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.

Page

Form 5500-C/R (1998)

Welfare Plans Do Not Complete Lines 15 Through 25. Skip To Line 26 on page 5.

Yes

15a

If this is a defined benefit plan subject to the minimum funding standards for this plan year, is Schedule B (Form 5500)

15a

required to be attached? (If this is a defined contribution plan, leave blank.)

If “Yes,” attach Schedule B (Form 5500).

If this is a defined contribution plan (i.e., money purchase or target benefit), is it subject to the minimum funding standards

15b

(if a waiver was granted, see instructions)? (If this is a defined benefit plan, leave blank.)

If “Yes,” complete (1), (2), and (3) below:

15b(1)

(1)

Amount of employer contribution required for the plan year under Code section 412

15b(2) $

(2)

Amount of contribution paid by the employer for the plan year

Enter date of last payment by employer

Month

Day

Year

(3)

If (1) is greater than (2), subtract (2) from (1) and enter the funding deficiency

here. Otherwise, enter -0-. (If you have a funding deficiency, file Form 5330.)

15b(3)

Has the annual compensation of each participant taken into account under the current plan year been limited as required

by section 401(a)(17)? (See instructions.)

17a(1)

17a

(1)

Did the plan distribute any annuity contracts this year? (See instructions.)

(2)

If (1) is “Yes,” did these contracts contain a requirement that the spouse consent before any distributions under

17a(2)

the contract are made in a form other than a qualified joint and survivor annuity?

Did the plan make distributions or loans to married participants and beneficiaries without the required consent of the

17b

participant’s spouse?

Upon plan amendment or termination, do the accrued benefits of every participant include the subsidized benefits that

the participant may become entitled to receive subsequent to the plan amendment or termination?

17c

Is the plan administrator making an election under section 412(c)(8) for an amendment adopted after the end of the plan

year? (See instructions.)

If a change in the actuarial funding method was made for the plan year pursuant to a Revenue Procedure providing

automatic approval for the change, indicate whether the plan sponsor/administrator agrees to the change

Is the employer electing to compute minimum funding for this plan year or either of the two immediately preceding plan

years using the transition rule of Code section 412(l)(11)?

Check if you are applying the substantiation guidelines from Revenue Procedure 93-42, in completing lines 21a through

21o (see instructions)

If you checked the box, enter the first day of the plan year for which data is being submitted

Month

Day

Year

Does the employer apply the separate line of business rules of Code section 414(r) when testing this plan for the coverage

21a

and discrimination tests requirements of Code sections 410(b) and 401(a)(4)?

If line 21a is “Yes,” enter the total number of separate lines of business claimed by the employer

If more than one separate line of business, see instructions for additional information to attach.

Does the employer apply the mandatory disaggregation rules under Income Tax Regulations section 1.410(b)–7(c)? If

21c

“Yes,” see instructions for additional information to attach

In testing whether this plan satisfies the coverage and discrimination tests of Code sections 410(b) and 401(a), does

21d

the employer aggregate plans?

Does the employer restructure the plan into component plans to satisfy the coverage and discrimination tests of Code

21e

sections 410(b) and 401(a)(4)?

If you meet either one of the following exceptions, check the applicable box to tell us which exception you meet and

DO NOT complete the rest of question 21:

(1)

No highly compensated employee benefited under the plan at any time during the plan year;

(2)

This is a collectively bargained plan that benefits only collectively bargained employees, no more than 2% of

whom are professional employees.

21g

g Did any leased employee perform services for the employer at any time during the plan year?

Number

Enter the total number of employees of the employer. Employer includes entities aggregated with the employer under

21h

Code section 414(b), (c), or (m). Include leased employees and self-employed individuals

Enter the total number of employees excludable under the plan because of: (1) failure to meet requirements for minimum

age and years of service; (2) collectively bargained employees; (3) nonresident aliens who receive no earned income

21i

from U. S. sources; and (4) 500 hours of service/last day rule

Form 5500-C/r - Return/report Of Employee Benefit Plan - 1998 Page 4

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