Report your self-funded defined benefit plan and its underlying assets in Part 2.

Assets within a Self-Funded Defined Benefit Plan

Assets within and Distributions from a Self-Funded Defined Benefit Plan

For You

Part 2

Part 2

Report a self-funded defined benefit plan if the value of the plan was more than $1,000 at the end of the reporting period or if you received more than $200 in income during the reporting period.  In addition, provide the names of each underlying asset within the plan that individually was worth more than $1,000 at the end of the reporting period.  Income is ordinarily reported when distributions are received.

Reporting the Plan

Description:  Write your name and describe the type of plan.  Provide the name of the financial institution through which the plan is held.

EIF:  Select “No” because a self-funded defined benefit plan is an investment vehicle that does not qualify as an excepted investment fund.

Income Type:  If applicable, describe the type of income received as “cash distributions” or “cash payments.”

Income Amount:  Provide the exact amount of your income during the reporting period.  If you do not have such income to report, leave this field blank.

Reporting the Underlying Assets

Description:  Provide the name of the underlying asset.

EIF:  For each underlying asset, indicate whether the asset (1) is an investment vehicle that qualifies as an EIF (“Yes”), (2) is an investment vehicle that does not qualify as an EIF (“No”), or (3) is not an investment vehicle that holds other assets (“N/A”).

Value:  Report the value of the underlying asset by selecting the appropriate category.

Income Amount:  Select the category for “None (or less than $201).”