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of 24 of Instructions for Form 5500 6

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

Cat. No. 13502B

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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., 46 min. 48 min.14 hr., 11 min.9 hr., 32 min.Form 5500 (initial filers)

82 hr., 16 min. 48 min.14 hr., 6 min.9 hr., 32 min.Form 5500 (all other filers)1 hr., 42 min.28 min.17 hr., 28 min. 16 min.Schedule A (Form 5500)3 hr., 28 min.2 hr., 47 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 simpler, we would be happy to hear from you. You can write toboth the Internal Revenue Service, Attention: Tax Forms Committee, 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 2Fringe benefit 3Welfare benefit 3

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

Directly With DOL 4What To File 5

Forms 5Lines 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 23, 24

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

Electronic Filing of Form 5500 1

Penalties 2

We ask for the information on this form to carry out the law as specified in ERISA andCode sections 6039D, 6047(e), 6057(b), and 6058(a). You are required to give us theinformation. We need it to determine whether the plan is operating according to the law.

Avoid Common Mistakes 1

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 for certain plans maintained under acollective bargaining agreement.

Section 1Plan YearFile 1994 forms for plan years that startedin 1994. 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. If

the plan administrator files thereturn/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 1994.

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, 1993-2 C.B. 513, for morespecific information.● Many filers receive rejection notices bymaking several common mistakes that canbe avoided as discussed in AvoidCommon Mistakes below. Thereturn/report will also be consideredincomplete and penalties may be assessed

if information required on a schedule is nottyped or printed on the appropriateschedule, such as the Schedule A (Form5500). See the instructions for Scheduleson page 6. An annual return/report mustbe filed for employee welfare benefit planswhich provide benefits wholly or partiallythrough a Multiple Employer WelfareArrangement (MEWA) as defined in ERISAsection 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.

Avoid Common MistakesFilers make several common mistakes. Toreduce the possibility of correspondenceand penalties, we remind filers to:● Enter only one code on line 4.● Attach the required accountant’sopinion. The instructions for line 26 explainwhich plans are not required to attach theopinion.


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● If you must complete lines 25, 27, and/or29:

1. You must check “Yes” or “No” on line25c.

2. You must attach and properly identifyany schedules required by the line 27instructions.

3. You must report the amount of anyloss to the plan caused by fraud ordishonesty on line 29b(2) if you checked“Yes” on line 29b(1).

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.

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 lastday 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 FileFile the return/report with the InternalRevenue Service Center indicated below.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 accounts established underCode section 403(b)(7) for regulatedinvestment company stock.

3. Individual retirement accounts (IRAs)established by an employer under Codesection 408(c).

4. Pension benefit plans 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) if contributions to theplan are deducted on its U.S. income tax


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return. For this type of plan, enter code Don line 6c. See Plans Excluded FromFiling below.

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

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

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

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

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 which are NOT unfundedinclude those plans that received employee(or former employee) contributions duringthe plan year and/or used a trust orseparately maintained fund (including aCode section 501(c)(9) trust) to hold planassets or act as a conduit for the transferof plan assets during 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) that 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 sucha 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) thatconforms 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).

10. A governmental plan.11. A welfare benefit plan that

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

12. 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 line 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 planthat 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.

File one return/report for the plan.Complete line 21 once for all of thegroup’s employees.

If the funds under the plan attributable toeach employer are available only to paybenefits to that employer’s employees,each employer in the group must file aseparate return/report as a single-employerplan.Note: If there are employers thatparticipate in a plan of one of the groupslisted above but those employers are notmembers of the group, the plan isconsidered a multiple-employer plan(other). See Multiple-Employer Plan(Other) on page 4 for more information.

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 elected


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before 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.

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 lines 1through 7a, 9, and 21. For the years youfile pages 1 and 2 as Form 5500-R,complete only lines 1 through 7a, 8a, and8b. Each participating employer filing theForm 5500-C/R must enter code F on line4 and use an appropriate number (001,002, etc.) on line 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 6

and 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 additionalinformation 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 notsuch 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 lines 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 employee


Page 5


benefit 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 iseither 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 lists the lines 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 benefit

plan, and fringe benefit plan (unlessotherwise exempted) with fewer than 100participants at the beginning of the planyear. Most one-participant plans do nothave to file the Form 5500-C/R. See Form5500-EZ below.Note: To determine whether to file Form5500 or Form 5500-C/R for an employeebenefit 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.

Other Forms● Use Form 945, Annual Return ofWithheld Federal Income Tax, to reportbackup withholding and withholding frompensions, annuities, and IRAs. SeeCircular E, Employer’s Tax Guide (Pub.15), for more information.● Use Form 1099-R, Distributions FromPensions, Annuities, Retirement orProfit-Sharing Plans, IRAs, InsuranceContracts, etc., to report payments anddistributions to plan beneficiaries. See theinstructions for Forms 1099, 1098, 5498,and W-2G for more information.● 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, whether

incorporated 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.Note: Some one-participant plans must filethe Form 5500-C/R. See the Form 5500-EZinstructions.

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

Lines 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.Fringe benefit plans.—For a Form 5500filed only for a fringe benefit plan that iseither a cafeteria plan described in section125 and/or an educational assistance plandescribed in Code section 127, completeonly lines 1 through 5, 6d (page 1 of Form5500), and Schedule F (Form 5500). DONOT file pages 3 through 6 of Form 5500or any other schedules.

If Form 5500 is filed for both a welfarebenefit plan and a fringe benefit plan,complete the above line items, allapplicable schedules, and the itemsspecified for Welfare benefit plans below.Welfare benefit plans.—Welfare benefitplans generally must complete thefollowing items on the Form 5500: Lines 1through 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 the

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)


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Form 5500 because it has 100 or moreparticipants, need not complete lines 31and 32.Note: If one Form 5500 is filed for both awelfare plan and a fringe benefit plan,check box 6d and complete Schedule F(Form 5500) in addition to the items listedabove for welfare benefit plans.Pension plans.—In general, most pensionplans (defined benefit and definedcontribution) are required to complete allline items on the form. However, some lineitems do not have to be completed bycertain types of pension plans, asdescribed below.1. Plans exclusively using a tax deferredannuity arrangement under Code section403(b)(1).—These plans (see Who MustFile on page 2) need only complete lines 1through 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 lines 1 through 5, 6b (enterpension code 9), and 9.3. 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 lines 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 must complete lines 1through 26, 29, 30, 32a, and 32e.

