Form 5500 - Annual Return/report Of Employee Benefit Plan - 1998

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5500
OMB Nos. 1210-0016
Annual Return/Report of Employee Benefit Plan
1210-0089
Form
(With 100 or more participants)
Department of the Treasury
1998
Internal Revenue Service
This form is required to be filed under sections 104 and 4065 of the Employee
Department of Labor
Retirement Income Security Act of 1974 and sections 6039D, 6047(e), 6057(b),
Pension and Welfare Benefits
and 6058(a) of the Internal Revenue Code, referred to as the Code.
This Form Is Open to
Administration
See separate instructions.
Public Inspection.
Pension Benefit Guaranty Corporation
For the calendar plan year 1998 or fiscal plan year beginning
, 1998, and ending
, 19
For IRS Use Only
If A(1) through A(4), B, C, and/or D, do not apply to this year’s
EP–ID
return/report, leave the boxes unmarked.
A
This return/report is:
(1)
the first return/report filed for the plan;
(3)
the final return/report filed for the plan; or
(4)
a short plan year return/report (less than 12 months).
(2)
an amended return/report;
B
Check here if any information reported in 1a, 2a, 2b, or 5a changed since the last return/report for this plan
C
If your plan year changed since the last return/report, check here
D
If you filed for an extension of time to file this return/report, check here and attach a copy of the extension
1a
Name and address of plan sponsor (employer, if for a single-employer plan)
1b
Employer identification number (EIN)
(Address should include room or suite no.)
1c
Sponsor’s telephone number
1d
Business code (see instructions, page 20)
1e
CUSIP issuer number
Name and address of plan administrator (if same as plan sponsor, enter ‘‘Same’’)
2b
Administrator’s EIN
2a
2c
Administrator’s telephone number
3
If the name, address, and EIN of the plan sponsor or plan administrator has changed since the last return/report filed for this plan, enter the
information from the last return/report in line 3a and/or line 3b and complete line 3c.
a
Sponsor
EIN
Plan number
b
Administrator
EIN
c
If line 3a indicates a change in the sponsor’s name, address, and EIN, is this a change in sponsorship only? (See line 3c on page 8 of the
instructions for the definition of sponsorship.) Enter “Yes” or “No.”
4
ENTITY CODE. (If not shown, enter the applicable code from page 8 of the instructions.)
5b
Effective date of plan (mo., day, yr.)
5a
Name of plan
5c
Three-digit
plan number
All filers must complete 6a through 6d, as applicable.
6a
Welfare benefit plan
6b
Pension benefit plan
(Enter the applicable codes from page 8 of the instructions in the boxes.)
6c
Pension plan features. (Enter the applicable pension plan feature codes from page 8 of the
instructions in the boxes.)
6d
Fringe benefit plan. Attach Schedule F (Form 5500). See instructions.
Caution: A penalty for the late or incomplete filing of this return/report will be assessed unless reasonable cause is established.
Under penalties of perjury and other penalties set forth in the instructions, I declare that I have examined this return/report, including accompanying schedules and
statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature of employer/plan sponsor
Date
Type or print name of individual signing above
Signature of plan administrator
Date
Type or print name of individual signing above
5500
For Paperwork Reduction Act Notice, see the instructions for Form 5500.
Cat. No. 13500F
Form
(1998)

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