Rtext sent (date) Requested (init. & date) (init. & date ...

27
Cat. No. 13502B Pension Benefit Guaranty Corporation Department of Labor Pension and Welfare Benefits Administration Department of the Treasury Internal Revenue Service Instructions for Form 5500 Annual Return/Report of Employee Benefit Plan (With 100 or more participants) Code references are to the Inter nal Revenue Code. ERISA refers to the Employee Retirement Income Secur ity Act of 1974. Paperwork Reduction Act Notice The time needed to complete and file the forms listed below reflects the combined requirements of the Internal Revenue Service, Department of Labor, Pension Benefit Guaranty Corporation, and the Social Security Administration. These times will vary depending on individual circumstances. The estimated average times are: Copying, assembling, and sending the form to the IRS Learning about the law or the form Preparing the form Recordkeeping 87 hr., 3 min. 48 min. 13 hr., 52 min. 9 hr., 15 min. Form 5500 (initial filers) 81 hr., 33 min. 48 min. 13 hr., 47 min. 9 hr., 15 min. Form 5500 (all other filers) 1 hr., 42 min. 28 min. 17 hr., 28 min. 16 min. Schedule A (Form 5500) 3 hr., 16 min. 2 hr., 35 min. 34 hr., 41 min. Schedule B (Form 5500) 23 min. 18 min. 5 hr., 16 min. Schedule C (Form 5500) Schedule E (Form 5500) (nonleveraged ESOP) 13 min. 12 min. 1 hr., 12 min. Schedule E (Form 5500) (leveraged ESOP) 1 hr., 56 min. 1 hr., 41 min. 10 hr., 2 min. 1 hr., 55 min. Schedule P (Form 5500) 33 min. 30 min. 6 hr., 42 min. Schedule SSA (Form 5500) 19 min. 12 min. If you have comments concerning the accuracy of these time estimates or suggestions for making these forms more simple, we would be happy to hear from you. You can write to both the Internal Revenue Service, Attention: Reports Clearance Officer, PC:FP, Washington, DC 20224; and the Office of Management and Budget, Paperwork Reduction Project (1210-0016), Washington, DC 20503. DO NOT send this form to either of these offices. Instead, see Where To File on page 2. How To Use This Instruction Booklet The instructions are divided into four main sections. Section 1 Page Who Must File 2 When To File 2 Extension of Time To File 2 Where To File 2 Section 2 Kinds of Plans 2 Pension benefit 2 Welfare benefit 2 Fringe benefit 3 Plans Excluded From Filing 3 Kinds of Filers 3 Investment Arrangements Filing Directly With DOL 4 What To File 5 Forms 5 Items To Complete on Form 5500 5 Schedules 6 Other Filings 6 Section 3 Section 4 Plan Year 1 Schedule F (Form 5500) Schedule G (Form 5500) Final Return/Report 7 Signature and Date 7 Reproductions 7 Change in Plan Year 7 Amended Return/Report 8 How the Annual Return/Report Information May Be Used 8 Information at the Top of the Form 8 Line-By-Line Instructions 8 Codes for Principal Business Activity and Principal Product or Service 22 2 hr., 52 min. 28 min. 24 min. 15 hr., 4 min. 21 min. 6 min. Electronic Filing of Form 5500 1 Penalties 1 We ask for the information on this form to carry out the law as specified in ERISA and Code section 6039D. You are required to give us the information. We need it to determine whether the plan is operating according to the law. A Change To Note for 1994 The Revenue Reconciliation Act of 1993 (Title XIII of OBRA ’93) amended Code section 401(a)(17) to reduce the maximum amount of annual compensation that may be taken into account under a qualified plan to $150,000 for benefits accruing in plan years beginning on or after January 1, 1994. See Act Section 13212 for the different effective dates and the transition rules. Section 1 Plan Year File 1993 forms for plan years that started in 1993. If the plan year differs from the calendar year, fill in the fiscal year space just under the form title. For a short plan year, see When To File on page 2. Electronic Filing of Form 5500 Form 5500 and the related schedules can be filed by magnetic media (magnetic tapes, floppy diskettes) or electronically. If the plan administrator files the return/report electronically or on magnetic media, he or she must also file Form 8453-E, Employee Benefit Plan Declaration and Signature for Electronic/Magnetic Media Filing. This is the declaration and signature form for the electronic/magnetic media return. For more information, see Pub. 1507, Procedures for Electronic/Magnetic Media Filing of Employee Benefit Plan Returns Forms 5500, 5500-C/R, and 5500-EZ for Plan Year 1993. Reminder Most qualified plans must be amended by the end of the 1994 plan year for several recent changes in the law. See IRS Notice 92-36, 1992-2 C.B. 364, and Rev. Proc. 93-39, 1993-31 I.R.B. 7, for more specific information. Many filers receive rejection notices for failing to complete items 4 and 6 properly. The return/report will also be considered incomplete and penalties may be assessed if information required on a schedule is not typed or printed on the appropriate schedule, such as the Schedule A (Form 5500). See Schedules on page 6. An annual return/report must be filed for employee welfare benefit plans which provide benefits wholly or partially through a Multiple Employer Welfare Arrangement (MEWA) as defined in ERISA section 3(40), unless otherwise exempt (see page 3). In addition to filing this form with the IRS, plans covered by the Pension Benefit Guaranty Corporation (PBGC) termination insurance program must file their Annual Premium Payment, PBGC Form 1, directly with that agency. Penalties ERISA and the Code provide for the assessment or imposition of penalties for not giving complete information and for not filing statements and returns/reports. Certain penalties are administrative (i.e., they may be imposed or assessed by one of the governmental agencies delegated to administer the collection of the Form 5500 series data). Others require a legal conviction.

Transcript of Rtext sent (date) Requested (init. & date) (init. & date ...

Page 1 of 24 of Instructions for Form 5500 5

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Cat. No. 13502B

Revised Proof Ok to PrintRtext sent (date) Requested (init. & date) (init. & date)

Pension BenefitGuaranty Corporation

Department of LaborPension and WelfareBenefits Administration

Department of the TreasuryInternal Revenue Service

Instructions for Form 5500Annual Return/Report of Employee BenefitPlan (With 100 or more participants)Code references are to the Internal Revenue Code. ERISArefers to the Employee Retirement Income Secur ity Act of 1974.

Paperwork Reduction Act Notice

The time needed to complete and file the forms listed below reflects the combinedrequirements of the Internal Revenue Service, Department of Labor, Pension BenefitGuaranty Corporation, and the Social Security Administration. These times will varydepending on individual circumstances. The estimated average times are:

Copying,assembling, andsending the form

to the IRS

Learning aboutthe law or the

form Preparing the formRecordkeeping87 hr., 3 min. 48 min.13 hr., 52 min.9 hr., 15 min.Form 5500 (initial filers)

81 hr., 33 min. 48 min.13 hr., 47 min.9 hr., 15 min.Form 5500 (all other filers)1 hr., 42 min.28 min.17 hr., 28 min. 16 min.Schedule A (Form 5500)3 hr., 16 min.2 hr., 35 min.34 hr., 41 min.Schedule B (Form 5500)

23 min.18 min.5 hr., 16 min.Schedule C (Form 5500)Schedule E (Form 5500)

(nonleveraged ESOP) 13 min.12 min.1 hr., 12 min.Schedule E (Form 5500)

(leveraged ESOP) 1 hr., 56 min.1 hr., 41 min.10 hr., 2 min.

1 hr., 55 min.Schedule P (Form 5500) 33 min.30 min.6 hr., 42 min.Schedule SSA (Form 5500) 19 min.12 min.

If you have comments concerning the accuracy of these time estimates or suggestionsfor making these forms more simple, we would be happy to hear from you. You can writeto both the Internal Revenue Service, Attention: Reports Clearance Officer, PC:FP,Washington, DC 20224; and the Office of Management and Budget, PaperworkReduction Project (1210-0016), Washington, DC 20503. DO NOT send this form to eitherof these offices. Instead, see Where To File on page 2.

How To Use This InstructionBookletThe instructions are divided into four mainsections.Section 1 Page

Who Must File 2When To File 2

Extension of Time To File 2Where To File 2Section 2Kinds of Plans 2

Pension benefit 2Welfare benefit 2Fringe benefit 3

Plans Excluded From Filing 3Kinds of Filers 3Investment Arrangements Filing

Directly With DOL 4What To File 5

Forms 5Items To Complete on Form 5500 5Schedules 6Other Filings 6

Section 3

Section 4

Plan Year 1

Schedule F (Form 5500)Schedule G (Form 5500)

Final Return/Report 7Signature and Date 7Reproductions 7Change in Plan Year 7Amended Return/Report 8How the Annual Return/Report Information

May Be Used 8

Information at the Top of the Form 8Line-By-Line Instructions 8Codes for Principal Business Activity and

Principal Product or Service 22

2 hr., 52 min. 28 min.24 min.15 hr., 4 min. 21 min.6 min.

Electronic Filing of Form 5500 1Penalties 1

We ask for the information on this form to carry out the law as specified in ERISA andCode section 6039D. You are required to give us the information. We need it todetermine whether the plan is operating according to the law.

A Change To Note for 1994The Revenue Reconciliation Act of 1993(Title XIII of OBRA ’93) amended Codesection 401(a)(17) to reduce the maximumamount of annual compensation that maybe taken into account under a qualifiedplan to $150,000 for benefits accruing inplan years beginning on or after January 1,1994. See Act Section 13212 for thedifferent effective dates and the transitionrules.

Section 1Plan YearFile 1993 forms for plan years that startedin 1993. If the plan year differs from thecalendar year, fill in the fiscal year spacejust under the form title. For a short planyear, see When To File on page 2.

Electronic Filing of Form 5500Form 5500 and the related schedules canbe filed by magnetic media (magnetictapes, floppy diskettes) or electronically. Ifthe plan administrator files the

return/report electronically or on magneticmedia, he or she must also file Form8453-E, Employee Benefit Plan Declarationand Signature for Electronic/MagneticMedia Filing. This is the declaration andsignature form for the electronic/magneticmedia return. For more information, seePub. 1507, Procedures forElectronic/Magnetic Media Filing ofEmployee Benefit Plan Returns Forms5500, 5500-C/R, and 5500-EZ for PlanYear 1993.

Reminder● Most qualified plans must be amendedby the end of the 1994 plan year forseveral recent changes in the law. See IRSNotice 92-36, 1992-2 C.B. 364, and Rev.Proc. 93-39, 1993-31 I.R.B. 7, for morespecific information.● Many filers receive rejection notices forfailing to complete items 4 and 6 properly.The return/report will also be consideredincomplete and penalties may be assessedif information required on a schedule is nottyped or printed on the appropriateschedule, such as the Schedule A (Form

5500). See Schedules on page 6. Anannual return/report must be filed foremployee welfare benefit plans whichprovide benefits wholly or partially througha Multiple Employer Welfare Arrangement(MEWA) as defined in ERISA section 3(40),unless otherwise exempt (see page 3).● In addition to filing this form with theIRS, plans covered by the Pension BenefitGuaranty Corporation (PBGC) terminationinsurance program must file their AnnualPremium Payment, PBGC Form 1, directlywith that agency.

PenaltiesERISA and the Code provide for theassessment or imposition of penalties fornot giving complete information and for notfiling statements and returns/reports.Certain penalties are administrative (i.e.,they may be imposed or assessed by oneof the governmental agencies delegated toadminister the collection of the Form 5500series data). Others require a legalconviction.

Page 2 of 24 of Instructions for Form 5500 5

Page 2

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Administrative Penalties

Listed below are various penalties for notmeeting the Form 5500 series filingrequirements. One or more of the followingfive penalties may be assessed or imposedin the event of incomplete filings or filingsreceived after the due date unless it isdetermined that your explanation for failureto file properly is for reasonable cause:

1. A penalty of up to $1,000 a day foreach day a plan administrator fails orrefuses to file a complete return/report.See ERISA section 502(c)(2) and 29 CFR2560.502c-2.

2. A penalty of $25 a day (up to $15,000)for not filing returns for certain plans ofdeferred compensation, certain trusts andannuities, and bond purchase plans by thedue date(s). See Code section 6652(e).This penalty also applies to returnsrequired to be filed under Code section6039D.

3. A penalty of $1 a day (up to $5,000)for each participant for whom a registrationstatement (Schedule SSA (Form 5500)) isrequired but not filed. See Code section6652(d)(1).

4. A penalty of $1 a day (up to $1,000)for not filing a notification of change ofstatus of a plan. See Code section6652(d)(2).

5. A penalty of $1,000 for not filing anactuarial statement. See Code section6692.

Other Penalties1. Any individual who willfully violates

any provision of Part 1 of Title I of ERISAshall be fined not more than $5,000 orimprisoned not more than 1 year, or both.See ERISA section 501.

2. A penalty of up to $10,000, 5 yearsimprisonment, or both, may be imposed formaking any false statement orrepresentation of fact, knowing it to befalse, or for knowingly concealing or notdisclosing any fact required by ERISA. Seesection 1027, Title 18, U.S. Code, asamended by section 111 of ERISA.

Who Must FileAny administrator or sponsor of anemployee benefit plan subject to ERISAmust file information about each planevery year (Code section 6058 and ERISAsections 104 and 4065). Every employermaintaining a specified fringe benefit planas described in Code section 6039D(except Code sections 79, 105, 106, 120,and 129 plans) is also required to file eachyear. The Internal Revenue Service (IRS),Department of Labor (DOL), and PensionBenefit Guaranty Corporation (PBGC) haveconsolidated their returns and report formsto minimize the filing burden for planadministrators and employers. The charton page 5 gives a brief guide to the typeof return/report to be filed.

When To FileFile all required forms and schedules bythe last day of the 7th month after the planyear ends. For a short plan year, file theform and applicable schedules by the last

day of the 7th month after the short planyear ends. For purposes of thisreturn/report, the short plan year ends onthe date of the change in accountingperiod or upon the complete distribution ofthe assets of the plan. (Also see Section3.) If the current year Form 5500 is notavailable before the due date of your shortplan year return/report, use the latest yearform available and change the date printedon the return/report to the current year.Also show the dates your short plan yearbegan and ended.

Extension of Time To File

A one time extension of time to file (up to2 1⁄2 months) may be granted for filingreturns/reports if Form 5558, Applicationfor Extension of Time To File CertainEmployee Plan Returns, is filed before thenormal due date (not including anyextensions) of the return/report.Exception: Plans are automatically grantedextensions of time to file Form 5500 untilthe due date of the Federal income taxreturn of the employer if all the followingconditions are met: (1) The plan year andthe employer’s tax year are the same. (2)The employer has been granted anextension of time to file its Federal incometax return to a date later than the normaldue date for filing the Form 5500. (3) Acopy of the IRS extension of time to filethe Federal income tax return is attachedto the Form 5500 filed with the IRS. Anextension granted by using this exceptionCANNOT be extended further by filing aForm 5558.Note: An extension of time to file thereturn/report does not operate as anextension of time to file the PBGCForm 1.

Where To FilePlease file the return/report with theInternal Revenue Service Center indicatedbelow. No street address is necessary.

See pages 6 and 7 for the filing addressfor investment arrangements filing directlywith DOL.

If the principal office ofthe plan sponsor or the

plan administrator islocated in

Use the followingInternal RevenueService Center

addressÄ Ä

Connecticut, Delaware,District of Columbia,Foreign Address, Maine,Maryland, Massachusetts,New Hampshire, NewJersey, New York,Pennsylvania, Puerto Rico,Rhode Island, Vermont,Virginia

Holtsville, NY 00501

Alabama, Alaska, Arkansas,California, Florida, Georgia,Hawaii, Idaho, Louisiana,Mississippi, Nevada, NorthCarolina, Oregon, SouthCarolina, Tennessee,Washington

Atlanta, GA 39901

Arizona, Colorado, Illinois,Indiana, Iowa, Kansas,Kentucky, Michigan,Minnesota, Missouri,Montana, Nebraska, NewMexico, North Dakota,Ohio, Oklahoma, SouthDakota, Texas, Utah, WestVirginia, Wisconsin,Wyoming

Memphis, TN 37501

All Form 5500-EZ filers Andover, MA 05501

Section 2Kinds of PlansEmployee benefit plans include pensionbenefit plans and welfare benefit plans. Filethe applicable return/report for any of thefollowing plans.

Pension Benefit Plan

This is an employee pension benefit plancovered by ERISA. The return/report is duewhether or not the plan is qualified andeven if benefits no longer accrue,contributions were not made this plan year,or contributions are no longer made(“frozen plan” or “wasting trust”). See FinalReturn/Report on page 7.

Pension benefit plans required to fileinclude defined benefit plans and definedcontribution plans (e.g., profit-sharing,stock bonus, money purchase plans, etc.).The following are among the pensionbenefit plans for which a return/reportmust be filed:

1. Annuity arrangements under Codesection 403(b)(1).

2. Custodial account established underCode section 403(b)(7) for regulatedinvestment company stock.

3. Individual retirement accountestablished by an employer under Codesection 408(c).

4. Pension benefit plan maintainedoutside the United States primarily fornonresident aliens if the employer whomaintains the plan is:

a. A domestic employer, orb. A foreign employer with income

derived from sources within the UnitedStates (including foreign subsidiaries ofdomestic employers) and deductscontributions to the plan on its U.S.income tax return. See Plans ExcludedFrom Filing on page 3.

5. Church plans electing coverage underCode section 410(d).

6. A plan that covers residents of PuertoRico, the Virgin Islands, Guam, WakeIsland, or American Samoa. This includes aplan that elects to have the provisions ofsection 1022(i)(2) of ERISA apply.

See Items To Complete on Form 5500on page 5 for more information about whatquestions must be completed by pensionplans.

Welfare Benefit Plan

This is an employee welfare benefit plancovered by Part 1 of Title I of ERISA.Welfare plans provide benefits such asmedical, dental, life insurance,

Page 3 of 24 of Instructions for Form 5500 5

Page 3

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

apprenticeship and training, scholarshipfunds, severance pay, disability, etc.

See Items To Complete on Form 5500on page 5 for more information about whatquestions must be completed for welfarebenefit plans.

Fringe Benefit Plan

Cafeteria plans described in Code section125 and educational assistance programsdescribed in Code section 127 areconsidered fringe benefit plans andgenerally are required to file the annualinformation specified by Code section6039D. However, Code section 127educational assistance programs, whichprovide only job-related training that isdeductible under Code section 162, do notneed to file Form 5500.Note: A fringe benefit plan may beassociated with one or more welfare plansas described above for which a Form 5500may be required to be filed.

See Items To Complete on Form 5500on page 5 for more information about howto complete this form for a fringe benefitplan.

Plans Excluded From FilingThese exemptions do not apply to a fringebenefit plan required to file to satisfy therequirements of Code section 6039D.

Do not file a return/report for anemployee benefit plan that is any of thefollowing:

1. A welfare benefit plan which coveredfewer than 100 participants as of thebeginning of the plan year and is:unfunded, fully insured, or a combinationof insured and unfunded.

a. An unfunded welfare benefit plan hasits benefits paid as needed directly fromthe general assets of the employer or theemployee organization that sponsors theplan.Note: Plans that are NOT unfunded includethose plans that received employee (orformer employee) contributions during theplan year and/or used a trust or separatelymaintained fund (including a Code section501(c)(9) trust) to hold plan assets or act asa conduit for the transfer of plan assetsduring the plan year.

b. A fully insured welfare benefit planhas its benefits provided exclusivelythrough insurance contracts or policies, thepremiums of which must be paid directlyby the employer or employee organizationfrom its general assets or partly from itsgeneral assets and partly fromcontributions by its employees or members(which the employer or organizationforwards within 3 months of receipt).

The insurance contracts or policiesdiscussed above must be issued by aninsurance company or similar organization(such as Blue Cross, Blue Shield or ahealth maintenance organization) which isqualified to do business in any state.

c. A combination unfunded/insuredwelfare plan has its benefits providedpartially as an unfunded plan and partiallyas a fully insured plan. An example of such

a plan is a welfare plan which providesmedical benefits as in a above and lifeinsurance benefits as in b above.

See 29 CFR 2520.104-20 and the DOLTechnical Release 92-01.Note: An “employees’ beneficiaryassociation” as used in Code section501(c)(9) should not be confused with theemployee organization or employer thatestablishes and maintains (i.e., sponsors)the welfare benefit plan.

2. An unfunded pension benefit plan oran unfunded or insured welfare benefitplan: (a) whose benefits go only to a selectgroup of management or highlycompensated employees, and(b) which meets the terms of Departmentof Labor Regulations 29 CFR 2520.104-23(including the requirement that anotification statement be filed with DOL) or29 CFR 2520.104-24.

3. Plans maintained only to comply withworkers’ compensation, unemploymentcompensation, or disability insurance laws.

4. An unfunded excess benefit plan.5. A welfare benefit plan maintained

outside the United States primarily forpersons substantially all of whom arenonresident aliens.

6. A pension benefit plan maintainedoutside the United States if it is a qualifiedforeign plan within the meaning of Codesection 404A(e) that does not qualify forthe treatment provided in Code section402(e)(5).

7. An annuity arrangement described in29 CFR 2510.3-2(f).

8. A simplified employee pension (SEP)described in Code section 408(k) whichconforms to the alternative method ofcompliance described in 29 CFR2520.104-48 or 29 CFR 2520.104-49. ASEP is a pension plan that meets certainminimum qualifications regarding eligibilityand employer contributions.

9. A church plan not electing coverageunder Code section 410(d) or agovernmental plan.

10. A welfare benefit plan thatparticipates in a group insurancearrangement that files a return/report Form5500 on behalf of the welfare benefit plan.See 29 CFR 2520.104-43.

