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5500 SUPPLEMENTAL STATEMENTS Report Guide

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5 5 0 0 S U P P L E M E N T A L S T A T E M E N T S

R e p o r t G u i d e

5500 SUPPLEMENTAL STATEMENTS

US Internal Revenue Service (IRS) and Department of

Labor (DOL) regulations require administrators and

sponsors of qualified employee benefits plans to file

Form 5500 annually for each master trust or investment

pool as well as for each plan.

Northern Trust’s 5500 Supplemental Statements package

is a suite of reports designed specifically to support clients

required to file Form 5500 with the Department of Labor

annually. The 10 supplemental schedules reflect data for

both domestic and foreign investments.

Presenting a sample page from each report, this guide:

■■ Offers a key to organization and content;

■■ References each data element for clarity; and

■■ Refers to corresponding line items on Form 5500

to facilitate filing preparation

The 5500 Supplemental Statements package complements

Northern Trust’s Portfolio Statement for clients. These two

reporting packages are fully integrated, rely on the same

database and are presented in similar formats. They are

both provided to clients annually and are reported using

a base currency of USD.

If you would like more information about the 5500

Supplemental Statements package, please contact

your Northern Trust representative.

C O N T E N T S

CURRENT VALUE OF ASSETS AND LIABILITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

SCHEDULE OF REALIZED GAINS AND LOSSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

SUMMARY OF GAINS AND LOSSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

SCHEDULES OF REPORTABLE 5% TRANSACTIONS . . . . . . . . . . . . . . . . . . . . . . . . . 6 - 9

SCHEDULE OF ACQUISITIONS AND DISPOSITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 10

SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES . . . . . . . . . . . . . . . . . . . . . 11

SCHEDULE C REPORTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 - 14

INCOME RECONCILIATION SCHEDULE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

SCHEDULE H REPORTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 - 19

TRANSFERS RECONCILIATION SCHEDULE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 - 21

SCHEDULE R REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 -23

APPENDIX

ASSET CATEGORIZATION FOR 5500 SUPPLEMENTAL STATEMENTS . . . . . . . . . . . . . 24

SCHEDULE C SERVICE CODES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

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northerntrust.com | 5500 Supplemental Statements | 3 of 30

C U R R E N T VA LU E O F A S S E T S A N D L I A B I L I T I E S

Form 5500 requires the reporting of the current

value of all assets at the beginning and end of

the plan year. The current value of realized and

unrealized gains and losses during the plan year

must be reported in Part II of Schedule H Lines

2(b)(4) through 2(b)(10). This is one of three

reports in this guide that specifically assists with

completing this information.

This report is a supporting schedule to the

Summary of Gains/Losses 5500 filing. It

provides supporting detail on the assets

and unrealized gains/losses reported in

Northern Trust’s Schedule H report at end

of the plan year.

a DOL Asset Category represents the

asset category for the underlying assets

according to the DOL guidelines.

b Security Description/Asset ID lists

the description of the asset and the

sedol or cusip number associated with

that security.

c Shares/Par Value indicates the amount

of carrying value on record.

dMarket Price lists the local market

price of the security as of the ending

report date.

eMarket Value lists the base market

value of the security.

fERISA Cost identifies the current value

cost of the security as required by the IRS

and DOL for reporting of realized and

unrealized gains/losses in Form 5500.

Current value cost is defined as market

value at the beginning of the fiscal year and

adjusted for acquisitions and dispositions

of shares or costs throughout the year.

gUnrealized Gain/Loss on Security Movement reflects the current value of

unrealized gain/loss associated with any

non-cash security movement moving

into or out of the client account.

hUnrealized Gain/Loss represents

the total of unrealized gains/losses

by security.

iTotal Unrealized Gain/Loss represents

the total of unrealized gains/losses reported.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

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S C H E D U L E O F R E A L I Z E D GA I N S A N D LO S S E S

4 of 30 | 5500 Supplemental Statements | northerntrust.com

Form 5500 requires the reporting of the current

value of all assets at the beginning and end of

the plan year. The current value of realized and

unrealized gains and losses during the plan year

must be reported in Part II of Schedule H Lines

2(b)(4) through 2(b)(10). This is one of three

reports in this guide that specifically assists with

completing this information.

