Manitoba Finance

Annual Information Return

Section 1 - Plan Administrator

Canada Revenue Agency Registration Number

End of Plan Fiscal Year Under Review

No. of months covered:

Name of the Plan (found in plan text)

Administrator of the Plan

APPENDIX 1 – PENSION COMMITTEE MEMBERS

List all pension committee members at the plan fiscal year end along with a designation code as follows:

A – active voting member
N – non-active voting member
E – employer
AN – active non-voting member
NN – non-active non-voting member

	NAME	CODE
	Name	Code

Name of the person who represents the Administrator of the Plan

Mailing Address

City

Province

Postal Code

Country

Telephone Number Ext.

Fax Number

Email address (required)

Has the above mailing address changed within the last 12 months?

The Pension Benefits Act (Act) and the Pension Benefits Regulation (Regulation) requires that the administrator of a pension plan file an Annual Information Return not later than 180 days after the fiscal year or termination date of the pension plan. All sections of the Annual Information Return must be completed including the Canada Revenue Agency (CRA) Schedule and Appendices. The Office of the Superintendent – Pension Commission (OSPC) collects the annual information required by CRA in the CRA Schedule which forms part of this Annual Information Return.

OSPC Late Filing Penalties

First contravention, 10% of the fee for the most recent Annual Information Return filed with the commission, for each 30 days the filing is late, up to a maximum of 100% of that fee.

Second and subsequent contravention, 15% of the fee for the most recent Annual Information Return filed with the commission, for each 30 days the filing is late, up to a maximum of 100%.

CRA Late Filing Penalties

If the Annual Information Return is filed late or is not filed at all CRA can impose financial penalties under subsection 162(7) of the Income Tax Act of $25.00 per day up to a maximum of $2,500.00 and under subsection 147.1(11) and (12) and can revoke a plan’s registration.

Section 2 - Plan Sponsor

Employer’s Name (If more than one participating employer in the plan complete Appendix 2)

Is there more than one participating employer?

APPENDIX 2 – CHANGE IN PARTICIPATING EMPLOYERS

List only additions and deletions during the fiscal year to the list of participating employers last filed with the Office of the Superintendent – Pension Commission. PLEASE REPORT CHANGES ONLY

ADDITIONS

	Name of Participating Employer	Effective Date
	Name of Participating Employer	Effective Date

DELETIONS

	Name of Participating Employer	Effective Date
	Name of Participating Employer	Effective Date

Mailling Address

City

Province

Postal Code

Country

Telephone Number Ext.

Fax Number

Corporate E-mail (required)

Has the above mailing address changed within the last 12 months?

Fund Holder/Custodian Information

Name

Address

City

Province

Postal Code

Country

Telephone Number

Fax Number

Corporate E-mail (required)

Consultant Information

Name

Address

City

Province

Postal Code

Country

Telephone Number Ext.

Fax Number

Corporate E-mail (required)

Actuary (if different from consultant) Information

Name

Address

City

Province

Postal Code

Country

Telephone Number Ext.

Fax Number

Corporate E-mail (required)

Section 3 - Administrative Documentation

Were any amendments made to this pension plan, supporting documents, or fund during the fiscal year under review?

Does the pension plan have a written statement of investment policies and procedures which complies with section 3.23 of the Regulation?

Has the plan’s written statement of investment policies and procedures been established or reviewed in the fiscal year covered by this return please provide a copy?

Note: If yes, a copy of the amendment, or of the statement as amended, must be provided to each person or organization entitled to a copy.

Has the plan’s audited financial statement as required by section 3.28 of Regulation been filed?

Section 4 - Contributions

Please refer to the Guide to Completing Annual Information Return (p. 9) for information on how to complete this section.

