Form 5310 (Rev. 4-88)

Page 5

20

10)

1)
(k)
0)
(m)
(n)
(0)

Liabilities and Net Assets
Accounts and notes payable—

A

(i) Past due benefits .
(ii) Employer. . 2...

(iii) Other .
Accrued expenses

Mortgagespayable. . . . . .. 1...
Acquisition indebtedness .

Other liabilities . . rr

Total liabilities (add lines @ through (m).

Net assets available to pay benefits (Subtract line (n (n) from line (hy

Complete This Part If You Checked Reason for Filing C or D and Checked “Yes” on Line 6(a).
If you checked Reason for filing C or D and ‘‘Not determined” on line 6(a), completion of this part is optional. However, if you do not
complete this part, you must file the plan document, any amendments to the plan document, and the IRS determination letter(s) for
the plan as described for lines 22(b), (c), and (g). If PBGC later determines that the termination insurance program covers the plan,

you must file the remainder of the information required by this Part (see Part IV instructions).

21 > (a) Name(s) of labor organization(s) representing plan participants (b) Telephone number
¢ )
Address (number and street) (c) Name of principal officer
City or town, state, and ZIP code (d) Title of principal officer
22 Indicate the applicability of items (a) through (i) by checking the appropriate column. Attach each item Applicable Not
that is applicable (see instructions): applicable
(a) Power of attorney. File 2 copies if you are filing “one-stop” (see General Instruction H)
(b) Copy of executed plandocument. . . . .
(c) Copy of executed amendment(s) to the plan document . hone
(d) Copy of executed group annuity or group insurance contract(s) . . .
(e) Copy of executed trust agreement(s). . . . Boe ee
(f) Copy of executed collective bargaining agreement(s)
(g) Copy of IRS determination letter(s)
(h) Copy of the most recent actuarial report .
(i) Copy of the most recent financial statement of plan assets .
23 Indicate the sufficiency of plan assets (see instructions): Yes No
(a) Are any participants entitled to receive benefits assigned to categories 1 through 4 under ERISA
section 4044? .
If “'Yes,"’ complete (b); if "No," enter N/A in (), ©. @, and ©. Ms
(b) Do you estimate that plan assets (excluding any amount described in (d) below) are adequate to
provide all the benefits assigned to categories 1 through 4 on the proposed date of plan termination?
If “Yes,” enter N/A in (c) and complete item (d); if “No,” complete (c) and (d).
(c) Indicate the estimated amount by which the value of benefits in categories 1 through 4 exceeds
the value of plan assets on the proposed date of plantermination ® $ Ms
(d)_ Is the employer making a commitment (in the form prescribed in the PBGC regulation on
determination of plan sufficiency) to pay, on or before the date assets are distributed, the amount
needed to provide all benefits in categories 1 through 4? .
If “Yes,’’ attach a signed copy of the commitment; if “No,” complete ©. Uh
(e) Has the plan sponsor paid or does the plan sponsor intend to pay employer liability as prescribed in
the PBGC regulation on employer liability before PBGC’s request for payment? woe ke
Note: Interest on employer liability will accrue from the date of plan termination.
24 Submit participant data schedules in the format shown in the instructions for the following groups of participants:

(a)
(b)
(c)

Retired participants and beneficiaries receiving benefits from the plan;
Participants separated from service not yet receiving vested benefits from the plan; and
All other participants with vested or nonvested accrued benefits.



Form 5310 (Rev. 4-88)

Page 4

17

(v) _ If this is a defined benefit plan, is it intended or is it a fact that any or all of the participants in the

terminating plan will be covered by a new or existing defined benefit plan of the employer?

(vi) If "Yes,"’ does the new plan give full prior service credit for vesting and entitlement purposes?

(vii) If (i) or (v) is “Yes,” then
(A) Has a Form 5300 been submitted for a determination letter for the other plan(s) involved?