11. An apprenticeship or training planmeeting all of the conditions specified in29 CFR 2520.104-22.

Kinds of FilersThe different types of plan entities that filethe forms are described below. (Also seeinstructions for item 4 on page 9.)

Single-Employer Plan

If one employer or one employeeorganization maintains a plan, file aseparate return/report for the plan. If theemployer or employee organizationmaintains more than one such plan, file aseparate return/report for each plan.

If a member of a controlled group ofcorporations, a group of trades orbusinesses under common control, or anaffiliated service group maintains a plan

that does not involve other groupmembers, file a separate return/report as asingle-employer plan.

If several employers participate in aprogram of benefits in which the fundsattributable to each employer are availableonly to pay benefits to that employer’semployees, each employer must file aseparate return/report.

Plan for Controlled Group ofCorporations, Group of Trades orBusinesses Under Common Control, oran Affiliated Service Group

These groups are defined in Code sections414(b), (c), and (m), and are referred to ascontrolled groups.

If the benefits are payable to participantsfrom the plan’s total assets without regardto contributions by each participant’semployer, file one return/report for theplan. On the return/report for the plan,complete item 21 only for the controlledgroup’s employees.Note: Employers who participate in apension plan of one of the groups listedabove but who are not members of thegroup must file a separate return/report.The return/report should be filed on Form5500-C/R regardless of the number ofparticipants. The years you are required tofile pages 1 and 3 through 6 as Form5500-C, complete only items 1 through 7a,9, and 21. The years you file pages 1 and 2as Form 5500-R complete only items 1through 7a, 8a, and 8b. These participatingemployers must enter code F in item 4 ofthe Form 5500-C/R.

If several employers participate in aprogram of benefits in which the fundsattributable to each employer are availableonly to pay benefits to that employer’semployees, each employer must file aseparate return/report as a single employerplan.

Multiemployer Plan

A multiemployer plan is a plan (1) to whichmore than one employer is required tocontribute, (2) that is maintained pursuantto one or more collective-bargainingagreements, and (3) has not made theelection under Code section 414(f)(5) andERISA section 3(37)(E). File onereturn/report for each plan. Contributingemployers do not file individually for theseplans. See Code section 414 for moreinformation.

Multiple-Employer-CollectivelyBargained Plan

A multiple-employer-collectively bargainedplan involves more than one employer; iscollectively bargained and collectivelyfunded; and, if covered by PBGCtermination insurance, had properly electedbefore September 27, 1981, not to betreated as a multiemployer plan underCode section 414(f)(5) or ERISA sections3(37)(E) and 4001(a)(3). File onereturn/report for each such plan.Participating employers do not fileindividually for these plans.

Page 4 of 24 of Instructions for Form 5500 5

Page 4

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Multiple-Employer Plan (Other)

A multiple-employer plan (other) involvesmore than one employer and is not one ofthe plans already described. File onereturn/report for each plan.Note: Each employer participating in aqualified defined contribution or definedbenefit plan, which is considered amultiple-employer plan (other), must file aForm 5500-C/R regardless of the numberof participants. For the years you arerequired to file pages 1 and 3 through 6 asForm 5500-C, complete only items 1through 7a, 9, and 21. For the years youfile pages 1 and 2 as Form 5500-R,complete only items 1 through 7a, 8a, and8b. Each participating employer filing theForm 5500-C/R must enter code F in item4 and use an appropriate number (001,002, etc.) in item 5c.Note: If a participating employer is also thesponsor of the multiple-employer plan(other), the plan number on thereturn/report filed for the plan should be333 and, if more than one plan, theyshould be consecutively numbered startingwith 333.

If more than one employer participates inthe plan and the plan provides that eachemployer’s contributions are available topay benefits only for that employer’semployees who are covered by the plan,one annual return/report must be filed foreach participating employer. These filerswill be considered single employers andshould complete the entire form.

Group Insurance Arrangement

This arrangement provides benefits to theemployees of two or more unaffiliatedemployers (not in connection with amultiemployer plan or a multiple-employer-collectively bargained plan), fully insuresone or more welfare plans of eachparticipating employer, and uses a trust (orother entity such as a trade association) asthe holder of the insurance contracts andthe conduit for payment of premiums tothe insurance company.

Do not file a separate return/report for awelfare benefit plan that is part of a groupinsurance arrangement if a consolidatedreturn/report for all the plans in thearrangement was filed by the trust or otherentity according to 29 CFR 2520.104-43.Form 5500 is required by 29 CFR2520.103-2 to be part of the consolidatedreport.

Investment Arrangements FilingDirectly With DOLSome plans invest in certain trusts,accounts, and other investmentarrangements which may file informationconcerning themselves and theirrelationship with employee benefit plansdirectly with DOL (as specified on pages 6and 7). Plans participating in an investmentarrangement as described inCommon/Collective Trust and PooledSeparate Account, Master Trust, and103-12 Investment Entities below arerequired to attach certain additional

information to the return/report filed withthe IRS as specified below.

Common/Collective Trust and PooledSeparate Account

Definition.—For reporting purposes, a“common/collective trust” is a trustmaintained by a bank, trust company, orsimilar institution which is regulated,supervised, and subject to periodicexamination by a state or Federal agencyfor the collective investment andreinvestment of assets contributed theretofrom employee benefit plans maintained bymore than one employer or a controlledgroup of corporations, as the term is usedin Code section 1563. For reportingpurposes, a “pooled separate account” isan account maintained by an insurancecarrier which is regulated, supervised, andsubject to periodic examination by a stateagency for the collective investment andreinvestment of assets contributed theretofrom employee benefit plans maintained bymore than one employer or controlledgroup of corporations, as the term is usedin Code section 1563. See 29 CFRsections 2520.103-3, 2520.103-4,2520.103-5, and 2520.103-9.Note: For reporting purposes, a separateaccount which is not considered to beholding plan assets pursuant to 29 CFR2510.3-101(h)(1)(iii) shall not constitute apooled separate account.Additional information required to beattached to the Form 5500 for plansparticipating in common/collective trustsand pooled separate accounts.—A planparticipating in a common/collective trustor pooled separate account must completethe annual return/report and attach either:(1) the most recent statement of the assetsand liabilities of any common/collectivetrust or pooled separate account, or (2) acertification that: (a) the statement of theassets and liabilities of thecommon/collective trust or pooled separateaccount has been submitted directly toDOL by the financial institution orinsurance carrier; (b) the plan has receiveda copy of the statement; and (c) includesthe EIN and other numbers used by thefinancial institution or insurance carrier toidentify the trusts or accounts, and thename and address provided in the directfiling made with DOL.

Master Trust

Definition.—For reporting purposes, amaster trust is a trust for which a regulatedfinancial institution (as defined below)serves as trustee or custodian (regardlessof whether such institution exercisesdiscretionary authority or control withrespect to the management of assets heldin the trust), and in which assets of morethan one plan sponsored by a singleemployer or by a group of employers undercommon control are held.

A “regulated financial institution” meansa bank, trust company, or similar financialinstitution which is regulated, supervised,and subject to periodic examination by astate or Federal agency. Common controlis determined on the basis of all relevantfacts and circumstances (whether or not

such employers are incorporated). See 29CFR 2520.103-1(e).

For reporting purposes, the assets of amaster trust are considered to be held inone or more “investment accounts.” Amaster trust investment account mayconsist of a pool of assets or a singleasset.

Each pool of assets held in a mastertrust must be treated as a separate mastertrust investment account if each planwhich has an interest in the pool has thesame fractional interest in each asset inthe pool as its fractional interest in thepool, and if each such plan may notdispose of its interest in any asset in thepool without disposing of its interest in thepool. A master trust may also containassets which are not held in such a pool.Each such asset must be treated as aseparate master trust investment account.

Financial information must generally beprovided for each master trust investmentaccount as specified on pages 6 and 7.Additional information required to beattached to the Form 5500 for plansparticipating in master trusts.—A planparticipating in a master trust mustcomplete the annual return/report andattach a schedule listing each master trustinvestment account in which the plan hasan interest indicating the plan’s name, EIN,and plan number and the name of themaster trust used in the master trustinformation filed with DOL (see page 6). Intabular format, show the net value of theplan’s interest in each investment accountat the beginning and end of the plan year,and the net investment gain (or loss)allocated to the plan for the plan year fromthe investment account (see instructionsfor items 31c(11) through (15) on page 20).Note: If a master trust investment accountconsists solely of one plan’s asset(s) duringthe reporting period, the plan may reportthe(se) asset(s) either as an investmentaccount to be reported as part of themaster trust report filed directly with DOLor as a plan asset(s) which is not part ofthe master trust (and therefore subject toall instructions pertaining to assets not heldin a master trust).

103-12 Investment Entities

29 CFR 2520.103-12 provides analternative method of reporting for planswhich invest in an entity (other than aninvestment arrangement filing with DOL asdescribed on this page inCommon/Collective Trust and PooledSeparate Accounts or Master Trust), theunderlying assets of which include “planassets” (within the meaning of 29 CFR2510.3-101) of two or more plans whichare not members of a “related group” ofemployee benefit plans. For reportingpurposes, a “related group” consists ofeach group of two or more employeebenefit plans (1) each of which receives10% or more of its aggregate contributionsfrom the same employer or from a memberof the same controlled group ofcorporations (as determined under Codesection 1563(a), without regard to Codesection 1563(a)(4)); or (2) each of which is

Page 5 of 24 of Instructions for Form 5500 5

Page 5

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

either maintained by, or maintainedpursuant to a collective-bargainingagreement negotiated by, the sameemployee organization or affiliatedemployee organizations. For purposes ofthis paragraph, an “affiliate” of anemployee organization means any personcontrolling, controlled by, or undercommon control with such organization.See 29 CFR 2520.103-12.

For reporting purposes, the investmententities described above with respect towhich the required information is fileddirectly with DOL constitute “103-12investment entities” (103-12 IEs).

What To FileThis section describes the differentcategories of the Form 5500 series and therelated schedules and also lists items to becompleted by different types of Form 5500filers. In addition, this section contains adescription of the special filingrequirements for plans which invest incertain investment arrangements. For abrief guide illustrating which forms andschedules are required by different typesof plans and filers, see the summaryabove.

Forms

The following are the different forms in the5500 series.● Form 5500, Annual Return/Report ofEmployee Benefit Plan, must be filedannually for each plan with 100 or moreparticipants at the beginning of the planyear.● Form 5500-C/R, Return/Report ofEmployee Benefit Plan, must be filed foreach pension benefit plan, welfare benefitplan, and fringe benefit plan (unlessotherwise exempted) with fewer than 100participants at the beginning of the planyear (one-participant plans see “Form5500-EZ” below).Note: To determine whether to file Form5500 or Form 5500-C/R for an employee

benefit plan, calculate the number ofparticipants in the same manner as item 7of the Form 5500 or 5500-C/R but thecalculation should be as of the beginningof the plan year. Also, under the filingrequirements explained above, if thenumber of plan participants increases to100 or more, or decreases below 100, fromone year to the next, you would generallyhave to file a different form from that filedthe previous year. However, there is anexception to this rule. The filer maycontinue to file the same form filed lastyear (i.e., Form 5500 or 5500-C/R), even ifthe number of participants changed,provided that at the beginning of this planyear the plan had at least 80 participants,but not more than 120.● Form 5500-EZ, Annual Return ofOne-Participant (Owners and TheirSpouses) Pension Benefit Plan, should befiled by most one-participant plans.

A one-participant plan is: (1) a pensionbenefit plan that covers only an individualor an individual and his or her spouse whowholly own a trade or business, whetherincorporated or unincorporated; or (2) apension benefit plan for a partnership thatcovers only the partners or the partnersand the partners’ spouses.

See Form 5500-EZ and its instructions tosee if the plan meets the requirements forfiling the form.

Form 8822, Change of Address, may beused to notify the IRS if the plan’s mailingaddress changes after the return/reporthas been filed.

Items To Complete on Form 5500Certain kinds of plans and certain kinds offilers that must file an annual Form 5500are not required to complete the entireform. These are described below, by typeof plan. Check the list of headings to see ifyour plan is affected.Welfare benefit plans.—Welfare benefitplans generally must complete thefollowing items on the Form 5500: 1

through 6a, 6e, 7a(4), 7b, 7c, and 7d; 8a,8b, 8d, and 8e; 9a, 9b, 9c, and 9f; 10athrough 10d; 11 through 14; 25 through29; and 31 through 33.Exception: An unfunded, fully insured, or acombination unfunded/insured welfare plan(described on page 3 under PlansExcluded from Filing), which must file theForm 5500 because it has 100 or moreparticipants, need not complete items 31and 32.Note: If one Form 5500 is filed for both awelfare plan and a fringe benefit plan,check item 6d and complete Schedule F(Form 5500) in addition to the items listedabove for welfare plans.Fringe benefit plans.—For a Form 5500filed only for a fringe benefit plandescribed in Code sections 125 and 127,complete only items 1 through 5, 6d, andSchedule F (Form 5500). DO NOT file anyother schedules.

If Form 5500 is filed for both a welfarebenefit plan and a fringe benefit plan,complete the above items, all applicableschedules, and the items specified forWelfare benefit plans above.Pension plans.—In general, most pensionplans (defined benefit and definedcontribution) are required to complete allitems on the form. However, some itemsdo not have to be completed by certaintypes of pension plans, as describedbelow.1. Plans exclusively using a tax deferredannuity arrangement under Code section403(b)(1).—These plans (see Who MustFile on page 2) need only complete items1 through 5, 6b (enter pension code 8),and 9.2. Plans exclusively using a custodialaccount for regulated investmentcompany stock under Code section403(b)(7).—These plans need onlycomplete items 1 through 5, 6b (enterpension code 9), and 9.

Summary of Filing Requirements for Employers and Plan Administrators(File forms ONLY with IRS)

Type of plan What to file When to file

File allrequired

forms andschedulesfor each

plan by thelast day of

the 7thmonth after

the planyear ends.

Most pension plans with only one participant or one participant and that participant’s spouse

Pension plan with fewer than 100 participants

Pension plan with 100 or more participants

Annuity under Code section 403(b)(1) or trust under Code section 408(c)

Custodial account under Code section 403(b)(7)

Welfare benefit plan with 100 or more participants

Welfare benefit plan with fewer than 100 participants (see exceptions on page 3 of these instructions)

Pension or welfare plan with 100 or more participants (see instructions for item 26)

Pension or welfare plan with benefits provided by an insurance company

Pension plan that requires actuarial information

Pension or welfare plan with 100 or more participants

Pension plan with ESOP benefits

Pension plan filing a registration statement identifying separated participants with deferredvested benefits from a pension plan

Form 5500-EZ

Form 5500-C/R

Form 5500

Form 5500 or Form 5500-C/R

Financial statements, schedules,and accountant’s opinion

Schedule A (Form 5500)

Schedule B (Form 5500)

Schedule C (Form 5500)

Schedule E (Form 5500)

Schedule SSA(Form 5500)

Form 5500 or Form 5500-C/R

Form 5500

Form 5500-C/R

Fringe benefit plan under Code section 6039D Schedule F (Form 5500)

Financial Schedules for item 27 Schedule G (Form 5500)

Page 6 of 24 of Instructions for Form 5500 5

Page 6

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

3. Individual retirement account plan.—Apension plan utilizing individual retirementaccounts or annuities (as described inCode section 408) as the sole fundingvehicle for providing benefits need onlycomplete items 1 through 5, 6b (enterpension code 0), and 9.4. Fully insured pension plan.—A pensionbenefit plan providing benefits exclusivelythrough an insurance contract, or contractswhich are fully guaranteed and that meetsall of the conditions of 29 CFR2520.104-44 need only complete items 1through 26, 29, and 30.

A pension plan including both insurancecontracts of the type described in 29 CFR2520.104-44 as well as other assetsshould limit its reporting in items 31 and 32to those other assets.Note: For purposes of the annual return/report and the alternative method ofcompliance set forth in 29 CFR2520.104-44, a contract is considered tobe “allocated” only if the insurancecompany or organization that issued thecontract unconditionally guarantees, uponreceipt of the required premium orconsideration, to provide a retirementbenefit of a specified amount. This amountmust be provided without adjustment forfluctuations in the market value of theunderlying assets of the company ororganization, to each participant, and eachparticipant has a legal right to suchbenefits, which is legally enforceabledirectly against the insurance company ororganization.5. Nonqualified pension benefit plansmaintained outside the United States.—Nonqualified pension benefit plansmaintained outside the United Statesprimarily for nonresident aliens required tofile a return/report (see Who Must File onpage 2) must only complete items 1through 8c (enter code D in item 6c), 9through 12, 15 and 16.Plans of more than one employer.—Allplans of more than one employer (plans ofa controlled group, multiemployer plans,multiple-employer-collectively bargainedplans, and multiple-employer plan (other))generally must complete all applicable(welfare or pension) items on the formexcept for item 6f. Only single-employerpension plans must complete item 6f.Multiemployer plans and multiple-employer-collectively bargained plans neednot complete item 7h.

Schedules

Note: All attachments to Forms 5500 and5500-C/R must include the name of theplan, the plan sponsor’s EIN, and plannumber (PN) as found in items 5a, 1b, and5c, respectively.

The various schedules to attach to thereturn/report are listed below:● Schedule A (Form 5500), InsuranceInformation, must be attached to Form5500 or 5500-C/R, if any benefits underthe plan are provided by an insurancecompany, insurance service, or othersimilar organization (such as Blue Cross,Blue Shield, or a health maintenanceorganization). (This includes investments

with insurance companies such asguaranteed investment contracts (GICs).)Exceptions. (1) Schedule A (Form 5500) isnot needed if the plan covers only: (a) anindividual, or an individual and his or herspouse, who wholly owns a trade orbusiness, whether incorporated orunincorporated; or (b) a partner(s) in apartnership, or a partner(s) and his or herspouse.

(2) A Schedule A (Form 5500) is notrequired to be filed with the Form 5500 orForm 5500-C/R if a Schedule A (Form5500) is filed for the contract as part of themaster trust or 103-12 IE information fileddirectly with DOL.

Do not file a Schedule A (Form 5500)with a Form 5500-EZ.● Schedule B (Form 5500), ActuarialInformation, must be attached to Form5500, 5500-C/R, or 5500-EZ for mostdefined benefit pension plans. See theinstructions for Schedule B.● Schedule C (Form 5500), ServiceProvider and Trustee Information, must beattached to Form 5500. See item 25 andthe instructions for Schedule C.● Schedule E (Form 5500), ESOP AnnualInformation, must be attached to Form5500, 5500-C/R, or 5500-EZ for all pensionbenefit plans with ESOP benefits. See theinstructions for Schedule E.● Schedule F (Form 5500), Fringe BenefitPlan Annual Information Return, must beattached to page 1 of Form 5500 or5500-C/R for all fringe benefit plans.● Schedule G (Form 5500), FinancialSchedules, may be attached to Form 5500when a “Yes” is checked for any item in27a through 27f. The Schedule G isoptional for 1993 (you may use theschedules specified in the instructions foritem 27 instead).● Schedule SSA (Form 5500), AnnualRegistration Statement IdentifyingSeparated Participants With DeferredVested Benefits, may be needed forseparated participants. See When ToReport a Separated Participant in theinstructions for Schedule SSA.● Schedule P (Form 5500), Annual Returnof Fiduciary of Employee Benefit Trust,may be filed by any fiduciary (trustee orcustodian) of an organization that isqualified under Code section 401(a) andexempt from tax under Code section501(a) who wants to protect theorganization under the statute of limitationsprovided in Code section 6501(a).

File the Schedule P (Form 5500) as anattachment to Form 5500, 5500-C/R, or5500-EZ for the plan year in which thetrust year ends.

Other Filings

Certain investment arrangements foremployee benefit plans file financialinformation directly with DOL. Thesearrangements include common/collectivetrusts, pooled separate accounts, mastertrusts, and 103-12 IEs. Definitions of theseinvestment arrangements may be found onpage 4. Their DOL filing requirements aredescribed below.

Common/collective trust and pooledseparate account information to be fileddirectly with DOL.—Financial institutionsand insurance carriers filing the statementof the assets and liabilities of acommon/collective trust or pooled separateaccount should identify the trust oraccount by providing the EIN of the trustor account, or (if more than one trust oraccount is covered by the same EIN) boththe EIN and any additional numberassigned by the financial institution orinsurance carrier (such as: 99-1234567Trust No. 1); and a list of all plansparticipating in the trust or account,identified by the plan number, EIN, andname of the plan sponsor. The direct filingshould be addressed to:Common/Collective Trust (OR)Pooled Separate AccountPension and Welfare Benefits

AdministrationU.S. Department of Labor, Room N5644200 Constitution Avenue, NWWashington, DC 20210Master trust information to be fileddirectly with DOL.—The followinginformation with respect to a master trustmust be filed with DOL by the planadministrator or by a designee, such as theadministrator of another plan participatingin the master trust or the financialinstitution serving as trustee of the mastertrust, no later than the date on which theplan’s return/report is due. While only onecopy of the required information should befiled for all plans participating in the mastertrust, the information is an integral part ofthe return/report of each participating plan,and the plan’s return/report will not bedeemed complete unless all theinformation is filed within the prescribedtime.Note: If a master trust investment accountconsists solely of one plan’s asset(s) duringthe reporting period, the plan may reportthe(se) asset(s) either as an investmentaccount to be reported as part of themaster trust report filed directly with DOLor as a plan asset(s) that is not part of themaster trust (and therefore subject to allinstructions pertaining to assets not held ina master trust).

Each of the following statements andschedules must indicate the name of themaster trust and the name of the mastertrust investment account. The informationshall be filed with DOL by mailing it to:Master TrustPension and Welfare Benefits

AdministrationU.S. Department of Labor, Room N5644200 Constitution Avenue, NWWashington, DC 20210

1. The name and fiscal year of themaster trust and the name and address ofthe master trustee.

2. A list of all plans participating in themaster trust, showing each plan’s name,EIN, PN, and its percentage interest ineach master trust investment account asof the beginning and end of the fiscal yearof the master trust ending with or withinthe plan year.

