Attention:
• Telephone requests for the 2006 Form 5500-series forms, schedules, and instructions will not be filled until December 1, 2006. • Requests for the 2006 Form 5500-series products can be made on the Internet (see below) beginning December 1, 2006. Requests made prior to that date will be filled with the 2005 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 1-800TAX-FORM (1-800-829-3676). Be sure to order using the IRS form number. Note: You can also use the Internet link http://www.irs.gov/formspubs/index.html to request a limited number of these forms and schedules. If you use this link, select “Order:” and “Forms and publications by U.S. mail.” 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. ________________________________________________
SCHEDULE G (Form 5500)
Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Administration
Financial Transaction Schedules
This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA) and section 6058(a) of the Internal Revenue Code (the Code).
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Official Use Only
OMB No. 1210-0110
File as an attachment to Form 5500.
and ending
B
A
Name of plan
C
Name of plan sponsor as shown on line 2a of Form 5500
Part I
Schedule of Loans or Fixed Income Obligations in Default or Classified as Uncollectible
(a)
Party-in-interest
(b) Identity and address of obligor
Name Street City
(c) Original amount of loan (d) Principal (e) Interest
ES
ON
LY ,
DO
NO
T
State
PO S
▲ ▲
▲
▲ ▲ ▲
.00 .00 .00
(f) Unpaid balance at end of year
PU R
Amount received during reporting year
▲
US
D
E
Three-digit plan number
Employer Identification Number
Zip Code
▼
FO R
For calendar plan year 2006 or fiscal plan year beginning
MM / D D / Y Y Y Y
MM / D D / Y Y Y Y
FI LI NG
▲ ▲ ▲ ▲
v9.1
2006
This Form is Open to Public Inspection.
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▲
▲
.00
(g) Detailed description of loan including dates of making and maturity, interest rate, the type and value of collateral, any renegotiation of the loan and the terms of the renegotiation, and other material items
Amt. overdue (h) Principal
IN FO RM AT
IO
N
▲
▲
▲
.00
Amt. overdue (i) Interest
▲
.00
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 14739A Schedule G (Form 5500) 2006
FO R
2
3
0
6
A
A
0
1
0
W
Schedule G (Form 5500) 2006
Page
2
Official Use Only
(a)
Party-in-interest
(b) Identity and address of obligor
Name Street City
(c) Original amount of loan (d) Principal (e) Interest
State
T
Amount received during reporting year
▲ ▲
▲ ▲
▲ ▲
.00 .00
(f) Unpaid balance at end of year
US
▲
▲
▲
.00
E
FO R
Zip Code
FI LI NG PU R PO S ES ON
▲ ▲
(g) Detailed description of loan including dates of making and maturity, interest rate, the type and value of collateral, any renegotiation of the loan and the terms of the renegotiation, and other material items
Amt. overdue (h) Principal
▲
.00
LY ,
Amt. overdue (i) Interest
DO
NO
▲
▲
▲
.00
▲
▲
▲
.00
(a)
Party-in-interest
(b) Identity and address of obligor
Name Street City
(c) Original amount of loan (d) Principal (e) Interest
State
Zip Code
N
IN FO RM AT
IO
▲
▲ ▲ ▲
▲ ▲ ▲
.00 .00 .00
(f) Unpaid balance at end of year
Amount received during reporting year
▲ ▲
▲
▲
▲
.00
(g) Detailed description of loan including dates of making and maturity, interest rate, the type and value of collateral, any renegotiation of the loan and the terms of the renegotiation, and other material items
FO R
Amt. overdue (h) Principal
▲
▲
2 3
▲
0 6
.00
A
Amt. overdue (i) Interest
▲
0 X
▲
▲
.00
A
0
2
Schedule G (Form 5500) 2006
Page
3
Official Use Only
Part II
Schedule of Leases in Default or Classified as Uncollectible
(a) Party-in-interest (b) Identity of lessor/lessee
(c)
Relationship to plan, employer, employee organization or other party-in-interest
(e)
Original cost
(h) Expenses paid during the plan year
NO
T
US
E
(d) Terms and description (type of property, location and date it was purchased, terms regarding rent, taxes, insurance, repairs, expenses, renewal options, date property was leased)
FO R
▲ ▲ ▲ ▲ ▲ ▲
(f)
Current value at time of lease
(i)
Net receipts
(g) Gross rental receipts during the plan year
(j)
▲
▲
▲
.00
ON
LY ,
▲
▲
▲
.00
DO
▲
▲
▲
.00
▲ ▲ ▲
▲ ▲ ▲
Amount in arrears
(c)
Relationship to plan, employer, employee organization or other party-in-interest
(e)
Original cost
IN FO RM AT
IO
N
(d) Terms and description (type of property, location and date it was purchased, terms regarding rent, taxes, insurance, repairs, expenses, renewal options, date property was leased)
PU R
PO S
(a) Party-in-interest (b) Identity of lessor/lessee
ES
(h) Expenses paid during the plan year
▲ ▲ ▲
▲ ▲ ▲
▲ ▲ ▲
2 3
.00
(i) Net receipts
▲ ▲
(j) Amount in arrears
▲ ▲ ▲
Y
(f)
Current value at time of lease
.00 .00
0 6 A A 0 3 0
FO R
(g) Gross rental receipts during the plan year
▲
FI LI NG
.00 .00 .00 .00 .00 .00
Schedule G (Form 5500) 2006
Page
4
Official Use Only
Part III
Nonexempt Transactions
(a)
Identity of party involved
(b) Relationship to plan, employer, or other party-in-interest
(c)
Description of transactions including maturity date, rate of interest, collateral, par or maturity value
▲
(e) Selling price
▲ ▲ ▲ ▲
▲ ▲ ▲ ▲
.00
(i)
NO
T
(d) Purchase price
(h) Cost of asset
US
E
FO R
▲ ▲ ▲ ▲ ▲ ▲
▲ ▲ ▲
Current value of asset
▲
(f) Lease rental
.00
(j)
DO
Net gain or (loss) on each transaction
▲ ▲
(a) Identity of party involved
.00 .00
LY ,
(b) Relationship to plan, employer, or other party-in-interest
(c)
Description of transactions including maturity date, rate of interest, collateral, par or maturity value
IO
N
PU R
PO S
ES
IN FO RM AT
(d) Purchase price
ON
(g) Expenses incurred in connection with transaction
(h) Cost of asset
▲ ▲ ▲
▲ ▲ ▲
▲ ▲ ▲ ▲
2 3
.00
(i)
▲
Current value of asset
▲ ▲ ▲
(e)
Selling price
.00
(j)
▲ ▲
(f)
Lease rental
Net gain or (loss) on each transaction
.00 .00
0 6 A A 0 4 0
FO R
(g) Expenses incurred in connection with transaction
▲
▲
Z
FI LI NG
.00 .00 .00
▲ ▲ ▲
If a nonexempt prohibited transaction occurred with respect to a disqualified person, file Form 5330 with the IRS to pay the excise tax on the transaction.
.00 .00 .00