Fillable Form 5500-C/r - Return/report Of Employee Benefit Plan

Complete page 1, and pages 3 through 6 only, if you are filing Form 5500-C. (See instructions on page 12.)

Form 5500-C/R (1998)

Page

6e Check all applicable investment arrangements below. (See instructions on page 12.):

(1)

Master trust

(2)

103-12 investment entity

(3)

Common/collective trust

(4)

Pooled separate account

Single-employer plans enter the tax year end of the employer in which this plan year ends

Month

Day

Year

Is any part of this plan funded by an insurance contract described in Code section 412(i)?

Yes

If line 6g is “Yes,” was the part subject to the minimum funding standards for either of the prior 2 plan years?

Yes

7a Total participants: (1) At the beginning of plan year

(2) At the end of plan year

Enter number of participants with account balances at the end of the plan year. (Defined benefits plans do not complete this

item.)

Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested

Yes

(1)

Were any participants in the pension benefit plan separated from service with a deferred vested benefit for which

7d(1)

a Schedule SSA (Form 5500) is required to be attached?

(2)

If “Yes,” enter the number of separated participants required to be reported

Was this plan ever amended since its effective date? If “Yes,” complete line 8b and, if the amendment was adopted in

this plan year, complete lines 8c through 8e

If line 8a is “Yes,” enter the date the most recent amendment was adopted

Month

Day

Year

Did any amendment during the current plan year result in the retroactive reduction of accrued benefits for any participant?

During this plan year, did any amendment change the information contained in the latest summary plan description or

summary description of modifications available at the time of amendment?

e If line 8d is “Yes,” has a summary plan description or summary description of modifications that reflects the plan

amendments referred to on line 8d been furnished to participants? (see instructions)

9a Was this plan terminated during this plan year or any prior plan year? If “Yes,” enter year

b Were all plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the

control of PBGC? (see instructions.)

Was a resolution to terminate this plan adopted during this plan year or any prior plan year?

d If line 9a or line 9c is “Yes,” have you received a favorable determination letter from the IRS for the termination?

e If line 9d is “No,” has a determination letter been requested from the IRS?

f If line 9a or line 9c is “Yes,” have participants and beneficiaries been notified of the termination or the proposed

termination?

If line 9a is “Yes” and the plan is covered by PBGC, is the plan continuing to file a PBGC Form 1 and pay premiums

until the end of the plan year in which assets are distributed or brought under the control of PBGC?

During this plan year, did any trust assets revert to the employer for which the Code section 4980 excise tax is due?

If line 9h is “Yes,” enter the amount of tax paid with Form 5330

10a

Was this plan merged or consolidated into another plan(s), or were assets or liabilities transferred to another plan(s) since

the end of the plan year covered by the last return/report Form 5500 or 5500-C that was filed for this plan (or during

10a

this plan year if this is the first return/report)? If “Yes,” complete lines 10b through 10e

If “Yes,” identify the other plan(s):

Employer identification number(s)

Plan number(s)

Name of plan(s)

If required, has a Form 5310-A been filed?

Yes

Enter the plan funding arrangement code

Enter the plan benefit arrangement code from

Yes

from page 13 of the instructions

page 13 of the instructions

Is this a plan established or maintained pursuant to one or more collective bargaining agreements?

If any benefits are provided by an insurance company, insurance service, or similar organization, enter the number of

Schedules A (Form 5500), Insurance Information, that are attached. If none, enter -0-.

Form 5500-C/r - Return/report Of Employee Benefit Plan - 1998 Page 3

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