Form 5500 - Annual Return/report Of Employee Benefit Plan - 2005 Page 2
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Form 5500 (2005)
Page
Official Use Only
2a
Plan sponsor's name and address (employer, if for single-employer plan) (Address should include room or suite no.)
Name
1)
Name Continued
c / o
2)
Street
3)
City
4)
2b Employer Identification Number (EIN)
State
Zip Code
5)
2c Sponsor's telephone
Foreign Routing Code
6)
number
2d Business code
Foreign Country
7)
(see instructions)
D/B/A
8)
Location Address if different than Street
9)
Location Address City/State/Zip if different than 4) or 5)
3a
Plan administrator's name and address (If same as plan sponsor, enter "Same")
Name
1)
Name Continued
c / o
2)
Street
3)
City
4)
3b Administrator's EIN
State
Zip Code
5)
Foreign Routing Code
6)
3c Administrator's telephone number
Foreign Country
7)
4
If the name and/or EIN of the plan sponsor has changed since the last return/report filed for this plan, enter the name, EIN and the plan
number from the last return/report below:
a
Sponsor's name
b
EIN
c PN
0
1
0
5
A
A
0
2
0
S
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Parent category: Financial