Yes 36

Does the application include
© the required plan documents,
© any recent amendments,
© the summary plan description (SPD),
* the summary of material modifications, and
* — the most recent determination letter?
See section 7.06.

74

Does the application include the required excerpts from the relevant collective
bargaining agreements and side agreements? See section 7.07.

74

Yes 38.

Does the application include the required excerpts from the most recently
filed Form 5500? See section 7.08.

74

Does the application include the most recently updated rehabilitation plan? See
section 7.09.

4

Does the application include this checklist, completed and placed on top of the
application. See section 7.10.

Appendix C

If the application is being submitted for resubmission review, does the
application include:
*  astatement that the application is being submitted for
resubmission review, and
© the date on which the Treasury Department gave approval to submit
an application for resubmission review?
See section 8

N/A

Redacted by the U.S. Department of the Treasury

Signature:

- . cts ES, ae
D py

Title or Authority:

A< TYME

Printed Name: _ ce. RA (G Vee ChER



Yes

27.

Does the application include deterministic projections of the sensitivity of the
plan’s solvency ratio throughout the extended period by taking into account more
conservative assumptions of investment experience and future contribution base
units than assumed elsewhere in the application? See section 6.04.

57-61

28.

Does the plan include deterministic projections for each year in the
extended period of

e the value of plan assets,

* the plan’s accrued liability, and

* — the plan’s funded percentage? See
section 6.05.

62-70

29.

Does the application include the plan sponsor's representation that, if it receives
the Treasury Department’s final authorization to suspend and 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 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.

71

30.

Does the application indicate whether the plan is a plan described in
§ 432(€)(9\(D)(vii)(II1) and, if so, how is that fact reflected in the proposed benefit
suspension. See section 6.07.

72

31.

Does the application include the required plan sponsor information,
including
*° name
address
telephone number
email address
fax number
employer identification number (EIN) and
©  3-digit plan number (PN)?
See section 7.01.

73

32.

Does the application include the required plan identification information? See
section 7.02.

73

33.

Does the application include the required retiree representative
information (if applicable)? See section 7.03.

73

Yes

34,

Does the application include the required enrolled actuary information? See
section 7.04.

73

Yes

35.

Does the application include a designation of power of attorney for each
authorized representative who will represent the plan sponsor in connection with
the application? See section 7.05 and Appendix B.

73 and
Appendix B

4



Appendix C
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 Local 805 Pension and Retirement Plan

Response Item Description of item Page number
number in application
Yes 1. Does the application include an original signature of the plan sponsor or an 2

authorized representative of the plan sponsor? See section 2.01.

Yes 2. Does the application include a description of the proposed benefit 3
suspension - calculated as if no other limitations apply - that includes:
e the suspension’s effective date (and its expiration date, if
applicable),
e whether the suspension provides for different treatment of
participants and beneficiaries,
© a description of the different categories or groups of individuals
affected, and
« how the suspension affects these individuals differently?
See section 2.02.

Yes 3. Does the application include a penalties-of-perjury statement signed by an 4
authorized trustee on behalf of the board of trustees? See Section 2.03.

Yes 4. Does the application include a statement, signed by an authorized trustee on 5
behalf of the board of trustees, acknowledging that the application and the
application’s supporting material will be publicly disclosed on the Treasury
Department's website? See section 2.04.

Yes 5. Does the application include the plan actuary’s certification of critical and 6-8
declining status and the supporting illustrations, including:
e the year-by-year projections demonstrating projected insolvency
during the relevant period and
© separately identifying the available resources (and the market value
of assets and changes in cash flow) during each of those years?
See section 3.01.

Yes 6. Does the application describe the assumptions used, including the new entrani 8
profile, the total contribution base units, and the average contribution rates?
See section 3.01.

Z:\065 805\p\Mise Corr\2016\Suspension\ Application\Attachments\Appendix C Checklist 805 16.docx


Yes

Does the application include the plan actuary’s certification that the plan is
projected to avoid insolvency if the suspension takes effect and the supporting
illustrations, including:

e the year-by-year projections demonstrating projected solvency during
the relevant period,

e a description of the assumptions used, including the new entrant
profile, the total contribution base units, and the average contribution
rates, and

© separately identifying the available resources (and the market value of
assets and changes in cash flow) during cach of those years?