This is a supporting schedule to the 5500 filing

– Summary of Gains/Losses. It indicates trans-

actions, their current value and realized gains

or losses for the reporting period.

a Denotes DOL Asset Category for

underlying assets according to DOL

guidelines.

b Security Description/Asset ID lists

the sedol or cusip number identifying

the security.

c Shares/Par Value indicates the

carrying value involved in the

transaction.

d Proceeds indicates the amounts

collected for sales of shares/par,

mark to market, principal paydowns,

net class settlements, maturities,

redemptions, calls, short sales and

other security-related principal receipts.

e ERISA Cost identifies the current value

cost of the security as required by IRS

and DOL for reporting realized/unreal-

ized gains/losses in Form 5500. Current

value cost is defined as the market value

at the beginning of period adjusted for

purchases and sales throughout the year.

f Current Value Gain/Loss indicates

the difference between proceeds and

ERISA cost.

g Total Realized Gain/Loss represents

the total of realized gains/losses reported.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

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northerntrust.com | 5500 Supplemental Statements | 5 of 30

S U M M A RY O F GA I N S A N D LO S S E S

Form 5500 requires the reporting of the current

value of all assets at the beginning and end of

the plan year. The current value of realized and

unrealized gains and losses during the plan year

must be reported in Part II of Schedule H Lines

2(b)(4) through 2(b)(10). This is one of three

reports in this guide that specifically assists with

completing this information.

This report assists with the completion of

Form 5500 Schedule H, Part II lines 2(b)(4)

through 2(b)(10). It reports the total gains

and losses as well as the market value of

assets as at the end of the plan year, grouped

by type of security.

a Asset Category denotes the asset

category for the underlying assets

according to DOL guidelines.

b Total Market Value lists the total

market value as of the end of the

period for the shares outstanding

in each category.

c Unrealized Gain/Loss indicates the

difference between the market value

and ERISA cost. The unrealized gain/

loss on security movement is also

included in this amount.

d Realized Gain/Loss indicates the

difference between the proceeds and

the ERISA cost from the sale/disposal

of a security.

e Total Gain/Loss indicates the sum of

the unrealized gain/loss and the realized

gain/loss. This amount can be reconciled

to the Change in Book & Market Value

report within Management Reporting.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a b c d e

S C H E D U L E O F R E P O R TA B L E 5 % T R A N S AC T I O N S – PA R T S A A N D C

6 of 30 | 5500 Supplemental Statements | northerntrust.com

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

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northerntrust.com | 5500 Supplemental Statements | 7 of 30

Form 5500 requires the reporting of

certain transactions that exceed 5% of

the previous year-end market value of the

Trust. These schedules can be used for the

completion of line item 4(j) of Part IV of

Schedule H. Four reports are provided to

assist with compiling this information. A

separate 5% Report will be provided for

each plan-identified asset.

5% Report – Part A: Single transactions in excess of 5%

Includes single transactions within the plan

year that are in excess of 5% of the current

value of plan assets.

a Denotes Security Description/Asset ID

identifying the individual security.

b Shares/Par indicates the carrying

value on transaction.

c Denotes trade Date of the transactions.

d Denotes the average Acquisition Price

per share of the transaction or series of

transactions.

e Specifies the average Disposition Price

per share of the transaction or series of

transactions.

f Denotes Lease Rental expense.

g Denotes broker commissions and

any other Expenses Incurred with

transaction.

h Denotes original acquisition Cost of asset.

iCurrent Value (of Asset) on Transaction Date lists the purchase value of security

(if purchase is involved) and/or sale

proceeds (if sale is involved).

j Net Gain/Loss appears when security

is sold within the period and represents

Current Value on Transaction Date i

minus sum of Cost h of asset.

k Represents prior year-end’s Market Value Including Accruals of total

trust; transactions in report are based

on 5% of this value.

