department of labor: 1996-5500inst

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Department of the Treasury Department of Labor Pension BenefitInternal Revenue Service Pension and Welfare Guaranty Corporation

Benefits Administration

96Instructions for Form 5500Annual Return/ Report of Employee Benefit Plan (With 100or more part icipants)Code references are to the Internal Revenue Code. ERISA refers to the EmployeeRetirement Income Security Act of 1974.

Paperwork Reduction Act NoticeWe ask for the information on this form to carry out the law as specified in ERISA and Codesections 6039D, 6047(e), 6057(b), and 6058(a). You are required to give us the information. Weneed it to determine whether the plan is operating according to the law.

You are not required to provide the information requested on a form that is subject to thePaperwork Reduction Act unless the form displays a valid OMB control number. Books andrecords relating to a form or its instructions must be retained as long as their contents maybecome material in the administration of the Internal Revenue Code or are required to bemaintained pursuant to Title I or IV of ERISA. Generally, the Form 5500 return/reports are opento public inspection. However, Schedules E, F, and SSA (Form 5500) are confidential, as requiredby Code section 6103.

The time needed to complete and file the forms listed below reflects the combined requirementsof the Internal Revenue Service, Department of Labor, Pension Benefit Guaranty Corporation, andthe Social Security Administration. These times will vary depending on individual circumstances.The estimated average times are:

If you have comments concerning the accuracy of these time estimates or suggestions formaking these forms simpler, we would be happy to hear from you. You can write to the Tax FormsCommittee, Western Area Distribution Center, Rancho Cordova, CA 957430001. DO NOT sendany of these forms or schedules to this address. Instead, see Where To File on page 2.

Contents

How To Get FormsBy personal computer. If you subscribe toan on-line service, ask if IRS information is

available and, if so, how to access it. Taxforms, instructions, publications, and other IRSinformation are available through IRIS, theInternal Revenue Information Services, onFedWorld, a government bulletin board. TheIRIS menus offer information on available fileformats and software needed to read and printfiles. You must print the forms to use them; theforms are not designed to be filled outon-screen.

IRIS is directly accessible by modem at7033218020. On the Internet, telnet toiris.irs.ustreas.gov or, for file transfer protocolservices, connect to ftp.irs.ustreas.gov. If youare using the World Wide Web, connect tohttp://www.irs.ustreas.gov. FedWorld's helpdesk offers technical assistance on accessingIRIS (not tax help) during regular business

hours at 7034874608.Tax forms, instructions, and publications are

also available on CD-ROM, including prior-yearforms starting with the 1991 tax year. Forordering information and softwarerequirements, contact the Government PrintingOffice's Superintendent of Documents(2025121800) or Federal Bulletin Board(2025121387).

By phone and in person.To order formsand publications, call 1800TAX-FORM(18008293676). You can also get mostforms and publications at your local IRS office.

General Instructions

Section 1

Plan YearFile 1996 forms for plan years that started in1996. If the plan year differs from the calendaryear, fill in the fiscal year space just under theform title. For a short plan year, check box A(4)and see When To File on page 2.

Electronic Filing of Form 5500Form 5500 and the related schedules can befiled by magnetic media (magnetic tapes,floppy diskettes) or electronically. If the planadministrator files the return/reportelectronically or on magnetic media, he or shemust also file Form 8453-E, Employee Benefit

Contents Page

Section 4

Information at the Top of the Form . . . 7

Line-By-Line Instructions . . . . . . . . 7

Codes for Principal Business Activityand Principal Product or Service . 20, 21

Recordkeeping

Learning aboutthe law or the

form Preparing the form

Copying,assembling, andsending the form

to the IRS

Form 5500 (initial filers) 87 hr., 3 min. 9 hr., 27 min. 14 hr., 5 min. 48 min.Form 5500 (all other filers) 81 hr., 33 min. 9 hr., 27 min. 13 hr., 59 min. 48 min.Schedule A (Form 5500) 17 hr., 28 min. 28 min. 1 hr., 42 min. 16 min.Schedule B (Form 5500) Part 1 30 hr., 37 min. 3 hr., 16 min. 3 hr., 55 min. - - - - - -Schedule B (Form 5500) Part 2 16 hr., 1 min. 1 hr., 23 min. 1 hr., 43 min. - - - - - -Schedule C (Form 5500) 5 hr., 16 min. 18 min. 23 min. - - - - - -Schedule E (Form 5500)

(nonleveraged ESOP) 1 hr., 12 min. 12 min. 13 min. - - - - - -Schedule E (Form 5500)

(leveraged ESOP) 10 hr., 2 min. 1 hr., 41 min. 1 hr., 56 min. - - - - - -

Schedule F (Form 5500) 2 hr., 52 min. 24 min. 28 min. - - - - - -Schedule G (Form 5500) 15 hr., 4 min. 6 min. 21 min. - - - - - -Schedule P (Form 5500) 1 hr., 55 min. 30 min. 33 min. - - - - - -Schedule SSA (Form 5500) 5 hr., 30 min. 6 min. 11 min. - - - - - -

Contents Page Contents PageHow To Get Forms . . . . . . . . . . 1 Kinds of Filers . . . . . . . . . . . . 3Section 1 Investment Arrangements Filing Directly With

DOL . . . . . . . . . . . . . . . . 4Plan Year . . . . . . . . . . . . . . . 1

What to File . . . . . . . . . . . . . 4Electronic Filing of Form 5500 . . . . . 1

Forms . . . . . . . . . . . . . . . 4Avoid Common Mistakes . . . . . . . . 2Lines to Complete on Form 5500 . . . 5Penalties . . . . . . . . . . . . . . . 2Schedules . . . . . . . . . . . . . 5Who Must File . . . . . . . . . . . . 2Other Filings . . . . . . . . . . . . 6

When to File . . . . . . . . . . . . . 2Section 3Extension of Time to File . . . . . . 2Final Return/Report . . . . . . . . . . 6Where to File . . . . . . . . . . . . . 2Signature and Date . . . . . . . . . . 7Section 2Reproductions . . . . . . . . . . . . 7Kinds of Plans . . . . . . . . . . . . 2Change in Plan Year . . . . . . . . . 7Pension Benefits . . . . . . . . . . 2Amended Return/Report . . . . . . . . 7Fringe Benefits . . . . . . . . . . . 3How the Annual Return/Report Information

May Be Used . . . . . . . . . . . . 7Welfare Benefits . . . . . . . . . . 3

Plans Excluded From Filing . . . . . . 3

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Plan Declaration and Signature forElectronic/Magnetic Media Filing. This is thedeclaration and signature form for theelectronic/magnetic media return. For moreinformation, see Pub. 1507, Procedures forElectronic/Magnetic Media Filing of Forms5500, 5500-C/R, and 5500-EZ for Plan Year1996.

Remindersq Many filers receive rejection notices bymaking several common mistakes that can beavoided as discussed in Avoid Common

Mistakes below. The return/report will also beconsidered incomplete and penalties may beassessed if information required on a scheduleis not typed or printed on the appropriateschedule, such as the Schedule A (Form5500). See the instructions for Schedules onpage 5. An annual return/report must be filedfor employee welfare benefit plans whichprovide benefits wholly or partially through aMultiple Employer Welfare Arrangement(MEWA) as defined in ERISA section 3(40),unless otherwise exempt (see page 3).q In addition to filing this form with the IRS,plans covered by the Pension Benefit GuarantyCorporation (PBGC) termination insuranceprogram must file their Annual PremiumPayment, PBGC Form 1, directly with thatagency.

Avoid Common MistakesFilers make several common mistakes. Toreduce the possibility of correspondence andpenalties, we remind filers to:q Enter only one code on line 4.q Attach the required accountant's opinion.The instructions for line 26 explain which plansare not required to attach the opinion.q If you must complete lines 25, 27, and/or 29:1. You must check Yes or No on line 25c.2. You must attach and properly identify anyschedules required by the line 27 instructions.3. You must report the amount of any lossto the plan caused by fraud or dishonesty online 29b(2) if you checked Yes on line 29b(1).

PenaltiesERISA and the Code provide for theassessment or imposition of penalties for notgiving complete information and for not filingstatements and returns/reports. Certainpenalties are administrative (i.e., they may beimposed or assessed by one of thegovernmental agencies delegated to administerthe collection of the Form 5500 series data).Others require a legal conviction.

Administrative Penalties

Listed below are various penalties for notmeeting the Form 5500 series filingrequirements. One or more of the following fivepenalties may be assessed or imposed in theevent of incomplete filings or filings receivedafter the due date unless it is determined that

your explanation for failure to file properly is forreasonable cause:1. A penalty of up to $1,000 a day for eachday a plan administrator fails or refuses to filea complete return/report. See ERISA section502(c)(2) and 29 CFR 2560.502c-2.2. A penalty of $25 a day (up to $15,000) fornot filing returns for certain plans of deferredcompensation, certain trusts and annuities, andbond purchase plans by the due date(s). SeeCode section 6652(e). This penalty also appliesto returns required to be filed under Codesection 6039D.3. A penalty of $1 a day (up to $5,000) foreach participant for whom a registrationstatement (Schedule SSA (Form 5500)) is

required but not filed. See Code section6652(d)(1).4. A penalty of $1 a day (up to $1,000) fornot filing a notification of change of status of aplan. See Code section 6652(d)(2).5. A penalty of $1,000 for not filing anactuarial statement. See Code section 6692.

