Form 5558 (Rev. September 2018)Application for Extension of Time To File Certain Employee Plan Returns Department of the Treasury Internal Revenue Service For Privacy Act and Paperwork Reduction Act Notice, see instructions. Go to www.irs.gov/Form5558 for the latest information. OMB No. 1545-0212 File With IRS Only Part I Identification A Name of filer, plan administrator, or plan sponsor (see instructions) Number, street, and room or suite no. (If a P.O. box, see instructions) City or town, state, and ZIP code BFiler222s identifying number (see instructions) Employer identification number (EIN) (9 digits XX-XXXXXXX)Social security number (SSN) (9 digits XXX-XX-XXXX)C Plan name Plan number Plan year ending227 MM DD YYYY 1 Check this box if you are requesting an extension of time on line 2 to file the first Form 5500 series return/report for the plan listed in Part I, C above. Part II Extension of Time To File Form 5500 Series, and/or Form 8955-SSA2I request an extension of time until/ / to file Form 5500 series. See instructions.Note: A signature IS NOT required if you are requesting an extension to file Form 5500 series.3I request an extension of time until/ / to file Form 8955-SSA. See instructions.Note: A signature IS NOT required if you are requesting an extension to file Form 8955-SSA.The application is automatically approved to the date shown on line 2 and/or line 3 (above) if (a) the Form 5558 is filed on or before the normal due date of Form 5500 series, and/or Form 8955-SSA for which this extension is requested; and (b) the date on line 2 and/or line 3 (above) is not later than the 15th day of the 3rd month after the normal due date. Part III Extension of Time To File Form 5330 (see instructions)4I request an extension of time until/ / to file Form 5330.You may be approved for up to a 6-month extension to file Form 5330, after the normal due date of Form 5330.aEnter the Code section(s) imposing the tax ........... a bEnter the payment amount attached ...................... b cFor excise taxes under section 4980 or 4980F of the Code, enter the reversion/amendment date ... c 5State in detail why you need the extension: Under penalties of perjury, I declare that to the best of my knowledge and belief, the statements made on this form are true, correct, and complete, and that I am authorized to prepare this application.Signature Date Cat. No. 12005TForm 5558 (Rev. 9-2018) American LegalNet, Inc. www.FormsWorkFlow.com Form 5558 (Rev. 9-2018) Page 2 General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.What's NewAn extension of time to file Form 5500 Series (Form 5500, Annual Return/Report of Employee Benefit Plan; Form 5500-SF, Short Form Annual Return/Report of Small Employee Benefit Plan; Form 5500-EZ, Annual Return of One-Participant (Owners and Their Spouses) Retirement Plan); and/or Form 8955-SSA, Annual Registration Statement Identifying Separated Participants With Deferred Vested Benefits; and an extension of time to file Form 5330, Return of Excise Taxes Related to Employee Benefit Plans, must be submitted on separate Forms 5558. A signature is not required for an extension of time to file Form 5500 series and Form 8955-SSA. However, a signature is required for an extension of time to file Form 5330.Future DevelopmentsFor the latest information about developments related to Form 5558 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form5558.Purpose of FormUse Form 5558 to apply for a one-time extension of time to file the Form 5500 series, Form 8955-SSA, or Form 5330. !CAUTIONTo avoid processing delays, the most recent version of this Form 5558 should always be used. For example, this Form 5558 (Rev. September 2018) should be used instead of the August 2012 version or any other prior version. To determine the most recent version of this form, go to www.irs.gov/Retirement.Where To FileFile Form 5558 with the Department of Treasury, Internal Revenue Service Center, Ogden, UT 84201-0045.Private delivery services. You can use certain private delivery services (PDS) designated by the IRS to meet the 223timely mailing as timely filing224 rule for tax returns. Go to www.irs.gov/PDS for the current list of designated services. The PDS can tell you how to get written proof of the mailing date. For the IRS mailing address to use if you're using PDS, go to www.irs.gov/PDSstreetAddresses. !CAUTIONPDS can222t deliver items to P.O. boxes. You must use the U.S. Postal Service to mail any item to an IRS P.O. box address.Specific InstructionsPart I. IdentificationA. Name and AddressEnter your name and address in the heading if you are requesting an extension of time to file the Form 5500, Form 5500-SF, Form 5500-EZ, and/or Form 8955-SSA, or Form 5330.The plan sponsor (generally, the employer for a single-employer plan) or plan administrator listed on the application should be the same as the plan sponsor or plan administrator listed on the annual return/report filed for the plan.Include the suite, room, or other unit number after the street address. If the Post Office does not deliver mail to the street address and you have a P.O. box, show the box number instead of the street address.If the entity222s address is outside the United States or its possessions, or territories, enter in the space for city or town, state, and ZIP code, the information in the following order: city, province or state, and country. Follow the country222s practice for entering the postal code. Do not abbreviate the country name.If your mailing address has changed since you filed your last return, use Form 8822-B, Change of Address or Responsible Party227 Business, to notify the IRS of the change. A new address shown on Form 5558 will not update your records. You can get Form 8822-B at www.irs.gov/Form8822B.B. Filer222s Identifying NumberEmployer identification number (EIN). Enter the nine-digit EIN in an XX-XXXXXXX format, assigned to the employer for all applications filed for the Form 5500 series (Form 5500, Form 5500-SF, Form 5500-EZ) and/or Form 8955-SSA. Also enter the EIN for applications filed for Form 5330 (see Social security number (SSN) next for exceptions).An entity that does not have an EIN should apply online by visiting the IRS website at www.irs.gov/EIN. The organization may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. Customers outside the United States or U.S. possessions may also apply for an EIN by calling 267-941-1099 (toll call).Social security number (SSN). If you made excess contributions to a section 403(b)(7)(A) custodial account or you are a disqualified person other than an employer, and you are applying for an extension of time to file Form 5330, enter your nine-digit SSN in an XXX-XX-XXXX format. Do not enter your SSN for Form 5500, Form 5500-SF, Form 5500-EZ, or Form 8955-SSA.C. Plan InformationComplete the plan name, plan number, and plan year ending for the plan included on this Form 5558.Part II. Extension of Time To File Form 5500 Series and/or Form 8955-SSAUse Form 5558 to apply for a one-time extension of time to file the Form 5500 series (Form 5500, Form 5500-SF, Form 5500-EZ) and/or Form 8955-SSA. !CAUTIONDo not include the Form 5500 series (Form 5500, Form 5500-SF, Form 5500-EZ) or the Form 8955-SSA with this form.Exception: Form 5500, Form 5500-SF, Form 5500-EZ, and Form 8955-SSA filers are automatically granted extensions of time to file until the extended due date of the federal income tax return of the employer (and are not required to file Form 5558) if both of the following conditions are met: (1) the plan year and the employer222s tax year are the same; and (2) the employer has been granted an extension of time to file its federal income tax return to a date later than the normal due date for filing the Form 5500, Form 5500-SF, Form 5500-EZ, or Form 8955-SSA. An extension granted under this exception cannot be extended further by filing a Form 5558 after the normal due date of the Form 5500, Form 5500-SF, Form 5500-EZ, or Form 8955-SSA.An extension of time to file a Form 5500, Form 5500-SF, Form 5500-EZ, and/or Form