MEMBER CONTRIBUTIONS

	Defined Benefit (DB)	Defined Contribution (DC)	Total DB and DC
Member Required	$ Defined Benefit (DB)	$ Defined Contribution (DC)	$ Total DB and DC
Member Voluntary	$ Member Voluntary	$ Defined Contribution (DC)	$ Total DB and DC
Optional Ancillary (DB only)	$ Defined Benefit (DB)	N/A	$ Total DB and DC
Total	$ Defined Benefit (DB)	$ Defined Contribution (DC)	$ Total DB and DC

EMPLOYER CONTRIBUTIONS (excluding special payments)

	Defined Benefit (DB)	Defined Contribution (DC)	Total DB and DC
Employer Required (for DB plans Normal cost)	$ Defined Benefit (DB)	$ Defined Contribution (DC)	$ Total DB and DC
Less surplus utilized (DB plans) only	$ Less surplus utilized (DB plans) only	N/A	$ Total DB and DC
Employer Required (for DB plans Normal Cost not funded by surplus)	$ Defined Benefit (DB)	N/A	$ Total DB and DC
Interest on late contributions	$ Defined Benefit (DB)	$ Defined Contribution (DC)	$ Total DB and DC
Total	$ Defined Benefit (DB)	$ Defined Contribution (DC)	$ Total DB and DC

For pension plans with a defined benefit provision, were the payments shown above determined in accordance with the formulas in the last cost certificate filed with the commission?

SPECIAL PAYMENTS (Defined Benefit Provision only)

Unfunded Liabilities

	Date Established per Last filed Cost Certificate	Unfunded Liability or Solvency Deficiency per Last filed Cost Certificate	Payments Required for the Plan Fiscal Year per Last filed Cost Certificate	Payments Made for the Plan Fiscal Year
	Date Established per Last filed Cost Certificate	$ Unfunded Liability or Solvency Deficiency per Last filed Cost Certificate	$ Payments Required for the Plan Fiscal Year per Last filed Cost Certificate	$ Payments Made for the Plan Fiscal Year

Solvency Deficiencies

	Date Established per Last filed Cost Certificate	Unfunded Liability or Solvency Deficiency per Last filed Cost Certificate	Payments Required for the Plan Fiscal Year per Last filed Cost Certificate	Payments Made for the Plan Fiscal Year
	Date Established per Last filed Cost Certificate	$ Unfunded Liability or Solvency Deficiency per Last filed Cost Certificate	$ Payments Required for the Plan Fiscal Year per Last filed Cost Certificate	$ Payments Made for the Plan Fiscal Year

Sub Total

Lump sum payments to fund Transfer Deficiency	N/A	N/A	$ Payments Made for the Plan Fiscal Year
Interest on late contributions	N/A	N/A	$ Payments Made for the Plan Fiscal Year
Payments due to filling of new valuation	N/A	$ Payments Required for the Plan Fiscal Year per Last filed Cost Certificate	$ Payments Made for the Plan Fiscal Year

Total

Were the payments shown above determined in accordance with the formulas given in the last cost certificate filed with the commission?

Section 5 - Plan Membership

TOTAL MEMBERSHIP

(a) Number of active members as at the plan`s previous year end	Number of active members as at the plan`s previous year end
(b) New entrants (employees who joined the plan during the plan year)	New entrants (employees who joined the plan during the plan year)
(c) Subtotal: (a + b)	Subtotal
Exits, employees who ceased to be active during the plan year for the following reasons
(d) Retirements	Retirements
(e) Death	Death
(f) Termination of membership in the plan	Termination of membership in the plan
(g) Subtotal: (d + e + f)	Subtotal
Total number of active members at the end of plan year (c – g)	Total number of active members at the end of plan year (c – g)
Pensioners and beneficiaries receiving a benefit from the plan	Pensioners and beneficiaries receiving a benefit from the plan
Former members and beneficiaries entitled to, but not yet in receipt of a benefit	Former members and beneficiaries entitled to, but not yet in receipt of a benefit