Page 7 of 24 of Instructions for Form 5500 5

Page 7

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in themaster trust.

4. A statement, in the same format asPart I of Schedule C (Form 5500), for eachmaster trust investment account showingamounts of compensation paid during thefiscal year of the master trust ending withor within the plan year to personsproviding services with respect to theinvestment account and subtracted fromthe gross income of the investmentaccount in determining the net increase(decrease) in net assets of the investmentaccount.

5. A statement for each master trustinvestment account showing the assetsand liabilities of the investment account atthe beginning and end of the fiscal year ofthe master trust ending with or within theplan year, grouped in the same categoriesas those specified in item 31 of Form5500.

6. A statement for each master trustinvestment account showing the incomeand expenses, changes in net assets, andnet increase (decrease) in net assets ofeach such investment account during thefiscal year of the master trust ending withor within the plan year, in the categoriesspecified in item 32 of Form 5500. In placeof item 32a, show the total of all transfersof assets into the investment account byparticipating plans. In place of item 32j,show the total of all transfers of assets outof the investment account by participatingplans.

7. Schedules, in the format set forth inthe instructions for item 27 of Form 5500,of the following items with respect to eachmaster trust investment account for thefiscal year of the master trust ending withor within the plan year: assets held forinvestment, nonexempt party-in-interesttransactions, defaulted or uncollectibleloans and leases, and 5% transactionsinvolving assets in the investment account.The 5% figure shall be determined bycomparing the current value of thetransaction at the transaction date with thecurrent value of the investment accountassets at the beginning of the applicablefiscal year of the master trust.103-12 IE information to be filed directlywith DOL.—The information describedbelow must be filed with DOL by thesponsor of the 103-12 IE no later than thedate on which the plan’s return/report isdue before the plan administrator can electthe alternative method of reporting. Whileonly one copy of the required informationshould be filed for the 103-12 IE, theinformation is an integral part of thereturn/report of each plan electing thealternative method of compliance. Thefiling address is:103-12 Investment EntityPension and Welfare Benefits

AdministrationU.S. Department of Labor, Room N5644200 Constitution Avenue, NWWashington, DC 20210

1. The name, fiscal year, and EIN of the103-12 IE and the name and address ofthe sponsor of the 103-12 IE. If more than

one 103-12 IE is covered by the same EIN,they shall be sequentially numbered asfollows: 99-1234567 Entity No. 1.

2. A list of all plans participating in the103-12 IE, showing each plan’s name, EIN,PN, and its percentage interest in the103-12 IE as of the beginning and end ofthe fiscal year of the 103-12 IE ending withor within the plan year.

3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in the103-12 IE.

4. A statement, in the same format asPart I of Schedule C (Form 5500), for the103-12 IE showing amounts ofcompensation paid during the fiscal year ofthe 103-12 IE ending with or within theplan year to persons providing services tothe 103-12 IE.

5. A statement showing the assets andliabilities at the beginning and end of thefiscal year of the 103-12 IE ending with orwithin the plan year, grouped in the samecategories as those specified in item 31 ofForm 5500.

6. A statement showing the income andexpenses, changes in net assets, and netincrease (decrease) in net assets duringthe fiscal year of the 103-12 IE ending withor within the plan year, grouped in thesame categories as those specified in item32 of Form 5500. In place of item 32a,show the total of all transfers of assets intothe 103-12 IE by participating plans. Inplace of item 32j, show the total of alltransfers of assets out of the 103-12 IE byparticipating plans.

7. Schedules, in the format set forth inthe instructions for item 27 of Form 5500(except item 27d) with respect to the103-12 IE for the fiscal year of the 103-12IE ending with or within the plan year.Substitute the term “103-12 IE” in place ofthe word “plan” when completing theschedules.

8. A report of an independent qualifiedpublic accountant regarding the aboveitems and other books and records of the103-12 IE that meets the requirements of29 CFR 2520.103-1(b)(5).

Section 3Final Return/ReportIf all assets under the plan (includinginsurance/annuity contracts) have beendistributed to the participants andbeneficiaries or distributed to another plan(and when all liabilities for which benefitsmay be paid under a welfare benefit planhave been satisfied), check the “finalreturn/report” box at the top of the formfiled for such plan. The year of completedistribution is the last year a return/reportmust be filed for the plan. For purposes ofthis paragraph, a complete distribution willoccur in the year in which the assets of aterminated plan are brought under thecontrol of PBGC.

For a defined benefit plan covered byPBGC, a PBGC Form 1 must be filed anda premium must be paid until the end ofthe plan year in which the assets are

distributed or brought under the control ofPBGC.

Filing the return/report marked “Finalreturn” and indicating that the planterminated satisfies the notificationrequirement of Code section 6057(b)(3).

Signature and DateThe plan administrator must sign and dateall returns/reports filed. The name of theindividual who signed as plan administratormust be typed or printed clearly on the lineunder the signature line. In addition, theemployer must sign a return/report filed fora single-employer plan or a plan requiredto file only because of Code section 6039D(i.e., for a fringe benefit plan).

When a joint employer-union board oftrustees or committee is the plan sponsoror plan administrator, at least oneemployer representative and one unionrepresentative must sign and date thereturn/report.

Participating employers in amultiple-employer plan (other), who arerequired to file Form 5500-C/R, arerequired to sign the return/report. The planadministrator need not sign the Form5500-C/R filed by the participatingemployer.

ReproductionsOriginal forms are preferable, but a clearreproduction of the completed form isacceptable. Sign the return/report after it isreproduced. All signatures must be original.

Change in Plan YearGenerally only defined benefit pensionplans need to get prior approval for achange in plan year. (See Code section412(c)(5).) Rev. Proc. 87-27, 1987-1 C.B.769 explains the procedure for automaticapproval of a change in plan year. Apension benefit plan that would ordinarilyneed to obtain approval for a change inplan year under Code section 412(c)(5) isgranted an automatic approval for achange in plan year if all the followingcriteria are met:

1. No plan year exceeds 12 months.2. The change will not delay the time

when the plan would otherwise have beenrequired to conform to the requirements ofany statute, regulation, or publishedposition of the IRS.

3. The trust, if any, retains its exemptstatus for the short period required toeffect the change, as well as for thetaxable year immediately preceding theshort period.

4. All actions necessary to implementthe change in plan year, including planamendment and a resolution of the boardof directors (if applicable), have been takenon or before the last day of the shortperiod.

5. No change in plan year has beenmade for any of the preceding plan years.

6. In the case of a defined benefit plan,deductions are taken in accordance withsection 5 of Rev. Proc. 87-27.

Page 8 of 24 of Instructions for Form 5500 5

Page 8

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

For the first return/report that is filedfollowing the change in plan year, checkthe box on line C at the top of the form.

Amended Return/ReportIf you file an amended return/report, checkbox A(2) “an amended return/report” at thetop of the form. When filing an amendedreturn, answer all questions and circle theamended item numbers.

How The Annual Return/ReportInformation May Be UsedAll Form 5500 series return/reports will besubjected to a computerized review. It is,therefore, in the filer’s best interest that theresponses accurately reflect thecircumstances they were designed toreport. Annual reports filed under Title I ofERISA must be made available by planadministrators to plan participants and bythe Department of Labor to the publicpursuant to ERISA section 104.

Section 4Important: Answer all items on the Form5500 with respect to the plan year, unlessotherwise explicitly stated in theitem-by-item instructions or on the formitself. Therefore, your responses usuallyapply to the year entered or printed at thetop of the first page of the form. “Yes” or“No” questions must be marked either“Yes” or “No,” but not both. “N/A”cannot be used to respond to a “Yes” or“No” question that is required to beanswered by the filer as specified onpage 5 under Items To Complete OnForm 5500.

Information at the Top of the FormOn the first line at the top of the formcomplete the space for dates when (1) the12-month plan year is not a calendar year,or (2) the plan year is less than 12 months(a short plan year).

A. Check box (1) if this is the initial filingfor this plan. Do not check this box if youhave ever filed for this plan even if it wason a different form (Form 5500 vs. Form5500-C or Form 5500-R).

Check box (2) if you have already filedfor the 1993 plan year and are nowsubmitting an amended return/report tocorrect errors and/or omissions on thepreviously filed return/report.

Check box (3) if the plan no longer existsto provide benefits. See Section 3 on page7 for instructions concerning therequirement to file a final return/report.

Check box (4) if this form is being filedfor a period of less than 12 months andshow the dates at the top.

B. Check this box if you make anychanges to the preprinted information onpage 1. Changes should be highlighted orentered in red ink if possible.

C. Check this box if the plan year hasbeen changed since the last return/reportwas filed.

D. Check this box if you filed for anextension of time to file this form. Attach acopy of the approved Form 5558 or a copy

of the employer’s extension of time to filethe income tax return if you are using theexception in Extension of Time To File onpage 2 of these instructions.

Line-By-Line Instructions

Page 1

Check the preprinted information for 1athrough 6d for accuracy andcompleteness. Cross out any incorrectinformation and enter the correctinformation. Add any incompleteinformation in red ink if possible.

If you did not receive a Form 5500 witha preprinted page 1, complete items 1through 6d as follows:

1a. Enter the name and address of theplan sponsor. If the plan covers only theemployees of one employer, enter theemployer’s name. If the Post Office doesnot deliver mail to the street address andthe sponsor has a P.O. box, show the boxnumber instead of the street address.

The term “plan sponsor” means—● The employer, for an employee benefitplan that a single employer established ormaintains;● The employee organization in the case ofa plan of an employee organization; or● The association, committee, joint boardof trustees, or other similar group ofrepresentatives of the parties whoestablish or maintain the plan, if the plan isestablished or maintained jointly by one ormore employers and one or moreemployee organizations, or by two or moreemployers.

Include enough information in item 1(a)to describe the sponsor adequately. Forexample, “Joint Board of Trustees of Local187 Machinists” rather than just “JointBoard of Trustees.”

For group insurance arrangements, enterthe name of the trust or other entity thatholds the insurance contracts. In addition,attach a list of all participating employersand their EINs.

A “group insurance arrangement” is anarrangement which provides benefits to theemployees of two or more unaffiliatedemployers (not in connection with amultiemployer plan or a multiple-employercollectively bargained plan), fully insuresone or more welfare plans of eachparticipating employer, and uses a trust (orother entity such as a trade association) asthe holder of the insurance contracts andthe conduit for payment of premiums tothe insurance company.

1b. Enter the nine-digit employeridentification number (EIN) assigned to theplan sponsor/employer. For example,00-1234567.

Employers and plan administrators whodo not have an EIN should apply for oneon Form SS-4, Application for EmployerIdentification Number. Form SS-4 can beobtained at most IRS or Social SecurityAdministration (SSA) offices. Send FormSS-4 to the Internal Revenue ServiceCenter where you will file this Form 5500.

A plan of a controlled group ofcorporations should use the EIN of one ofthe sponsoring members. This EIN must beused in all subsequent filings of the annualreturns/reports for the controlled group.

If the plan sponsor is a group ofindividuals, get a single EIN for the group.When you apply for a number, enter online 1 of Form SS-4 the name of the group,such as “Joint Board of Trustees of theLocal 187 Machinists’ Retirement Plan.”Note: Although EINs for funds (trusts orcustodial accounts) associated with plansare generally not required to be furnishedon the Form 5500 series returns/reports,the IRS will issue EINs for such funds forother trust reporting purposes. EINs maybe obtained by filing Form SS-4 asexplained above.

Plan sponsors should use the trust EINdescribed in the Note above when openinga bank account or conducting othertransactions for a trust that requires anEIN.

1d. From the list of business codes onpages 22 and 23, enter the one that bestdescribes the nature of the employer’sbusiness. If more than one employer isinvolved, enter the business code for themain business activity.

1e. Plans entering entity code A or B initem 4 must enter the first six digits of theCUSIP (Committee on Uniform SecuritiesIdentification Procedures) number, “issuernumber,” if one has been assigned to theplan sponsor for purposes of issuingcorporate securities. CUSIP issuernumbers are assigned to corporations andother entities that issue public securitieslisted on stock exchanges or traded overthe counter. The CUSIP issuer number isthe first six digits of the number assignedto the individual securities that are traded.If the plan sponsor has no CUSIP issuernumber, enter “N/A.”

2a. If the document constituting the planappoints or designates a plan administratorother than the sponsor, enter theadministrator’s name and address. If theplan administrator is also the sponsor,enter “Same.” If filing as a group insurancearrangement, enter “Same.” If “Same” isentered on 2a, leave items 2b and 2cblank.

The term “administrator” means—● The person or group of personsspecified as the administrator by theinstrument under which the plan isoperated;● The plan sponsor/employer if anadministrator is not so designated; or● Any other person prescribed byregulations of the Secretary of Labor if anadministrator is not designated and a plansponsor cannot be identified.

2b. A plan administrator must have anEIN for reporting purposes. Enter the planadministrator’s nine-digit EIN here. If theplan administrator does not have an EIN,apply for one as explained in 1b above.

Employees of an employer are not planadministrators unless so designated in theplan document, even though they engage

Page 9 of 24 of Instructions for Form 5500 5

Page 9

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

in administrative functions of the plan. If anemployee of the employer is designated asthe plan administrator, that employee mustget an EIN.

3. If the plan sponsor’s/administrator’sname, address, and EIN have changedsince the last return/report was filed forthis plan, enter the plansponsor’s/administrator’s name, address,and EIN as it appeared on the lastreturn/report filed for this plan.

3c. Indicate if the change in 3a is only achange in sponsorship. “Change insponsorship” means the plan’s sponsorhas been changed but no assets orliabilities have been transferred to anotherplan(s), the plan has not terminated ormerged with any other plan. Therefore, theplan is now the responsibility of the newsponsor whose name is entered in item 1aof this return/report.

4. Plan Entity Code.—From thefollowing list of plan entities choose theone that describes your plan entity andenter that code in item 4.

Entity CodeSingle-employer plan APlan of controlled group of corporations

or common control employers BMultiemployer plan CMultiple-employer-collectively

bargained plan DMultiple-employer plan (other) EGroup insurance arrangement

(of welfare plans) F

5a. Enter the formal name of the plan,group insurance arrangement, or enoughinformation to identify the plan. This nameshould not exceed 70 characters. If thepresent plan name exceeds 70 charactersand spaces, try to abbreviate it.

5b. Enter the date the plan first becameeffective.

5c. Enter the three-digit number theemployer or plan administrator assigned tothe plan. All welfare benefit plan numbersand Code section 6039D plan numbersstart at 501. All other plans start at 001.

Once you use a plan number, continueto use it for that plan on all future filingswith the IRS, DOL, and PBGC. Do not useit for any other plan even if you terminatedthe first plan.

6a. Welfare Benefit Plan Codes.—Check this box and enter every code fromthe list below that describes the welfarebenefit plan for which this return/report isbeing filed.Example. If your plan provides healthinsurance, life insurance, dental insurance,and eye examinations, the four codes A, B,D, and E should be entered. If your planhas a benefit not described by one of thecodes, enter “Z” and write in a descriptionof this benefit in the space provided.

Type of Welfare Plan CodeHealth (other than dental or vision) ALife insurance BSupplemental unemployment CDental DVision ETemporary disability (accident and sickness) FPrepaid legal G

Long-term disability HSeverance pay IApprenticeship and training JScholarship (funded) KDeath benefits (other than life ins.) LTaft-Hartley Financial Assistance

for Employee Housing Expenses POther (specify on page 1) Z

6b. Pension Benefit Plan Codes.—Check this box and enter the codes fromthe list below that describe the type ofbenefits for which the Form 5500 is beingfiled.Note: A pension plan must be either adefined benefit or a defined contributionplan.

Type of Pension Benefit Plan CodeDefined benefit 1

Defined Contribution

Profit-sharing 2Stock bonus 3Target Benefit 4Other money purchase 5Other (specify on page 1) 6

Other

Defined benefit plan with benefitsbased partly on balance of separateaccount of participant (Code section414(k)) 7

Annuity arrangement of certainexempt organizations (Code section403(b)(1)) 8

Custodial account for regulatedinvestment company stock (Codesection 403(b)(7)) 9

Pension plan utilizing individualretirement accounts or annuities(described in Code section 408) asthe sole funding vehicle forproviding benefits 0

6c. Pension Plan Feature Codes.—Enter the code(s) from the list below thatdescribes the pension plan features.

Type of Pension Plan Feature Code(see descriptions and codes below)Employee Stock Ownership Plan (ESOP) ALeveraged ESOP BParticipant-Directed Account Plan CPension Plan maintained outside the USA DPlan covering self-employed individuals EAffiliated Service Group (Code section 414(m)(2)) F401(k) Plan—(Plan containing a cash or deferred

arrangement) GTop-Heavy plan (in 1984 or subsequent plan

year) HPlan with Permitted Disparity Provisions—(See

Code sections 401(a)(5) and 401(l) IMaster plan JPrototype plan KRegional Prototype plan L

● If you enter code A or B, you mustcomplete Schedule E (Form 5500) andattach it to the Form 5500 you file for thisplan.● Enter code B for a leveraged ESOP ifthe plan acquires employer securities withborrowed money or other debt-financingtechniques.● Enter code C for a pension plan thatprovides for individual accounts andpermits a participant or beneficiary toexercise independent control over theassets in his or her account (see ERISAsection 404(c)).

● Enter Code D for a pension benefit planmaintained outside the United Statesprimarily for nonresident aliens. See Kindsof Filers on page 3 for more information.● Enter code F for a plan of an AffiliatedService Group. In general, Code section414(m)(2) defines an affiliated service groupas a first service organization (FSO) thathas:

1. A service organization (A-ORG) that isa shareholder or partner in the FSO andthat regularly performs services for theFSO, or is regularly associated with theFSO in performing services for thirdpersons, and/or

2. Any other organization (B-ORG) if:a. A significant portion of the business of

that organization consists of performingservices for the FSO or A-ORG of a typehistorically performed by employees in theservice field of the FSO or A-ORG, and

b. 10% or more of the interest of theB-ORG is held by persons who are highlycompensated employees of the FSO orA-ORG.

An affiliated service group also includesa group consisting of an organizationwhose principal business is performingmanagement functions for anotherorganization (or one organization and otherrelated organizations) on a regular andcontinuing basis, and the organization forwhich such functions are so performed bythe organization.● Enter Code G for a cash or deferredarrangement described under Code section401(k) that is part of a qualified definedcontribution plan that provides for anelection by employees to defer part of theircompensation or receive these amounts incash.● Enter Code H if the plan is top heavy. A“top-heavy plan” is a plan that during anyplan year is:

1. Any defined benefit plan if, as of thedetermination date, the present value ofthe cumulative accrued benefits under theplan for key employees exceeds 60% ofthe present value of the cumulativeaccrued benefits under the plan for allemployees; and

2. Any defined contribution plan if, as ofthe determination date, the aggregate ofthe accounts of key employees under theplan exceeds 60% of the aggregate of theaccounts of all employees under the plan.

Each plan of an employer included in arequired aggregation group must betreated as a top-heavy plan if such groupis a top-heavy group. See definitions ofrequired aggregation group and top-heavygroup, below.

A “key employee” is any participant inan employer plan who at any time duringthe plan year, or any of the 4 precedingyears, is:

1. An officer of the employer having anannual compensation greater than 50% of$115,641, the defined benefit dollarlimitation for 1993 under Code section415(b)(1)(A),

2. One of the 10 employees havingannual compensation from the employer

Page 10 of 24 of Instructions for Form 5500 5

Page 10

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

greater than $30,000, the definedcontribution dollar limitation for 1993 underCode section 415(c)(1)(A) and owning (orconsidered as owning within the meaningof Code section 318) the largest interestsin the employer,

3. A 5% owner of the employer, or4. A 1% owner of the employer having

an annual compensation from the employerof more than $150,000.

In determining whether an individual isan officer of the employer, no more than50 employees, or, if less, the greater of 3employees or 10% of the employees, areto be treated as officers. See Code section416(i) and T-12 of Regulations section1.416-1. A key employee will not includeany officer or employee of a governmentalplan under Code section 414(d).

A “required aggregation group” consistsof:

1. Each plan of the employer in which akey employee is or was a participant, and

2. Each other plan of the employer thatenables a plan to meet the requirementsfor nondiscrimination in contributions orbenefits under Code section 401(a)(4), orthe participation requirements under Codesection 410.

A “top-heavy group” is an aggregationgroup if, as of the determination date, thesum of the present value of the cumulativeaccrued benefits for key employees underall defined benefit plans included in suchgroup and the aggregate of the accountsof key employees under all definedcontribution plans in such group exceeds60% of a similar sum determined for allemployees. To determine if a plan istop-heavy, include distributions made inthe 5-year period ending on thedetermination date. However, do not takeinto account accrued benefits for anindividual who has not performed servicesfor the employer during the 5-year periodending on the determination date.

A qualified plan must limit the annualcompensation of each employee taken intoaccount for this year to $235,840, adjustedannually for the cost of living. The familymembers (spouse and lineal descendentsunder age 19) of 5% owners or one of the10 most highly compensated employeesare treated as a single employee. Qualifiedplans may comply with this requirement inoperation even if the plan has not yet beenamended to comply with the Tax ReformAct of 1986.

6d. Fringe Benefit Plan.—Complete onlypage 1 (items 1 through 5 and 6d) andSchedule F (Form 5500) for a Form 5500filed only because of Code section 6039D.Check this box and see page 5 foradditional instructions on Items ToComplete on Form 5500 for a fringebenefit plan.

