Form 5500 - Schedule Mb - Multiemployer Defined Benefit Plan And Certain Money Purchase Plan Actuarial Information - 2015 Page 2

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2-
Schedule MB (Form 5500) 2015
Page
1 x
2
Operational information as of beginning of this plan year:
a
Current value of assets (see instructions) ...................................................................................................………… 2a
-123456789012345
b
(1) Number of participants
(2) Current liability
“RPA ‘94” current liability/participant count breakdown:
(1) For retired participants and beneficiaries receiving payment ....................................
12345678
-123456789012345
(2) For terminated vested participants ............................................................................
12345678
-123456789012345
(3) For active participants:
(a) Non-vested benefits ............................................................................................
-123456789012345
(b) Vested benefits ...................................................................................................
-123456789012345
(c) Total active ..........................................................................................................
-123456789012345
(4) Total ...........................................................................................................................
12345678
-123456789012345
c
If the percentage resulting from dividing line 2a by line 2b(4), column (2), is less than 70%, enter such
2c
123.12
%
percentage ................................................................................................................................................................
3
Contributions made to the plan for the plan year by employer(s) and employees:
(a) Date
(b) Amount paid by
(c) Amount paid by
(a) Date
(b) Amount paid by
(c) Amount paid by
(MM-DD-YYYY)
employer(s)
employees
(MM-DD-YYYY)
employer(s)
employees
Totals ►
3(b)
3(c)
4
Information on plan status:
a
4a
%
Funded percentage for monitoring plan’s status (line 1b(2) divided by line 1c(3)) ...................................................
b
Enter code to indicate plan’s status (see instructions for attachment of supporting evidence of plan’s status). If
4b
123.1
code is “N,” go to line 5 .............................................................................................................................................
c
X
X
Is the plan making the scheduled progress under any applicable funding improvement or rehabilitation plan? .............................................................
Yes
No
d
X
X
If the plan is in critical status or critical and declining status, were any benefits reduced (see instructions)? ..................................................
Yes
No
e
If line d is “Yes,” enter the reduction in liability resulting from the reduction in benefits (see instructions),
4e
-123456789012345
measured as of the valuation date ............................................................................................................................
f
If the rehabilitation plan projects emergence from critical status or critical and declining status, enter the plan
year in which it is projected to emerge.
4f
If the rehabilitation plan is based on forestalling possible insolvency, enter the plan year in which insolvency is
expected and check here ……………………………….......................................................................................
5
Actuarial cost method used as the basis for this plan year’s funding standard account computations (check all that apply):
a
b
c
d
X
X
X
X
Attained age normal
Entry age normal
Accrued benefit (unit credit)
Aggregate
e
f
g
h
X
X
X
X
Frozen initial liability
Individual level premium
Individual aggregate
Shortfall
j
i
X
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI AB ABCDEFGHI
X
Other (specify):
Reorganization
ABCDEFGHI ABCDEFGHI C ABCDEFGHI ABCDEFGHI ABCDEFGHI DE
k
5k
YYYY-MM-DD
If box h is checked, enter period of use of shortfall method .........................................................................................
l
X
X
Has a change been made in funding method for this plan year? ......................................................................................................................
Yes
No
m
X
X
If line l is “Yes,” was the change made pursuant to Revenue Procedure 2000-40 or other automatic approval? .............................................
Yes
No
n
If line l is “Yes,” and line m is “No,” enter the date (MM-DD-YYYY) of the ruling letter (individual or class)
5n
YYYY-MM-DD
approving the change in funding method .....................................................................................................................
6
Checklist of certain actuarial assumptions:
a
Interest rate for “RPA ‘94” current liability. ............................................................................................................................................ 6a
123.12
%
Pre-retirement
Post-retirement
b
X
X
X
X
X
X
Yes
No
N/A
Yes
No
N/A
Rates specified in insurance or annuity contracts .....................................
c
Mortality table code for valuation purposes:

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