A pension plan including both insurancecontracts of the type described in 29 CFR2520.104-44 as well as other assetsshould limit its reporting in lines 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 complete lines 1 through 8c(enter code D in the box on line 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 line 6f. Only single-employerpension plans must complete line 6f.Multiemployer plans and multiple-employer-collectively bargained plans donot have to complete line 7h.

Schedules

Note: All schedules and attachments toForms 5500 and 5500-C/R must includethe name of the plan, the plan sponsor’sEIN, and plan number (PN) as found inlines 5a, 1b, and 5c, 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 investmentswith insurance companies such asguaranteed investment contracts (GICs).)Caution: Your return/report is subject torejection if you submit a privately designedand printed substitute Federal form thathas not been approved by the IRS.Exceptions. (1) Do not file Schedule A(Form 5500) 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) Do not file Schedule A (Form 5500)with the Form 5500 or Form 5500-C/R if aSchedule A (Form 5500) is filed for thecontract as part of the master trust or103-12 IE information filed directly withDOL.

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 line 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 line in27a through 27f. The Schedule G isoptional for 1994 (you may use the

schedules specified in the instructions forline 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 N5638200 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 the


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information 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 N5638200 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.

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 on lines 31a through 31lof Form 5500.

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 on line 32 of Form 5500. In placeof line 32a, show the total of all transfersof assets into the investment account byparticipating plans. In place of line 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 lines 27a through 27fon Form 5500, of the following items withrespect to each master trust investment

account for the fiscal year of the mastertrust ending with or within the plan year:assets held for investment, nonexemptparty-in-interest transactions, defaulted oruncollectible loans and leases, and 5%transactions involving assets in theinvestment account. The 5% figure shallbe determined by comparing the currentvalue of the transaction at the transactiondate with the current value of theinvestment account assets at thebeginning of the applicable fiscal year ofthe 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 N5638200 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 thanone 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 on line 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 line32 of Form 5500. In place of line 32a,show the total of all transfers of assets intothe 103-12 IE by participating plans. Inplace of line 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 line 27 of Form 5500(except line 27d) with respect to the

103-12 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 aredistributed 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 prior approval for a change inplan year. (See Code section 412(c)(5).)


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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 ordinarilyhave 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.

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 line 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 questions on theForm 5500 with respect to the plan year,unless otherwise explicitly stated in theline-by-line 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 Lines 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).Line A.—Check box (1) if this is the initialfiling for this plan. Do not check this box ifyou have ever filed for this plan even if itwas on a different form (Form 5500 vs.Form 5500-C or Form 5500-R).

Check box (2) if you have already filedfor the 1994 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.Line B.—Check box B if you reportinformation in 1a, 2a, 2b, or 5a that isdifferent from that reported on the lastreturn/report filed. Be certain to provide allinformation in lines 1 through 6d. Pleaseenter changes in red ink and/or circle theline numbers if the information has beenchanged since the last return/report.Line C.—Check this box if the plan yearhas been changed since the lastreturn/report was filed.Line D.—Check this box if you filed for anextension of time to file this form. Attach acopy of the approved Form 5558 or a copyof the employer’s extension of time to filethe income tax return if you are using theexception in the instructions for Extensionof Time To File on page 2.

Line-By-Line Instructions

Page 1

If a return/report was filed last year, aForm 5500 with information from thatreturn/report printed on page 1 shouldhave been mailed to the filer. Check anypreprinted information in lines 1 through 6dfor accuracy and completeness. Provideany additional information to completelyanswer the questions and cross out anyincorrect information. Enter thesecorrections on page 1. Please use red inkto enter this information and/or circle linenumbers. This will help us process theforms more efficiently and reduce our needto contact you. The return/report must becompleted in accordance with thefollowing specific instructions.Line 1a.—Enter the name and address ofthe plan sponsor. If the plan covers onlythe employees 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 on line 1a todescribe 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.Line 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 require an EIN.Line 1d.—From the list of business codeson pages 23 and 24, enter the one thatbest describes the nature of theemployer’s business. If more than oneemployer is involved, enter the businesscode for the main business activity.


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Line 1e.— Plans entering entity code A orB on line 4 must enter the first six digits ofthe CUSIP (Committee on UniformSecurities Identification Procedures)number, “issuer number,” if one has beenassigned to the plan sponsor for purposesof issuing corporate securities. CUSIPissuer numbers are assigned tocorporations and other entities that issuepublic securities listed on stock exchangesor traded over the counter. The CUSIPissuer number is the first six digits of thenumber assigned to the individualsecurities that are traded. If the plansponsor has no CUSIP issuer number,enter “N/A.”Line 2a.—If the document constituting theplan appoints or designates a planadministrator other than the sponsor, enterthe administrator’s name and address. Ifthe plan administrator is also the sponsor,enter “Same.” If filing as a group insurancearrangement, enter “Same.” If “Same” isentered on line 2a, leave lines 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.Line 2b.—A plan administrator must havean EIN for reporting purposes. Enter theplan administrator’s nine-digit EIN here. Ifthe plan administrator does not have anEIN, apply for one as explained in theinstructions for line 1b on page 8.

Employees of an employer are not planadministrators unless so designated in theplan document, even though they engagein administrative functions of the plan. If anemployee of the employer is designated asthe plan administrator, that employee mustget an EIN.Line 3.—If the plan sponsor’s/administrator’s name, address, and EINhave changed since the last return/reportwas filed for this plan, enter the plansponsor’s/administrator’s name, address,and EIN as it appeared on the lastreturn/report filed for this plan.Line 3c.—Indicate if the change on line 3ais only a change in sponsorship. “Changein sponsorship” 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.Line 4.—Entity Code.—From the followinglist of entities choose the one thatdescribes your entity and enter that codeon line 4.

