Form 5500 Schedule Multiple-Employer Retirement Plan Information

SCHEDULE MEP (Form 5500) Department of the Treasury Internal Revenue Service ________________________

MULTIPLE-EMPLOYER RETIREMENT PLAN INFORMATION This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA) and Section 6058(a) of the Internal Revenue Code (the Code) File as an attachment to Form 5500.

OMB Nos. 1210-XXXX 1210-XXXX ____________________________

2023 ____________________________

Department of Labor Employee Benefits Security Administration

This Form is Open to Public Inspection

For calendar plan year 2023 or fiscal plan year beginning and ending

A

Name of plan

B

Three-digit Plan number (PN) 4

C

Plan administrator’s name as shown on line 3a of Form 5500/Form 5500-SF

D

Administrator’s EIN

Part I

Type of Multiple-Employer Pension Plan. All multiple-employer pension plans must complete.

1 Check the appropriate box to indicate type of multiple-employer pension plan. (Only defined contribution plans may check lines 1a, 1b, and 1c. Defined benefit plans and defined contribution plans not checking lines 1a, 1b, or 1c should check line 1d. See Instructions).

a

association retirement plan (See 29 CFR 2510.3-55) (Complete Part II)

b

professional employer organization plan (PEO Plan) (See 29 CFR 29 CFR 2510.3-55) (Complete Part II)

c

pooled employer plan (PEP) (See 29 CFR 2510.3-44) (Complete Parts II and III)

d

other multiple-employer pension plan (Describe)____________________________________________________ (Complete Part II)

Part II

Participating Employer Information.

2 All multiple-employer pension plans that are subject to section 210(a) of ERISA (see instructions for filing the Form 5500) must complete Part II, in addition to Part I, in accordance with the instructions, to report the information for each employer participating in the multiple-employer pension plan. Defined contribution plans must complete lines 2a-2d. All other multiple-employer pension plans complete lines 2a-2c only. Complete as many entries as needed to list the required information for each participating employer that is not an individual person (see instructions).

2a Name of Participating Employer

2b EIN

2c Percentage of Total Contributions for the Plan Year

2d Aggregate Account Balances Attributable to Participating Employer

2a Name of Participating Employer

2b EIN

2c Percentage of Total Contributions for the Plan Year

2d Aggregate Account Balances Attributable to Participating Employer

CAUTION Do not individually list information for working owners (see instructions and 29 CFR 2510.3-55(d)(2)) or other individuals who are participants or beneficiaries in the plan or arrangement that are no longer associated with a particular participating employer or participating employer plan (see instructions). Providing identifying information for individuals may result in rejection of this filing. If there are any such individuals in the plan, answer “Yes” to line 2e and provide the total information for all such individuals, without providing names or other identifying information.

2e

Does the plan include any individuals not participating through an employer or who are individual working owners?

2e

Yes No

2f

If you answer “Yes” in line 2e, enter a good faith estimate of the percentage of total contributions made by all such individuals that are not listed on line 2a during the plan year.

2f

2g

If you answer “Yes” in Line 2e, enter the aggregate account balances for all such individuals that are not listed on line 2a.

2g

For Paperwork Reduction Act Notice, see the Instructions for Form 5500.

Schedule MEP (2023) v. 230127

Part III		Pooled Employer Plan Information
Line 3. All Pooled employer plans must answer all of the questions in Part III, in addition to completing all of Parts I and II.
3a	Is the pooled plan provider (identified as the plan sponsor and administrator in Part II of the Form 5500) currently in compliance with the Form PR (Pooled Plan Provider Registration Statement) requirements? (See instructions and 29 CFR 2510.3-44)		Yes No
3b	If line 3a is “Yes”, enter the ACK ID for the most recent Form PR that was required to be filed under the Form PR filing requirements. (Failure to enter a valid ACK ID will subject the Form 5500 filing to rejection as incomplete.) ACK ID