5% Report – Part C: Series of transactions by issue in excess of 5%

This report reflects a series of transactions of the

same issue if, when aggregated, the series exceeds

5% of the current value of the plan assets.

As permitted by DOL regulations (29 CFR

2520.103-6), Northern Trust has included an

alternative method of using a single line to

summarize each series of transactions by issue

in excess of 5%. The detail of the transactions

reflected in Part C are available upon request.

l Denotes the Security Description/Asset ID identifying individual security.

m Total Number of Transactions reflects

the total proceeds paid on purchases and

the number of sales that occurred within

the plan year.

n Acquisition Price reflects the total

proceeds paid on purchases.

o Disposition Price reflects the total net

proceeds received on sales.

p Denotes Lease Rental not populated.

q Expenses Incurred reflects broker

commissions.

r Cost of Asset reflects total of acquisition

costs minus disposition costs.

s Current Value of Asset on Transaction Date lists the purchase value of security

(if purchase) and/or sale proceeds (if sale).

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a b c d fe g h i j

k

S C H E D U L E O F R E P O R TA B L E 5 % T R A N S AC T I O N S – PA R T S B A N D D

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a b c d fe g h i j

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northerntrust.com | 5500 Supplemental Statements | 9 of 30

5% Report – Part B Series of non-security transactions with the same party in excess of 5%

This report reflects any series of transactions

with the same party that involve property

other than securities and aggregate within

the plan year to more than 5% of the current

value of the plan assets. The typical transac-

tions excluded from this report are preferred

and common stock; government, municipal

and corporate bonds; and common, collective

and mutual funds.

5% Report – Part D Series of transactions with same party in excess of 5%

This report includes any transaction within

the plan year with a party if any prior or

subsequent single transactions within the

plan year with the same party exceeds 5% of the

current value of plan assets. This report includes

all transactions with all parties.

Please note that this report excludes the

following security types as identified

within DOL regulation 29 CFR 2520.103-6

(please note that the regulation allows other

exclusions).

■■ Debt obligations of the United States

or any US agency securities with a

maturity of not more than one year

■■ Participation in a bank common or

collective trust

■■ Interests issued by a company registered

under the Investment Act of 1940

(e.g. mutual funds)

a Denotes Security Description/Asset ID

identifying the individual security.

b Shares/Par indicates the carrying value

on transaction.

c Denotes the trade Date of transaction.

d Denotes the average Acquisition Price

per share of transaction or series of

transactions.

e Denotes the average Disposition Price

per share of transaction or series of

transactions.

f Denotes the Lease Rental expense not

populated.

g Denotes broker commission and any other

Expenses Incurred on transactions.

h Historical Cost of asset refers to original

or acquisition cost of asset.

i Current Value (of Asset) on Transaction Date lists purchase value of security

(if purchase is involved) and/or sale

proceeds (if sale is involved)

jNet Gain (Loss) appears when a

security is sold within period; Current

Value of Asset – i minus sum of Cost

of Asset – h

k Represents prior year-end’s Market Value Including Accruals of total trust; trans-

actions in this report are based on 5% of

this value.

Note:

A separate 5% Report will be provided for

each plan-identified asset.

S C H E D U L E O F AC Q U I S I T I O N S A N D D I S P O S I T I O N S

10 of 30 | 5500 Supplemental Statements | northerntrust.com

Form 5500 requires the reporting of select

investment assets held during the plan year

and disposed of before the end of the plan

year. This report, provided for each trust

or account, lists securities acquired and

disposed of during the year. The Schedule

of Acquisitions and Dispositions can assist

in completing Line 4(i) on Part IV of

Schedule H.

This schedule will exclude the following

security types as identified within DOL

regulation 29 CFR 2520.103-11 (please

note that the regulations allow for other

exclusions).