6e. See pages 4 through 7 for definitionsand other information pertaining to mastertrusts, 103-12 investment entities,common/collective trusts and pooledseparate accounts. Also see theinstructions for items 25 through 32 forspecific reporting requirements for planswhich utilize these entities.

6e(1). In the space provided in line 6e,enter the name of the trust and financialinstitution. Also enter the city and statewhere the trust is maintained. (See MasterTrust on page 4 for more information.)

6e(2). In the space provided in line 6e,enter the name and address of the 103-12IE. (See page 7 for 103-12 IE instructions.)

6f. For single-employer pension plans,enter the date the employer’s tax yearends. For example, if the tax year is acalendar year, enter 12-31-93. Do notcomplete 6f for plans with more than oneemployer.

6g and 6h. A defined benefit plan isgenerally subject to the minimum fundingrequirements under section 412 unless it isa fully insured plan that is exempt from theminimum funding requirements undersection 412(i). A plan is considered a 412(i)plan whether or not all or part of the planis trusteed or a noninsured top-heavy sidefund is maintained. All such plans mustcheck their 412(i) status in item 6g. Checkbox 6h if any part of the plan that wasformerly subject to the minimum fundingrequirements under section 412 for eitherof the prior two plan years has becomeexempt under section 412(i).Note: All defined benefit plans subject tothe minimum funding requirements underSection 412 must complete item 15a andattach Schedule B (Form 5500). Alsocomplete item 15a and attach Schedule B(Form 5500) for all 412(i) plans where allpremiums for the plan year required undersection 412(i) have not been paid beforethe lapse of any insurance contract underthe plan and/or where a noninsuredtop-heavy side fund is maintained.

7. The description of “participant” in theinstructions below is only for purposes ofitem 7 of this form.

For welfare plans, the number ofparticipants should be determined byreference to 29 CFR 2510.3-3(d).Dependents are considered to be neitherparticipants nor beneficiaries. For pensionbenefit plans, “alternate payees” entitled tobenefits under a qualified domesticrelations order are not to be counted asparticipants for this item.

“Participant” means any individual whois included in one of the categories below.

7a. Active participants include anyindividuals who are currently inemployment covered by a plan and whoare earning or retaining credited serviceunder a plan. This category includes anyindividuals who are: (1) currently below thepermitted disparity level in a plan that isintegrated with social security, and/or(2) eligible to elect to have the employermake payments to a Code section 401(k)qualified cash or deferred arrangement.Active participants also include anynonvested individuals who are earning orretaining credited service under a plan.This category does not include nonvestedformer employees who have incurred thebreak in service period specified in theplan.

For determining if active participants arefully vested, partially vested, or nonvested,

consider vesting in employer contributionsonly.

7b. Inactive participants receivingbenefits are any individuals who are retiredor separated from employment covered bythe plan and who are receiving benefitsunder the plan. This includes formeremployees who are receiving group healthcontinuation coverage benefits pursuant toPart 6 of ERISA who are covered by theemployee welfare benefit plan. Thiscategory does not include any individual towhom an insurance company has made anirrevocable commitment to pay all thebenefits to which the individual is entitledunder the plan.

7c. Inactive participants entitled to futurebenefits are individuals who are retired orseparated from employment covered bythe plan and who are entitled to beginreceiving benefits under the plan in thefuture. This category does not include anyindividual to whom an insurance companyhas made an irrevocable commitment topay all the benefits to which the individualis entitled under the plan.

7e. Deceased participants are anydeceased individuals who had one or morebeneficiaries who are receiving or areentitled to receive benefits under the plan.This category does not include anindividual if an insurance company hasmade an irrevocable commitment to pay allthe benefits to which the beneficiaries ofthat individual are entitled under the plan.

7g. Enter the number of participantsincluded in line 7f who have accountbalances at the end of the plan year. Forexample, for a Code section 401(k) plan,the number entered on line 7g should bethe number of participants counted in line7f who have made a contribution to theplan during this plan year or any prior planyear.

7h. Include any participant whoterminated employment during this planyear, whether or not the participantincurred a break in service. Multiemployerplans and multiple-employer-collectivelybargained plans need not complete 7h.

7i(1). If “Yes,” file Schedule SSA (Form5500) as an attachment to Form 5500.Plan administrators: Code section 6057(e)provides that the plan administrator mustgive each participant a statement showingthe same information reported on ScheduleSSA for that participant.

8a. Check “Yes” if an amendment to theplan was adopted regardless of theeffective date of the amendment.

8b. Enter the date the most recentamendment was adopted regardless of thedate of the amendment or the effectivedate of the amendment.

8c. Check “Yes” only if the accruedbenefits were retroactively reduced. Forexample, a plan provides a benefit of 2%for each year of service, but the plan isamended to change the benefit to 11⁄2% ayear for all years of service under the plan.Do not check “Yes” if accrued benefitswere retroactively reduced solely to theextent permitted under a model

Page 11 of 24 of Instructions for Form 5500 5

Page 11

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

amendment provided in IRS Notice 88-131,1988-2 C.B. 546.

8d. Check “Yes” only if an amendmentchanged the information previouslyprovided to participants by the summaryplan description or summary description ofmodifications.

8e. A revised summary plan descriptionor summary description of modificationsmust be filed with the DOL and distributedto all participants and pension planbeneficiaries no later than 210 days afterthe close of the plan year in which theamendment(s) was adopted. If the materialwas distributed and filed since theamendments were adopted (even if afterthe end of the plan year), check “Yes” toitem 8e.

9a. Check “Yes” if the plan wasterminated and enter the year oftermination if applicable.

9b. If the plan was terminated but allplan assets were not distributed, areturn/report must be filed for each yearthe plan has assets. In that case, thereturn/report must be filed by the planadministrator, if designated, or by theperson or persons who actually control theplan’s property.

If all plan assets were used to buyindividual annuity contracts and thecontracts were distributed to theparticipants, check “Yes.”

If all the plan assets were legallytransferred to the control of another planor brought under the control of PBGC,check “Yes.”

Do not check “Yes” for a welfare benefitplan that is still liable to pay benefits forclaims that were incurred prior to thetermination date, but not yet paid. See 29CFR 2520.104b-2(g)(2)(ii).

9h. The Code provides for anondeductible excise tax on a reversion ofassets from a qualified plan.

9i. The employer must report thereversion by filing Form 5330 and pay anyapplicable tax. The tax will not be imposedon employers who are tax-exempt entitiesunder Code section 501(a). See theinstructions for Form 5330.

10a. If this plan was merged orconsolidated into another plan(s), or planassets or liabilities were transferred toanother plan(s), indicate which other planor plans were involved.

10c. Enter the EIN of the sponsor(employer, if for a single-employer plan) ofthe other plan.

10e. Pension benefit plans must fileForm 5310-A, Notice of Merger,Consolidation, or Transfer of Plan Assetsor Liabilities, at least 30 days before anyplan merger or consolidation or anytransfer of plan assets or liabilities toanother plan.Caution: There is a penalty for not filingForm 5310-A on time.

11. Funding Arrangement.—Enter thecode for the funding arrangement used bythe plan for the plan year from the listbelow.

The “funding arrangement” is themethod used during the plan year for thereceipt, holding, investment, andtransmittal of plan assets prior to the timethe plan actually provides the benefitspromised under the plan. For purposes ofitems 11 and 12, the term “trust” includesany fund or account which receives, holds,transmits, or invests plan assets other thanan account or policy of an insurancecompany.Note: An employee benefit plan that enterscode 2, 3, or 5 in item 11 and/or 12 mustattach a Schedule A (Form 5500),Insurance Information, to provideinformation pertaining to each contractyear ending with or within the plan year.See the instructions for Schedule A (Form5500). A plan attaching a Schedule A mayor may not be exempt from therequirement to engage an independentqualified public accountant. See theinstructions for item 26 on page 15.

Plan FundingArrangement

Codes

Trust 1Trust and insurance 2Insurance 3Exclusively from general assets

of sponsor (unfunded) 4Partially insured and partially

from general assets of sponsor 5Other 6

12. Benefit Arrangement.—Enter thecode for the benefit arrangement used bythe plan for the plan year from the listbelow.

The “benefit arrangement” is the methodby which benefits were actually providedduring the plan year to participants by theplan. For example, if all participantsreceived their benefits from a trust (asdefined in 11 above) the plan’s benefitarrangement code would be “1.” If somebenefits come from a trust and some comefrom an insurance company, the codewould be “2.” If all benefits were paid froman account or policy of an insurancecompany, the code would be “3.”

Plan BenefitArrangement

Codes

Trust 1Trust and insurance 2Insurance 3Exclusively from general assets

of sponsor (unfunded) 4Partially insured and partially

from general assets of sponsor 5Other 6

13a. Check “Yes” if either thecontributions to the plan or the benefitspaid by the plan are subject to thecollective bargaining process, even if theplan is not established and administeredby a joint board of trustees. Check “Yes”even if only some of those covered by theplan are members of a collectivebargaining unit that negotiates benefitlevels on its own behalf. The benefitschedules do not have to be identical forall employees under the plan.

13b. All plans that entered code C or Don line 4 must enter the six-digit LMnumber to identify each sponsoring labor

organization that is a party to the collectivebargaining agreement. Other plans that aremaintained pursuant to collectivebargaining agreements should enter theappropriate LM number, if available. The“LM number” is the six-digitLabor-Management file number entered bythe sponsoring labor organization in item 1of the Form LM-2 or LM-3 (LaborOrganization Annual Report) filed with theDepartment of Labor. Accordingly, the LMnumber(s) should be readily available fromthe sponsoring labor organization(s). If allsponsoring labor organizations’ LMnumbers cannot be entered in the spacesprovided in item 13b on the form, enter theadditional LM numbers on a supplementalsheet to accompany the Form 5500.

14. If either the funding arrangementcode (item 11) and/or the benefitarrangement code (item 12) is 2, 3, or 5, atleast one Schedule A (Form 5500) must beattached to the Form 5500 filed forpension and welfare plans to provideinformation concerning the contract yearending with or within the plan year. Theinsurance company (or similar organization)that provides benefits is required toprovide the plan administrator with theinformation needed to complete thereturn/report, pursuant to ERISA section103(a)(2). If you do not receive thisinformation in a timely manner, contact theinsurance company (or similarorganization). If information is missing onSchedule A (Form 5500) due to a refusal toprovide this information, note this on theSchedule A. If there is no Schedule(s) Aattached, enter “0.”

15a. If “Yes” is checked for line 15a,attach Schedule B (Form 5500) and theschedule on page 12 to the Form 5500.This schedule, prepared by the enrolledactuary who prepared the Schedule B,should show the distribution of activeparticipants by age and service groupingswith average compensation data. Theschedule must be clearly labeled “Item15a—Schedule of Active ParticipantData.”

The schedule should be provided on thesame size paper as the Form 5500 anduse the above or a similar format. Expandthis schedule by adding columns after the“5 to 9” column and before the “40 & up”column for active participants with totalyears of credited service in the followingranges: 10 to 14; 15 to 19; 20 to 24; 25 to29; 30 to 34; and 35 to 39. For eachcolumn, enter the number of activeparticipants with the specified number ofyears of credited service divided accordingto age group. For participants with partialyears of credited service, round the totalnumber of years of credited service to thenext lower whole number.

For each grouping, enter the averagecompensation of the active participants inthat group. For this purpose, compensationis the compensation taken into account foreach participant under the plan’s benefitformula, limited to the amount definedunder section 401(a)(17) of the Code.Years of credited service are the yearscredited under the plan’s benefit formula.

Page 12 of 24 of Instructions for Form 5500 5

Page 12

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Exception: Do not enter the averagecompensation in any grouping thatcontains fewer than 20 participants. Forexample, if there are 19 participants thathave attained ages 30 to 34 and earned 5to 9 years of credited service, only enterthe number of participants in that groupingand do not enter the averagecompensation.

15b. If a waived funding deficiency isbeing amortized in the current plan year,do not complete (1), (2), and (3), butcomplete items 1, 2, 3, 7, and 9 ofSchedule B (Form 5500). An enrolledactuary does not have to sign Schedule Bunder these circumstances.

15b(3). File Form 5330 with the IRS topay the excise tax on any fundingdeficiency. Caution: There is a penalty fornot filing Form 5330 on time.

17a(1). Check “Yes” if the plandistributed any annuity contracts. Check“Yes” even if the plan was terminated.

17a(2). If “Yes” was checked for item17a(1), the annuity contract must providethat all distributions from it will meet theparticipant and spousal consentrequirements of Code section 417.However, consent is not needed for thedistribution of the contract itself. If thecontracts contained the Code section 417requirements, check “Yes.”

17b. In general, distributions must bemade in the form of a qualified joint andsurvivor annuity for life or a qualifiedpreretirement survivor annuity. A qualifiedjoint and survivor annuity for a participantwho is not married is an annuity for the lifeof the participant. Check “Yes” ifdistributions in other forms were made,even if those distributions were permissible(e.g., because consent was obtained orwas not required).

17c. Generally, within the 90 days priorto the date of any benefit payment or thedate a loan was made to a participant, youmust get the spouse’s consent to thepayment of the benefit or the use of theaccrued benefit to make the loan.However, there are some circumstanceswhere obtaining this spousal consent is notrequired. The following is a partial list of

circumstances when spousal consent isnot required:

1. The participant is not married and noformer spouse is required to be treated asa current spouse under a qualifieddomestic relations order issued by a court.

2. The participant’s nonforfeitableaccrued benefit in the plan does not havea present value of more than $3,500 at thetime of distribution.

3. The benefit is paid in the form of aqualified joint and survivor annuity (i.e., anannuity for the life of the participant with asurvivor annuity for the life of the spousethat is not less than 50% of, and is notgreater than 100% of, the amount of theannuity that is payable during the joint livesof the participant and the spouse). SeeCode section 417(b).

4. The payout is from a profit-sharing orstock bonus plan that pays the spouse theparticipant’s full account balance upon theparticipant’s death, an annuity payment isnot elected by the participant, and theprofit-sharing or stock bonus plan is not atransferee plan with respect to theparticipant (i.e., had not received a transferfrom a plan that was subject to theconsent requirements with respect to theparticipant).

5. The participant had no service underthe plan after August 22, 1984.

17d. A plan may not eliminate asubsidized benefit or a retirement optionby plan amendment or plan termination.

18. If distributions were not made inaccordance with the joint and survivorannuity rules of Code sections 411(a)(11)and 417(e), answer “No.” If distributionsdid comply with Code sections 411(a)(11)and 417(e), answer “Yes.” If nodistributions were made, enter “N/A.”

19. The maximum annual benefit thatmay be provided under a defined benefitplan may not exceed the lesser of$115,641 or 100% of average annualcompensation. However, if benefits beginbefore the social security retirement age,the $115,641 limit must be reduced asdescribed in IRS Notice 87-21, 1987-1C.B. 458.

In addition, the dollar limitations will bereduced for participants with fewer than 10years of participation in a defined benefitplan (i.e., a 10% reduction for each yearunder 10 years of participation).

For defined contribution plans, Codesection 415 now provides that the dollarlimit on annual additions to a qualified planmay not exceed the greater of $30,000 or25% of the defined benefit dollar limit forsuch limitation year. The limitation fordefined contributions plans under section415(c)(1)(A) remains at $30,000 for 1993since the law provides that it shall not bechanged until the section 415(b)(1)(A) limit($115,641 for 1993) for defined benefitplans exceeds $120,000.

Annual additions to a definedcontribution plan will, for years beginningafter December 31, 1986, include 100% ofall after-tax employee contributions. Forparticipants in plans of tax-exemptorganizations, the pre-Tax Reform Actlimits remain in effect.

The Tax Reform Act of 1986 providesthat a participant’s previously accruedbenefit will not be reduced merely becauseof the reduction in dollar limits or increasesin required periods of participation. Thetransitional rule applies to an individualwho was a participant prior to January 1,1987, in a plan in existence on May 5,1986. If this participant’s current accruedbenefit exceeds the dollar limit under theTax Reform Act of 1986, but complies withprior law, then the applicable dollar limit forthe participant is equal to the currentaccrued benefit. The term “current accruedbenefit” is defined as the participant’saccrued benefit as of the close of the lastlimitation year beginning before January 1,1987, and expressed as an annual benefit.To compute the defined benefit fraction,the current accrued benefit would replacethe dollar limit otherwise used in thedenominator of the fraction. The currentaccrued benefit is also reflected in thenumerator of the defined benefit fraction.

20. Check “Yes” if, for purposes ofcomputing the minimum fundingrequirements for the plan year, the planadministrator is making an electionintended to satisfy the requirements ofCode section 412(c)(8).

Under Code section 412(c)(8), a planadministrator may elect to have anyamendment, which is adopted after theclose of the plan year to which it applies,treated as having been made on the firstday of that plan year if all the followingrequirements are met:● The amendment is adopted no later than2 1⁄2 months after the close of such planyear (2 years for a multiemployer plan);● The amendment does not reduce theaccrued benefit of any participantdetermined as of the beginning of suchplan year;● The amendment does not reduce theaccrued benefit of any participantdetermined as of the adoption of theamendment unless the plan administratornotified the Secretary of the Treasury ofthe amendment and the Secretary eitherapproved the amendment or failed to

Item 15a—Schedule of Active Participant Data

YEARS OF CREDITED SERVICEUnder 1 1 to 4 5 to 9Attained

Age

No. Comp.

Avg.

No. Comp.

Avg.

No. Comp.

Avg.

No. Comp.

Avg.

Under 25

25 to 29

30 to 34

60 to 64

65 to 69

70 & up

40 & up

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

Page 13 of 24 of Instructions for Form 5500 5

Page 13

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

disapprove the amendment within 90 daysafter the date the notice was filed.

See Temporary Regulations section11.412(c)-7(b) for details on when and howto make the election and the information toinclude on the statement of election, whichmust be filed with the appropriate Form5500 or Form 5500-C/R.

21. An employer may complete item 21based on a reasonable, good-faithinterpretation of Code sections 410(b),401(a)(4), and other related Code sections,that differs from the regulations under suchCode sections. Check the box in 21(i) ifyou are applying a reasonable, good-faithinterpretation that differs from theregulations under such Code sections. Youmay, but need not, attach an explanationof the areas in item 21 in which such areasonable, good-faith interpretation isbeing applied.

Revenue Procedure 93-42, 1993-31I.R.B. 32, provides guidelines designed toreduce the burdens of substantiatingcompliance with the nondiscriminationprovisions. Generally, Rev. Proc. 93-42sets forth new guidelines with respect to:(1) the quality of data used insubstantiating compliance with thenondiscrimination rules, (2) the timing ofnondiscrimination testing, (3) theidentification of highly compensatedemployees, (4) the testing cycle of a plan,and (5) the qualified separate lines ofbusiness rules. The substantiationguidelines may be used in completing item21. Although Rev. Proc. 93-42 is effectivefor plan years beginning on or afterJanuary 1, 1994, employers may rely onthis revenue procedure and Announcement92-81, 1992-22 I.R.B. 56, for 1993 andprior plan years.

Check the box in 21(ii) if you are relyingon the substantiation guidelines incompleting item 21. An employer usingboth a reasonable, good-faith interpretationthat differs from the regulations and thesubstantiation guidelines should check thebox in both 21(i) and 21(ii). In addition,enter the first day of the plan year forwhich the coverage information is beingsubmitted in item 21.

In general, a plan must satisfy one of thecoverage tests on each day of the yearbeing tested. However, if the plan satisfiesone of the tests on at least one day ineach quarter of the year being tested, theplan will be deemed to pass the coveragetests for the entire year provided that thequarterly testing dates reasonablyrepresent the coverage of the plan over theentire plan year. Complete item 21 for thetesting date selected by the employer(typically the last day of the plan year). Foran annual alternative testing option seeIncome Tax Regulations section1.410(b)-8(a)(4).

Multiemployer plans (code C in item 4)and multiple-employer collectivelybargained plans (code D in item 4) neednot complete item 21. Multiple-employerplan (other) filers (Code E in item 4) are notrequired to complete item 21. However,the participating employers inmultiple-employer plan (other) pension

benefit plans are required to complete theapplicable questions in item 21 on theForm 5500-C/R that they file.

21a. In general, if the employer operatedseparate lines of business within themeaning of Code section 414(r) for a year,the employer may apply the coverage andnondiscrimination requirements separatelyto employees in each separate line ofbusiness. If 21a is “Yes,” complete 21bthrough 21o for each separate line ofbusiness covered by the plan as if theemployees of the separate line of businesswere the sole employees of the employer.If this plan benefits employees in morethan one separate line of business,complete item 21 for one of the lines ofbusiness, and for each additional line ofbusiness with employees benefiting underthe plan, submit an attachment completedin the same format as item 21.

21c. Certain single plans must bedisaggregated into two or more separateplans. Each of the disaggregated parts ofthe plan must then satisfy the coveragerequirements under Code section 410(b) asif it were a separate plan. Under theregulations, the following plans must bedisaggregated: (a) a plan that has asection 401(k) provision (a qualified cash ordeferred arrangement (CODA)) and aprovision that is not a 401(k) plan, (b) aplan that has a section 401(m) provision(employee and matching contributions) anda provision that is not a 401(m) provision,(c) a plan that has an ESOP provision anda provision that is not an ESOP, and (d) aplan that benefits both collectively andnoncollectively bargained employees.

If any of the above apply to your plan,complete item 21 for one of thedisaggregated plans and for eachadditional part of the plan that must bedisaggregated, submit an attachmentcompleted in the same format as item 21.

21d. Employers can satisfy coverage byaggregating any qualified pension or profitsharing plans that are not mandatorilydisaggregated under the rules for item 21cabove. However, the aggregated plansmust also satisfy the nondiscriminationrules of section 401(a)(4) on an aggregatedbasis. Note that a special aggregation ruleapplies for the purposes of computing theaverage benefit percentage. See item21o(1) below. If the employer aggregatesplans for the purposes of the coverage andnondiscrimination tests (other than for thepurpose of computing the average benefitpercentage), check this item “Yes,” andcomplete the rest of item 21 for the plans,as aggregated.

