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Federal Free Printable Form 5330 (Rev. December 2013) for 2019 Federal Return of Excise Taxes Related to Employee Benefit Plans

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Return of Excise Taxes Related to Employee Benefit Plans
Form 5330 (Rev. December 2013)

5330 Form (Rev. December 2013) Department of the Treasury Internal Revenue Service Return of Excise Taxes Related to Employee Benefit Plans (Under sections 4965, 4971, 4972, 4973(a)(3), 4975, 4976, 4977, 4978, 4979, 4979A, 4980, and 4980F of the Internal Revenue Code) ▶ Information about Form 5330 and its instructions is at www.irs.gov/form5330. Filer tax year beginning A , OMB No. 1545-0575 and ending , Name of filer (see instructions) B Filer’s identifying number (Enter either the EIN or SSN, but not both. See instructions.) Number, street, and room or suite no. (If a P.O. box or foreign address, see instructions.) Employer identification number (EIN) City or town, state or province, country, and ZIP or foreign postal code Social security number (SSN) C Name of plan E Plan sponsor’s EIN D Name and address of plan sponsor F Plan year ending (MM/DD/YYYY) H If this is an amended return, check here Part I . . . . . . . . . . . . . . . G Plan number ▶ Taxes. You can only complete one section of Part I for each Form 5330 filed (see instructions). Section A. Taxes that are reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) 1 Section 4972 tax on nondeductible contributions to qualified plans (from Schedule A, line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Section 4973(a)(3) tax on excess contributions to section 403(b)(7)(A) custodial accounts (from Schedule B, line 12) . . . . . . . . . . . . . . . . . . . . . . 3a Section 4975(a) tax on prohibited transactions (from Schedule C, line 3) . b Section 4975(b) tax on failure to correct prohibited transactions . . . . . . . . . . . . . . . . 4 . . . Section 4976 tax on disqualified benefits for funded welfare plans . 5a Section 4978 tax on ESOP dispositions . . . . b The tax on line 5a is a result of the application of: 6 . . . . . . Sec. 664(g) FOR IRS USE ONLY 161 1 164 2 224 3a 3b 4 159 . . . . . 200 . . . . . . . Sec. 1042 . 209 Section 4979A tax on certain prohibited allocations of qualified ESOP securities or ownership of synthetic equity . . . . . . . . . . . . . . . . . . . . . . . . . 203 5a 5b 6 7 Total Section A taxes. Add lines 1 through 6. Enter here and on Part II, line 17 . . . . ▶ 7 Section B. Taxes that are reported by the last day of the 7th month after the end of the employer’s tax year or 81/2 months after the last day of the plan year that ends within the filer’s tax year 8a Section 4971(a) tax on failure to meet minimum funding standards (from Schedule D, line 2) . b Section 4971(b) tax for failure to correct minimum funding standards . . . . . . . . . 9a Section 4971(f)(1) tax on failure to pay liquidity shortfall (from Schedule E, line 4) b Section 4971(f)(2) tax for failure to correct liquidity shortfall . . . . . . . . . . . . . . . 163 225 226 227 8a 8b 9a 9b 10a Section 4971(g)(2) tax on failure to comply with a funding improvement or rehabilitation plan (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 450 b Section 4971(g)(3) tax on failure to meet requirements for plans in endangered or critical status (from Schedule F, line 1c) . . . . . . . . . . . . . . . . . . . . 451 c Section 4971(g)(4) tax on failure to adopt rehabilitation plan (from Schedule F, line 2d) . . 452 Section B1. Tax that is reported by the last day of the 7th month after the end of the calendar fringe benefits were paid to the employer’s employees 11 Section 4977 tax on excess fringe benefits (from Schedule G, line 4) . . . . . . . . 