Form 5500 Schedule Multiemployer Defined Benefit Plans and Certain Money Pu

SCHEDULE MB (Form 5500) Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Administration Pension Benefit Guaranty Corporation		Multiemployer Defined Benefit Plan and Certain Money Purchase 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 2021 This Form is Open to Public Inspection
For calendar plan year 2021 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: (1) X Multiemployer Defined Benefit (2) X Money Purchase (see instructions)
1a Enter the valuation date: Month _________ Day _________ Year _________
b Assets
(1) Current value of assets						1b(1)
(2) Actuarial value of assets for funding standard account						1b(2)
c (1) Accrued liability for plan using immediate gain methods						1c(1)
(2) Information for plans using spread gain methods:
(a) Unfunded liability for methods with bases						1c(2)(a)		-123456789012345
(b) Accrued liability under entry age normal method						1c(2)(b)		-123456789012345
(c) Normal cost under entry age normal method						1c(2)(c)		-123456789012345
(3) Accrued liability under unit credit cost method						1c(3)		-123456789012345
d Information on current liabilities of the plan:
(1) Amount excluded from current liability attributable to pre-participation service (see instructions)						1d(1)		-123456789012345
(2) “RPA ‘94” information:
(a) Current liability						1d(2)(a)		-123456789012345
(b) Expected increase in current liability due to benefits accruing during the plan year						1d(2)(b)		-123456789012345
(c) Expected release from “RPA ‘94” current liability for the plan year						1d(2)(c)		-123456789012345
(3) Expected plan disbursements for the plan year						1d(3)		-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
Type or print name of actuary				Most recent enrollment number
Firm name				Telephone number (including area code)
123456789 ABCDEFGHI ABCDEFGHI ABCDE 123456789 ABCDEFGHI ABCDEFGHI ABCDE UK
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 MB (Form 5500) 2021 v. 201209

2 Operational information as of beginning of this plan year:
a Current value of assets (see instructions) ................................................................................................... …………………………………………………………………………………………………………………………………		2a	-123456789012345
b “RPA ‘94” current liability/participant count breakdown:	(1) Number of participants		(2) Current liability
(1) For retired participants and beneficiaries receiving payment	12345678		-123456789012345
(2) For terminated vested participants	12345678		-123456789012345
(3) For active participants:
(a) Non-vested benefits			-123456789012345
(b) Vested benefits			-123456789012345
(c) Total active			-123456789012345
(4) Total	12345678		-123456789012345
c If the percentage resulting from dividing line 2a by line 2b(4), column (2), is less than 70%, enter such percentage		2c	123.12%
3 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
	Totals
			Totals ►	3(b)		3(c)
(d) Total withdrawal liability amounts included in line 3(b) total						3(d)

4 Information on plan status:
a Funded percentage for monitoring plan’s status (line 1b(2) divided by line 1c(3))	4a	%
b Enter code to indicate plan’s status (see instructions for attachment of supporting evidence of plan’s status). If entered code is “N,” go to line 5 ………………………………………………………………………………………..	4b
c Is the plan making the scheduled progress under any applicable funding improvement or rehabilitation plan? X Yes X No
d If the plan is in critical status or critical and declining status, were any benefits reduced (see instructions)? X Yes X No
e If line d is “Yes,” enter the reduction in liability resulting from the reduction in benefits (see instructions), measured as of the valuation date	4e	-123456789012345
f If the rehabilitation plan projects emergence from critical status or critical and declining status, enter the plan year in which it is projected to emerge. If the rehabilitation plan is based on forestalling possible insolvency, enter the plan year in which insolvency is expected and check here …………………………….......................................................................................	4f
5 Actuarial cost method used as the basis for this plan year’s funding standard account computations (check all that apply):

a X Attained age normal	b X Entry age normal	c X Accrued benefit (unit credit)			d X Aggregate
e X Frozen initial liability	f X Individual level premium	g X Individual aggregate			h X Shortfall
i X Other (specify):_ ____________________________________________________________________________
j If box h is checked, enter period of use of shortfall method			5j	YYYY-MM-DD
k Has a change been made in funding method for this plan year? X Yes X No
l If line k is “Yes,” was the change made pursuant to Revenue Procedure 2000-40 or other automatic approval? X Yes X No
m If line k is “Yes,” and line l is “No,” enter the date (MM-DD-YYYY) of the ruling letter (individual or class) approving the change in funding method			5m	YYYY-MM-DD

6 Checklist of certain actuarial assumptions:
a Interest rate for “RPA ‘94” current liability.						6a	123.12%
		Pre-retirement			Post-retirement
b Rates specified in insurance or annuity contracts		X Yes X No X N/A			X Yes X No X N/A
c Mortality table code for valuation purposes:
(1) Males	6c(1)
(2) Females	6c(2)
d Valuation liability interest rate	6d	123.12%			123.12%
e Expense loading	6e	123.12%	X N/A		123.12%			X N/A
f Salary scale	6f	123.12%	X N/A
g Estimated investment return on actuarial value of assets for year ending on the valuation date				6g	-123.1%
h Estimated investment return on current value of assets for year ending on the valuation date				6h	-123.1%