Other Penalties

1. Any individual who willfully violates anyprovision of Part 1 of Title I of ERISA shall befined not more than $5,000 or imprisoned notmore than 1 year, or both. See ERISA section

501.2. A penalty of up to $10,000, 5 yearsimprisonment, or both, may be imposed formaking any false statement or representationof fact, knowing it to be false, or for knowinglyconcealing or not disclosing any fact requiredby ERISA. See section 1027, Title 18, U.S.Code, as amended by section 111 of ERISA.

Who Must FileAny administrator or sponsor of an employeebenefit plan subject to ERISA must fileinformation about each plan every year (Codesection 6058 and ERISA sections 104 and4065). Every employer maintaining a specifiedfringe benefit plan as described in Code section6039D (except Code sections 79, 105, 106,120, and 129 plans) is also required to file

each year. The Internal Revenue Service (IRS),Department of Labor (DOL), and PensionBenefit Guaranty Corporation (PBGC) haveconsolidated their returns and report forms tominimize the filing burden for planadministrators and employers. The chart onpage 5 gives a brief guide to the type ofreturn/report to be filed.

When To FileFile all required forms and schedules by thelast day of the 7th month after the plan yearends. For a short plan year, file the form andapplicable schedules by the last day of the 7thmonth after the short plan year ends. Forpurposes of this return/report, the short planyear ends on the date of the change inaccounting period or upon the complete

distribution of the assets of the plan. (Also seeSection 3.) If the current year Form 5500 is notavailable before the due date of your short planyear return/report, use the latest year formavailable and change the date printed on thereturn/report to the current year. Also show thedates your short plan year began and ended.

Extension of Time To File

A one-time extension of time to file (up to 21/2months) may be granted for filingreturns/reports if Form 5558, Application forExtension of Time To File Certain EmployeePlan Returns, is filed before the normal duedate (not including any extensions) of thereturn/report.Exception: Plans are automatically grantedextensions of time to file Form 5500 until the

due date of the Federal income tax return ofthe employer if all the following conditions aremet: (1) The plan year and the employer's taxyear are the same. (2) The employer has beengranted an extension of time to file its Federalincome tax return to a date later than thenormal due date for filing the Form 5500. (3)A copy of the IRS extension of time to file theFederal income tax return is attached to theForm 5500 filed with the IRS. An extensiongranted by using this exception CANNOT beextended further by filing a Form 5558.Note: An extension of time to file thereturn/report does not operate as an extensionof time to file the PBGC Form 1.

Where To FileFile the return/report with the Internal RevenueService Center indicated below. No streetaddress is necessary.

See pages 6 and 7 for the filing address forinvestment arrangements filing directly withDOL.

Section 2

Kinds of PlansEmployee benefit plans include pension benefitplans and welfare benefit plans. File theapplicable return/report for any of the followingplans.

Pension Benefit Plan

This is an employee pension benefit plancovered by ERISA. The return/report is duewhether or not the plan is qualified and even ifbenefits no longer accrue, contributions werenot made this plan year, or contributions areno longer made (frozen plan or wastingtrust). See Final Return/Report on page 6.

Pension benefit plans required to file includedefined benefit plans and defined contributionplans (e.g., profit-sharing, stock bonus, moneypurchase plans, etc.). The following are amongthe pension benefit plans for which areturn/report must be filed:1. Annuity arrangements under Code section403(b)(1).2. Custodial accounts established underCode section 403(b)(7) for regulatedinvestment company stock.

3. Individual retirement accounts (IRAs)established by an employer under Codesection 408(c).4. Pension benefit plans maintained outsidethe United States primarily for nonresidentaliens if the employer who maintains the planis:a. A domestic employer, orb. A foreign employer with income derivedfrom sources within the United States(including foreign subsidiaries of domesticemployers) if contributions to the plan arededucted on its U.S. income tax return. For thistype of plan, enter code D on line 6c. SeePlans Excluded From Filing on page 3.

If the principal office of Use the followingthe plan sponsor or the Internal Revenue

plan administrator is Service Centerlocated in address

Connecticut, Delaware, Districtof Columbia, Foreign Address,Maine, Maryland,Massachusetts, NewHampshire, New Jersey, NewYork, Pennsylvania, PuertoRico, Rhode Island, Vermont,Virginia

Holtsville, NY00501-0044

Alabama, Alaska, Arkansas,California, Florida, Georgia,Hawaii, Idaho, Louisiana,Mississippi, Nevada, NorthCarolina, Oregon, SouthCarolina, Tennessee,Washington

Atlanta, GA39901-0044

Arizona, Colorado, Indiana,Iowa, Kansas, Kentucky,Michigan, Minnesota, Missouri,

Montana, Nebraska, NewMexico, North Dakota, Ohio,Oklahoma, South Dakota,Texas, Utah, West Virginia,Wisconsin, Wyoming

Memphis, TN37501-0044

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5. Church plans electing coverage underCode section 410(d).6. A plan that covers residents of PuertoRico, the U.S. Virgin Islands, Guam, WakeIsland, or American Samoa. This includes aplan that elects to have the provisions ofsection 1022(i)(2) of ERISA apply.

See Lines To Complete on Form 5500 onpage 5 for more information about whatquestions must be completed by pension plans.

Fringe Benefit Plan

Cafeteria plans described in Code section 125

and educational assistance programsdescribed in Code section 127 are consideredfringe benefit plans and generally are requiredto file the annual information specified by Codesection 6039D. However, Code section 127educational assistance programs, whichprovide only job-related training that isdeductible under Code section 162, do notneed to file Form 5500.Note: A fringe benefit plan may be associatedwith one or more welfare plans as describedbelow for which a Form 5500 may be requiredto be filed.

See Lines To Complete on Form 5500 onpage 5 for more information about how tocomplete this form for a fringe benefit plan.

Welfare Benefit Plan

This is an employee welfare benefit plancovered by Part 1 of Title I of ERISA. Welfareplans provide benefits such as medical, dental,life insurance, apprenticeship and training,scholarship funds, severance pay, disability,etc.

See Lines To Complete on Form 5500 onpage 5 for more information about whatquestions must be completed for welfarebenefit plans.

Plans Excluded From FilingThese exemptions do not apply to a fringebenefit plan required to file to satisfy therequirements of Code section 6039D.

Do not file a return/report for an employeebenefit plan that is any of the following:1. A welfare benefit plan which covered

fewer than 100 participants as of the beginningof the plan year and is: unfunded, fully insured,or a combination of insured and unfunded.a. An unfunded welfare benefit plan has itsbenefits paid as needed directly from thegeneral assets of the employer or theemployee organization that sponsors the plan.Note: Plans which are NOT unfunded includethose plans that received employee (or formeremployee) contributions during the plan yearand/or used a trust or separately maintainedfund (including a Code section 501(c)(9) trust)to hold plan assets or act as a conduit for thetransfer of plan assets during the plan year.b. A fully insured welfare benefit plan has itsbenefits provided exclusively through insurancecontracts or policies, the premiums of whichmust be paid directly by the employer or

employee organization from its general assetsor partly from its general assets and partly fromcontributions by its employees or members(which the employer or organization forwardswithin 3 months of receipt).

The insurance contracts or policiesdiscussed above must be issued by aninsurance company or similar organization(such as Blue Cross, Blue Shield or a healthmaintenance organization) that is qualified todo business in any state.c. A combination unfunded/insured welfareplan has its benefits provided partially as anunfunded plan and partially as a fully insuredplan. An example of such a plan is a welfare

plan which provides medical benefits as in aabove and life insurance benefits as in babove.

See 29 CFR 2520.104-20 and the DOLTechnical Release 92-01.Note: An employees' beneficiary associationas used in Code section 501(c)(9) should notbe confused with the employee organizationor employer that establishes and maintains(i.e., sponsors) the welfare benefit plan.2. An unfunded pension benefit plan or anunfunded or insured welfare benefit plan: (a)whose benefits go only to a select group ofmanagement or highly compensatedemployees, and (b) which meets the terms ofDepartment of Labor Regulations 29 CFR2520.104-23 (including the requirement that anotification statement be filed with DOL) or 29CFR 2520.104-24.3. Plans maintained only to comply withworkers' compensation, unemploymentcompensation, or disability insurance laws.4. An unfunded excess benefit plan.5. A welfare benefit plan maintained outsidethe United States primarily for personssubstantially all of whom are nonresidentaliens.6. A pension benefit plan maintained outsidethe United States if it is a qualified foreign planwithin the meaning of Code section 404A(e)that does not qualify for the treatment provided

in Code section 402(e)(5).7. An annuity arrangement described in 29CFR 2510.3-2(f).8. A simplified employee pension (SEP)described in Code section 408(k) that conformsto the alternative method of compliancedescribed in 29 CFR 2520.104-48 or 29 CFR2520.104-49. A SEP is a pension plan thatmeets certain minimum qualifications regardingeligibility and employer contributions.9. A church plan not electing coverage underCode section 410(d).10. A governmental plan.11. A welfare benefit plan that participates ina group insurance arrangement that files areturn/report Form 5500 on behalf of thewelfare benefit plan. See 29 CFR 2520.104-43.12. An apprenticeship or training plan

meeting all of the conditions specified in 29CFR 2520.104-22.

