2009 Instructions For Schedule A (Form 5500) Insurance Information Page 3


Part IV - Provision of Information
other similar organization to provide information, check “Yes” on
line 11 and enter a description of the information not provided
The insurance company, insurance service, or other similar
on line 12. If you received all the information necessary to
organization is required under ERISA section 103(a)(2) to
receive the Schedule A, check “No” and leave line 12 blank.
provide the plan administrator with the information needed to
complete this return/report. If you do not receive this information
As noted above, the insurance company, insurance
in a timely manner, contact the insurance company, insurance
service, or other similar organization is statutorily
service, or other similar organization.
required to provide you with all of the information
Lines 11 and 12. If information is missing on Schedule A due
necessary to complete the Schedule A, but need not provide
to a refusal by the insurance company, insurance service, or
the information on a Schedule A itself.
Instructions for Schedule A (Form 5500)


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