SFA 205-A SFA Template 5A

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Overview

Template 5A Instructions
5A-1 Baseline Ben Pmts
5A-2 Baseline Pcount & AdExp
5A-3 Baseline Details

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Sheet 1: Template 5A Instructions

TEMPLATE 5A

v20220701p

Baseline - for non-MPRA plans using the "basic method", or for MPRA plans for which the requested amount of SFA is determined under the "increasing assets method"

File name: Template 5A Plan Name, where "Plan Name" is an abbreviated version of the plan name.

Instructions for Section C, Item (5) of the Instructions for Filing Requirements for Multiemployer Plans Applying for Special Financial Assistance:

This Template 5A is not required if all assumptions and methods used to determine the requested SFA amount are identical to those used in the most recent actuarial certification of plan status completed before 1/1/2021 ("pre-2021 certification of plan status"), except the non-SFA and SFA interest rates, and except any assumptions that were changed in accordance with Section III, Acceptable Assumption Changes in PBGC's SFA assumptions guidance (other than the acceptable assumption change for "missing" terminated vested participants described in Section III.E. of PBGC's SFA assumptions guidance).

Provide a separate deterministic projection ("Baseline") using the same calculation methodology used to determine the requested SFA amount, in the same format as Template 4A (Sheets 4A-2, 4A-3, and either 4A-4 or 4A-5) that shows the amount of SFA that would be determined if all underlying assumptions and methods used in the projection were the same as those used in the pre-2021 certification of plan status, except the plan's non-SFA interest rate and SFA interest rate, which should be the same as used in Template 4A (Sheet 4A-1).

For purposes of this Template 5A, any assumption change made in accordance with Section III, Acceptable Assumption Changes, in PBGC's SFA assumptions guidance should be reflected in this Baseline calculation of the SFA amount and supporting projection information, except that an assumption change for “missing” terminated vested participants described in Section III.E of PBGC’s SFA assumptions guidance should not be reflected in the Baseline projections. See examples in the SFA instructions for Section C, Item (5).

Additional instructions for each individual worksheet:

Sheet

5A-1

Baseline - Benefit Payments for the "basic method", or for MPRA plans for which the requested amount of SFA is determined under the "increasing assets method"

See Template 4A instructions for Sheet 4A-2, except provide the benefit payment projection used to determine the Baseline SFA amount.

5A-2

Baseline - Participant Count and Administrative Expenses for the "basic method", or for MPRA plans for which the requested amount of SFA is determined under the "increasing assets method"

See Template 4A instructions for Sheet 4A-3, except provide the projected total participant count and administrative expense projection used to determine the Baseline SFA amount.

5A-3

Baseline - Details for the "basic method" under § 4262.4(a)(1) for non-MPRA plans, or for the "increasing assets method" under § 4262.4(a)(2)(i) for MPRA plans for which the requested amount of SFA is determined under that method

For non-MPRA plans, see Template 4A instructions for Sheet 4A-4, except provide the projection used to determine the Baseline SFA amount under the "basic method" described in § 4262.4(a)(1). Unlike Sheet 4A-4, it is not necessary to explicitly identify the projected SFA exhaustion year in Sheet 5A-3. For MPRA plans for which the requested amount of SFA is determined under the "increasing assets method", see Template 4A instructions for Sheet 4A-5, except provide the projection used to determine the Baseline SFA amount under the "increasing assets method" described in § 4262.4(a)(2)(i). Unlike Sheet 4A-5, it is not necessary to identify the projected SFA exhaustion year in Sheet 5A-3.

Version Updates (newest version at top)

Version

Date updated

v20220701p

7/1/2022

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Sheet 2: 5A-1 Baseline Ben Pmts

TEMPLATE 5A - Sheet 5A-1						v20220701p
Baseline - Benefit Payments for the "basic method", or for MPRA plans for which the requested amount of SFA is determined under the "increasing assets method"
See Template 4A instructions for Sheet 4A-2, except provide the benefit payment projection used to determine the Baseline SFA amount.
PLAN INFORMATION
Abbreviated Plan Name:
EIN:
PN:
SFA Measurement Date:
		On this Sheet, show all benefit payment amounts as positive amounts.
		PROJECTED BENEFIT PAYMENTS for:
SFA Measurement Date / Plan Year Start Date	Plan Year End Date	Current Retirees and Beneficiaries in Pay Status	Current Terminated Vested Participants	Current Active Participants	New Entrants	Total

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Sheet 3: 5A-2 Baseline Pcount & AdExp

TEMPLATE 5A - Sheet 5A-2						v20220701p
Baseline - Participant Count and Administrative Expenses for the "basic method", or for MPRA plans for which the requested amount of SFA is determined under the "increasing assets method"
See Template 4A instructions for Sheet 4A-3, except provide the projected total participant count and administrative expense projection used to determine the Baseline SFA amount.
PLAN INFORMATION
Abbreviated Plan Name:
EIN:
PN:
SFA Measurement Date:
			On this Sheet, show all administrative expense amounts as positive amounts.
			PROJECTED ADMINISTRATIVE EXPENSES for:
SFA Measurement Date / Plan Year Start Date	Plan Year End Date	Total Participant Count at Beginning of Plan Year	PBGC Premiums	Other	Total
		N/A

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Sheet 4: 5A-3 Baseline Details

TEMPLATE 5A - Sheet 5A-3

v20220701p

Baseline - Details for the "basic method" under § 4262.4(a)(1) for non-MPRA plans, or for the "increasing assets method" under § 4262.4(a)(2)(i) for MPRA plans for which the requested amount of SFA is determined under that method

See Template 4A instructions for Sheet 4A-4 or Sheet 4A-5, except provide the projection used to determine the Baseline SFA amount.

PLAN INFORMATION

Abbreviated Plan Name:

EIN:

PN:

MPRA Plan?

If a MPRA Plan, which method yields the greatest amount of SFA?

SFA Measurement Date:

Fair Market Value of Assets as of the SFA Measurement Date:

SFA Amount as of the SFA Measurement Date under the method calculated in this Sheet:

Non-SFA Interest Rate:

SFA Interest Rate:

On this Sheet, show payments INTO the plan as positive amounts, and payments OUT of the plan as negative amounts.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

SFA Measurement Date / Plan Year Start Date

Plan Year End Date

Contributions

Withdrawal Liability Payments

Other Payments to Plan (excluding financial assistance and SFA)

Benefit Payments (should match total from Sheet 5A-1)

Make-up Payments Attributable to Reinstatement of Benefits Suspended through the SFA Measurement Date

Administrative Expenses (excluding amount owed PBGC under 4261 of ERISA; should match total from Sheet 5A-2)

Benefit Payments (from (4) and (5)) and Administrative Expenses (from (6)) Paid from SFA Assets

SFA Investment Income Based on SFA Interest Rate

Projected SFA Assets at End of Plan Year (prior year assets + (7) + (8))

Benefit Payments (from (4) and (5)) and Administrative Expenses (from (6)) Paid from Non-SFA Assets

Non-SFA Investment Income Based on Non-SFA Interest Rate

Projected Non-SFA Assets at End of Plan Year (prior year assets + (1) + (2) + (3) + (10) + (11))