■■ Debt obligations of the United States

or any of its agencies

■■ Participation in Bank Common or

collective trusts

■■ Interests issued by a company

registered under the Investment

Company Act of 1940

a Asset ID lists the sedol or cusip number

identifying the security.

b Denotes the Security Description identi-

fying security.

c Denotes type of Transaction represented.

d Shares/Par identifies the amount of

carrying value on transactions.

e Cost of Acquisitions represents the

historical cost on purchase or acquisition.

f Proceeds of Dispositions reflects cash

received on sale or disposition.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a b c dfe

northerntrust.com | 5500 Supplemental Statements | 11 of 30

S C H E D U L E O F A S S E T S H E L D F O R I N V E S T M E N T P U R P O S E S

A Schedule of Assets Held for Investment

Purposes must report all investment assets

held by the plan on the last day of the plan

year. This report assists with the completion

of Line 4(i) on Part IV of Schedule H.

Note:

■■ 5500 reports are derived on a trade date

basis and will reflect market value and

cost of pending share positions.

■■ Information about securities loaned, and

about collateral, is available separately.

a DOL Asset Category represents the

asset category for the underlying assets

according to DOL guidelines.

b Security Description/Asset ID lists

a description of asset and sedol or

cusip number.

c Shares/Par Value identifies the amount

of carrying value on record.

d Denotes the Historical Cost of the security.

e Current Value lists the base market value

of the shares on record.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a

b

c d e

S C H E D U L E C – PA R T S A A N D B

12 of 30 | 5500 Supplemental Statements | northerntrust.com

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a

b c d

a

bc

d

fe

northerntrust.com | 5500 Supplemental Statements | 13 of 30

These schedules include information regard-

ing payments to service providers from the

master trust. Parts A and B assist in compiling

information for Schedule C of Form 5500. Part

C provides information to assist you with the

reconciliation of your total fees to the annual

accounting reports. For master trusts, the

Schedule C payments can be grouped either

by master trust account or plan.

PART A

■■ Lists vendors that received fees greater

than or equal to $5,0001 and all vendors

that received fees less than $5,000. This

assists in the completion of Part I, Line 2

of Schedule C of Form 5500.

■■ Lists all allocated fees for payments to

federal, state, local governments and

agencies, simplifying the process of

balancing total fees to accounting

statements. (This information is

not requested by Schedule C of the

Form 5500.)

■■ Lists all remaining fees posted without

EINs and other expenses.

PART B

Lists vendors that received fees by plan. This

assists in completing Part I, Line 1 and 2 of

Schedule C, Form 5500.

a Vendor Name to whom fees were paid.

b Employer Identification Number

of each vendor whom fees were paid.

99-9999999 denotes EIN was not

available, 44-4444444 denotes notional

interest payments and 77-7777777

denotes foreign vendor payments. The

EINs listed above are not actual EINs

and are Northern Trust assigned as a

way to aggregate transaction activity.

c Denotes the amount of Fees and Expenses Paid to each vendor.

d Service Code identifies the type of

service provided in accordance with

Form 5500 classifications. Service codes

are assigned to vendors based on a

primary service provided, as indicated

by each vendor. A list of service codes

is included in the appendix.

e Total Fees and Expenses paid during

the plan year.

f Plan Number of each plan participating

in a master trust will be identified and the

fees related to that plan will be reported.

Note:

■■ Schedule C nets most fees on real estate

transactions.

■■ Schedule C is provided for master

trusts, investment pools and plans

where applicable.

■■ Transactions without an EIN are catego-

rized at the end of the reports and under

the following specific categories.

— American Depository Receipt (ADR)/

Global Depository Receipt (GDR) Fees

— Delivery and Receipt Fees

— Tax Reclaim Fees

— Issuance Fees

— Legal Entity Identifier (LEI)

Registration Fees

— Foreign Market Taxes

— Notional Interest Payments

— Vendor Name Not Provided

— Swap Related Fees and Expenses

— Other Market Associated Costs

— Other Fees and Expenses

Foreign Exchange

Northern Trust will conduct foreign exchange

transaction services at exchange rates estab-

lished at its discretion, based on exchange

rates available in the foreign exchange market

on the global trading day. Northern Trust

retains any profit derived from such service.

1 A contract administrator fee greater than or equal to $5,000 should be reported as in the first item in Part I on Line 2 when completing Schedule C of your Form 5500.