21e. Income Tax Regulations section1.401(a)(4)-9(c) allows an employer torestructure a plan into component plans tosatisfy the coverage and discriminationtests. Check “Yes,” if the employer issatisfying the coverage and discriminationtests by restructuring the plan, and do notcomplete the rest of item 21.

21f(1). Check this box if this planbenefited no highly compensatedemployees (within the meaning of Codesection 414(q)). This box should bechecked for plans under which no

employee receives an allocation or accruesa benefit. See the instructions to item 21mfor the definition of “benefiting.”

21f(2). See Regulations section1.410(b)-6(d)(2) for the definition ofcollectively bargained employee andRegulations section 1.410(b)-9 for thedefinition of professional employee.

21g. Check “Yes” if any leasedemployee, within the meaning of section414(n), performed services for theemployer or any entity aggregated with theemployer under Code sections 414(b), (c),or (m).

21h. Enter the total number ofemployees of the employer. Include allself-employed individuals, common-lawemployees and leased employees, withinthe meaning of Code section 414(n), of anyof the entities aggregated with theemployer under Code section 414(b), (c), or(m). If any employees are aggregatedunder the family aggregation rules ofsection 414(q)(6), for purposes of item 21,treat the family group as a single employeewith aggregated compensation andbenefits.

21i. Enter the total number of excludableemployees in the following categories:

1. Employees who have not attained theminimum age and service requirements ofthe plan.

2. Collectively bargained employees.3. Nonresident aliens who receive no

U.S. source income.4. Employees who fail to benefit solely

because they fail to satisfy a minimumhours of service or a last day requirementunder the plan.

21k. See the instructions for item 21mfor the definition of “benefiting.”

21l. The definition of highlycompensated employee is contained inCode section 414(q) and its relatedregulations.

21m. In general, an employee is“benefiting” if the employee receives anallocation of contributions or forfeitures, oraccrues a benefit under the plan for theplan year. Certain other employees aretreated as benefiting even if they fail toreceive an allocation of contributionsand/or forfeitures, or to accrue a benefitsolely because the employee is subject toplan provisions that limit plan benefits,such as a provision for maximum years ofservice, maximum retirement benefits, orlimits designed to satisfy Code section415. An employee is treated as benefitingunder a plan (or portion of a plan) thatprovides for elective contributions underCode section 401(k) if the employee iseligible to make elective contributions tothe 401(k) plan even if he or she does notactually make elective contributions.Similarly, an employee is treated asbenefiting under a plan (or portion of aplan) that provides for after-tax employeecontributions or matching contributionsunder Code section 401(m) if the employeeis eligible to make after-tax employeecontributions or receive allocations ofmatching contributions even if none areactually made or received.

Page 14 of 24 of Instructions for Form 5500 5

Page 14

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

21o(1). A plan satisfies the averagebenefit test if it satisfies both thenondiscriminatory classification test andthe average benefit percentage test. A plansatisfies the nondiscriminatoryclassification test if the plan benefits suchemployees as qualify under a classificationset up by the employer and found by theSecretary not to be discriminatory in favorof highly compensated employees. Thistest takes into account all relevant factsand circumstances, including: (1) thedifference between the coveragepercentages of the highly compensatedemployees and of the nonhighlycompensated employees, (2) thepercentage of total employees covered,and (3) the difference between thecompensation of those employees coveredunder the plan and those employees whoare excluded from coverage under theplan. Under Income Tax Regulationssection 1.410(b)-4, a classification will bedeemed nondiscriminatory if the ratio initem 21o(2) below is equal to or greaterthan the safe harbor percentage. The safeharbor percentage is 50%, reduced by 3⁄4of a percentage point for each percentagepoint by which the nonhighly compensatedemployee concentration percentageexceeds 60%. The nonhighly compensatedemployee concentration percentage is thepercentage of all the employees of theemployer who are not highly compensatedemployees.

In general, a plan satisfies the averagebenefit percentage test if the actual benefitpercentage for nonhighly compensatedemployees is at least 70% of the actualbenefit percentage for highly compensatedemployees. All qualified plans of theemployer, including ESOPs, CODAs andplans containing employee or matchingcontributions (Code section 401(k) or (m))are aggregated in determining the actualbenefit percentages. Do not aggregateplans that may not be aggregated for thepurposes of satisfying the ratio percentagetest, other than ESOPs and plans subjectto Code section 401(k) or (m). In addition,all nonexcludable employees, includingthose with no benefit under any qualifiedplan of the employer, are included indetermining the actual benefit percentages.

21o(2). In general, to compute the ratio,divide the number of nonexcludableemployees who benefit under the plan andare not highly compensated by the totalnumber of nonexcludable nonhighlycompensated employees; put this result inthe numerator (top of the fraction). Dividethe number of nonexcludable employeeswho benefit under the plan and who arehighly compensated by the total number ofnonexcludable highly compensatedemployees; put this result in thedenominator (bottom of the fraction).Divide the numerator by the denominatorand enter the result in item 21o(2).

22a. Check “Yes” if it is your intentionthat this plan qualify under Code section401(a). Otherwise check “No” and go toitem 23.

22b. If item 22a is “Yes,” and you havereceived a determination letter from the

IRS, enter the date of the most recentdetermination letter received.

22c. Check “Yes” if you have applied fora determination letter from the IRS buthave not yet received a reply. Otherwisecheck “No.”

23a. An accurate assessment of fairmarket value is essential to a plan’s abilityto comply with the requirements set forthin the Code (e.g., the exclusive benefit ruleof Code section 401(a)(2), the limitationson benefits and contributions under Codesection 415, and the minimum fundingrequirements under Code section 412.)Examples of assets which may not have areadily determinable value on anestablished market include real estate,nonpublicly traded securities, shares in alimited partnership, and collectibles. Do notcheck “Yes” on line 23a if the plan is adefined contribution plan and the onlyassets the plan holds, which do not have areadily determinable value on anestablished market, are: (1) participantloans not in default, or (2) assets overwhich the participant exercises controlwithin the meaning of section 404(c) ofERISA.

23b. Although the fair market value ofplan assets must be determined each year,there is no requirement that the assets(other than certain nonpublicly tradedemployer securities held in ESOPs) bevalued every year by independentthird-party appraisers.

23c. Enter the fair market value of theassets referred to on line 23a which werenot valued by an independent third-partyappraiser in the 1993 plan year. SeeRevenue Ruling 59-60, 1959-1 C.B. 237,for guidance on determining fair marketvalue.

23d. Enter the most recent date theassets referred to on line 23c were valuedby an independent third-party appraiser. Ifthe value of more than one asset isentered on line 23c, and these assets weremost recently valued by an independentthird-party appraiser on different dates,enter the earliest date.

25a. Check “Yes” if any person(including, when applicable, a corporationor partnership) received, directly orindirectly, $5,000 or more during the planyear for providing services to the plan. Forexceptions, see the instructions for Part Iof Schedule C (Form 5500). If you checked“Yes,” complete Part I of Schedule C(Form 5500), and attach it to Form 5500.Include payments from the plan sponsorthat are reimbursable by the plan.

Check “No” if all plan assets are held ina master trust and the master trust reportfiled with DOL includes a Schedule C thatreports all payments to service providersfor the master trust.

25b. Include all trustees in office duringthe plan year. List these trustees on Part IIof Schedule C (Form 5500) and attach it tothe Form 5500.

25c. Check “Yes” if there has been atermination in the appointment of anyperson for which a box must be checkedin item 25d. In case the service provider is

not an individual (i.e., when the serviceprovider is a legal entity such as acorporation, partnership, etc.), check “Yes”when the service provider (not theindividual) has been terminated. If item 25cis checked “Yes,” complete Part III ofSchedule C (Form 5500) and attach theSchedule C to the Form 5500. Otherwise,check “No” and skip to item 25g.

25d. Check all appropriate boxes andcomplete Part III of Schedule C (Form5500). At least one box must be checked ifitem 25c is answered “Yes.”

25e. If item 25c is checked “Yes,” check25e “Yes” if, during the 2 most recent planyears preceding the termination and anysubsequent interim period preceding suchtermination, resignation, or dismissal, therewere any disagreements (whether or notthe disagreements were a factor in thetermination) on any matter of professionaljudgment that, if not resolved to thesatisfaction of the former appointee, wouldhave caused (or did cause) the formerappointee to take some action, such asincluding the subject matter of thedisagreement in a written report. Forexample, check “Yes” if the accountantwas terminated as a result of adisagreement over the valuation of planassets and the accountant would haverequired that the matter be disclosed in anote to the financial statements.Disagreements not involving a matter ofprofessional judgment, such as thepayment or nonpayment of fees, or theamount of the fee charged should not beincluded.

25f. If item 25d(1) or 25d(2) has beenchecked, indicating that an independentqualified public accountant or enrolledactuary has been terminated, the planadministrator must provide the terminatedaccountant or enrolled actuary with a copyof the explanation for the terminationprovided in Part III of Schedule C (Form5500), along with a completed copy of thenotice that follows.

In accordance with this requirement, I, as planadministrator, verify that the explanation that iseither reproduced below or attached to this noticeis the explanation concerning your termination asreported on the Schedule C (Form 5500) attachedto the 1993 Annual Return/Report Form 5500 forthe (enter name of plan).This return/report is identified in item 1b by thenine-digit EIN – (enter EmployerIdentification Number) and in item 5c by thethree-digit PN (enter plan number).

SignedDated

Any comments concerning this explanationshould include the name, EIN, and PN of theplan and be submitted directly to:

Office of EnforcementPension and Welfare Benefits

AdministrationU. S. Department of Labor200 Constitution Avenue, NWWashington, DC 20210

Notice To TerminatedAccountant or Enrolled Actuary

Page 15 of 24 of Instructions for Form 5500 5

Page 15

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

An explanation of the reasons for thetermination of an accountant or enrolledactuary (terminated party) must beprovided as part of the annual report (PartIII of Schedule C). The plan administratorof the employee benefit plan is alsorequired to provide the terminated partywith a copy of this explanation and anotification that the terminated party hasthe opportunity to comment directly to theDepartment of Labor concerning anyaspect of this explanation.

25g. A Schedule C (Form 5500) must beattached if item 25a, 25b, and/or 25c arechecked “Yes.” More than one Schedule Cmay be required if additional space isrequired to complete any part of theSchedule C. If no Schedule(s) C is requiredto be attached, enter “0”.

26. Employee benefit plans filing theAnnual Return/Report Form 5500 aregenerally required to engage anindependent qualified public accountantpursuant to ERISA section 103(a)(3)(A). Anindependent qualified public accountant’sopinion must be attached to Form 5500unless: (a) the plan is an employee welfarebenefit plan which is unfunded, fullyinsured, or a combination of unfunded andinsured, as described in 29 CFR2520.104-44(b)(1); (b) the plan is anemployee pension benefit plan whose soleasset(s) consists of insurance contractswhich provide that, upon receipt of thepremium payment, the insurance carrierfully guarantees the amount of benefitpayments attributable to plan participantsfor that plan year as specified in 29 CFR2520.104-44(b)(2); (c) the plan has electedto defer attaching the accountant’s opinionfor the first of 2 plan years, one of which isa short plan year of 7 months or less asallowed by 29 CFR 2520.104-50; or(d) the plan meets the requirements of theDOL Technical Release 92-01. (Also seethe instructions for item 26a below.)

Welfare benefit plans sponsored by oneemployer (or by a controlled group ofemployers) that use a Code section501(c)(9) trust are generally not exemptfrom the requirement of engaging anindependent qualified public accountant.

26a. Plans meeting (a), (b), or (d) aboveshould check “Yes” for item 26a and skipto item 28. Plans meeting (c) must attachthe required explanation and statements inlieu of the opinion and should check “No”to item 26a and “Other” to item 26b, andspecify, in the space provided, that “theopinion is to be attached to the next Form5500 pursuant to 29 CFR 2520.104-50.” Allother plans, including those checking item26b(2), should check “No.” “N/A” is NOTan acceptable response to this item. If therequired accountant’s opinion is notattached to the Form 5500, the filing issubject to rejection as incomplete andpenalties may be imposed (see page 1).

26b and c. 29 CFR 2520.103-1(b)requires that any separate financialstatements prepared in order for theindependent qualified public accountant toform the opinion and notes to financialstatements (or items 31 and 32 ifapplicable) must be attached to the annualreturn/report Form 5500. Any separate

statements must include the informationrequired to be disclosed in items 31 and32 of the Form 5500; however, they maybe aggregated into categories in a mannerother than that used on Form 5500. Theseparate statements should be eithertypewritten or printed and consist ofreproductions of items 31 and 32 orstatements incorporating by referenceitems 31 and 32. See 29 CFR2520.103-1(b).

26b(1). Generally, an unqualified opinionis issued when the auditor concludes thatthe plan’s financial statements presentfairly, in all material respects, the financialstatus of the plan as of the end of theperiod audited, and the changes in itsfinancial status for the period under auditare in conformity with generally acceptedaccounting principles. Check this box if theplan received an unqualified opinion.

26b(2). Department of Labor Regulations29 CFR 2520.103-8 and 2520.103-12(d)generally state that the examination andreport of an independent qualified publicaccountant need not extend to: (a)information prepared and certified to by abank or similar institution or by aninsurance carrier that is regulated andsupervised and subject to periodicexamination by a state or Federal agency,or (b) information concerning a 103-12 IEthat is reported directly to the Departmentof Labor. Check this box if the planreceived an accountant’s opinion asdiscussed in 26b(1) above except for theinformation not audited pursuant to theabove regulations. These regulations donot exempt the plan administrator fromattaching the accountant’s report.

26b(3). Generally, a qualified opinion isissued by an independent qualified publicaccountant when the plan’s financialstatements present fairly, in all materialrespects, the financial position of the planas of the end of the audit period and theresults of its operations for the audit periodare in conformity with generally acceptedaccounting principles except for the effectsof one or more matters that are describedin the opinion. A disclaimer of opinion isissued when the independent qualifiedpublic accountant does not express anopinion on the financial statementsbecause he or she has not performed anaudit sufficient in scope to enable him orher to form an opinion of the financialstatements. Check this box if the planreceived a qualified opinion or if adisclaimer of opinion was issued. If theaudit was of limited scope pursuant to 29CFR 2520.103-8 and/or 2520.103-12(d),and no other limitations as to scope orprocedures were in effect, then check thebox in item 26b(2).

26b(4). Generally, an adverse opinion isissued by an independent qualified publicaccountant when the plan’s financialstatements do not present fairly, in allmaterial respects, the financial position ofthe plan as of the end of the audit periodand the results of its operations for theaudit period in conformity with generallyaccepted accounting principles. Check thisbox if the plan received an adverseaccountant’s opinion.

26b(5). Generally, an independentqualified public accountant’s opinion willbe described by one of the categories in26b(1) through (4). Check this box if theaccountant’s opinion received by the planis not described by one of the categoriesin 26b(1) through (4). Explain the nature ofthe opinion in the space next to this box. Ifthe explanation requires more space, enter“See attached” and on a separate sheet ofpaper explain in detail the nature of theaccountant’s opinion. Any attachmentsshould identify the item number andinclude the plan’s name, EIN, and PN.

26c and 26d. These items must beanswered by all plans required to engagean independent qualified public accountant(item 26a is “No”). The disclosure of thetransactions and financial conditions listedin 26c are some of the disclosures requiredto be made when a plan’s financialstatements are presented in accordancewith generally accepted accountingprinciples. (Usually these disclosures arecontained in the notes to the financialstatements.) If you are unsure if thedisclosures presented in or accompanyingthe plan’s financial statements fall withinone of the disclosures described in 26c,you should consult with the plan’sindependent qualified public accountant.

Check 26c “Yes” and provide theamount involved in 26d if the financialstatements or the notes to the statementscontain any of the disclosures listed in 26c.The amount should be determined byadding the amounts of all of the applicabledisclosures. For example, if two significanttransactions are disclosed between theplan and the sponsor, the amounts, if any,disclosed in the notes should be addedtogether and the total reported.

If you confirm, through consultation withthe accountant, if necessary, that theaccountant’s report, including anyapplicable financial statements or notes,does not contain any of the disclosuresnoted in item 26c, check item 26c “No”and enter “0” in item 26d.

27. Plans with assets held in acommon/collective trust, pooled separateaccount, master trust and/or 103-12 IE(see pages 4 and 5 for definitions andother information) should complete items27a, b, c, and d to report these entities,but not the investments made by theseentities.Exception: Plans with all of their fundsheld in a master trust should not completesub-items 27a through 27f (or attach theSchedule G (Form 5500)).

“Cost” or “Cost of Asset” for the item27a, 27d, 27e, and 27f schedules, refers tothe original or acquisition cost of the asset.

“Current value” means fair market valuewhere available. Otherwise, it means thefair value as determined in good faithunder the terms of the plan by a trustee ora named fiduciary, assuming an orderlyliquidation at time of the determination.

If “Yes” is checked for item(s) 27a, b, c,d, e, and/or f, schedules must becompleted and attached to the Form 5500.If the Schedule G (Form 5500) is notproperly completed and attached, or the

Page 16 of 24 of Instructions for Form 5500 5

Page 16

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

required schedule is not clearly labeledand attached to the Form 5500, the filing issubject to rejection as incomplete andpenalties may be imposed (see page 1).Any attachments must identify the itemnumber and include the plan’s name, EIN,and PN.

27a–27d. If the assets or investmentinterests of two or more plans aremaintained in one trust (except investmentarrangements reported in 31c(11) through31c(15) (see page 20)), all entries in theschedules included under items 27a, 27b,and 27c that relate to the trust shall be

completed by including the plan’s allocableportion of the trust. For purposes of item27d, the plan’s allocable portion of thetransactions of the trust shall be combinedwith the other transactions of the plan, ifany, to determine which transactions (orseries of transactions) are reportable. Donot include individual transactions ofinvestment arrangements reported in31c(11) through 31c(15).

For purposes of this form,party-in-interest is deemed to include adisqualified person—see Code section

4975(e)(2). The term “party-in-interest”means, as to an employee benefit plan—

A. Any fiduciary (including, but notlimited to, any administrator, officer,trustee or custodian), counsel, or employeeof the plan;

B. A person providing services to theplan;

C. An employer, any of whoseemployees are covered by the plan;

D. An employee organization, any ofwhose members are covered by the plan;

(Continued on page 18)

27a. Check “Yes” and attach one or both of the following two schedules to the Form 5500 if the plan had any assets held forinvestment purposes at any time during the plan year. Assets held for investment purposes shall include:

1. Any investment asset held by the plan on the last day of the plan year; and2. Any investment asset purchased during the plan year and sold before the end of the plan year except:a. Debt obligations of the United States or any U.S. agency.b. Interests issued by a company registered under the Investment Company Act of 1940 (e.g., a mutual fund).c. Bank certificates of deposit with a maturity of one year or less.d. Commercial paper with a maturity of 9 months, or less, if it is valued in the highest rating category by at least two nationally

recognized statistical rating services and is issued by a company required to file reports with the Securities and Exchange Commissionunder section 13 of the Securities Exchange Act of 1934.

e. Participations in a bank common or collective trust.f. Participations in an insurance company pooled separate account.g. Securities purchased from a broker-dealer registered under the Securities Exchange Act of 1934 and either:(1) listed on a national securities exchange and registered under section 6 of the Securities Exchange Act of 1934, or (2) quoted on

NASDAQ. Assets held for investment purposes shall not include any investment which was not held by the plan on the last day of theplan year if that investment is reported in the annual report for that plan year in any of the following:

(a) The schedule of loans or fixed income obligations in default required by item 27b;(b) The schedule of leases in default or classified as uncollectible required by item 27c;(c) The schedule of reportable transactions required by item 27d; and(d) The schedule of party-in-interest transactions required by items 27e and 27f.The first schedule required to be attached to the Form 5500 is a schedule of all assets held for investment purposes at the end of the

plan year, aggregated and identified by issue, maturity date, rate of interest, collateral, par or maturity value, cost and current value,and, in the case of a loan, the payment schedule. The schedule must use the following or a similar format and the same size paper asthe Form 5500.

Note: In column (a), place an asterisk (*) on the line of each identified person known to be a party-in-interest to the plan. In column (c),include any restriction on transferability of corporate securities. (Include lending of securities permitted under Prohibited TransactionsExemption 81-6.)The following schedule must be clearly labeled “Item 27a — Schedule of Assets Held for Investment Purposes.”

(e) Currentvalue

(c) Description of investment including maturity date,rate of interest, collateral, par or maturity value

(d) Cost(b) Identity of issue, borrower, lessor, or similar party(a)

The second schedule required to be attached to the Form 5500 is a schedule of investment assets which were both acquired and disposed ofwithin the plan year (see 29 CFR 2520.103-11). The schedule should use the following or a similar format and the same size paper as the Form5500. The following schedule must be clearly labeled “Item 27a – Schedule of Assets Held for Investment Purposes.”

(d) Proceeds ofdispositions

(c) Costs ofacquisitions

(b) Description of investment including maturity date,rate of interest, collateral, par or maturity value(a) Identity of issue, borrower, lessor, or similar party

Note: Participant loans under an individual account plan with investment experience segregated for each account, that are made inaccordance with 29 CFR 2550.408b-1 and that are secured solely by a portion of the participant’s vested accrued benefit, may beaggregated for reporting purposes in item 27a. Under identity of borrower enter “Participant loans,” under rate of interest enter thelowest rate and the highest rate charged during the plan year (e.g., 8%-10%), under the cost and proceeds columns enter “-0-”, andunder current value enter the total amount of these loans.

