002 Actuarial Valuation

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Actuarial Valuation Information
*Required fields
*Plan name: New Actuarial Valuation Information
*EIN: 00-0000001

(ex. 33-3333333)

*PN: 123

(ex. 333)

*Notice filer name: Zjfh Xceu Rkgsy
*Role of filer:

Attorney

*Plan year for which the
2019
information is being filed:

(YYYY)

Plan Sponsor Information
*Plan sponsor name: Twest
*Address: Test

*City: Est
*State:

FM

*Zip Code: 78987
*Telephone: 789-987-9878

(ex. 12345-1234)
(ex. 202-111-1111)

E-mail address:

Ext.
(ex. aa@a.com)

Fax:

(ex. 202-111-1111)

Plan Sponsor’s Duly Authorized Representative (if any)
First name:
Last name:
Company:
Title:
Address:

City:
State:
Zip Code:
Telephone:

- select a state (ex. 12345-1234)
(ex. 202-111-1111)

Ext.

E-mail address:

(ex. aa@a.com)

Fax:

*Is the plan terminated?

*Is the plan insolvent?

(ex. 202-111-1111)

Yes

Yes

No
If yes, date of plan termination:

05/02/2019

(MM/DD/YYYY)

If yes, date of plan insolvency:

05/16/2019

(MM/DD/YYYY)

No

Benefits Used for Actuarial Valuation

*Active Participants:
Select one

Plan benefit
Resource benefit level
Guaranteed benefit

*Deferred Vested
Participants:
Select one

Plan benefit
Resource benefit level
Guaranteed benefit

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Actuarial Valuation Information
Attached Documents
Click here for additional instructions.
For a plan receiving financial assistance where the value of nonforfeitable benefits is more than $50 million,
the plan is required to file for each plan year the actuarial valuation for the plan year (document 1).
For a plan receiving financial assistance where the value of nonforfeitable benefits is $50 million or less, the
plan is required to file every 5 plan years:
1. The plan's actuarial valuation for the plan year
OR documents 2 - 4
2. Most recent summary plan description. If this document was previously filed with PBGC, provide the date
in the "Comments" box below.
3. Most recent actuarial valuation for the plan. If this document was previously filed with PBGC, provide the
date in the "Comments" box below.
4. A participant data schedule (Microsoft Excel compatible).
Comments:

File:
Document
Type:

Choose File No file chosen
- Select a document type Attach
Maximum file size is 25MB. It may take a minute or two to attach large files. Please click
only once. To send files larger than 25MB, please click on this link:
http://PBGC.leapfile.com, click "Secure Upload", enter the recipient's email address, and
follow the prompts. For additional assistance, please contact us at
multiemployerprogram@pbgc.gov or 1-800-736-2444 (ext. 3993 or 6047). Local callers
may directly dial 202-326-4000 (ext. 3993 or 6047).

1. The plan's actuarial valuation for the plan year
File 1.docx

Delete

2. Most recent summary plan description of the plan, or the date the document was previously filed with PBGC

File 2.docx

Delete

3. Most recent actuarial valuation for the plan, or the date the document was previously filed with PBGC

File 3.docx

Delete

4. A participant data schedule (Microsoft Excel compatible) which must list all of the following information
for all participants (actives, deferred vesteds and retirees and beneficiaries in pay status):

i.
Name
ii.
Gender
iii. Participant status (active, deferred vested, retiree, beneficiary, disabled)
iv. Date of birth
v. Date of hire
vi. Date of death, if applicable
vii. Date left covered service
viii. Date of disability, if applicable
ix. Salary, if applicable to benefit formula
x. Benefit commencement date
xi. Normal retirement date
xii. Credited service used to calculate the monthly benefit
xiii. Credited service used for early retirement eligibility
xiv. Current monthly benefit for participants in pay
xv. Vested monthly benefit for participants not in pay
xvi. Form of annuity (including survivor percentage and original certain period, if applicable)
xvii. Spouse (or beneficiary) date of birth, if applicable
xviii. Spouse (or beneficiary) date of death, if applicable
File 4.docx

Delete

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Data Summary

Actuarial Valuation Information
New Actuarial Valuation Information - 00-0000001/123

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Plan Filing Information

Edit

Plan name:

New Actuarial Valuation Information

EIN / PN:

00-0000001/123

Notice filer name:

Zjfh Xceu Rkgsy

Role of filer:

Attorney

Plan year for which the information is being filed:

2019

Plan Sponsor Information
Name:

Twest

Address:

Test Est, FM 78987

Phone:

789-987-9878

Email:

N/A

Fax:

N/A

Plan Sponsor’s Duly Authorized Representative
Name:
Company:

N/A

Title:

N/A

Address:
Phone:

N/A

Email:

N/A

Fax:

N/A

Is the plan terminated?
If yes, date of plan termination:
Is the plan insolvent?
If yes, date of insolvency:
Active Participants:

Yes
5/2/2019
Yes
5/16/2019
Resource benefit level

Deferred Vested Participants:

Guaranteed benefit

Attached Documents

Edit

The plan's actuarial valuation for the plan year
Most recent summary plan description of the plan, or the date the document was previously filed with PBGC
Most recent actuarial valuation for the plan, or the date the document was previously filed with PBGC
Participant data schedule
Comments
N/A

CONFIDENTIAL

PBGC
Actuarial Valuation Information
Plan Filing Information
Plan name:

New Actuarial Valuation
Information

EIN/PN:

000000001/123

Notice filer name:

Zjfh Xceu Rkgsy

Role of filer:

Attorney

Plan year for which the
information is being filed:

2019

Plan Sponsor Information
Plan sponsor name:

Twest

Address:

Test

City:

Est

State:

FM

Zip:

78987

Telephone:

(789) 987-9878 Ext:

E-mail:

Fax:

Plan Sponsor's Authorized Representative Information

First name:

Last name:

Company:

Title:

Address:

City:

State:

Zip:

Telephone:

Ext:

E-mail:

Fax:

Is the plan terminated?

Yes

No

Date of plan termination:

02-MAY-2019

Is the plan insolvent?

Yes

No

Date of insolvency:

16-MAY-2019

Benefits Used for Actuarial Valuation:

Active Participants:

Plan benefit
Resource benefit level
Guaranteed benefit

Deferred Vested
Participants:

Plan benefit
Resource benefit level
Guaranteed benefit

Submission status - Filing not yet submitted

CONFIDENTIAL

Attached Documents
The plan's actuarial valuation for the plan year
Most recent summary plan description of the plan, or the date the document was previously filed with PBGC
Most recent actuarial valuation for the plan, or the date the document was previously filed with PBGC
Participant data schedule

Missing Information If required information has not been submitted, explain below.

Submission status - Filing not yet submitted
Go To Data Summary