SCHEDULE R(Form 5500)Department of the Treasury Internal Revenue Service
Department
of Labor Pension Benefit Guaranty Corporation |
Retirement Plan Information
This schedule is required to be filed under sections 104 and 4065 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 No. 1210-0110
This Form is Open to Public Inspection. |
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For calendar plan year 2024 or fiscal plan year beginning and ending |
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A Name of plan ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI |
B
Three-digit |
001 |
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C Plan sponsor’s name as shown on line 2a of Form 5500 ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI |
D
Employer Identification Number (EIN) |
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Part I |
Distributions |
All references to distributions relate only to payments of benefits during the plan year. |
1 Total value of distributions paid in property other than in cash or the forms of property specified in the instructions……………………………………………………………………………………………………………...... |
1 |
-123456789012345 |
2 Enter the EIN(s) of payor(s) who paid benefits on behalf of the plan to participants or beneficiaries during the year (if more than two, enter EINs of the two payors who paid the greatest dollar amounts of benefits): |
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EIN(s): |
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Profit-sharing plans, ESOPs, and stock bonus plans, skip line 3. |
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3 Number of participants (living or deceased) whose benefits were distributed in a single sum, during the plan year |
3 |
12345678 |
Part II |
Funding Information (If the plan is not subject to the minimum funding requirements of section 412 of the Internal Revenue Code or ERISA section 302, skip this Part.) |
4 Is the plan administrator making an election under Code section 412(d)(2) or ERISA section 302(d)(2)? |
X Yes |
X No |
X N/A |
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If the plan is a defined benefit plan, go to line 8. |
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5 If
a waiver of the minimum funding standard for a prior year is being
amortized in this |
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Date: Month _________ Day _________ Year _________ |
If you completed line 5, complete lines 3, 9, and 10 of Schedule MB and do not complete the remainder of this schedule. |
6 a Enter the minimum required contribution for this plan year (include any prior year accumulated funding deficiency not waived) |
6a |
-123456789012345 |
b Enter the amount contributed by the employer to the plan for this plan year |
6b |
-123456789012345 |
c
Subtract the amount in line 6b from the amount in line 6a.
Enter the result |
6c |
-123456789012345 |
If you completed line 6c, skip lines 8 and 9. |
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7 Will the minimum funding amount reported on line 6c be met by the funding deadline? |
X Yes |
X No |
X N/A |
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8 If a change in actuarial cost method was made for this plan year pursuant to a revenue procedure or other authority providing automatic approval for the change or a class ruling letter, does the plan sponsor or plan administrator agree with the change? |
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X Yes |
X No |
X N/A |
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Part III |
Amendments |
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9 If this is a defined benefit pension plan, were any amendments adopted during this plan year that increased or decreased the value of benefits? If yes, check the appropriate box. If no, check the “No” box. |
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X Increase |
X Decrease |
X Both |
X No |
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Part IV |
ESOPs (see instructions). If this is not a plan described under section 409(a) or 4975(e)(7) of the Internal Revenue Code, skip this Part. |
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10 Were unallocated employer securities or proceeds from the sale of unallocated securities used to repay any exempt loan? |
X Yes |
X No |
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11 a Does the ESOP hold any preferred stock? |
X Yes |
X No |
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b If
the ESOP has an outstanding exempt loan with the employer as
lender, is such loan part of a “back-to-back” loan?
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X Yes |
X No |
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12 Does the ESOP hold any stock that is not readily tradable on an established securities market? |
X Yes |
X No |
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For Paperwork Reduction Act Notice, see the Instructions for Form 5500. |
Schedule R (Form 5500) 2024 v. 240311 |
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Part V |
Additional Information for Multiemployer Defined Benefit Pension Plans |
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13 Enter the following information for each employer that (1) contributed more than 5% of total contributions to the plan during the plan year or (2) was one of the top-ten highest contributors (measured in dollars). See instructions. Complete as many entries as needed to report all applicable employers. |
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a Name of contributing employer |
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b EIN |
c Dollar amount contributed by employer |
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d Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box X and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month _______ Day _______ Year _______ |
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e Contribution rate information (If more than one rate applies, check this box X and see instructions regarding required attachment. Otherwise, complete lines 13e(1) and 13e(2).)(1) Contribution rate (in dollars and cents) _____________ (2) Base unit measure: X Hourly X Weekly X Unit of production X Other (specify): |
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a Name of contributing employer |
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b EIN |
c Dollar amount contributed by employer |
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d Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box X and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month _______ Day _______ Year _______ |
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e Contribution rate information (If more than one rate applies, check this box X and see instructions regarding required attachment. Otherwise, complete lines 13e(1) and 13e(2).)(1) Contribution rate (in dollars and cents) _____________ (2) Base unit measure: X Hourly X Weekly X Unit of production X Other (specify): _______________________________ |
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a Name of contributing employer |
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b EIN |
c Dollar amount contributed by employer |
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d Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box X and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month _______ Day _______ Year _______ |
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e Contribution rate information (If more than one rate applies, check this box X and see instructions regarding required attachment. Otherwise, complete lines 13e(1) and 13e(2).)(1) Contribution rate (in dollars and cents) _____________ (2) Base unit measure: X Hourly X Weekly X Unit of production X Other (specify): _______________________________ |
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a Name of contributing employer |
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b EIN |
c Dollar amount contributed by employer |
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d Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box X and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month _______ Day _______ Year _______ |
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e Contribution rate information (If more than one rate applies, check this box X and see instructions regarding required attachment. Otherwise, complete lines 13e(1) and 13e(2).)(1) Contribution rate (in dollars and cents) _____________ (2) Base unit measure: X Hourly X Weekly X Unit of production X Other (specify): _______________________________ |
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a Name of contributing employer |
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b EIN |
c Dollar amount contributed by employer |
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d Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box X and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month _______ Day _______ Year _______ |
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e Contribution rate information (If more than one rate applies, check this box X and see instructions regarding required attachment. Otherwise, complete lines 13e(1) and 13e(2).)(1) Contribution rate (in dollars and cents) _____________ (2) Base unit measure: X Hourly X Weekly X Unit of production X Other (specify): _______________________________ |
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a Name of contributing employer |
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b EIN |
c Dollar amount contributed by employer |
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d Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box X and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month _______ Day _______ Year _______ |
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e Contribution rate information (If more than one rate applies, check this box X and see instructions regarding required attachment. Otherwise, complete lines 13e(1) and 13e(2).)(1) Contribution rate (in dollars and cents) _____________ (2) Base unit measure: X Hourly X Weekly X Unit of production X Other (specify): _______________________________ |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | 2024 Schedule R |
Author | United States Department of Labor |
File Modified | 0000-00-00 |
File Created | 2024-07-27 |