27b. Check “Yes” and attach the following schedule to the Form 5500 if the plan had any loans or fixed income obligations in defaultor determined to be uncollectible as of the end of the plan year. Include obligations where the required payments have not been madeby the due date. With respect to notes and loans, the due date, payment amount, and conditions for default are usually contained inthe note or loan documents. Defaults can occur at any time for those obligations that require periodic repayment. Generally, loans and

Page 17 of 24 of Instructions for Form 5500 5

Page 17

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

fixed income obligations are considered uncollectible when payment has not been made and there is little probability that payment willbe made. A loan by the plan is in default when the borrower is unable to pay the obligation upon maturity. A fixed income obligationhas a fixed maturity date at a specified interest rate. List any loans by the plan that are in default and any fixed income obligations thathave matured, but have not been paid, for which it has been determined that payment will not be made. The schedule should use thefollowing or similar format and the same size paper as the Form 5500. The following schedule must be clearly labeled “Item 27b —Schedule of Loans or Fixed Income Obligations.”

Note: In column (a), place an asterisk (*) on the line of each identified person known to be a party-in-interest to the plan. Include allloans that were renegotiated during the plan year. Also, explain what steps have been taken or will be taken to collect overdue amountsfor each loan listed.

(g) Detailed description of loanincluding dates of making and

maturity, interest rate, the type andvalue of collateral, any renegotiation

of the loan and the terms of therenegotiation, and other material items

Amount received duringreporting year Amount overdue(f) Unpaid

balance atend of year

(c) Originalamountof loan

(b) Identity andaddress of obligor(a)

(i) Interest(h) Principal(e) Interest(d) Principal

27c. Check “Yes,” and attach to Form 5500 the following schedule if the plan had any leases in default or classified as uncollectible.The schedule should use the following or a similar format and the same size paper as Form 5500. The following schedule must beclearly labeled “Item 27c — Schedule of Leases in Default or Classified as Uncollectible.”

A lease is an agreement conveying the right to use property, plant, or equipment for a stated period. A lease is in default when therequired payment(s) has not been made. An uncollectible lease is one where the required payments have not been made and for whichthere is little probability that payment will be made. Also, explain what steps have been taken or will be taken to collect overdueamounts for each lease listed.

(d) Terms and description (typeof property, location and date itwas purchased, terms regardingrent, taxes, insurance, repairs,

expenses, renewal options, dateproperty was leased)

(h)Expenses

paidduring theplan year

(g) Grossrental

receiptsduring theplan year

(c) Relationship toplan, employer,

employeeorganization, or other

party-in-interest

(f) Currentvalue attime oflease

(e) Originalcost

(j) Amount inarrears

(i) Netreceipts

(b) Identity oflessor/lessee(a)

27d. Check “Yes” and attach to the Form 5500 the following schedule if the plan had any reportable transactions (see 29 CFR2520.103-6 and the examples provided in the regulation). The schedule should use the following or a similar format and the same sizepaper as the Form 5500.

A reportable transaction includes:a. A single transaction within the plan year in excess of 5% of the current value of the plan assets;b. Any series of transactions with, or in conjunction with, the same person, involving property other than securities, which amount in

the aggregate within the plan year (regardless of the category of asset and the gain or loss on any transaction) to more than 5% of thecurrent value of plan assets;

c. Any transaction within the plan year involving securities of the same issue if within the plan year any series of transactions withrespect to such securities amount in the aggregate to more than 5% of the current value of the plan assets; and

d. Any transaction within the plan year with respect to securities with, or in conjunction with, a person if any prior or subsequentsingle transaction within the plan year with such person, with respect to securities, exceeds 5% of the current value of plan assets.

The 5% figure is determined by comparing the current value of the transaction at the transaction date with the current value of theplan assets at the beginning of the plan year.

If the assets of two or more plans are maintained in one trust, the plan’s allocable portion of the transactions of the trust shall becombined with the other transactions of the plan, if any, to determine which transactions (or series of transactions) are reportable (5%)transactions. This does not apply to investment arrangements whose current value is reported in items 31c(11) through 31c(15). Instead,for investments in common/collective trusts, pooled separate accounts, 103-12 IEs, and registered investment companies, determinethe 5% figure by comparing the transaction date value of the acquisition and/or disposition of units of participation or shares in theentity with the current value of the plan assets at the beginning of the plan year. Do not complete item 27d if all plan funds are held in amaster trust. Plans with assets in a master trust that have other transactions should determine the 5% figure by subtracting the currentvalue of plan assets held in the master trust from the current value of all plan assets at the beginning of the plan year. Do not includeindividual transactions of investment arrangements reported in items 31c(11) through 31c(15).

In the case of a purchase or sale of a security on the market, do not identify the person from whom purchased or to whom sold.The following schedule must be clearly labeled “Item 27d — Schedule of Reportable Transactions.”

(h) Currentvalue of asseton transaction

date

(f) Expenseincurred

with transaction

(b) Description of asset(include interest rate andmaturity in case of a loan)

(i) Net gainor (loss)

(g) Cost ofasset

(e) Leaserental

(d) Sellingprice

(c) Purchaseprice

(a) Identity ofparty involved

27e and f. Check “Yes” and attach the following schedule to the Form 5500 if the plan had any nonexempt transactions with aparty-in-interest.

For purposes of this form, party-in-interest is deemed to include a disqualified person (see Code section 4975(e)(2)). The term“party-in-interest” is defined on page 16. Nonexempt transactions with a party-in-interest include any direct or indirect:

Page 18 of 24 of Instructions for Form 5500 5

Page 18

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

a. Sale or exchange, or lease, of any property between the plan and a party-in-interest.b. Lending of money or other extension of credit between the plan and party-in-interest.c. Furnishing of goods, services, or facilities between the plan and a party-in-interest.d. Transfer to, or use by or for the benefit of, a party-in-interest, of any income or assets of the plan.e. Acquisition, on behalf of the plan, of any employer security or employer real property in violation of ERISA section 407(a).f. Dealing with the assets of the plan for a fiduciary’s own interest or own account.g. Acting in a fiduciary’s individual or any other capacity in any transaction involving the plan on behalf of a party (or represent a

party) whose interests are adverse to the interests of the plan or the interests of its participants or beneficiaries.h. Receipt of any consideration for his or her own personal account by a party-in-interest who is a fiduciary for any party dealing with

the plan in connection with a transaction involving the income or assets of the plan.Do not check “Yes” for item 27e or 27f, or list transactions that are statutorily exempt under Part 4 of Title I of ERISA, or

administratively exempt under ERISA section 408(a), or exempt under Code sections 4975(c) and 4975(d), or include transactions of a103-12 IE with parties other than the plan. You may indicate that an application for an administrative exemption is pending.

If you are unsure whether a transaction is exempt or not, you should consult with either the plan’s independent qualified publicaccountant or legal counsel or both.

Set out each transaction with the information set forth below in the following or similar format using the same size paper as the Form5500. The following schedules must be clearly labeled as appropriate “Item 27e — Schedule of Nonexempt Transactions” and/or“Item 27f — Schedule of Nonexempt Transactions.”

If a nonexempt prohibited transaction occurred with respect to a disqualified person, file Form 5330 with the IRS to pay the excisetax on the transaction.

(g) Expensesincurred inconnection

withtransaction

(c) Description oftransactions includingmaturity date, rate ofinterest, collateral, par

or maturity value

(b) Relationshipto plan, employer,or other party-in-

interest

(j) Net gain or(loss) on each

transaction

(i) Currentvalue of asset

(h) Cost ofasset

(f) Leaserental

(e) Sellingprice

(d) Purchaseprice

(a) Identity ofparty involved

(Continued from page 16)E. An owner, direct or indirect, of 50%

or more of—(1) the combined voting powerof all classes of stock entitled to vote, orthe total value of shares of all classes ofstock of a corporation, (2) the capitalinterest or the profits interest of apartnership, or (3) the beneficial interest ofa trust or unincorporated enterprise that isan employer or an employee organizationdescribed in C or D;

F. A relative of any individual describedin A, B, C, or E;

G. A corporation, partnership, or trust orestate of which (or in which) 50% or moreof: (1) the combined voting power of allclasses of stock entitled to vote or thetotal value of shares of all classes of stockof such corporation, (2) the capital interestor profits interest of such partnership, or(3) the beneficial interest of such trust orestate is owned directly or indirectly, orheld by, persons described in A, B, C, D,or E;

H. An employee, officer, director (or anindividual having powers or responsibilitiessimilar to those of officers or directors), ora 10% or more shareholder, directly orindirectly, of a person described in B, C,D, E, or G, or of the employee benefit plan;or

I. A 10% or more (directly or indirectly incapital or profits) partner or joint venturerof a person described in B, C, D, E, or G.

27g. Employer Security.—An employersecurity is any security issued by anemployer (including affiliates) of employeescovered by the plan. These may includecommon stocks, preferred stocks, bonds,zero coupon bonds, debentures,convertible debentures, notes, andcommercial paper. Generally, a publicly

traded security is a security that is boughtand sold on a recognized market (e.g.,NYSE, AMEX, over the counter, etc.) forwhich there is a pool of willing buyers andsellers. Securities which are listed on amarket but for which there does not exist apool of willing buyers and sellers are notpublicly traded.Qualifying Employer Security.—Anemployer security that is a stock or a“marketable obligation” is considered aqualifying employer security. For purposesof this definition, the term “marketableobligation” means a bond, debenture, note,certificate, or other evidence ofindebtedness (obligation) if:

1. Such obligation is acquired—a. On the market, either: (1) at the price

of the obligation prevailing on a nationalsecurities exchange that is registered withthe Securities and Exchange Commission,or (2) if the obligation is not traded on sucha national securities exchange, at a pricenot less favorable to the plan than theoffering price for the obligation asestablished by current bid and askedprices quoted by persons independent ofthe issuer;

b. From an underwriter, at a price:(1) not in excess of the public offeringprice for the obligation as set forth in aprospectus or offering circular filed withthe Securities and Exchange Commission,and (2) at which a substantial portion ofthe same issue is acquired by personsindependent of the issuer; or

c. Directly from the issuer, at a price notless favorable to the plan than the pricepaid currently for a substantial portion ofthe same issue by persons independent ofthe issuer;

2. Immediately following the acquisitionof such obligation—

a. Not more than 25% of the aggregateamount of obligations issued in such issueand outstanding at the time of acquisitionis held by the plan, and

b. At least 50% of the aggregate amountreferred to in subparagraph a is held bypersons independent of the issuer; and

3. Immediately following the acquisitionof the obligation, not more than 25% ofthe assets of the plan is invested inobligations of the employer or an affiliate ofthe employer.

For purposes of the qualifying employersecurity definition, the term “stock” mustmeet the following conditions:

1. No more than 25% of the aggregateamount of stock of the same class issuedand outstanding at the time of acquisitionis held by the plan, and

2. At least 50% of the aggregate amountof stock described in the precedingparagraph is held by persons independentof the issuer.

For exceptions to the above, see ERISAsection 407(f).

27h. Generally, as it relates to thisquestion, an appraisal by an unrelated thirdparty is an evaluation of the value of asecurity prepared by an individual or firmwho knows how to judge the value ofsecurities and does not have an ongoingrelationship with the plan or planfiduciaries except for preparing theappraisal. Nonpublicly traded securities aregenerally held by few people and nottraded on a stock exchange.

29a(1). Generally, every plan official ofan employee benefit plan who “handles”funds or other property of such plan must

Page 19 of 24 of Instructions for Form 5500 5

Page 19

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

be bonded. Generally, a person shall bedeemed to be handling funds or otherproperty of a plan, so as to requirebonding, whenever his or her duties oractivities with respect to given funds aresuch that there is a risk that such fundscould be lost in the event of fraud ordishonesty on the part of such person,acting either alone or in collusion withothers. Section 412 of ERISA andRegulations 29 CFR 2580 provide thebonding requirements, including thedefinition of “handling” (29 CFR2580.412-6), the permissible forms ofbonds (29 CFR 2580.412-10), the amountof the bond (29 CFR 2580, subpart C), andcertain exemptions such as the exemptionfor unfunded plans, certain banks andinsurance companies (ERISA section 412),and the exemption allowing plan officials topurchase bonds from surety companiesauthorized by the Secretary of the Treasuryas acceptable reinsurers on Federal bonds(29 CFR 2580.412-23).

Check “Yes” only if the plan itself (asopposed to the plan sponsor oradministrator) is a named insured under afidelity bond covering plan officials and ifthe plan is protected as described in 29CFR 2580.412-18.

Plans are permitted under certainconditions to purchase fiduciary liabilityinsurance. These policies do not protectthe plan from dishonest acts and are notbonds that should be reported in item 29.

29a(2). Indicate the aggregate amount ofcoverage available for all claims.

29b(1). Check “Yes” if the plan hassuffered or discovered any loss as theresult of a dishonest or fraudulent act(s).

29b(2). If item 29b(1) has been answered“Yes,” enter the full amount of the loss. Ifthe full amount of the loss has not yetbeen determined, provide and disclose thatthe figure is an estimate, such as“Approximately $1,000.”Note: Willful failure to report is a criminaloffense. See ERISA section 501.

30a. If you are uncertain whether theplan is covered under the PBGCtermination insurance program, check thebox “Not determined” and contact thePBGC and request a coveragedetermination. Welfare plans do notcomplete this item.

31 and 32. Use either the cash, modifiedaccrual, or accrual basis for recognition oftransactions in items 31 and 32, as long asyou use one method consistently.

Round off all amounts in items 31 and32 to the nearest dollar. Any otheramounts are subject to rejection. Check allsubtotals and totals carefully.Caution: Do not mark through the printedline descriptions and insert your owndescription as this may cause additionalcorrespondence due to a newcomputerized review of the Form 5500.

“Current value” means fair market value,where available. Otherwise, it means thefair value as determined in good faithunder the terms of the plan by a trustee ora named fiduciary, assuming an orderlyliquidation at the time of the determination.

If the assets of two or more plans aremaintained in one trust, such as when anemployer has two plans that are fundedthrough a single trust (except investmentarrangements reported in items 31c(11)through 31c(15)), complete items 31 and32 by entering the plan’s allocable part ofeach line item.

If assets of one plan are maintained intwo or more trust funds, report thecombined financial information in items 31and 32.

Unfunded, fully insured, andunfunded/insured welfare plans, and fullyinsured pension plans meeting theconditions of 29 CFR 2520.104-44, neednot complete items 31 and 32.

To determine if your welfare benefit planis unfunded, fully insured, orunfunded/insured, see Plans ExcludedFrom Filing on page 3. To determine ifyour pension plan is fully insured, seepage 6.

31. Use column (a) to enter the currentvalue of plan assets and liabilities as of thebeginning of the plan year. Use column (b)to enter the current value of plan assetsand liabilities as of the end of the planyear.

Amounts reported in column (a) must bethe same as reported for correspondingline items in column (b) of the return/reportfor the preceding plan year.Note: Do not include contributionsdesignated for the 1993 plan year incolumn (a).

31a. Total noninterest-bearing cashincludes, among other things, cash onhand or cash in a noninterest-bearingchecking account.

31b(1). Noncash basis filers shouldinclude contributions due the plan by theemployer but not yet paid. Do not includeother amounts due from the employer suchas the reimbursement of an expense or therepayment of a loan.

31b(2). Noncash basis filers shouldinclude contributions withheld by theemployer from participants and amountsdue directly from participants that have notyet been received by the plan. Do notinclude the repayment of participant loans.

31b(3). Noncash basis filers shouldinclude income from investment incomeearned but not yet received by the plan.

31b(4). Noncash basis filers shouldinclude amounts due to the plan that arenot includable in items 31b(1)–(3) above.These may include amounts due from theemployer or another plan for expensereimbursement or from a participant for therepayment of an overpayment of benefits.

31c(1). Include all assets that earninterest in a financial institution accountincluding interest bearing checkingaccounts, passbook savings accounts, etal., or in a money market fund.

31c(3). Include securities issued orguaranteed by the U.S. Government or itsdesignated agencies such as U.S. SavingsBonds, Treasury bonds, Treasury bills,FNMA, and GNMA.

31c(4). Include investment securitiesissued by a corporate entity at a statedinterest rate repayable on a particularfuture date such as most bonds,debentures, convertible debentures,commercial paper, and zero couponbonds. Do not include debt securities ofGovernmental units or municipalitiesreported under 31c(3) or 31c(17).

“Preferred” means any of the abovesecurities that are publicly traded on arecognized securities exchange and thesecurities have a rating of “A” or above. Ifthe securities are not “preferred” they arelisted as “Other.”

31c(5)(A). Include stock issued bycorporations that is accompanied bypreferential rights such as the right toshare in distributions of earnings at ahigher rate or has general priority over thecommon stock of the same entity. Includethe value of warrants convertible intopreferred stock.

31c(5)(B). Include any stock thatrepresents regular ownership of thecorporation and is not accompanied bypreferential rights plus the value ofwarrants convertible into common stock.

31c(6). Include the value of the plan’sparticipation in a partnership or jointventure if the underlying assets of thepartnership or joint venture are notconsidered to be plan assets under 29CFR 2510.3-101. Do not include the valueof a plan’s interest in a partnership or jointventure which is a 103-12 IE (see theinstructions for 31c(11) through 31c(15),below).

31c(7)(A). Include the current value ofreal property owned by the plan thatproduces income from rentals, etc. Thisproperty is not to be included in item 31e,buildings and other property used in planoperations.

31c(7)(B). Include the current value ofreal property owned by the plan that is notproducing income or used in planoperations.

31c(8)(A). Include the current value of allloans made by the plan to providemortgage financing to purchasers (otherthan plan participants) of residentialdwelling units, either by making orparticipating in loans directly or bypurchasing mortgage loans originated by athird party. (For participant loans, see31c(9)(A) and (B), below.)

31c(8)(B). Include the current value of allloans made by the plan to providemortgage financing to purchasers (otherthan participants) of commercial realestate, either by making or participating inthe loans directly or by purchasingmortgage loans originated by a third party.(For participant loans, see 31c(9)(A) and(B), below.)

31c(9)(A). Include the current value of allloans to participants that are made by theplan to provide mortgage financing toparticipants who were purchasers of realproperty, irrespective of whether themortgage was for residential, commercial,or farm property.

Page 20 of 24 of Instructions for Form 5500 5

Page 20

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

31c(9)(B). Include the balance of anyloans made to participants that were notreported in item 31c(9)(A).

31c(10). Include all loans made by theplan that are not to be reported elsewherein item 31 such as loans for construction,securities loans, and other miscellaneousloans.

31c(11) through 31c(15). In items31c(11) through 31c(15), enter the currentvalue of the plan’s interest at the beginningand end of the plan year. If some planfunds are held in these investmentarrangements, and other plan funds areheld in other funding media, complete allapplicable subitems of item 31 with regardto assets held in other funding media.

A plan investing in common/collectivetrusts or pooled separate accounts shouldattach to the return/report either thestatement of assets and liabilities of thecommon/collective trust or pooled separateaccount or the certification discussed onpage 4 of these instructions.

The value of the plan’s interest in amaster trust is the sum of the net values ofthe plan’s interest in master trustinvestment accounts. The net values ofsuch interests are obtained by multiplyingthe plan’s percentage interest in eachmaster trust investment account by the netassets of the investment account (totalassets minus total liabilities) at thebeginning and end of the plan year.

31c(16). You can use the same methodfor determining the value of the insurancecontracts reported in 31c(16) that you usedfor line 6e of Schedule A (Form 5500) aslong as the contract values are stated asof the beginning and end of the plan year.

31c(17). Other investments includeoptions, index futures, repurchaseagreements, and state and municipalsecurities among other things.

31d. See 27g on page 18 for thedefinition of employer security.

31e. Include the current (not book) valueof the buildings and other property used inthe operation of the plan. Buildings orother property held as plan investmentsshould be reported in item 31c(7)(A) or (B),or 31d(2).

Do not include the value of futurepension payments in items 31g, 31h, 31i,31j, or 31k.

31g. Noncash basis plans should includethe total amount of benefit claims thathave been processed and approved forpayment by the plan.

31h. Noncash basis plans should includethe total amount of obligations owed bythe plan that were incurred in the normaloperations of the plan and have beenapproved for payment by the plan but havenot been paid.

31i. Acquisition Indebtedness.—“Acquisition indebtedness,” fordebt-financed property other than realproperty, means the outstanding amount ofthe principal debt incurred:

1. By the organization in acquiring orimproving the property;

2. Before the acquisition or improvementof the property if the debt was incurredonly to acquire or improve the property; or

3. After the acquisition or improvementof the property if the debt was incurredonly to acquire or improve the propertyand was reasonably foreseeable at thetime of such acquisition or improvement.

For further explanation, see Codesection 514(c).

31j. Noncash basis plans should includeamounts owed for any liabilities that wouldnot be classified as benefit claims payable,operating payables, or acquisitionindebtedness.

31l. Column (b) must equal the sum ofcolumn (a) plus items 32i and 32j.

32a(1). Include the total cashcontributions received and/or (for accrualbasis plans) due to be received.

32a(1)(B). For welfare plans, report allemployee contributions, including allelective contributions under a cafeteriaplan (Code section 125). For pensionplans, participant contributions, forpurposes of this item, also include electivecontributions under a qualified cash ordeferred arrangement (Code section401(k)).

32a(2). Use the current value, at datecontributed, of securities or other noncashproperty.

32b(1)(A). Include the interest earned oninterest-bearing cash. This is derived frominvestments that are includable in 31c(1),including earnings from sweep accounts,STIF accounts, etc.

32b(1)(B). Include the interest earned oncertificates of deposit. This is the interestearned on the investments that arereported on line 31c(2).

32b(1)(C). Include the interest earned onU.S. Government securities. This is theinterest earned on the investments that arereported on line 31c(3).

