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401kfedforms

Paragraph-style Summary Annual Report

At right is a sample Summary Annual Report for Amber Industries, the fictitious company in our demo 401k software. (Note: All dollar amounts used in this sample are completely fabricated and intended for instructional purposes only.)

This sample is done “paragraph style,” meaning it conveys the required information within explanatory paragraphs rather than listing the data as in the spreadsheet-style SAR. Bold orange items are those that you would replace with your own plan's data.

Choose either this format or the spreadsheet-style format, whichever is more convenient for you and useful to your plan's participants and beneficiaries.

For a ready-to-complete PDF of the sample SAR at right into which you can plug your plan's relevant information, download the file "sarpar.pdf."

Summary Annual Report for the Amber Industries 401k Plan

Employer Identification Number: 12-3456789
Plan Number: 001
Plan Year: January 1, 2001 through December 31, 2001

This is a summary of the annual report for the Amber Industries 401(k) Plan for the period January 1, 2000 through December 31, 2000. The annual report has been filed with the Internal Revenue Service as required under the Employee Retirement Income Security Act of 1974 (ERISA).

Basic Financial Statement
Benefits under the plan are provided through a trust fund. Plan expenses for the year were $65,042, which included $58,750 in benefits paid to participants and beneficiaries and $6,292 in other expenses (hardship withdrawals, etc.). Forty-two people were participants in or beneficiaries of our plan as of the close of the plan year.

Our plan had total plan assets (less any liabilities) of $493,665 at the beginning of the year. That amount had grown to $692,888 by the close of the year, a growth in plan assets of $199,223. This growth includes unrealized appreciation and depreciation, meaning it accounts for the difference between the value of plan assets at the end of the year versus the beginning of the year, or the cost of assets acquired during the year. Our plan's total income for the year was $264,265, which included $25,595 in employer contributions, $216,973 in employee contributions, and $21,697 in earnings from investments.

Minimum Funding Standards
Enough money was contributed to the plan to keep it funded in accordance with the minimum funding standards set forth in ERISA.

Your Rights to Additional Information
You have the right to request and receive a copy of the annual report from or to examine said report, either in part or in its entirety at our company or the Department of Labor for copying costs. At our company, call our Plan Administrator, Jonathan Donnell, at (408) 555-1234 or write or go to our offices at 410 City Line Avenue, San Jose, CA 95125; at the DOL, write or go to Public Disclosure Room, N-5638, Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C., 20210.

You also have the right to request and receive from our Plan Administrator, at no charge, a statement of the plan's assets and liabilities and any accompanying notes, or a statement of the plan's income and expenses and any accompanying notes, or both. (Note to participants/beneficiaries that receiving a full copy of the annual report includes such statements and notes.)

— end of sample —


Go to…
Ready-to-Complete Paragraph-style Summary Annual Report (PDF for download)
Spreadsheet-style Summary Annual Report
(sample plus link to ready-to-complete PDF for download)

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