OMB No. 1210-0110 
        SCHEDULE H                                          Financial Information 
         (Form 5500)                                                                                                                                                
Department of the Treasury                  This schedule is required to be filed under section 104 of the Employee                                            2022 
         Department of the Treasury 
         Internal Revenue Service           Retirement Income Security Act of 1974 (ERISA), and section 6058(a) of the 
         Department of Labor                                Internal Revenue Code (the Code).                                                                       
  Employee Benefits Security Administration              File as an attachment to Form 5500.                                                         This Form is Open to Public 
    Pension Benefit Guaranty Corporation                                                                                                                Inspection  
For calendar plan year 2022 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  Plan sponsor’s name as shown on line 2a of Form 5500                                                                             D    Employer Identification Number (EIN) 
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                                                           012345678        
ABCDEFGHI  
Part I    Asset and Liability Statement 
1 Current value of plan assets and liabilities at the beginning and end of the plan year. Combine the value of plan assets held in more than one trust. Report 
    the value of the plan’s interest in a commingled fund containing the assets of more than one plan on a line-by-line basis unless the value is reportable on 
    lines 1c(9) through 1c(14). Do not enter the value of that portion of an insurance contract which guarantees, during this plan year, to pay a specific dollar 
    benefit at a future date. Round off amounts to the nearest dollar.  MTIAs, CCTs, PSAs, and 103-12 IEs do not complete lines 1b(1), 1b(2), 1c(8), 1g, 1h, 
    and 1i. CCTs, PSAs, and 103-12 IEs also do not complete lines 1d and 1e. See instructions. 
                                            Assets                                                                              (a) Beginning of Year          (b) End of Year 
 a  Total noninterest-bearing cash ......................................................................              1a       -123456789012345        -123456789012345 
 b  Receivables (less allowance for doubtful accounts):                                                                                                 
    (1)  Employer contributions .........................................................................              1b(1)    -123456789012345        -123456789012345 
    (2)  Participant contributions ........................................................................            1b(2)    -123456789012345        -123456789012345 
    (3)  Other ....................................................................................................    1b(3)    -123456789012345        -123456789012345 
 c  General investments:                                                                                                                                                                                   
    (1)  Interest-bearing cash (include money market accounts & certificates  
                                                                                                                       1c(1) 
         of deposit) ...........................................................................................                -123456789012345        -123456789012345 
    (2)  U.S. Government securities ..................................................................                 1c(2)    -123456789012345        -123456789012345 
    (3)  Corporate debt instruments (other than employer securities):                                                                                                                                      
         (A)  Preferred ........................................................................................      1c(3)(A)  -123456789012345        -123456789012345 
         (B)  All other ..........................................................................................    1c(3)(B)  -123456789012345        -123456789012345 
    (4)  Corporate stocks (other than employer securities):                                                                                                                                                
         (A)  Preferred ........................................................................................      1c(4)(A)  -123456789012345        -123456789012345 
         (B)  Common ........................................................................................         1c(4)(B)  -123456789012345        -123456789012345 
    (5)  Partnership/joint venture interests .........................................................                 1c(5)    -123456789012345        -123456789012345 
    (6)  Real estate (other than employer real property) ....................................                          1c(6)    -123456789012345        -123456789012345 
    (7)  Loans (other than to participants) ..........................................................                 1c(7)    -123456789012345        -123456789012345 
    (8)  Participant loans ...................................................................................SAMPLE   1c(8)    -123456789012345        -123456789012345 
    (9)  Value of interest in common/collective trusts .........................................                       1c(9)    -123456789012345        -123456789012345 
    (10) Value of interest in pooled separate accounts .......................................                         1c(10)   -123456789012345        -123456789012345 
    (11) Value of interest in master trust investment accounts ............................                            1c(11)   -123456789012345        -123456789012345 
    (12) Value of interest in 103-12 investment entities ......................................                        1c(12)   -123456789012345        -123456789012345 
    (13) Value of interest in registered investment companies (e.g., mutual                                            1c(13)   -123456789012345        -123456789012345 
            funds) ...................................................................................  
    (14) Value of funds held in insurance company general account (unallocated                                         1c(14)   -123456789012345        -123456789012345 
         contracts)..............................................................................................  
    (15) Other .....................................................................................................   1c(15)   -123456789012345        -123456789012345 
                                                                                                                                                                                                  
