Schedule R (Form 5500) - Retirement Plan Information - 2016 Page 3
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Schedule R (Form 5500) 2016
Page
14
Enter the number of participants on whose behalf no contributions were made by an employer as an employer
123456789012345
of the participant for:
14a
a
The current year ................................................................................................................................................
14b
b
123456789012345
The plan year immediately preceding the current plan year ..............................................................................
14c
c
123456789012345
The second preceding plan year ......................................................................................................................
15
Enter the ratio of the number of participants under the plan on whose behalf no employer had an obligation to make an
employer contribution during the current plan year to:
15a
a
123456789012345
The corresponding number for the plan year immediately preceding the current plan year ...............................
15b
b
123456789012345
The corresponding number for the second preceding plan year .......................................................................
16
:
Information with respect to any employers who withdrew from the plan during the preceding plan year
16a
a
123456789012345
Enter the number of employers who withdrew during the preceding plan year ...............................................
b
If line 16a is greater than 0, enter the aggregate amount of withdrawal liability assessed or estimated to be
16b
123456789012345
assessed against such withdrawn employers ...................................................................................................
17
If assets and liabilities from another plan have been transferred to or merged with this plan during the plan year, check box and see instructions regarding
.......................................................................................................................
supplemental information to be included as an attachment.
X
Part VI
Additional Information for Single-Employer and Multiemployer Defined Benefit Pension Plans
18
If any liabilities to participants or their beneficiaries under the plan as of the end of the plan year consist (in whole or in part) of liabilities to such participants
and beneficiaries under two or more pension plans as of immediately before such plan year, check box and see instructions regarding supplemental
X
information to be included as an attachment .......................................................................................................................................................................
19
If the total number of participants is 1,000 or more, complete lines (a) through (c)
a
Enter the percentage of plan assets held as:
Stock:
_____
% Investment-Grade Debt:
_____
%
High-Yield Debt:
_____
%
Real Estate:
_____
% Other:
_____
%
b
Provide the average duration of the combined investment-grade and high-yield debt:
X
0-3 years
X
3-6 years
X
6-9 years
X
9-12 years
X
12-15 years
X
15-18 years
X
18-21 years
X
21 years or more
c
What duration measure was used to calculate line 19(b)?
X
X
X
X
Effective duration
Macaulay duration
Modified duration
Other (specify):
Part VII
IRS Compliance Questions
20a
X
X
Is the plan a 401(k) plan? If “No,” skip b .....................................................................................................
Yes
No
Design-based
“Prior year”
X
X
20b
safe harbor
ADP test
How did the plan satisfy the nondiscrimination requirements for employee deferrals under section
401(k)(3) for the plan year? Check all that apply: ......................................................................................
“Current year”
X
X
N/A
ADP test
21a
Ratio
What testing method was used to satisfy the coverage requirements under section 410(b) for the plan
Average
X
X
X
percentage
N/A
year? Check all that apply: ........................................................................................................................
benefit test
test
21b
Did the plan satisfy the coverage and nondiscrimination requirements of sections 410(b) and 401(a)(4)
X
Yes
X
No
for the plan year by combining this plan with any other plan under the permissive aggregation rules? .......
22a
If the plan is a master and prototype plan (M&P) or volume submitter plan that received a favorable IRS opinion letter or advisory letter, enter the date of
the letter _____/_____/_____ and the serial number ______________.
22b
If the plan is an individually-designed plan that received a favorable determination letter from the IRS, enter the date of the most recent determination
letter _____/_____/______.
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