealers
444110 Home Centers
444120 Paint & Wallpaper Stores
444130 Hardware Stores
444190 Other Building Material
Dealers
444200 Lawn & Garden Equipment &
Supplies Stores
Food and Beverage Stores
445110 Supermarkets and Other
Grocery (except
Convenience) Stores
445120 Convenience Stores
445210 Meat Markets
445220 Fish & Seafood Markets
445230 Fruit & Vegetable Markets
445291 Baked Goods Stores
445292 Confectionery & Nut Stores
445299 All Other Specialty Food
Stores
445310 Beer, Wine, & Liquor Stores
Health and Personal Care Stores
446110 Pharmacies & Drug Stores
446120 Cosmetics, Beauty Supplies,
& Perfume Stores
446130 Optical Goods Stores
446190 Other Health & Personal
Care Stores
Gasoline Stations
447100 Gasoline Stations (including
convenience stores with gas)
Clothing and Clothing Accessories
Stores
448110 Men’s Clothing Stores
448120 Women’s Clothing Stores
448130 Children’s & Infants’ Clothing
Stores

Family Clothing Stores
Clothing Accessories Stores
Other Clothing Stores
Shoe Stores
Jewelry Stores
Luggage & Leather Goods
Stores
Sporting Goods, Hobby, Book, and
Music Stores
451110 Sporting Goods Stores
451120 Hobby, Toy, & Game Stores
451130 Sewing, Needlework, & Piece
Goods Stores
451140 Musical Instrument &
Supplies Stores
451211 Book Stores
451212 News Dealers & Newsstands
451220 Prerecorded Tape, Compact
Disc, & Record Stores
General Merchandise Stores
452110 Department Stores
452900 Other General Merchandise
Stores
Miscellaneous Store Retailers
453110 Florists
453210 Office Supplies & Stationery
Stores
453220 Gift, Novelty, & Souvenir
Stores
453310 Used Merchandise Stores
453910 Pet & Pet Supplies Stores
453920 Art Dealers
453930 Manufactured (Mobile) Home
Dealers
453990 All Other Miscellaneous Store
Retailers (including tobacco,
candle, & trophy shops)
Nonstore Retailers
454110 Electronic Shopping &
Mail-Order Houses
454210 Vending Machine Operators
454311 Heating Oil Dealers
454312 Liquefied Petroleum Gas
(bottled gas) Dealers
454319 Other Fuel Dealers
454390 Other Direct Selling
Establishments (including
door-to-door retailing, frozen
food plan providers, party
plan merchandisers, &
coffee-break service
providers)

Transportation and
Warehousing
Air, Rail, and Water Transportation
481000 Air Transportation
482110 Rail Transportation
483000 Water Transportation
Truck Transportation
484110 General Freight Trucking,
Local
484120 General Freight Trucking,
Long-distance
484200 Specialized Freight Trucking
Transit and Ground Passenger
Transportation
485110 Urban Transit Systems
485210 Interurban & Rural Bus
Transportation
485310 Taxi Service
485320 Limousine Service
485410 School & Employee Bus
Transportation
485510 Charter Bus Industry
485990 Other Transit & Ground
Passenger Transportation
Pipeline Transportation
486000 Pipeline Transportation
Scenic & Sightseeing Transportation
487000 Scenic & Sightseeing
Transportation

Information
Publishing Industries (except
Internet)
511110 Newspaper Publishers
511120 Periodical Publishers
511130 Book Publishers
511140 Directory & Mailing List
Publishers
511190 Other Publishers
511210 Software Publishers
Motion Picture and Sound
Recording Industries
512100 Motion Picture & Video
Industries (except video
rental)
512200 Sound Recording Industries
Broadcasting (except Internet)
515100 Radio & Television
Broadcasting
515210 Cable & Other Subscription
Programming
Telecommunications
517000 Telecommunications
(including paging, cellular,
satellite, cable & other
program distribution,
resellers, other
telecommunications, &
internet service providers)
Data Processing Services
518210 Data Processing, Hosting, &
Related Services
Other Information Services
519100 Other Information Services
(including news syndicates,
libraries, internet publishing &
broadcasting)

