2008 Form 5500 Schedule C

85500c.pdf

Annual Information Return/Report

2008 Form 5500 Schedule C

OMB: 1210-0110

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SCHEDULE C
(Form 5500)

Service Provider Information

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.

2008

FI
LI
NG

This Form is Open to
Public Inspection.

File as an attachment to Form 5500.

Pension Benefit Guaranty Corporation

A

MM / D D / Y Y Y Y

MM / D D / Y Y Y Y

FO
R

For calendar plan year 2008
or fiscal plan year beginning

and ending

Name of plan

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

2

Enter the total dollar amount of compensation paid by the plan to all persons,
other than those listed below, who received compensation during the plan year: ..........

▲

DO

1

Service Provider Information (see instructions)

Employer Identification Number

NO
T

Part I

D

▲

▲

.00

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).
(a)

ON
LY
,

C

Three-digit
plan number

US
E

B

▼

▼

Department of Labor
Employee Benefits Security Administration

Official Use Only

Name

PU
RP
OS
ES

(b) Employer identification number (see instructions)

Co n t r a c t

(c) Official plan position
(d) Relationship to employer,
employee organization, or person
known to be a party-in-interest
(e) Gross salary or allowances paid by plan

(a)

Name

▲

(f) Fees and commissions paid by plan

.00

▲

IN
FO
RM
AT
IO
N

▲

a dm i n i s t r a t o r

▲

.00

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

.00

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

1 2

(b) Employer identification number (see instructions)
(c) Official plan position
(d) Relationship to employer,
employee organization, or person
known to be a party-in-interest
(e) Gross salary or allowances paid by plan

▲

.00

▲

▲

FO
R

▲

(f) Fees and commissions paid by plan

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 13515E Schedule C (Form 5500) 2008

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v11.3

Schedule C (Form 5500) 2008

Page

2
Official Use Only

Name

FI
LI
NG

(a)

(c) Official plan position
(d) Relationship to employer,
employee organization, or person
known to be a party-in-interest
(e) Gross salary or allowances paid by plan

.00

▲

.00

▲

Name

(b) Employer identification number (see instructions)

▲

(f) Fees and commissions paid by plan

ON
LY
,

Gross salary or allowances paid by plan

▲

.00

▲

Name

▲

PU
RP
OS
ES

(a)

DO

(c) Official plan position
(d) Relationship to employer,
employee organization, or person
known to be a party-in-interest
(e)

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

NO
T

(a)

▲

(f) Fees and commissions paid by plan

US
E

▲

FO
R

(b) Employer identification number (see instructions)

.00

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

.00

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

.00

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

(b) Employer identification number (see instructions)
(c) Official plan position
(d) Relationship to employer,
employee organization, or person
known to be a party-in-interest
(e) Gross salary or allowances paid by plan

(a)

Name

▲

.00

▲

IN
FO
RM
AT
IO
N

▲

(f) Fees and commissions paid by plan

▲

(b) Employer identification number (see instructions)
(c) Official plan position
(d) Relationship to employer,
employee organization, or person
known to be a party-in-interest
(e) Gross salary or allowances paid by plan

▲

.00

▲

▲

FO
R

▲

(f) Fees and commissions paid by plan

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Schedule C (Form 5500) 2008

Page

3

Part II Termination Information on Accountants and Enrolled Actuaries (see instructions)

Official Use Only

(b) EIN

(c) Position

Street Address
City

State

Telephone No.

ON
LY
,

DO

NO
T

E
X
P
L
A
N
A
T
I
O
N

(b) EIN

(d)
Address

(c) Position

Street Address
City

IN
FO
RM
AT
IO
N

Telephone No.

State

FO
R

(e)

PU
RP
OS
ES

(a)
Name

E
X
P
L
A
N
A
T
I
O
N

Zip Code

US
E

(e)

FO
R

(d)
Address

FI
LI
NG

(a)
Name

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0

0

0

3

0

K

Zip Code


File Typeapplication/pdf
File Title55500c
Subject55500c
AuthorRhodHM
File Modified2008-06-05
File Created2008-06-03

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