Kinds of FilersThe different types of plan entities that file theforms are described below. (Also seeinstructions for line 4 on page 8.)

Single-Employer Plan

If one employer or one employee organizationmaintains a plan, file a separate return/reportfor the plan. If the employer or employeeorganization maintains more than one suchplan, file a separate return/report for each plan.

If a member of a controlled group ofcorporations, a group of trades or businessesunder common control, or an affiliated service

group maintains a plan that does not involveother group members, file a separatereturn/report as a single-employer plan.

If several employers participate in a programof benefits in which the funds attributable toeach employer are available only to paybenefits to that employer's employees, eachemployer must file a separate return/report.

Plan for Controlled Group ofCorporations, Group of Trades orBusinesses Under Common Control,or an Affiliated Service Group

These groups are defined in Code sections414(b), (c), and (m), and are referred to ascontrolled groups.

File one return/report for the plan. Completeline 21 once for all of the group's employees.

If the funds under the plan attributable toeach employer are available only to paybenefits to that employer's employees, eachemployer in the group must file a separatereturn/report as a single-employer plan.Note: If there are employers that participate ina plan of one of the groups listed above butthose employers are not members of the group,the plan is considered a multiple-employer plan(other). SeeMultiple-Employer Plan (Other)below for more information.

Multiemployer PlanA multiemployer plan is a plan (1) to whichmore than one employer is required tocontribute, (2) that is maintained pursuant toone or more collective-bargaining agreements,and (3) has not made the election under Codesection 414(f)(5) and ERISA section 3(37)(E).File one return/report for each plan.Contributing employers do not file individuallyfor these plans. See Code section 414 for moreinformation.

Multiple-Employer-CollectivelyBargained Plan

A multiple-employer-collectively bargained planinvolves more than one employer; iscollectively bargained and collectively funded;

and, if covered by PBGC terminationinsurance, had properly elected beforeSeptember 27, 1981, not to be treated as amultiemployer plan under Code section414(f)(5) or ERISA sections 3(37)(E) and4001(a)(3). File one return/report for each suchplan. Participating employers do not fileindividually for these plans.

Multiple-Employer Plan (Other)

A multiple-employer plan (other) involves morethan one employer and is not one of the plansalready described. File one return/report foreach plan.Note: Each employer participating in aqualified defined contribution or defined benefitplan, which is considered a multiple-employerplan (other), must file a Form 5500-C/R

regardless of the number of participants. Forthe years you are required to file pages 1 and3 through 6 as Form 5500-C, complete onlylines 1 through 7a, 9, and 21. For the years youfile pages 1 and 2 as Form 5500-R, completeonly lines 1 through 7a, 8a, and 8b. Eachparticipating employer filing the Form 5500-C/Rmustenter code F on line 4 and use anappropriate number (001, 002, etc.) on line 5c.Note: If a participating employer is also thesponsor of the multiple-employer plan (other),the plan number on the return/report filed forthe plan should be 333 and, if more than oneplan, they should be consecutively numberedstarting with 333.

If more than one employer participates in theplan and the plan provides that eachemployer's contributions are available to paybenefits only for that employer's employeeswho are covered by the plan, one annualreturn/report must be filed for each participatingemployer. These filers will be considered singleemployers and should complete the entireform.

Group Insurance Arrangement

This arrangement provides benefits to theemployees of two or more unaffiliatedemployers (not in connection with amultiemployer plan or amultiple-employer-collectively bargained plan),fully insures one or more welfare plans of eachparticipating employer, and uses a trust (orother entity such as a trade association) as the

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holder of the insurance contracts and theconduit for payment of premiums to theinsurance company.

Do not file a separate return/report for awelfare benefit plan that is part of a groupinsurance arrangement if a consolidatedreturn/report for all the plans in thearrangement was filed by the trust or otherentity according to 29 CFR 2520.104-43. Form5500 is required by 29 CFR 2520.103-2 to bepart of the consolidated report.

Investment Arrangements FilingDirectly With DOLSome plans invest in certain trusts, accounts,and other investment arrangements which mayfile information concerning themselves andtheir relationship with employee benefit plansdirectly with DOL (as specified on page 6).Plans participating in an investmentarrangement as described inCommon/Collective Trust and PooledSeparate Account, Master Trust, and 103-12Investment Entities below are required toattach certain additional information to thereturn/report filed with the IRS as specifiedbelow.

Common/Collective Trust and PooledSeparate Account

Definition. For reporting purposes, a

common/collective trust is a trust maintainedby a bank, trust company, or similar institutionwhich is regulated, supervised, and subject toperiodic examination by a state or Federalagency for the collective investment andreinvestment of assets contributed thereto fromemployee benefit plans maintained by morethan one employer or a controlled group ofcorporations, as the term is used in Codesection 1563. For reporting purposes, a pooledseparate account is an account maintained byan insurance carrier which is regulated,supervised, and subject to periodicexamination by a state agency for the collectiveinvestment and reinvestment of assetscontributed thereto from employee benefitplans maintained by more than one employeror controlled group of corporations, as the termis used in Code section 1563. See 29 CFRsections 2520.103-3, 2520.103-4, 2520.103-5,and 2520.103-9.Note: For reporting purposes, a separateaccount which is not considered to be holdingplan assets pursuant to 29 CFR2510.3-101(h)(1)(iii) shall not constitute apooled separate account.

Additional information required to beattached to the Form 5500 for plansparticipating in common/collective trustsand pooled separate accounts. A planparticipating in a common/collective trust orpooled separate account must complete theannual return/report and attach either: (1) themost recent statement of the assets andliabilities of any common/collective trust orpooled separate account, or (2) a certificationthat: (a) the statement of the assets andliabilities of the common/collective trust orpooled separate account has been submitteddirectly to DOL by the financial institution orinsurance carrier; (b) the plan has received acopy of the statement; and (c) includes the EINand other numbers used by the financialinstitution or insurance carrier to identify thetrusts or accounts, and the name and addressprovided in the direct filing made with DOL.

Master Trust

Definition. For reporting purposes, a mastertrust is a trust for which a regulated financialinstitution (as defined below) serves as trustee

or custodian (regardless of whether suchinstitution exercises discretionary authority orcontrol with respect to the management ofassets held in the trust), and in which assetsof more than one plan sponsored by a singleemployer or by a group of employers undercommon control are held.

A regulated financial institution means abank, trust company, or similar financialinstitution which is regulated, supervised, andsubject to periodic examination by a state orFederal agency. Common control isdetermined on the basis of all relevant factsand circumstances (whether or not such

employers are incorporated). See 29 CFR2520.103-1(e).

For reporting purposes, the assets of amaster trust are considered to be held in oneor more investment accounts. A master trustinvestment account may consist of a pool ofassets or a single asset.

Each pool of assets held in a master trustmust be treated as a separate master trustinvestment account if each plan which has aninterest in the pool has the same fractionalinterest in each asset in the pool as itsfractional interest in the pool, and if each suchplan may not dispose of its interest in any assetin the pool without disposing of its interest inthe pool. A master trust may also containassets which are not held in such a pool. Eachsuch asset must be treated as a separate

master trust investment account.Financial information must generally be

provided for each master trust investmentaccount as specified on page 6.

Additional information required to beattached to the Form 5500 for plansparticipating in master trusts. A planparticipating in a master trust must completethe annual return/report and attach a schedulelisting each master trust investment account inwhich the plan has an interest, indicating theplan's name, EIN, and plan number and thename of the master trust used in the mastertrust information filed with DOL (see page 6).In tabular format, show the net value of theplan's interest in each investment account atthe beginning and end of the plan year, and the

net investment gain (or loss) allocated to theplan for the plan year from the investmentaccount (see instructions for lines 31c(11)through (15) on page 17).Note: If a master trust investment accountconsists solely of one plan's asset(s) during thereporting period, the plan may report the(se)asset(s) either as an investment account to bereported as part of the master trust report fileddirectly with DOL or as a plan asset(s), whichis not part of the master trust (and thereforesubject to all instructions pertaining to assetsnot held in a master trust).

103-12 Investment Entities

29 CFR 2520.103-12 provides an alternativemethod of reporting for plans which invest inan entity (other than an investment

arrangement filing with DOL as described onthis page in Common/Collective Trust andPooled Separate Accounts or MasterTrust), the underlying assets of which includeplan assets (within the meaning of 29 CFR2510.3-101) of two or more plans which are notmembers of a related group of employeebenefit plans. For reporting purposes, arelated group consists of each group of twoor more employee benefit plans (1) each ofwhich receives 10% or more of its aggregatecontributions from the same employer or froma member of the same controlled group ofcorporations (as determined under Codesection 1563(a), without regard to Code section1563(a)(4)); or (2) each of which is either

maintained by, or maintained pursuant to acollective-bargaining agreement negotiated by,the same employee organization or affiliatedemployee organizations. For purposes of thisparagraph, an affiliate of an employeeorganization means any person controlling,controlled by, or under common control withsuch organization. See 29 CFR 2520.103-12.

For reporting purposes, the investmententities described above with respect to whichthe required information is filed directly withDOL constitute 103-12 investment entities(103-12 IEs).

What To FileThis section describes the different categoriesof the Form 5500 series and the relatedschedules and lists the lines to be completedby different types of Form 5500 filers. Inaddition, this section contains a description ofthe special filing requirements for plans whichinvest in certain investment arrangements. Fora brief guide illustrating which forms andschedules are required by different types ofplans and filers, see the summary on page 5.