Finance and Insurance
Depository Credit Intermediation
522110 Commercial Banking
522120 Savings Institutions
522130 Credit Unions
522190 Other Depository Credit
Intermediation
Nondepository Credit Intermediation
522210 Credit Card Issuing
522220 Sales Financing
522291 Consumer Lending
522292 Real Estate Credit (including
mortgage bankers &
originators)
522293 International Trade Financing
522294 Secondary Market Financing
522298 All Other Nondepository
Credit Intermediation

-59-

Real Estate and Rental and
Leasing
Real Estate
531110 Lessors of Residential
Buildings & Dwellings
(including equity REITs)
531114 Cooperative Housing
(including equity REITs)
531120 Lessors of Nonresidential
Buildings (except
Miniwarehouses) (including
equity REITs)
531130 Lessors of Miniwarehouses &
Self-Storage Units (including
equity REITs)
531190 Lessors of Other Real Estate
Property (including equity
REITs)
531210 Offices of Real Estate Agents
& Brokers
531310 Real Estate Property
Managers
531320 Offices of Real Estate
Appraisers
531390 Other Activities Related to
Real Estate
Rental and Leasing Services
532100 Automotive Equipment Rental
& Leasing
532210 Consumer Electronics &
Appliances Rental
532220 Formal Wear & Costume
Rental
532230 Video Tape & Disc Rental

Page 60 of 62

Instructions for Form 5500

9:33 - 25-SEP-2007

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Forms 5500 and 5500-EZ Codes for Principal Business Activity (continued)
Code

Code

Code

Code

532290 Other Consumer Goods
Rental
532310 General Rental Centers
532400 Commercial & Industrial
Machinery & Equipment
Rental & Leasing
Lessors of Nonfinancial Intangible
Assets (except copyrighted works)
533110 Lessors of Nonfinancial
Intangible Assets (except
copyrighted works)

561210 Facilities Support Services
561300 Employment Services
561410 Document Preparation
Services
561420 Telephone Call Centers
561430 Business Service Centers
(including private mail centers
& copy shops)
561440 Collection Agencies
561450 Credit Bureaus
561490 Other Business Support
Services (including
repossession services, court
reporting, & stenotype
services)
561500 Travel Arrangement &
Reservation Services
561600 Investigation & Security
Services
561710 Exterminating & Pest Control
Services
561720 Janitorial Services
561730 Landscaping Services
561740 Carpet & Upholstery Cleaning
Services
561790 Other Services to Buildings &
Dwellings
561900 Other Support Services
(including packaging &
labeling services, &
convention & trade show
organizers)
Waste Management and
Remediation Services
562000 Waste Management &
Remediation Services

Medical and Diagnostic Laboratories
621510 Medical & Diagnostic
Laboratories
Home Health Care Services
621610 Home Health Care Services
Other Ambulatory Health Care
Services
621900 Other Ambulatory Health
Care Services (including
ambulance services & blood
& organ banks)
Hospitals
622000 Hospitals
Nursing and Residential Care
Facilities
623000 Nursing & Residential Care
Facilities
Social Assistance
624100 Individual & Family Services
624200 Community Food & Housing,
& Emergency & Other Relief
Services
624310 Vocational Rehabilitation
Services
624410 Child Day Care Services

722300 Special Food Services
(including food service
contractors & caterers)
722410 Drinking Places (Alcoholic
Beverages)

