Schedule Mb (Form 5500) - Multiemployer Defined Benefit Plan And Certain Money Purchase Plan Actuarial Information - 2016

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UK
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OMB No. 1210-0110
SCHEDULE MB
Multiemployer Defined Benefit Plan and Certain
Money Purchase Plan Actuarial Information
(Form 5500)
2016
Department of the Treasury
Internal Revenue Service
This schedule is required to be filed under section 104 of the Employee
Retirement Income Security Act of 1974 (ERISA) and section 6059 of the
Department of Labor
This Form is Open to Public
Employee Benefits Security Administration
Internal Revenue Code (the Code).
Inspection
Pension Benefit Guaranty Corporation
File as an attachment to Form 5500 or 5500-SF.
For calendar plan year 2016 or fiscal plan year beginning
and ending
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.
A
Name of plan
B
Three-digit
plan number (PN)
C
Plan sponsor’s name as shown on line 2a of Form 5500 or 5500-SF
D
Employer Identification Number (EIN)
E
Type of plan:
(1)
Multiemployer Defined Benefit
(2)
Money Purchase (see instructions)
1a
Enter the valuation date:
Month _________
Day _________
Year _________
b
Assets
(1) Current value of assets .....................................................................................................................
1b(1)
(2) Actuarial value of assets for funding standard account ......................................................................
1b(2)
c
1c(1)
(1) Accrued liability for plan using immediate gain methods ....................................................................
(2) Information for plans using spread gain methods:
1c(2)(a)
(a) Unfunded liability for methods with bases ...................................................................................
1c(2)(b)
(b) Accrued liability under entry age normal method .........................................................................
1c(2)(c)
(c) Normal cost under entry age normal method ...............................................................................
1c(3)
(3) Accrued liability under unit credit cost method ...................................................................................
d
Information on current liabilities of the plan:
(1) Amount excluded from current liability attributable to pre-participation service (see instructions) .......
1d(1)
(2) “RPA ‘94” information:
(a) Current liability ............................................................................................................................
1d(2)(a)
(b) Expected increase in current liability due to benefits accruing during the plan year .....................
1d(2)(b)
(c) Expected release from “RPA ‘94” current liability for the plan year ..............................................
1d(2)(c)
(3) Expected plan disbursements for the plan year .................................................................................
1d(3)
Statement by Enrolled Actuary
To the best of my knowledge, the information supplied in this schedule and accompanying schedules, statements and attachments, if any, is complete and accurate. Each prescribed assumption was applied
in accordance with applicable law and regulations. In my opinion, each other assumption is reasonable (taking into account the experience of the plan and reasonable expectations) and such other
assumptions, in combination, offer my best estimate of anticipated experience under the plan.
SIGN
HERE
Signature of actuary
Date
Type or print 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 or 5500-SF.
Schedule MB (Form 5500) 2016
v. 160205

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