32b(1)(D). Generally, this is the interestearned on securities that are reported onlines 31c(4)(A) and (B) and 31d(1).

32b(1)(E). Include the interest earned onthe investments that is reported on lines31c(8)(A) and (B) and 31c(9)(A).

32b(1)(F). Include the interest earned onthe investments that are reported on lines31c(9)(B) and 31c(10).

32b(1)(G). Include any interest notreported in 32b(1)(A)–(F).

32b(2)(A) and (B). Generally, thesedividends are from the investments thatare reported in items 31c(5)(A) and (B) and31d(1).

For accrual basis plans, include anydividends declared for stock held on thedate of record, but not yet received as ofthe end of the plan year.

32b(3). Generally, rents represent theincome earned on the real property that isreported in items 31c(7)(A) and 31d(2).Rents should be entered as a “Net” figure.Net rents are determined by taking thetotal rent received and subtracting allexpenses directly associated with theproperty. If the real property is jointly used

as income producing property and for theoperation of the plan, that portion of theexpenses attributable to the incomeproducing portion of the property shouldbe netted against the total rents received.

32b(4). Column (b), total of net gain(loss) on sale of assets, should reflect thesum of the net realized gain (or loss) oneach asset held at the beginning of theplan year which was sold or exchangedduring the plan year, and each asset thatwas both acquired and disposed of withinthe plan year.Note: As current value reporting is requiredfor the Form 5500, assets are revalued tocurrent value at the end of the plan year.For purposes of this form, the increase ordecrease in the value of assets since thebeginning of the plan year (if held on thefirst day of the plan year) or theiracquisition date (if purchased during theplan year) is reported in item 32b(5) below,with two exceptions: (1) the realized gain(or loss) on each asset which was disposedof during the plan year is reported in 32b(4)(NOT in 32b(5)), and (2) the net investmentgain (or loss) from certain investmentarrangements is reported in items 32b(6)through 32b(10).

The sum of the realized gain (or loss) ofall assets sold or exchanged during theplan year is to be calculated by—

a. Entering the sum of the amountreceived for these former assets in 32b(4),column (a), line (A),

b. Entering in 32b(4), column (a), line (B),the sum of the current value of theseformer assets as of the beginning of theplan year, for those assets on hand at thebeginning of the plan year, or the purchaseprice for those assets acquired during theplan year, and

c. Subtracting (B) from (A) and enteringthis result on line c in column (b).

A negative figure should be placed inparentheses.Note: Bond write-offs should be reportedas realized losses.

32b(5). Subtract the current value ofassets at the beginning of the year plusthe cost of any assets acquired during theplan year from the current value of assetsat the end of the year to obtain this figure.A negative figure should be placed inparentheses. Do not include the value ofassets reportable in items 32b(4) and32b(6) through 32b(10).

32b(6) through (10). Report all earnings,expenses, gains or losses, and unrealizedappreciation or depreciation that wereincluded in computing the net investmentgain (or loss) from these investmentarrangements here. If some plan funds areheld in any of these investmentarrangements and other plan funds areheld in other funding media, complete allapplicable subitems of item 32 to reportplan earnings and expenses relating to theother funding media.

The net investment gain (or loss)allocated to the plan for the plan year fromthe plan’s investment in these investmentarrangements is equal to:

Page 21 of 24 of Instructions for Form 5500 5

Page 21

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

a. The sum of the current value of theplan’s interest in each investmentarrangement at the end of the plan year,

b. Minus the current value of the plan’sinterest in each investment arrangement atthe beginning of the plan year,

c. Plus any amounts transferred out ofeach investment arrangement by the planduring the plan year, and

d. Minus any amounts transferred intoeach investment arrangement by the planduring the plan year.

Enter the net gain as a positive numberor the net loss in parentheses.

32c. Include any other plan incomeearned that is not included in 32a or 32b.Do not include transfers from other plansthat should be reported in item 32j.

32d. Add all amounts in column (b) andenter the total income.

32e. If distributions include securities orother property, use the current value atdate distributed for this item. See page 15for the definition of current value.

32e(1). Include the current value of allcash, securities, or other property at thedate of distribution.

32e(2). Include payments to insurancecompanies and similar organizations suchas Blue Cross, Blue Shield, and healthmaintenance organizations for theprovision of plan benefits (e.g., paid-upannuities, accident insurance, healthinsurance, vision care, dental coverage,stop-loss insurance whose claims are paidto the plan (or which is otherwise an assetof the plan)), etc.

32e(3). Include payments made to otherorganizations or individuals providingbenefits. Generally, these are individualproviders of welfare benefits such as legalservices, day care services, and trainingand apprenticeship services.

32f. Interest expense is a monetarycharge for the use of money borrowed bythe plan. This amount should include thetotal of interest paid or to be paid (foraccrual basis plans) during the plan year.

32g. Expenses incurred in the generaloperations of the plan are classified asadministrative expenses. Report alladministrative expenses (by specifiedcategory) paid by or charged to the plan,including those that were not subtractedfrom the gross income of

common/collective trusts, pooled separateaccounts, master trust investmentaccounts, and 103-12 IEs in determiningtheir net investment gain(s) or loss(es).

32g(1). Include all of the plan’sexpenditures such as salaries and thepayment of premiums to provide benefitsto plan employees (e.g., health insurance,life insurance, etc.).

32g(2). Include the total fees paid (or inthe case of accrual basis plans, costsincurred during the plan year but not paidas of the end of the plan year) by the planfor outside accounting services. These mayinclude the fee(s) for the annual audit ofthe plan by an independent qualified publicaccountant, for payroll audits, and foraccounting/bookkeeping services. Thesedo not include amounts paid to planemployees to perform accountingfunctions.

32g(3). Include the total fees paid (or inthe case of accrual basis plans, costsincurred during the plan year but not paidas of the end of the plan year) to anactuary for services rendered to the plan.

32g(4). Include the total fees paid (or inthe case of accrual basis plans, costsincurred during the plan year but not paidas of the end of the plan year) to acontract administrator for performingadministrative services for the plan. Forpurposes of the return/report, a contractadministrator is any individual, partnership,or corporation, responsible for managingthe clerical operations (e.g., handlingmembership rosters, claims payments,maintaining books and records) of the planon a contractual basis. Do not includesalaried staff or employees of the plan orbanks, or insurance carriers.

32g(5). Include the total fees paid (or inthe case of accrual basis plans, costsincurred during the plan year but not paidas of the end of the plan year) to anindividual, partnership, or corporation (orother person) for advice to the plan relatingto its investment portfolio. These mayinclude fees paid to manage the plan’sinvestments, fees for specific advice on aparticular investment, and fees for theevaluation of the plan’s investmentperformance.

32g(6). Include total fees paid (or in thecase of accrual basis plans, costs incurred

during the plan year but not paid as of theend of the plan year) to a lawyer forservices rendered to the plan. Include feespaid for rendering legal opinions, litigation,and advice but not for providing legalservices as a benefit to plan participants.

32g(7). Include the total fees paid (or inthe case of accrual basis plans, costsincurred during the plan year but not paidas of the end of the plan year) forvaluations or appraisals to determine thecost, quality, or value of an item. Thesemay include the fee(s) paid for appraisalsof real property (real estate, gemstones,coins, etc.), and a valuation of closely heldsecurities for which there is no readymarket.

32g(8). Include the total fees andexpenses paid to or on behalf of plantrustees (or in the case of accrual basisplans, costs incurred during the plan yearbut not paid as of the end of the planyear). These may include reimbursement ofexpenses associated with trustees such aslost time, seminars, travel, meetings, etc.

32g(9). Other expenses are those thatcannot be associated definitely with items32g(1) through 32g(8). All miscellaneousexpenses are also included in this figure.These may include expenses for officesupplies and equipment, cars, telephone,postage, rent, and expenses associatedwith the ownership of a building used inthe operation of the plan.

32h. Add column (b) of items 32e(4), 32f,and 32g(10).

32i. Subtract item 32h from item 32d.32j. Include in this reconciliation figure

any transfers of assets into or out of theplan resulting from mergers andconsolidations of plans or associated withbenefit liabilities that are also beingtransferred. A transfer is not a shifting ofassets or liabilities from one investmentmedium to another used for a single plan(e.g., between a trust and an annuitycontract). Transfers out should be shownin parentheses.

32k. Include the amount of net assets atthe beginning of the year. This amountmust equal item 31l, column (a).

32l. Include the amount of net assets atthe end of the year. This amount mustequal item 31l, column (b).

Page 22 of 24 of Instructions for Form 5500 5

Page 22

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Codes for Principal BusinessActivity and Principal Product or Service

These industry titles and definitions are based, in general, on the Enterprise StandardIndustrial Classification System authorized by the Regulatory and Statistical Analysis Division,Office of Information and Regulatory Affairs, Office of Management and Budget, to classifyenterprises by type of activity in which they are engaged.

AGRICULTURE, FORESTRY, AND FISHINGCode0120 Field crop.0150 Fruit, tree nut, and vegetable.0180 Horticultural specialty.0230 Livestock.0270 Animal specialty.

Agricultural services and forestry:0740 Veterinary services.0750 Animal services, except veterinary.0780 Landscape and horticultural services.0790 Other agricultural services.0800 Forestry.

Farms:

Fishing, hunting, and trapping:0930 Commercial fishing, hatcheries, and preserves.0970 Hunting, trapping, and game propagation.

MINING

Metal mining:1010 Iron ores.1070 Copper, lead and zinc, gold and silver ores.1098 Other metal mining.1150 Coal mining.

Oil and gas extraction:1330 Crude petroleum, natural gas, and natural

gas liquids.1380 Oil and gas field services.

Nonmetallic minerals (except fuels) mining:1430 Dimension, crushed and broken stone; sand

and gravel.1498 Other nonmetallic minerals, except fuels.

CONSTRUCTION

General building contractors and operativebuilders:1510 General building contractors.1531 Operative builders.

Heavy construction contractors:1611 Highway and street construction.1620 Heavy construction, except highway.

Special trade contractors:1711 Plumbing, heating, and air conditioning.1721 Painting, paperhanging, and decorating.1731 Electrical work.1740 Masonry, stonework, and plastering.1750 Carpentering and flooring.1761 Roofing and sheet metal work.1771 Concrete work.1781 Water well drilling.1790 Miscellaneous special trade contractors.

MANUFACTURING

Food and kindred products:2010 Meat products.2020 Dairy products.2030 Preserved fruits and vegetables.2040 Grain mill products.2050 Bakery products.2060 Sugar and confectionary products.2081 Malt liquors and malt.2088 Alcoholic beverages, except malt liquors and

malt.2089 Bottled soft drinks and flavorings.2096 Other food and kindred products.2100 Tobacco manufacturers.

Textile mill products:2228 Weaving mills and textile finishing.2250 Knitting mills.2298 Other textile mill products.

Apparel and other textile products:2315 Men’s and boys’ clothing.

2345 Women’s and children’s clothing.2388 Hats, caps, millinery, fur goods, and other

apparel and accessories.

Code

2390 Misc. fabricated textile products.

Lumber and wood products:2415 Logging camps and logging contractors,

sawmills, and planing mills.2430 Millwork, plywood, and related products.2498 Other wood products, including wood

buildings and mobile homes.2500 Furniture and fixtures.

Paper and allied products:2625 Pulp, paper, and board mills.2699 Other paper products.

Printing, publishing, and allied industries:2710 Newspapers.2720 Periodicals.2735 Books, greeting cards, and miscellaneous

publishing.2799 Commercial and other printing, and printing

trade services.

Chemical and allied products:2815 Industrial chemicals, plastics materials, and

synthetics.2830 Drugs.2840 Soap, cleaners, and toilet goods.2850 Paints and allied products.2898 Agricultural and other chemical products.

Petroleum refining and related industries(including those integrated with extraction):2910 Petroleum refining (including those

integrated with extraction).2998 Other petroleum and coal products.

Rubber and miscellaneous plastics products:3050 Rubber products, plastics footwear, hose,

and belting.3070 Misc. plastics products.

Leather and leather products:3140 Footwear, except rubber.3198 Other leather and leather products.

Stone, clay, glass, and concrete products:3225 Glass products.3240 Cement, hydraulic.3270 Concrete, gypsum, and plaster products.3298 Other nonmetallic mineral products.

Primary metal industries:3370 Ferrous metal industries; miscellaneous

primary metal products.3380 Nonferrous metal industries.

Fabricated metal products, exceptmachinery and transportation equipment:3410 Metal cans and shipping containers.3428 Cutlery, hand tools, and hardware; screw machine

products, bolts, and similar products.3430 Plumbing and heating, except electric and

warm air.3440 Fabricated structural metal products.3460 Metal forgings and stampings.3470 Coating, engraving, and allied services.3480 Ordnance and accessories, except vehicles

and guided missiles.3490 Miscellaneous fabricated metal products.

Machinery, except electrical:3520 Farm machinery.3530 Construction, mining and materials handling

machinery, and equipment.3540 Metalworking machinery.3550 Special industry machinery, except

metalworking machinery.3560 General industrial machinery.3570 Office, computing, and accounting machines.

3598 Engines and turbines, service industrymachinery, and other machinery, exceptelectrical.

Code

Electrical and electronic machinery,equipment, and supplies:

3630 Household appliances.3665 Radio, television, and communication

equipment.3670 Electronic components and accessories.3698 Other electric equipment.

Transportation equipment:3710 Motor vehicles and equipment.3725 Aircraft, guided missiles, and parts.3730 Ship and boat building and repairing.3798 Other transportation equipment.

Measuring and controlling instruments;photographic and medical goods, watchesand clocks:3815 Scientific instruments and measuring

devices; watches and clocks.3845 Optical, medical, and ophthalmic goods.3860 Photographic equipment and supplies.3998 Other manufacturing products.

TRANSPORTATION, COMMUNICATION,ELECTRIC, GAS, SANITARY SERVICES

Transportation:4000 Railroad transportation.

Local and interurban passenger transit:4121 Taxicabs.4189 Other passenger transportation.

Trucking and warehousing:4210 Trucking, local and long distance.4289 Public warehousing and trucking terminals.

Other transportation includingtransportation services:4400 Water transportation.4500 Transportation by air.4600 Pipelines, except natural gas.4722 Passenger transportation arrangement.4723 Freight transportation arrangement.4799 Other transportation services.

Communication:4825 Telephone, telegraph, and other

communication services.4830 Radio and television broadcasting.

Electric, gas, and sanitary services:4910 Electric services.4920 Gas production and distribution.4930 Combination utility services.4990 Water supply and other sanitary services.

WHOLESALE TRADE

Durable:5010 Motor vehicles and automotive equipment.5020 Furniture and home furnishings.5030 Lumber and construction materials.5040 Sporting, recreational, photographic, and

hobby goods, toys, and supplies.5050 Metals and minerals, except petroleum and

scrap.5060 Electrical goods.5070 Hardware, plumbing, and heating equipment.5083 Farm machinery and equipment.5089 Other machinery, equipment, and supplies.5098 Other durable goods.

Nondurable:5110 Paper and paper products.5129 Drugs, drug proprietaries, and druggists’

sundries.5130 Apparel, piece goods, and notions.5140 Groceries and related products, except

meats and meat products.5147 Meats and meat products.5150 Farm product raw materials.5160 Chemicals and allied products.5170 Petroleum and petroleum products.5180 Alcoholic beverages.5190 Miscellaneous nondurable goods.

Page 23 of 24 of Instructions for Form 5500 (Page 24 is blank) 5

Page 23

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

RETAIL TRADECodeBuilding materials hardware, gardensupply, and mobile home dealers:5211 Lumber and other building materials dealers.5231 Paint, glass, and wallpaper stores.5251 Hardware stores.5261 Retail nurseries and garden stores.5271 Mobile home dealers.

General merchandise:5331 Variety stores.5398 Other general merchandise stores.

Food stores:5411 Grocery stores.5420 Meat and fish markets and freezer

provisioners.5431 Fruit stores and vegetable markets.5441 Candy, nut, and confectionary stores.5451 Dairy products stores.5460 Retail bakeries.5490 Other food stores.

Automotive dealers and service stations:5511 New car dealers (franchised).5521 Used car dealers.5531 Auto and home supply stores.5541 Gasoline service stations.5551 Boat dealers.5561 Recreational vehicle dealers.5571 Motorcycle dealers.5599 Aircraft and other automotive dealers.

Apparel and accessory stores:5611 Men’s and boys’ clothing and furnishings.5621 Women’s ready-to-wear stores.5631 Women’s accessory and specialty stores.5641 Children’s and infants’ wear stores.5651 Family clothing stores.5661 Shoe stores.5681 Furriers and fur shops.5699 Other apparel and accessory stores.

Furniture, home furnishings, andequipment stores:5712 Furniture stores.5713 Floor covering stores.5714 Drapery, curtain, and upholstery stores.5719 Home furnishings, except appliances.5722 Household appliance stores.5732 Radio and television stores.5733 Music stores.

Eating and drinking places:5812 Eating places.5813 Drinking places.

Miscellaneous retail stores:5912 Drug stores and proprietary stores.5921 Liquor stores.5931 Used merchandise stores.5941 Sporting goods stores and bicycle shops.5942 Book stores.5943 Stationery stores.5944 Jewelry stores.5945 Hobby, toy, and game shops.5946 Camera and photographic supply stores.5947 Gift, novelty, and souvenir shops.5948 Luggage and leather goods stores.5949 Sewing, needlework, and piece goods stores.5961 Mail order houses.

5962 Merchandising machine operators.5963 Direct selling organizations.5982 Fuel and ice dealers (except fuel oil and

bottle gas dealers).5983 Fuel oil dealers.5984 Liquefied petroleum gas (bottled gas).5992 Florists.5993 Cigar stores and stands.5994 News dealers and newsstands.5996 Other miscellaneous retail stores.

FINANCE, INSURANCE, AND REALESTATE

Code

Banking:6030 Mutual savings banks.6060 Banking holding companies.6090 Banks, except mutual savings banks and

bank holding companies.

Credit agencies other than banks:6120 Savings and loan associations.6140 Personal credit institutions.6150 Business credit institutions.6199 Other credit agencies.

Security, commodity brokers, dealers,exchanges, and services:6212 Security underwriting syndicates.6218 Security brokers and dealers, except

underwriting syndicates.6299 Commodity contract brokers and dealers;

security and commodity exchanges; andallied services.

Insurance:6355 Life insurance.6356 Mutual insurance, except life or marine and

certain fire or flood insurance companies.6359 Other insurance companies.6411 Insurance agents, brokers, and services.

Real estate:6511 Real estate operators (except developers)

and lessors of buildings.6516 Lessors of mining, oil, and similar property.6518 Lessors of railroad property and other real

property.6531 Real estate agents, brokers, and managers.6541 Title abstract offices.6552 Subdividers and developers, except

cemeteries.6553 Cemetery subdividers and developers.6599 Other real estate.6611 Combined real estate, insurance, loans, and

law offices.

Holding and other investment companies:6742 Regulated investment companies.6743 Real estate investment trusts.6744 Small business investment companies.6749 Holding and other investment companies,

except bank holding companies.

SERVICES

Hotels and other lodging places:7012 Hotels.7013 Motels, motor hotels, and tourist courts.7021 Rooming and boarding houses.7032 Sporting and recreational camps.7033 Trailer parks and camp sites.7041 Organizational hotels and lodging houses

on a membership basis.

Personal services:7215 Coin-operated laundries and dry cleaning.7219 Other laundry, cleaning, and garment

services.7221 Photographic studios, portrait.7231 Beauty shops.7241 Barber shops.7251 Shoe repair and hat cleaning shops.7261 Funeral services and crematories.7299 Miscellaneous personal services.

Business services:7310 Advertising.7340 Services to buildings.7370 Computer and data processing services.7392 Management, consulting, and public

relations services.7394 Equipment rental and leasing.7398 Other business services.

Code

Automotive repair and services:7510 Automotive rentals and leasing, without

drivers.7520 Automobile parking.7531 Automobile top and body repair shops.7538 General automobile repair shops.7539 Other automobile repair shops.7540 Automobile services, except repair.

Miscellaneous repair services:7622 Radio and TV repair shops.7628 Electrical repair shops, except radio and TV.7641 Reupholstery and furniture repair.7680 Other miscellaneous repair shops.

7812 Motion picture production, distribution, andservices.

7830 Motion picture theaters.

Amusement and recreation services:7920 Producers, orchestras, and entertainers.7932 Billiard and pool establishments.7933 Bowling alleys.7980 Other amusement and recreation services.

Medical and health services:8011 Offices of physicians.8021 Offices of dentists.8031 Offices of osteopathic physicians.8041 Offices of chiropractors.8042 Offices of optometrists.8048 Registered and practical nurses.8050 Nursing and personal care facilities.8060 Hospitals.8071 Medical laboratories.8072 Dental laboratories.8098 Other medical and health services.

Other services:8111 Legal services.8200 Educational services.8911 Engineering and architectural services.8932 Certified public accountants.8933 Other accounting, auditing, and bookkeeping

services.8999 Other services not classified elsewhere.

TAX-EXEMPT ORGANIZATIONS9002 Church plans making an election under

section 410(d) of the Internal Revenue Code.9319 Other tax-exempt organizations.9904 Governmental instrumentality or agency.

Motion pictures:

Printed on recycled paper

Page 1 of 4 of Instructions for Schedule B (Form 5500) 3

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Cat. No. 13513I

Revised Proof Ok to PrintRtext sent (date) Requested (init. & date) (init. & date)

Department of LaborPension and Welfare

Benefits Administration

Department of the TreasuryInternal Revenue Service

Pension BenefitGuaranty Corporation

Instructions for Schedule B(Form 5500)Actuarial InformationCode references are to the Internal Revenue Code. ERISA refers to theEmployee Retirement Income Secur ity Act of 1974.

