APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR

IRON WORKERS LOCAL UNION 16 PENSION FUND

EIN/PN: 52-6148924 / 001

Exhibit 7.11 (Checklist Item #42)

Application Checklist

Page 1 of 7

Response

Item

Number

Rev Proc 

2017-43

Section Description of Item

Page 

Number(s) in 

Application

Exhibit 

Number(s)

Yes 1. 2.01

Does the application include an original signature of the plan sponsor or an authorized 

representative of the plan sponsor? 3 n/a

Yes 2. 2.02

Does the application include a description of the 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 of participants and 

beneficiaries,

 a description of the different categories or groups of individuals affected, and

 how the suspension affects these individuals differently?

3-4 n/a

Yes 3. 2.03

Does the application include a penalties-of-perjury statement signed by an authorized 

trustee on behalf of the board of trustees? 5 n/a

Yes 4. 2.04

Does the application include a statement, signed by an authorized trustee on 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?

5 n/a

Yes 5. 3.01

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 of those years?

6

Exhibit 3.01a

Exhibit 3.01b

Yes 6. 3.02

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 if the suspension takes effect, and the supporting illustrations, including:

 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 of those years?

6 Exhibit 3.02

IW16-0001
APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR

IRON WORKERS LOCAL UNION 16 PENSION FUND

EIN/PN: 52-6148924 / 001

Exhibit 7.11 (Checklist Item #42)

Application Checklist

Page 2 of 7

Response

Item

Number

Rev Proc 

2017-43

Section Description of Item

Page 

Number(s) in 

Application

Exhibit 

Number(s)

Yes 7. 3.03

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? 6 n/a

Yes 8. 4.01

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 guaranteebased limitation and the disability-based limitation?

7 Exhibit 4.01

Yes 9. 4.02(1)

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?

7-8 Exhibit 3.02

n/a 10. 4.02(2)

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 if the plan is not required to 

appoint a retiree representative under § 432(e)(9)(B)(v)(I).)

8 n/a

Yes 11. 4.03

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 solvency during 

the relevant period, and

 a separate identification of the available resources (and the market value of 

assets and changes in cash flow) during each of those years?

8 Exhibit 3.02

IW16-0002
APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR

IRON WORKERS LOCAL UNION 16 PENSION FUND

EIN/PN: 52-6148924 / 001

Exhibit 7.11 (Checklist Item #42)

Application Checklist

Page 3 of 7

Response

Item

Number

Rev Proc 

2017-43

Section Description of Item

Page 

Number(s) in 

Application

Exhibit 

Number(s)

Yes 12. 4.04

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 or groups,

___________________________________________________

 a list of the factors taken into account,

 an explanation of how any difference in treatment among categories or groups of 

individuals results from a reasonable application of the relevant factors,

 an explanation of why none of the factors listed in § 432(e)(9)(D)(vi) were taken 

into account (not applicable), and

 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 (not applicable)?

8

_________

9-11

Exhibit 4.04(1)

Exhibit 4.04(2)

_________

Yes 13. 4.05(1)

Appendix A

Does the application include a copy of the notices (excluding personally identifiable 

information) that meet the requirements under § 432(e)(9)(F)? 11 Exhibit 4.05(1)a

Exhibit 4.05(1)b

Yes 14. 4.05(2)

Does the application include a description of the efforts that are being taken to contact 

participants, beneficiaries in pay status, and alternate payees? 11 n/a

N/A 15. 4.05(3)

Does the application describe the steps the plan sponsor has taken to ensure that notices 

delivered electronically are reasonably accessible to the recipients? 11 n/a

Yes 16. 4.05(4)

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? 11 Exhibit 4.05(4)

Yes 17. 5.01

Does the application include information on past and current measures taken to avoid 

insolvency? 12-14 n/a

Yes 18. 5.02

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? 

14-19 Exhibit 5.02

IW16-0003
APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR

IRON WORKERS LOCAL UNION 16 PENSION FUND

EIN/PN: 52-6148924 / 001

Exhibit 7.11 (Checklist Item #42)

Application Checklist

Page 4 of 7

Response

Item

Number

Rev Proc 

2017-43

Section Description of Item

Page 

Number(s) in 

Application

Exhibit 

Number(s)

Yes 19. 5.03

Does the application describe how the plan sponsor took into account – or did not take 

into account – the factors listed in section 5.02 of this revenue procedure in the 

determination that all reasonable measures were taken to avoid insolvency?

20-21 n/a

Yes 20. 5.03

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 level

20-21 n/a

Yes 21. 5.04

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? 21 n/a

Yes 22. 6.01

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?

