Schedule D DFE/Participating Plan Information

DFE/Participating Plan Information

SCHEDULE D
(Form 5500)

Official Use Only

OMB No. 1210-0110

Department of the Treasury
Internal Revenue Service

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

2007

Department of Labor
Employee Benefits Security Administration

έ File as an attachment to Form 5500.

This Form is Open to
Public Inspection.

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

C

,

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

Part I

and ending
,
B Three-digit
plan number έ
D Employer Identification Number

Information on interests in MTIAs, CCTs, PSAs, and 103-12 IEs (to be completed by plans and DFEs)

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(d)

(d)

(d)

(d)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

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

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Schedule D (Form 5500) 2007

Schedule D (Form 5500) 2007

Page

2
Official Use Only

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(a)

Name of MTIA, CCT, PSA, or 103-12IE

(b)

Name of sponsor of entity listed in (a)

(c)

EIN-PN

(d)

(d)

(d)

(d)

(d)

(d)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)

Entity code

(e)

Dollar value of interest in MTIA, CCT, PSA,
or 103-12IE at end of year (see instructions)
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Schedule D (Form 5500) 2007

Page

3
Official Use Only

Part II

Information on Participating Plans (to be completed by DFEs)

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(a)

Plan name

(b)

Name of plan sponsor

(c)

EIN-PN

(c)

EIN-PN

(c)

EIN-PN

(c)

EIN-PN

(c)

EIN-PN

(c)

EIN-PN

(c)

EIN-PN

(c)

EIN-PN
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