Transcription of Part I Annual Report Identification Information
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Part I Annual Report Identification Information
Official Use Only DateType or print name of individual signing as plan administrator DateType or print name of individual signing as employer, plan sponsor or DFEThis Form is Open toPublic Nos. 1210-0110 / 1210-0089 Department of the TreasuryInternal Revenue ServiceDepartment of LaborEmployee Benefits SecurityAdministrationPension BenefitGuaranty CorporationForm 5500 Part IAnnual Report Identification InformationFor the calendar plan year 2005or fiscal plan year beginning and ending Part IIBasic plan Information -- enter all requested of planAnnual Return/ Report of Employee Benefit PlanThis form is required to be filed under sections 104 and 4065 of the EmployeeRetirement Income Security Act of 1974 (ERISA) and sections 6047(e),6057(b), and 6058(a) of the Internal Revenue Code (the Code).
Official Use Only 4 If the name and/or EIN of the plan sponsor has changed since the last return/report filed for this plan, enter the name, EIN and the plan number from the last return/report below:
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