Entity CodeSingle-employer plan APlan of controlled group of corporations

or common control employers B

Multiemployer plan CMultiple-employer-collectively

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

(of welfare plans) F

Line 5a.—Enter the formal name of theplan, group insurance arrangement, orenough information to identify the plan.This name should not exceed 70characters. If the present plan nameexceeds 70 characters and spaces, try toabbreviate it.Line 5b.—Enter the date the plan firstbecame effective.Line 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.Line 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 isfiled.Example. If your plan provides healthinsurance, life insurance, dental insurance,and eye examinations enter the codes A,B, D, and E. If your plan has a benefit notdescribed by one of the codes, enter “Z”and write in a description of this benefit inthe 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 GLong-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

Line 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 separate

account 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 (IRAs) or annuities(described in Code section 408) asthe sole funding vehicle forproviding benefits 0

Line 6c.—Pension Plan Feature Codes.—If the plan includes pension benefits, enterthe code(s) from the list of pension planfeature codes below.

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 LOne-participant plan M

● 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 organization


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whose 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$118,800, the defined benefit dollarlimitation for 1994 under Code section415(b)(1)(A),

2. One of the 10 employees havingannual compensation from the employergreater than $30,000, the definedcontribution dollar limitation for 1994 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), or

the 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.● Enter code M for a one-participant planfiling Form 5500 or Form 5500-C/R. Seethe instructions for Plans Excluded FromFiling on page 3 and Form 5500-EZ underOther Forms on page 5.Line 6d.—Fringe Benefit Plan.—Completeonly page 1 (lines 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 Lines ToComplete on Form 5500 for a fringebenefit plan.Line 6e.—Line 6e must be answered if theplan used any of these investmentarrangements at any time during the planyear. See pages 4 through 7 for definitions,additional information to attach to Form5500, and other information pertaining tomaster trusts, 103-12 investment entities,common/collective trusts and pooledseparate accounts. Also see theinstructions for lines 25 through 32 forspecific reporting requirements for planswhich utilize these entities.Line 6e(1).—In the space provided in line6e, enter the name of the trust andfinancial institution. Also enter the city andstate where the trust is maintained. (SeeMaster Trust on page 4 for moreinformation.)Line 6e(2).—In the space provided in line6e, enter the name and address of the103-12 IE. (See page 7 for 103-12 IEinstructions.)Line 6f.—For single-employer pensionplans, enter the date the employer’s taxyear ends. For example, if the tax year is acalendar year, enter 12-31-94. Do notcomplete line 6f for plans with more thanone employer.Lines 6g and 6h.—A defined benefit planis generally subject to the minimumfunding requirements under section 412unless it is a fully insured plan that isexempt from the minimum fundingrequirements under section 412(i). A plan isconsidered a 412(i) plan whether or not allor part of the plan is trusteed or anoninsured top-heavy side fund ismaintained. All such plans must checktheir 412(i) status on line 6g. Check box 6hif any part of the plan that was formerlysubject to the minimum fundingrequirements under section 412 for either

of the prior 2 plan years has becomeexempt under section 412(i).Note: All defined benefit plans subject tothe minimum funding requirements underSection 412 must complete line 15a andattach Schedule B (Form 5500). Alsocomplete line 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.Line 7.—The description of “participant” inthe instructions below is only for purposesof line 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 line.

“Participant” means any individual whois included in one of the categories below.Line 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.Line 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.Line 7c.—Inactive participants entitled tofuture benefits are individuals who areretired or separated from employmentcovered by the plan and who are entitledto begin receiving benefits under the planin the future. This category does notinclude any individual to whom aninsurance company has made anirrevocable commitment to pay all thebenefits to which the individual is entitledunder the plan.


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Line 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.Line 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.Line 7h.—Include any participant whoterminated employment during this planyear, whether or not the participantincurred a break in service. Multiemployerplans and multiple-employer-collectivelybargained plans do not have to completeline 7h.Line 7i(1).—If “Yes,” file Schedule SSA(Form 5500) as an attachment to Form5500. Plan administrators: Code section6057(e) provides that the planadministrator must give each participant astatement showing the same informationreported on Schedule SSA for thatparticipant.Line 8a.—Check “Yes” if an amendment tothe plan was adopted regardless of theeffective date of the amendment.Line 8b.—Enter the date the most recentamendment was adopted regardless of thedate of the amendment or the effectivedate of the amendment.Line 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 modelamendment provided in IRS Notice 88-131,1988-2 C.B. 546.Line 8d.—Check “Yes” only if anamendment changed the informationpreviously provided to participants by thesummary plan description or summarydescription of modifications.Line 8e.—A revised summary plandescription or summary description ofmodifications must be filed with the DOLand distributed to all participants andpension plan beneficiaries no later than210 days after the close of the plan year inwhich the amendment(s) was adopted. Ifthe material was distributed and filed sincethe amendments were adopted (even ifafter the end of the plan year), check “Yes”for question 8e.Line 9a.—Check “Yes” if the plan wasterminated and enter the year oftermination if applicable.Line 9b.—If the plan was terminated butall plan assets were not distributed, areturn/report must be filed for each yearthe plan has assets. In that case, the

return/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.”

Check “No” for a welfare benefit planthat is still liable to pay benefits for claimsthat were incurred prior to the terminationdate, but not yet paid. See 29 CFR2520.104b-2(g)(2)(ii).Line 9h.—The Code provides for anondeductible excise tax on a reversion ofassets from a qualified plan.Line 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.Line 10a.—If this plan was merged orconsolidated or spunoff into anotherplan(s), or plan assets or liabilities weretransferred to another plan(s), indicatewhich other plan or plans were involved.Line 10c.—Enter the EIN of the sponsor(employer, if for a single-employer plan) ofthe other plan.Line 10e.—Pension benefit plans must fileForm 5310-A, Notice of Plan Merger orConsolidation, Spinoff or Transfer of PlanAssets or Liabilities; Notice of QualifiedSeparate Lines of Business, at least 30days before any plan merger orconsolidation or any transfer of plan assetsor liabilities to another plan.Caution: There is a penalty for not filingForm 5310-A on time.Line 11.—Funding Arrangement.—Enterthe code for the funding arrangement usedby the 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 oflines 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 on line(s) 11 and/or 12must attach 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 line 26 on page 15.

