Document
SFA Template 3
ICR 202609-1212-001 · OMB 1212-0074 · Object 172909801.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | SFA Template 3 |
| Author | Day Stacey |
| Last Modified By | Calc |
| File Modified | 2024-03-25 |
| File Created | 2026-09-12 |
| Conversion State | complete |
Extracted Text
TEMPLATE 3 File name: Template 3 Pension Plan Name, where "Pension Plan Name" is an abbreviated version of the plan name. Historical Plan Information For supplemental submission due to merger under § 4262.4(f)(1)(ii): Template 3 Pension Plan Name Merged, where "Pension Plan Name Merged" is an abbreviated version of the plan name for the separate plan involved in the merger. v20210706p Provide historical plan information for each of the most recent 10 plan years immediately preceding the application filing date that separately identifies: total contributions, total contribution base units (including identification of the base unit used (i.e., hourly, weekly)), average contribution rates, and number of active participants at the beginning of each plan year. Also show separately for each of the most recent 10 plan years immediately preceding the application filing date all other sources of noninvestment income, including, if applicable, withdrawal liability payments collected, reciprocity contributions (if applicable), additional contributions from the rehabilitation plan (if any), and other identifiable contribution streams. If the sum of all contributions and withdrawal liabilities shown on this table does not equal the amount shown as contributions credited to the funding standard account on the plan year Schedule MB of Form 5500, include an explanation as a footnote to this table. PLAN INFORMATION Abbreviated Plan Name: EIN: PN: Unit (e.g. hourly, weekly) All Other Sources of Non-Investment Income Plan Year (in order from oldest to most recent) Plan Year Start Date Plan Year End Date Total Contributions* Total Contribution Base Units Average Contribution Rate Reciprocity Contributions (if applicable) Additional Rehab Plan Contributions (if applicable) * Total contributions shown here should be contributions based upon CBUs and should not include items separately shown in any columns under "All Other Sources of Non-Investment Income." Other - Explain if Applicable Withdrawal Liability Payments Collected Number of Active Participants at Beginning of Plan Year