3
Form 5500 (2005)
Page
Official Use Only
5
Preparer information (optional)
a
Name (including firm name, if applicable) and address
Name
1)
Name Continued
Street
2)
City
3)
b
EIN
Zip Code
State
4)
Foreign Routing Code
c
Telephone number
5)
Foreign Country
6)
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6
Total number of participants at the beginning of the plan year ...........................................................................
7
Number of participants as of the end of the plan year (welfare plans complete only lines 7a, 7b, 7c, and 7d)
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a Active participants .................................................................................................................................................
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b Retired or separated participants receiving benefits ............................................................................................
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c Other retired or separated participants entitled to future benefits .......................................................................
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d Subtotal. Add lines 7a, 7b, and 7c .......................................................................................................................
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e Deceased participants whose beneficiaries are receiving or are entitled to receive benefits ............................
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f Total. Add lines 7d and 7e ....................................................................................................................................
g Number of participants with account balances as of the end of the plan year (only defined
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contribution plans complete this item) ..................................................................................................................
h Number of participants that terminated employment during the plan year with accrued benefits that
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were less than 100% vested ................................................................................................................................
i If any participant(s) separated from service with a deferred vested benefit, enter the number of
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separated participants required to be reported on a Schedule SSA (Form 5500) .............................................
0
1
0
5
A
A
0
3
0
T