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401kfedforms

Spreadsheet-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 “spreadsheet style,” meaning it is more a listing of data and their categories than a textual summary of the same activity. Bold orange items are those that you would replace with your own plan's data.

Choose either this format or the paragraph-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 "sar_sp.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. The following summarizes the year's activity:

End-of-year number of plan participants/beneficiaries.............42

Total plan assets (less any liabilities) — beginning of year.......$493,665

Total plan assets (less any liabilities) — end of year...............$692,888

Change in plan assets (i.e., growth)*...................................$199,223

Total plan expenses for year...............................................$65,042
Benefits paid to participants and beneficiaries.......$58,750
Other expenses (hardship withdrawals, etc.)........$6,292

Total plan income for year.................................................$264,265
Employer contributions.....................................$25,595
Employee contributions....................................$216,973
Earnings from investments...............................$21,697

*The stated growth in plan assets includes unrealized appreciation and depreciation in plan assets, meaning the difference between the value of plan assets at the end of the year versus the beginning of the year, which is the same as saying the cost of assets acquired during the year.

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

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