For Paperwork Reduction Act Notice, see the Instructions for Form 5500.                                                                                Schedule H (Form 5500) 2022 
                                                                                                                                                                                                 v. 220413 
 

         Schedule H (Form 5500) 2022                                                                                      Page  2
                                                                                                                                                                           
  1d Employer-related investments:                                                                                               (a) Beginning of Year  (b) End of Year 
     (1)  Employer securities ...............................................................................          1d(1)     -123456789012345       -123456789012345 
     (2)  Employer real property ..........................................................................            1d(2)     -123456789012345       -123456789012345 
  1e Buildings and other property used in plan operation ....................................                          1e        -123456789012345       -123456789012345 
  1f Total assets (add all amounts in lines 1a through 1e) ..................................                          1f        -123456789012345       -123456789012345 
                                  Liabilities                                                                                                                
  1g Benefit claims payable ................................................................................           1g        -123456789012345       -123456789012345 
  1h Operating payables .....................................................................................          1h        -123456789012345       -123456789012345 
  1i Acquisition indebtedness .............................................................................            1i        -123456789012345       -123456789012345 
  1j Other liabilities .............................................................................................   1j        -123456789012345       -123456789012345 
  1k Total liabilities (add all amounts in lines 1g through1j) .................................                       1k        -123456789012345       -123456789012345 
                                Net Assets                                                                                                                   
  1l Net assets (subtract line 1k from line 1f) ......................................................                 1l        -123456789012345       -123456789012345 
  Part II   Income and Expense Statement 
  2  Plan income, expenses, and changes in net assets for the year. Include all income and expenses of the plan, including any trust(s) or separately maintained 
     fund(s) and any payments/receipts to/from insurance carriers. Round off amounts to the nearest dollar. MTIAs, CCTs, PSAs, and 103-12 IEs do not 
     complete lines 2a, 2b(1)(E), 2e, 2f, and 2g. 
                                   Income                                                                                            (a) Amount         (b) Total 
   a  Contributions:                                                                                                                                         
     (1)  Received or receivable in cash from: (A) Employers .............................                            2a(1)(A)   -123456789012345 
         (B)  Participants ...................................................................................        2a(1)(B)   -123456789012345 
         (C)  Others (including rollovers) ............................................................               2a(1)(C)   -123456789012345 
     (2)  Noncash contributions ...........................................................................            2a(2)     -123456789012345                        
     (3)  Total contributions. Add lines 2a(1)(A), (B), (C), and line 2a(2) .............                              2a(3)                            -123456789012345 
   b  Earnings on investments:                                                                                         
     (1)  Interest:                                                                                                                                     
         (A)  Interest-bearing cash (including money market accounts and                                              2b(1)(A)   -123456789012345  
             certificates of deposit) ....................................................................  
         (B)   U.S. Government securities ...........................................................                 2b(1)(B)   -123456789012345  
         (C)   Corporate debt instruments ...........................................................   2b(1)(C)                 -123456789012345 
         (D)   Loans (other than to participants) ..................................................   2b(1)(D)                  -123456789012345 
         (E)   Participant loans ............................................................................   2b(1)(E)         -123456789012345 
         (F)   Other .............................................................................................   2b(1)(F)    -123456789012345 
         (G)   Total interest. Add lines 2b(1)(A) through (F) .................................   2b(1)(G)                                              -123456789012345 
     (2)  Dividends: (A) Preferred stock ............................................................... SAMPLE2b(2)(A)          -123456789012345 
         (B)  Common stock ..............................................................................             2b(2)(B)   -123456789012345 
         (C)  Registered investment company shares (e.g. mutual funds) ..........   2b(2)(C)                                                                             
         (D) Total dividends. Add lines2b(2)(A),(B), and (C)                                                          2b(2)(D)                          -123456789012345 
     (3)  Rents ....................................................................................................   2b(3)                            -123456789012345 
     (4)  Net gain (loss) on sale of assets:  (A) Aggregate proceeds ...................                              2b(4)(A)   -123456789012345                        
         (B)   Aggregate carrying amount (see instructions) ................................                          2b(4)(B)   -123456789012345                        
         (C) Subtract line 2b(4)(B) from line 2b(4)(A) and enter result ..............                                2b(4)(C)                          -123456789012345 
     (5) Unrealized appreciation (depreciation) of assets: (A) Real estate ....................   2b(5)(A)                                                               
         (B)  Other .............................................................................................   2b(5)(B)                                             
         (C) Total unrealized appreciation of assets.                                                                 2b(5)(C) 
             Add lines  2b(5)(A) and (B) .............................................................                                                                   
                                                                                                                                                                         