If “Yes,” attach plan numbers.
(B) Has the IRS granted approval for a change in funding method in connection with this termina-

tion for the other plan(s) involved? If ‘‘Yes,”’ attach a copy of such approval letter(s). . . .
(viii) _ Has the employer previously received a reversion of assets upon termination of a defined benefit

plan in the past 15 years? If ‘'Yes,"’ attach explanation . .
(ix) If the plan was ever a contributory plan, were distributions of employee contributions made within

the 12 month period immediately preceding the date of plan termination? :

(i) Is this plan or trust currently under examination or is any issue relating to this plan or trust ‘currently
pending before the Internal Revenue Service, the Department of Labor, the Pension Benefit Guaranty
Corporation or any court? If ‘'Yes,” attach a statement naming the agency(s) and/or e court and briefly
describe the issues

(j) Did any plan participant during the ‘current plan year or in the 5 prior plan years receive a ‘a lump-st ‘sum
distribution (see instructions) or have an annuity contract purchased by the plan from an insurance
company on his or her behalf? .

If “Yes,"’ state the largest amount so distributed or applied to purchase a an annuity ‘contract $

(k) Does the plan have ESOP/TRASOP features? .

(1) Were plan benefits not required to be provided in annuity form valued a as of the proposed distribution
date in accordance with PBGC Regulation 29 CFR 2619.26(b) and (c)? (Attach an explanation of how
lump sum values were determined.) .

(m) Does the plan require appropriate written participant and/or ‘spousal consent(s) for distributions where
the present value of the nonforfeitable accrued benefit exceeds $3,500? (See instructions.) :

(n) In the case of a distribution from a defined benefit plan, is the interest rate used to determine the
present value of the accrued benefit and the amount to be distributed not greater than the PBGC
interest rate for valuing immediate annuities?

18

Defined contribution plans (other than money purchase plans) such as profit-sharing, “stock | bonus, or other such
plans where forfeitures are credited to individual account balances, enter the information for the current plan year

hi I the followii :
and the 5 prior plan years on the following schedule: 19 19 19 19. 19.

(a) Employer contributions

Not
Yes | No | Applicable
Ms
Mi I
Mi
Current year
19

(b) Forfeitures
(c) Attach a statement explaining bases on which forfeitures were allocated.

19

Indicate how distributions will be made on termination (check applicable box(es)):

(a) 0 Lump-sum distribution (b) [] Annuitycontract (c) (] Periodic payments from trust
(d)_() Transfer of assets and liabilities to another plan (e) () Other (specify) >

20

Statement of net assets available to pay benefits as of the proposed date of plan termination. Read specific instruction 20, and if you

checked Reason for Filing C or D, read specific instruction 25(c) before completing this item.

Assets TTT

(a) Cashandcashequivalents .... .

(b) Receivables— I en

(i) Employer contributions

(ii) Other. .

(c) Party-in-interest investments —
(i) Loanstoemployer. © 2 1 6 ee ee ee

(ii) Employer securities

(iii) Other

(d) Other investments—

(i) Governmentsecurities 2. 6 6 6 1 ee ee ee ee
(ii) Pooled funds/mutual funds .

(iii) Corporate (debt and equity instruments) . woe ee ee
(iv) Realestate and mortgages .

(v) Other. . . eo
(e) Buildings and other depreciable property . fn

(f) Unallocatedinsurancecontracts . 2. 2... 1 1 ee

(g) Otherassets .

(h) Total assets (add lines (a) through (g)) : : : : : :



Form 5310 (Rev. 4-88) Page 6
25 Indicate the information you are filing with this notice by checking one of the following boxes (see instructions):
(a) O tam filinga complete Form 5310 including required attachments.
(b) [1 Jam filing a complete Form 5310 except the information showing plan assets allocated to participants (see note below).
(c) O tam filing a complete Form 5310 except plan asset information (line 20) and participant data schedules (line 24). | will
file the information required by lines 20 and 24 within 90 days after the date of this filing. (See note below.) By not filing
lines 20 and 24 with the form, | am agreeing to extend the 90-day period prescribed by ERISA section 4041(a) during
which | will not make any distributions pursuant to the proposed termination of the plan.
(d) O With this form | am filing a request for an extension of time to file the information required by line(s)
(other than the information required by lines 20 and 24). (See note below.) For more information about extensions see
the instructions.
Note: If you checked reason for filing C and you are not sending all the information required in Parts I, Ill, 1V, and either completed
Form(s) 6088 or a second copy of the complete participant data schedules described in the line 24 instructions of Form