S C H E D U L E C – B R O K E R C O M M I S S I O N S

14 of 30 | 5500 Supplemental Statements | northerntrust.com

This schedule provides broker commission data.

a The Broker Name to whom commission

was paid.

b Denotes Amount of Commission paid

to each broker.

c Service Code identifies the type of

service provided in accordance with

Form 5500 classifications. Service

codes are assigned to vendors based on

a primary service provided, as indicated

by each vendor. A list of service codes

is included in the appendix.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a

bc

northerntrust.com | 5500 Supplemental Statements | 15 of 30

I N C O M E R E C O N C I L I AT I O N S C H E D U L E

The Income Reconciliation Schedule does not

contain specific information required on the

Form 5500. It is a report designed to assist with

the reconciliation of Northern Trust annual

accounting reports and the 5500 Supplemental

Statements. It specifically assists in reconciling

income related information required for comple-

tion of Schedule H and provides the breakdown

for the total reported on Schedule H – Part II

Line items 2(b) through 2(c).

a Denotes the Income Category according

to DOL guidelines.

b Denotes the DOL Asset Category for

underlying assets according to DOL

guidelines.

c Income Received/Expense Paid identifies income received/paid

during the reporting period.

d Current Year Accruals identifies current

accrual amounts as of the report period’s

end date.

e Prior Year Accruals identifies prior

year’s accrual amounts as of the prior

reporting period’s end date.

f Accrual Receipts/Deliveries identifies

accrual amounts received and delivered

during the reporting period.

g Amortization/Accretion identifies

current amounts during the reporting

period.

h Denotes Total Income/Expense for the

plan year. This amount will equal Income

Received c plus Current Year Accruals

d minus Prior Year Accruals e

i Denotes the current value Unrealized Gain/Loss amounts as of the report

ending date.

j Denotes the Realized Gain/Loss amounts recognized during the

reporting period.

k Denotes the Net Investment Gain/Loss for the DOL category. This amount

is equal to Total Income f plus

Unrealized Gain or Loss g plus

Realized Gain or Loss h.

a

b

cd

fe

g h

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

h j ki

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a

b c

d

f

e

S C H E D U L E H R E P O R T S

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Form 5500 requests an Asset and Liability

Statement for the beginning of the plan

year and the end of the plan year to provide

the current value of the plan assets and

liabilities according to DOL categorizations.

For each master trust or account, a Schedule H

report will be provided for each plan-identified

asset. Per DOL regulations, when filing as

a master trust investment pool, the transfer

section of Schedule H should reflect certain

transactions.

If a reporting entity transacts many repurchase

agreements, the total reported proceeds and

aggregate carrying amounts will naturally be

large compared to the total value of the trust. The

large values themselves are expected and will be

reflected as such on the Schedule H report.

Part 1 should reflect the market value (to the

penny) for the following categories as of the end

of the previous plan year in column 2 and as of

the end of the current plan year in column 2.

This information is broken out by assets and

liabilities.

AThe Category used to identify the

underlying assets according to DOL

guidelines.

BDenotes the Market Value as of the

beginning of the current plan year.

CDenotes the Market Value as of the

end of the current plan year.

DTotal Assets reflects the total market

value as of the beginning and end of

the current plan year.

ETotal Liabilities reflects the total market

value of liabilities as of the beginning

and end of the current plan year.

FNet Assets represents Total Assets D

minus Total Liabilities e

18 of 30 | 5500 Supplemental Statements | northerntrust.com

S C H E D U L E H R E P O R T S

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a

b

c

d

f

e

g

hi

northerntrust.com | 5500 Supplemental Statements | 19 of 30

This statement is an Income Statement

for the plan year, including information

regarding contributions, earnings on

investments, other income, benefit payments,

administrative expenses and transfers to

and from the plan. Earnings on investments

include income and gains/losses on a current

value basis as required by Form 5500.

