Attention:

This form or schedule is provided for information purposes and should not be

reproduced on personal computer printers by individual taxpayers for filing.

The Form 5500-series of forms and schedules is printed on special paper with

dropout ink so it can be processed by the computerized processing system

"EFAST." The Forms 5500 and 5500-EZ (and related schedules) may be

obtained by calling 1-800-TAX-FORM (1-800-829-3676). Be sure to order using

the IRS form number.

additional information concerning the processing system, electronic filing,

software, and "non-standard" filings.

Check the Department of Labor's website at www.efast.dol.gov for
Official Use Only

FOR INFORMATION PURPOSES ONLY, DO NOT USE FOR FILING

 Date

Type or print name of individual signing as plan administrator

 Date

Type or print name of individual signing as employer, plan sponsor or DFE

This Form is Open to

Public Inspection.

2004

OMB Nos. 1210-0110 / 1210-0089

Department of the Treasury

Internal Revenue Service

Department of Labor

Employee Benefits Security

Administration

Pension Benefit

Guaranty Corporation

Form 5500

Part I Annual Report Identification Information

For the calendar plan year 2004

or fiscal plan year beginning and ending

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Part II Basic Plan Information -- enter all requested information.

1a Name of plan

Annual Return/Report of Employee Benefit Plan

This form is required to be filed under sections 104 and 4065 of the Employee

Retirement Income Security Act of 1974 (ERISA) and sections 6047(e),

6057(b), and 6058(a) of the Internal Revenue Code (the Code).

 Complete all entries in accordance with

 the instructions to the Form 5500.

A This return/report is for: (1) a multiemployer plan; (3) a multiple-employer plan; or

(2) a single-employer plan (other than (4) a DFE (specify) .....................

a multiple-employer plan);

B This return/report is: (1) the first return/report filed for the plan; (3) the final return/report filed for the plan;

(2) an amended return/report; (4) a short plan year return/report

(less than 12 months).

C If the plan is a collectively-bargained plan, check here ...............................................................................................................................

D If filing under an extension of time or the DFVC program, check box and attach required information. (see instructions) ......................

MM / DD / Y Y Y Y

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1b Three-digit plan number (PN) ▼

MM / DD / Y Y Y Y

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Form 5500 (2004)

Caution: A penalty for the late or incomplete filing of this return/report will be assessed unless reasonable cause is established.

MM / DD / Y Y Y Y

MM / DD / Y Y Y Y

01 0 4 0 00 1 0 6

MM / DD / Y Y Y Y

Cat. No. 13500F

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a

b

1c Effective date of plan

v7.1

Under penalties of perjury and other penalties set forth in the instructions, I declare that I have examined this return/report, including accompanying

schedules, statements and attachments, as well as the electronic version of this return/report if it is being filed electronically, and to the best of my

knowledge and belief, it is true, correct and complete.

Signature of plan administrator

SIGN HERE

Signature of employer/plan sponsor/DFE

SIGN HERE ▼
Official Use Only

FOR INFORMATION PURPOSES ONLY, DO NOT USE FOR FILING

4 If the name and/or EIN of the plan sponsor has changed since the last return/report filed for this plan, enter the name, EIN and the plan

number from the last return/report below:

a Sponsor's name

b EIN c PN

2a Plan sponsor's name and address (employer, if for single-employer plan) (Address should include room or suite no.)

Form 5500 (2004) Page 2

01 0 4 0 00 2 0 7

Name

Name Continued

Street

City

State

D/B/A

c/o

1)

2)

1)

Zip Code

2b Employer Identification Number (EIN)

2c Sponsor's telephone

2d Business code

(see instructions)

number

3a Plan administrator's name and address (If same as plan sponsor, enter "Same")

3b Administrator's EIN

3c Administrator's telephone number

Name

Name Continued

Street

City

State Zip Code

Foreign Routing Code

Foreign Country

c/o

3)

4)

5)

6)

7)

8)

9)

2)

3)

4)

5)

6)

7)

Location Address if different than Street

Location Address City/State/Zip if different than 4) or 5)

Foreign Country

Foreign Routing Code
Official Use Only

FOR INFORMATION PURPOSES ONLY, DO NOT USE FOR FILING

5 Preparer information (optional)

a Name (including firm name, if applicable) and address

b EIN

c Telephone number

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)

a Active participants .................................................................................................................................................

b Retired or separated participants receiving benefits ............................................................................................

c Other retired or separated participants entitled to future benefits .......................................................................

d Subtotal. Add lines 7a, 7b, and 7c .......................................................................................................................

e Deceased participants whose beneficiaries are receiving or are entitled to receive benefits ............................

f Total. Add lines 7d and 7e ....................................................................................................................................

g Number of participants with account balances as of the end of the plan year (only defined

contribution plans complete this item) ..................................................................................................................

h Number of participants that terminated employment during the plan year with accrued benefits that

were less than 100% vested ................................................................................................................................

i If any participant(s) separated from service with a deferred vested benefit, enter the number of

separated participants required to be reported on a Schedule SSA (Form 5500) .............................................

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Form 5500 (2004) Page 3

01 0 4 0 00 3 0 8

Name

Name Continued

Street

City

State

Foreign Routing Code

Foreign Country

1)

2)

3)

4)

5)

6)

Zip Code
Official Use Only

FOR INFORMATION PURPOSES ONLY, DO NOT USE FOR FILING

b Financial Schedules

1) H (Financial Information)

2) I (Financial Information--Small Plan)

3) A (Insurance Information)

4) C (Service Provider Information)

5) D (DFE/Participating Plan

Information)

6) G (Financial Transaction Schedules)

7) P (Trust Fiduciary Information)

9b Plan benefit arrangement (check all that apply)

(1) Insurance

(2) Code section 412(i) insurance contracts

(3) Trust

(4) General assets of the sponsor

10 Schedules attached (Check all applicable boxes and, where indicated, enter the number attached. See instructions.)

8 Benefits provided under the plan (complete 8a and 8b, as applicable)

a Pension benefits (check this box if the plan provides pension benefits and enter below the applicable pension feature codes from the List

of Plan Characteristics Codes printed in the instructions):

b Welfare benefits (check this box if the plan provides welfare benefits and enter below the applicable welfare feature codes from the List

of Plan Characteristics Codes printed in the instructions):

9a Plan funding arrangement (check all that apply)

(1) Insurance

(2) Code section 412(i) insurance contracts

(3) Trust

(4) General assets of the sponsor

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a Pension Benefit Schedules

1) R (Retirement Plan Information)

2) T (Qualified Pension Plan

Coverage Information)

If a Schedule T is not attached

because the plan is relying on

coverage testing information for

a prior year, enter the year ..........

3) B (Actuarial Information)

4) E (ESOP Annual Information)

5) SSA (Separated Vested

Participant Information)

Form 5500 (2004) Page 4

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