5310, the 270-day period prescribed by Code section 7476(b)(3) will not commence until you file the remaining required
information.



rom 9310 Application for Determination Upon Termination; — | omen. 1545-0202
Notice of Merger, Consolidation or Transfer of Plan |_&"254309

(Rev. April 1988)

Department of the Treasury Assets or Liabilities; For Agency Use Only
Internal Revenue Service Notice of Intent To Terminate
Gusrants Corporation (Under sections 401(a) and 6058(b) of the Internal Revenue Code and

section 4041(a) of the Employee Retirement Income Security Act of 1974)
Complete every applicable part of this form. If an item in an applicable part does not apply, enter N/A.
Multiemployer plans covered by PBGC insurance program, see Purpose on page 1 of the instructions.

Reason for filing (check applicable box(es); see General Instructions):

A (0 Notice of plan—(i) Merger, (ii) Consolidation, or (iii) Transfer of plan assets or liabilities to another plan.

B C Application for ONLY an Internal Revenue Service (IRS) determination letter regarding a plan termination. (This is NOT a notice
of intent to terminate for the Pension Benefit Guaranty Corporation.)

C LC Defined benefit plan filing ‘ONE STOP” for:
(i) Notice of intent to terminate under the Pension Benefit Guaranty Corporation (PBGC) termination insurance program AND
(ii) Application for an IRS determination letter upon plan termination.
(One-Stop filing is a voluntary choice in lieu of separate filings under B and D. it is NOT available when the Enrolled Actuary
Certification Program is being used.)

D ( Defined benefit plan filing ONLY a notice of intent to terminate under the PBGC termination insurance program. (This is NOT a
request for an IRS determination letter.)

E (J Enrolled Actuary Certification for a defined benefit plan filing ONLY a notice of intent to terminate under the PBGC termination
insurance program

All Filers Complete This Part

1 (a) Name of plan sponsor (see instructions): 1(b) Employer identification number
Address (number and street) 1(c) Sponsor's telephone number
( )
City or town, state, and ZIP code 1(d) Employer's tax year ends
Month Day Year 19
2 (a) Name of plan administrator (if same as 1(a), enter ‘‘same'’) 1 (e) Business code number
Address (number and street) 1(f) Date business incorporated or began
City or town, state, and ZIP code
2 (b) Administrator's employer identification number 2 (c) Administrator's telephone number
¢ )
2 (d) Name, address, and telephone number of person to be contacted if more information is needed (see instructions):
Name Telephone number ( )
Address

2 (e) Office of the District Director of the key district where sponsor is located (see instructions):
3 Ifyou checked reason for filing B, C, D, or E, has each party w who is required t to be notified been properly informed of

this filing (see instructions)? . ..-O Yes O No
4 Type of plan entity (check only one bor: see ¢ instructions)
(a) © Single-employer plan (d) (© Multiple-employer plan (other)

(b) (1 Plan of controlled group of corporations or trades or businesses under common control (e) [1 Other (specify)
(c) [J Multiple-employer-collectively-bargained plan (other than a multiemployer plan)

5 (a) Planname (b) Plannumber __|(c) Plan year ends

6 (a) Isthis a defined benefit plan covered under the Pension Benefit Guaranty

Corporation termination insurance program (see Part IV instructions)? . . (i) O Yes (ii) No (iii) D. Notdetermined
(b) If you checked ‘‘Yes” or ‘“‘Not determined,” have you ever used an employer identification number or plan
number in any prior filing with PBGC other than the ones entered on lines 1(b) or 5(b) above? . . . . . . O Yes O No

If 'Yes,”’ enter the number(s) previously reported. >
7 Indicate type of plan (see General Instruction E):
(a) 1 Defined benefit (ij) O Fixedbenefit (ii) C1 Unitbenefit (ii) C1 Flat benefit
(b) [J Money purchase (c) [1] Profit-sharing (d) [1] Other (specify) >

Under penalties of perjury, I declare that | have examined this application, including accompanying statements, and tothe best of my knowledge and belie itis true, correct
and complete.