As per DOL regulations, the transfer section

of Schedule H when filing as a master trust

investment pool should reflect certain

transactions. Northern Trust reflects various

activity on lines 2(l)(1) and 2(l)(2).

a Contributions: Employer, participant

and other contributions reported in

the current plan year.

b Earnings on Investments identifies

Income, Realized Gains/Losses, and

Unrealized Gains/Losses reported in

the current year.

c Denotes any Other Income.

d Total Income equals the sum of

Contributions a plus Earnings on

Investments b plus Other Income c

e Benefit Payments and Payments

provides benefits reported for the

current plan year.

f Administrative Expenses identifies

expenses incurred during the plan year.

Expenses are categorized according

to DOL guidelines and the service

codes reported in the Schedule C. For

explanation of categorization, refer to

the Schedule C insert.

g Total Expenses equals the sum

of Benefit Payments, Corrective

Distributions, Deemed Distributions

of Participant Loans, Interest Expense

and Administrative Expenses.

h Net Income reflects the difference

between Total Income D and Total

Expenses g

i Transfer of Assets to and from the

plan are reflected here.

Note:

Contributions and benefit payments are

also reflected here. Please refer to the

Transfers Reconciliation Schedule for a

detailed breakdown by transaction type.

T R A N S F E R S R E C O N C I L I AT I O N S C H E D U L E

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The Transfers Reconciliation Schedule assists

with reconciling transfers to and from the

plan as reported on Schedule H – Part II,

Line items 2(l)(1) and 2(l)(2). It provides a

detailed breakdown of the financial information

included on the transfers to and from lines of

Northern Trust’s Schedule H report. This is

not a required Form 5500 schedule.

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a b c d e

northerntrust.com | 5500 Supplemental Statements | 21 of 30

Please note that when filing Form 5500

at the plan level, these transactions should

be entered on the appropriate line of

Schedule H according to Form 5500

instructions. Information about securities

loaned, and collateral is available separately.

Transfers to the plan:

■■ Sponsor contributions

■■ Participant contributions

■■ Insurance contract receipts

■■ Plan rollover receipts

■■ Lump sum re-deposits

■■ Participant loan repayments

■■ Redeposit of refunds

■■ Security receipts

■■ Miscellaneous cash receipts

■■ Inter-portfolio transfers

Transfers from the plan:■■ Benefit payments

■■ Participant loans

■■ Lump sum payments

■■ Participant deposit refunds

■■ Plan rollover disbursements

■■ Miscellaneous cash disbursements

■■ Security disbursements

■■ Inter-portfolio transfers

a Transaction Type denotes the category

used to identify the type of transaction.

b Receipts denotes transactions resulting

in cash/securities received.

c Disbursements denotes transactions

resulting in cash/securities disbursed.

d Market Value denotes the market value

of securities transferred in and out.

e Total Transfers denotes receipts minus

disbursements.

S C H E D U L E R

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Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

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a

ej k m

Northern =ust *Generated by Northern Trust from periodic data on 31 Jan XX

a

b

c jd fe g h i lk

northerntrust.com | 5500 Supplemental Statements | 23 of 30

This report assists clients in completing the

(Schedule R) Distribution of Assets Information

required by the DOL Form 5500. Defined

benefit plans with over 1,000 participants

need to include additional asset breakdowns on

an attachment to the Form 5500 Schedule R.

This information is requested by the Pension

Benefit Guarantee Corporation (PBGC) and

will require you to:

■■ Provide the percentage of plan assets

by five specific asset categories

■■ Disclose the weighted average duration

for the plan’s debt securities

As required, the Schedule R report provides

the beginning-of-year distribution of assets

for the following categories, along with

the weighted average of effective durations

based on ratings from S&P, Moody’s and

Fitch (as available): stocks, investment-

grade debt instruments, high-yield debt

instruments, real estate, and other asset

classes. Please consult with your auditors

and tax advisors regarding your Form 5500

filing requirements.

a DOL Asset Category* represents the

asset category for the underlying assets

according to PBGC guidelines.

b Description/Asset ID lists a description

of asset and sedol or cusip number.

c Shares identifies the amount of carrying

value on record.

d Denotes the Market Value of the

security as of previous year end without

accruals.

