Schedule H (Form 5500) - Financial Information - 2016 Page 2
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Schedule H (Form 5500) 2016
Page
1d
Employer-related investments:
(a) Beginning of Year
(b) End of Year
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(1) Employer securities .................................................................................. 1d(1)
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(2) Employer real property ............................................................................. 1d(2)
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1e
1e
Buildings and other property used in plan operation .......................................
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1f
1f
Total assets (add all amounts in lines 1a through 1e) .....................................
Liabilities
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1g
1g
Benefit claims payable ....................................................................................
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1h
1h
Operating payables ........................................................................................
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1i
1i
Acquisition indebtedness ................................................................................
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1j
1j
Other liabilities ................................................................................................
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1k
1k
Total liabilities (add all amounts in lines 1g through1j) ....................................
Net Assets
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1l
Net assets (subtract line 1k from line 1f) .........................................................
1l
Part II Income and Expense Statement
2
Plan income, expenses, and changes in net assets for the year. Include all income and expenses of the plan, including any trust(s) or separately maintained
fund(s) and any payments/receipts to/from insurance carriers. Round off amounts to the nearest dollar. MTIAs, CCTs, PSAs, and 103-12 IEs do not
complete lines 2a, 2b(1)(E), 2e, 2f, and 2g.
Income
(a) Amount
(b) Total
a
Contributions:
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(1) Received or receivable in cash from: (A) Employers ................................. 2a(1)(A)
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(B) Participants ....................................................................................... 2a(1)(B)
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(C) Others (including rollovers) ............................................................... 2a(1)(C)
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(2) Noncash contributions .............................................................................. 2a(2)
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(3) Total contributions. Add lines 2a(1)(A), (B), (C), and line 2a(2) ................. 2a(3)
b
Earnings on investments:
(1) Interest:
(A) Interest-bearing cash (including money market accounts and
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2b(1)(A)
certificates of deposit) .......................................................................
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(B) U.S. Government securities .............................................................. 2b(1)(B)
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(C) Corporate debt instruments ............................................................... 2b(1)(C)
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(D) Loans (other than to participants) ...................................................... 2b(1)(D)
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(E) Participant loans ............................................................................... 2b(1)(E)
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(F) Other ................................................................................................ 2b(1)(F)
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(G) Total interest. Add lines 2b(1)(A) through (F) .................................... 2b(1)(G)
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(2) Dividends: (A) Preferred stock .................................................................. 2b(2)(A)
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(B) Common stock .................................................................................. 2b(2)(B)
(C) Registered investment company shares (e.g. mutual funds) ............. 2b(2)(C)
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2b(2)(D)
(D) Total dividends. Add lines 2b(2)(A), (B), and (C)
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(3) Rents ........................................................................................................ 2b(3)
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(4) Net gain (loss) on sale of assets: (A) Aggregate proceeds....................... 2b(4)(A)
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(B) Aggregate carrying amount (see instructions) ................................... 2b(4)(B)
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(C) Subtract line 2b(4)(B) from line 2b(4)(A) and enter result ................. 2b(4)(C)
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(5) Unrealized appreciation (depreciation) of assets: (A) Real estate ........................ 2b(5)(A)
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(B) Other ................................................................................................ 2b(5)(B)
(C) Total unrealized appreciation of assets.
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2b(5)(C)
Add lines 2b(5)(A) and (B) ................................................................
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