Signature > Title > Date >
Signature > Title > Date >
For Paperwork Reduction Act Notice, see page 1 of the instructions. Form 5310 (Rev. 4-88)



If more space is needed for any item, attach additional sheets the same size as this
Form 5310 (Rev. 4-88) form. Identify each sheet with the plan sponsor's name and EIN and identify each item, Page 2

Complete This Part If You Checked Reason for Filing A

8 Other plan(s) involved in transaction (see instructions): (b) Name of employer
(a) Planname

(c) Employer identification number
i

(f) If the plan listed in 5(a) is a defined benefit plan, attach an actuarial statement of valuation evidencing compliance with the
requirements of Code section 401(a)(12) and the Income Tax Regulations under Code section 414(I).

| Part 111] Complete This Part If You Checked Reason for Filing B, C, D, or E
If you checked reason for filing E, complete only 9, 10(a), (b), 11(a) and 12

9 Effective date of plan

Yes | No
10 (a) Has the plan ever received an IRS determination letter? .
(b) If (a) is ‘‘Yes,"’ enter the file folder number and date of the most recent determination letter and complete @
through (g). File folderNo. _.__ 2.2222 222 eee eee eee Date Pm eee eee
(c) If (a) is ‘‘No” and your reason for filing is B or C, attach a copy of the executed original plan document or
joinder/adoption agreement, all plan amendments, trust agreement, group annuity contracts and custodial
agreements (do not complete (d) through (g)). Mh
(d) _ If (@) is ‘'Yes,"’ has the plan been amended since the last determination letter? +
(e) If (d) is ‘‘Yes,”’ and your reason for filing is B or C, attach a copy of the amendment(s) and ‘complete © and ©. I
(f) Doany of the amendments alter the plan’s vesting provisions? : woe ee
(g) Do any of the amendments (including the termination) decrease plan benefits? (see' instructions)
11 (a) Proposed date of plan termination ® ___.- eee.
(b) Attach copies of records of all actions taken to terminate the plan (see instructions).
(c) Last contribution to the plan:
(i) Date (ii) Amount (see instructions) $ (iii) For plan year ended
12 Reason for termination (check only one box to indicate primary reason for termination):
(a) © Change in ownership by merger
(b) O Liquidation or dissolution of employer
(c) O Change in ownership by sale or transfer
(d) OO Adverse business conditions (see instructions and attach explanation)
(e) (1 Adoption of new plan (see instructions and attach explanation)
(f)_ [) Other (specify) >
13 Indicate funding arrangement:
(a) O Trust (benefits provided in whole from trust funds)
(b) (1 Trust or other arrangement providing benefits partially through insurance and/or annuity contracts
(c) © Trust or other arrangement providing benefits exclusively through insurance and/or annuity contracts
(4) 1 Custodial account described in Code section 401(f) and not included in (c) above
(e) (J Other (specify) >
14 (a) Name(s) of trustee(s) or custodian(s) \(b) Date trust’s accounting period ends

Address (number and street)

City or town, state, and ZIP code

15 Participation (see instructions): Collectively bargained plans and plans filing only a notice of intent to terminate | yes} No Not
(reason for filing D) do not complete (a) and (c). Certain

(a) (i) Isthe employer a member of an affiliated service group? :
If there is uncertainty whether the employer is a member of an affiliated. service se group, check ‘the “Not,
Certain’ column.

