SCHEDULE D                                 DFE/Participating Plan Information                                      OMB No. 1210-0110 
       (Form 5500)
   Department of the Treasury                 This schedule is required to be filed under section 104 of the Employee 
   Internal Revenue Service                          Retirement Income Security Act of 1974 (ERISA).                                 2023 
       Department of Labor                                 File as an attachment to Form 5500.
 Employee Benefits Security Administration 
                                                                                                                      This Form is Open to Public 
                                                                                                                                     Inspection. 
For calendar plan year 2023 or fiscal plan year beginning                                      and ending         
A  Name of plan                                                                                      B    Three-digit
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                                 plan number (PN)                    001 
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
ABCDEFGHI ABCDEFGHI  
C  PlanD    Employer Identification Number (EIN)                                                                                                          or DFE sponsor’s name as shown on line 2a of Form 5500 
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                               012345678 
ABCDEFGHI  
Part I     Information on interests in MTIAs, CCTs, PSAs, and 103-12 IEs (to be completed by plans and DFEs) 
           (Complete as many entries as needed to report all interests in DFEs) 
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHISAMPLEABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:             ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):          ABCDEFGHI 
                                           d  Entity       e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                      code   1        103-12 IE at end of year (see instructions)             -123456789012345
For Paperwork Reduction Act Notice, see the Instructions for Form 5500.                                               Schedule D (Form 5500) 2023 
                                                                                                                                                 v. 230728

       Schedule D (Form 5500) 2023                          Page 2 -  1 x 

a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of sponsor of entity listed in (a):        ABCDEFGHISAMPLE 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345
a  Name of MTIA, CCT, PSA, or 103-12 IE:          ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD 
                                                  ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b  Name of sponsor of entity listed in (a):       ABCDEFGHI 
                                      d  Entity     e  Dollar value of interest in MTIA, CCT, PSA, or
c  EIN-PN  123456789-123                    code  1    103-12 IE at end of year (see instructions)   -123456789012345

          Schedule D (Form 5500) 2023       Page 3 -  1 x 
6 
  Part II Information on Participating Plans (to be completed by DFEs, other than DCGs) 
          (Complete as many entries as needed to report all participating plans. DCGs must report each participating plan using Schedule DCG.) 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHISAMPLEABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123 
               ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
a Plan name    ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI 
b Name of      ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI c  EIN-PN 
  plan sponsor ABCDEFGHI ABCDEFGHI                                                      123456789-123