Plan FundingArrangement CodesTrust 1Trust and insurance 2Insurance 3Exclusively from general assets

of sponsor (unfunded) 4Partially insured and partially

from general assets of sponsor 5Other 6

Line 12.—Benefit Arrangement.—Enterthe code for the benefit arrangement usedby the 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 the instructions for line 11above) the plan’s benefit arrangementcode would be “1.” If some benefits comefrom a trust and some come from aninsurance company, the code would be“2.” If all benefits were paid from anaccount or policy of an insurancecompany, the code would be “3.”

Plan BenefitArrangement CodesTrust 1Trust and insurance 2Insurance 3Exclusively from general assets

of sponsor (unfunded) 4Partially insured and partially

from general assets of sponsor 5Other 6

Line 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.Line 13b.—All plans that entered code Cor D on line 4 must enter the six-digit LMnumber to identify each sponsoring labororganization 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 on line 13b on the form, enter theadditional LM numbers on a supplementalsheet to accompany the Form 5500.Line 14.—If either the funding arrangementcode (line 11) and/or the benefitarrangement code (line 12) is 2, 3, or 5, atleast one Schedule A (Form 5500) must beattached to the Form 5500 filed forpension and welfare plans to provide


Page 12


information 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.”Line 15a.—If “Yes” is checked for line 15a,attach Schedule B (Form 5500) and theschedule shown above to the Form 5500instructions. This schedule, prepared bythe enrolled actuary who prepared theSchedule B, must show the distribution ofactive participants by age and servicegroupings with average compensationdata. The schedule must be labeled “Line15a—Schedule of Active ParticipantData.” Use the format shown above anduse the same size paper as the Form5500.

Expand this schedule by adding columnsafter the “5 to 9” column and before the“40 & up” column for active participantswith total years of credited service in thefollowing ranges: 10 to 14; 15 to 19; 20 to24; 25 to 29; 30 to 34; and 35 to 39. Foreach column, 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.Exception: Do not enter the averagecompensation in any grouping thatcontains fewer than 20 participants. For

example, 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.

If this plan is a multiple-employer plan(other), complete one or more schedules ofactive-participant data in a mannerconsistent with the computations for thefunding requirements reported on line 9 ofSchedule B (Form 5500). See the specificinstructions for Lines 9a through 9p ofSchedule B. For example, if the fundingrequirements are computed as if eachparticipating employer maintained aseparate plan, attach a separate schedulefor each participating employer in themultiple-employer plan (other).Line 15b.—If a waived funding deficiencyis being amortized in the current plan year,do not complete (1), (2), and (3), butcomplete lines 1, 2, 3, 7, and 9 ofSchedule B (Form 5500). An enrolledactuary does not have to sign Schedule Bunder these circumstances.Line 15b(3).—File Form 5330 with the IRSto pay the excise tax on any fundingdeficiency. Caution: There is a penalty fornot filing Form 5330 on time.Line 16.—The 1994 annual compensationlimit under Code section 401(a)(17) is$150,000. However, the 1994 annualcompensation limit for governmental plansand certain plans maintained under acollective bargaining agreement is$242,280.Line 17a(1).—Check “Yes” if the plandistributed any annuity contracts. Check“Yes” even if the plan was terminated.Line 17a(2).—If “Yes” was checked for line17a(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.”Line 17b.—In general, distributions mustbe made in the form of a qualified joint andsurvivor annuity for life or a qualified

preretirement 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).Line 17c.—Generally, within the 90 daysprior to the date of any benefit payment orthe date a loan was made to a participant,you must 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 ofcircumstances 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 did not have serviceunder the plan after August 22, 1984.Line 17d.—A plan may not eliminate asubsidized benefit or a retirement optionby plan amendment or plan termination.Line 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.”Line 19.—The maximum annual benefitthat may be provided under a definedbenefit plan may not exceed the smaller of$118,800 or 100% of average annualcompensation. However, if benefits beginbefore the social security retirement age,the $118,800 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).

Line 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


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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 1994since the law provides that it shall not bechanged until the section 415(b)(1)(A) limit($118,800 for 1994) 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.Line 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 todisapprove 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 to

include on the statement of election, whichmust be filed with the appropriate Form5500 or Form 5500-C/R.Line 21.—For plan years beginning on orafter January 1, 1994, certain employersmay complete item 21 based on areasonable, good-faith interpretation ofCode sections 410(b), 401(a)(4), and otherrelated Code sections, that differs from theregulations under such Code sections.Check the box in 21(i) if you are applying areasonable, good-faith interpretation thatdiffers from the regulations under suchCode sections. You may, but are notrequired to, attach an explanation of theareas in line item 21 for which you areapplying a reasonable, good-faithinterpretation.Note: Most employers cannot comply withthe nondiscrimination rules for the 1994plan year on the basis of a reasonable,good-faith interpretation of the statute. SeeRegulations sections 1.401(a)(4)-13 and1.410(b)-10 to identify the employers thatmay rely on a reasonable, good-faithinterpretation of the statute for the 1994plan year (generally limited to plans oftax-exempt organizations).

Revenue Procedure 93-42, 1993-2 C.B.540, provides guidelines designed toreduce the burdens of substantiatingcompliance with the nondiscriminationprovisions. Generally, Rev. Proc. 93-42sets forth new guidelines for: (1) the qualityof data used in substantiating compliancewith the nondiscrimination rules, (2) thetiming of nondiscrimination 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 line21.

