Schedule R Retirement Plan Information

Official Use Only

SCHEDULE R
(Form 5500)

Retirement Plan Information

Department of the Treasury
Internal Revenue Service

This schedule is required to be filed under sections 104 and 4065 of the
Employee Retirement Income Security Act of 1974 (ERISA) and section 6058(a)
of the Internal Revenue Code (the Code).

Department of Labor
Employee Benefits Security
Administration
Pension Benefit Guaranty Corporation

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

,

This Form is Open to
Public Inspection.
,

and ending

B

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

Part I

2007

έ File as an Attachment to Form 5500.

A

C

OMB No. 1210-0110

D

Three-digit
έ
plan number
Employer Identification Number

Distributions

All references to distributions relate only to payments of benefits during the plan year.
1 Total value of distributions paid in property other than in cash or the forms of property specified
in the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 $
2 Enter the EIN(s) of payor(s) who paid benefits on behalf of the plan to participants or beneficiaries
during the year (if more than two, enter EINs of the two payors who paid the greatest dollar amounts
of benefits).
Profit-sharing plans, ESOPs, and stock bonus plans, skip line 3.
3 Number of participants (living or deceased) whose benefits were distributed in a single sum, during
the plan year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Part II
Funding Information (If the plan is not subject to the minimum funding requirements of section 412 of the Internal Revenue
Code or ERISA section 302, skip this Part)
Yes
No
4 Is the plan administrator making an election under Code section 412(c)(8) or ERISA section 302(c)(8)? . . . . . . . . . . . .
If the plan is a defined benefit plan, go to line 7.
5 If a waiver of the minimum funding standard for a prior year is being amortized in this
plan year, see instructions, and enter the date of the ruling letter granting the waiver . . . . . . . . . . . . . . έ
Month
Day
Year
If you completed line 5, complete lines 3, 9, and 10 of Schedule B and do not complete the remainder of this schedule.
6a Enter the minimum required contribution for this plan year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a $
b Enter the amount contributed by the employer to the plan for this plan year . . . . . . . . . . . . . . . . . . . . . . . . . 6b $
c Subtract the amount in line 6b from the amount in line 6a. Enter the result (enter a minus sign to the left
of a negative amount) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6c $
If you completed line 6c, skip lines 7 and 8 and complete line 9.
7 If a change in actuarial cost method was made for this plan year pursuant to a revenue procedure providing automatic
approval for the change or a class ruling letter, does the plan sponsor or plan administrator agree with the change? . .
Yes
No

N/A

N/A

Part III
Amendments
8 If this is a defined benefit pension plan, were any amendments adopted during this plan year that
increased or decreased the value of benefits? If yes, check the appropriate box(es). If no, check the
"No" box. (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV
Coverage (See instructions.)
9 Check the box for the test this plan used to satisfy the coverage requirements . . . .

Increase

the ratio percentage test
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500.
v10.1

2 2 0 7 0 0 0 1 0 C

Decrease

No

average benefit test
Schedule R (Form 5500) 2007