INSTRUCTIONS FOR THE
REQUIRED ONE-TIME DEPARTMENT OF LABOR FILING
To ensure that your nonqualified plan remains exempt 1 from most of the provisions of ERISA,
including the participation, testing, funding, and fiduciary responsibilities, you must timely file a
one-time statement to the Department of Labor.
Key Points Regarding the DOL “Top Hat” Statement:
 Statement must be filed within 120 days of the plan’s effective date
 Statement can be filed using one of the options below 2:
o
o
US Postal Service
Electronically through the Department of Labor website using the following link:
http://www.dol.gov/ebsa/efiletophatplanfilinginstructions.html.
 If you choose to use the US Postal Service, the following requirements must be met:
o
o
o
Statement must be presented on company letterhead
Statement must be mailed certified, return-receipt requested, to ensure receipt
Retain a copy of the statement and mailing receipt (if applicable) for your records
 If you choose to use electronic filing, be sure to save a PDF of your filing as well as the email
confirmation you will receive for your records. These will serve as proof of your timely filed
statement.
 If you choose to use electronic filing, please note that The Pangburn Group is not the Plan
Administrator for your plan. The Pangburn Group is your third party recordkeeper. You or
someone at your company will generally act as Plan Administrator as directed by the
plan agreement and board resolutions.
 You are not required to send a copy of your plan document to the Department of Labor
unless they specifically request a copy.
The following page contains a TEMPLATE notification statement that may be
replicated by you on company letterhead. You are responsible for timely filing the
statement to the Department of Labor. If you need assistance, please contact our
office at 800-634-3287.
1
The nonqualified deferred compensation plan being established by your company is considered a “top hat” plan as
defined under the Employee Retirement Income Security Act of 1974 (ERISA). A top hat plan is an unfunded
nonqualified plan maintained primarily for the purpose of providing deferred compensation for a select group of
management or highly compensated employees. Top hat plans are subject to Part 1 (reporting and disclosure) and
Part 5 (enforcement and preemption) of Title I of ERISA; however, they are exempt from Parts 2, 3, and 4 of Title I
of ERISA (participation, vesting, funding, and fiduciary responsibilities).
2
There is a proposed regulation that would make it mandatory to electronically file the statement. Plan
administrators of top hat plans are encouraged to file plan statements using the electronic system but are not required
to do so at this time.
(COMPANY LETTERHEAD)
Date:
VIA CERTIFIED MAIL
United States Department of Labor
Employee Benefits Security Administration
Top Hat Plan Exemption
200 Constitution Ave., N.W., Ste N-1513
Washington, D.C. 20210
RE: ABC Incorporated Supplemental Executive Retirement Plan
Dear Sir or Madam:
In accordance with Department of Labor Regulation § 2520.104-23, this letter will serve as
the alternative method of compliance with the reporting and disclosure requirements of Part I of
Title I of the Employee Retirement Income Security Act of 1974, as amended, for a pension plan for
a select group of management or highly compensated employees.
1.
ABC Incorporated (the “Sponsor”), a _____________ corporation, maintains and
sponsors a nonqualified Supplemental Executive Retirement Plan (the “Plan”).
2.
The address of the Sponsor is ___________________________________________.
3.
The employer identification number assigned by the Internal Revenue Service to the
Sponsor is ______________.
4.
The Sponsor declares it maintains the following plan primarily for the purpose of
providing deferred compensation for a select group of management or highly compensated
employees.
5.
6.
There are ____ employees participating in the Plan.
A copy of the plan document will be furnished upon request.
Sincerely,
____________________________
Officer Name, Title