Document
2020 Sch SB

ICR 202101-1210-001 · OMB 1210-0110 · Object 107636401.
This document may belong to an older filing. More recent activity for OMB 1210-0110:
Document Viewer [docx]

Status: Original and derived artifacts are available for this document.
Download: docx | pdf | html
Primary: docxSource: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Loading document viewer…
Document Metadata

Record metadata
File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	2020 Sch SB
Author	Bruce Silver
Last Modified By	Writer
File Modified	2020-02-03
File Created	2026-09-01
Conversion State	complete
Extracted Text

SCHEDULE SB
(Form 5500)
Department of the Treasury
Internal Revenue Service
Department of Labor
Employee Benefits Security Administration
Pension Benefit Guaranty Corporation
Single-Employer Defined Benefit Plan Actuarial Information

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).
 File as an attachment to Form 5500 or 5500-SF.
OMB No. 1210-0110

2020

This Form is Open to Public Inspection
For calendar plan year 2020 or fiscal plan year beginning                                                                            and ending                                                      
Round off amounts to nearest dollar.
Caution: A penalty of $1,000 will be assessed for late filing of this report unless reasonable cause is established.
A  Name of plan
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
B	Three-digit
plan number (PN)         
001


C  Plan sponsor’s name as shown on line 2a of Form 5500 or 5500-SF
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
D    Employer Identification Number (EIN)
012345678
E  Type of plan:   X  Single     X  Multiple-A    X  Multiple-B

F  Prior year plan size:  X  100 or fewer    X  101-500   X  More than 500
Part I
  Basic Information 

3	Funding target/participant count breakdown

(1) Number of participants
(2) Vested Funding Target
(3) Total Funding Target
	a For retired participants and beneficiaries receiving payment	.



	b For terminated vested participants	



c For active participants	



	d Total	



4	If the plan is in at-risk status, check the box and complete lines (a) and (b)	X

a Funding target disregarding prescribed at-risk assumptions	
4a
-123456789012345
b Funding target reflecting at-risk assumptions, but disregarding transition rule for plans that have been in
at-risk status for fewer than five consecutive years and disregarding loading factor	
4b
-123456789012345
5	Effective interest rate	
5
123.12%
6	Target normal cost	
6
-123456789012345
Statement by Enrolled Actuary
	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
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDE

YYYY-MM-DD
Type or print name of actuary

Most recent enrollment number
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDE

1234567
Firm name

Telephone number (including area code)
123456789 ABCDEFGHI ABCDEFGHI ABCDE
123456789 ABCDEFGHI ABCDEFGHI ABCDE
UK

1234567890
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
X
For Paperwork Reduction Act Notice, see the Instructions for Form 5500 or 5500-SF.


Schedule SB (Form 5500) 2020 
v. 200204





Part II
  Beginning of Year Carryover and Prefunding Balances

(a) Carryover balance
(b)  Prefunding balance
 7	Balance at beginning of prior year after applicable adjustments (line 13 from prior year)	
-123456789012345
-123456789012345
 8	Portion elected for use to offset prior year’s funding requirement (line 35 from prior year) 	  
-123456789012345
-123456789012345
 9	Amount remaining (line 7 minus line 8)	
-123456789012345
-123456789012345
10	Interest on line 9 using prior year’s actual return of                   %	
-123456789012345
-123456789012345
11	Prior year’s excess contributions to be added to prefunding balance:


	a Present value of excess contributions (line 38a from prior year)	

-123456789012345
	b(1) Interest on the excess, if any, of line 38a over line 38b from prior year   
             Schedule SB, using prior year's effective interest rate of                   %	
	b(2) Interest on line 38b from prior year Schedule SB, using prior year's actual     
                  return	
      	c Total available at beginning of current plan year to add to prefunding balance	
   