Check the box in 21(ii) if you are relyingon the substantiation guidelines incompleting line 21. An employer using botha reasonable, good-faith interpretation thatdiffers 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 line 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 line 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 on line 4)and multiple-employer collectivelybargained plans (code D on line 4)complete line 21 only if during the planyear the plan benefited employees who arenot collectively bargained employees ormore than 2% of the employees covered

by the plan are professional employees.See Regulations sections 1.410(b)-6(d) and1.410(b)-9 for the definitions of collectivelybargained employee and professionalemployee. If the plan benefitsnoncollectively bargained employees,attach a separate statement completed inthe same format as line 21, for eachemployer with noncollectively bargainedemployees benefiting under the plan as ifsuch noncollectively bargained employeeswere benefiting under a separate plan. Donot complete line 21 for the portion of theplan benefiting collectively bargainedemployees. If more than 2% of theemployees covered by a collectivelybargained plan are professional employees,attach a separate statement completed inthe same format as line 21, for eachemployer with employees benefiting underthe plan as if all employees benefitingunder the plan were noncollectivelybargained employees.

Multiple-employer plan (other) filers(code E on line 4) are not required tocomplete line 21. However, theparticipating employers inmultiple-employer plan (other) pensionbenefit plans are required to complete theapplicable questions in line 21 on the Form5500-C/R that they file.Line 21a.—In general, if the employeroperated qualified separate lines ofbusiness within the meaning of Codesection 414(r) for a year, the employer mayapply the coverage and nondiscriminationrequirements separately to employees ineach qualified separate line of business. Ifline 21a is “Yes,” complete lines 21bthrough 21o for each qualified separateline of business covered by the plan as ifthe employees of the separate line ofbusiness were the sole employees of theemployer. If this plan benefits employees inmore than one qualified separate line ofbusiness, complete line 21 for one of thelines of business, and for each additionalline of business with employees benefitingunder the plan, submit an attachmentcompleted in the same format as line 21.Line 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 line 21 for one of thedisaggregated plans and for eachadditional part of the plan that must bedisaggregated, submit an attachmentcompleted in the same format as line 21.Line 21d.—Employers can satisfy coverageby aggregating any qualified pension or


Page 14


profit sharing plans that are notmandatorily disaggregated under the rulesfor line 21c above. However, theaggregated plans must also satisfy thenondiscrimination rules of section 401(a)(4)on an aggregated basis. Note that aspecial aggregation rule applies for thepurposes of computing the average benefitpercentage. See line 21o(1) below. If theemployer aggregates plans for thepurposes of the coverage andnondiscrimination tests (other than for thepurpose of computing the average benefitpercentage), check this item “Yes,” andcomplete the rest of line 21 for the plans,as aggregated.Line 21e.—Income Tax Regulationssection 1.401(a)(4)-9(c) allows an employerto restructure a plan into component plansto satisfy the coverage and discriminationtests. Check “Yes,” if the employer issatisfying the coverage and discriminationtests by restructuring the plan, and do notcomplete the rest of line 21.Line 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 noemployee receives an allocation or accruesa benefit. See the instructions to line 21mfor the definition of “benefiting.”Line 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.Line 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).Line 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 line 21,treat the family group as a single employeewith aggregated compensation andbenefits.Line 21i.—Enter the total number ofexcludable employees in the followingcategories:

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 accrue a

benefit solely because they:● Fail to satisfy a minimum hour of serviceor a last day requirement under the plan,● Do not have more than 500 hours ofservice for the plan year, and● Are not employed on the last day of theplan year.

Line 21k.—See the instructions for line21m for the definition of “benefiting.”Line 21l.—The definition of highlycompensated employee is contained inCode section 414(q) and its relatedregulations.Line 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.Line 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 inline 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 the

employer, 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.Line 21o(2).—In general, to compute theratio, 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 denominator,multiply by 100, and enter the result in line21o(2). Enter to the nearest 0.1%.Line 22a.—Check “Yes” if it is yourintention that this plan qualify under Codesection 401(a). Otherwise, check “No” andgo to line 23.Line 22b.—If line 22a is “Yes,” and youhave received a determination letter fromthe IRS, enter the date of the most recentdetermination letter received.Line 22c.—Check “Yes” if you haveapplied for a determination letter from theIRS but have not yet received a reply.Otherwise, check “No.”Line 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.Line 23b.—Although the fair market valueof plan assets must be determined eachyear, there is no requirement that theassets (other than certain nonpubliclytraded employer securities held in ESOPs)be valued every year by independentthird-party appraisers.Line 23c.—Enter the fair market value ofthe assets referred to on line 23a whichwere not valued by an independentthird-party appraiser in the 1994 plan year.See Revenue Ruling 59-60, 1959-1 C.B.


Page 15


237, for guidance on determining fairmarket value.Line 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.Line 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.Line 25b.—Include all trustees in officeduring the plan year. List these trustees onPart II of Schedule C (Form 5500) andattach it to the Form 5500.Line 25c.—Check “Yes” if there has beena termination in the appointment of anyperson for which a box must be checkedon line 25d. In case the service provider isnot 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 line 25cis checked “Yes,” complete Part III ofSchedule C (Form 5500) and attach theSchedule C to the Form 5500. Otherwise,check “No” and skip to line 25g.Line 25d.—Check all appropriate boxesand complete Part III of Schedule C (Form5500). At least one box must be checked ifline 25c is answered “Yes.”Line 25e.—If line 25c is checked “Yes,”check line 25e “Yes” if, during the 2 mostrecent plan years preceding thetermination and any subsequent interimperiod preceding such termination,resignation, or dismissal, there were anydisagreements (whether or not thedisagreements 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.Line 25f.—If line 25d(1) or 25d(2) has beenchecked, indicating that an independent

qualified 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 1994 Annual Return/Report Form 5500 forthe (enter name of plan).This return/report is identified in line 1b by thenine-digit EIN – (enter EmployerIdentification Number) and in line 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

