Sample Annual Report

SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
TABLE OF CONTENTS
ANNUAL COMPLIANCE SUMMARY
ACTION ITEMS CHECKLIST
1
COMPOSITION OF NET ASSETS AND CASH FLOW SUMMARY
2
0
1
4
PLAN SPECIFICATIONS
EMPLOYEE CENSUS
2
A
N
N
U
ACCOUNT BALANCE STATEMENT
A
ADJUSTMENTS TO ACCOUNT BALANCE STATEMENT
3
L
V
DISCRIMINATION TESTS
A
•
•
•
•
•
•
•
L
U
A
T
I
Limit on Deductible Contributions
IRC § 416 Top-Heavy Test
IRC § 401(k) Average Deferral Percentage Test
IRC § 410(b) Minimum Coverage Test
IRC § 401(a)(4) General Test
Glossary of Discrimination Tests
2014 IRS Annual Plan Limits
4
O
N
ANNUAL INFORMATION FILING
•
•
Form 5500-SF
Summary Annual Report
5
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 ANNUAL COMPLIANCE SUMMARY
FINANCIAL INFORMATION
Pre-Tax 401(k) Contributions
SUMMARY
$52,100.00
COMMENTS
$0.00 accrued as of 12/31/2014.
Source
Deductible Employer Contributions
$124,940.00
Forfeitures This Year
$1,590.00
Total
Safe Harbor
$18,450.00
Profit Sharing
$52,800.00
(Less Forfeitures)
($0.00)
Total Deductible
$124,940.00
Accrued @ PYE
$124,940.00
Used to pay Fees
Employer contributions = 14.84% of
considered compensation.
Total Considered Plan Compensation
$670,000.00
Please note that in accordance with IRS
regulations, severance pay is excluded for
all Plan purpose.
DISCRIMINATION TESTING
RESULTS
COMMENTS
Limit on Deductible Contributions
PASS
Employer contributions were less than
25% of considered compensation.
Key employee balances are greater than
60% of total considered plan assets.
This year’s allocations satisfy Top Heavy
Plan requirements.
IRC § 416 Top-Heavy Test
TOP HEAVY
The Plan is TH for 2014 as balances for Key
Employees as of 12/31/2013 exceed 60% of
Plan Assets.
The Plan will be subject to minimum
allocations in 2014 if either Key Employee
makes any salary deferral contributions in
2014. Your typical Profit Sharing
Contribution would satisfy the minimum.
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 ANNUAL COMPLIANCE SUMMARY
Plan uses Safe Harbor QNEC to meet
testing requirements.
IRC § 401(k) Average Deferral
Percentage Testing
PASS
HCE’s for next year are:
Second In Command
Top Dog
Please refer to the Action Items Checklist
for corrective measures to be taken.
IRC § 402(g) Deferral Limitation Test
PASS/FAIL
Deferrals are limited to the lesser of
100% of compensation or $17,500.
Participants who are age 50 or older may
defer an additional $5,500.
IRC § 410(b) Minimum Coverage Test
PASS
Passes using either the Ratio Percentage
or Average Benefits testing techniques.
PASS
Employer classification based
contributions satisfied benefits based
testing.
IRC § 401(a)(4) General Test
IRC § 415 Annual Additions
Limitations
PLAN DOCUMENTATION
Plan Amendments this year and
Summary of Material Modifications
(SMM)
Qualification Status
Class Allocation Resolution
NO
VIOLATIONS
STATUS
N/A
COMPLIANT
REQUIRED
No participant’s total contribution
allocations exceeded $51,000 or 100% of
compensation (excluding catch-up
contributions).
COMMENTS
No changes this year.
Determination Letter #207455934-A
dated 09/03/2013 issued for EGTRRA
restatement.
As of today, your Plan is not missing any
amendments
Resolution has been executed on
05/14/2014
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 ANNUAL COMPLIANCE SUMMARY
Any fees paid with Trust assets must be
reasonable and necessary. Benchmarking
of your plan arrangement against industry
standards by an independent third party is
strongly recommended to ensure unbiased
and accurate results.
Certification of Reasonableness
UNKNOWN
Failure to have evidence of your
benchmarking may result in a Prohibited
Transaction reportable on the Form
5500.
Be sure to maintain any documentation of
your decision process for the design and
selection of your new service providers.
This may serve as proof that you have
determined your current arrangement to
be reasonable.
ANNUAL INFORMATION FILING
Form 5500-SF
STATUS
COMMENTS
FILING
PENDING
Electronic filing with EBSA is mandatory.
Please refer to the Action Items Checklist
for filing instructions.
All deposits made within DOL safe harbor
timeline.
Participant Salary Deferral and Loan
Payment Withholdings Deposited to
Trust On Time - Within Mandated
Guidelines
COMPLIANT
Be sure to deposit payroll withholdings as
soon as it is administratively feasible to
segregate them from company assets.
Generally, follow the same deposit
timeline as the company has to follow for
submitting federal tax withheld from
payroll payments. Plans with less than
100 participants may use a safe harbor
standard of depositing these monies within
7 business days from the payroll date, if
necessary.
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 ANNUAL COMPLIANCE SUMMARY
ERISA Fidelity Bond Coverage
$100,000.00
You are required to maintain fidelity bond
coverage equal to no less than 10% of
plan assets as of the beginning of the Plan
Year; up to a maximum coverage
threshold of $500,000
Coverage is sufficient for the current plan
year.
