Schedule R (Form 5500) - Retirement Plan Information - 2011 Page 2
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3Schedule R (Form 5500) 2011
Page
1 x
2 -
Part V
Additional Information for Multiemployer Defined Benefit Pension Plans
Enter the following information for each employer that contributed more than 5% of total contributions to the plan during the plan year (measured in
13
dollars). See instructions. Complete as many entries as needed to report all applicable employers.
Name of contributing employer
a
EIN
Dollar amount contributed by employer
b
c
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
X
d
Month _______
Day _______
Year _______
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
X
Contribution rate information (If more than one rate applies, check this box
e
and see instructions regarding required attachment. Otherwise,
complete items 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
(2)
Base unit measure:
X
Hourly
X
Weekly
X
Unit of production
X
Other (specify):
Name of contributing employer
a
EIN
Dollar amount contributed by employer
b
c
X
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
d
Month _______
Day _______
Year _______
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Contribution rate information (If more than one rate applies, check this box
X
e
and see instructions regarding required attachment. Otherwise,
complete items 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify): _______________________________
Name of contributing employer
a
EIN
Dollar amount contributed by employer
b
c
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
X
d
Month _______
Day _______
Year _______
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
X
Contribution rate information (If more than one rate applies, check this box
e
and see instructions regarding required attachment. Otherwise,
complete items 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
(2)
Base unit measure:
X
Hourly
X
Weekly
X
Unit of production
X
Other (specify): _______________________________
Name of contributing employer
a
EIN
Dollar amount contributed by employer
b
c
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
X
d
Month _______
Day _______
Year _______
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
X
Contribution rate information (If more than one rate applies, check this box
e
and see instructions regarding required attachment. Otherwise,
complete items 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
(2)
Base unit measure:
X
Hourly
X
Weekly
X
Unit of production
X
Other (specify): _______________________________
Name of contributing employer
a
EIN
Dollar amount contributed by employer
b
c
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
X
d
Month _______
Day _______
Year _______
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
X
Contribution rate information (If more than one rate applies, check this box
e
and see instructions regarding required attachment. Otherwise,
complete items 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
(2)
Base unit measure:
X
Hourly
X
Weekly
X
Unit of production
X
Other (specify): _______________________________
Name of contributing employer
a
EIN
Dollar amount contributed by employer
b
c
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
X
d
Month _______
Day _______
Year _______
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Contribution rate information (If more than one rate applies, check this box
X
e
and see instructions regarding required attachment. Otherwise,
complete items 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
(2)
Base unit measure:
X
Hourly
X
Weekly
X
Unit of production
X
Other (specify): _______________________________
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