Professional, Scientific, and
Technical Services
Legal Services
541110 Offices of Lawyers
541190 Other Legal Services
Accounting, Tax Preparation,
Bookkeeping, and Payroll Services
541211 Offices of Certified Public
Accountants
541213 Tax Preparation Services
541214 Payroll Services
541219 Other Accounting Services
Architectural, Engineering, and
Related Services
541310 Architectural Services
541320 Landscape Architecture
Services
541330 Engineering Services
541340 Drafting Services
541350 Building Inspection Services
541360 Geophysical Surveying &
Mapping Services
541370 Surveying & Mapping (except
Geophysical) Services
541380 Testing Laboratories
Specialized Design Services
541400 Specialized Design Services
(including interior, industrial,
graphic, & fashion design)
Computer Systems Design and
Related Services
541511 Custom Computer
Programming Services
541512 Computer Systems Design
Services
541513 Computer Facilities
Management Services
541519 Other Computer Related
Services
Other Professional, Scientific, and
Technical Services
541600 Management, Scientific, &
Technical Consulting
Services
541700 Scientific Research &
Development Services
541800 Advertising & Related
Services
541910 Marketing Research & Public
Opinion Polling
541920 Photographic Services
541930 Translation & Interpretation
Services
541940 Veterinary Services
541990 All Other Professional,
Scientific, & Technical
Services

Management of Companies
(Holding Companies)
551111 Offices of Bank Holding
Companies
551112 Offices of Other Holding
Companies

Educational Services
611000 Educational Services
(including schools, colleges,
& universities)

Health Care and Social
Assistance
Offices of Physicians and Dentists
621111 Offices of Physicians (except
mental health specialists)
621112 Offices of Physicians, Mental
Health Specialists
621210 Offices of Dentists
Offices of Other Health Practitioners
621310 Offices of Chiropractors
621320 Offices of Optometrists
621330 Offices of Mental Health
Practitioners (except
Physicians)
621340 Offices of Physical,
Occupational & Speech
Therapists, & Audiologists
621391 Offices of Podiatrists
621399 Offices of All Other
Miscellaneous Health
Practitioners
Outpatient Care Centers
621410 Family Planning Centers
621420 Outpatient Mental Health &
Substance Abuse Centers
621491 HMO Medical Centers
621492 Kidney Dialysis Centers
621493 Freestanding Ambulatory
Surgical & Emergency
Centers
621498 All Other Outpatient Care
Centers

Arts, Entertainment, and
Recreation
Performing Arts, Spectator Sports,
and Related Industries
711100 Performing Arts Companies
711210 Spectator Sports (including
sports clubs & racetracks)
711300 Promoters of Performing Arts,
Sports, & Similar Events
711410 Agents & Managers for
Artists, Athletes, Entertainers,
& Other Public Figures
711510 Independent Artists, Writers,
& Performers
Museums, Historical Sites, and
Similar Institutions
712100 Museums, Historical Sites, &
Similar Institutions
Amusement, Gambling, and
Recreation Industries
713100 Amusement Parks & Arcades
713200 Gambling Industries
713900 Other Amusement &
Recreation Industries
(including golf courses, skiing
facilities, marinas, fitness
centers, & bowling centers)

Accommodation and Food
Services
Accommodation
721110 Hotels (except Casino Hotels)
& Motels
721120 Casino Hotels
721191 Bed & Breakfast Inns
721199 All Other Traveler
Accommodation
721210 RV (Recreational Vehicle)
Parks & Recreational Camps
721310 Rooming & Boarding Houses
Food Services and Drinking Places
722110 Full-Service Restaurants
722210 Limited-Service Eating
Places

Administrative and Support
and Waste Management and
Remediation Services
Administrative and Support Services
561110 Office Administrative
Services

