Attention:

This form or schedule is provided for information purposes and should not be
reproduced on personal computer printers by individual taxpayers for filing.

The Form 5500-series of forms and schedules is printed on special paper with
dropout ink so it can be processed by the computerized processing system
"EFAST." The Forms 5500 and 5500-EZ (and related schedules) may be
obtained by calling 1-800-TAX-FORM (1-800-829-3676). Be sure to order using
the IRS form number.

Check the Department of Labor's website at www.efast.dol.gov for

additional information concerning the processing system, electronic filing,
software, and "non-standard" filings.
 SCHEDULE G Official Use Only

(Form 5500) Financial Transaction Schedules OMB No. 1210-0110

2004

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

LI
Department of Labor This Form is Open to

▼
Employee Benefits Security File as an attachment to Form 5500.

FI
Administration Public Inspection.

For calendar plan year 2004

MM / D D / Y Y Y Y MM / D D / Y Y Y Y

R
or fiscal plan year beginning and ending

FO
A Name of plan
B Three-digit

▼
plan number

E
US
C Name of plan sponsor as shown on line 2a of Form 5500 D Employer Identification Number

T
NO
Part I Schedule of Loans or Fixed Income Obligations in Default or Classified as Uncollectible

DO
(a) Party-in-interest

(b) Identity and address of obligor ,

LY
Name
ON

Street

City State Zip Code

ES

(c) Original amount of loan

.00
OS

▲ ▲ ▲
Amount (d) Principal ▲ ▲ ▲ .00 (f) Unpaid balance at end of year
RP

received during
reporting year
(e) Interest ▲ ▲ ▲ .00 ▲ ▲ ▲ .00
PU

(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
N
IO
AT

Amt. overdue Amt. overdue

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
RM

(h) Principal (i) Interest

FO

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Cat. No. 14739A Schedule G (Form 5500) 2004
IN
R
FO

2 3 0 4 0 0 0 1 0 A

v7.1
 Schedule G (Form 5500) 2004 Page 2
Official Use Only

NG
(a) Party-in-interest

LI
(b) Identity and address of obligor

FI
Name

R
Street

FO
City State Zip Code

E
(c) Original amount of loan
▲ ▲ ▲ .00

US
Amount
received during
(d) Principal ▲ ▲ ▲ .00 (f) Unpaid balance at end of year

T
reporting year
(e) Interest ▲ ▲ ▲ .00 ▲ ▲ ▲ .00

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

, DO
LY
Amt. overdue Amt. overdue
(h) Principal ▲ ▲ ▲ .00 (i) Interest ▲ ▲ ▲ .00
ON
ES

(a) Party-in-interest
OS

(b) Identity and address of obligor

Name
RP

Street
PU

City State Zip Code

N

(c) Original amount of loan

▲ ▲ ▲ .00
IO

Amount (d) Principal ▲ ▲ ▲ .00 (f) Unpaid balance at end of year

AT

received during
reporting year
(e) Interest ▲ ▲ ▲ .00 ▲ ▲ ▲ .00
RM

(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
IN
R

Amt. overdue Amt. overdue

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
FO

(h) Principal (i) Interest

2 3 0 4 0 0 0 2 0 B
 Schedule G (Form 5500) 2004 Page 3
Official Use Only

Part II Schedule of Leases in Default or Classified as Uncollectible

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

FI
R
(c) Relationship to plan, employer, employee organization or other party-in-interest

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

E
options, date property was leased)

US
T
NO
(e) Original cost (h) Expenses paid during the plan year

▲ ▲ ▲ .00 ▲ ▲ ▲ .00

DO
(f) Current value at time of lease (i) Net receipts

▲ ▲ ▲ .00 , ▲ ▲ ▲ .00
LY
(g) Gross rental receipts during the plan year (j) Amount in arrears
ON

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
ES

(a) Party-in-interest
OS

(b) Identity of lessor/lessee

RP

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

PU

(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)
N
IO
AT
RM

(e) Original cost (h) Expenses paid during the plan year

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
FO

(f) Current value at time of lease (i) Net receipts

IN

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
(g) Gross rental receipts during the plan year (j) Amount in arrears
R

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
FO

2 3 0 4 0 0 0 3 0 C
 Schedule G (Form 5500) 2004 Page 4
Official Use Only

Part III Nonexempt Transactions

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

LI
(a) Identity of party involved

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

R
FO
(c) Description of transactions including maturity date, rate of interest, collateral, par or maturity value

E
US
(d) Purchase price (h) Cost of asset

T
NO
▲ ▲ ▲ .00 ▲ ▲ ▲ .00
(e) Selling price (i) Current value of asset

DO
▲ ▲ ▲ .00 ▲ ▲ ▲ .00
(f) Lease rental (j) Net gain or (loss) on each transaction

.00
, .00
LY
▲ ▲ ▲ ▲ ▲ ▲
(g) Expenses incurred in connection with transaction
ON

▲ ▲ ▲ .00
ES

(a) Identity of party involved

OS

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

RP

(c) Description of transactions including maturity date, rate of interest, collateral, par or maturity value
PU
N
IO

(d) Purchase price (h) Cost of asset

AT

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
RM

(e) Selling price (i) Current value of asset

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
FO

(f) Lease rental (j) Net gain or (loss) on each transaction

IN

▲ ▲ ▲ .00 ▲ ▲ ▲ .00
(g) Expenses incurred in connection with transaction
R

▲ ▲ ▲ .00
FO

2 3 0 4 0 0 0 4 0 D