Forms

The following are the different forms in the5500 series.qForm 5500, Annual Return/Report ofEmployee Benefit Plan, must be filed annually

for each plan with 100 or more participants atthe beginning of the plan year.qForm 5500-C/R, Return/Report of EmployeeBenefit Plan, must be filed for each pensionbenefit plan, welfare benefit plan, and fringebenefit plan (unless otherwise exempted) withfewer than 100 participants at the beginning ofthe plan year. Most one-participant plans donot have to file the Form 5500-C/R. See Form5500-EZ below.Note: To determine whether to file Form 5500or Form 5500-C/R for an employee benefitplan, calculate the number of participants in thesame manner as item 7 of the Form 5500 or5500-C/R but the calculation should be as ofthebeginningof the plan year. Also, under thefiling requirements explained above, if thenumber of plan participants increases to 100or more, or decreases below 100, from oneyear to the next, you would generally have tofile a different form from that filed the previousyear. However, there is an exception to thisrule. The filer may continue to file the sameform filed last year (i.e., Form 5500 or5500-C/R), even if the number of participantschanged, provided that at the beginning of thisplan year the plan had at least 80 participants,but not more than 120.

Other Forms

q Use Form 945, Annual Return of WithheldFederal Income Tax, to report backupwithholding and withholding from pensions,annuities, and IRAs. See Circular E,Employer's Tax Guide (Pub. 15), for moreinformation.q

Use Form 1099-R, Distributions FromPensions, Annuities, Retirement orProfit-Sharing Plans, IRAs, InsuranceContracts, etc., to report payments anddistributions to plan beneficiaries. See theinstructions for Forms 1099, 1098, 5498, andW-2G for more information.qForm 5500-EZ, Annual Return ofOne-Participant (Owners and Their Spouses)Retirement Plan, should be filed by mostone-participant plans.

A one-participant plan is: (1) a pensionbenefit plan that covers only an individual oran individual and his or her spouse who whollyown a trade or business, whether incorporatedor unincorporated; or (2) a pension benefit plan

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for a partnership that covers only the partnersor the partners and the partners' spouses.

See Form 5500-EZ and its instructions tosee if the plan meets the requirements for filingthe form.Note: Some one-participant plans must file theForm 5500-C/R. See the Form 5500-EZinstructions.qForm 8822, Change of Address, may beused to notify the IRS if the plan's mailingaddress changes after the return/report hasbeen filed.

Lines To Complete on Form 5500Certain kinds of plans and certain kinds of filersthat must file an annual Form 5500 are notrequired to complete the entire form. These aredescribed below, by type of plan. Check the listof headings to see if your plan is affected.Fringe benefit plans. For a Form 5500 filedonly for a fringe benefit plan that is either acafeteria plan described in section 125 and/oran educational assistance plan described inCode section 127, complete only lines 1through 5, 6d (page 1 of Form 5500), andSchedule F (Form 5500). DO NOT file pages3 through 6 of Form 5500 or any otherschedules.

If Form 5500 is filed for both a welfarebenefit plan and a fringe benefit plan, completethe above line items, all applicable schedules,

and the items specified for Welfare benefitplans below.Welfare benefit plans. Welfare benefit plansgenerally must complete the following items onthe Form 5500: Lines 1 through 6a, 6e, 7a(4),7b, 7c, and 7d; 8a, 8b, 8d, and 8e; 9a, 9b, 9c,and 9f; 10a through 10d; 11 through 14; 25through 29; and 31 through 33.Exception: An unfunded, fully insured, or acombination unfunded/insured welfare plan(described on page 3 underPlans ExcludedFrom Filing), which must file the Form 5500because it has 100 or more participants, neednot complete lines 31 and 32.Note: If one Form 5500 is filed for both awelfare plan and a fringe benefit plan, checkbox 6d and complete Schedule F (Form 5500)in addition to the items listed above for welfare

benefit plans.Pension plans. In general, most pensionplans (defined benefit and defined contribution)are required to complete all line items on the

form. However, some line items do not have tobe completed by certain types of pensionplans, as described below.1. Plans exclusively using a tax deferredannuity arrangement under Code section403(b)(1). These plans (see Who Must Fileon page 2) need only complete lines 1 through5, 6b (enter pension code 8), and 9.2. Plans exclusively using a custodialaccount for regulated investment companystock under Code section 403(b)(7). Theseplans need only complete lines 1 through 5, 6b(enter pension code 9), and 9.

3. Individual retirement account plan. Apension plan utilizing individual retirementaccounts or annuities (as described in Codesection 408) as the sole funding vehicle forproviding benefits need only complete lines 1through 5, 6b (enter pension code 0), and 9.4. Fully insured pension plan. A pensionbenefit plan providing benefits exclusivelythrough an insurance contract, or contractswhich are fully guaranteed and that meets allof the conditions of 29 CFR 2520.104-44 mustcomplete lines 1 through 26, 29, and 30.

A pension plan including both insurancecontracts of the type described in 29 CFR2520.104-44 as well as other assets shouldlimit its reporting in lines 31 and 32 to thoseother assets.Note: For purposes of the annual return/

report and the alternative method ofcompliance set forth in 29 CFR 2520.104-44,a contract is considered to be allocated onlyif the insurance company or organization thatissued the contract unconditionally guarantees,upon receipt of the required premium orconsideration, to provide a retirement benefitof a specified amount. This amount must beprovided without adjustment for fluctuations inthe market value of the underlying assets of thecompany or organization, to each participant,and each participant has a legal right to suchbenefits, which is legally enforceable directlyagainst the insurance company or organization.

5. Nonqualified pension benefit plansmaintained outside the United States.Nonqualified pension benefit plans maintainedoutside the United States primarily fornonresident aliens required to file areturn/report (see Who Must File on page 2)must complete lines 1 through 8c (enter codeD in the box on line 6c), 9 through 12, 15, and16.

Plans of more than one employer. Allplans of more than one employer (plans of acontrolled group, multiemployer plans,multiple-employer-collectively bargained plans,and multiple-employer plan (other)) generallymust complete all applicable (welfare orpension) items on the form except for line 6f.Only single-employer pension plans mustcomplete line 6f. Multiemployer plans andmultiple-employer-collectively bargained plansdo not have to complete line 7h.

Schedules

Note: All schedules and attachments to Forms5500 and 5500-C/R must include the name ofthe plan, the plan sponsor's EIN, and plannumber (PN) as found in lines 5a, 1b, and 5c,respectively.

The various schedules to attach to thereturn/report are listed below:qSchedule A (Form 5500), InsuranceInformation, must be attached to Form 5500or 5500-C/R, if any benefits under the plan areprovided by an insurance company, insuranceservice, or other similar organization (such asBlue Cross, Blue Shield, or a healthmaintenance organization). (This includesinvestments with insurance companies such asguaranteed investment contracts (GICs).)Caution: Your return/report is subject torejection if you submit a privately designed andprinted substitute Federal form that has notbeen approved by the IRS.

Exceptions. (1) Do not file Schedule A(Form 5500) if the plan covers only: (a) anindividual, or an individual and his or herspouse, who wholly owns a trade or business,whether incorporated or unincorporated; or (b)a partner(s) in a partnership, or a partner(s)and his or her spouse.

(2) Do not file Schedule A (Form 5500) withthe Form 5500 or Form 5500-C/R if a ScheduleA (Form 5500) is filed for the contract as partof the master trust or 103-12 IE informationfiled directly with DOL.

Do not file a Schedule A (Form 5500) witha Form 5500-EZ.qSchedule B (Form 5500), ActuarialInformation, must be attached to Form 5500,

5500-C/R, or 5500-EZ for most defined benefitpension plans. See the instructions forSchedule B.qSchedule C (Form 5500), Service Providerand Trustee Information, must be attached to

Summary of Filing Requirements for Employers and Plan Administrators(File forms ONLY with IRS)

Type of plan What to file When to file

File all

required

forms andschedules

for each

plan by the

last day of

the 7th

month after

the plan

year ends.

Most pension plans with only one participant or one participant and that participants spouse

Pension plan with fewer than 100 participants

Pension plan with 100 or more participants

Annuity under Code section 403(b)(1) or trust under Code section 408(c)

Custodial account under Code section 403(b)(7)

Welfare benefit plan with 100 or more participants

Welfare benefit plan with fewer than 100 participants (see exceptions on page 3 of these instructions)

Pension or welfare plan with 100 or more participants (see instructions for item 26)

Pension or welfare plan with benefits provided by an insurance company

Pension plan that requires actuarial information

Pension or welfare plan with 100 or more participants

Pension plan with ESOP benefits

Pension plan filing a registration statement identifying separated participants with deferredvested benefits from a pension plan

Form 5500-EZ

Form 5500-C/R

Form 5500

Form 5500 or Form 5500-C/R

Financial statements, schedules,and accountants opinion

Schedule A (Form 5500)

Schedule B (Form 5500)

Schedule C (Form 5500)

Schedule E (Form 5500)

Schedule SSA(Form 5500)

Form 5500 or Form 5500-C/R

Form 5500

Form 5500-C/R

Fringe benefit plan under Code section 6039D Schedule F (Form 5500)

Financial Schedules for item 27 Schedule G (Form 5500)

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Form 5500. See line 25 and the instructions forSchedule C.qSchedule E (Form 5500), ESOP AnnualInformation, must be attached to Form 5500,5500-C/R, or 5500-EZ for all pension benefitplans with ESOP benefits. See the instructionsfor Schedule E.qSchedule F (Form 5500), Fringe BenefitPlan Annual Information Return, must beattached to page 1 of Form 5500 or 5500-C/Rfor all fringe benefit plans.qSchedule G (Form 5500), FinancialSchedules, may be attached to Form 5500when a Yes is checked for any line in 27athrough 27f. The Schedule G is optional for1996 (you may use the schedules specified inthe instructions for line 27 instead).qSchedule SSA (Form 5500), AnnualRegistration Statement Identifying SeparatedParticipants With Deferred Vested Benefits,may be needed for separated participants. SeeWhen To Report a Separated Participant inthe instructions for Schedule SSA.qSchedule P (Form 5500), Annual Return ofFiduciary of Employee Benefit Trust, may befiled by any fiduciary (trustee or custodian) ofan organization that is qualified under Codesection 401(a) and exempt from tax underCode section 501(a) who wants to protect theorganization under the statute of limitationsprovided in Code section 6501(a).