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.Line 25g.—A Schedule C (Form 5500)must be attached if line 25a, 25b, and/or25c are checked “Yes.” More than oneSchedule C may be required if additionalspace is required to complete any part ofthe Schedule C. If no Schedule(s) C isrequired to be attached, enter “zero.”Line 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 that is unfunded, fully insured,or a combination of unfunded and insured,as described in 29 CFR 2520.104-44(b)(1);(b) the plan is an employee pension benefitplan whose sole asset(s) consists ofinsurance contracts which provide that,upon receipt of the premium payment, theinsurance carrier fully guarantees theamount of benefit payments attributable toplan participants for that plan year asspecified in 29 CFR 2520.104-44(b)(2);(c) the plan has elected to defer attachingthe accountant’s opinion for the first of 2plan years, one of which is a short plan

year of 7 months or less as allowed by 29CFR 2520.104-50; or (d) the plan meetsthe requirements of the DOL TechnicalRelease 92-01. (Also see the instructionsfor line 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.Line 26a.—Plans meeting (a), (b), or (d)above should check “Yes” for line 26a andskip to line 28. Plans meeting (c) mustattach the required explanation andstatements in lieu of the opinion andshould check “No” to line 26a and “Other”to line 26b, and specify, in the spaceprovided, that “the opinion is to beattached to the next Form 5500 pursuantto 29 CFR 2520.104-50.” All other plans,including those checking line 26b(2),should check “No.” “N/A” is NOT anacceptable 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 2).Lines 26b and 29c.—29 CFR2520.103-1(b) requires that any separatefinancial statements prepared in order forthe independent qualified publicaccountant to form the opinion and notesto financial statements (or lines 31 and 32if applicable) must be attached to theannual return/report Form 5500. Anyseparate statements must include theinformation required to be disclosed inlines 31 and 32 of the Form 5500;however, they may be aggregated intocategories in a manner other than thatused on Form 5500. The separatestatements should be either typewritten orprinted and consist of reproductions oflines 31 and 32 or statementsincorporating by reference lines 31 and 32.See 29 CFR 2520.103-1(b).Line 26b(1).—Generally, an unqualifiedopinion is issued when the auditorconcludes that the plan’s financialstatements present fairly, in all materialrespects, the financial status of the plan asof the end of the period audited, and thechanges in its financial status for theperiod under audit are in conformity withgenerally accepted accounting principles.Check this box if the plan received anunqualified opinion.Line 26b(2).—Department of LaborRegulations 29 CFR 2520.103-8 and2520.103-12(d) generally state that theexamination and report of an independentqualified public accountant need notextend to: (a) information prepared andcertified to by a bank or similar institutionor by an insurance carrier that is regulatedand supervised 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 the instructions for line 26b(1)above except for the information notaudited pursuant to the above regulations.These regulations do not exempt the plan


Page 16


administrator from attaching theaccountant’s report.Line 26b(3).—Generally, a qualified opinionis issued by an independent qualifiedpublic accountant 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 line 26b(2).Line 26b(4).—Generally, an adverseopinion is issued by an independentqualified public accountant when theplan’s financial statements do not presentfairly, in all material respects, the financialposition of the plan as of the end of theaudit period and the results of itsoperations for the audit period inconformity with generally acceptedaccounting principles. Check this box if theplan received an adverse accountant’sopinion.Line 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.Lines 26c and 26d.—These items must beanswered by all plans required to engage

an independent qualified public accountant(line 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 line 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 line 26c, check line 26c “No” andenter “0” on line 26d.Line 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 lines27a, 27b, 27c, and 27d to report theseentities, but not the investments made bythese entities.Exception: Plans with all of their fundsheld in a master trust should not completelines 27a through 27f (or attach theSchedule G (Form 5500)). However, theseplans are not exempt from complying withthe instructions found on page 4 forAdditional information required to beattached to the Form 5500.

“Cost” or “Cost of Asset” for the line27a, 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 line(s) 27a, b, c,d, e, and/or f and information is required tobe provided on a schedule as specifiedbelow, the schedule(s) must be completed,clearly labeled as specified below, andattached to the Form 5500 or the filing willbe subject to rejection and penalties maybe assessed (see page 2). Anyattachments must identify the line numberand include the plan’s name, EIN, and PN.A Schedule G (Form 5500) may besubmitted to provide the informationrequired by the instructions below.Lines 27a–27d.—If the assets orinvestment interests of two or more plansare maintained in one trust (exceptinvestment arrangements reported on lines31c(11) through 31c(15) (see page 20)), allentries in the schedules included underlines 27a, 27b, and 27c that relate to thetrust shall be completed by including theplan’s allocable portion of the trust. Forpurposes of line 27d, the plan’s allocableportion of the transactions of the trust shallbe combined with the other transactions ofthe plan, if any, to determine whichtransactions (or series of transactions) arereportable. Do not include individualtransactions of investment arrangementsreported on lines 31c(11) through 31c(15).

For purposes of this form,party-in-interest is deemed to include adisqualified person—see Code section4975(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 19)

Line 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:


Page 17


(1) listed on a national securities exchange and registered under section 6 of the Securities Exchange Act of 1934, or (2) quoted onNASDAQ. 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 line 27b;(b) The schedule of leases in default or classified as uncollectible required by line 27c;(c) The schedule of reportable transactions required by line 27d; and(d) The schedule of party-in-interest transactions required by lines 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 “Line 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 anddisposed of within the plan year (see 29 CFR 2520.103-11). The schedule should use the following or a similar format and the same sizepaper as the Form 5500. The following schedule must be clearly labeled “Line 27a – Schedule of Assets Held for InvestmentPurposes.”

(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 on line 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.Line 27b.—Check “Yes” and attach the following schedule to the Form 5500 if the plan had any loans or fixed income obligations indefault or determined to be uncollectible as of the end of the plan year. Include obligations where the required payments have not beenmade by the due date. For notes and loans, the due date, payment amount, and conditions for default are usually contained in the noteor loan documents. Defaults can occur at any time for those obligations that require periodic repayment. Generally, loans and fixedincome obligations are considered uncollectible when payment has not been made and there is little probability that payment will bemade. A loan by the plan is in default when the borrower is unable to pay the obligation upon maturity. A fixed income obligation has afixed maturity date at a specified interest rate. List any loans by the plan that are in default and any fixed income obligations that havematured, 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 “Line 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

Line 27c.—Check “Yes,” and attach to Form 5500 the following schedule if the plan had any leases in default or classified asuncollectible. The schedule should use the following or a similar format and the same size paper as Form 5500. The following schedulemust be clearly labeled “Line 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.


