Schedule R (Form 5500) - Retirement Plan Information - 2016 Page 2
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Schedule R (Form 5500) 2016
Page
Part V
Additional Information for Multiemployer Defined Benefit Pension Plans
13
Enter the following information for each employer that contributed more than 5% of total contributions to the plan during the plan year (measured in
dollars). See instructions. Complete as many entries as needed to report all applicable employers.
a
Name of contributing employer
b
c
EIN
Dollar amount contributed by employer
X
d
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Month _______
Day _______
Year _______
X
e
Contribution rate information (If more than one rate applies, check this box
and see instructions regarding required attachment. Otherwise,
complete lines 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify):
a
Name of contributing employer
b
c
EIN
Dollar amount contributed by employer
X
d
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Month _______
Day _______
Year _______
X
e
Contribution rate information (If more than one rate applies, check this box
and see instructions regarding required attachment. Otherwise,
complete lines 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify): _______________________________
a
Name of contributing employer
b
c
EIN
Dollar amount contributed by employer
X
d
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Month _______
Day _______
Year _______
X
e
Contribution rate information (If more than one rate applies, check this box
and see instructions regarding required attachment. Otherwise,
complete lines 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify): _______________________________
a
Name of contributing employer
b
c
EIN
Dollar amount contributed by employer
X
d
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Month _______
Day _______
Year _______
X
e
Contribution rate information (If more than one rate applies, check this box
and see instructions regarding required attachment. Otherwise,
complete lines 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify): _______________________________
a
Name of contributing employer
b
c
EIN
Dollar amount contributed by employer
X
d
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Month _______
Day _______
Year _______
X
e
Contribution rate information (If more than one rate applies, check this box
and see instructions regarding required attachment. Otherwise,
complete lines 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify): _______________________________
a
Name of contributing employer
b
c
EIN
Dollar amount contributed by employer
X
d
Date collective bargaining agreement expires (If employer contributes under more than one collective bargaining agreement, check box
and see instructions regarding required attachment. Otherwise, enter the applicable date.)
Month _______
Day _______
Year _______
X
e
Contribution rate information (If more than one rate applies, check this box
and see instructions regarding required attachment. Otherwise,
complete lines 13e(1) and 13e(2).)
(1)
Contribution rate (in dollars and cents) _____________
X
X
X
X
(2)
Base unit measure:
Hourly
Weekly
Unit of production
Other (specify): _______________________________
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