22 Exhibit 6.01

No 23. 6.02

Does the application indicate whether the plan sponsor is requesting approval from PBGC 

of a proposed partition under section 4233 of ERISA? 22 n/a

n/a 24. 6.02

If the answer to item 23 is yes, does the application specify the effective date of the 

proposed partition and include a year-by-plan-year projection of the amount of the 

reduction in benefit payments attributable to the partition?

22 n/a

Yes 25. 6.03

Appendix B

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 of this revenue procedure,

 supporting evidence for the selection of those assumptions, and

 an explanation of any differences among the assumptions used for various 

purposes?

22 Exhibit 6.03

IW16-0004
APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR

IRON WORKERS LOCAL UNION 16 PENSION FUND

EIN/PN: 52-6148924 / 001

Exhibit 7.11 (Checklist Item #42)

Application Checklist

Page 5 of 7

Response

Item

Number

Rev Proc 

2017-43

Section Description of Item

Page 

Number(s) in 

Application

Exhibit 

Number(s)

Yes 26. 6.04

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 of return on plan assets?

22-23 n/a

Yes 27. 6.05

Does the application include deterministic projections of the sensitivity of the 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?

23-24 Exhibits 6.05a-d

Yes 28. 6.06

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

 the value of plan assets,

 the plan’s accrued liability, and

 the plan’s funded percentage?

24 Exhibit 3.02

Yes 29. 6.07

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 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?

24 n/a

Yes 30. 6.08

Does the application indicate whether the plan is a plan described in §432(e)(9)(D)(vii)(III) 

and, if it is, how is that fact reflected in the proposed benefit suspension? 24 n/a

IW16-0005
APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR

IRON WORKERS LOCAL UNION 16 PENSION FUND

EIN/PN: 52-6148924 / 001

Exhibit 7.11 (Checklist Item #42)

Application Checklist

Page 6 of 7

Response

Item

Number

Rev Proc 

2017-43

Section Description of Item

Page 

Number(s) in 

Application

Exhibit 

Number(s)

Yes. 31. 6.09

Does the application include a narrative statement of the reasons the plan is in critical and 

declining status? 25 n/a

Yes 32. 7.01

Does the application include the required plan sponsor identification and contact 

information? 26 n/a

Yes 33. 7.02 Does the application include the required plan identification information? 26 n/a

n/a 34. 7.03

Does the application include the required retiree representative information (if

applicable)? 26 n/a

Yes 35. 7.04 Does the application include the required enrolled actuary information? 26 n/a

Yes 36. 7.05

Appendix C

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? 26 Exhibit 7.05

Yes 37. 7.06

Does the application include:

 the required plan documents 

 any recent amendments

 the summary plan description (SPD)

 any summaries of material modifications, and

 the most recent determination letter?

26 Exhibit 7.06a-c

Yes 38. 7.07 Does the application include the required excerpts from the relevant collective bargaining 

agreements and side agreements? 27 Exhibit 7.07

Yes 39. 7.08 Does the application include the required excerpts from the most recently filed Form 

5500? 27 Exhibit 7.08

Yes 40. 7.09 Does the application include the most recently updated rehabilitation plan? 27 Exhibit 7.09

Yes 41. 7.10 Does the application include the two most recent actuarial valuation reports? 27 Exhibit 7.10a

Exhibit 7.10b

Yes 42. 7.11

Appendix D

Does the application include this checklist, completed and placed on top of the 

application? 27 Exhibit 7.11

IW16-0006
Rev Proc 

Item 2017-43 

Response Number Section 

n/a 43. 8 

APPLICATION FOR APPROVAL OF BENEFIT SUSPENSION FOR 

IRON WORKERS LOCAL UNION 16 PENSION FUND 

EIN/PN: 52-6148924 I 001 

Exhibit 7.11 (Checklist Item #42} 

Application Checklist 

Descript ion of Item 

If the application is being submitted for resubmission review, does t he application 

include: 

• cross-references to information in the prior application wit h respect to 

information t hat has not changed from t he prior application, 

• a statement that the application is being submitted for resubmission review, and 

• t he date t he Treasury Department indicated t hat the application is a candidate 

for resubmission review? 

Page 

Number(s) in Exhibit 

Applicat ion Number(s) 

n/a n/a 

I am submitting this checklist on behalf of the board of trustees of the lronworkers Local Union 16 Pension Fund, in accordance with the authority 

provided to me in Exhibit 7.05 (power of attorney) of the application for approval of a proposed suspension of benefits. 

12/ 28/ 2017 

Date 

Enrolled Actuarv for the Pension Fund 

Title or Authority 

Page 7 of 7 

IW16-0007