12 Total Section B taxes. Add lines 8a through 11. Enter here and on Part II, line 17 . . . ▶ Section C. Tax that is reported by the last day of the 15th month after the end of the plan year 13 Section 4979 tax on excess contributions to certain plans (from Schedule H, line 2). Enter here and on Part II, line 17 . . . . . . . . . . . . . . . . . . . . . ▶ For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11870M 201 10a 10b 10c year in which the excess 11 12 205 13 Form 5330 (Rev. 12-2013) Form 5330 (Rev. 12-2013) Page 2 Name of Filer: Filer’s identifying number: Section D. Tax that is reported by the last day of the month following the month in which the reversion occurred 14 Section 4980 tax on reversion of qualified plan assets to an employer (from Schedule I, line 3). Enter here and on Part II, line 17 . . . . . . . . . . . . . . . . . ▶ 14 204 Section E. Tax that is reported by the last day of the month following the month in which the failure occurred 15 Section 4980F tax on failure to provide notice of significant reduction in future accruals (from Schedule J, line 5). Enter here and on Part II, line 17 . . . . . . . . . . . ▶ 15 228 Section F. Taxes reported on or before the 15th day of the 5th month following the close of the entity manager’s taxable year during which the plan became a party to a prohibited tax shelter transaction 16 Section 4965 tax on prohibited tax shelter transactions for entity managers (from Schedule K, line 2). Enter here and on Part II, line 17 . . . . . . . . . . . . . . . . ▶ 16 237 Part II Tax Due 17 Enter the amount from Part I, line 7, 12, 13, 14, 15, or 16 (whichever is applicable) . . . . . . 17 18 Enter amount of tax paid with Form 5558 or any other tax paid prior to filing this return . . . . 18 19 Tax due. Subtract line 18 from line 17. If the result is greater than zero, enter here, and attach check or money order payable to “United States Treasury.” Write your name, identifying number, plan number, and “Form 5330, Section(s) ” on your payment . . . . ▶ 19 Your Signature Print/Type preparer’s name Firm’s name ▶ Firm's address ▶ Preparer's signature ▲ ▲ Paid Preparer Use Only ▲ Sign Here Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Telephone number Date Date PTIN Check if self-employed Firm's EIN ▶ Phone no. Form 5330 (Rev. 12-2013) Form 5330 (Rev. 12-2013) Page 3 Name of Filer: Filer’s identifying number: Schedule A. Tax on Nondeductible Employer Contributions to Qualified Employer Plans (Section 4972) Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) Total contributions for your tax year to your qualified employer plan (under section 401(a), 403(a), 408(k), or 408(p)) . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Amount allowable as a deduction under section 404 . . . . . . . . 2 3 4 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . Enter amount of any prior year nondeductible contributions made for years beginning after 12/31/86 . . . . . . . . . . . . . . Amount of any prior year nondeductible contributions for years beginning after 12/31/86 returned to you in this tax year for any prior tax year . . . . . . . . . 3 1 5 . . . . . . 4 5 6 Subtract line 5 from line 4 . . . 6 7 Amount of line 6 carried forward and deductible in this tax year . . . 7 8 Subtract line 7 from line 6 . . . . . . . . . . . . . 8 9 Tentative taxable excess contributions. Add lines 3 and 8 . . . . . . . . . . . . . 9 . . . . . . 10 . . . . . . 11 . . . . . . . . . . . . . . . . . . . . . . 10 Nondeductible section 4972(c)(6) or (7) contributions exempt from excise tax 11 Taxable excess contributions. Subtract line 10 from line 9 . . . . . . . 12 Multiply line 11 by 10%. Enter here and on Part I, line 1 . . . . . . . . . . . . ▶ 12 Schedule B. Tax on Excess Contributions to Section 403(b)(7)(A) Custodial Accounts (Section 4973(a)(3)) Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) 1 Total amount contributed for current year less rollovers (see instructions) . . . . . . . 1 2 Amount excludable from gross income under section 403(b) (see instructions) . . . . . . 2 3 Current year excess contributions. Subtract line 2 from line 1. If zero or less, enter -0- . . . 3 4 Prior year excess contributions not previously eliminated. If zero, go to line 8 . . . . 4 5 Contribution credit. If line 2 is more than line 1, enter the excess; otherwise, enter -0- . . . . 5 6 Total of all prior years’ distributions out of the account included in your gross income under section 72(e) and not previously used to reduce excess contributions . . . . . . . . . 6 7 Adjusted prior years’ excess contributions. Subtract the total of lines 5 and 6 from line 4 8 Taxable excess contributions. Add lines 3 and 7 . . . . . . . . . . . . . 