File the Schedule P (Form 5500) as anattachment to Form 5500, 5500-C/R, or5500-EZ for the plan year in which the trustyear ends.

Other Filings

Certain investment arrangements for employeebenefit plans file financial information directlywith DOL. These arrangements includecommon/collective trusts, pooled separateaccounts, master trusts, and 103-12 IEs.Definitions of these investment arrangementsmay be found on page 4. Their DOL filingrequirements are described below.Common/collective trust and pooledseparate account information to be fileddirectly with DOL. Financial institutions andinsurance carriers filing the statement of the

assets and liabilities of a common/collectivetrust or pooled separate account should identifythe trust or account by providing the EIN of thetrust or account, or (if more than one trust oraccount is covered by the same EIN) both theEIN and any additional number assigned by thefinancial institution or insurance carrier (suchas: 99-1234567 Trust No. 1); and a list of allplans participating in the trust or account,identified by the plan number, EIN, and nameof the plan sponsor. The direct filing should beaddressed to:

Common/Collective Trust (OR)Pooled Separate AccountPension and Welfare Benefits AdministrationU.S. Department of Labor, Room N5638200 Constitution Avenue, NWWashington, DC 20210

Master trust information to be filed directlywith DOL. The following information withrespect to a master trust must be filed withDOL by the plan administrator or by adesignee, such as the administrator of anotherplan participating in the master trust or thefinancial institution serving as trustee of themaster trust, no later than the date on whichthe plan's return/report is due. While only onecopy of the required information should be filedfor all plans participating in the master trust, theinformation is an integral part of thereturn/report of each participating plan, and theplan's return/report will not be deemedcomplete unless all the information is filedwithin the prescribed time.

Note: If a master trust investment accountconsists solely of one plan's asset(s) during thereporting period, the plan may report the(se)asset(s) either as an investment account to bereported as part of the master trust report fileddirectly with DOL oras a plan asset(s) that isnot part of the master trust (and thereforesubject to all instructions pertaining to assetsnot held in a master trust).

Each of the following statements andschedules must indicate the name of themaster trust and the name of the master trustinvestment account. The information shall befiled with DOL by mailing it to:

Master TrustPension and Welfare Benefits AdministrationU.S. Department of Labor, Room N5638200 Constitution Avenue, NWWashington, DC 20210

1. The name and fiscal year of the mastertrust and the name and address of the mastertrustee.2. A list of all plans participating in themaster trust, showing each plan's name, EIN,PN, and its percentage interest in each mastertrust investment account as of the beginningand end of the fiscal year of the master trustending with or within the plan year.3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in the mastertrust.

4. A statement, in the same format as Part Iof Schedule C (Form 5500), for each mastertrust investment account showing amounts ofcompensation paid during the fiscal year of themaster trust ending with or within the plan yearto persons providing services with respect tothe investment account and subtracted fromthe gross income of the investment account indetermining the net increase (decrease) in netassets of the investment account.5. A statement for each master trustinvestment account showing the assets andliabilities of the investment account at thebeginning and end of the fiscal year of themaster trust ending with or within the plan year,grouped in the same categories as thosespecified on lines 31a through 31l of Form5500.

6. A statement for each master trustinvestment account showing the income andexpenses, changes in net assets, and netincrease (decrease) in net assets of each suchinvestment account during the fiscal year of themaster trust ending with or within the plan year,in the categories specified on line 32 of Form5500. In place of line 32a, show the total of alltransfers of assets into the investment accountby participating plans. In place of line 32j,show the total of all transfers of assets out ofthe investment account by participating plans.7. Schedules, in the format set forth in theinstructions for lines 27a through 27f on Form5500, of the following items with respect toeach master trust investment account for thefiscal year of the master trust ending with orwithin the plan year: assets held for investment,nonexempt party-in-interest transactions,defaulted or uncollectible loans and leases, and5% transactions involving assets in theinvestment account. The 5% figure shall bedetermined by comparing the current value ofthe transaction at the transaction date with thecurrent value of the investment account assetsat the beginning of the applicable fiscal yearof the master trust.103-12 IE information to be filed directlywith DOL. The information described belowmust be filed with DOL by the sponsor of the103-12 IE no later than the date on which theplan's return/report is due before the planadministrator can elect the alternative methodof reporting. While only one copy of the

required information should be filed for the103-12 IE, the information is an integral partof the return/report of each plan electing thealternative method of compliance. The filingaddress is:

103-12 Investment EntityPension and Welfare Benefits AdministrationU.S. Department of Labor, Room N5638200 Constitution Avenue, NWWashington, DC 20210

1. The name, fiscal year, and EIN of the103-12 IE and the name and address of thesponsor of the 103-12 IE. If more than one

103-12 IE is covered by the same EIN, theyshall be sequentially numbered as follows:99-1234567 Entity No. 1.2. A list of all plans participating in the103-12 IE, showing each plan's name, EIN,PN, and its percentage interest in the 103-12IE as of the beginning and end of the fiscalyear of the 103-12 IE ending with or within theplan year.3. A Schedule A (Form 5500) for eachinsurance or annuity contract held in the103-12 IE.4. A statement, in the same format as Part Iof Schedule C (Form 5500), for the 103-12 IEshowing amounts of compensation paid duringthe fiscal year of the 103-12 IE ending with orwithin the plan year to persons providingservices to the 103-12 IE.

5. A statement showing the assets andliabilities at the beginning and end of the fiscalyear of the 103-12 IE ending with or within theplan year, grouped in the same categories asthose specified on line 31 of Form 5500.6. A statement showing the income andexpenses, changes in net assets, and netincrease (decrease) in net assets during thefiscal year of the 103-12 IE ending with orwithin the plan year, grouped in the samecategories as those specified in line 32 of Form5500. In place of line 32a, show the total of alltransfers of assets into the 103-12 IE byparticipating plans. In place of line 32j, showthe total of all transfers of assets out of the103-12 IE by participating plans.7. Schedules, in the format set forth in theinstructions for line 27 of Form 5500 (except

line 27d) with respect to the 103-12 IE for thefiscal year of the 103-12 IE ending with orwithin the plan year. Substitute the term103-12 IE in place of the word plan whencompleting the schedules.8. A report of an independent qualified publicaccountant regarding the above items andother books and records of the 103-12 IE thatmeets the requirements of 29 CFR2520.103-1(b)(5).

Section 3

Final Return/ReportIf all assets under the plan (includinginsurance/annuity contracts) have beendistributed to the participants and beneficiaries

or distributed to another plan (and when allliabilities for which benefits may be paid undera welfare benefit plan have been satisfied),check the final return/report box at the top ofthe form filed for such plan. The year ofcomplete distribution is the last year areturn/report must be filed for the plan. Forpurposes of this paragraph, a completedistribution will occur in the year in which theassets of a terminated plan are brought underthe control of PBGC.

For a defined benefit plan covered byPBGC, a PBGC Form 1 must be filed and apremium must be paid until the end of the planyear in which the assets are distributed orbrought under the control of PBGC.

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Filing the return/report marked Final returnand indicating that the plan terminated satisfiesthe notification requirement of Code section6057(b)(3).

Signature and DateThe plan administrator must sign and date allreturns/reports filed. The name of the individualwho signed as plan administrator must betyped or printed clearly on the line under thesignature line. In addition, the employer mustsign a return/report filed for a single-employerplan or a plan required to file only because ofCode section 6039D (i.e., for a fringe benefitplan).

When a joint employer-union board oftrustees or committee is the plan sponsor orplan administrator, at least one employerrepresentative and one union representativemust sign and date the return/report.

Participating employers in amultiple-employer plan (other), who arerequired to file Form 5500-C/R, are required tosign the return/report. The plan administratorneed not sign the Form 5500-C/R filed by theparticipating employer.

ReproductionsOriginal forms are preferable, but a clearreproduction of the completed form isacceptable. Sign the return/report after it is

reproduced. All signatures must be original.Change in Plan YearGenerally only defined benefit pension plansneed prior approval for a change in plan year.(See Code section 412(c)(5).) Rev. Proc.87-27, 1987-1 C.B. 769, explains the procedurefor automatic approval of a change in planyear. A pension benefit plan that wouldordinarily have to obtain approval for a changein plan year under Code section 412(c)(5) isgranted an automatic approval for a change inplan year if all the following criteria are met:1. No plan year exceeds 12 months.2. The change will not delay the time whenthe plan would otherwise have been requiredto conform to the requirements of any statute,regulation, or published position of the IRS.