e % of Total represents the market value

percentage on the total market value of

included assets.

f S&P Rating represents the credit rating

that was received for debt security.

g Moody Rating represents the credit

rating that was received for debt security.

h Fitch Rating represents the credit rating

that was received for debt security.

i Denotes the Effective Duration of the

security represented in years.

j Market Value Included represents the

market value of a security where we have

duration information.

k Market Value Excluded represents the

market value of a security where duration

information is not available.

l Effective Duration Factor represents

the Effective Duration multiplied by the

Market Value of the Security, divided by

the Market Values of all debt securities

for which effective duration values are

available.

m Weighted Average Effective Duration

for the portfolio debt instruments

(where an effective duration value is

available) is the sum of all the Effective

Duration Factors.

* The PBGC’s draft FAQs state “investment-grade debt” includes debt instruments with S&P ratings of BBB- or higher, Moody’s ratings of Baa3 or higher, or equivalent ratings from another rating agency. According to information from Fitch’s website, “investment-grade debt” instruments are those with ratings of BBB- or higher.

A P P E N D I X : A S S E T C AT E G O R I Z AT I O N F O R 5 5 0 0 S U P P L E M E N TA L S TAT E M E N T S

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These are the categories reflected on holdings

reports including Current Value of Assets and

Liabilities, Assets Held for Investment Purposes

and the Schedule H reports.

Total Non-Interest Bearing Cash: Cash

on hand or cash in a non-interest bearing

checking account.

Receivables:

■■ Employer contributions due but not

yet received

■■ Participant contributions due but not

yet received.

■■ Income: Income due but not yet received.

■■ Other: Income and other items due but

not yet received, including the net of

receivables/payables for pending trades

when filing on a trade date basis.

General Investments:

■■ Interest Bearing Cash: All assets that

earn interest in a financial institution

account or money market fund, including

interest-bearing checking accounts.

■■ Certificates of Deposit: Denotes all

certificates of deposit.

■■ US Government Securities: Securities

issued or guaranteed by the US

government or its designated agencies,

such as US savings bonds, Treasury

bonds, Treasury bills, GNMAs, FNMAs,

FHLMCs and FHAs.

■■ Corporate Debt Instruments: Investment

securities issued by a corporate entity

at a stated interest rate payable on a

particular future date, such as most

bonds, debentures, convertible bonds,

commercial paper, zero coupon bonds

and CMOs.

■■ Preferred: All corporate debt instruments

with a rating of “A” or above, as provided

by the rating services used by The

Northern Trust Company.

■■ Other: All corporate debt instruments

with a rating below “A”.

Corporate Stock:

■■ Preferred: Stock issued by corporations

accompanied by preferential rights or

warrants convertible into preferred stock.

■■ Common: Any holding that represents

regular ownership in stock.

Partnership/Joint Venture Interests: Denotes any limited partnership or

joint venture.

Real Estate:

■■ Income Producing: Real property that

received or accrued for income.

■■ Non-Income Producing: Real property

that did not receive or accrue for income.

Loans To Participants – Other: All loans

made to participants.

Other Loans: Any loan not reported in loans

to participants.

Value of Interest in Common/Collective Trusts: Any holding in common or collective

funds. These funds are maintained by a bank,

trust company or similar institution that is

regulated, supervised, and subject to periodic

examination by a state or federal agency.

Value of Interest in Pooled Separate Accounts: Denotes any holdings in insurance

carrier pooled separate accounts.

Value of interest In Master Trusts: Denotes

any allocated participation in a master trust

or participation represented by ownership of

master trust units.

Value of Interest in 103-12 Entities: Denotes any participation in a 103-12 entity.

Value of Interest in Registered Investment Companies: Denotes any holdings of unallo-

cated registered investment companies, such

as mutual funds.

Value of Funds Held in Insurance Company General Accounts: Denotes

any holdings of insurance contracts such

as GICs, GACs and general funds.

Other: Denotes any other assets, such as

futures, options, non-U.S. government

securities, REITs, swaps, repurchase agree-

ments, hedge funds and municipal bonds.