9 Multiply line 8 by 6% . . . . . . . . . . . . 10 Enter the value of your account as of the last day of the year . . . . . . . 11 Multiply line 10 by 6% . . . . . . 12 . . . . . 7 . . . 8 . . . . 9 . . . . . 10 . . . . . 11 Excess contributions tax. Enter the lesser of line 9 or line 11 here and on Part I, line 2 . . ▶ 12 . . . . . . . . . . . . . . . . . . . . . . Form 5330 (Rev. 12-2013) Form 5330 (Rev. 12-2013) Page 4 Name of Filer: Filer’s identifying number: Schedule C. Tax on Prohibited Transactions (Section 4975) (see instructions) Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) 1 Is the excise tax a result of a prohibited transaction that was (box “a” or box “b” must be checked): a discrete b other than discrete (a lease or a loan) Complete the table below to disclose the prohibited transactions and figure the initial tax (see instructions) 2 (a) Transaction number (b) Date of transaction (see instructions) (c) Description of prohibited transaction (d) Amount involved in prohibited transaction (see instructions) (e) Initial tax on prohibited transaction (multiply each transaction in column (d) by the appropriate rate (see instructions)) (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (xi) (xii) 3 4 Add amounts in column (e); enter here and on Part I, line 3a . . . . . . . . . . . . ▶ Have you corrected all of the prohibited transactions that you are reporting on this return? If “Yes,” ▶ complete Schedule C, line 5, on the next page. If “No,” attach statement (see instructions) . . . Yes Form 5330 No (Rev. 12-2013) Form 5330 (Rev. 12-2013) Page 5 Name of Filer: Filer’s identifying number: Schedule C. Tax on Prohibited Transactions (Section 4975) Reported by the last day of the 7th month after the end of the tax year of the employer (or other person who must file the return) (continued) Complete the table below, if applicable, of other participating disqualified persons and description of correction 5 (see instructions). (a) Item no. from line 2 (b) Name and address of disqualified person (c) EIN or SSN (d) Date of correction (e) Description of correction Schedule D. Tax on Failure to Meet Minimum Funding Standards (Section 4971(a)) Reported by the last day of the 7th month after the end of the employer’s tax year or 81/2 months after the last day of the plan year that ends within the filer’s tax year 1 2 Aggregate unpaid required contributions (accumulated funding deficiency for multiemployer plans) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . Multiply line 1 by 10% (5% for multiemployer plans). Enter here and on Part I, line 8a . . . . ▶ 1 2 Form 5330 (Rev. 12-2013) Form 5330 (Rev. 12-2013) Page 6 Name of Filer: Filer’s identifying number: Schedule E. Tax on Failure to Pay Liquidity Shortfall (Section 4971(f)(1)) Reported by the last day of the 7th month after the end of the employer’s tax year or 81/2 months after the last day of the plan year that ends within the filer’s tax year (a) 1st Quarter (b) 2nd Quarter (c) 3rd Quarter (d) 4th Quarter (e) Total Add cols. a-d for line 3 1 Amount of shortfall . . . . 1 2 Shortfall paid by the due date 2 3 Net shortfall amount . . . 3 4 Multiply line 3, column (e), by 10%. Enter here and on Part I, line 9a . . . . . . . . ▶ 4 Schedule F. Tax on Multiemployer Plans in Endangered or Critical Status (Section 4971(g)(3), 4971(g)(4)) Reported by the last day of the 7th month after the end of the employer’s tax year or 81/2 months after the last day of the plan year that ends within the filer’s tax year 1 a b c 2 a Section 4971(g)(3) tax on failure to meet requirements for plans in endangered or critical status . . Enter the amount of contributions necessary to meet the applicable benchmarks or requirements . Enter the amount of the accumulated funding deficiency . . . . . . . . . . . . . Enter the greater of line 1a or line 1b, here and on Part I, line 10b . . . . . . . . . ▶ Section 4971(g)(4) tax on failure to adopt rehabilitation plan . . . . . . . . . . . . Enter the amount of the excise tax on the accumulated funding deficiency under section 4971(a)(2) from Schedule D, line 2 . . . . . . . . . . . . . . . . . . . . . . . . b Enter the number of days during the tax year which are included in the period beginning on the first day of the 240 day period and ending on the day the rehabilitation plan is adopted ▶ 1 1a 1b 1c 2 2a 2b c Multiply line 2b by $1,100 . . . . . . . . . . . . . . . . . . . . . . . 