NOTE: ALL FIELDS IN THIS TAB ARE AUTOMATICALLY POPULATED. USERS SHALL NOT ENTER ANY DATA IN THIS TAB. THE FINAL ALLOWABLE PENSION AMOUNT IS LISTED BELOW ON LINE 53.													
2	Provider/Plan Name:	 $-   											
3		Year 1	Year 2	Year 3	Year 4	Year 5							
4	Plan Year Beginning	01/00/1900	01/00/1900	01/00/1900	01/00/1900	01/00/1900							
5	Valuation Date	01/00/1900	01/00/1900	01/00/1900	01/00/1900	01/00/1900							
6													
7	SECTION A :  DEVELOPMENT OF REPORTABLE PENSION COSTS - Version 1.01												
8													
9	Valuation Interest Rate	0.00%	0.00%	0.00%	0.00%	0.00%							
10													
11	Normal Cost	 $-   	 $-   	 $-   	 $-   	 $-   							
12													
13	Funded Status												
14	Actuarial Accrued Liability	 $-   	 $-   	 $-   	 $-   	 $-   							
15	Actuarial Value of Assets	 -   	 -   	 -   	 -   	 -   							
16	Unfunded Actuarial Liability / (Surplus)	 -   	 -   	 -   	 -   	 -   							
17													
18	Unfunded Actuarial Liability (Spread Gain Methods)	 $- 	 $- 	 $- 	 $- 	 $- 							
19	Funding Standard Account Credit Balance	 $- 	 $- 	 $- 	 $- 	 $- 							
20	Accumulated Prepayments	 -   	 -   	 -   	 -   	 -   							
21	Adjusted Unfunded Liability / (Surplus)	 $-   	 $-   	 $-   	 $-   	 $-   							
22													
23	Development of Amortization Amount												
24	10-Year Amortization Amount	 $- 	 $- 	 $- 	 $- 	 $- 							
25													
26	ERISA Amortization Amount 	 $- 	 $- 	 $- 	 $- 	 $- 							
27	   ERISA Amortization Balance	 $- 	 $- 	 $- 	 $- 	 $- 							
28	Adjusted ERISA Amortization Amount	 $- 	 $- 	 $- 	 $- 	 $- 							
29													
30	Greater of 10-Yr or Adjusted ERISA Amount	 $- 	 $- 	 $- 	 $- 	 $- 							
31													
32	Development of Current Period Pension Cost												
33	Normal Cost	 $- 	 $- 	 $- 	 $- 	 $- 							
34	Surplus Available to Liquidate Normal Cost	 - 	 - 	 - 	 - 	 - 							
35	Applicable Amortization Amount	 - 	 - 	 - 	 - 	 - 							
36	Total Pension Cost (Valuation Date)	 $-   	 $-   	 $-   	 $-   	 $-   							
37	Discount Factor From Valuation to BOY	1.00000	1.00000	1.00000	1.00000	1.00000							
38	Total Pension Cost at BOY	 $- 	 $- 	 $- 	 $- 	 $- 							
39													
40	Funding Towards Pension Cost												
41	Current Yr Contribution Deposits	 $-   	 $-   	 $-   	 $-   	 $-   							
42	Interest Discount to BOY	 -   	 -   	 -   	 -   	 -   							
43	Present Value of Contributions	 $-   	 $-   	 $-   	 $-   	 $-   							
44	Prepayment Carry-Over From Prior Year	 -   	 -   	 -   	 -   	 -   							
45	Total Funding Available (BOY)	 $-   	 $-   	 $-   	 $-   	 $-   							
46													
47	Reportable Pension Cost												
48	Funded by Prepayment Carry-Over	 $- 	 $- 	 $- 	 $- 	 $- 							
49	Funded by Current Period Deposits	 - 	 - 	 - 	 - 	 - 							
50	Reportable Pension Cost (BOY)	 $- 	 $-   	 $-   	 $-   	 $-   							
51	Allowable Interest on Current Yr Deposits	 - 	 - 	 - 	 - 	 - 							
52	Prior Period Cost Adjustment Carryover Applied	 - 	 - 	 - 	 - 	 - 							
53	Reportable Pension Cost (w/interest)	 $- 	 $- 	 $- 	 $- 	 $- 							
54													
55	Adjustment for Actual Cost Allowance												
56	Prior Period Cost Adjustment Carryover	 $- 	 $- 	 $- 	 $- 	 $- 							
57	Prior Period Cost Adjustment Carryover Applied	 - 	 - 	 - 	 - 	 - 							
58	Pension Cost Reported for Current Period	 - 	 - 	 - 	 - 	 - 							
59	Reportable Cost for Current Period 	 - 	 - 	 - 	 - 	 - 							
60	Cost Adjustment Carryover	 $- 	 $- 	 $- 	 $- 	 $- 							
61													
62	Prepayment Credit												
63	Available Funding in Excess of Pension Cost	 $-   	 $-   	 $-   	 $-   	 $-   							
64	Interest to EOY	 -   	 -   	 -   	 -   	 -   							
65	Prepayment Carry-Over 	 $-   	 $-   	 $-   	 $-   	 $-   							
64													
67	END OF PENSION COST CALCULATION WORKSHEET												
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
													