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 ANNUAL COMPLIANCE SUMMARY
PARTICIPATION RESULTS
Percentage of Eligible Employees
Participating
Average Age - All Eligible Employees
Average Plan Compensation – All Eligible
Employees
Highly Compensated Employee Deferral
Rate
Non Highly Compensated Employee
Deferral Rate
Percentage of Catch-Up Eligible
Employees Making Catch-Up
CURRENT
YEAR
PRIOR
YEAR
COMMENTS
100%
100%
No Change
44
43
Increased
$134,000
$129,000
Increased
6.73%
6.42%
Increased
9.10%
8.9%
Increased
100%
100%
No Change
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 PLAN YEAR END ACTION ITEMS CHECKLIST
Checklist Item
Accrued Employer Contributions
Form 5500-SF
Summary Annual Report (SAR)
Client Satisfaction Survey
Due Date
03/15/2015
OR IF
EXTENDED
09/15/2015
ASAP
NO LATER
THAN
07/25/2015
Action Required
Be sure to deposit your 12/31/2014
accrued contributions to the plan by
the deadline for filing your business
tax return, including extensions.
• Profit Sharing accrual: $52,800
• Safe Harbor accrual: $18,450
Please review the Form 5500-SF or
Form 5500 and related schedules (if
any), sign and return page 1 to our
attention.
PWI will file the Form electronically
upon receipt of the signature page and
will provide you a confirmation of the
filing.
ASAP
NO LATER
THAN
09/30/2015
Distribute the SAR to all participants
by the due date.
ASAP
Please let us know how we are doing
and how we can improve our services
to you and your staff. Return the
completed survey to PWI in the preaddressed envelope provided.
Distributions Payable
ASAP
Your Plan requires that terminated
Participants with balances less than
$1,000 be paid out of the Plan as soon
as possible. Those with balances
between $5,000 and $1,000 must also
be paid out via their own distribution
election or an automatic rollover
following a 30 day notice period.
Please refer to the Vested Balance
Statement for a listing of terminated
participants eligible for distribution.
Pension Works will begin processing
these distributions on your behalf.
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 PLAN YEAR END ACTION ITEMS CHECKLIST
Checklist Item
Due Date
Action Required
Please notify our office if any of these
participants have been rehired and are
therefore not eligible for a distribution
at this time.
Fiduciary - Certification of
Reasonableness
ASAP
If you haven’t benchmarked your
plan’s service providers and their
related fees and would like assistance
with this, we can help. Give us a call
to get this started.
Provide the following disclosures 30
days prior to their official plan entry
date.
New Participants
Employees become participants in
the plan on January 1st or July 1st
after they have completed one year of
service during which they worked
1,000 hours and attained age 21
06/01/2014
&
12/01/2014
• Summary Plan Description (SPD)
• Summary Material Modifications
(SMM)
• Enrollment/Beneficiary Designation
Form
• Investment Platform Enrollment kit
• Qualified Default Investment
Alternative (QDIA)Notice
• 404(a)(5) Participant Fee
Disclosure Notice
• Annual 401(k) Safe Harbor Notice
Please be sure you collect completed
enrollment forms from all participants
whether they elect to actively
participate or not.
Required Annual Participant Notices
11/30/2014
The following notices will be provided
to you by Pension Works in advance of
the due date and need to be provided
to all participants:
• Qualified Default Investment
Arrangement (QDIA)Notice
• 401(k) Safe Harbor Notice
• 404(a)(5) Participant Fee
Disclosure
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
2014 PLAN YEAR END ACTION ITEMS CHECKLIST
Checklist Item
Military Leave
Due Date
REMINDER
Action Required
Under the terms of USERRA and the
HEART Act, Plan Sponsors are
required to provide allocations of any
Employer Contribution that
Participants would have received had
they not been called to military duty.
You are required to provide these
make-up allocations as soon as
possible following the date the
participants return to employment
after completing their Qualified
Military Service, or should they be
killed or disabled in the line of
duty. Please contact Pension Works,
Inc. immediately if you have an
employee return to employment after
any Qualified Military Service or
should you be notified of their death or
disability so that we may advise you of
any necessary actions. Note that
adjustments will be made for any
allocations that were made based on
Differential Wage Payments so be sure
to keep track of this type of
compensation should it apply.
SAMPLE COMPANY, INC. 401(k) PROFIT SHARING PLAN
COMPOSITION OF NET ASSETS
AND CASH FLOW SUMMARY
01/01/2014 THROUGH 12/31/2014
INVESTMENTS:
Investment Platform
Forfeiture Account
Loans
Subtotal
RECEIVABLES:
Profit Sharing Contribution
Pre-Tax 401(k) Contribution
Roth 401(k) Contribution
Safe Harbor QNEC Contribution
Subtotal
TOTAL GROSS ASSETS:
LESS PAYABLES:
NET ASSETS:
01/01/2014
-----------------------------
12/31/2014
-----------------------------
$98,821.51
$0.00
$0.00
----------------------------$98,821.51
$228,799.48
$1,590.00
$0.00
----------------------------$230,389.48
$50,000.00
$49,000.00
$0.00
$17,250.00
----------------------------$116,250.00
----------------------------$215,071.51
$0.00
----------------------------$215,071.51
$52,800.00
$52,100.00
$0.00
$18,450.00
----------------------------$123,350.00
----------------------------$353,739.48
$0.00
----------------------------$353,739.48
================
CASH FLOW SUMMARY
INCOME:
Profit Sharing Contribution
Pre-Tax 401(k) Contribution
Roth 401(k) Contribution
Safe Harbor QNEC Contribution
Rollover Contribution
Forfeitures Used to Reduce
Interest/Dividends
Loan Interest
Loan Write Off
$52,800.00
$52,100.00
$0.00
$18,450.00
$1,590.00
$0.00
$0.00
$0.00
$0.00
-----------------------------
Subtotal
EXPENSES:
Participant Distributions
Corrective Distributions
Fees
$124,940.00
$0.00
$0.00
$0.00
-----------------------------
Subtotal
OTHER CHANGES:
Net Gain/(Loss)
Adjustments
Subtotal
NET ASSETS AT 12/31/2013:
$0.00
$13,727.97
$0.00
----------------------------$13,727.97
-------------------------$353,739.48
================
Plan Specifications
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Employer:
Type of Entity
Dates:
Sample Plan, Inc.
