(viii) Total number of participants (include certain retired and terminated employees), see (b) Complete only for plans other than in 15(a): (i) Total number of participants (include certain retired and terminated employees) (ii) Participants whose benefits or accounts are fully vested (iii) Number of contributing employers. (c) Are employees of the representative labor unions or of the plan included in the plan? If "Yes," attach a completed Form 5302 with respect to each such union. X X Art.VII, S4 p.43 18 is any issue relating to the qualification of this plan, or exemption of the trust currently pending before the Section and page number. 19 Vesting: (i) (a) Vesting Schedule-Check the appropriate box to indicate the vesting provisions of the plan: Full and immediate (vi) (vii) 3 33 00 5- to 15-year vesting, i.e., 25% after 5 years of service, 5% additional for each of Art.IV, S3, ᄆᄆ For each year of service, commencing with the 4th such year, vesting not less than 40% after 4 years of service, 5% additional for each of the next 2 years, and 10% additional for each of the next 5 years 100% vesting within 5 years after contributions are made (class year plans only) (b) If box (a) (v) or (vii) was checked, check whether you include the following years Yes No (i) Years of service before age 22. ΝΑ (ii) Years of service for a period during which the employee declined to contribute to plan requiring employee contributions. (iii) Years of service during which the employer did not maintain the plan or a (iv) Years of service excluded under section 411(a)(6) (v) Years of service described in section 411(a)(4) (E) (vi) Years of service described in section 411(a)(4) (F) of plan or other document-trust or collective bargaining agreement. Trustees if you checked (i) or (ii), enter date executed ► March 16, 1955 (b) Enter name and identifying number of fiduciary (trustee or custodian), if any of Central States, Southeast and Southwest Areas Pension Fund 36-6514764 (c) Enter name and identifying number of fund (trust or custodial account), if any Central States, Southeast and Southwest Areas Pension Fund 36-6514764 (d) Does trust agreement prohibit reversion of funds to the employer? (•) If borrowing on insurance contracts is permitted, is it on a pro-rata basis and only for payment of premiums? NA. (1) If Puerto Rican trust, does it qualify for tax exemption under the laws of Puerto Rico?. NA 21 Additional information for all plans: (a) If participants may withdraw their contributions or earnings, may such withdrawal (d) If plan provides for payment of annuity benefits, does the plan provide a joint and (•) Does the plan provide that the payment of benefits, unless the employee elects otherwise, will commence not later than the 60th day after the latest of (1) the close of the plan year in which the participant attains the earlier of age 65 or the normal retirement age specified under the plan, (2) the close of the plan year in which occurs the 10th anniversary of the year in which participant commenced participation or (3) the close of the plan year in which the participant terminates his service with the employer? . (f) Are all optional modes of distribution of equal value? (g) Does the plan prohibit the assignment or alienation of benefits? (h) Does the plan preclude divestment for cause? 22 Additional information for defined benefit plans only: (a) Are benefits computed on the basis of total compensation?. (b) Benefit at normal retirement age is From $90 per month to $550, determined by benefit class (c) Benefit at early retirement age is Actuarial equivalent of entitlement. at first age at which unreduced pension payable.. (d) Normal form of retirement benefit Life annuity. (0) Is there a disability benefit under the plan? . (f) Does the plan provide for a death benefit before retirement? . If "Yes," indicate whether such benefits are limited to Yes No X Art.VII,S2, 6.42 Art.1,510,p.4 Art.IV,S4,p.19-20 The actuarial equivalent of the benefits accrued to the date of death. (g) Is duplication of benefits upon re-entry into the plan prohibited? 23 Additional information for defined contribution plans only: ΝΑ (a) Are contributions allocated on the basis of total compensation? . (b) Enter the maximum amount of employer contribution (or rate of compensation) that may be allocated to a participant... (c) Are trust assets valued at current fair market value? (d) Trust assets are valued: Art.IV,S7, p.24-26 10-89848-1 24 Were contributions made to the trust during periods before all essential conditions for qualification of the plan and trust were first met? . If "Yes," furnish statement of receipts and disbursements and other information bearing on the operation of the plan and trust for each period. Yes No GOVERNMENT Art.VIII,S3, p.45 Art.VIII,S3 p.45 (c) Upon complete discontinuance of contributions under a profit-sharing or stock bonus plan are the participants' rights under the plan nonforfeitable? NA . 