Other Liabilities: Denotes any other

liabilities, such as other payables, pending

trade purchases, pending foreign exchange

sales and derivative liabilities.

northerntrust.com | 5500 Supplemental Statements | 25 of 30

A P P E N D I X : S C H E D U L E C S E RV I C E C O D E S

Service Code Service Code NameNorthern Trust’s Schedule C Abbreviations

Northern Trust’s Schedule H Mapping

10 Accounting (Including Auditing) ACCNTG 2(i)1

11 Actuarial ACTURAL 2(i)1

12 Claims Processing CLM-PROC 2(i)2

13 Contract Administrator CONTRACT 2(i)2

14 Plan Administrator PLN-ADMR 2(i)2

15 Recordkeeping and Information Management (computing, tabulating data processing) RDKPINMT 2(i)2

16 Consulting General CONSULTG 2(i)1

17 Consulting Pension CONSULTP 2(i)1

18 Custodial (other than securities) CUSTDYNS 2(i)1

19 Custodial CUSTODY 2(i)1

20 Trustee (individual) TRUSTEIN 2(i)1

21 Trustee (bank, trust company or other similar institution TRUSTECO 2(i)1

22 Insurance Agents and Brokers INSAGT 2(i)4

23 Insurance Services INSRNCSV 2(i)4

24 Trustee (discretionary) TRTE-DIS 2(i)1

25 Trustee (directed) TRTE-DIR 2(i)1

26 Investment Advisory (participants) INADV-PA 2(i)3

27 Investment Advisory (plan) INADV-PL 2(i)3

28 Investment Management INV-MGMT 2(i)3

29 Legal LEGAL 2(i)1

30 Employee (plan) EMPLOYEE 2(i)4

31 Named Fiduciary NMD-FIDY 2(i)3

32 Real Estate Brokerage RE-BRKR 2(i)3

33 Securities Brokerage SEC-BRKR 2(i)3

34 Valuations VALUTN 2(i)1

35 Employee (Plan Sponsor) EMPLOYER 2(i)2

36 Copying and Duplicating COP-DUPL 2(i)4

37 Participant Loan Processing PARTLOAN 2(i)4

38 Participant Communication PART-COM 2(i)4

40 Foreign Entity (e.g. agent, broker, bank or insurance company not operating in the jurisdiction of the US) FORGN-EN 2(i)4

49 Other OTHER 2(i)4

N OT E S

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N OT E S

N OT E S

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IRS CIRCULAR 230 NOTICE: To the extent that this message or any attachment concerns tax matters, it is not intended to be used and

cannot be used by a taxpayer for the purpose of avoiding penalties that may be imposed by law. For more information about this notice,

see http://www.northerntrust.com/circular230.

This material is directed to professional clients only and is not intended for retail clients. For Asia-Pacific markets, it is directed to institutional investors, expert

investors and professional investors only and should not be relied upon by retail investors. For legal and regulatory information about our offices and legal entities,

visit northerntrust.com/disclosures. The following information is provided to comply with local disclosure requirements: The Northern Trust Company, London

Branch; Northern Trust Global Services Limited; Northern Trust Global Investments Limited. The following information is provided to comply with Article 9(a)

of The Central Bank of the UAE’s Board of Directors Resolution No 57/3/1996 Regarding the Regulation for Representative Offices: Northern Trust Global Services

Limited, Abu Dhabi Representative Office. Northern Trust Global Services Limited Luxembourg Branch, 2 rue Albert Borschette, L-1246, Luxembourg, Succursale

d’une société de droit étranger RCS B129936. Northern Trust Luxembourg Management Company S.A., 2 rue Albert Borschette, L-1246, Luxembourg, Société

anonyme RCS B99167. Northern Trust (Guernsey) Limited (2651)/Northern Trust Fiduciary Services (Guernsey) Limited (29806)/Northern Trust International

Fund Administration Services (Guernsey) Limited (15532) Registered Office: Trafalgar Court Les Banques, St Peter Port, Guernsey GY1 3DA.

© 2014 Northern Trust Corporation

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