APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR THE 

LABORERS LOCAL NO. 265 PENSION PLAN 

Response Item 

Number Description of Item 

Page Number 

in Application 

YES 1. Does the application include an original signature ofthe plan 

sponsor or an authorized representative ofthe plan sponsor? 

See section 2.01 of this revenue procedure. 

00001, 

00014 

YES 2. Does the application include a description ofthe proposed 

benefit suspension - calculated as if no other limitations apply 

- that includes: 

the suspension's effective date (and its expiration • 

date, if applicable), 

• whether the suspension provides for different 

treatment ofparticipants and beneficiaries, 

a description ofthe different categories or groups of • 

individuals affected, and 

• how the suspension affects these individuals 

differently? 

See section 2. 02 ofthis revenue procedure. 

00006 

YES 3. Does the application include a penalties-of-perjury statement 

signed by an authorized trustee on behalf ofthe board of 

trustees? 

See Section 2.03 ofthis revenue procedure. 

00014 

YES 4. Does the application include a statement, signed by an 

authorized trustee on behalf ofthe board oftrustees, 

acknowledging that the application and the application's 

supporting material will be publicly disclosed on the Treasury 

Department's website? 

See section 2. 04 qfthis revenue procedure. 

00014 

YES 5. Does the application include the plan actuary's certification 

of critical and declining status and the supporting 

illustrations, including: 

• the plan-year-by-plan-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 ofthose years? 

See section 3.01 ofthis revenue procedure. 

00007, 

00015-00017 

YES 6. Does the application include the plan actuary's certification 

that, taking into account the proposed suspension and, if 

applicable, a proposed partition, the plan is projected to avoid 

insolvency ifthe suspension takes effect, and the supporting 

illustrations, including: 

00007, 

00018-00050 
Response Item 

Number Description of Item 

Page Number 

in Application 

• the plan-year-by-plan-year projections demonstrating 

projected solvency during the relevant period, 

• separately identifying the available resources (and the 

market value of assets and changes in cash flow) 

during each ofthose years? 

See section 3. 02 ofthis revenue procedure. 

YES 

7. Does the application include the plan sponsor's determination 

ofprojected insolvency that includes the documentation set 

forth in section 5 ofthe revenue procedure? 

See section 3.03 of this revenue procedure. 

00051-00057 

YES 8. Does the application include a demonstration that the 

limitations on individual suspensions are satisfied, including a 

description of each benefit based on disability, as defined 

under the plan, that is paid to an individual under the plan 

(without regard to whether the disability benefits are available 

to newly disabled participants) and calculations regarding: 

the guarantee-based limitation, • 

• the disability-based limitation, 

• the age-based limitation, taking into account the 

guarantee-based limitation, and 

• if applicable, the age-based limitation taking into 

account both the guarantee-based limitation and the 

disability-based limitation? 

See section 4.01 ofthis revenue procedure. 

00007-00008, 

00058-00062 

YES 9. 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) of this revenue procedure. 

00008, 

00025-00027 

NIA 10. Does the application include an illustration that the proposed 

suspension is reasonably estimated to achieve the level 

necessary to avoid insolvency for the extended period 

utilizing stochastic projections? (This illustration is optional 

ifthe plan is not required to appoint a retiree representative 

under§ 432(e)(9)(B)(v)(I).) 

See section 4.02(2) ofthis revenue procedure. 

YES 11. Does the application include a demonstration that the 

proposed suspension is not projected to materially exceed the 

level necessary to avoid insolvency, including: 

• the plan-year-by-plan-year projections demonstrating 

projected insolvency during the relevant period, and 

00008, 

00028-00030 

ii 
Item Page Number Response Number Description of Item in Application 

• a separate identification ofthe available resources 

(and the market value of assets and changes in cash 

flow) during each ofthose years? 

See section 4. 03 ofthis revenue procedure. 

YES 12. Does the application include a demonstration that the 00008, 

proposed suspension is equitably distributed, including: 00064 

• information on the effect ofthe suspension on the 

plan in the aggregate, 

• information on the effect ofthe suspension for 

different categories or groups, 

• a list ofthe factors taken into account, 

• an explanation ofwhy none ofthe 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 

• an explanation of how any difference in treatment 

among categories or groups of individuals results 

from a reasonable application of the relevant factors? 

See section 4. 04 ofthis revenue procedure. 

YES 13. Does the application include a copy ofthe notices ( excluding 00009, 

personally identifiable information) that meet the 00065-00098 

requirements under§ 432(e)(9)(F)? 

See section 4.05(1) ofthis revenue procedure. 

YES 14. Does the application include a description ofthe efforts that 00009 

are being taken to contact participants, beneficiaries in pay 

status, and alternate payees? 

See section 4.05(2) ofthis revenue procedure. 

YES 15. Does the application describe the steps the plan sponsor has 00009 

taken to ensure that notices delivered electronically are 

reasonably accessible to the recipients? 

See section 4.05(3) ofthis revenue procedure. 

YES 16. Does the application include a list of each employer who has 00009-00010 

an obligation to contribute under the plan and each employee 

organization representing participants under the plan? 

See section 4.05(4) ofthis revenue procedure. 

YES 17. Does the application include information on past and current 00010, 

measures taken to avoid insolvency? 00051-00057 

See section 5.01 ofthis revenue procedure. 

iii 
Response Item 

Number Description of Item 

Page Number 

in Application 

YES 18. Does the application include information regarding the plan 

factors described in§ 432(e)(9)(C)(ii), for the past 10 plan 

years immediately preceding the plan year in which the 

application is submitted? 

See section 5. 02 of this revenue procedure. 

