Form 5500 - Annual Return/report Of Employee Benefit Plan - 2015 Page 3

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Form 5500 (2015)
Page
Part III
Form M-1 Compliance Information (to be completed by welfare benefit plans)
11a
If the plan provides welfare benefits, was the plan subject to the Form M-1 filing requirements during the plan year? (See instructions and 29 CFR
2520.101-2.) ........................………..….
X
Yes
X
No
If “Yes” is checked, complete lines 11b and 11c.
11b
Is the plan currently in compliance with the Form M-1 filing requirements? (See instructions and 29 CFR 2520.101-2.) …….....
X
Yes
X
No
11c
Enter the Receipt Confirmation Code for the 2015 Form M-1 annual report. If the plan was not required to file the 2015 Form M-1 annual report,
enter the Receipt Confirmation Code for the most recent Form M-1 that was required to be filed under the Form M-1 filing requirements. (Failure
to enter a valid Receipt Confirmation Code will subject the Form 5500 filing to rejection as incomplete.)
Receipt Confirmation Code______________________

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