MP-200 Template MP-200 Template

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Overview

Instructions
Schedule A
Schedule B

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Sheet 1: Instructions

	Instructions for Completing Excel Template
1)	Overwrite the sample data in each tab and populate the applicable tab for:
	- Notifying PBGC of transfer to Financial Institution: Schedule A; or
	- Transferring Funds to PBGC: Schedule B
2)	If both schedules aren't required, delete the non-applicable Schedule tab from the spreadsheet.
3)	Enter your applicable case number in the heading of the applicable tab.
4)	Use the appropriate schedule as a guide while filling out this spreadsheet.
5)	When the instructions on the schedule direct to leave an item number or part of the schedule blank, please leave the appropriate field(s) blank on this spreadsheet.
6)	Save your spreadsheet as "Form 200 Excel Attachment_12345600" where "12345600" is the applicable case number of your plan.
	If you have any questions on what you should populate in any field, please see the appropriate item number on the schedule and research the applicable section of the Form MP-200 Instructions.
1.	Review the Form MP-200 instructions before entering data.
2.	Overwrite the sample data shown with the data that needs to be reported.
3.	Delete the non-applicable tab from the spreadsheet (i.e., Transferring Plans delete the Schedule A tab; Notifying Plans delete the Schedule B tab.
4.	Enter the PBGC case number assgined to your plan in the heading of the applicable tab.
5.	Save your spreadsheet as "Form 200 Excel Attachment_12345600" where "12345600" is the applicable case number of your plan.
6.	Feel free to add a row at the bottom totalling amounts, counting participants, etc., but please insert a blank row between the individual data and any "total" row you want to add.

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Sheet 2: Schedule A

Schedule A individual data - Attachment to Form MP-200

See instructions for detailed information about data to be entered, including information about which items may be left blank

Case Number

12345600

Financial institution information

Financial institution address

Missing distributee's name

Date of birth

Social security number (enter w-o dashes)

Last-known address

Account information

Amended Filing Code

Name

Contact Name

Contact Telephone

Contact Email

Street

City

State

Zip

Last

First

Middle

Street

City

State

Zip

Account number

Account balance transferred

2(a)

2b(1)

2b(2)

2b(3)

2c(1)

2c(2)

2c(3)

2c(4)

3a(1)

3a(1)

3a(1)

3a(2)

3a(3)

3b(1)

3b(2)

3b(3)

3b(4)

3c(1)

3c(2)

4

First National Bank

Sarah Parker

(888) 555-2222

s.parker@FNB.com

502 Mockingbird Street

Atlanta

GA

30301

White

Betty

E

5/5/1955

111111111

123 Robin Hwy Ave

City1

DE

42345

1111111111

$25,000.00

First National Bank

Sarah Parker

8885552222

s.parker@FNB.com

502 Mockingbird Street

Atlanta

GA

30301

Yellow

Joseph

F

6/6/1965

222222222

123 Blackbird Rd

City2

WV

52345

2222222222

$10,000.00

First National Bank

Sarah Parker

8885552222

s.parker@FNB.com

502 Mockingbird Street

Atlanta

GA

30301

Black

Polly

G

7/7/1970

333333333

123 Eagle St

City3

DE

62345

3333333333

$2,500.00

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Sheet 3: Schedule B

Schedule B individual data - Attachment to Form MP-200

See instructions for detailed information about data to be entered, including information about which items may be left blank

Case Number

12345600

Part II - Individual Information

Part III - Transfer Amount

Part IV - Miscellaneous Information

Missing distributee's name

Date of birth

Social security number (enter w-o dashes)

Last-known address

Other name(s) ever used

Type of distributee

Transfer amount

Beneficiary information

Post-Tax Contributions (YES or NO)

Amended Filing Code

Last

First

Middle

Street

City

State

Zip

P if Participant B if Beneficiary

Pre Tax Contributions

Qualified Roth transfers

Non-qualified Roth transfers

Other

Total

Non U.S. Source Income

Non-qualified Roth transfer

Valid Beneficiary Election Form?

Name

SSN enter w-o dashes

Relationship

(Yes or No)

Date of 1st Roth Contribution

2a

2a

2a

2b

2c

2d(1)

2d(2)

2d(3)

2d(4)

2e

2f

3

4a

4b

4c

5

6

7

8a

8b

8c

8d

9

White

James

E

5/5/1955

111111111

123 Robin Hwy Ave

City1

DE

42345

P

$2,000.00

$0.00

$5,000.00

$0.00

$7,000.00

YES

Jane White

999999999

Spouse

YES

Yellow

Joe

F

6/6/1965

222222222

123 Blackbird Rd

City2

WV

52345

P

$10,000.00

$0.00

$0.00

$0.00

$10,000.00

NO

NO

Black

Polly

G

7/7/1970

333333333

123 Eagle St

City3

DE

62345

B

$0.00

$25,000.00

$0.00

$3,500.00

$28,500.00

NO