Sch SB (Form 5500) Single-Employer Defined Benefit Plan Actuarial Informati

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Single-Employer Defined Benefit Plan
Actuarial Information

SCHEDULE SB
(Form 5500)
Department of the Treasury
Internal Revenue Service
Department of Labor
Employee Benefits Security Administration
Pension Benefit Guaranty Corporation

This schedule is required to be filed under section 104 of the Employee
Retirement Income Security Act of 1974 (ERISA) and section 6059 of the
Internal Revenue Code (the Code).
έ Attach to Form 5500 or 5500-EZ if applicable. (See instructions.)

For calendar plan year 2008 or fiscal plan year beginning

,

Official Use Only

OMB No. 1210-0110

2008
This Form is Open to
Public Inspection.

and ending

,

έ Round off amounts to nearest dollar.
έ Caution: A penalty of $1,000 will be assessed for late filing of this report unless reasonable cause is established.
A

Name of plan

B

C

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

D

E Type of plan:
Single
Part I
Basic Information
1 Enter the valuation date:

Multiple-A

F

Multiple-B

Month

Prior year plan size:

Day

100 or fewer

Assets:
Market value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a
Actuarial value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2b
3 Funding target/participant count breakdown
(1) Number of participants
a For retired participants and beneficiaries receiving payment . . . . . . . .
3a
b For terminated vested participants . . . . . . . . . . . . . . . . . . . . . . . . . . .
3b
c For active participants:
(1) Non-vested benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3c(1)
(2) Vested benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3c(2)
(3) Total active . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3c(3)
d Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3d
4 If the plan is in at-risk status, check the box and complete lines 4a and 4b . . . . . . . . . . . έ
a Funding target disregarding prescribed at-risk assumptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a
b Funding target reflecting at-risk assumptions, but disregarding transition rule for plans that have been
at-risk for fewer than five consecutive years and disregarding loading factor . . . . . . . . . . . . . . . . . . . . . . .
4b
5 Effective interest rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6 Target normal cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
Statement by Enrolled Actuary

More than 500

(2) Funding Target

D

PR

a
b

101-500

Year

O
O
F

2

Three-digit
plan number (PN) έ
Employer Identification Number (EIN)

3R

%

To the best of my knowledge, the information supplied in this schedule and accompanying schedules, statements and attachments, if any, is complete and accurate. Each
prescribed assumption was applied in accordance with applicable law and regulations. In my opinion, each other assumption is reasonable (taking into account the experience
of the plan and reasonable expectations) and such other assumptions, in combination, offer my best estimate of anticipated experience under the plan.

SIGN
HERE

Signature of actuary

Date

Type or print name of actuary

Most recent enrollment number

Firm name

Telephone number (including area code)

Address of the firm
If the actuary has not fully reflected any regulation or ruling promulgated under the statute in completing this schedule,
check the box and see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice and OMB Control Numbers,
Schedule SB (Form 5500) 2008
v11.2
see the instructions for Form 5500 or 5500-EZ.

Should read "(See instructions.)"
Schedule SB (Form 5500) 2008

Page

2
Official Use Only

Part II

Beginning of year carryover and prefunding balances (see instructions)
(a) Carryover balance

7

(b) Prefunding balance

Balance at beginning of prior year after applicable adjustments (line 13 from
prior year) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Portion used to offset prior year's funding requirement (line 35 from prior year)
Amount remaining (line 7 minus line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest on line 9 using prior year's actual return of
%. . . . . . .
Prior year's excess contributions to be added to prefunding balance:
Excess contributions (line 38 from prior year) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest on line 11a using prior year's effective rate of
%.....
Total available at beginning of current plan year to add to prefunding balance . .
Portion of line 11c to be added to prefunding balance . . . . . . . . . . . . . . . . . . . .
Reduction in balances due to elections or deemed elections . . . . . . . . . . . . . . .
Balance at beginning of current year (line 9 + line 10 + line 11d - line 12). . . . . .

