SFA Template 5B

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TEMPLATE 5B

v20220802p

Baseline - for MPRA plans for which the requested amount of SFA is determined under the "present value method"
File name: Template 5B Plan Name, where "Plan Name" is an abbreviated version of the plan name.
Instructions for Addendum D of the Instructions for Filing Requirements for Multiemployer Plans Applying for Special Financial Assistance:
This Template 5B is not required if all assumptions and methods used to develop the benefit payment projections and used in determining the requested SFA amount
are identical to those used in the most recent actuarial certification of plan status completed before 1/1/2021 ("pre-2021 certification of plan status"), except the SFA
interest rate, and except any assumptions that were changed in accordance with Section III, Acceptable Assumption Changes in PBGC's SFA assumptions guidance
(other than the acceptable assumption change for "missing" terminated vested participants described in Section III.E. of PBGC's SFA assumptions guidance).

Provide a separate deterministic projection ("Baseline") using the same calculation methodology used to determine the requested SFA amount, in the same format as
Template 4B (Sheets 4B-1 and 4B-2) that shows the amount of SFA that would be determined if all underlying assumptions used in the projection were the same as
those used in the pre-2021 certification of plan status, except the plan's SFA interest rate, which should be the same as used in Template 4B (Sheet 4B-2).

For purposes of this Template 5B, any assumption change made in accordance with Section III, Acceptable Assumption Changes, in PBGC's SFA assumptions
guidance should be reflected in this Baseline calculation of the SFA amount and supporting projection information, except that an assumption change for “missing”
terminated vested participants described in Section III.E of PBGC’s SFA assumptions guidance should not be reflected in the Baseline projections. See examples in
the SFA instructions for Section C, Item (5).

Additional instructions for each individual worksheet:
Sheet
5B-1

Baseline - Benefit Payments for MPRA plans for which the requested amount of SFA is determined under the "present value method"

See Template 4B instructions for Sheet 4B-1, except provide the benefit payment projection used to determine the Baseline SFA amount under the "present value
method" described in § 4262.4(a)(2)(ii).

5B-2

Baseline - Details for the "present value method" under § 4262.4(a)(2)(ii) for MPRA plans for which the requested amount of SFA is determined
under that method

See Template 4B instructions for Sheet 4B-2, except provide the projection used to determine the Baseline SFA amount under the "present value method" described
in § 4262.4(a)(2)(ii).

Version Updates (newest version at top)
Version

Date updated

v20220802p

8/2/2022

v20220701p

7/1/2022

Updated instructions in this sheet to specify that any assumption changes for "missing" terminated vested participants
should not be reflected in the Baseline projections. Also made cosmetic changes to increase the size of some rows

TEMPLATE 5B - Sheet 5B-1

v20220802p

Baseline - Benefit Payments for MPRA plans for which the requested amount of SFA is determined under the "present value method"
See Template 4B instructions for Sheet 4B-1, except provide the benefit payment projection used to determine the Baseline SFA amount.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
SFA Measurement Date:
On this Sheet, show all benefit payment amounts as positive amounts.
PROJECTED BENEFIT PAYMENTS for:
Current Retirees and Beneficiaries in Pay Status

SFA Measurement
Date / Plan Year Start
Date

Plan Year End Date

Current Terminated Vested Participants

(1)

(2)

(3)

Benefit Payments after
Reinstatement

Reduced Benefit
Payments under the
Approved Suspension

Difference in Benefit
Payments due to
Reinstatement
(1) - (2)

Current Active Participants

(4)

(5)

(6)

Benefit Payments after
Reinstatement

Reduced Benefit
Payments under the
Approved Suspension

Difference in Benefit
Payments due to
Reinstatement
(4) - (5)

New Entrants

(7)

(8)

(9)

Benefit Payments after
Reinstatement

Reduced Benefit
Payments under the
Approved Suspension

Difference in Benefit
Payments due to
Reinstatement
(7) - (8)

Total

(10)

(13)

(14)

(15)

Projected Benefit
Payments

Benefit Payments after
Reinstatement
(1) + (4) + (7) + (10)

Reduced Benefit
Payments under the
Approved Suspension
(2) + (5) + (8) + (10)

Difference in Benefit
Payments due to
Reinstatement
(13) - (14)

TEMPLATE 5B - Sheet 5B-2

v20220802p

Baseline - Details for the "present value method" under § 4262.4(a)(2)(ii) for MPRA plans for which the requested amount of SFA is determined under that
method
See Template 4B instructions for Sheet 4B-2, except provide the projection used to determine the Baseline SFA amount.
PLAN INFORMATION
Abbreviated
Plan Name:
EIN:
PN:
MPRA Plan?
If a MPRA Plan, which
method yields the
greatest amount of SFA?
SFA Measurement Date:
SFA Amount as of the
SFA Measurement Date
under the method
calculated in this Sheet:
SFA Interest Rate:
PRESENT VALUE as of the SFA Measurement
Date of Projected Amounts for:
PV of (1)

PV of (2)

Difference in Benefit
Payments due to
Reinstatement

Make-up Payments
Attributable to
Reinstatement of
Benefits Suspended
through the SFA
Measurement Date

On this Sheet, show all benefit payment amounts
as positive amounts.

SFA Measurement
Date / Plan Year Start
Date

Plan Year End Date

(1)

(2)

Difference in Benefit
Payments due to
Reinstatement (should
match total from Sheet
5B-1)

Make-up Payments
Attributable to
Reinstatement of
Benefits Suspended
through the SFA
Measurement Date