Schedule D DFE/Participating Plan Information

CUMULATIVE CHANGES
SCHEDULE D
(Form 5500)

Department of Labor
Employee Benefits Security Administration

For calendar plan year 2008
or fiscal plan year beginning

C

MM / D D / Y Y Y Y

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

Three-digit
plan number

D

Employer Identification Number

▼

B

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

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

(d) Entity
code

PR

EIN

PN

▲

▲

▲

.00

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

D

(a)

MM / D D / Y Y Y Y

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

(b) Name of sponsor of entity listed in (a)

(c)

and ending

Name of plan or DFE

Part I
(a)

2008

This Form is Open to
Public Inspection.

File as an attachment to Form 5500.

O
O
F

A

OMB No. 1210-0110

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

Department of the Treasury
Internal Revenue Service

Official Use Only

DFE/Participating Plan Information

(c)

EIN

3R

(b) Name of sponsor of entity listed in (a)

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

(d) Entity
code

PN

▲

▲

▲

.00

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 22774J Schedule D (Form 5500) 2008

1

1

0

8

0

0

0

1

0

B
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Schedule D (Form 5500) 2008

Page

2
Official Use Only

(a)

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

(b) Name of sponsor of entity listed in (a)

(c)

EIN

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

(d) Entity
code

PN

▲

(a)

O
O
F

EIN

(d) Entity
code

PN

D

(d) Entity
code

PN

▲

.00

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

3R

(a)

EIN

▲

PR

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

(b) Name of sponsor of entity listed in (a)

(c)

.00

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

▲

(a)

▲

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

(b) Name of sponsor of entity listed in (a)

(c)

▲

▲

▲

▲

.00

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

(b) Name of sponsor of entity listed in (a)

(c)

EIN

(d) Entity
code

PN

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

▲

1

1

0

8

0

0

0

2

0

▲

C
v11.1

▲

.00

Schedule D (Form 5500) 2008

Page

3
Official Use Only

Part II
(a)

Information on Participating Plans (to be completed by DFEs)

Plan name

(b) Name of plan sponsor

(c)

EIN

(a)

Plan name

PN

(c)

EIN

(a)

Plan name

PN

EIN

(a)

Plan name

PN

(c)

EIN

(a)

Plan name

3R

(b) Name of plan sponsor

D

(c)

PR

(b) Name of plan sponsor

O
O
F

(b) Name of plan sponsor

PN

(b) Name of plan sponsor

(c)

EIN

PN

1

1

0

8

0

0

0

3

0

D
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Schedule D (Form 5500) 2008

Page

4
Official Use Only

(a)

Plan name

(b) Name of plan sponsor

(c)

EIN

(a)

Plan name

PN

(c)

EIN

(a)

Plan name

PN

EIN

(a)

Plan name

PN

(c)

EIN

(a)

Plan name

3R

(b) Name of plan sponsor

D

(c)

PR

(b) Name of plan sponsor

O
O
F

(b) Name of plan sponsor

PN

(b) Name of plan sponsor

(c)

EIN

PN

1

1

0

8

0

0

0

4

0

E
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