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14568-E Model VCP Compliance Statement - …

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Form 14568-E (Rev. 6-2018) Number 66149QFor Paperwork Reduction Act information see current EPCRS Revenue 14568-E (June 2018)Department of the Treasury - Internal Revenue ServiceModel VCP Compliance Statement - Schedule 5: plan Loan Failures (Qualified Plans and 403(b) Plans)OMB Number 1545-1673Include the plan name, Applicant s EIN and plan number on each page of the Compliance Statement , including attachmentsPlan nameEINPlan numberSection I - Identification of FailureThe plan identified above did not comply with the requirements of Section 72(p)(2) of the Internal Revenue Code (IRC). (Note: The conditions of IRC Section 72(p)(2) must be satisfied for a participant loan to be exempt from being treated as a distribution to the participant under IRC Section 72(p)(1).)

Any participant affected by this failure will make a corrective repayment to the plan. After repaying the excess of the loan amount over the maximum loan amount under IRC Section 72(p)(2)(A) (the “excess loan amount”), the remaining

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