3. The trust, if any, retains its exempt statusfor the short period required to effect thechange, as well as for the taxable yearimmediately preceding the short period.4. All actions necessary to implement thechange in plan year, including plan amendmentand a resolution of the board of directors (ifapplicable), have been taken on or before thelast day of the short period.5. No change in plan year has been madefor any of the preceding plan years.6. In the case of a defined benefit plan,deductions are taken in accordance withsection 5 of Rev. Proc. 87-27.

For the first return/report that is filedfollowing the change in plan year, check thebox on line C at the top of the form.

Amended Return/ReportIf you file an amended return/report, check boxA(2) an amended return/report at the top ofthe form. When filing an amended return,answer all questions and circle the amendedline numbers.

How The Annual Return/ReportInformation May Be UsedAll Form 5500 series return/reports will besubjected to a computerized review. It is,therefore, in the filer's best interest that theresponses accurately reflect the circumstancesthey were designed to report. Annual reportsfiled under Title I of ERISA must be made

available by plan administrators to planparticipants and by the Department of Labor tothe public pursuant to ERISA section 104.

Section 4Important: Answer all questions on the Form5500 with respect to the plan year, unlessotherwise explicitly stated in the line-by-lineinstructions or on the form itself. Therefore,your responses usually apply to the yearentered or printed at the top of the first pageof the form. Yes or No questions mustbe marked either Yes or No, but not

both. N/A cannot be used to respond to aYes or No question that is required tobe answered by the filer as specified onpage 5 under Lines To Complete On Form5500.

Information at the Top of the FormOn the first line at the top of the form completethe space for dates when (1) the 12-month planyear is not a calendar year, or (2) the plan yearis less than 12 months (a short plan year).Line A. Check box (1) if this is the initial filingfor this plan. Do not check this box if you haveever filed for this plan even if it was on adifferent form (Form 5500 vs. Form 5500-C orForm 5500-R).

Check box (2) if you have already filed forthe 1996 plan year and are now submitting anamended return/report to correct errors and/oromissions on the previously filed return/report.

Check box (3) if the plan no longer exists toprovide benefits. See Section 3 on page 6 forinstructions concerning the requirement to filea final return/report.

Check box (4) if this form is being filed for aperiod of less than 12 months and show thedates at the top.Line B. Check box B if you report informationin 1a, 2a, 2b, or 5a that is different from thatreported on the last return/report filed. Becertain to provide all information in lines 1through 6d. Please enter changes in red inkand/or circle the line numbers if the informationhas been changed since the last return/report.Line C. Check this box if the plan year has

been changed since the last return/report wasfiled.Line D. Check this box if you filed for anextension of time to file this form. Attach a copyof the approved Form 5558 or a copy of theemployer's extension of time to file the incometax return if you are using the exception in theinstructions for Extension of Time To File onpage 2.

Line-By-Line Instructions

Page 1

If a return/report was filed last year, a Form5500 with information from that return/reportprinted on page 1 should have been mailed tothe filer. Check any preprinted information inlines 1 through 6d for accuracy and

completeness. Provide any additionalinformation to completely answer the questionsand cross out any incorrect information. Enterthese corrections on page 1. Please use redink to enter this information and/or circle linenumbers. This will help us process the formsmore efficiently and reduce our need to contactyou.

The return/report must be completed inaccordance with the following specificinstructions.Line 1a. Enter the name and address of theplan sponsor. If the plan covers only theemployees of one employer, enter theemployer's name. If the Post Office does notdeliver mail to the street address and the

sponsor has a P.O. box, show the box numberinstead of the street address.

The term plan sponsor meansq The employer, for an employee benefit planthat a single employer established ormaintains;q The employee organization in the case of aplan of an employee organization; orq The association, committee, joint board oftrustees, or other similar group ofrepresentatives of the parties who establish ormaintain the plan, if the plan is established ormaintained jointly by one or more employers

and one or more employee organizations, orby two or more employers.Include enough information on line 1a to

describe the sponsor adequately. For example,Joint Board of Trustees of Local 187Machinists rather than just Joint Board ofTrustees.

For group insurance arrangements, enterthe name of the trust or other entity that holdsthe insurance contracts. In addition, attach alist of all participating employers and their EINs.

A group insurance arrangement is anarrangement which provides benefits to theemployees of two or more unaffiliatedemployers (not in connection with amultiemployer plan or a multiple-employercollectively bargained plan), fully insures oneor more welfare plans of each participating

employer, and uses a trust (or other entity suchas a trade association) as the holder of theinsurance contracts and the conduit forpayment of premiums to the insurancecompany.Line 1b. Enter the nine-digit employeridentification number (EIN) assigned to the plansponsor/employer. For example, 00-1234567.

Employers and plan administrators who donot have an EIN should apply for one on FormSS-4, Application for Employer IdentificationNumber. Form SS-4 can be obtained at mostIRS or Social Security Administration (SSA)offices. Send Form SS-4 to the InternalRevenue Service Center where you will file thisForm 5500.

A plan of a controlled group of corporationsshould use the EIN of one of the sponsoring

members. This EIN must be used in allsubsequent filings of the annual returns/reportsfor the controlled group.

If the plan sponsor is a group of individuals,get a single EIN for the group. When you applyfor a number, enter on line 1 of Form SS-4 thename of the group, such as Joint Board ofTrustees of the Local 187 Machinists'Retirement Plan.Note: Although EINs for funds (trusts orcustodial accounts) associated with plans aregenerally not required to be furnished on theForm 5500 series returns/reports, the IRS willissue EINs for such funds for other trustreporting purposes. EINs may be obtained byfiling Form SS-4 as explained above.

Plan sponsors should use the trust EINdescribed in the Note above when opening a

bank account or conducting other transactionsfor a trust that require an EIN.Line 1d. From the list of business codes onpages 20 and 21, enter the one that bestdescribes the nature of the employer'sbusiness. If more than one employer isinvolved, enter the business code for the mainbusiness activity.Line 1e. Plans entering entity code A or Bon line 4 must enter the first six digits of theCUSIP (Committee on Uniform SecuritiesIdentification Procedures) number, issuernumber, if one has been assigned to the plansponsor for purposes of issuing corporatesecurities. CUSIP issuer numbers are assignedto corporations and other entities that issue

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public securities listed on stock exchanges ortraded over the counter. The CUSIP issuernumber is the first six digits of the numberassigned to the individual securities that aretraded. If the plan sponsor has no CUSIPissuer number, enter N/A.Line 2a. If the document constituting the planappoints or designates a plan administratorother than the sponsor, enter theadministrator's name and address. If the planadministrator is also the sponsor, enterSame. If filing as a group insurancearrangement, enter Same. If Same isentered on line 2a, leave lines 2b and 2c blank.

The term administrator meansq The person or group of persons specified asthe administrator by the instrument under whichthe plan is operated;q The plan sponsor/employer if anadministrator is not so designated; orq Any other person prescribed by regulationsof the Secretary of Labor if an administrator isnot designated and a plan sponsor cannot beidentified.Line 2b. A plan administrator must have anEIN for reporting purposes. Enter the planadministrator's nine-digit EIN here. If the planadministrator does not have an EIN, apply forone as explained in the instructions for line 1bon page 7.

Employees of an employer are not plan

administrators unless so designated in the plandocument, even though they engage inadministrative functions of the plan. If anemployee of the employer is designated as theplan administrator, that employee must get anEIN.Line 3. If the plan sponsor's/ administrator'sname, address, and EIN have changed sincethe last return/report was filed for this plan,enter the plan sponsor's/administrator's name,address, and EIN as it appeared on the lastreturn/report filed for this plan.Line 3c. Indicate if the change on line 3a isonly a change in sponsorship. Change insponsorship means the plan's sponsor hasbeen changed but no assets or liabilities havebeen transferred to another plan(s), the planhas not terminated, or merged with any other

plan. Therefore, the plan is now theresponsibility of the new sponsor whose nameis entered in item 1a of this return/report.Line 4.Entity Code. From the following listof entities choose the one that describes yourentity and enter that code on line 4.

Line 5a. Enter the formal name of the plan,group insurance arrangement, or enoughinformation to identify the plan. This name

should not exceed 70 characters. If the presentplan name exceeds 70 characters and spaces,try to abbreviate it.Line 5b. Enter the date the plan first becameeffective.Line 5c. Enter the three-digit number theemployer or plan administrator assigned to theplan. All welfare benefit plan numbers andCode section 6039D plan numbers start at 501.All other plans start at 001.

Once you use a plan number, continue touse it for that plan on all future filings with theIRS, DOL, and PBGC. Do not use it for anyother plan even if you terminated the first plan.

Line 6a.Welfare Benefit Plan Codes.Check this box and enter every code from thelist below that describes the welfare benefitplan for which this return/report is filed.Example. If your plan provides healthinsurance, life insurance, dental insurance, andeye examinations, enter the codes A, B, D, andE. If your plan has a benefit not described byone of the codes, enter Z and write in adescription of this benefit in the spaceprovided.

