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Form 15091: Benefit Assurance
IRS Form 15091 is a Benefit Assurance document used to certify that a plan's liabilities have been satisfied by purchases or payments; the form has a Catalog Number of 71905U.
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IRS Form 15091 - Benefit Assurance
IRS Form 15091 is a Benefit Assurance document used to certify that a plan's liabilities have been satisfied by purchases or payments; the form has a Catalog Number of 71905U.
Risk Radar
Scan points- 1Ensure the certification statement accurately reflects that liabilities have been satisfied by annuity purchases OR lump sum payments.
- 2Failing to include the Plan name and Plan number on Form 15091.
- 3Omitting the Date(s) of termination for the benefit plan.
- 4Not certifying that liabilities were satisfied by annuity purchases OR lump sum payments.
- 5Missing the signature, title, or date field at the bottom of Form 15091.
Plain English
This form officially tells the IRS that a specific benefit plan has settled all its financial obligations. It confirms this settlement either through buying guaranteed annuity contracts or by making lump sum distributions to participants. Filing Form 15091 provides official proof of these satisfied liabilities.
Submission Date
- Filing date: 2024-12-04 22:10:58
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when certifying that a plan's liabilities have been satisfied by purchasing guaranteed annuity contracts or paying lump sum distributions.
- Do not use it when the basis for liability satisfaction is not related to purchased guaranteed annuity contracts or paid lump sum distributions.
- Check Form 15091 itself instead when you need to certify benefit assurance for a specific plan.
Form selector
Use this form or another form?
Plan has satisfied liabilities via guarantees/payments
This form is the required certification document.
✓ Check the 'Date(s)' fields to ensure accuracy.
Need to certify satisfaction for a specific plan
The form allows identification by Plan Name and Plan Number.
✓ Ensure the EIN matches your organization's records.
General benefit assurance documentation is required
This form serves as the official certification of liability satisfaction.
✓ Confirm the 'I certify that...' statement accurately reflects the plan status.
Deadline or filing window
The source does not state a specific filing deadline date or period for IRS Form 15091. The form must be completed when the plan's liabilities are satisfied, which triggers the need to file it with the Internal Revenue Service.
Checklist
What you need before filling it out
Plan name
The specific name of the plan being certified · Listed on Form 15091
EIN
The Employer Identification Number · Listed on Form 15091
Date(s) excess assets received
Dates when excess assets were received · Listed on Form 15091
Amount (excess assets)
The dollar amount of excess assets received · Listed on Form 15091
Certification statement
"I certify that the above plan's liabilities to all plan participants have been satisfied by the purchase of guaranteed annuity contracts or the payment of lump sum distributions." · Bottom of Form 15091
Contact telephone number
The phone number for the person to contact regarding this form · Listed on Form 15091
Before you submit
- 1Verify that the Plan Name and Plan Number are completely filled out.
- 2Ensure the Employer Identification Number (EIN) is accurately entered.
- 3Confirm the Date of termination, if applicable, is recorded.
- 4Double-check all amounts for excess assets received, guaranteed annuity contracts purchased, and lump sum distributions paid.
- 5Verify that the certification statement's condition ('satisfied by purchase... or payment...') matches reality.
- 6Ensure a Signature and Title are present below the certification statement.
- 7Confirm the mailing address is 1100 Commerce Street Dallas, TX 75242-1027.
How to file this form
- 1Complete all required fields on Form 15091, including the Plan Name and EIN.
- 2Enter dates and amounts for excess assets received, guaranteed annuity contracts purchased, and lump sum distributions paid.
- 3Certify the satisfaction of liabilities by signing and providing your Title below the certification statement.
- 4Mail the completed Form 15091 to IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group at 1100 Commerce Street Dallas, TX 75242-1027.
Known limitations
- 1The form certifies that liabilities have been satisfied by purchasing guaranteed annuity contracts or paying lump sum distributions for a specific plan.
- 2It does not specify which types of plans must file, other than referencing 'the above plan's liabilities to all plan participants'.
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
Almost done reviewing the fields?
Fillable formOpen in Editor->The current edition is January 2019 (Rev. 1-2019); the source does not specify a link to a page containing the absolute latest information.
