Attention:
• Telephone requests for the 2007 Form 5500-series forms, schedules, and instructions will not be filled until October 16, 2007. • Requests for the 2007 Form 5500-series products can be made on the Internet (see below) beginning October 16, 2007. Requests made prior to that date will be filled with the 2006 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 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. ________________________________________________
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).
▼
Official Use Only
OMB No. 1210-0110
2007
This Form is Open to Public Inspection.
▼ FI LI N
File as an attachment to Form 5500.
For calendar plan year 2007 or fiscal plan year beginning
A Name of plan
MM / D D / Y Y Y Y
and ending
B
MM / D D / Y Y Y Y
Three-digit plan number
C
Name of plan sponsor as shown on line 2a of Form 5500
D
Employer Identification Number
(a)
Party-in-interest
(b) Identity and address of obligor
Street City
(c) Original amount of loan (d) Principal (e) Interest
S E
S
O N
Name
LY
,D
O
N
O
State
T
Part I
Schedule of Loans or Fixed Income Obligations in Default or Classified as Uncollectible
U
O
U R
▲ ▲
▲
▲ ▲ ▲
.00 .00 .00
(f) Unpaid balance at end of year
Amt. overdue (h) Principal
IN FO
R
M
A
T
IO
(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
N
A
Amount received during reporting year
L
P
P
▲ ▲
S E
Zip Code
FO
R
G
▲ ▲
▲
▲
▲
.00
▲
▲
▲
.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) 2007
FO
R
2
3
0
7
0
0
0
1
0
D
v10.1
Schedule G (Form 5500) 2007
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
Zip Code
S E
Amount received during reporting year
▲ ▲
▲ ▲
▲ ▲
.00 .00
(f) Unpaid balance at end of year
FO
▲
▲
▲
R
.00
FI LI N
▲
G N A L P U R P O S E S O N
▲ ▲ ▲
Amt. overdue (h) Principal
.00
Amt. overdue (i) Interest
LY
,D
O
N
O
(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
T
U
▲
▲
.00
▲
▲
▲
.00
(a)
Party-in-interest
(b) Identity and address of obligor
Name Street City
(c) Original amount of loan (d) Principal (e) Interest
T
IO
State
Zip Code
R
M
▲ ▲ ▲
▲ ▲ ▲
▲ ▲ ▲
.00 .00 .00
(f) Unpaid balance at end of year
IN FO
Amount received during reporting year
A
▲
▲
▲
.00
FO
(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
R
Amt. overdue (h) Principal
▲
▲
2 3
▲
0 7
.00
0
Amt. overdue (i) Interest
▲
0 E
▲
▲
.00
0
0
2
Schedule G (Form 5500) 2007
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
O
T
(e)
Original cost
(h) Expenses paid during the plan year
U
S E
FO
R
▲ ▲ ▲ ▲ ▲ ▲
(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)
(g) Gross rental receipts during the plan year
(j)
▲
▲
▲
.00
O N
LY
▲
▲
▲
.00
,D
O
(f)
Current value at time of lease
(i)
Net receipts
N
▲
▲
▲
.00
▲ ▲ ▲
▲ ▲ ▲
Amount in arrears
(e)
Original cost
IN FO
R
M
A
T
(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)
IO
N
A
L
(c)
Relationship to plan, employer, employee organization or other party-in-interest
P
U R
(a) Party-in-interest (b) Identity of lessor/lessee
P
O
S E
R
S
(h) Expenses paid during the plan year
(f)
Current value at time of lease
FO
▲ ▲ ▲
▲ ▲ ▲
▲ ▲ ▲
2 3
.00
(i) Net receipts
▲ ▲
(j) Amount in arrears
▲ ▲ ▲
F
.00 .00
0 7 0 0 0 3 0
(g) Gross rental receipts during the plan year
▲
FI LI N
(c)
Relationship to plan, employer, employee organization or other party-in-interest
G
.00 .00 .00 .00 .00 .00
Schedule G (Form 5500) 2007
Page
4
Official Use Only
Part III
Nonexempt Transactions
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.
(a)
Identity of party involved
(c)
Description of transactions including maturity date, rate of interest, collateral, par or maturity value
(d) Purchase price
(h) Cost of asset
(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
M
A
T
IO
N
A
L
P
U R
P
O
S E
IN FO
R
(d) Purchase price
S
▲
▲
▲
.00
O N
(g) Expenses incurred in connection with transaction
(h) Cost of asset
LY
▲
▲
▲
.00
,D
(f)
Lease rental
(j)
Net gain or (loss) on each transaction
O
▲
▲
▲
.00
N
O
(e)
Selling price
(i)
Current value of asset
T
▲
▲
▲
.00
U
S E
FO
R
▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲
▲ ▲ ▲
▲ ▲ ▲ ▲
▲ ▲ ▲ ▲
2 3
.00
(i)
▲
Current value of asset
▲ ▲ ▲
▲ ▲ ▲
(e)
Selling price
R
FO
.00
(j)
▲ ▲
(f)
Lease rental
Net gain or (loss) on each transaction
.00 .00
0 7 0 0 0 4 0
(g) Expenses incurred in connection with transaction
▲
G
FI LI N
.00 .00 .00 .00 .00 .00
G
(b) Relationship to plan, employer, or other party-in-interest