General InstructionsWho Must FileThe employer or plan administrator of adefined benefit plan that is subject tothe minimum funding standards (seeCode section 412 and Part 3 of Title I ofERISA) must file this schedule as anattachment to the return/report filed forthis plan year.Note: (1) For split-funded plans, thecosts and contr ibutions reported onSchedule B should include those relatingto both trust funds and insurancecarr iers. (2) For plans with fundingstandard account amortization chargesand credits see the instructions for lines9c and 9j regarding attachment.

Statement by Enrolled ActuaryAn enrolled actuary must sign ScheduleB. The signature of the enrolled actuarymay be qualified to state that it issubject to attached qualifications. SeeIncome Tax Regulations section301.6059-1(d) for permittedqualifications. A stamped or machineproduced signature is not acceptable. Inaddition, the actuary may offer any othercomments related to the informationcontained in Schedule B.

Specific Instructions(References are to line items on theform. )

4a. Only certain collectively bargainedplans may elect the shortfall fundingmethod (see regulations under Codesection 412). Advance approval from theIRS of the election of the shortfallmethod of funding is NOT required if it isfirst adopted for the first plan year towhich Code section 412 applies.However, advance approval from IRS isrequired if the shortfall funding methodis adopted at a later time, if a specificcomputation method is changed, or ifthe shortfall method is discontinued.

4b. Attach an explanation of the basisfor the determination that the plan is in

reorganization for this plan year. Also,attach a worksheet showing for this planyear (i) the amounts consideredcontributed by employers, (ii) anyamount waived the by IRS, (iii) thedevelopment of the minimumcontribution requirement (taking intoaccount the applicable overburdencredit, cash-flow amount, contributionbases and limitation on requiredincreases on the rate of employercontributions), and (iv) the resultingaccumulated funding deficiency, if any,which is to be reported on line 8e in lieuof an amount from line 9o.

5. Changes in funding methodsinclude changes in actuarial costmethod, changes in asset valuationmethod, and changes in the valuationdate of plan costs and liabilities or ofplan assets. Generally, these changesrequire IRS approval. If approval wasgranted by an individual ruling letter forthis plan, attach a copy of the letter. Ifapproval was granted pursuant to aregulation, class ruling, or revenueprocedure, attach a copy of the itemsrequired by the applicable regulation,ruling, or revenue procedure.

6a. The valuation for a plan year maybe as of any date in the year, includingthe first and last. Valuations must beperformed within the period specified byERISA section 103(d) and Code section412(c)(9).

6b. In computing current liability,certain service may be disregardedunder Code section 412(l)(7)(D), andERISA section 302(d)(7)(D). If the planhas participants to whom thoseprovisions apply, only a percentage ofthe years of service before suchindividual became a participant in theplan is taken into account, unless theemployer has elected otherwise.

6c. Enter the current value of totalassets as of the beginning of the planyear, as shown on Form 5500 or Form5500-C/R. Contributions designated for1993 should not be included in thisamount.

6d, 6e, and 6f. All plans regardless ofthe number of participants must providethe information indicated in accordancewith these instructions.

With the exception of the interest rate,each actuarial assumption used incalculating the current liability reportedin line 12 should reflect the bestestimate of the plan’s future experiencesolely with respect to that assumptionapplicable to the plan on an ongoing(rather than a terminating) basis. Theactuary must take into account rates ofearly retirement and the plan’s earlyretirement provisions as they relate tobenefits, where these would significantlyaffect the results. With the exception ofline 6e, no salary scale projectionsshould be used in computing thepresent values.

The interest rate used to compute thecurrent liability must be in accordancewith guidelines issued by the IRS.

The current liability must be computedin accordance with guidelines issued bythe IRS.

Omit from lines 6d, 6e, and 6fliabilities fully funded by annuity andinsurance contracts other than anycontract funds not allocated toindividuals.

6d. Enter the current liability as of thebeginning of the plan year. Do notinclude the liability attributable tobenefits accruing during the plan year.

Column (1)—If the valuation date isnot the beginning of the plan year, enterthe number of participants as of themost recent valuation date.

Column (2)—Include only the portionof the current liability attributable tovested benefits.

Column (3)—Include the currentliability attributable to all benefits, bothvested and nonvested.

6e. Enter the amount by which thecurrent liability is expected to increasedue to benefits accruing during the planyear. One year’s salary scale may bereflected. This amount is included in thefull funding limitation calculation.

Page 2 of 4 of Instructions for Schedule B (Form 5500) 3

Page 2

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

6f. Enter the amount of benefitpayments expected to be paid duringthe plan year.

6g(i). Check “Yes” if line 6c, thecurrent value of total assets as of thebeginning of the plan year, is less than70% of line 6d(iv), column (3), the totalcurrent liability as of the beginning of theplan year.

6g(ii). Enter the percentage if line 6cis less than 70% of line 6d(iv), column(3). Enter “N/A” on this line if thepercentage is 70% or more.

7. Show all employer and employeecontributions for the plan year, andemployer contributions made not laterthan 2 1⁄2 months (or the later dateallowed under Code section 412(c)(10)and ERISA section 302(c)(10)) after theend of the plan year. Show onlycontributions actually made to the planby the date Schedule B is signed.Certain employer contributions must bemade in quarterly installments, see Codesection 412(m).

Add the amounts in both columns (b)and (c) and enter the result on the totalline.

8a. If the attained age normal,aggregate, frozen initial liability, or othermethod that does not develop anaccrued liability is used, enter “N/A.”

8b. Enter the value of assetsdetermined in accordance with Codesection 412(c)(2) or ERISA section302(c)(2). Contributions designated for1993 should not be included in thisamount.

8d(ii). For the methods to be used todetermine the shortfall gain (loss), seethe regulations under Code section 412.

8e. Enter amount from line 9o.However, if the alternative method iselected and line 10h is smaller than line9o, enter the amount from line 10h.Multiemployer plans in reorganization,see instruction 4b. File Form 5330 withthe IRS to pay the 10% excise tax (5%in the case of a multiemployer plan) onthe funding deficiency.

9. Under the shortfall method offunding, the normal cost in the fundingstandard account is the charge per unitof production (or per unit of service)multiplied by the actual number of unitsof production (or units of service) whichoccurred during the plan year. Eachamortization installment in the fundingstandard account is similarly calculated.

9c and 9j. If there are anyamortization charges or credits, attachthe maintenance schedule of fundingstandard account base. The attachmentshould clearly indicate the type of base(i.e., original unfunded liability,amendments, actuarial losses, etc.), theoutstanding balance of each base, thenumber of years remaining in theamortization period, and the amortizationamount.

The outstanding balance may be as ofany day in this plan year.

9c(i). Amortization for waivers must bebased on the mandated interest rate.

9c(ii). If a credit described in 9l(ii) wasentered on the prior year’s Schedule B,establish a new base equal to theamount of the credit and amortize thebase over a 10-year period at thevaluation rate.

9e. Enter the required additionalfunding charge from line 13r (or 13q if13r does not apply). Enter “N/A” if line13 is not applicable.

For corporations described in section806(b) of the Steel Import StabilizationAct, enter the smaller of line 13r and thetransition charge provided under Actsection 9303(e) of OBRA 1987. Includean attachment outlining the calculationof the transition charge.

9f. Interest is charged for the entireperiod of underpayment. Refer to IRSNotice 89-52, 1989-1, C.B. 692, for adescription of how this amount iscalculated.Note: Notice 89-52 was issued pr ior tothe amendment of section 412(m)(1) bythe Revenue Reconciliation Act of 1989.Rather than using the rate in the Notice,the applicable interest rate for thispurpose is the greater of (1) 175% of theFederal mid-term rate at the beginningof the plan year or (2) the rate used todetermine the current liability. All otherdescr iptions of the additional interestcharge contained in Notice 89-52 stillapply.

9l(i). Enter the excess, if any, of theaccumulated funding deficiency,disregarding the credit balance, if any,over the full funding limitation (FFL)before reflecting the 150% currentliability component.

9l(ii). If the full funding limitation afterreflecting the 150% current liabilitycomponent is less than the full fundinglimitation before reflecting the 150%current liability component, enter theamount which, absent the 150% currentliability component, would have beenrequired.Note: The sum of lines 9l(i) and 9l(ii) isthe excess of the accumulated fundingdeficiency over the full funding limitation(i.e., the full funding credit under Codesection 412(c)(6)).

9l(iii). Enter a credit for a waivedfunding deficiency for the current planyear (Code section 412(b)(3)(C)). If awaiver of a funding deficiency ispending, do not report it as a credit butas a funding deficiency. If the waiver isgranted, file an amended Schedule B(Form 5500) to report it.

9p. The reconciliation account iscomprised of those components thatupset the balance equation of IncomeTax Regulations section 1.412(c)(3)-1(b).Valuation assets should not be adjustedby the reconciliation account balance

when computing the required minimumfunding.

9p(i). The accumulation of additionalfunding charges for prior plan yearsmust be included. Enter the sum of line9p(i) (increased by 1 year’s interest atthe valuation rate) and line 9e, both fromthe prior year’s Schedule B (Form 5500).Example. Enter the 1991 additionalcharge with 1 year’s interest plus the1992 additional funding charge.

9p(ii). The accumulation of additionalinterest charges due to late or unpaidquarterly installments for prior plan yearsmust be included. Enter the sum of line9p(ii) (increased with 1 year’s interest atthe valuation rate) and line 9f, both fromthe prior year’s Schedule B (Form 5500).Example. For 1993, enter the 1991additional interest charges with 1 year’sinterest at the valuation rate, plus the1992 additional interest charges.

9p(iii)(a). If a waived fundingdeficiency is being amortized at aninterest rate that differs from thevaluation rate, enter the prior year’s“reconciliation waiver outstandingbalance” increased with 1 year’s interestat the valuation rate and decreased withthe year end amortization amount basedon the mandated interest rate.

This amount must be as of the samedate entered in line 9(c)(i).

9p(iv). Enter the sum of lines (i), (ii),and (iii)(b) (each adjusted with interest atthe valuation rate, if necessary).Note: The net outstanding balance ofamortization charges and credits minusthe pr ior year’s credit balance minus theamount on line 9p(iv) (each adjusted withinterest at the valuation rate, ifnecessary) must equal the unfundedliability.

10a. If the entry age normal costmethod was not used to determine theentries on line 9, the alternativeminimum funding standard account maynot be used.

10d. The value of accrued benefitsshould exclude benefits accrued for thecurrent plan year. The market value ofassets should be reduced by the amountof any contributions for the current planyear.

11. Enter only the primary methodused. If the plan uses one actuarial costmethod in 1 year as the basis ofestablishing an accrued liability for useunder the frozen initial liability method insubsequent years, answer as if thefrozen initial liability method were usedin all years.

For a modified individual levelpremium method for which actuarialgains and losses are spread as a part offuture normal cost, check the box for11g and describe the cost method. Forthe shortfall funding method, check theappropriate box for the underlying

Page 3 of 4 of Instructions for Schedule B (Form 5500) 3

Page 3

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

actuarial cost method used to determinethe annual computation charge.

12. If gender-based statistics are usedin developing plan costs, enter thoserates where appropriate in line 12. Notethat requests for gender-based costinformation do not suggest thatgender-based benefits are legal.Complete all blanks. Enter “N/A” if notapplicable.

If unisex tables are used, enter thevalues in both the “Male” and “Female”columns.

Attach a statement of actuarialassumptions (if not fully described byline 12), and actuarial methods used tocalculate: (i) the figures shown in lines 8,9, and 10 (if not fully described by line11), and (ii) the value of assets shown online 8b. Also attach a summary of theprincipal eligibility and benefit provisionson which the valuation was based, anidentification of benefits not included inthe valuation, a description of anysignificant events that occurred duringthe year, a summary of any changes inprincipal eligibility or benefit provisionssince the last valuation, a description (orreasonably representative sample) ofplan early retirement factors, and anychange in actuarial assumptions or costmethods and justifications for any suchchange. Also, include any otherinformation needed to fully and fairlydisclose the actuarial position of theplan.Note: See the 1993 Instructions forForm 5500 or 5500-C/R (item 15a ofForm 5500, item 15a of Form 5500-C,or item 12a of Form 5500-R), for asuggested format and instructions toprovide the information on thedistr ibution of active employees by ageand service groupings with averagecompensation data.

12a. Check “Yes,” if the rates in thecontract were used (e.g., purchase ratesat retirement).

12b. Enter the mortality table code asfollows:

Table Code

1937 Standard Annuity 1a-1949 Table 2Progressive Annuity Table 31951 Group Annuity 41971 Group Annuity Mortality 51971 Individual Annuity Mortality 6UP-1984 71983 I.A.M 81983 G.A.M 9Other 10None 11

Where an indicated table consists ofseparate tables for males and females,add F to the female table (e.g., 4F).When a projection is used with a table,

follow the code with “P” and the year ofprojection (omit the year if the projectionis unrelated to a single calendar year);the identity of the projection scaleshould be omitted. When an agesetback or setforward is used, indicatewith “–” or “1” and the years. Forexample, if for females the 1951 GroupAnnuity Table with Projection C to 1971is used with a 5-year setback, enter“4P71-5.” If the table is not one of thoselisted, enter “10” with no furthernotation. If the valuation assumes amaturity value to provide thepost-retirement income withoutseparately identifying the mortality,interest and expense elements, under“post-retirement,” enter on line 12b thevalue of $1.00 of monthly pensionbeginning at the age shown on line 12d,assuming the normal form of annuity foran unmarried person; in this case enter“N/A” on lines 12c and 12e.

12c(i). Enter the interest rate used todetermine the current liability on line 6.The rate used must be in accordancewith the guidelines issued by the IRS.See Notice 90-11, 1990-1 C.B. 319.

12c(ii). Enter the assumption as to theexpected interest rate (investmentreturn) used to determine all othercalculated values with the exception ofcurrent liability and liabilities determinedunder the alternative minimum fundingstandard (line 10). If the assumed ratevaries with the year, enter the weightedaverage of the assumed rate for 20years following the valuation date.

12d. If each participant is assumed toretire at his/her normal retirement age,enter the age specified in the plan asnormal retirement age; do not enter“NRA.” Otherwise, enter the assumedretirement age. If the valuation usesrates of retirement at various ages, enterthe nearest whole age that is theweighted average retirement age. On anattachment to Schedule B, list the rateof retirement at each age and describethe methodology used to compute theweighted average retirement age,including a description of the weightapplied at each potential retirement age.

12e. If there is no expense loading,enter -0-. If there is a single expenseloading not separately identified aspre-retirement or post-retirement, enter itunder pre-retirement and enter “N/A”under post-retirement. Where expensesare assumed other than as a percent ofplan costs or liabilities, enter theassumed expense as a percent of thecalculated normal cost.

12f. Enter rates to the nearest 0.1%. Ifselect and ultimate rates that vary withboth age and years of service are used,enter the rates for a new participant atthe age shown and enter “S” before therate.

12g. Enter the salary ratio for the ageindicated to the nearest 1%.

12h. Enter the estimated rate of returnon the actuarial value of plan assets forthe 1-year period ending on thevaluation date. For this purpose, the rateof return is determined by using theformula 2I/(A 1 B – I), where I is thedollar amount of investment return underthe asset valuation method used for theplan, A is the actuarial value of theassets 1 year ago, and B is the actuarialvalue of the assets on the currentvaluation date.Note: If the actuary feels that the resultof using the formula above does notrepresent the true estimated rate ofreturn on the actuar ial value of planassets for the 1-year per iod ending onthe valuation date, line 12h should stillbe completed according to theinstructions above, and the actuary mayattach a statement to Schedule Bshowing both the actuary’s estimate ofthe rate of return and the actuary’scalculations of that rate.

13. Multiemployer plans or plans withNO unfunded current liability or planswith 100 or fewer participants shouldcheck this box and skip lines 13athrough 13r.

A plan has 100 or fewer participantsonly if there were 100 or fewerparticipants (both active participants andnonactive participants) on each day ofthe preceding plan year taking intoaccount participants in all definedbenefit plans maintained by the sameemployer who are also employees ofsuch employer.

13a. Enter the current liability as ofthe valuation date. If the valuation dateis the beginning of the plan year, thisamount is the same as line 6d(iv),column (3) “total benefits.” Otherwise,adjust the current liability by interest (atthe rate used to determine currentliability).

13b. Enter the actuarial value ofassets (reduced by the prior year’s creditbalance) as of the valuation date. If theprior year’s credit balance (line 9h) wasdetermined at a date other than thevaluation date, adjust the balance withthe appropriate interest adjustmentbefore subtracting. Do not make anyadjustment to reflect a prior year’sfunding deficiency.

13c. Enter the adjusted actuarial valueof assets expressed as a percentage ofcurrent liability. Round off to two decimalplaces (e.g., 28.72%).

13e. Enter the outstanding balance ofthe unfunded old liability as of thevaluation date.Note: In the case of a collectivelybargained plan, this amount must beincreased by the unamortized portion ofany “unfunded benefit increase liability”in accordance with Code section412(l)(3)( C).

13f. Enter the liability with respect toany unpredictable contingent event

Page 4 of 4 of Instructions for Schedule B (Form 5500) 3

Page 4

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

benefit that was included on line 13a,whether or not such event has occurred.

13g. This amount is the unfunded newliability. It will be recalculated each year.If the result is negative, enter -0-.

13h. If the unfunded new liability iszero, enter $0 for unfunded new liabilityamount. If the unfunded new liabilityamount is greater than zero, calculatethe amortization percentage as follows:

1. If the funded current liabilitypercentage (line 13c) is less than orequal to 35%, enter 30%.

2. If the funded current liabilitypercentage exceeds 35%, reduce 30%by the product of 25% and the amountof such excess; round off to two decimalplaces, and enter the resultingpercentage.

The unfunded new liability amount isequal to the above-calculatedpercentage of the unfunded new liability.

13i. Enter the amortization of theoutstanding balance of the unfunded oldliability as of the valuation date (line13e). In the case of a collectivelybargained plan, the unfunded old liabilityamount to be entered on line 13i mustinclude the amortization of any unfundedexisting benefit increase liabilitycalculated in accordance with Codesection 412(l)(3)(C)(ii). On a separateattachment show the breakdown of thevarious liabilities being amortized, theoutstanding balance of each liability, thenumber of years remaining in theamortization period, and the amortizationamount.

Any such amortization amount mustbe determined based on: (1) the currentliability interest rate in effect at thebeginning of the plan year, and (2) usethe valuation date as the due date of theamortization payment. The amortizationperiod must be the remainder of theoriginal 18-year period that applies whenthe amortization began.

Any such amortization amount mustbe redetermined each year based on theoutstanding balance (line 13e). If theplan becomes fully funded as a currentliability basis, the unfunded old liability

(including any arising from collectivelybargained plans) will be considered fullyamortized.

13j. Enter the sum of lines 13h and13i. This amount is the deficit reductioncontribution at the valuation date.

13k. When entering the netamortization amounts for certain basesinclude only charges (included on line9c) and credits (included on line 9j)attributable to original unfunded liability,amendments, funding waivers, chargesresulting from a “switchback” arisingfrom the utilization of the alternativeminimum, and “offsetable bases” asdescribed in Announcement 90-87,1990-30 I.R.B. 23, which were shown asan attachment to your 1989 Schedule B.

If a base resulted from combiningand/or offsetting pre-existing basesamong which were bases notdesignated in the preceding paragraph,then such resulting base may not beincluded in this line 13k.

Regardless of how the attachment(schedule of bases described in theinstructions for lines 9c and 9j) isprepared, enter the amount assumingthe payment was on the valuation date.

13l. Item l does not apply to theunpredictable contingent event benefits(and liabilities attributable thereto) forwhich the event occurred before the firstplan year beginning after December 31,1988.

13l(i). Enter the total of all benefitspaid during the plan year that were paidsolely because the unpredictablecontingent event occurred.

13l(ii). Enter 100% minus the fundedcurrent liability percentage (line 13c).

13l(iii). Enter 20% for plan yearsbeginning in 1993. (See Code section412(l)(5)(B).)

13l(v). Amortization should be basedon the current liability interest rate andassume beginning of year payments fora 7-year period.Note: Alternative calculation ofunpredictable contingent event amountis available for the first year ofamortization. Refer to Code section

412(l)(5)( D) for a descr iption. Ifalternative is used, include anattachment descr ibing the calculation.

13p. Enter the applicable amount ofinterest, based on the current liabilityinterest rate, to bring the additionalfunding charge (line 13o) to the end ofthe plan year.

13r. If the plan had 150 or moreparticipants on each day of thepreceding plan year, enter N/A. If theplan had less than 150 participants butmore than 100 participants on each dayof the preceding plan year, only anapplicable percentage of line 13q ischarged to the funding standardaccount. The same aggregation ruledescribed in the instructions for line 13applies.

The applicable percentage iscalculated as follows:

a. Determine the excess of thegreatest number of participants duringthe preceding plan year over 100.

b. The applicable percentage is 2% ofsuch excess.

This amount (or line 13q, if line 13r isN/A) will also be entered on line 9e.

14. Generally, if the actuary signs therequired certification statement on theactuarial report, but “materially qualifies”that statement, the certification isinvalid. However, Income TaxRegulations section 301.6059-1(d) listscertain qualifying statements that theactuary is allowed to make. Among themis a statement that in his or her opinion,the report fully reflects the requirementsof the statute, but does not conform tothe requirements of a regulation or rulingthat the actuary believes is contrary tothat statute (Income Tax Regulationssection 301.6059-1(d)(5)).

Check the “Yes” box on line 14 if thereport is being signed subject to thisqualification. If a funding deficiency or adisallowed contribution would haveresulted for this plan year had the reportconformed to the requirements of aregulation or ruling under the subjectstatute, the actuary must state that onan attachment to Schedule B.