THE GRAND JURY CHARGES:
That on or about (date) in the ____________ District of __________ the defendant, _______________________, did embezzle, steal and unlawfully and willfully abstract and convert to his/her own use [and the use of another] in the approximate amount of $_________, the moneys, funds, securities, premiums, credits, property and other assets of (name of plan) [an employee welfare benefit plan] [an employee pension benefit plan] subject to Title I of the Employee Retirement Income Security Act of 1974* and of a fund connected** with such plan.
All in violation of Title 18, United States Code, Section 664.
* 29 U.S.C. 1001-1145; see definitions at 29 U.S.C. 1002 and 1003; certain employee benefit plans are omitted from coverage including plans which federal or state governments fund or administer for their employees.
** See United States v. Blood, 806 F.2d 1218 (4th Cir. 1986), which discusses theft from a trust fund managed by a third party administrator and connected with several welfare benefit plans maintained by different employee groups.
[cited in USAM 9-133.010]