EIN: 12-3456789
C-Corporation
Effective: 01/01/2001
Valuation: 12/31/2014
TIN:
Plan #: 001
Year-end: 12/31/2014
Period beginning: 01/01/2014 and ending: 12/31/2014
Eligibility:
All employees except non-resident aliens, members of an excluded class, union.
Participation
Minimum
Age
Months of
Service
Hours
Required
Employed
on
PROFIT SHARING
21
12
1000
N/A
EMPLOYEE 401(K)
21
12
1000
N/A
Entry Date
PROFIT SHARING
First day of 1st or 7th month of plan year on or next following eligibility satisfaction
EMPLOYEE 401(K)
First day of 1st or 7th month of plan year on or next following eligibility satisfaction
Allocation and Vesting:
Contribution Allocation
Active
Terminated
Deceased
Vesting
Disabled
Retired
Hours
Hours
Hours
Hours
Hours
Required Share Required Share Required Share Required Share Required
Hours
Required
PROFIT SHARING
1000
Yes
0
Yes
0
Yes
0
Yes
0
1000
EMPLOYEE 401(K)
0
Yes
0
Yes
0
Yes
0
Yes
0
N/A
Retirement:
Normal
Early
First of month coincident with or next following attainment of age 65.
Not provided
Contribution Frequency:
PROFIT SHARING
Plan Year
EMPLOYEE 401(K)
Each Payroll Period
Contribution:
401(k) ADP Safe Harbor
Nonelective
3.00% of each participant's compensation
EMPLOYEE 401(K)
At participant's discretion.
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
Plan Specifications
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Contribution: (cont)
PROFIT SHARING
Allocation is based on compensation by class
Percent of
Comp
0%
Min Amt
$25,150
Max Amt
$25,150
2
0%
$25,150
$25,150
3
2%
$0
N/A
4
2%
$0
N/A
5
2%
$0
N/A
Class
1
****** TOP HEAVY MINIMUM ALLOCATION OF 3.00% OF COMPENSATION APPLIES ******
Limitation Maximums
§415 Percent of compensation - 100% Dollar amount - $52,000.00
§404(a) Deductible employer contribution - 25% of total compensation
§401(a)(17) Compensation - $260,000.00
§402(g) Deferral for calendar year - $17,500 §414(v) Catch-up - $5,500
Compensation from entry date in first year of participation for Non-Elective, Elective, 401(k) Safe Harbor, 415
Compensation for Allocation, 401(a)(4) Discrimination Testing and 401(k) Discrimination Testing
Vesting:
PROFIT SHARING
0% In the first year, then 20% per year
Vesting service includes all years of service
All other contribution source accounts are 100% vested at all times.
Deceased and disabled participants are immediately 100% vested in all sources.
Pre-Retirement Death Benefit: Account Balance
Discrimination Test Assumptions:
HCE Determination
Otherwise Excludable
Based on all employees
Otherwise Excludable HCEs are included with the Not Otherwise Excludable employees
410(b)/401(a)(4) Testing:
Pre-Retirement
8.5% Interest
Post-Retirement
I83F - 1983 Individual Annuity (female) at 8.5% interest
Permissively Aggregated plans - tested separately
Compensation used - Annual Compensation
ADP/ACP Testing
401(k) Test
NHCE Average Deferral %
NHCE Average Contribution %
Shifting
401(k) Safe Harbor Plan - Both ADP and ACP are Deemed to Pass
Based on current year
Based on current year
ADP shifted to ACP test
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
Plan Specifications
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Projection Assumptions:
Normal Form
Pre-Retirement
Lump Sum
6% Interest
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
March 10, 2014
Employee Census
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 01/01/2014 through 12/31/2014
Key
Percent
Owner
SVC
Ages
PS FS
Gender
Dates
PA AA RA
Birth
Hire
Part
Retire
Compensation Hours Worked HCE OEX
3 Administrative Asst 1
Cls- 3
29
15
M
40
50
65
01/01/64 01/01/86 01/01/04 01/01/29
$40,000.00
2,080.00
30
F
25
35
65
01/01/79 01/01/05 01/01/04 01/01/44
$60,000.00
2,080.00
35
M
20
30
65
01/01/84 01/01/07 01/01/04 01/01/49
$25,000.00
2,080.00
29
1
F
54
64
65
01/01/50 01/01/86 01/01/04 01/01/15
$245,000.00
2,080.00
Y
29
5
M
50
60
65
01/01/54 01/01/86 01/01/04 01/01/19
$300,000.00
2,080.00
Y
4 Administrative Asst 2
Cls- 4
29
5 Administrative Asst 3
Cls- 5
29
2 Second In Command
Cls- 2
Y
1 Top Dog
Cls- 1
Y
100.00
Participants at Beginning of Plan Year
5
Census Count
New Participants on First Day of Year
0
Total Compensation
New Participants During Year
0
Retired or Separated Without Any Future Benefits
0
Participants at End of Year
5
Key:
AA=Attained Age
FS=Future Service
HCE=Highly Compensated Employee
OEX=Otherwise Excludable
PA=Participation Age
PS=Past Service
RA=Retirement Age
