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Schedule C (Form 5500) 2022 Page 3 - 1 x
2. Information on Other Service Providers Receiving Direct or Indirect Compensation. Except for those persons for whom you
answered “Yes” to line 1a above, complete as many entries as needed to list each person receiving, directly or indirectly, $5,000 or more in total compensation
(i.e., money or anything else of value) in connection with services rendered to the plan or their position with the plan during the plan year. (See instructions).
(a) Enter name and EIN or address (see instructions)
(b) (c) (d) (e) (f) (g) (h)
Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service
Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a
organization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula instead of
person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or
a party-in-interest sponsor) disclosures? compensation for which you estimated amount?
answered “Yes” to element
(f). If none, enter -0-.
ABCDEFGHI 123456789012 123456789012345
ABCDEFGHI 345 Yes NoX X Yes NoX X Yes NoX X
ABCD
(a) Enter name and EIN or address (see instructions)
(b) (c) (d) (e) (f) (g) (h)
Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service
Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a
organization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula instead of
person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or
a party-in-interest sponsor) disclosures? compensation for which you estimated amount?
answered “Yes” to element
(f). If none, enter -0-.
ABCDEFGHI 123456789012 123456789012345
ABCDEFGHI 345 Yes NoX X Yes NoX X Yes NoX X
ABCD
(a) Enter name and EIN or address (see instructions)
SAMPLE
(b) (c) (d) (e) (f) (g) (h)
Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service
Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a
organization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula instead of
person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or
a party-in-interest sponsor) disclosures? compensation for which you estimated amount?
answered “Yes” to element
(f). If none, enter -0-.
ABCDEFGHI 123456789012
ABCDEFGHI 345 Yes NoX X Yes NoX X Yes NoX X
ABCD
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