          Schedule H (Form 5500) 2022                                                                                        Page  3

                                                                                                                                         (a) Amount         (b) Total 
      (6)  Net investment gain (loss) from common/collective trusts ........................                               2b(6)                            123456789012345   
      (7)  Net investment gain (loss) from pooled separate accounts ......................                                 2b(7)                            -123456789012345-
      (8)  Net investment gain (loss) from master trust investment accounts ...........                                    2b(8)                            -123456789012345- 
      (9)  Net investment gain (loss) from 103-12 investment entities .....................                                2b(9)                            -123456789012345- 
                                                                                                                                                            -123456789012345- 
     (10)  Net investment gain (loss) from registered investment                                                           2b(10) 
           companies (e.g., mutual funds) ...............................................................                                                   123456789012345 
   c  Other income ................................................................................................        2c                               -123456789012345  
   d  Total income. Add all income amounts in column (b) and enter total ....................                              2d                                                 
                                     Expenses                                                                                                                    
   e  Benefit payment and payments to provide benefits:                                                                                                                       
      (1)  Directly to participants or beneficiaries, including direct rollovers .............                             2e(1)       -123456789012345    
      (2)  To insurance carriers for the provision of benefits ...................................                         2e(2)       -123456789012345                       
      (3)  Other .......................................................................................................   2e(3)       -123456789012345                       
      (4)  Total benefit payments. Add lines 2e(1) through     (3) ................................                        2e(4)                                              
   f  Corrective distributions (see instructions) ......................................................                   2f                                                 
   g  Certain deemed distributions of participant loans (see instructions) ...............                                 2g                                                 
   h  Interest expense ............................................................................................        2h                                                 
   i  Administrative expenses: (1) Professional fees ............................................                          2i(1)       -123456789012345  
      (2)  Contract administrator fees .....................................................................               2i(2)       -123456789012345 
      (3)  Investment advisory and management fees ............................................                            2i(3)       -123456789012345 
      (4)  Other .......................................................................................................   2i(4)       -123456789012345 
      (5)  Total administrative expenses. Add lines 2i(1) through (4) ......................                               2i(5)                            -123456789012345 
   j  Total expenses. Add all expense amounts in column (b) and enter total .......                                        2j                               -123456789012345 
                     Net Income and Reconciliation                                                                                                               
   k  Net income (loss). Subtract line  2jfrom line 2d .........................................................           2k                                                 
   l  Transfers of assets:                                                                                                                                  
      (1)  To this plan..............................................................................................      2l(1)                            -123456789012345 
      (2)  From this plan .........................................................................................        2l(2)                            -123456789012345 
  Part III    Accountant’s Opinion 
 3   Complete lines 3a through 3c if the opinion of an independent qualified public accountant is attached to this Form 5500. Complete line 3d if an opinion is not 
     attached. 
  a  The attached opinion of an independent qualified public accountant for this plan is (see instructions): 
           (1) X  Unmodified         (2) X  Qualified          (3) X  Disclaimer          (4)                             X  Adverse 
  b Check the appropriate box(es) to indicate whether the IQPA performed an ERISA section 103(a)(3)(C) audit. Check both boxes (1) and (2) if the audit was 
      performed pursuant to both 29 CFR 2520.103-8 andSAMPLE29 CFR 2520.103-12(d). Check box (3) if pursuant to neither. 
     (1)   XDOL Regulation 2520.103-8     (2)   XDOL Regulation 2520.103-12(d)            (3)   Xneither DOL Regulation 2520.103-8 nor DOL Regulation 2520.103-12(d).  
  c  Enter the name and EIN of the accountant (or accounting firm) below:                                                              
           (1) Name: ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCD                                                                               (2) EIN: 123456789 
  0Bd The opinion of an independent qualified public accountant is not attached because: 
           (1) X This form is filed for a CCT, PSA, or MTIA.      (2) X It will be attached to the next Form 5500 pursuant to 29 CFR 2520.104-50. 
  Part IV    Compliance Questions 
 4     CCTs and PSAs do not complete Part IV. MTIAs, 103-12 IEs, and GIAs do not complete lines 4a, 4e, 4f, 4g, 4h, 4k, 4m, 4n, or 5.  
       103-12 IEs also do not complete lines 4j and 4l. MTIAs also do not complete line 4l. 
       During the plan year:                                                                                                                       Yes No   Amount 
  a    Was there a failure to transmit to the plan any participant contributions within the time                                                           
       period described in 29 CFR 2510.3-102? Continue to answer “Yes” for any prior year failures until 
       fully corrected. (See instructions and DOL’s Voluntary Fiduciary Correction Program.) ..................                                4a          
                                                                                                                                                                               

