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Attention

:
• Telephone requests for the 2005 Form 5500-series forms, schedules and instructions will not be filled until December 1, 2005. • Requests for the 2005 Form 5500-series products can be made on the Internet (see below) beginning December 1, 2005. Requests made prior to that date will be filled with the 2004 version of the products. The product you are about to view is provided for information purposes and should not be reproduced on personal computer printers by individual taxpayers for filing. The Forms 5500 and 5500-EZ (and related schedules) are printed on special paper with dropout ink so they can be processed by the computerized processing system “EFAST.” These forms and schedules may be obtained by calling 1800-TAX-FORM (1-800-829-3676). Be sure to order using the IRS form number. Note: You can also use the Internet link http://www.irs.gov/formspubs/index.html to request a limited number of these forms and schedules. If you use this link, select “Order:” and “Forms and publications by U.S. mail.” Check the Department of Labor’s website at www.efast.dol.gov for additional information concerning the processing system, electronic filing, software, and “nonstandard” filings. ________________________________________________

SCHEDULE G (Form 5500)
Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Administration

Financial Transaction Schedules
This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA) and section 6058(a) of the Internal Revenue Code (the Code).

Official Use Only

OMB No. 1210-0110

2005
FI LI

File as an attachment to Form 5500.

For calendar plan year 2005 or fiscal plan year beginning
A Name of plan

MM / D D / Y Y Y Y

and ending
B

MM / D D / Y Y Y Y

(b) Identity and address of obligor

Name Street City
(c) Original amount of loan (d) Principal (e) Interest

ES

ON

LY

,D

(a)

Party-in-interest

O

NO

Part I

Schedule of Loans or Fixed Income Obligations in Default or Classified as Uncollectible

T

State

OS

▲ ▲ ▲

▲ ▲

▲ ▲ ▲

.00 .00 .00
(f) Unpaid balance at end of year

PU

Amount received during reporting year

RP

US E

C

Name of plan sponsor as shown on line 2a of Form 5500

D

FO

Three-digit plan number

Employer Identification Number

Zip Code

R

NG

This Form is Open to Public Inspection.

.00

Amt. overdue (h) Principal

FO RM

AT IO N

(g) Detailed description of loan including dates of making and maturity, interest rate, the type and value of collateral, any renegotiation of the loan and the terms of the renegotiation, and other material items

.00

Amt. overdue (i) Interest

.00

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 14739A Schedule G (Form 5500) 2005

FO R

IN

2

3

0

5

A

A

0

1

0

V
v8.2

Schedule G (Form 5500) 2005

Page

2
Official Use Only

(a)

Party-in-interest

Name Street City
(c) Original amount of loan (d) Principal (e) Interest

▲ ▲ ▲

▲ ▲ ▲

▲ ▲ ▲

.00 .00 .00

Amount received during reporting year

(f) Unpaid balance at end of year

US E

FO

R

State

Zip Code

FI

LI

NG PU RP OS ES ON
▲ ▲

(b) Identity and address of obligor

Amt. overdue (h) Principal

.00

Amt. overdue (i) Interest

LY

,D

O

NO

(g) Detailed description of loan including dates of making and maturity, interest rate, the type and value of collateral, any renegotiation of the loan and the terms of the renegotiation, and other material items

T

.00

.00

(a)

Party-in-interest

(b) Identity and address of obligor

Name Street City
(c) Original amount of loan (d) Principal (e) Interest

AT IO N

State

Zip Code

▲ ▲ ▲

▲ ▲ ▲

.00 .00 .00
(f) Unpaid balance at end of year

FO RM

Amount received during reporting year

.00

(g) Detailed description of loan including dates of making and maturity, interest rate, the type and value of collateral, any renegotiation of the loan and the terms of the renegotiation, and other material items

FO R

IN

Amt. overdue (h) Principal


2 3


0 5

.00
A

Amt. overdue (i) Interest


0 W

.00

A

0

2

Schedule G (Form 5500) 2005

Page

3
Official Use Only

Part II

Schedule of Leases in Default or Classified as Uncollectible

(c)

Relationship to plan, employer, employee organization or other party-in-interest

(d) Terms and description (type of property, location and date it was purchased, terms regarding rent, taxes, insurance, repairs, expenses, renewal options, date property was leased)


(f)

▲ ▲ ▲

▲ ▲ ▲

.00
(i)

NO

(e)

Original cost

(h) Expenses paid during the plan year

T

US E

FO

R
▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲ ▲

FI
.00 .00 .00

Current value at time of lease

Net receipts

▲ ▲

.00
(j)

(g) Gross rental receipts during the plan year

(d) Terms and description (type of property, location and date it was purchased, terms regarding rent, taxes, insurance, repairs, expenses, renewal options, date property was leased)

(e)

Original cost

FO RM

AT IO N

PU

(c)

Relationship to plan, employer, employee organization or other party-in-interest

RP

OS

(a) Party-in-interest (b) Identity of lessor/lessee

ES

(f)

Current value at time of lease

IN

▲ ▲ ▲

▲ ▲ ▲

▲ ▲ ▲
2 3

.00
(i) Net receipts

ON

.00

(h) Expenses paid during the plan year

LY

Amount in arrears

,D

O

LI
▲ ▲
(j) Amount in arrears

NG
▲ ▲ ▲
X

(a) Party-in-interest (b) Identity of lessor/lessee

▲ ▲ ▲

.00 .00 .00

FO R

.00 .00
0 5 A A 0 3 0

(g) Gross rental receipts during the plan year

Schedule G (Form 5500) 2005

Page

4
Official Use Only

Part III

Nonexempt Transactions
If a nonexempt prohibited transaction occurred with respect to a disqualified person, file Form 5330 with the IRS to pay the excise tax on the transaction.

(b) Relationship to plan, employer, or other party-in-interest

(c)

Description of transactions including maturity date, rate of interest, collateral, par or maturity value

(d) Purchase price

(h) Cost of asset

(e)

Selling price

(i)

Current value of asset

(g) Expenses incurred in connection with transaction


(a) Identity of party involved

.00

(c)

Description of transactions including maturity date, rate of interest, collateral, par or maturity value

(d) Purchase price

AT IO N

PU

RP

(b) Relationship to plan, employer, or other party-in-interest

OS

ES

FO RM


(e) Selling price

▲ ▲ ▲

▲ ▲ ▲ ▲
2 3

.00
(i)

ON

(h) Cost of asset

LY

.00

,D

(f)

Lease rental

(j)

Net gain or (loss) on each transaction

O

.00

NO

.00

T

US E

FO

R
▲ ▲ ▲ ▲ ▲ ▲

FI
▲ ▲ ▲

LI
.00 .00 .00

Current value of asset

NG
▲ ▲ ▲ ▲ ▲ ▲

(a)

Identity of party involved

.00 .00 .00

(f)

Lease rental

IN

▲ ▲ ▲

.00
(j)

▲ ▲

Net gain or (loss) on each transaction

FO R

.00 .00
0 5 A A 0 4 0

(g) Expenses incurred in connection with transaction

Y