Annual Information Return/Report

PBGC Proposed Changes to the Form 5500 Schedule MB Instructions for 2015
(RLSO Based on Clean Version of 2014 Form 5500 Instructions)

Form 5500 Schedule MB Instructions
Line 4. Information on Plan Status. All multiemployer plans regardless of the number of participants
must provide the information indicated in accordance with these instructions.
Line 4a. All plans enter the funded percentage for monitoring the plan’s status. This is line 1b(2)
divided by line 1c(3). Enter the code for the status of the plan of the multiemployer plan for the plan
year, as certified by the plan actuary, using one of the following codes:
Code
Plan Status
E
Endangered Status
S
Seriously Endangered Status
C
Critical Status
N
Not in Endangered or Critical Status
______________________________________________________________________________
If the plan is certified to be in endangered status, seriously endangered status, or critical status,
attach a copy of the actuarial certification of such status to this Schedule MB. Also, attach an illustration
showing the details providing support for the actuarial certification of status and label the illustration
“Schedule MB, line 4a – Illustration Supporting Actuarial Certification of Status.” For example, if a plan
is certified to be in critical status based on Code section 432(b)(2)(B), show the funded percentage (if
applicable) and the projection of the funding standard account for the year where the accumulated
funding deficiency occurs.
Line 4b. Enter the code for the status of the multiemployer plan for the plan year, as certified by the
plan actuary (or as elected by the plan sponsor in accordance with Code section 432(b)(4)(A) and ERISA
section 305(b)(4)(A)), using one of the following codes:
Code
Plan Status
E
Endangered Status
S
Seriously Endangered Status
C
Critical Status
D
Critical and Declining Status
N
Not in Endangered or Critical Status
______________________________________________________________________________
If the plan is certified to be in endangered status, seriously endangered status, critical status, or
critical and declining status, attach a copy of the actuarial certification of such status to this Schedule
MB. Also, attach an illustration showing the details (including year-by-year cash flow projections
demonstrating the solvency of the plan over the relevant period if the plan is in critical and declining
status) providing support for the actuarial certification of status and label the illustration “Schedule MB,
line 4b – Illustration Supporting Actuarial Certification of Status.” For example, if a plan is certified to be
in critical status based on Code section 432(b)(2)(B), show the funded percentage (if applicable) and the

projection of the funding standard account for the year in which the accumulated funding deficiency
occurs. All supporting certifications should include descriptions of the assumptions used.
Lines 4d and 4e. If Code C (Critical Status) or Code D (Critical and Declining Status) was entered on line
4b, an entry on line 4d is required. For purposes of lines 4d and 4e, in determining whether adjustable
benefits have been reduced, only adjustable benefits that would otherwise be protected under Code
section 411(d)(6) and ERISA section 204(g) are taken into account if the plan is certified as critical status.
Plans that are certified as critical and declining status should determine whether benefits have been
reduced, including all benefits that were adjusted (only adjustable benefits that would otherwise be
protected under Code section 411(d)(6) and ERISA section 204(g) are taken into account) plus any
benefits that have been suspended under Code section 432(e)(9) including benefit reductions due to a
partition under ERISA section 4233, if applicable. For a plan that has benefits suspended under Code
section 432(e)(9) and/or partitioned under ERISA section 4233, attach a full description of the
transaction and label the attachment “Schedule MB, Lines 4d and 4e – Description of Benefit
Reductions Due to Suspension or Partition.” In addition, only adjustable benefit reductions that are
first reflected in line 1c(3) for the current year's Schedule MB should be reported, and this amount
should not include any amounts previously reported on any prior year's Schedule MB.
Line 4f. If Code C (Critical Status) or Code D (Critical and Declining Status) was entered on line 4b you
must complete line 4f. If the rehabilitation plan projects emergence from critical status or critical and
declining status, enter the plan year in which the plan is projected to emerge. If the rehabilitation plan is
based on forestalling possible insolvency, check the box provided and enter the plan year in which the
insolvency is expected.
* * * * *
Line 6c. Mortality Table. The mortality table published in section 1.431(c)(6)-1 of the Treasury
Regulations must be used in the calculation of current liability for non-disabled lives. Enter the mortality
table code for non-disabled lives used for valuation purposes as follows:
Mortality Table

Code

1951 Group Annuity……………………………………………………………...1
1971 Individual Annuity Mortality (I.A.M.)…………………………….2
1971 Group Annuity (G.A.M.)………………………………………………..3
UP-1984………………………………………………………………………………….4
1983 A.I.M……………………………………………………………………………..5
1983 G.A.M.…………………………..………………………………………………6
1983 G.A.M. (solely per Rev. Rul. 95-28)……………………………..…7
UP-1994………………………………………………………………………………….8
Mortality table applicable to current plan year under
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section 1.431(c)(6)-1 of the Income Tax Regulations…..…….…..9
RP-2000…………………………………………………………………………………10
RP-2000 (with Blue Collar Adjustment)…………………………………11
Other……………………………………………………….………………………...…A
None…………………….…………………………………………………………….…0
* * * *
Line 8b(1). Schedule of Projection of Expected Benefit Payments. Check “Yes” only if this is a
multiemployer plan covered by Title IV of ERISA that has 500 or more total participants as of the
valuation date.
If line 8b(1) is “Yes,” in an attachment, provide a projection of benefits expected to be paid for
the entire plan (not to include expected expenses) in each of the next ten years starting with the current
plan year of this filing assuming (1) no additional accruals, (2) experience (e.g., termination, mortality,
and retirement) are in line with valuation assumptions, and (3) no new entrants are covered by the plan.
Use the format shown below and label the schedule “Schedule MB, line 8b(1) – Schedule of Projection of
Expected Benefit Payments.”
Schedule MB, line 8b(1) – Schedule of Projection of Expected Benefit Payments
Plan Year
Expected Annual Benefit Payments
Current Plan Year
Current Plan Year +1
Current Plan Year +2
Current Plan Year +3
Etc….
Current Plan Year +9
Line 8b(2). Schedule of Active Participant Data. Check “Yes” only if this is a multiemployer plan covered
by Title IV of ERISA that has active participants.
If line 8b(2) is “Yes,” attach a schedule of the active plan participant data used in the valuation
for this plan year. Use the format shown below and label the schedule “Schedule MB, line 8b(2) –
Schedule of Active Participant Data.”

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