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
5
$670,000.00
Account Balance Statement
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Beginning
Balance
Contribution
Forfeitures
Allocated
Gain (Loss)
Adjustments
$31,749.48
$1,904.97
$800.00
$0.00
$0.00
$0.00
$1,200.00
$0.00
$0.00
Ending
Balance
Vested Amount
Percent
Amount
$34,454.45
100
$34,454.45
$1,200.00
100
$1,200.00
100
3 Administrative Asst 1
PROFIT SHARING
401(k) ADP Safe Harbor Nonelective
$0.00
EMPLOYEE 401(K)
Employee Total:
$0.00
$0.00
$2,000.00
$0.00
-$28.00
$1,972.00
$31,749.48
$1,904.97
$4,000.00
$0.00
-$28.00
$37,626.45
$1,972.00
$17,500.00
$1,050.00
$1,200.00
$0.00
$0.00
$19,750.00
100
$19,750.00
$0.00
$1,800.00
$0.00
$0.00
$1,800.00
100
$1,800.00
100
$37,626.45
4 Administrative Asst 2
PROFIT SHARING
401(k) ADP Safe Harbor Nonelective
$0.00
EMPLOYEE 401(K)
Employee Total:
$0.00
$0.00
$900.00
$0.00
-$28.00
$872.00
$17,500.00
$1,050.00
$3,900.00
$0.00
-$28.00
$22,422.00
$872.00
$8,750.00
$525.00
$500.00
$0.00
$0.00
$9,775.00
100
$9,775.00
$0.00
$750.00
$0.00
$0.00
$750.00
100
$750.00
100
$22,422.00
5 Administrative Asst 3
PROFIT SHARING
401(k) ADP Safe Harbor Nonelective
$0.00
EMPLOYEE 401(K)
Employee Total:
$0.00
$0.00
$5,200.00
$0.00
-$28.00
$5,172.00
$8,750.00
$525.00
$6,450.00
$0.00
-$28.00
$15,697.00
$5,172.00
$56,000.00
$3,360.00
$25,150.00
$0.00
$0.00
$84,510.00
100
$84,510.00
$0.00
$0.00
$7,350.00
$0.00
$0.00
$7,350.00
100
$7,350.00
$0.00
$0.00
$22,000.00
$0.00
-$28.00
$21,972.00
100
$21,972.00
$56,000.00
$3,360.00
$54,500.00
$0.00
-$28.00
$113,832.00
$114,800.00
$6,888.00
$25,150.00
$0.00
$0.00
$146,838.00
100
$146,838.00
$0.00
$7,350.00
$0.00
$0.00
$7,350.00
100
$7,350.00
$0.00
$0.00
$22,000.00
$0.00
-$28.00
$21,972.00
100
$114,800.00
$6,888.00
$54,500.00
$0.00
-$28.00
$176,160.00
$15,697.00
2 Second In Command
PROFIT SHARING
401(k) ADP Safe Harbor Nonelective
EMPLOYEE 401(K)
Employee Total:
$113,832.00
1 Top Dog
PROFIT SHARING
401(k) ADP Safe Harbor Nonelective
$0.00
EMPLOYEE 401(K)
Employee Total:
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
$21,972.00
$176,160.00
Account Balance Statement
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Beginning
Balance
Gain (Loss)
$228,799.48
Ending
Balance
Vested Amount
Contribution
Forfeitures
Allocated
Adjustments
$13,727.97
$52,800.00
$0.00
$0.00
$295,327.45
$295,327.45
$0.00
$0.00
$18,450.00
$0.00
$0.00
$18,450.00
$18,450.00
$0.00
$0.00
$52,100.00
$0.00
-$140.00
$51,960.00
$51,960.00
$228,799.48
$13,727.97
$123,350.00
$0.00
-$140.00
$365,737.45
$365,737.45
Percent
Amount
Totals for each account:
PROFIT SHARING
401(k) ADP Safe Harbor Nonelective
EMPLOYEE 401(K)
Grand Total:
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
Adjustments to Account Balance Statement
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 01/01/2014 through 12/31/2014
Transfers
Expenses
Adjustments
Withdrawals
Vested
Payments
Total
Adjustments
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-28.00
0.00
0.00
-140.00
0.00
0.00
-140.00
0.00
0.00
-140.00
0.00
0.00
-140.00
3 Administrative Asst 1
EMPLOYEE 401(K)
4 Administrative Asst 2
EMPLOYEE 401(K)
5 Administrative Asst 3
EMPLOYEE 401(K)
2 Second In Command
EMPLOYEE 401(K)
1 Top Dog
EMPLOYEE 401(K)
Totals for each account:
EMPLOYEE 401(K)
Grand Total:
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
Limit on Deductible Contributions
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Eligible Compensation
401(a)(17) Limit ($260,000.00) Adjustment
Total Participating Payroll
$670,000.00
$40,000.00
$630,000.00
PROFIT SHARING Contribution
$52,800.00
401(k) ADP Safe Harbor Nonelective Contribution
$18,450.00
Total Employer Contribution Allocated
$71,250.00
Contribution as Percent of Participating Payroll
25% of Payroll
11.31%
$157,500.00
Contribution Passes Deductibility Test
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
Top Heavy Test
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 01/01/2014 through 12/31/2014
The Plan is Top Heavy for the Next Plan Year
Employees
Considered
Account
Balance
Receivable
Excluded
Balance
Prior
Distributions
Adjusted
Balance
Percent
of Total
Key Employees
2
289,992.00
0.00
0.00
0.00
289,992.00
79.28%
Non-Key Employees
3
75,745.45
0.00
0.00
0.00
75,745.45
20.72%
5
$365,737.45
$0.00
$0.00
$0.00
Employee Classification
Totals:
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
$365,737.45 100.00%
401(k) Discrimination Test
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