What changed or needs a fresh check
- Edition date — confirm it reads January 2019 (Rev. 1-2019)
- Fee — Not stated in the official source
- Mailing address — confirm it is IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group, Mail Stop 4910DAL, 1100 Commerce Street Dallas, TX 75242-1027
- Signature — ensure the authorized person signs and prints their Title below the certification statement
Quick Facts
Downloads
After you file
- 1Keep a copy of the completed IRS Form 15091 for records.
- 2The form must be signed by an individual and include their Title and Date.
- 3Mail the information to IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group at 1100 Commerce Street, Dallas, TX 75242-1027.
- 4Ensure the Employer Identification Number (EIN) is included on the form.
Sources
- SRCForm 15091 has Catalog Number 71905U (Form p.1).
- SRCThe form is dated January 2019 and its revision date is 01/19 (Form p.1).
- SRCIt requires the Employer Identification Number (EIN), DLN, Address, Person to contact, Contact telephone number, Plan name, and Plan number (Form p.1).
- SRCThe form must include dates for termination, excess assets received, guaranteed annuity contracts purchased, and lump sum distributions paid (Form p.1).
- SRCCertification states that the plan's liabilities have been satisfied by purchasing guaranteed annuity contracts or paying lump sum distributions (Form p.1).
- SRCMail destination is IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group, Mail Stop 4910DAL at 1100 Commerce Street, Dallas, TX 75242-1027 (Form p.1).
Common confusion points
What do I need to certify?
The filer certifies that the plan's liabilities have been satisfied by either buying guaranteed annuity contracts or paying out lump sum distributions.
→ Check the certification statement at the bottom of Form 15091.
Where do I send this form?
Mail it to IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group, specifically to Mail Stop 4910DAL at 1100 Commerce Street, Dallas, TX 75242-1027.
→ Verify the address on Form 15091.
What information must I include besides the plan details?
The form requires a Date of termination, dates excess assets received (with amount), and dates guaranteed annuity contracts purchased (with amount) or dates lump sum distributions paid (with amount).
→ Review all fields above the certification statement on Form 15091.
Who must sign this?
The person certifying the plan's liabilities must provide their Signature, Title, and Date.
→ Look at the signature block near the bottom of Form 15091.
What if I don't have a specific termination date?
Not stated in the official source — verify on the agency site
Does this form apply to all plans?
The form pertains to 'the above plan,' so the filer must ensure it applies to their specific entity.
→ Check the Plan name and Plan number fields.
Workflow map
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⚠ If something goes wrong
- Not stated in the official source — verify on the agency site
Questions about IRS Form 15091
What is IRS Form 15091 used for?
This form officially tells the IRS that a specific benefit plan has settled all its financial obligations. It confirms this settlement either through buying guaranteed annuity contracts or by making lump sum distributions to participants. Filing Form 15091 provides official proof of these satisfied liabilities.
Who must file IRS Form 15091?
The filer is generally an entity associated with the plan, as indicated by fields for Plan name and Plan number on IRS Form 15091.
What information does IRS Form 15091 require?
The form collects identifying information such as the Employer Identification Number (EIN) and Plan name. It also requires details on the Date(s) of termination, excess assets received, guaranteed annuity contracts purchased, and lump sum distributions paid.
Where do I file IRS Form 15091?
Mail the form to the IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group at Mail Stop 4910DAL, 1100 Commerce Street, Dallas, TX 75242-1027.
How do I complete IRS Form 15091?
First, fill out all identifying information and detail the financial activity (e.g., Date(s) excess assets received). Next, the certifying party must sign the form, providing their Title and the current Date. Finally, mail the completed Form 15091 to the specified IRS address.
What happens if IRS Form 15091 is filed incorrectly?
The consequence of filing incorrectly is that the certification stating liabilities have been satisfied by guaranteed annuity contracts or lump sum distributions may be deemed inaccurate by the IRS.
What do I need to certify?
The filer certifies that the plan's liabilities have been satisfied by either buying guaranteed annuity contracts or paying out lump sum distributions. Check the certification statement at the bottom of Form 15091.
Where do I send this form?
Mail it to IRS - Tax Exempt and Government Entities CPC:C&CA Referrals Group, specifically to Mail Stop 4910DAL at 1100 Commerce Street, Dallas, TX 75242-1027. Verify the address on Form 15091.
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