7 New amortization bases established in the current plan year:
(1) Type of base	(2) Initial balance			(3) Amortization Charge/Credit
A	-123456789012345			-123456789012345
A	-123456789012345			-123456789012345
A	-123456789012345			-123456789012345
8 Miscellaneous information:
a If a waiver of a funding deficiency has been approved for this plan year, enter the date (MM-DD-YYYY) of the ruling letter granting the approval					8a		YYYY-MM-DD
b(1) Is the plan required to provide a projection of expected benefit payments? (See the instructions.) If “Yes,” attach a schedule.							X Yes X No
b(2) Is the plan required to provide a Schedule of Active Participant Data? (See the instructions.) If “Yes,” attach a schedule.						X Yes X No
c Are any of the plan’s amortization bases operating under an extension of time under section 412(e) (as in effect prior to 2008) or section 431(d) of the Code? .							X Yes X No
d If line c is “Yes,” provide the following additional information:
(1) Was an extension granted automatic approval under section 431(d)(1) of the Code?					X Yes X No
(2) If line 8d(1) is “Yes,” enter the number of years by which the amortization period was extended					8d(2)		12
(3) Was an extension approved by the Internal Revenue Service under section 412(e) (as in effect prior to 2008) or 431(d)(2) of the Code?							X Yes X No
(4) If line 8d(3) is “Yes,” enter number of years by which the amortization period was extended (not including the number of years in line (2))					8d(4)		12
(5) If line 8d(3) is “Yes,” enter the date of the ruling letter approving the extension					8d(5)		YYYY-MM-DD
(6) If line 8d(3) is “Yes,” is the amortization base eligible for amortization using interest rates applicable under section 6621(b) of the Code for years beginning after 2007?							X Yes X No
e If box 5h is checked or line 8c is “Yes,” enter the difference between the minimum required contribution for the year and the minimum that would have been required without using the shortfall method or extending the amortization base(s)					8e		-123456789012345
9 Funding standard account statement for this plan year:
Charges to funding standard account:
a Prior year funding deficiency, if any					9a		-123456789012345
b Employer’s normal cost for plan year as of valuation date					9b		-123456789012345
c Amortization charges as of valuation date:			Outstanding balance
(1) All bases except funding waivers and certain bases for which the amortization period has been extended		9c(1)	-123456789012345				-123456789012345
(2) Funding waivers		9c(2)	-123456789012345				-123456789012345
(3) Certain bases for which the amortization period has been extended		9c(3)	-123456789012345				-123456789012345
d Interest as applicable on lines 9a, 9b, and 9c					9d		-123456789012345
e Total charges. Add lines 9a through 9d					9e		-123456789012345
Credits to funding standard account:
f Prior year credit balance, if any					9f		-123456789012345
g Employer contributions. Total from column (b) of line 3					9g		-123456789012345
			Outstanding balance
h Amortization credits as of valuation date		9h	-123456789012345				-123456789012345
i Interest as applicable to end of plan year on lines 9f, 9g, and 9h					9i		-123456789012345

j Full funding limitation (FFL) and credits:
(1) ERISA FFL (accrued liability FFL)	9j(1)	-123456789012345
(2) “RPA ‘94” override (90% current liability FFL)	9j(2)	-123456789012345
(3) FFL credit			9j(3)	-123456789012345
k (1) Waived funding deficiency			9k(1)	-123456789012345
(2) Other credits			9k(2)	-123456789012345
l Total credits. Add lines 9f through 9i, 9j(3), 9k(1), and 9k(2)			9l	-123456789012345
m Credit balance: If line 9l is greater than line 9e, enter the difference			9m	-123456789012345
n Funding deficiency: If line 9e is greater than line 9l, enter the difference			9n	-123456789012345

9 o Current year’s accumulated reconciliation account:
(1) Due to waived funding deficiency accumulated prior to the 2021 plan year	9o(1)	-123456789012345
(2) Due to amortization bases extended and amortized using the interest rate under section 6621(b) of the Code:
(a) Reconciliation outstanding balance as of valuation date	9o(2)(a)	-123456789012345
(b) Reconciliation amount (line 9c(3) balance minus line 9o(2)(a))	9o(2)(b)	-123456789012345
(3) Total as of valuation date	9o(3)	-123456789012345
10 Contribution necessary to avoid an accumulated funding deficiency. (See instructions.)	10	-123456789012345
11 Has a change been made in the actuarial assumptions for the current plan year? If “Yes,” see instructions. ..		X Yes X No