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Suffolk New York Form 2159: What You Should Know

The NH must determine the NH code of the NYS HRA plans based solely on records maintained by the NH. (e.g., the Plan Sponsor and the Plan Administrator may have different names for those programs). For an existing NYS HRA plan, the original form 2159 that was signed must still be filed as the most recent information available.  For a plan that is located outside NYS HRA, the NH will need to use the existing agreement as the case precedent. For an existing NYS HRA plan located in NYS HRA, the NH will need documentation to prove that the Plan Sponsor is located in NYS HRA in order to determine the N code of the plan. For a plan that is located in NYS HRA and the Plan Administrator has no evidence that the plan was established in NYS HRA, the NH will need to rely on the following criteria to determine the n code of the plan. The NH will be required to review the Plan Sponsor's documentation and determine that the plan was established in NYS HRA by reviewing records maintained by the NH.  Based on all evidence, including the following criteria, the NH will determine the NYS HRA plan. 1. Is the Form 1120, Plan Tax Return, for the Plan a copy of the Form 2159 signed by the Plan Sponsor? If yes, the original Agreement must still be submitted. If no copy of Form 1120, was signed, then the NH may consider the Plan Sponsor's documentation only. 2. Is the current Statement of Facts signed by the NH on Form 2159? If yes, submit the current Statement of Facts and other supporting information. If no Statement of Facts are signed, then a letter from a financial representative must be sent to the NH showing the Plan Sponsor's financial and operational status, including if the Plan Sponsor's organization is exempt. 3. Do you have any documentation regarding the Plan Sponsor's relationship with NYS?  If yes, submit proof identifying the NYS agency responsible for financial administration of the NYS plan that may be responsible for any NYS income tax. 4.

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