PASSED 401(k) Discrimination Test
401K
Participants
Average Deferral
Percentage
Non-Highly Compensated
3
9.10%
2
6.94%
Highly Compensated
401(k) Deferral
(ADP) Test
All Participants
Maximum average percentage
Actual average percentage
11.38%
6.94% Pass
Type(s) of Contribution(s) included in this test:
EMPLOYEE 401(K)
NHCEs percentages based on current year data
Highly
Testing
Compensated Compensation
Contribution
Deferral
Percent
Y
Total deferral
Less catch-up
245,000.00
22,000.00
4,500.00
17,500.00
7.14
Y
Total deferral
Less catch-up
260,000.00
22,000.00
4,500.00
17,500.00
6.73
Total deferral
Less catch-up
505,000.00
44,000.00
9,000.00
35,000.00
13.87
Highly Compensated
2 Second In Command
1 Top Dog
Highly Compensated Total
Non-Highly Compensated
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
401(k) Discrimination Test
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Highly
Testing
Compensated Compensation
Contribution
Deferral
Percent
40,000.00
2,000.00
5.00
60,000.00
900.00
1.50
25,000.00
5,200.00
20.80
125,000.00
8,100.00
27.30
52,100.00
9,000.00
$43,100.00
41.17%
3 Administrative Asst 1
4 Administrative Asst 2
5 Administrative Asst 3
Non-Highly Compensated Total
Grand Total:
Total deferral
Less catch-up from limits
$630,000.00
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
410(b) Minimum Coverage Test
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 01/01/2014 through 12/31/2014
Passed 410(b) Minimum
Coverage Test
I. Ratio Percentage Test -
Passed
Passed
Satisfied Plan Eligibility
Number of Participants
A. Benefiting
B. Not Benefiting
C. Total
D. Percentage (A/C)
NHCE's
HCE's
Total
3
2
5
0
0
0
3
2
5
100.00%
100.00%
E. Ratio Percentage (NHCE's/HCE's)
d
(must be 70% or more)
Ratio percentage exception codes: a=Only HCE's, b=No HCE's benefiting, d=All NHCE's benefiting
II. Average Benefit Test - Passed
A. Nondiscriminatory Classification Test
Passed
1. NHCE's Concentration Percentage
2. Safe Harbor Percentage
3. Unsafe Harbor Percentage
4. Ratio Percentage
60.00
50.00
40.00
d
Passes if ratio percentage is 1) greater than or equal to Safe Harbor percentage or 2) greater than or equal to Unsafe Harbor percentage subject to
facts and circumstances
All Together
Contribution Basis
B. Average Benefit Percentage Test
1. Average Benefit Percentage of NHCE's
2. Average Benefit Percentage of HCE's
3. Average Benefit Percentage (B1/B2)
(must be 70% or more)
Annual
w/o PD
with PD
Equivalent Benefit Basis
Annual
w/o PD
with PD
Accrued-to-Date
w/o PD
with PD
14.10
16.10
19.32
19.97
5.26
5.91
19.82
22.47
2.66
2.88
0.71
0.82
71.14%
71.65%
726.32%
693.40%
740.85%
720.73%
Pass
Pass
Pass
Pass
Pass
Pass
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
410(b) Minimum Coverage Test
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 01/01/2014 through 12/31/2014
Passed 410(b) Minimum
Coverage Test 401(k)
I. Ratio Percentage Test -
Passed
Passed
Satisfied Plan Eligibility
Number of Participants
A. Benefiting
B. Not Benefiting
C. Total
D. Percentage (A/C)
NHCE's
HCE's
Total
3
2
5
0
0
0
3
2
5
100.00%
100.00%
E. Ratio Percentage (NHCE's/HCE's)
d
(must be 70% or more)
Ratio percentage exception codes: a=Only HCE's, b=No HCE's benefiting, d=All NHCE's benefiting
II. Average Benefit Test - Passed
A. Nondiscriminatory Classification Test
Passed
1. NHCE's Concentration Percentage
2. Safe Harbor Percentage
3. Unsafe Harbor Percentage
4. Ratio Percentage
60.00
50.00
40.00
d
Passes if ratio percentage is 1) greater than or equal to Safe Harbor percentage or 2) greater than or equal to Unsafe Harbor percentage subject to
facts and circumstances
All Together
Contribution Basis
B. Average Benefit Percentage Test
1. Average Benefit Percentage of NHCE's
2. Average Benefit Percentage of HCE's
3. Average Benefit Percentage (B1/B2)
(must be 70% or more)
Annual
w/o PD
with PD
Equivalent Benefit Basis
Annual
w/o PD
with PD
Accrued-to-Date
w/o PD
with PD
14.10
16.10
19.32
19.97
5.26
5.91
19.82
22.47
2.66
2.88
0.71
0.82
71.14%
71.65%
726.32%
693.40%
740.85%
720.73%
Pass
Pass
Pass
Pass
Pass
Pass
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
410(b) For 401(a)(4) Top Heavy Safe Harbor
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 01/01/2014 through 12/31/2014
No participants received additional contribution for top heavy minimum or the plan does
not use a 401(a)(4) safe harbor formula (e.g. proportional to salary or integrated).