-60-

Other Services
Repair and Maintenance
811110 Automotive Mechanical &
Electrical Repair &
Maintenance
811120 Automotive Body, Paint,
Interior, & Glass Repair
811190 Other Automotive Repair &
Maintenance (including oil
change & lubrication shops &
car washes)
811210 Electronic & Precision
Equipment Repair &
Maintenance
811310 Commercial & Industrial
Machinery & Equipment
(except Automotive &
Electronic) Repair &
Maintenance
811410 Home & Garden Equipment &
Appliance Repair &
Maintenance
811420 Reupholstery & Furniture
Repair
811430 Footwear & Leather Goods
Repair
811490 Other Personal & Household
Goods Repair & Maintenance
Personal and Laundry Services
812111 Barber Shops
812112 Beauty Salons
812113 Nail Salons
812190 Other Personal Care
Services (including diet &
weight reducing centers)
812210 Funeral Homes & Funeral
Services
812220 Cemeteries & Crematories
812310 Coin-Operated Laundries &
Drycleaners
812320 Drycleaning & Laundry
Services (except
Coin-Operated)
812330 Linen & Uniform Supply
812910 Pet Care (except Veterinary)
Services
812920 Photofinishing
812930 Parking Lots & Garages
812990 All Other Personal Services
Religious, Grantmaking, Civic,
Professional, and Similar
Organizations
813000 Religious, Grantmaking,
Civic, Professional, & Similiar
Organizations (including
condominium and
homeowners associations)
813930 Labor Unions and Similar
Labor Organizations
921000 Governmental Instrumentality
or Agency

Page 61 of 62

Instructions for Form 5500

9:33 - 25-SEP-2007

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

ERISA COMPLIANCE QUICK CHECKLIST
Compliance with the Employee Retirement Income Security Act (ERISA) begins with knowing the rules. Plan
administrators and other plan officials can use this checklist as a quick diagnostic tool for assessing a plan’s compliance
with certain important ERISA rules; it is not a complete description of all ERISA’s rules and it is not a substitute for a
comprehensive compliance review. Use of this checklist is voluntary, and it should not be filed with your Form 5500.
If you answer “No” to any of the questions below, you should review your plan’s operations because you may
not be in full compliance with ERISA’s requirements.
1.

Have you provided plan participants with a summary plan description, summaries of any material modifications
of the plan, and annual summary financial reports?

2.

Do you maintain copies of plan documents at the principal office of the plan administrator for examination by
participants and beneficiaries?

3.

Do you respond to written participant inquires for copies of plan documents and information within 30 days?

4.

Does your plan include written procedures for making benefit claims and appealing denied claims, and are you
complying with those procedures?

5.

Is your plan covered by a fidelity bond against losses due to fraud or dishonesty?

6.

Are the plan’s investments diversified so as to minimize the risk of large losses?

7.

If the plan permits participants to select the investments in their plan accounts, has the plan provided them with
enough information to make informed decisions?

8.

Has a plan official determined that the investments are prudent and solely in the interest of the plan’s
participants and beneficiaries, and evaluated the risks associated with plan investments before making the
investments?

9.

Did the employer or other plan sponsor send participant contributions to the plan on a timely basis?

10.

Did the plan pay participant benefits on time and in the correct amounts?

11.

Did the plan give participants and beneficiaries 30 days advance notice before imposing a “blackout period” of at
least three consecutive business days during which participants or beneficiaries of a 401(k) or other individual
account pension plan were unable to change their plan investments, obtain loans from the plan, or obtain
distributions from the plan?

If you answer “Yes” to any of the questions below, you should review your plan’s operations because you may
not be in full compliance with ERISA’s requirements.
1.

Has the plan engaged in any financial transactions with persons related to the plan or any plan official? (For
example, has the plan made a loan to or participated in an investment with the employer?)

2.

Has the plan official used the assets of the plan for his/her own interest?

3.

Have plan assets been used to pay expenses that were not authorized in the plan document, were not
necessary to the proper administration of the plan, or were more than reasonable in amount?

If you need help answering these questions or want additional guidance about ERISA requirements, a plan
official should contact the U.S. Department of Labor Employee Benefits Security Administration office in your
region or consult with the plan’s legal counsel or professional employee benefit advisor.

-61-