00010, 

00051-00057 

YES 19. Does the application describe bow the plan sponsor took into 

account - or did not take into account - the factors listed in 

section 5.02 ofthis revenue procedure in the determination 

that all reasonable measures were taken to avoid insolvency? 

See section 5. 03 of this revenue procedure. 

00010, 

00051-00057 

YES 20. 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 of this revenue procedure. 

00011, 

00051-00057 

YES 21. 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 ofthis revenue procedure. 

00011, 

00056-00057 

YES 22. Does the application include a copy of the proposed ballot, 

excluding the information regarding the statement lil 

opposition, the individualized estimate, and the voting 

procedures? 

See section 6.01 of this revenue procedure. 

00011, 

00099-00102 

YES 23. Does the application indicate whether the plan sponsor is 

requesting approval from PBGC of a proposed partition under 

section 4233 ofERISA? 

See section 6. 02 of this revenue procedure. 

00011 

NIA 24. Ifthe answer to item 23 is yes, does the application specify the 

effective date ofthe proposed partition and include a plan-yearby-plan-year projection of the amount of the reduction in 

benefit payments attributable to the partition? See section 6. 02 

ofthis revenue procedure. 

YES 25. Does the application include: 

a description of each of the assumptions used in the • 

projections required under sections 3.01, 3.02, 4.02(1), 

4.02(2), and 4.03 ofthis revenue procedure, 

00018-00050, 

00416-00481 

iv 
Response Item 

Number Description of Item 

Page Number 

in Application 

• supporting evidence for the selection of those 

assumptions, and 

an explanation of any differences among the • 

assumptions used for various purposes? 

See section 6. 03 and Avvendix B of this revenue procedure. 

YES 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: 

• the total contributions, 

• the total contribution base units, 

• the average contribution rates, 

• the withdrawal liability payments, and 

• the rate ofreturn on plan assets? 

See section 6. 04 of this revenue procedure. 

00018-00050 

YES 27. Does the application include deterministic projections of the 

sensitivity ofthe plan's solvency ratio throughout the extended 

period by taking into account the more conservative 

assumptions of investment experience and future contribution 

base units than assumed elsewhere in the application? 

See section 6. 05 of this revenue procedure. 

00018-00050 

YES 28. Does the plan include deterministic projections for each year 

in the extended period of: 

• the value ofplan assets, 

the plan's accrued liability, and • 

the plan's funded percentage? • 

See section 6. 06 of this revenue procedure. 

00018-00050 

YES 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 provide that the suspension will cease upon the • 

plan sponsor's failure to maintain a written record of 

its annual determination that (i) all reasonable 

measures continue to be taken to avoid insolvency 

and (ii) the plan would not be projected to avoid 

insolvency 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. 07 ofthis revenue procedure. 

00012 

V 
Item Page Number Response Number Description of Item in Application 

YES 30. Does the application indicate whether the plan is a plan 00012 

described in§ 432(e)(9)(D)(vii) and, ifit is, how that is 

reflected in the proposed benefit suspension? 

See section 6. 08 ofthis revenue procedure. 

YES 31. Does the application include a narrative statement ofthe 00012,

reasons the plan is in critical and declining status? 00103-00106 

See section 6. 09 ofthis revenue procedure. 

YES 32. Does the application include the required plan sponsor 00012-00013,

identification and contact information? 00108 

See section 7.01 ofthis revenue procedure. 

YES 33. Does the application include the required plan identification 00013,

information? 00108 

See section 7. 02 ofthis revenue procedure. 

YES 34. Does the application include the required retiree 00013 

representative information (if applicable)? 

See section 7. 03 ofthis revenue procedure. 

YES 35. Does the application include the required enrolled actuary 00013,

information? 00110 

See section 7 .04 ofthis revenue procedure. 

YES 36. Does the application include a designation ofpower of 00013,

attorney for each authorized representative who will represent 00107-00111 

the plan sponsor in connection with the application? 

See section 7. 05 and ADDendix C of this revenue procedure. 

YES 37. Does the application include: 00013,

00112-00277 • the required plan documents 

• any recent amendments 

• the summary plan description (SPD) 

• any summary of material modifications, and 

• the most recent determination letter? 

See section 7. 06 of this revenue procedure. 

YES 38. Does the application include the required excerpts from the 00013,

relevant collective bargaining agreements and side 00278-00288 

agreements? 

See section 7. 07 ofthis revenue procedure. 

YES 39. Does the application include the required excerpts from the 00013-00014,

most recently filed Form 5500? 00289-00338 

See section 7. 08 ofthis revenue procedure. 

vi 
Response Item 

Number Description ofItem 

Page Number 

in Application 

YES 40. Does the application include the most recently updated 

rehabilitation plan? 

See section 7. 09 of this revenue procedure. 

00014, 

00339-00342 

YES 41. Does the application include the two most recent actuarial 

valuation reports? 

See section 7.10 of this revenue procedure. 

00014, 

00343-00415 

YES 42. Does the application include this checklist, completed and 

placed on top ofthe application? 

See section 7.11 ofthis revenue procedure and this Appendix 

D. 

i-vii 

NIA 43. Ifthe application is being submitted for resubmission review, 

does the application include: 

• cross-references to information in the prior 

application with respect to information that has not 

changed from the prior application, 

a statement that the application is being submitted for • 

resubmission review, and 

• the date on which the Treasury Department indicated 

that the application is a candidate for resubmission 

review? 

See section 8 ofthis revenue procedure. 

Mr. ii Neumann 

Authorized Trustee on behalfofthe 

Board ofTrustees for the Laborers 

Local No. 265 Pension Plan 

vii