2c d Enter the greater of line 2a or line 2c, here and on Part I, line 10c . . . . . . . . . ▶ 2d Schedule G. Tax on Excess Fringe Benefits (Section 4977) Reported by the last day of the 7th month after the end of the calendar year in which the excess fringe benefits were paid to the employer’s employees 1 Did you make an election to be taxed under section 4977? . . . . . . . Yes No 2 If “Yes,” enter the calendar year (YYYY) in which the excess fringe benefits were paid ▶ 3 If line 1 is “Yes,” enter the excess fringe benefits on this line (see instructions) . . . . . . 3 4 Enter 30% of line 3 here and on Part I, line 11 . . . . . . . . . . . . . . . . ▶ 4 Schedule H. Tax on Excess Contributions to Certain Plans (Section 4979) Reported by the last day of the 15th month after the end of the plan year Enter the amount of an excess contribution under a cash or deferred arrangement that is part of a plan 1 qualified under section 401(a), 403(a), 403(b), 408(k), or 501(c)(18) or excess aggregate contributions . 1 2 Multiply line 1 by 10% and enter here and on Part I, line 13 . . . . . . . . . . . ▶ 2 Schedule I. Tax on Reversion of Qualified Plan Assets to an Employer (Section 4980) Reported by the last day of the month following the month in which the reversion occurred 1 2a 3 4 Date reversion occurred . . . . . . . . . . . ▶ MM DD Employer reversion amount b Excise tax rate Multiply line 2a by line 2b and enter the amount here and on Part I, line 14 . . Explain below why you qualify for a rate other than 50%: YY . . . . ▶ 3 Schedule J. Tax on Failure to Provide Notice of Significant Reduction in Future Accruals (Section 4980F) Reported by the last day of the month following the month in which the failure occurred 1 2 3 4 5 6 Enter the number of applicable individuals who were not provided ERISA section 204(h) notice ▶ Enter the effective date of the amendment . . . . . ▶ MM DD YY Enter the number of days in the noncompliance period ▶ Enter the total number of failures to provide ERISA section 204(h) notice (see instructions) . Multiply line 4 by $100. Enter here and on Part I, line 15 . . . . . . . . . . . . Provide a brief description of the failure, and of the correction, if any . ▶ 1 2 3 4 5 Schedule K. Tax on Prohibited Tax Shelter Transactions (Section 4965) Reported on or before the 15th day of the 5th month following the close of the entity manager’s tax year during which the plan became a party to a prohibited tax shelter transaction 1 Enter the number of prohibited tax shelter transactions you caused the same plan to be a party to ▶ 1 2 Multiply line 1 by $20,000. Enter the result here and on Part I, line 16 . . . . . . . . ▶ 2 Form 5330 (Rev. 12-2013)
Extracted from PDF file 2018-federal-form-5330.pdf, last modified December 2014

More about the Federal Form 5330 Other TY 2018

We last updated the Return of Excise Taxes Related to Employee Benefit Plans in February 2019, so this is the latest version of Form 5330, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 5330 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 5330 from the Internal Revenue Service in February 2019.

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Historical Past-Year Versions of Federal Form 5330

We have a total of seven past-year versions of Form 5330 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 5330

Form 5330 (Rev. December 2013)

2017 Form 5330

Form 5330 (Rev. December 2013)

2016 Form 5330

Form 5330 (Rev. December 2013)

Return of Excise Taxes Related to Employee Benefit Plans 2015 Form 5330

Form 5330 (Rev. December 2013)

Return of Excise Taxes Related to Employee Benefit Plans 2013 Form 5330

Form 5330 (Rev. December 2013)

Return of Excise Taxes Related to Employee Benefit Plans 2012 Form 5330

Form 5330 (Rev. April 2009)

Return of Excise Taxes Related to Employee Benefit Plans 2011 Form 5330

Form 5330 (Rev. April 2009)


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