(ii) If (i) is “Yes” or “Not Certain,” did a prior ruling letter rule on what organizations were members of the
employer's affiliated service group or did the employer receive a determination letter on this plan that
considered the effect of Code section 414(m)? . . hoe eee

(iii) \f (ii) is “Yes,” have the facts on which that letter was ‘based materially changed?

(b) Is the employer a member of a controlled group of corporations or or a group of trades or businesses under
common control? Frere



Form 5310 (Rev. 4-88)

Page 3

15

(Continued):
(c) Complete the following as of the proposed date of plan termination

Currer

19

nt year

(current year) and asoftheendofthe2priorplanyears; = == |_*$7 ----=
(i) Did the plan satisfy the percentage tests of Code section Yes

Yes

410(b)(1)(A)? .
(ii) Total number of employees (if more ‘than 100 enter "100 plus”) .

(d) Enter the total number of participants employed for the current plan year and each of the 5 prior plan years on the schedule below:

(ij) | Number at beginning of plan year

Curr
19

ent year

(ii) | Number added during the plan year.
(ii) Total (add lines (i) and (ii)

(iv) | Number dropped during the plan year
(v) Number at end of plan year

(subtract (iv) from (iii)

(vi) Total number of participants in this
plan separated from service during
the plan year without full vesting

16

otal ‘Amount of monthly benefits as of

Summary of participants or claimants by category: number ‘the most recent payment date

(a) Retirees and beneficiaries (including disability retirees) receiving benefits

(b) Active participants eligible for normal retirement oe
(c) Active participants eligible for early (but not normal) retirement

(d) Active participants vested before termination (other than normal or early retirement) .
(e) Allother active participants

(f) Participants separated from service with deferred vested benefits .

(g) Total (add lines (a) through (f)

Uh

17

Miscellaneous:

(a) Asaresult of the termination, are accrued benefits or account balances nonforfeitable as required under
Code section 411(d)(3)? .

(b) For each participant, do the accrued benefits upon termination include the subsidized benefits that the
participant may become entitled to receive subsequent to the termination? (See instructions)

(c) Will the trust continue to operate after termination of the plan? (See instructions)

(d) Were any funds contributed in the form of, or invested in, obligations or property of the employer 0 or any
group of corporations or group of trades or businesses under common control? .

(e) Will distribution include property other than cash? :

(f) For a defined benefit or money purchase plan, do you estimate there will be a an accumulated funding
deficiency as of the end of the plan year during which the proposed termination date occurs if no
additional plan contributions are made? . .

If “Yes,"’ enter the estimated accumulated funding deficiency $ weeee

(g) (i) If there are unallocated funds which can be reallocated to parti ipants without exceeding the

limitations of Code section 415, have these funds been reallocated? .
(ii) If (i) is "Yes," did the plan originally contain a provision allowing this allocation? .
(iii) If (ii) is No,” was the plan amended to provide for this allocation? . . . soe

(h) Will any funds be, or have any funds been, returned to the employer? (See specific instructions)

If “Yes,” enter the estimated amount B® $ ___.........---.------

Complete (i) through (ix) only if 17(h) is “Yes.”

(i) Has the terminating plan been involved in a spinoff or other transfer of assets or liabilities, subject
to Code section 414(!), within 60 months preceding the proposed date of termination? If “Yes,”
attach a list and explanation of the transaction(s) involved that have occurred within the 60 month
period preceding the proposed date of termination

(ii) \f(i)is “Yes,” answer (A) and (B).
(A) Are the accrued benefits of all participants, in the other plan(s) included in (i), fully vested and
nonforfeitable as of the date of this plan termination? (See instructions) .

(B) Have cash distributions or guaranteed annuity contracts been provided for all accrued benefits, a as of

the date of this termination, of all participants in the other plan(s) included in (i)? (See instructions)
Note: Distributions may not be made to employed participants in nonterminating plans.
(iii) Have cash distributions or guaranteed annuity contracts been provided for all accrued benefits of
all participants in this plan? .

(iv) Attach a statement providing the dates and amounts of these cash distributions « or purchase of
annuity contracts.

Yes | No

Not
Applicable