Federal Appendix C Part II Schedule 2 Nonamender Failures (other than those to which Schedule 1 applies) and Failure to Adopt a 403(b) Plan Timely

Appendix C Part II Schedule 2 Nonamender Failures (other than those to which Schedule 1 applies) and Failure to Adopt a 403(b) Plan Timely
Form 14568-B (Rev. 7-2023)
Department of the Treasury - Internal Revenue Service

Form 14568-B
(July 2023)

Model VCP Compliance Statement - Schedule 2:
Nonamender Failures for IRC 401(a) Plans

OMB Number
1545-1673

Include the plan name, Applicant’s EIN, and plan number on each page of the compliance statement, including attachments.
Plan name

Applicant’s EIN

Plan number

Section I - Identification of Failures
The plan identified above was not amended to comply with the applicable provisions of the following legislative and regulatory
requirements by the applicable deadlines in accordance with Internal Revenue Code (IRC) Section 401(b) and the regulations
thereunder:

A. Pre-approved Plans:
The changes required by the 2004 Cumulative List (Notice 2004-84) for an eligible employer using a pre-approved defined
contribution plan who failed to adopt the pre-approved plan by April 30, 2010, as required by Announcement 2008-23.
The changes required by the 2006 Cumulative List (Notice 2007-3) for any eligible employer using a pre-approved defined benefit
plan who failed to adopt the pre-approved plan by April 30, 2012, as required by Announcement 2010-20.
The changes required by the 2010 Cumulative List (Notice 2010-90) for any eligible employer using a pre-approved defined
contribution plan who failed to adopt the pre-approved plan by April 30, 2016, as required by Announcement 2014-16.
The changes required by the 2012 Cumulative List (Notice 2012-76) for any eligible employer using a pre-approved defined
benefit plan who failed to adopt the pre-approved plan by July 31, 2020, as required by Notice 2018-5 and Notice 2020-35.
The changes required by the 2017 Cumulative List (Notice 2017-37) for any eligible employer using a pre-approved defined
contribution plan who failed to adopt the pre-approved plan by July 31, 2022, as required by Announcement 2020-7.

B. Individually Designed Plans:
For individually designed plans subject to the 5-year remedial amendment cycle prior to January 1, 2017, the changes required by
the Cumulative List.
(For each statutory regulatory or other requirement for which the plan was not timely amended, list each item, and specify the year
of the Cumulative List including a reference to the IRS notice, the applicable cycle and required adoption date for the applicable
cycle. Attach additional pages as needed. Label the attachment “Section I.B. of Form 14568-B, Identification of Failures, The
Changes required by the Cumulative List” and include the plan name, Applicant’s EIN, and plan number at the top of each page.)

The changes required by the Required Amendments List applicable to individually designed plans.
(For each statutory regulatory or other requirement for which the plan was not timely amended, list each item and specify the year
of the Required Amendments List including a reference to the IRS notice that includes the item. Attach additional pages as
needed. Label the attachment “Section I.B. of Form 14568-B, Identification of Failures, The Changes required by the Required
Amendments List” and include the plan name, Applicant’s EIN, and plan number at the top of each page.)

Catalog Number 66146J
www.irs.gov
For Paperwork Reduction Act information see current EPCRS Revenue Procedure.

Form 14568-B (Rev. 7-2023)

Page 2
Plan name

Applicant’s EIN

Plan number

C. All IRC 401(a) Plans:
Amendments required as a condition for a favorable determination letter.
Other (specify the late amender failure not listed above) (Attach additional pages as needed. Label the attachment “Section I.C.of
Form 14568-B, Identification of Other Nonamender Failures” and include the plan name, Applicant’s EIN, and plan number at the
top of each page.)

Section II - Description of Proposed Method of Correction
The Applicant (or the plan sponsor) adopted amendments that satisfy the requirements of all the items checked in Section I of this
Form 14568-B, retroactively to the effective dates of the specific provisions contained in the amendments. Copies of the signed and
dated amendments and/or restated plan documents (where applicable) are enclosed with this VCP submission.

Section III - Change in Administrative Procedures
The Applicant indicated the plan sponsor has taken (or will take) the following steps to ensure that the failures will not recur:

Section IV - Enclosures
The plan sponsor encloses the following documents, as appropriate, with this VCP submission:
• Copies of all signed and dated amendments used to correct the failures.
• A copy of the plan document in effect prior to any of the amendments used to correct the failures.
• A copy of the most recent determination letter issued with respect to the plan (if applicable).

Catalog Number 66146J

www.irs.gov

Form 14568-B (Rev. 7-2023)