Line 6b.Pension Benefit Plan Codes.Check this box and enter the codes from thelist below that describe the type of benefits forwhich the Form 5500 is being filed.Note: A pension plan must be either a defined

benefit or a defined contribution plan.

Line 6c.Pension Plan Feature Codes. Ifthe plan includes pension benefits, enter thecode(s) from the list of pension plan featurecodes below.

q If you enter code A or B, you must completeSchedule E (Form 5500) and attach it to theForm 5500 you file for this plan.q Enter code B for a leveraged ESOP if theplan acquires employer securities withborrowed money or other debt-financingtechniques.q Enter code C for a pension plan thatprovides for individual accounts and permits a

participant or beneficiary to exerciseindependent control over the assets in his orher account (see ERISA section 404(c)).q Enter Code D for a pension benefit planmaintained outside the United States primarilyfor nonresident aliens. See Kinds of Filers onpage 3 for more information.q Enter code F for a plan of an affiliatedservice group. In general, Code section414(m)(2) defines an affiliated service groupas a first service organization (FSO) that has:1. A service organization (A-ORG) that is ashareholder or partner in the FSO and thatregularly performs services for the FSO, or isregularly associated with the FSO in performingservices for third persons, and/or2. Any other organization (B-ORG) if:a. A significant portion of the business of thatorganization consists of performing services forthe FSO or A-ORG of a type historicallyperformed by employees in the service field ofthe FSO or A-ORG, andb. 10% or more of the interest of the B-ORGis held by persons who are highly compensatedemployees of the FSO or A-ORG.

An affiliated service group also includes agroup consisting of an organization whoseprincipal business is performing managementfunctions for another organization (or oneorganization and other related organizations)on a regular and continuing basis, and the

organization for which such functions are soperformed by the organization.q Enter Code G for a cash or deferredarrangement described under Code section401(k) that is part of a qualified definedcontribution plan that provides for an electionby employees to defer part of theircompensation or receive these amounts incash.q Enter Code H if the plan is top heavy. Atop-heavy plan is a plan that during any planyear is:

1. Any defined benefit plan if, as of thedetermination date, the present value of thecumulative accrued benefits under the plan forkey employees exceeds 60% of the presentvalue of the cumulative accrued benefits underthe plan for all employees; and

2. Any defined contribution plan if, as of thedetermination date, the aggregate of theaccounts of key employees under the planexceeds 60% of the aggregate of the accountsof all employees under the plan.

Each plan of an employer included in arequired aggregation group must be treated asa top-heavy plan if such group is a top-heavygroup. See definitions of required aggregationgroup and top-heavy group on page 9.

A key employee is any participant in anemployer plan who at any time during the planyear, or any of the 4 preceding years, is:1. An officer of the employer having anannual compensation greater than 50% of$120,000, the defined benefit dollar limitationfor 1996 under Code section 415(b)(1)(A),2. One of the 10 employees having annualcompensation from the employer greater than$30,000, the defined contribution dollarlimitation for 1996 under Code section415(c)(1)(A) and owning (or considered asowning within the meaning of Code section318) the largest interests in the employer,3. A 5% owner of the employer, or4. A 1% owner of the employer having anannual compensation from the employer ofmore than $150,000.

In determining whether an individual is anofficer of the employer, no more than 50employees, or, if less, the greater of 3employees or 10% of the employees, are to betreated as officers. See Code section 416(i)

Type of Welfare Plan Code

Health (other than dental or vision) ...................... ALife insurance........................................................ BSupplemental unemployment................................ CDental .................................................................... DVision .................................................................... ETemporary disability (accident and sickness)....... FPrepaid legal......................................................... GLong-term disability............................................... HSeverance pay...................................................... IApprenticeship and training .................................. JScholarship (funded)............................................. KDeath benefits (other than life ins.) ...................... LTaft-Hartley Financial Assistance for EmployeeHousing Expenses................................................ POther (specify on page 1)..................................... Z

Type of Pension Benefit Plan Code

Defined benefit...................................................... 1

Defined Contribution

Profit-sharing ......................................................... 2Stock bonus .......................................................... 3Target benefit........................................................ 4Other money purchase......................................... 5Other (specify on page 1)..................................... 6

Other

Defined benefit plan with benefits based partlyon balance of separate account of participant(Code section 414(k)) ........................................... 7Annuity arrangement of certain exemptorganizations (Code section 403(b)(1))................ 8Custodial account for regulated investmentcompany stock (Code section 403(b)(7)) ............. 9

Pension plan utilizing individual retirementaccounts (IRAs) or annuities (described in Codesection 408) as the sole funding vehicle forproviding benefits.................................................. 0

Entity Code

Single-employer plan ............................................ AType of Pension Plan Feature CodePlan of controlled group of corporations or

common control employers................................... B (see descriptions and codes below)Employee stock ownership plan (ESOP).............. AMultiemployer plan................................................ CLeveraged ESOP.................................................. BMultiple-employer-collectively bargained plan...... DParticipant-directed account plan.......................... CMultiple-employer plan (other) .............................. EPension plan maintained outside the USA........... DGroup insurance arrangement (of welfare plans). FPlan covering self-employed individuals............... EAffiliated service group (Code section 414(m)(2)). F401(k) plan(plan containing a cash or deferredarrangement) ......................................................... GTop-heavy plan (in 1984 or subsequent plan

year) ...................................................................... HPlan with permitted disparity provisions(SeeCode sections 401(a)(5) and 401(l))..................... IMaster plan ........................................................... JPrototype plan....................................................... KRegional prototype plan........................................ LOne-participant plan.............................................. M

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and T-12 of Regulations section 1.416-1. A keyemployee will not include any officer oremployee of a governmental plan under Codesection 414(d).

A required aggregation group consists of:1. Each plan of the employer in which a keyemployee is or was a participant, and2. Each other plan of the employer thatenables a plan to meet the requirements fornondiscrimination in contributions or benefitsunder Code section 401(a)(4), or theparticipation requirements under Code section410.

A top-heavy group is an aggregation groupif, as of the determination date, the sum of thepresent value of the cumulative accruedbenefits for key employees under all definedbenefit plans included in such group and theaggregate of the accounts of key employeesunder all defined contribution plans in suchgroup exceeds 60% of a similar sumdetermined for all employees. To determine ifa plan is top-heavy, include distributions madein the 5-year period ending on thedetermination date. However, do not take intoaccount accrued benefits for an individual whohas not performed services for the employerduring the 5-year period ending on thedetermination date.q Enter code M for a one-participant plan filingForm 5500 or Form 5500-C/R. See theinstructions for Plans Excluded From Filingon page 3 and Form 5500-EZ under OtherForms on page 4.Line 6d.Fringe Benefit Plan. Completeonly page 1 (lines 1 through 5 and 6d) andSchedule F (Form 5500) for a Form 5500 filedonly because of Code section 6039D. Checkthis box and see page 5 for additionalinstructions on Lines To Complete on Form5500 for a fringe benefit plan.Line 6e. Line 6e must be answered if theplan used any of these investmentarrangements at any time during the plan year.See page 4 for definitions, additionalinformation to attach to Form 5500, and otherinformation pertaining to master trusts, 103-12investment entities, common/collective trustsand pooled separate accounts. Also see theinstructions for lines 25 through 32 for specificreporting requirements for plans which utilizethese entities.Line 6e(1). In the space provided in line 6e,enter the name of the trust and financialinstitution. Also enter the city and state wherethe trust is maintained. (See Master Trust onpage 4 for more information.)Line 6e(2). In the space provided in line 6e,enter the name and address of the 103-12 IE.(See page 4 for 103-12 IE instructions.)Line 6f. For single-employer pension plans,enter the date the employer's tax year ends.For example, if the tax year is a calendar year,enter 12-31-96. Do not complete line 6f forplans with more than one employer.Lines 6g and 6h. A defined benefit plan isgenerally subject to the minimum funding

requirements under section 412 unless it is afully insured plan that is exempt from theminimum funding requirements under section412(i). A plan is considered a 412(i) planwhether or not all or part of the plan is trusteedor a noninsured top-heavy side fund ismaintained. All such plans must check their412(i) status on line 6g. Check box 6h if anypart of the plan that was formerly subject to theminimum funding requirements under section412 for either of the prior 2 plan years hasbecome exempt under section 412(i).Note: All defined benefit plans subject to theminimum funding requirements under Section412 must complete line 15a and attach

Schedule B (Form 5500). Also complete line15a and attach Schedule B (Form 5500) for all412(i) plans where all premiums for the planyear required under section 412(i) have notbeen paid before the lapse of any insurancecontract under the plan and/or where anoninsured top-heavy side fund is maintained.

Line 7. The description of participant in theinstructions below is only for purposes of line7 of this form.

For welfare plans, the number of participantsshould be determined by reference to 29 CFR2510.3-3(d). Dependents are considered to beneither participants nor beneficiaries. Forpension benefit plans, alternate payeesentitled to benefits under a qualified domesticrelations order are not to be counted asparticipants for this line.

Participant means any individual who isincluded in one of the categories below.Line 7a. Active participants include anyindividuals who are currently in employmentcovered by a plan and who are earning orretaining credited service under a plan. Thiscategory includes any individuals who are: (1)currently below the permitted disparity level ina plan that is integrated with social security,and/or (2) eligible to elect to have the employermake payments to a Code section 401(k)qualified cash or deferred arrangement. Activeparticipants also include any nonvestedindividuals who are earning or retainingcredited service under a plan. This categorydoes not include nonvested former employeeswho have incurred the break in service periodspecified in the plan.

