Attention:
Telephone requests for the forms, schedules, and instructions for the 2008 Form 5500-series will not be filled until December 10, 2008. Requests for the 2008 Form 5500-series products can be made on the Internet (see below) beginning December 10, 2008. Requests made prior to that date will be filled with the 2007 version of the products. The product you are about to view is provided for information purposes and should not be reproduced on personal computer printers by individual taxpayers for filing. The Forms 5500 and 5500-EZ (and related schedules) are printed on special paper with dropout ink so they can be processed by the computerized processing system "EFAST." These forms and schedules may be obtained by calling 1-800-TAX-FORM (1-800-829-3676). Be sure to order using the IRS form number. Note: You can also use the Internet link Forms and Publications by U.S. Mail to request a limited number of these forms and schedules. Check the Department of Labor's website at www.efast.dol.gov for additional information concerning the processing system, electronic filing, software, and "non-standard" filings. Note: There is no Schedule B (Form 5500) for filing 2008 plan year actuarial information. Instead, file the 2008 Schedule MB (Form 5500), Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information, or the Schedule SB (Form 5500), Single-Employer Defined Benefit Plan Actuarial Information, as applicable. For only plan year 2008 filings, paper Schedules MB and SB are provided in the format presented for completion by pen or typewriter. ________________________________________________
SCHEDULE C (Form 5500)
Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Administration Pension Benefit Guaranty Corporation
Service Provider Information
This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974. File as an attachment to Form 5500.
Official Use Only
OMB No. 1210-0110
2008
This Form is Open to Public Inspection.
and ending
B
A
Name of plan
Three-digit plan number
D
Part I
1
Service Provider Information (see instructions)
NO
Enter the total dollar amount of compensation paid by the plan to all persons, other than those listed below, who received compensation during the plan year: ..........
T
US E
FO
C
Plan sponsor's name as shown on line 2a of Form 5500
Employer Identification Number
R
FI LI NG
For calendar plan year 2008 or fiscal plan year beginning
MM / D D / Y Y Y Y
MM / D D / Y Y Y Y
.00
(a)
Name
(b) Employer identification number (see instructions) (c) Official plan position (d) Relationship to employer, employee organization, or person known to be a party-in-interest (e) Gross salary or allowances paid by plan
PU
NA
L
(f) Fees and commissions paid by plan
RP
Co n t r a c t
O
SE
S
a dm i n i s t r a t o r
(g) Nature of service code(s) (see instructions)
O
NL
Y,
D
2
On the first item below list the contract administrator, if any, as defined in the instructions. On the other items, list service providers in descending order of the compensation they received for the services rendered during the plan year. List only the top 40. 103-12 IEs should enter N/A in (c) and (d).
O
(a)
Name
(b) Employer identification number (see instructions) (c) Official plan position (d) Relationship to employer, employee organization, or person known to be a party-in-interest (e) Gross salary or allowances paid by plan
FO
R
IN
FO
RM
AT
IO
.00
.00
1 2
(f) Fees and commissions paid by plan
.00
.00
(g) Nature of service code(s) (see instructions)
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 13515E Schedule C (Form 5500) 2008
0
9
0
8
0
0
0
1
0
I
v11.3
Schedule C (Form 5500) 2008
Page
2
Official Use Only
(a)
Name
(b) Employer identification number (see instructions) (c) Official plan position (d) Relationship to employer, employee organization, or person known to be a party-in-interest (e) Gross salary or allowances paid by plan
(f) Fees and commissions paid by plan
(a)
Name
(b) Employer identification number (see instructions) (c) Official plan position (d) Relationship to employer, employee organization, or person known to be a party-in-interest (e) Gross salary or allowances paid by plan
(a) Name
.00
NL
Y,
(f) Fees and commissions paid by plan
D
O
NO
T
US E
.00
(b) Employer identification number (see instructions) (c) Official plan position (d) Relationship to employer, employee organization, or person known to be a party-in-interest (e) Gross salary or allowances paid by plan
NA
L
PU
(f) Fees and commissions paid by plan
RP
O
SE
S
O
IO
(a) Name
.00
.00
(b) Employer identification number (see instructions) (c) Official plan position (d) Relationship to employer, employee organization, or person known to be a party-in-interest (e) Gross salary or allowances paid by plan
FO
R
IN
FO
RM
AT
(f) Fees and commissions paid by plan
.00
.00
0
9
0
8
0
0
0
2
0
J
FO
(g) Nature of service code(s) (see instructions) (g) Nature of service code(s) (see instructions) (g) Nature of service code(s) (see instructions)
R
.00
.00
(g) Nature of service code(s) (see instructions)
FI LI NG
Schedule C (Form 5500) 2008
Page
3
Official Use Only
Part II Termination Information on Accountants and Enrolled Actuaries (see instructions)
(a) Name (b) EIN (c) Position
(d) Address
Street Address City State Zip Code
(e)
Telephone No.
E X P L A N A T I O N
Street Address
(e)
Telephone No.
E X P L A N A T I O N
FO
R
IN
FO
RM
AT
IO
0
NA
City
L
PU
(d) Address
RP
O
(b) EIN
(c) Position
SE
(a) Name
S
O
NL
Y,
D
O
NO
State
T
9
0
8
0
0
0
3
0
US E
Zip Code K
FO
R
FI LI NG