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
401(a)(4) General Test
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Minimum Allocation Gateway --
Passed - Highest HCE Allocation Rate Is No More Than 3 Times the Lowest NHCE
A. Highest HCE Allocation Rate
B. Lowest NHCE Allocation Rate
C. Lowest NHCE Rate (415(c) Comp)
Rate
13.27 %
5.00 %
5.00 %
Times 1/3 =
4.42 %
IRS Sec. 1.401(a)(4)-8(b) regulations allow 401(a)(4) cross testing (i.e. contributions can be
tested as equivalent benefits) if:
(1) A. is no more than 3 times B
(2) C. is 5% or greater
(3) The plan has Broadly Available Allocation Rates (i.e. for the group of employees at each allocation
rate or higher, the group passes 410(b) without regard to the average benefit test of 1.410(b) -5 (i.e.
generally it passes either the ratio percentage or the nondiscriminatory classification test)), or
(4) The plan has Age-Based Allocation with either a gradual age or service schedule (i.e. smoothly
increasing allocation rates that an NHCE can grow into with increasing age or service) or is based on
a Uniform Target Benefit Allocation
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
401(a)(4) General Test
Minimum Allocation Gateway
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
HCE
3
4
5
2
1
Administrative Asst 1
Administrative Asst 2
Administrative Asst 3
Second In Command
Top Dog
Y
Y
DB
415(c)
DC Alloc
DB Average Aggregate
415(c) Aggregate
Rate Rate
Rate DC Rate
Rate
Rate
5.00
5.00
5.00
13.27
12.50
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.00
5.00
5.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
415(c)
Compensation
40,000.00
60,000.00
25,000.00
245,000.00
260,000.00
401(a)(4) General Test
March 10, 2014
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Testing 5% range
PASSED 401(a)(4) Discrimination Test
The plan as a whole must pass the 401(a)(4) Minimum Allocation Gateway in order to pass the general test.
A Rate Group passes if the Ratio Percent is 70% or more, or if the plan passes the average benefit percentage test and the Rate Group's
Ratio Percent is greater than or equal to the mid-point between the Safe and Unsafe Harbor Percentages.
Minimum Allocation Gateway
Average Benefit Percentage Test
NHCE's Concentration Percent
Safe Harbor Percent
Mid-Point
Unsafe Harbor Percent
-
Passed
Passed
60.00%
50.00%
45.00%
40.00%
Passed -- Method: Equivalent Accrual (Annual) without Permitted Disparity
Non-Highly Compensated Employees
Percent in
this Group
Highly Compensated Employees
Rate
Group
Rate
Number Greater
or Equal
Total
Number Greater
or Equal
1
1.85
2
3
66.67
1
2
50.00
133.34
Pass
2
1.49
3
3
100.00
2
2
100.00
100.00
Pass
Total
Percent in
this Group
Note: Grouping of allocation rates Rates within the greater of 5% or .05 of a percent from a mid point rate are assumed to be equal to that mid point rate.
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
Ratio
Percent Pass/Fail
401(a)(4) General Test - Rate Grouping
Sample Company, Inc. 401(k) Profit Sharing Plan
For the plan year 1/1/2014 through 12/31/2014
Testing 5% range
Passed
Method: Equivalent Accrual (Annual) without Permitted Disparity
Highly Compensated Employees
Rate
Rate
Group 1 Group 2
Rate >=1.85 >=1.49
2 Second In Command Class - 2
1.50
*
Y
1 Top Dog Class - 1
1.95
Y
Y
1
2
2
2
Number of HCE's in Group
Total Number of HCE's
50.00% 100.00%
Percent of HCE's
Non-Highly Compensated Employees
3 Administrative Asst 1 Class - 3
1.77
*
Y
4 Administrative Asst 2 Class - 4
6.01
Y
Y
5 Administrative Asst 3 Class - 5
9.03
Y
Y
Number of NHCE's in Group
2
3
Total Number of NHCE's
3
3
Percent of NHCE's
Ratio Percent of NHCE's/HCE's
66.67% 100.00%
133.34% 100.00%
PASS
PASS
Grouping of Allocation/Accrual rates Rates within the greater of 5% or .05 of a percent from a mid point rate are assumed to be equal to that mid point rate.
***** SAMPLE REPORTS FOR ILLUSTRATION PURPOSES ONLY *****
March 10, 2014
GLOSSARY OF DISCRIMINATION TESTS
A Highly Compensated Employee is any employee who:
Highly Compensated
Employees (HCE)
IRC § 414(q)(1)(B)
•
•
•
was greater than a 5% owner in the current or prior year;
was an employed spouse, direct ascendant or descendant of a greater than
5% owner in the current or prior year; or
had compensation in excess of $115,000 (indexed annually) in the ‘lookback’ year (and if elected in the plan document, was in the top 20% of
employees for the ‘look-back’ year when ranked by compensation *).
