Schedule D DFE/Participating Plan Information

Annual Return/Report of Employee Benefit Plan

2009 Form 5500 SchD EFAST

Annual Return/Report of Employee Benefit Plan

OMB: 1545-1610

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1545-1610 can be found here:
2024-04-15 - No material or nonsubstantive change to a currently approved collection
2023-08-31 - No material or nonsubstantive change to a currently approved collection
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SCHEDULE D

DFE/Participating Plan Information

(Form 5500)
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

OMB No. 1210-0110

2009

 File as an attachment to Form 5500.

Department of Labor
Employee Benefits Security Administration

This Form is Open to Public
Inspection.

For calendar plan year 2009 or fiscal plan year beginning

and ending

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

d

d

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

Entity
code

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

D

123456789-123

Entity
code

R

123456789-123

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

AF

a

T

A Name of plan
B Three-digit
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
001

plan number (PN)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI
D Employer Identification Number (EIN)
C Plan or DFE sponsor’s name as shown on line 2a of Form 5500
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
012345678
ABCDEFGHI
Part I Information on interests in MTIAs, CCTs, PSAs, and 103-12 IEs (to be completed by plans and DFEs)
(Complete as many entries as needed to report all interests in DFEs)
a Name of MTIA, CCT, PSA, or 103-12 IE:
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
b Name of sponsor of entity listed in (a):
ABCDEFGHI
Entity
d
e Dollar value of interest in MTIA, CCT, PSA, or
c EIN-PN 123456789-123
1
-123456789012345
code
103-12 IE at end of year (see instructions)

d

123456789-123

d
123456789-123

d
123456789-123

d
123456789-123

Entity
code

Entity
code

Entity
code

Entity
code

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500.

Schedule D (Form 5500) 2009
v.092308.1

Page 2-

Schedule D (Form 5500) 2009

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

a

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

b

Name of sponsor of entity listed in (a):

c

EIN-PN

d
123456789-123

d
123456789-123

d
123456789-123

d
123456789-123

d
123456789-123

Entity
code

Entity
code

Entity
code

Entity
code

Entity
code

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

R

d

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

D

123456789-123

Entity
code

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

T

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

AF

a

d

123456789-123

d
123456789-123

d
123456789-123

d
123456789-123

Entity
code

Entity
code

Entity
code

Entity
code

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI
e Dollar value of interest in MTIA, CCT, PSA, or
1
-123456789012345
103-12 IE at end of year (see instructions)

Page 3-

Schedule D (Form 5500) 2009
6

Part II

Information on Participating Plans (to be completed by DFEs)
(Complete as many entries as needed to report all participating plans)

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

a

Plan name

b

Name of
plan sponsor

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI ABCDEFGHI
123456789-123
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

T

Name of
plan sponsor

ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN
ABCDEFGHI
123456789-123

AF

b

ABCDEFGHI
ABCDEFGHI
ABCDEFGHI
ABCDEFGHI

R

Plan name

D

a
File Type	application/pdf
File Title	Microsoft Word - DEL 22 Final PY 2009 and PY 2010 Form-Schedule Proofs Resubmission.doc
Author	hickk2
File Modified	2009-06-29
File Created	2009-05-05