See section 3.02.

11-25

Yes

Does the application include the plan sponsor’s determination of projected
insolvency that includes the documentation set forth in section 5 of the revenue
procedure? See section 3.03.

26

Yes

Does the application include a demonstration that the limitations on individual
suspensions are satisfied, including calculations regarding:

© the guarantee-based limitation,

© the disability-based limitation, and

¢ the age-based _ limitation?
See section 4.01.

31-35

Yes

Does the application include a demonstration that the proposed suspension is
reasonably estimated to achieve the level necessary to avoid insolvency for the
extended period, including illustrations regarding the plan’s solvency ratio and
available resources? See section 4.02(1).

36-46

N/A

Does the application include the required illustration utilizing stochastic
projections? (This illustration is not required if the plan is not required to appoint
a retiree representative under § 432(e)(9)(B)(v)(1) and stochastic projections were
not used in making the required determination.) See section 4.02(2).

N/A

Yes

Does the application include a demonstration that the proposed suspension is not
projected to materially exceed the level necessary to avoid insolvency, including
illustrations regarding the plan’s solvency ratio and available resources? See
section 4.03.

47

NA

Does the application include a demonstration that the proposed
suspension is equitably distributed, including
« information on the effect of the suspension on the plan in the aggregate,
information on the effect of the suspension for different categories o1
groups,
* alist of the factors taken into account,
© anexplanation of why none of the factors listed in
§ 432(e)(9)(D)(vi) were taken into account (if applicable),
© — for each factor taken into account that is not one of the factors listed in
§ 432(e)(9)(D)(vi), an explanation why the factor is relevant, and
e how any difference in treatment among categories or groups of
individuals results from a reasonable application of the relevant factors.
See section 4.04.

48

Yes

Does the application include a copy of the notices (excluding personally identifiabl¢
information) that meet the requirements under § 432(e)(9)(F)?
See section 4.05(1).

Appendix A

Yes

Does the application include a description of the efforts that are being taken to
contact participants, beneficiaries in pay status, and alternate payees. See

section 4.05(2).

48



Does the application describe the steps the plan sponsor has taken to ensure that
notices delivered electronically are reasonably accessible to the recipients?
See section 4.05(3)

48

Yes

Does the application include a list of each employer who has an obligation to
contribute under the Plan and each employee organization representing participants
under the Plan. See section 4.05(4).

48-49

Does the application include information on past and current measures taken to
avoid insolvency? See section 5.01.

50

Does the application include the plan information required by section 5.02?

50

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 determination that all
reasonable measures were taken to avoid insolvency? See section 5.03.

50

21.

Does the application describe how the plan sponsor took into account - or did not
take into account - in the determination that all reasonable measures have been
taken to avoid insolvency the impact of
«benefit and contribution levels on retaining active participants 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.

50

22.

Does the application include a discussion of any other factors the plan sponsor took
into account including how and why those factors were taken into account? See
section 5.04.

50

23.

Does the application include a copy of the proposed ballot, excluding the
information regarding the statement in opposition, the individualized estimate,
and the voting procedures? See section 6.01.

51

24.

Does the application indicate whether the plan sponsor is requesting approval
from the PBGC of a proposed partition under section 4233 of ERISA? Sce
section 6.02.

31

Yes

25.

If the answer to item 24 is yes, does the application specify the effective date of the
proposed partition and include a plan-year-by-plan-year projection of the amount
of the reduction in benefit payments attributable to the partition? See section 6.02.

51-55

26.

Does the application describe the plan’s experience with certain critical
assumptions, including a disclosure for each of the 10 plan years immediately
preceding the application that separately identifies

¢ — total contributions,

* — total contribution base units,

® average contribution rates,

* — withdrawal liability payments, and

« the rate of return on plan assets? See
section 6.03.

56