*The Top 20% election is typically used in smaller plans with
many otherwise Highly Compensated Individuals.
For Plan Years beginning after December 31, 2001, an Employee or former
Employee (including any deceased Employee) who, at any time during the Plan
Year that includes the Determination Date (generally, the last day of the prior
plan year) is either:

Key Employees
IRC § 416(i)(1)
Limit on Deductible
Contributions
IRC § 404(a)(3)


An officer of the Employer having an Annual Compensation greater
than $165,000 (as adjusted by Code section 416(i));
A 5-Percent Owner; or
Any person who owns directly or indirectly more than one percent (1
%) of the outstanding stock of the Employer or stock possessing more
than one percent (1 %) of the total combined voting power of all stock
of the Employer or, in the case of an unincorporated Employer, the
capital or profits interest in the Employer and has Annual
Compensation from the Employer of more than one hundred fifty
thousand dollars ($150,000).
IRS limits the annual amount of aggregate tax deductible employer contributions
that can be made to a tax qualified retirement plan. That amount is equal to 25%
of aggregate eligible compensation. The definition of compensation provided in
the plan document will impact this limit and great care should be taken to ensure
that it is accurately determined for all employees covered by the plan. The plan
compensation should be reconciled to all employee’s individual compensation
amounts that flow together on the Form W-3 or Payroll Summary (or 941 reports
that you make quarterly to IRS) to ensure all employees are accurately
considered. If a plan contribution exceeding the 25% limit is inadvertently made
to a plan, corrective measures must be taken to identify the excess, and then either
hold it in suspense for subsequent deduction or return it to the employer if it can
be construed to have occurred by mistake. Penalties of up to 10% of the excess
contribution may apply.
GLOSSARY OF DISCRIMINATION TESTS
A Top Heavy plan is defined by IRS as one in which more than 60% of plan
assets are allocated to the accounts of Key Employees (defined above).
When the plan becomes Top Heavy, a minimum contribution is required be made
on behalf of Non-Key Employees equal to the highest allocation rate made for the
year to a Key Employee, but not to exceed 3% of compensation.
Top Heavy Test
IRC § 416(c)(2)
Exception is provided for a Top Heavy 401(k) Plan whose plan document
provides for a Safe Harbor contribution. When the 3% Non-Elective Safe Harbor
provision is used, the plan will automatically satisfy the Top Heavy requirement.
When a Safe Harbor Matching provision is used, the Top Heavy Minimum
contribution will also be satisfied as long as no other Employer contributions are
allocated to the Plan for that Plan Year.
All Employer contributions are considered towards satisfaction of the Top Heavy
Minimum contribution requirements in a Top Heavy Plan.
If a retirement plan provides for Employee Salary Deferrals on either a pre-tax or
Roth after-tax basis, the Average Deferral Percentage Test (ADP) and the Actual
Contribution Percentage (ACP) tests may be required and are the exclusive means
of demonstrating that the plan satisfies the non-discrimination requirements of
IRC §401(k) and 401(m). These tests are performed on the basis of contribution
rates for the current or prior plan year to determine if the Highly Compensated
Employee group (HCE) has deferred above the maximum allowable amount when
compared to the group of Non-Highly Compensated Employees (NHCE).
Average Deferral
Percentage Test (ADP)
IRC § 401(k)
While pre-tax Salary Deferrals are generally tested alone under the ADP test,
Roth after-tax, along with Matching contributions are generally tested together
under the ACP test.
&
Average Contribution
Percentage Test (ACP)
IRC § 401(m)
IRS provides many techniques for performing and\or satisfying these tests.
Component testing, contribution sharing, Failsafe or Qualified Non-Elective
Contributions, Re-characterization, etc. are all possible techniques to be
considered when trying to correct a failing test. The rules can be complex.
If corrective action is necessary, some or all of the HCE contribution amounts
may require distribution.
Because both tests operate on the basis of individual contribution\compensation
by participant percentages, accurate contribution amounts by participant along
with accurate employee compensation and accurate determination of the Highly
Compensated Employee group are all critical to properly performing these tests.
GLOSSARY OF DISCRIMINATION TESTS
A retirement plan is not tax qualified unless it benefits a minimum number of
employees for each source of contribution being provided. The minimum number
required depends on the size of the employer, the employee demographics and
sometimes the level of benefits provided under the plan. Employees excluded by
plan age and service requirements do not need to be tested, BUT those left out
due to employment classifications or other plan related reasons need to be tested
to demonstrate adequate coverage.
Minimum Coverage Test
IRC § 410(b)
There are two minimum coverage tests under IRC § 410(b). One of the two tests
must be passed annually or the plan risks disqualification. The ratio percentage
test is the simpler of the two and requires that the ratio of the Non-Highly
Compensated Employees benefitting over the ratio of Highly Compensated
Employees is at least 70%. The average benefits percentage test is generally
used when the ratio test is failed. The IRS provides up to six different complex
techniques by which to pass this test. Generally, the average benefit test is
comprised of two parts (nondiscriminatory classification test and average benefits
percentage test), both of which must pass for the plan to pass the average benefits
test. Each contribution source MUST pass one of the two tests.
Contributions or benefits under a qualified retirement plan must not favor Highly
Compensated Employees (HCE’s) except as permitted by statute or regulation. In
addition, a qualified plan must make all benefits, rights and features under the
plan available on a nondiscriminatory basis. Failure to demonstrate
nondiscrimination will cause a plan to lose its tax qualification.