ACTIVE PLAN MEMBERS ON PAYROLL

No Active Members

Designated Province - Area of Employment	Active Plan Members on Payroll
Designated Province - Area of Employment	Male	Female
Alberta	Male	Female
British Columbia	Male	Female
Manitoba	Male	Female
New Brunswick	Male	Female
Newfoundland and Labrador	Male	Female
Northwest Territories	Male	Female
Nova Scotia	Male	Female
Nunavut	Male	Female
Ontario	Male	Female
Prince Edward Island	Male	Female
Quebec	Male	Female
Saskatchewan	Male	Female
Yukon Territory	Male	Female
Employment under federal jurisdiction	Male	Female
Outside Canada	Male	Female
Total	Male	Female

Section 6 - Filing Fee

FILING FEE

In accordance with subsection 3.26(1) of the Regulation, a fee is required in respect of each active plan member on payroll in a designated Province and area of employment but in no event less than $120.00. A fee is not required if there are no active plan members.

Number of Active Plan Members	Fee
1 – 16	$ 120.00 (minimum)
17 – 2499	$ 7.20 (per member)
2500 and over	$18,000.00 (maximum)

(Example: 17 employees x $7.20 = $122.40)

Filing fee due $

Filing fee remitted $

Section 7 - Indexation

INDEXATION (Defined Benefits Provision Only)

Were adjustments made to pensions in pay during the plan year covered by this return?

Section 8 - Certification

ADMINISTRATOR’S CERTIFICATION

I hereby certify that to the best of my knowledge and belief:

(a) the contributions paid to the pension plan or fund are at least equal to those required under the Regulation;
(b) the plan or fund and the investments thereof have been administered in accordance with the Act and Regulation;
(c) the plan complies with and is being administered in accordance with the Income Tax Act and Regulation;
(d) the details entered on this information return are true and correct;
(e) I am the authorized person who represents the plan administrator as defined in section 28.1 of the Act and as identified on page 1 of the Annual Information Return as the Administrator of the Plan.

Date

First Name

Last Name

Title or Position

Canada Revenue Agency Schedule

1. Identification

Canada Revenue Agency Registration Number

Is the location of books and records the same as the mailing address?

Company Name:

Address:

City/Town:

Province:

Postal Code:

2. Financial Data (Plan Year)

Amounts transferred in from other plans - Line 1 $

Net investment earnings (losses) - Line 2 $

Payment of benefits - Line 3 $

Transfer of benefits to other plans - Line 4 $

Assets (market value) at beginning of the plan year - Line 5 $

Assets (market value) at end of plan year - Line 6 $

Actuarial Liabilities resulting from plan obligations - Line 7 $

Date of actuarial liability assessment - Line 8

3. Did the pension plan terminate or become inactive in this year or in a previous year?

4. How many active members were persons connected with the employer?

Note: Only connected members as described in point #4 in the “How to Complete the Canada Revenue Agency Schedule” should be reported

5. How many employers participated in the plan at plan year end?

6. Did any member of this plan participate: in any other RPP or DPSP provided by this plan sponsor? in a RPP or DPSP of any other sponsor who does not deal at arm’s length with this sponsor?

7. Have any connected persons joined or left the plan in the plan year?

8. In the plan year, has a person or group acquired control of the corporation that is sponsoring the pension plan?

9. Were any plan members provided with post-1989 past-service benefits in the plan year?

10. Have any plan members who are connected persons been provided with pre-1992 past-service benefits in the plan year?

We acknowledge that the AIR filing fee payment of $0.00 must be paid electronically as soon as possible.

(Please check)

Office of the Superintendent
Pension Commission
824-155 Carlton Street
Winnipeg, MB R3C 3H8
Phone No. (204) 945-2740
Fax: (204) 948-2375

Please print and submit with filing fee.

Annual Information Return Remittance Form


Plan Name:
Registration Number:
Filling Fee to be Remitted:
End of Plan Fiscal Year Under Review: