CHECKLIST· IS THE SUBMISSION COMPLETE? 

Instructions The application must include a completed checklist placed on top of the 

application. This will help ensure that the application is complete. Answer each 

question in the checklist by circling Y for yes, N for no or N/A for not applicable, as 

appropriate, in the blank next to the item. Also insert in the appropriate blank next to 

each item the page number or numbers where the item appears in the application. 

APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR THE CENTRAL 

STATES, SOUTHEAST AND SOUTHWEST AREAS PENSION FUND 

Response Item Description of item Page number 

number in application 

~ 1. Does the application include an original signature of the plan sponsor or 

an authorized representative of the plan sponsor. See section 2.01. 1.0; 

N/A 1.1 

~ 2. Does the application include a description of the proposed benefit 

suspension - calculated as if no other limitations apply -that includes: 

N/A • the suspension's effective date (and its expiration date, if 

applicable), 2.0; 

• a description of the different categories or groups of individuals 2.1.1-2.1 .6; 

affected, and 2.2.1-2.2.29 

• how the suspension affects these individuals differently . 

See section 2.02. 

~ 3. Does the application include a penalties-of-perjury statement signed by an 3.0; 

No authorized trustee on behalf of the board of trustees. See Section 2.03. 3.1 

N/A 

~ 4. Does the application include a statement, signed by an authorized trustee 

on behalf of the board of trustees, acknowledging that the application and 4.0; 

N/A the application's supporting material will be publicly disclosed on the 4.1 

Treasury Department's website. See section 2.04. 

I~ 5. Does the application include the plan actuary's certification of critical and 

declining status and the supporting illustrations, including: 5.0; N/A • the year-by-year projections demonstrating projected insolvency 5.1.1-5.1.15; during the relevant period and 5.2.1-5.2.6; 

• separately identifying the available resources (and the market 5.3.1-5.3.84 

value of assets and changes in cash flow) during each of those 

years. 

See section 3.01 . 

cw 6. Does the application describe the assumptions used. See section 3.01 . 6.0 

N/A 

1 

40.1 
·~ 7. Does the application include the plan actuary's certification that the plan is 

projected to avoid insolvency if the suspension takes effect and the 

N/A supporting illustrations, including: 

• the year-by-year projections demonstrating projected solvency 

during the relevant period and 7.0; 

• separately identifying the available resources (and the market 7.1.1.-7.1.29; 

value of assets and changes in cash flow)during each of those 7.2.1-7.2.83 

years. 

See section 3.02. 

~~ 8. Does the application include the plan sponsor's determination of projected 8.0; 8.1 .1; insolvency that includes the documentation set forth in section 5 of the 8.2.1-8.2.178 

N/A revenue procedure. See section 3.03. 

WP 9. Does the application include a demonstration that the limitations on 9.0; individual suspensions are satisfied, including calculations regarding: 9.1.1-9.1.3; N/A • the guarantee-based limitation, 9.2.1-9.2.127 

• the disability-based limitation, and 

• the age-based limitation . 

See section 4.01 . 

~ 10. Does the application include a demonstration that the proposed 

suspension is reasonably estimated to achieve the level necessary to 10.0 

N/A avoid insolvency for the extended period, including illustrations regarding 

the plan's solvency ratio and available resources. See section 4.02(1). 

~ 11. Does the application include the required illustration utilizing stochastic 

projections. (This illustration is not required if the plan is not required to 11 .0 

N/A appoint a retiree representative under§ 432(e)(9)(B)(v)(l) and stochastic 

projections were not used in making the required determination.) See 

section 4.02{2). 

~ 12. Does the application include a demonstration that the proposed 

suspension is not projected to materially exceed the level necessary to 12.0 

N/A avoid insolvency, including illustrations regarding the plan's solvency ratio 

and available resources. See section 4.03. 

~ 13. Does the application include a demonstration that the proposed 

No suspension is equitably distributed, including 

N/A • a list of the factors taken into account, 

• an explanation of why none of the factors listed in 13.0; 

§ 432(e)(9)(D)(vi) were taken into account (if applicable), and 13.1.1-13.1.11 ; 

13.2.1-13.2.3 

• how any difference in treatment among categories or groups of 

individuals results from a reasonable application of the relevant 

factors. 

See section 4.04. 

~ 14. Does the application include a copy of the actual notices (including 14.0; redacted sample calculations) that meet the requirements under 

N/A § 432(e)(9)(F). See section 4.05(1 ). 14.1.1-14.1.362 

~ 15. Does the application include a description of the efforts that are being 

No taken to contact participants, beneficiaries in pay status, and alternate 15.0; 15.1.1; 

N/A payees. See section 4.05(2). 15.2.1; 15.3.1 

2 

40.2 
..... 

~ 16. Does the application describe the steps the plan sponsor has taken to 16.0 

ensure that notices delivered electronically are reasonably accessible to 16.1.1 

N/A the recipients. See section 4.05(3) 

~ 17. Does the application include a list of each employer who has an obligation to contribute under the Plan and each employee organization representing 17.0-17.32 

N/A participants under the Plan. See section 4.05(4). 

~ 

- 18. Does the application include information on past and current measures 18.0-18.12 No taken to avoid insolvency. See section 5.01. 

N/A 

1Q0·1Q 11· 

~ 19. Does the application include the plan information required by section 5.02. 19.2.1; 19.3.1-3; 

19.4.1; 19.5.1-2; 

N/A 19.6.1; 19.7.1-3; 

19.8.1-325 

~ 20. Does the application describe how the plan sponsor took into account- or did not take into account -the factors listed in section 5.02 in the 20.1-20.13 

N/A determination that all reasonable measures were taken to avoid 

insolvency. See section 5.03. 

~ 21 . Does the application describe how the plan sponsor took into account - or 

No did not take into account - in the determination that all reasonable 

N/A measures have been taken to avoid insolvency the impact of 

• benefit and contribution levels on retaining active participants 20.1-20.13 

and bargaining groups under the plan, and 

• past and anticipated contribution increases under the plan on 

employer attrition and retention levels. 

See section 5.03. 

~ Yes ) 22. Does the application include a discussion of any other factors the plan 20.1-20.13 No sponsor took into account including how and why those factors were taken 

N/A into account. See section 5.04. 

( Yes) - 23. Does the application include a copy of the proposed ballot. See section 23.0; 23.1-13; 

~ 6.01 . 23.2.1-2; 23.3.1-17 

N/A 

~ 24. Does the application indicate whether the plan sponsor is requesting 24.0 c approval from the PBGC of a proposed partition under section 4233 of 

NiA ERISA. See section 6.02. 

Yes 25. If the answer to item 24 is yes, does the application specify the effective 

N-2, date of the proposed partition and include a year-by-year projection of the 25.0 

( N/A ) amount of the reduction in benefit payments attributable to the partition. 

- See section 6.02. 

<:Yes) 26. Does the application describe the plan's experience with certain critical 

NO" assumptions, including a disclosure for each of the 10 plan years 

N/A immediately preceding the application that separately identifies 26.0; 

• total contributions, 26.1.1-26.1.20 

• total contribution base units, 

• average contribution rates, 

• withdrawal liability payments, and 

• the rate of return on plan assets . 

See section 6.03. 

3 

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·~ 27. Does the application include deterministic projections of the sensitivity of 

the plan's solvency ratio throughout the extended period by taking into 

N 27.0 /A account more conservative assumptions of investment experience and 

future contribution base units than assumed elsewhere in the application. 

See section 6.04. 

~ 28. Does the plan include deterministic projections for each year in the 

extended period of 

N/A • the value of plan assets, 28.0 

• the plan's accrued liability, and 

• the plan's funded percentage . 

See section 6.05. 

~ 29. Does the application include the plan sponsor's representation that, if it 

receives the Treasury Department's final authorization to suspend and 

N/A then chooses to implement the suspension, it will also amend the plan 

• to indicate that the suspension will cease upon the plan 

sponsor's failure to determine that both all reasonable measures 

continue to be taken to avoid insolvency and that the plan is 29.0-29.1 

projected to become insolvent without a suspension, 

• to require that any future benefit improvements must satisfy 

§ 432(e)(9)(E), and 

• to specify that the plan sponsor will not modify these 

amendments, notwithstanding any other provision of the plan 

document. 

See section 6.06. 

30.0' 30.1.1-38' 

~ 30. Does the application indicate whether the plan is a plan described in 30.2.1-48; 

§ 432(e)(9)(D)(vii)(lll) and, if so, how is that fact reflected in the proposed 30.3.1-3; 

N/A benefit suspension. See section 6.07. 30.4.1 -52; 

JU.!:>.1-J4 

~ 31 . Does the application include the required plan sponsor information, 

including 

N/A • name 

• address 31.0 

• telephone number 

• email address 

• fax number 

• employer identification number (EIN) and 

• 3-digit plan number (PN) . 

See section 7.01 . 

~ 32. Does the application include the required plan identification information. 

No See section 7.02. 32.0 

N/A 

c;rp 33. Does the application include the required retiree representative 

information (if applicable). See section 7.03. 33.0 

N/A 

~ 34. Does the application include the required enrolled actuary information. See section 7.04. 34.0 

N/A 

4 

40.4 
Signature redacted by the US 

Department of the Treasury