O
O
F

8
9
10
11
a
b
c
d
12
13
Part III Funding percentages
14 Funding target attainment percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Adjusted funding target attainment percentage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16 Prior year's funding percentage for purposes of determining whether carryover/prefunding balances may be used to
offset current year's funding requirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......

17 If the current value of the assets of the plan is less than 70 percent of the funding target, enter such percentage
Part IV Contributions and liquidity shortfalls
18 Contributions made to the plan for the plan year by employer(s) and employees:
(b) Amount paid by
employer(s)

(c) Amount paid by
employees

(a) Date
(MM-DD-YYYY)

(b) Amount paid by
employer(s)

%
%

16
17

%
%

(c) Amount paid by
employees

Totals έ 18(b)
18(c)
Discounted employer contributions -- see instructions for small plan with a valuation date after the beginning of the year:
Contributions allocated toward unpaid minimum required contribution from prior years . . . . . . . . . . . . . . . 19a
Contributions made to avoid benefit restrictions adjusted to valuation date . . . . . . . . . . . . . . . . . . . . . . . . 19b
Contributions allocated toward minimum required contribution for current year, adjusted to valuation date 19c
Quarterly contributions and liquidity shortfall(s):
Did the plan have a "funding shortfall" for the prior year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 20a is "Yes," were required quarterly installments for the current year made in a timely manner? . . . . . . . . . . . . . . . . .
If line 20a is "Yes," see instructions and complete the following table as applicable:
Liquidity shortfall as of end of quarter of this plan year
(1) 1st
(2) 2nd
(3) 3rd
(4)

3R

19
a
b
c
20
a
b
c

D

PR

(a) Date
(MM-DD-YYYY)

14
15

v11.2

Yes
Yes

4th

No
No

Schedule SB (Form 5500) 2008

Page

3
Official Use Only

Part V Assumptions used to determine funding target and target normal cost
21 Discount rate:
1st segment:

2nd segment:

3rd segment:

N/A, full yield curve used

a Segment rates:
%
%
%
b Applicable month (enter code) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21b
22 Weighted average retirement age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Mortality table(s) (see instructions)
Prescribed -- combined
Prescribed -- separate
Substitute
Part VI Miscellaneous items
24 Has a change been made in the non-prescribed actuarial assumptions for the current plan year? If "Yes," see instructions
25
26
27

regarding required attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Has a method change been made for the current plan year? If "Yes," see instructions regarding required attachment . . . . . .
Is the plan required to provide a Schedule of Active Participants? If "Yes," see instructions regarding required attachment . .
If the plan is eligible for (and is using) alternative funding rules, enter applicable code and see
Add "s"
instructions regarding attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27

28

O
O
F

Part VII Reconciliation of unpaid minimum required contributions for prior years
28 Unpaid minimum required contribution for all prior years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29 Discounted employer contributions allocated toward unpaid minimum required contributions from prior

D

Carryover balance
Prefunding balance
Balances used to offset funding requirement. . .
Additional cash requirement (line 34 minus line 35) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributions allocated toward minimum required contribution for current year, adjusted to valuation date
(line 19c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest-adjusted excess contributions for current year (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . .
Unpaid minimum required contribution for current year (excess, if any, of line 36 over line 37) . . . . . . . . . .
Unpaid minimum required contribution for all years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
v11.2

3R

38
39
40

PR

years (line 19a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
30 Remaining amount of unpaid minimum required contributions (line 28 minus line 29) . . . . . . . . . . . . . . . . 30
Part VIII Minimum required contribution for current year
31 Target normal cost, adjusted, if applicable (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Outstanding Balance
32 Amortization installments:
a Net shortfall amortization installment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b Waiver amortization installment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33 If a waiver has been approved for this plan year, enter the date of the ruling letter granting the approval
(Month
Day
Year
) and the waived amount . . . . . . . . . . . . . . . . . . . .
33
34 Total funding requirement before reflecting carryover/prefunding balances
(line 31 + line 32a + line 32b - line 33) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34

35
36
37

Yes
Yes
Yes

Installment

Total balance

36
37
38
39
40

No
No
No