          Schedule H (Form 5500) 2022                                                     Page    4  - 1  x                                                    
 
                                                                                                                                                               Yes       No        Amount 
  b     Were any loans by the plan or fixed income obligations due the plan in default as of the                                                                                                      
     close of the plan year or classified during the year as uncollectible? Disregard participant loans 
     secured by participant’s account balance. (Attach Schedule G (Form 5500) Part I if “Yes” is 
     checked.) ........................................................................................................................................... 4b                                         
  c  Were any leases to which the plan was a party in default or classified during the year as                                                                                                        
     uncollectible? (Attach Schedule G (Form 5500) Part II if “Yes” is checked.) .......................................                                   4c                -123456789012345 
  d  Were there any nonexempt transactions with any party-in-interest? (Do not include transactions                                                                                                   
     reported on line 4a. Attach Schedule G (Form 5500) Part III if “Yes” is  
     checked.) ........................................................................................................................................... 4d                -123456789012345 
  e  Was this plan covered by a fidelity bond? ...........................................................................................                 4e                -123456789012345 
  f  Did the plan have a loss, whether or not reimbursed by the plan’s fidelity bond, that was caused by                                                                                              
     fraud or dishonesty?  ..........................................................................................................................      4f                -123456789012345 
  g  Did the plan hold any assets whose current value was neither readily determinable on an                                                                                                          
     established market nor set by an independent third party appraiser? .................................................                                 4g                -123456789012345 
  h  Did the plan receive any noncash contributions whose value was neither readily                                                                                                                   
     determinable on an established market nor set by an independent third party appraiser? ..................                                             4h                -123456789012345 
  i  Did the plan have assets held for investment? (Attach schedule(s) of assets if “Yes” is checked, and                                                                                             
     see instructions for format requirements.) ...........................................................................................                4i                                         
     value of plan assets? (Attach schedule of transactions if “Yes” is checked and                                                                          
  j  Were any plan transactions or series of transactions in excess of 5% of the current                                                                                                              
     see instructions for format requirements.) ...........................................................................................                4j                                         
  k  Were all the plan assets either distributed to participants or beneficiaries, transferred to another                                                                                             
     plan, or brought under the control of the PBGC? ................................................................................                      4k                                         
  l  Has the plan failed to provide any benefit when due under the plan? .................................................                                 4l                -123456789012345 
  m  If this is an individual account plan, was there a blackout period? (See instructions and 29 CFR                                                                     
     2520.101-3.) .......................................................................................................................................  4m                                         
  n  If 4m was answered “Yes,” check the “Yes” box if you either provided the required notice or one of                                                                   
     the exceptions to providing the notice applied under 29 CFR 2520.101-3. ..........................................                                    4n                                         
 5a   Has a resolution to terminate the plan been adopted during the plan year or any prior plan year?........   X                                           Yes      XNo   
     If “Yes,” enter the amount of any plan assets that reverted to the employer this year ____________________________________. 
 5b  If, during this plan year, any assets or liabilities were transferred from this plan to another plan(s), identify the plan(s) to which assets or liabilities were 
     transferred. (See instructions.) 
           5b(1) Name of plan(s)                                                                                                                                             5b(2) EIN(s) 5b(3) PN(s) 
                                                                                                                                                                             123456789    123 

     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                                                                                             123456789    123 
     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                                                                            
     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                                                                                             123456789    123 
     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI                                                                                            
     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI SAMPLE 123456789                                                                                                         123 
     ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFHI 
 5c Was the plan a defined benefit plan covered under the PBGC insurance program at any time during this plan year? (See ERISA section 4021 and 
    instructions.)  …………………………………………………………………………………………………………..   XYes      XNo       NotX                                                                                    determined 
    If “Yes” is checked, enter the My PAA confirmation number from the PBGC premium filing for this plan year ____________________.