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Part I
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Distributions
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All references to distributions relate only to payments of benefits during the
plan year.
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1
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Total value of distributions paid in property other than in cash or the forms of
property specified in the
instructions
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1
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2
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Enter the EIN(s) of payor(s) who paid benefits on behalf of the plan to participants
or beneficiaries during the year (if more than two, enter EINs of the two payors
who paid the greatest dollar amounts of benefits):
EIN(s): 43-6389220
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Profit-sharing plans, ESOPs, and stock bonus plans, skip line 3.
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3
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Number of participants (living or deceased) whose benefits were distributed in a
single sum, during the plan year
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3
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Part II
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Funding Information (If the plan
is not subject to the minimum funding requirements of section 412 of the Internal
Revenue Code or
ERISA section 302, skip this Part)
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4
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Is the plan administrator making an election under Code section 412(d)(2) or ERISA
section 302(d)(2)?
If the plan is a defined benefit plan, go to line 8.
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Yes
No
N/A
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5
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If a waiver of the minimum funding standard for a prior plan year is being amortized
in this
plan year, see instructions, and enter the date of the ruling letter granting the
waiver.
Date:
If you completed line 5, complete lines 3, 9, and 10 of Schedule MB and do not
complete the remainder of this schedule.
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6
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a Enter the minimum required contribution for this plan
year
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6a
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b Enter the amount contributed by the employer to the
plan for this plan year
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6b
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c Subtract the amount in line 6b from the amount in
line 6a. Enter the result
(enter a minus sign to the left of a negative amount)
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6c
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If you completed line 6c, skip lines 8 and 9
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7
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Will the minimum funding amount reported on line 6c be met by the funding deadline?
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Yes
No
N/A
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8
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If a change in actuarial cost method was made for this plan year pursuant to a revenue
procedure providing automatic approval for the change or a class ruling letter,
does the plan sponsor or plan administrator agree with the change?
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Yes
No
N/A
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Part III
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Amendments
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9
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If this is a defined benefit pension plan, were any amendments adopted
during this plan year that increased or decreased the value of benefits?
If yes, check the appropriate box(es). If no, check the “No” box
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Increase
Decrease
Both
No
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Part IV
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ESOPs (see instructions). If this
is not a plan described under Section 409(a) or 4975(e)(7) of the Internal Revenue
Code,
skip this Part.
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10
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Were unallocated employer securities or proceeds from the sale of unallocated securities
used to repay any exempt loan?
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Yes
No
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11
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a Does the ESOP hold any preferred stock?
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Yes
No
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b If the ESOP has an outstanding exempt loan with the
employer as lender, is such loan part of a “back-to-back” loan? (See
instructions for definition of “back-to-back” loan.)
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Yes
No
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12
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Does the ESOP hold any stock that is not readily tradable on an established securities
market?
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Yes
No
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For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions
for Form 5500.
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Schedule R (Form 5500) 2010
v.092308.1
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Part V
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Additional Information for Multiemployer Defined
Benefit Pension Plans
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13
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Enter the following information for each employer that contributed more than 5%
of total contributions to the plan during the plan year (measured in dollars). See
instructions. Complete as many entries as needed to report all applicable employers.
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14
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Enter the number of participants on whose behalf no contributions were made by an
employer as an employer of the participant for:
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a The current year
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14a
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b The plan year immediately preceding the current plan
year
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14b
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c The second preceding plan year
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14c
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15
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Enter the ratio of the number of participants under the plan on whose behalf no
employer had an obligation to make an employer contribution during the current
plan year to:
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a The corresponding number for the plan year immediately
preceding the current plan year
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15a
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b The corresponding number for the second preceding
plan year
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15b
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16
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Information with respect to any employers who withdrew from the plan during the
preceding plan year:
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a Enter the number of employers who withdrew during
the preceding plan year
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16a
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b If item 16a is greater than 0, enter the aggregate
amount of withdrawal liability assessed or estimated to be assessed against such
withdrawn employers
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16b
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17
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If assets and liabilities from another plan have been transferred to or merged with
this plan during the plan year, check box and see instructions regarding
information to be included as an attachment.
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Part VI
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Additional Information for Single-Employer and
Multiemployer Defined Benefit Pension Plans
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18
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If any liabilities to participants or their beneficiaries under the plan as of the
end of the plan year consist (in whole or in part) of liabilities to such participants
and beneficiaries under two or more pension plans as of immediately before such
plan year, check box and see instructions regarding supplemental
information to be included as an attachment
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19
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If the total number of participants is 1,000 or more, complete items (a) through
(c)
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a Enter the percentage of plan assets held as:
Stock: % Investment-Grade
Debt: % High-Yield Debt:
% Real Estate: %
Other: %
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b Provide the average duration of the combined investment-grade
and high-yield debt: 0-3 years 3-6
years 6-9
years 9-12
years 12-15
years 15-18
years 18-21
years 21
years or more
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c What duration measure was used to calculate item 19(b)?
Effective
duration Macaulay
duration Modified
duration Other
(specify):
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