26 In the case of an initial qualification, have the following documents been included with this form as required by the instructions: (a) Copies of all instruments constituting the plan or joinder agreement? (b) Copy of collective bargaining agreement? (c) Copies of trust indentures or group annuity contracts? (d) Specimen copy of each type of individual insurance contract? (e) Balance sheet of the trust or custodial account? . (f) Statement of receipts and disbursements of the trust or custodial account? (g) Specimen copy of formal announcement containing description to employees? (h) A detailed description of all methods, factors and assumptions used in determining costs or actual experience under the plan (including any loading, contingency reserves, or special factors, and the basis of any insured costs or liabilities involved therein) explaining their source and application in detail to permit ready analysis and verification? (i) Actuarial report?. 27 In the case of a request involving an amendment, after initial qualification, have the following docu. ments been included: (a) A copy of the amendment(s)? (b) Copy of collective bargaining agreement? . Yes No X X (c) Balance sheet of the trust or custodial account? X (d) Statement of receipts and disbursements of the trust or custodial accounts? X (e) A description of the amendment covering the items changed and an explanation of the provisions before and after the amendment? . See Attachment C. X (1) A completely restated plan? † X (g) A working copy of the plan in which there has been incorporated all of the previous amendments representing the provisions of the plan as currently in effect? † X (h) Copies of all amendments adopted since the date of the last determination letter for which no determination letter has been issued by the Internal Revenue Service? + X X (i) Specimen copy of formal announcement containing detailed description to employees? † If plan is being amended for the first time to conform to the participation and vesting standards of the Employee Retirement Income Security Act of 1974, or if the plan has been amended at least three times since the last restated plan was submitted, one of the documents specified under (f) or (g) must be attached. If any item in 25, 26 or 27 is answered "No," please explain. of plan or other document-trust or collective bargaining agreement. If more space is needed for any item, attach additional sheets of the same size. GPO 810-441 APPLICATION FOR DETERMINATION FOR COLLECTIVELY EMPLOYEES ELIGIBLE TO PARTICIPATE IN CENTRAL STATES, SOUTHEAST AND SOUTHWEST AREAS PENSION PLAN (EFFECTIVE JANUARY 1, 1976) Attachment "A" Response to Item 14(a)(iv) on Form 5303 Central States, Southeast and Southwest Areas Pension Plan (effective January 1, 1976) permits participation by an Employee who shall be identified and defined as follows: (a) (b) (c) A person (other than a person employed in a supervisory capacity) who has been on the payroll of an Employer for at least 30 days who is employed under the terms and conditions of a collective bargaining agreement entered into between an Employer as herein defined and a Union as herein defined, and on whose behalf payments are made or are presently required to be made to the Fund by the Employer; or All persons employed by the Union, upon being proposed by the Union and after acceptance by the Trustees; and as to such Union personnel the Union shall be considered an Employer, solely for the purpose of contributions, within the meaning of the Agreement and Declaration of Trust and shall, on behalf of such personnel, make payments to the Trust at the times and at the rate of payment equal to that made by any other Employer who is party to the Trust for the same benefits; or All persons employed by the Central States, Southeast and Southwest Areas Pension Fund or the Central States, Southeast and Southwest Areas Health and Welfare Fund upon acceptance by the Trustees; and as to such Trust personnel the Trustees shall be deemed an Employer, solely for the purpose of contributions, within the meaning of the Agreement and Declaration of Trust and shall, on behalf of such personnel, make payments to the Trust at the times and at the rate of payment equal to that made by any other Employer who is a party to the Trust for the same benefits. |