Page 18


(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)

Line 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 lines 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 line 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 lines 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 “Line 27d — Schedule of Reportable Transactions.”(h) Current

value 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

Lines 27e and 27f.—Check “Yes” and attach the following schedule to the Form 5500 if the plan had any nonexempt transactions witha party-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:

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” on line 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 “Line 27e.— Schedule of Nonexempt Transactions” and/or“Line 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.


Page 19


(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.Line 27g.—Employer Security.—Anemployer security is any security issued byan employer (including affiliates) ofemployees covered by the plan. Thesemay include common stocks, preferredstocks, bonds, zero coupon bonds,debentures, convertible debentures, notes,and commercial paper. Generally, apublicly traded security is a security that isbought and sold on a recognized market(e.g., NYSE, AMEX, over the counter, etc.)for which there is a pool of willing buyersand sellers. 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 price

not 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).Line 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.Line 29a(1).—Generally, every plan officialof an employee benefit plan who “handles”funds or other property of such plan mustbe 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 are

such 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 on line 29.Line 29a(2).—Indicate the aggregateamount of coverage available for all claims.Line 29b(1).—Check “Yes” if the plan hassuffered or discovered any loss as theresult of a dishonest or fraudulent act(s).Line 29b(2).—If line 29b(1) has beenanswered “Yes,” enter the full amount ofthe loss. If the full amount of the loss hasnot yet been determined, provide anddisclose that the figure is an estimate,such as “Approximately $1,000.”Note: Willful failure to report is a criminaloffense. See ERISA section 501.Line 30a.—If you are uncertain whetherthe plan is covered under the PBGCtermination insurance program, check thebox “Not determined” and contact thePBGC and request a coveragedetermination. Welfare plans do notcomplete this item.Lines 31 and 32.—Use either the cash,modified accrual, or accrual basis forrecognition of transactions on lines 31 and32, as long as you use one methodconsistently.

Round off all amounts on lines 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.


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“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 on lines 31c(11)through 31c(15)), complete lines 31 and 32by 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 on lines 31and 32.

Unfunded, fully insured, andunfunded/insured welfare plans, and fullyinsured pension plans meeting theconditions of 29 CFR 2520.104-44, neednot complete lines 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.Line 31.—Use column (a) to enter thecurrent value of plan assets and liabilitiesas of the beginning of the plan year. Usecolumn (b) to enter the current value ofplan assets and liabilities as of the end ofthe plan year.

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 1994 plan year incolumn (a).Line 31a.—Total noninterest-bearing cashincludes, among other things, cash onhand or cash in a noninterest-bearingchecking account.Line 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.Line 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.Line 31b(3).—Noncash basis filers shouldinclude income from investment incomeearned but not yet received by the plan.Line 31b(4).—Noncash basis filers shouldinclude amounts due to the plan that arenot includable in lines 31b(1)–31(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.Line 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.

Line 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.Line 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 lines 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.”Line 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.Line 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.Line 31c(6).—Include the value of theplan’s participation 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 lines 31c(11) through31c(15) below).Line 31c(7)(A).—Include the current valueof real property owned by the plan thatproduces income from rentals, etc. Thisproperty is not to be included on line 31e,buildings and other property used in planoperations.Line 31c(7)(B).—Include the current valueof real property owned by the plan that isnot producing income or used in planoperations.Line 31c(8)(A).—Include the current valueof all loans 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, see theinstructions for lines 31c(9)(A) and (B)below.)Line 31c(8)(B).—Include the current valueof all loans 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 the instructionsfor lines 31c(9)(A) and (B) below.)Line 31c(9)(A).—Include the current valueof all loans to participants that are made

by the plan to provide mortgage financingto participants who were purchasers of realproperty, irrespective of whether themortgage was for residential, commercial,or farm property.Line 31c(9)(B).—Include the balance ofany loans made to participants that werenot reported on line 31c(9)(A).Note: The total amount of the unpaidprincipal balance (plus accrued but unpaidinterest, if any) of participant loansaggregated for purposes of the line 27aschedules should be included in line31c(9). When applicable, combine thisamount with the current value of any otherparticipant loans.Line 31c(10).—Include all loans made bythe plan that are not to be reportedelsewhere on line 31 such as loans forconstruction, securities loans, and othermiscellaneous loans.Lines 31c(11) through 31c(15).—On lines31c(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 line 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.Line 31c(16).—You can use the samemethod for determining the value of theinsurance contracts reported on line31c(16) that you used for line 6e ofSchedule A (Form 5500) as long as thecontract values are stated as of thebeginning and end of the plan year.Line 31c(17).—Other investments includeoptions, index futures, repurchaseagreements, and state and municipalsecurities among other things.Line 31d.—See the instructions for line27g on page 19 for the definition ofemployer security.Line 31e.—Include the current (not book)value of the buildings and other propertyused in the operation of the plan. Reportbuildings or other property held as planinvestments on line 31c(7)(A), 31c(7)(B), or31d(2).

Do not include the value of futurepension payments on lines 31g, 31h, 31i,31j, or 31k.Line 31g.—Noncash basis plans shouldinclude the total amount of benefit claimsthat have been processed and approvedfor payment by the plan.


