Schedule C Service Provider Information

SCHEDULE C
(Form 5500)

Official Use Only

Service Provider Information

Department of the Treasury
Internal Revenue Service
Department of Labor
Employee Benefits Security Administration

2007

This schedule is required to be filed under section 104 of the
Employee Retirement Income Security Act of 1974.

This Form is Open to
Public Inspection.

έ File as an attachment to Form 5500.

Pension Benefit Guaranty Corporation

For calendar plan year 2007 or fiscal plan year beginning
Name of plan

,

and ending

A

C

OMB No. 1210-0110

B
D

Plan sponsor's name as shown on line 2a of Form 5500

,
Three-digit
plan number έ
Employer Identification Number

Part I Service Provider Information (see instructions)
1 Enter the total dollar amount of compensation paid by the plan to all persons, other than those
2

listed below, who received compensation during the plan year: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
On the first item below list the contract administrator, if any, as defined in the instructions. On the other items, list service providers in
descending order of the compensation they received for the services rendered during the plan year. List only the top 40. 103-12 IEs should
enter N/A in (c) and (d).
(b) Employer
identification
(c) Official plan
(a) Name
number (see
position
instructions)

Contract administrator
(d) Relationship to employer,
employee organization, or
person known to be a
party-in-interest

(e) Gross salary
or allowances
paid by plan

(f) Fees and
commissions
paid by plan

(g) Nature of
service code(s)
(see instructions)

12
(a) Name

(d) Relationship to employer,
employee organization, or
person known to be a
party-in-interest

(b) Employer
identification
number (see
instructions)

(e) Gross salary
or allowances
paid by plan

(c) Official plan
position

(f) Fees and
commissions
paid by plan

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500.

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(g) Nature of
service code(s)
(see instructions)

Schedule C (Form 5500) 2007

Schedule C (Form 5500) 2007

Page

2
Official Use Only

(a) Name

(d) Relationship to employer,
employee organization, or
person known to be a
party-in-interest

(a) Name

(d) Relationship to employer,
employee organization, or
person known to be a
party-in-interest

(a) Name

(d) Relationship to employer,
employee organization, or
person known to be a
party-in-interest

(b) Employer
identification
number (see
instructions)

(e) Gross salary
or allowances
paid by plan

(c) Official plan
position

(f) Fees and
commissions
paid by plan

(b) Employer
identification
number (see
instructions)

(e) Gross salary
or allowances
paid by plan

(c) Official plan
position

(f) Fees and
commissions
paid by plan

(b) Employer
identification
number (see
instructions)

(e) Gross salary
or allowances
paid by plan

(g) Nature of
service code(s)
(see instructions)

(g) Nature of
service code(s)
(see instructions)

(c) Official plan
position

(f) Fees and
commissions
paid by plan

(g) Nature of
service code(s)
(see instructions)

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Schedule C (Form 5500) 2007

Page

3
Official Use Only

Part II

Termination Information on Accountants and Enrolled Actuaries (see instructions)

(a) Name
(c)

(b) EIN

Position

(d) Address
(e)

Telephone No.

Explanation:

(a) Name
(c)

(b) EIN

Position

(d) Address
(e)

Telephone No.

Explanation:

(a) Name
(c)

(b) EIN

Position

(d) Address
(e)

Telephone No.

Explanation:

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