For determining if active participants are fullyvested, partially vested, or nonvested, considervesting in employer contributions only.Line 7b. Inactive participants receivingbenefits are any individuals who are retired orseparated from employment covered by theplan and who are receiving benefits under theplan. This includes former employees who arereceiving group health continuation coveragebenefits pursuant to Part 6 of ERISA who arecovered by the employee welfare benefit plan.This category does not include any individualto whom an insurance company has made anirrevocable commitment to pay all the benefits

to which the individual is entitled under theplan.Line 7c. Inactive participants entitled tofuture benefits are individuals who are retiredor separated from employment covered by theplan and who are entitled to begin receivingbenefits under the plan in the future. Thiscategory does not include any individual towhom an insurance company has made anirrevocable commitment to pay all the benefitsto which the individual is entitled under theplan.Line 7e. Deceased participants are anydeceased individuals who had one or morebeneficiaries who are receiving or are entitledto receive benefits under the plan. Thiscategory does not include an individual if aninsurance company has made an irrevocable

commitment to pay all the benefits to which thebeneficiaries of that individual are entitledunder the plan.Line 7g. Enter the number of participantsincluded in line 7f who have account balancesat the end of the plan year. For example, for aCode section 401(k) plan, the number enteredon line 7g should be the number of participantscounted in line 7f who have made acontribution to the plan during this plan yearor any prior plan year.Line 7h. Include any participant whoterminated employment during this plan year,whether or not the participant incurred a breakin service. Multiemployer plans and

multiple-employer-collectively bargained plansdo not have to complete line 7h.Line 7i(1). If Yes, file Schedule SSA (Form5500) as an attachment to Form 5500. Planadministrators: Code section 6057(e)provides that the plan administrator must giveeach participant a statement showing the sameinformation reported on Schedule SSA for thatparticipant.Line 8a. Check Yes if an amendment to theplan was adopted regardless of the effectivedate of the amendment.Line 8b. Enter the date the most recent

amendment was adopted regardless of thedate of the amendment or the effective date ofthe amendment.Line 8c. Check Yes only if the accruedbenefits were retroactively reduced. Forexample, a plan provides a benefit of 2% foreach year of service, but the plan is amendedto change the benefit to 11/2% a year for allyears of service under the plan. Do not checkYes if accrued benefits were retroactivelyreduced solely to the extent permitted under amodel amendment provided in IRS Notice88-131, 1988-2 C.B. 546.Line 8d. Check Yes only if an amendmentchanged the information previously provided toparticipants by the summary plan descriptionor summary description of modifications.Line 8e. A revised summary plan description

or summary description of modifications mustbe filed with the DOL and distributed to allparticipants and pension plan beneficiaries nolater than 210 days after the close of the planyear in which the amendment(s) was adopted.If the material was distributed and filed sincethe amendments were adopted (even if afterthe end of the plan year), check Yes forquestion 8e.Line 9a. Check Yes if the plan wasterminated and enter the year of termination ifapplicable.Line 9b. If the plan was terminated but allplan assets were not distributed, a return/reportmust be filed for each year the plan has assets.In that case, the return/report must be filed bythe plan administrator, if designated, or by theperson or persons who actually control the

plan's property.If all plan assets were used to buy individualannuity contracts and the contracts weredistributed to the participants, check Yes.

If all the plan assets were legally transferredto the control of another plan or brought underthe control of PBGC, check Yes.

Check No for a welfare benefit plan that isstill liable to pay benefits for claims that wereincurred prior to the termination date, but notyet paid. See 29 CFR 2520.104b-2(g)(2)(ii).Line 9h. The Code provides for anondeductible excise tax on a reversion ofassets from a qualified plan.Line 9i. The employer must report thereversion by filing Form 5330 and pay anyapplicable tax. The tax will not be imposed onemployers who are tax-exempt entities under

Code section 501(a). See the instructions forForm 5330.Line 10a. If this plan was merged orconsolidated or spunoff into another plan(s),or plan assets or liabilities were transferred toanother plan(s), indicate which other plan orplans were involved.Line 10c. Enter the EIN of the sponsor(employer, if for a single-employer plan) of theother plan(s).Line 10d. Enter the plan number of the otherplan(s).Line 10e. Pension benefit plans must fileForm 5310-A, Notice of Plan Merger orConsolidation, Spinoff or Transfer of Plan

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Assets or Liabilities; Notice of QualifiedSeparate Lines of Business, at least 30 daysbefore any plan merger or consolidation or anytransfer of plan assets or liabilities to anotherplan.Caution: There is a penalty for not filing Form5310-A on time.

Line 11.Funding Arrangement. Enter thecode for the funding arrangement used by theplan for the plan year from the list below.

The funding arrangement is the methodused during the plan year for the receipt,holding, investment, and transmittal of plan

assets prior to the time the plan actuallyprovides the benefits promised under the plan.For purposes of lines 11 and 12, the termtrust includes any fund or account whichreceives, holds, transmits, or invests planassets other than an account or policy of aninsurance company.Note: An employee benefit plan that enterscode 2, 3, or 5 on line(s) 11 and/or 12 mustattach aSchedule A (Form 5500), InsuranceInformation, to provide information pertainingto each contract year ending with or within theplan year. See the instructions for ScheduleA (Form 5500). A plan attaching a Schedule Amay or may not be exempt from therequirement to engage an independentqualified public accountant. See theinstructions for line 26 on page 12.

Line 12.Benefit Arrangement. Enter thecode for the benefit arrangement used by theplan for the plan year from the list below.

The benefit arrangement is the method bywhich benefits were actually provided duringthe plan year to participants by the plan. Forexample, if all participants received theirbenefits from a trust (as defined in theinstructions for line 11 above) the plan's benefit

arrangement code would be 1. If somebenefits come from a trust and some comefrom an insurance company, the code wouldbe 2. If all benefits were paid from an accountor policy of an insurance company, the codewould be 3.

Line 13a. Check Yes if either thecontributions to the plan or the benefits paid

by the plan are subject to the collectivebargaining process, even if the plan is notestablished and administered by a joint boardof trustees. Check Yes even if only some ofthose covered by the plan are members of acollective bargaining unit that negotiatesbenefit levels on its own behalf. The benefitschedules do not have to be identical for allemployees under the plan.Line 13b. All plans that entered code C orD on line 4 must enter the six-digit LM numberto identify each sponsoring labor organizationthat is a party to the collective bargainingagreement. Other plans that are maintainedpursuant to collective bargaining agreementsshould enter the appropriate LM number, if

available. The LM number is the six-digitLabor-Management file number entered by thesponsoring labor organization in item 1 of theForm LM-2 or LM-3 (Labor OrganizationAnnual Report) filed with the Department ofLabor. Accordingly, the LM number(s) shouldbe readily available from the sponsoring labororganization(s). If all sponsoring labororganizations' LM numbers cannot be enteredin the spaces provided on line 13b on the form,enter the additional LM numbers on asupplemental sheet to accompany the Form5500.Line 14. If either the funding arrangement

code (line 11) and/or the benefit arrangementcode (line 12) is 2, 3, or 5, at least oneSchedule A (Form 5500) must be attached tothe Form 5500 filed for pension and welfareplans to provide information concerning thecontract year ending with or within the planyear. The insurance company (or similarorganization) that provides benefits is requiredto provide the plan administrator with theinformation needed to complete thereturn/report, pursuant to ERISA section103(a)(2). If you do not receive this informationin a timely manner, contact the insurancecompany (or similar organization). Ifinformation is missing on Schedule A (Form5500) due to a refusal to provide thisinformation, note this on the Schedule A. Ifthere is no Schedule(s) A attached, enter -0-.

Line 15a. If Yes is checked, attachSchedule B (Form 5500) to the Form 5500.Line 15b. If a waived funding deficiency isbeing amortized in the current plan year, do notcomplete (1), (2), and (3), but complete lines3, 8a, 9, and 10 of Schedule B (Form 5500).An enrolled actuary does not have to signSchedule B under these circumstances.Line 15b(2). The date of last payment byemployer refers to contributions for the planyear being reported. This date can be after theend of the plan year.Line 15b(3). Subtract line 15b(2) from line15b(1). If zero or less, enter -0-. If greater thanzero, enter the amount of the fundingdeficiency. File Form 5330 with the IRS to paythe excise tax on any funding deficiency.Caution: There is a penalty for not filing Form

5330 on time.Line 16. The 1996 annual compensation limitunder Code section 401(a)(17) is $150,000.However, the 1996 annual compensation limitfor certain plans maintained under a collectivebargaining agreement is $250,000.Line 17a(1). Check Yes if the plandistributed any annuity contracts. Check Yeseven if the plan was terminated.Line 17a(2). If Yes was checked for line17a(1), the annuity contract must provide thatall distributions from it will meet the participantand spousal consent requirements of Codesection 417. However, consent is not neededfor the distribution of the contract itself. If thecontracts contained the Code section 417requirements, check Yes.Line 17b. Generally, within the 90 days priorto the date of any benefit payment or the datea loan was made to a participant, you must getthe spouse's consent to the payment of thebenefit or the use of the accrued benefit tomake the loan. However, there are somec