Fillable Schedule B (Form 5500) - Actuarial Information

Actuarial Information

SCHEDULE B

OMB No. 1210-0016

(Form 5500)

This schedule is required to be filed under section 104 of the Employee

1998

Retirement Income Security Act of 1974, referred to as ERISA, except when

attached to Form 5500-EZ and, in all cases, under section 6059(a) of the

Department of the Treasury

Internal Revenue Service

Internal Revenue Code, referred to as the Code.

This Form Is Open to

Department of Labor

Public Inspection

Attach to Form 5500, 5500-C/R, or 5500-EZ if applicable.

Pension and Welfare Benefits Administration

(except when attached

See separate instructions.

to Form 5500-EZ)

Pension Benefit Guaranty Corporation

For calendar plan year 1998 or fiscal plan year beginning

, 1998, and ending

, 19

If an item does not apply, enter “N/A.”

Round off amounts to nearest dollar.

Caution: A penalty of $1,000 will be assessed for late filing of this report unless reasonable cause is established.

Name of employer/plan sponsor as shown on line 1a of Form 5500, 5500-C/R, or 5500-EZ

Employer identification number

Name of plan

Three-digit

plan number

Type of plan:

(1)

Single employer

(2)

Multiemployer

(3)

Multiple employer

100 or fewer participants in prior plan year

Part I

Basic Information (To be completed by all plans)

Enter the actuarial valuation date:

Month

Day

Year

b Assets:

b(1)

(1)

Current value of assets

b(2)

(2)

Actuarial value of assets for funding standard account

c(1)

(1)

Accrued liability for plans using immediate gain methods

(2)

Information for plans using spread gain methods:

c(2)(a)

(a)

Unfunded liability for methods with bases

c(2)(b)

(b)

Accrued liability under entry age normal method

c(2)(c)

(c)

Normal cost under entry age normal method

d Information on current liabilities of the plan:

(1)

Amount excluded from current liability attributable to pre-participation service (see

d(1)

instructions)

(2)

“RPA ’94” information:

d(2)(a)

(a)

Current liability

d(2)(b)

(b)

Expected increase in current liability due to benefits accruing during the plan year

d(2)(c)

(c)

Current liability computed at highest allowable interest rate (see instructions)

d(2)(d)

(d)

Expected release from “RPA ’94” current liability for the plan year

“OBRA ’87” information:

(3)

d(3)(a)

(a)

Current liability

d(3)(b)

(b)

Expected increase in current liability due to benefits accruing during the plan year

d(3)(c)

(c)

Expected release from “OBRA ’87” current liability for the plan year

(4)

Expected plan disbursements for the plan year

d(4)

Statement by Enrolled Actuary (see instructions before signing):

To the best of my knowledge, the information supplied in this schedule and on the accompanying statements, if any, is complete and accurate, and in my opinion

each assumption used in combination, represents my best estimate of anticipated experience under the plan. Furthermore, in the case of a plan other than a multiemployer

plan, each assumption used (a) is reasonable (taking into account the experience of the plan and reasonable expectations) or (b) would, in the aggregate, result in a

total contribution equivalent to that which would be determined if each such assumption were reasonable. In the case of a multiemployer plan, the assumptions used,

in the aggregate, are reasonable (taking into account the experience of the plan and reasonable expectations).

Signature of actuary

Date

—

Print or type name of actuary

Most recent enrollment number

Firm name

Telephone number (including area code)

Address of the firm

If the actuary has not fully reflected any regulation or ruling promulgated under the statute in completing this schedule,

check the box and see instructions

For Paperwork Reduction Act Notice, see the Instructions for Form 5500, 5500-C/R or 5500-EZ.