2008 Form 5500 Schedule R

A

File as an Attachment to Form 5500.

MM / D D / Y Y Y Y

MM / D D / Y Y Y Y

and ending

Name of plan

D

Part I

Employer Identification Number

NO
T

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

Three-digit
plan number

US
E

B

C

FI
LI
NG

For the calendar plan year 2008
or fiscal plan year beginning

2008

This Form is Open to
Public Inspection.

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Department of Labor
Employee Benefits Security Administration
Pension Benefit Guaranty Corporation

OMB No. 1210-0110

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).

FO
R

Department of the Treasury
Internal Revenue Service

Official Use Only

Retirement Plan Information

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SCHEDULE R
(Form 5500)

Distributions

All references to distributions relate only to payments of benefits during the plan year.

2

DO

Total value of distributions paid in property other than in cash
or the forms of property specified in the instructions ................................................
Enter the EIN(s) of payor(s) who paid benefits on behalf of the plan to
participants or beneficiaries during the plan year (if more than two, enter
EINs of the two payors who paid the greatest dollar amounts of benefits).

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.00

ON
LY
,

1

}

...............................

Profit-sharing plans, ESOPs, and stock bonus plans, skip line 3.

Number of participants (living or deceased) whose benefits were distributed in a single
sum, during the plan year ..................................................................................................................................

Part II

Is the plan administrator making an election under Code section 412(d)(2) or
ERISA section 302(d)(2)? ...............................................................................................
If the plan is a defined benefit plan, go to line 7.

Yes

If a waiver of the minimum funding standard for a prior plan year is being amortized in this
plan year, see instructions, and enter the date of the ruling letter granting the waiver ................

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5

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)

IN
FO
RM
AT
IO
N

4

PU
RP
OS
ES

3

No

N/A

MM / D D / Y Y Y Y

If you completed line 5, complete lines 3, 9, and 10 of Schedule MB and
do not complete the remainder of this schedule.

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.00

b Enter the amount contributed by the employer to the plan for this plan year ..........

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.00

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) ...............................................

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.00

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6a Enter the minimum required contribution for this plan year .......................................

If you completed line 6c, skip lines 7 and 8 and complete line 9.
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 24419B Schedule R (Form 5500) 2008

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8

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0

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0

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v11.3

Schedule R (Form 5500) 2008

Page

2

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? ...................

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.)

Check the box for the test this plan used to satisfy the coverage requirements:
average benefit test

IN
FO
RM
AT
IO
N

PU
RP
OS
ES

ON
LY
,

DO

ratio percentage test

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R

9

Increase

US
E

8

Amendments

2

1

0

8

0

0

0

2

N/A

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R

Part III

No

Yes

NO
T

7

FI
LI
NG

Official Use Only

0

D

Decrease

No