-123456789012345






	d Portion of (c) to be added to prefunding balance	

-123456789012345
	

-123456789012345
12	Other reductions in balances due to elections or deemed elections	
-123456789012345
-123456789012345
13	Balance at beginning of current year (line 9 + line 10 + line 11d – line 12)	
-123456789012345
-123456789012345
Part III
  Funding Percentages
14	Funding target attainment percentage	
14
123.12%
15	Adjusted funding target attainment percentage	
15
123.12%
16	Prior year’s funding percentage for purposes of determining whether carryover/prefunding balances may be used to reduce current year’s funding requirement	
16
123.12%
17	If the current value of the assets of the plan is less than 70 percent of the funding target, enter such percentage.	
17
123.12%
Part IV
  Contributions and Liquidity Shortfalls
18	Contributions made to the plan for the plan year by employer(s) and employees:
 (a) Date 
(MM-DD-YYYY)
(b) Amount paid by employer(s)
(c) Amount paid by employees
(a) Date 
(MM-DD-YYYY)
(b) Amount paid by employer(s)
(c) Amount paid by employees






YYYY-MM-DD
123456789012345

123456789012345

YYYY-MM-DD

123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
YYYY-MM-DD
123456789012345

123456789012345

YYYY-MM-DD

123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
YYYY-MM-DD
123456789012345

123456789012345

YYYY-MM-DD

123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
YYYY-MM-DD
123456789012345

123456789012345

YYYY-MM-DD

123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
123456789012345-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
-123456789012345
YYYY-MM-DD
123456789012345

123456789012345





Totals  ►
  18(b)

18(c)


Liquidity shortfall as of end of quarter of this plan year
(1)   1st
(2)	2nd
(3)	3rd
(4)	4th


-123456789012345
-123456789012345
-123456789012345
-123456789012345


Part V
Assumptions Used to Determine Funding Target and Target Normal Cost
21	Discount rate:
	a  Segment rates:
1st segment:
123.12_%
2nd segment:
123.12_%
3rd segment:
123.12 %
X N/A, full yield curve used
	b Applicable month (enter code)	
21b
1
22	Weighted average retirement age	
22
12
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 regarding required 
	attachment.	X Yes X No
25	Has a method change been made for the current plan year?  If “Yes,” see instructions regarding required attachment.	X Yes X No
26	Is the plan required to provide a Schedule of Active Participants?  If “Yes,” see instructions regarding required attachment.	X Yes X No
27	If the plan is subject to alternative funding rules, enter applicable code and see instructions regarding attachment	
27

Part VII
Reconciliation of Unpaid Minimum Required Contributions For Prior Years
28	Unpaid minimum required contributions for all prior years	
28
-123456789012345
29	Discounted employer contributions allocated toward unpaid minimum required contributions from prior years (line 19a)	 
29
-123456789012345
30	Remaining amount of unpaid minimum required contributions (line 28 minus line 29)	
30
-123456789012345
Part VIII
Minimum Required Contribution For Current Year
31   Target normal cost and excess assets (see instructions):
	   a Target normal cost (line 6)	
31a
-123456789012345
      b Excess assets, if applicable, but not greater than line 31a 	
31b

32	Amortization installments:
Outstanding Balance
Installment
a Net shortfall amortization installment	
-123456789012345
-123456789012345
b Waiver amortization installment	
-123456789012345
-123456789012345
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
-123456789012345
34	Total funding requirement before reflecting carryover/prefunding balances (lines 31a - 31b + 32a + 32b - 33).....
34
-123456789012345
	
Carryover balance
Prefunding balance
Total balance
35	Balances elected for use to offset funding requirement	
-123456789012345
-123456789012345
-123456789012345
36	Additional cash requirement (line 34 minus line 35)	
36
-123456789012345
37	Contributions allocated toward minimum required contribution for current year adjusted to valuation date (line 19c)	
37
-123456789012345
38	Present value of excess contributions for current year (see instructions)
-123456789012345
      a Total (excess, if any, of line 37 over line 36) 	
38a

      b Portion included in line 38a attributable to use of prefunding and funding standard carryover balances 	
38b

39	Unpaid minimum required contribution for current year (excess, if any, of line 36 over line 37)	
39
-123456789012345
40	Unpaid minimum required contributions for all years	
40
-123456789012345
Part IX
Pension Funding Relief Under Pension Relief Act of 2010 (See Instructions)
41  If an election was made to use PRA 2010 funding relief for this plan:
      a Schedule elected 	   2 plus 7 years      X 15 years
      b Eligible plan year(s) for which the election in line 41a was made 	 X 2008   X 2009  X 2010  X  2011