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Line 31h.—Noncash basis plans shouldinclude the total amount of obligationsowed by the plan that were incurred in thenormal operations of the plan and havebeen approved for payment by the planbut have not been paid.Line 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).Line 31j.—Noncash basis plans shouldinclude amounts owed for any liabilitiesthat would not be classified as benefitclaims payable, operating payables, oracquisition indebtedness.Line 31l.—Column (b) must equal the sumof column (a) plus lines 32i and 32j.Line 32a(1).—Include the total cashcontributions received and/or (for accrualbasis plans) due to be received.Line 32a(1)(B).—For welfare plans, reportall employee 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)).Line 32a(2).—Use the current value, atdate contributed, of securities or othernoncash property.Line 32b(1)(A).—Include the interestearned on interest-bearing cash. This isderived from investments that areincludable on line 31c(1), includingearnings from sweep accounts, STIFaccounts, etc.Line 32b(1)(B).—Include the interestearned on certificates of deposit. This isthe interest earned on the investments thatare reported on line 31c(2).Line 32b(1)(C).—Include the interestearned on U.S. Government securities.This is the interest earned on theinvestments that are reported on line31c(3).Line 32b(1)(D).—Generally, this is theinterest earned on securities that arereported on lines 31c(4)(A) and (B) and31d(1).Line 32b(1)(E).—Include the interestearned on the investments that is reportedon lines 31c(8)(A) and (B) and 31c(9)(A).Line 32b(1)(F).—Include the interestearned on the investments that arereported on lines 31c(9)(B) and 31c(10).Line 32b(1)(G).—Include any interest notreported on lines 32b(1)(A)–(F).

Line 32b(2)(A) and (B).—Generally, thesedividends are from the investments thatare reported on lines 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.Line 32b(3).—Generally, rents representthe income earned on the real propertythat is reported on lines 31c(7)(A) and31d(2). Rents should be entered as a “Net”figure. Net rents are determined by takingthe total rent received and subtracting allexpenses directly associated with theproperty. If the real property is jointly usedas 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.Line 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 on line 32b(5) below,with two exceptions: (1) the realized gain(or loss) on each asset which was disposedof during the plan year is reported on line32b(4) (NOT on line 32b(5)), and (2) the netinvestment gain (or loss) from certaininvestment arrangements is reported onlines 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 on line32b(4), column (a), line (A),

b. Entering on line 32b(4), column (a),line (B), the sum of the current value ofthese former assets as of the beginning ofthe plan year, for those assets on hand atthe beginning of the plan year, or thepurchase price for those assets acquiredduring the plan year, and

c. Subtracting line 32b(4)(B) from32b(4)(A) and entering this result on line32b(4)(C) in column (b).

A negative figure should be placed inparentheses.Note: Bond write offs should be reportedas realized losses.Line 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 on lines 32b(4) and32b(6) through 32b(10).

Lines 32b(6) through (10).—Report allearnings, expenses, gains or losses, andunrealized appreciation or depreciation thatwere included in computing the netinvestment gain (or loss) from theseinvestment arrangements here. If someplan funds are held in any of theseinvestment arrangements and other planfunds are held in other funding media,complete all applicable subitems of line 32to report plan earnings and expensesrelating to the other 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:

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.Line 32c.—Include any other plan incomeearned that is not included on lines 32a or32b. Do not include transfers from otherplans that should be reported on line 32j.Line 32d.—Add all amounts in column (b)and enter the total income.Line 32e.—If distributions includesecurities or other property, use thecurrent value at date distributed for thisitem. See page 14 for the definition ofcurrent value.Line 32e(1).—Include the current value ofall cash, securities, or other property at thedate of distribution.Line 32e(2).—Include payments toinsurance companies and similarorganizations such as Blue Cross, BlueShield, and health maintenanceorganizations for the provision of planbenefits (e.g., paid-up annuities, accidentinsurance, health insurance, vision care,dental coverage, stop-loss insurancewhose claims are paid to the plan (orwhich is otherwise an asset of the plan)),etc.Line 32e(3).—Include payments made toother organizations or individuals providingbenefits. Generally, these are individualproviders of welfare benefits such as legalservices, day care services, and trainingand apprenticeship services.Line 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.Line 32g.—Expenses incurred in thegeneral operations of the plan areclassified as administrative expenses.Report all administrative expenses (byspecified category) paid by or charged tothe plan, including those that were notsubtracted from the gross income of


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common/collective trusts, pooled separateaccounts, master trust investmentaccounts, and 103-12 IEs in determiningtheir net investment gain(s) or loss(es).Line 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.).Line 32g(2).—Include the total fees paid(or in the case of accrual basis plans,costs incurred during the plan year but notpaid as of the end of the plan year) by theplan for outside accounting services. Thesemay include the fee(s) for the annual auditof the plan by an independent qualifiedpublic accountant, for payroll audits, andfor accounting/bookkeeping services.These do not include amounts paid to planemployees to perform accountingfunctions.Line 32g(3).—Include the total fees paid(or in the case of accrual basis plans,costs incurred during the plan year but notpaid as of the end of the plan year) to anactuary for services rendered to the plan.Line 32g(4).—Include the total fees paid(or in the case of accrual basis plans,costs incurred during the plan year but notpaid as 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 include

salaried staff or employees of the plan orbanks, or insurance carriers.Line 32g(5).—Include the total fees paid(or in the case of accrual basis plans,costs incurred during the plan year but notpaid as 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.Line 32g(6).—Include 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 a lawyerfor services rendered to the plan. Includefees paid for rendering legal opinions,litigation, and advice but not for providinglegal services as a benefit to planparticipants.Line 32g(7).—Include the total fees paid(or in the case of accrual basis plans,costs incurred during the plan year but notpaid as 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.Line 32g(8).—Include the total fees andexpenses paid to or on behalf of plan

trustees (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.Line 32g(9).—Other expenses are thosethat cannot be associated definitely withlines 32g(1) through 32g(8). Allmiscellaneous expenses are also includedin this figure. These may include expensesfor office supplies and equipment, cars,telephone, postage, rent, and expensesassociated with the ownership of a buildingused in the operation of the plan.Line 32h.—Add column (b) for lines 32e(4),32f, and 32g(10).Line 32i.—Subtract line 32h from line 32d.Line 32j.—Include in this reconciliationfigure any transfers of assets into or out ofthe plan 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.Line 32k.—Include the amount of netassets at the beginning of the year. Thisamount must equal line 31l, column (a).Line 32l.—Include the amount of netassets at the end of the year. This amountmust equal line 31l, column (b).


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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.


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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:

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