General Test
IRC § 401(a)(4)
In demonstrating a plan to be nondiscriminatory, either contributions or the
benefits produced by contributions can be measured. A plan is required to test
each year on a “plan year” basis. A number of design based safe harbors exist
that when used are deemed nondiscriminatory and need not be tested. Albeit, such
safe harbors are limited and designed to produce uniform allocations that often
don’t meet a Plan Sponsors objectives or needs.
Plans that allocate contributions under a non designed based safe harbor technique
such as a classification based allocation system must pass The General Test in
order to be deemed nondiscriminatory.
The General Test is comprised of two components and the plan must pass each
component:
• Minimum Allocation Gateway – all benefitting Non-Highly Compensated
Employees (NHCE’s) allocations are at a rate of at least 1/3 of that
received by the HCEs (up to 5% of compensation).
• Rate Group Testing – each HCE’s benefit rate is tested separately to
ensure that the minimum number of NHCE’s have the same or greater
rate.
GLOSSARY OF DISCRIMINATION TESTS
General Test
IRC § 401(a)(4)… continued
Up to six different methods can be used to develop the benefit testing rate. Five of
the six methods calculate the benefit produced at normal retirement age that is
actuarially equivalent to each participant’s contribution allocation, sometimes
combined with their account balance, expressed as a percentage of their
compensation (a rate). The actuarial factors to be used in the rate calculations are
only those permitted by statute.
The number of NHCE’s needed in any rate group is generally dependent on which
method the plan used to pass the Minimum Coverage Test (either the ratio
percentage test or the Average Benefits Test). Additionally other options are
permitted for working through failing tests such as component testing and
rounding of rate factors. General Testing is complex.
A defined contribution plan must limit the annual additions (contributions and
forfeitures) that are allocated to a participant’s account each year. When a plan
violates the limit, the excess must be returned. Each year this test should be run
to ensure that none of the participants have received more than allowed.
Annual Additions Limits
(Contributions &
Forfeitures)
IRC § 415
For 2012, the annual dollar limit is $50,000. Several additions are not included
when calculating the annual limit.
•
•
•
•
Catch-up contributions (amounts contributed by participants age 50 and
older);
Rollover and transfer amounts;
Loan repayment amounts;
Restoration of Losses pursuant to a Department of Labor order.
For Employer contributions the Annual Additions Limit is measured separately
by the Employer and includes all plans of the Employer. For example an
individual may work for two unrelated Employers and receive the maximum
annual addition limit in Employer contributions under both Employers’ plans.
If your Plan’s Definition of Compensation excludes certain items of taxable
income, such as overtime, commissions or bonuses, this test is required to prove
that, in operation, the definition of Plan Compensation is non-discriminatory
(meets the requirements of IRS Section 414(s)).
Compensation Test
IRC § 414(s)
The test compares the ratios of Plan Compensation to Total Compensation for
HCE’s and NHCE’s. The NHCE’s ratio must be greater than or equal to the ratio
for HCE’s. Otherwise the definition of Plan Compensation is discriminatory.
Only those benefiting are included. While three methods can be used to perform
the test - Individual, Combination and Aggregate, only the Individual method is
accepted by the IRS without further explanation. Additionally, under the
Individual and Combination methods an election can be made to include or
exclude participants with zero compensation, sometimes making the difference to
pass this test.
IRS ANNUAL PLAN LIMITS – 2014 CALENDAR YEAR
Maximum Considered Compensation
$260,000
Maximum Annual Addition (Defined Contribution)
$52,000
Maximum Annual Benefit (Defined Benefit)
$210,000
Maximum Salary Reduction Contribution
$17,500
Maximum Catch Up Contribution
$5,500
Highly Compensated Employee Earnings Threshold
$115,000
Key Person Compensation Threshold
$170,000
Social Security Taxable Wage Base
$117,000
ESOP Extended Payment Account Balance Threshold
$1,050,000
Department of the Treasury
Internal Revenue Service
Pension Benefit Guaranty Corporation
This return/report is for:
Complete all entries in accordance with the instructions to the Form 5500-SF.
X a single-employer plan
This return/report is:
C
This Form is Open to Public
Inspection
Annual Report Identification Information
For calendar plan year 2013 or fiscal plan year beginning
A
B
2013
This form is required to be filed under sections 104 and 4065 of the Employee
Retirement Income Security Act of 1974 (ERISA), and section 6057(b) and 6058(a) of
the Internal Revenue Code (the Code).
Department of Labor
Employee Benefits Security Administration
Part I
OMB Nos. 1210-0110
1210-0089
Short Form Annual Return/Report of Small Employee
Benefit Plan
Form 5500-SF
Check box if filing under:
and ending
01/01/2014
12/31/2014
a multiple-employer plan (not multiemployer)
a one-participant plan
the first return/report
the final return/report
an amended return/report
a short plan year return/report (less than 12 months)
Form 5558
automatic extension
DFVC program
special extension (enter description)
Part II
Basic Plan Information --- enter all requested information
1a Name of plan
1b
Sample Company, Inc. 401(k) Profit Sharing Plan
1c
Three-digit
plan number
001
(PN)
Effective date of plan
01/01/2004
2a
Plan sponsor's name and address; include room or suite number (employer, if for a single-employer plan)
Sample Company, Inc.
US Smallville
Employer Identification Number
(EIN) 03-0713777
2c
Sponsor's telephone number
2d
Business code (see instructions)
3b
Administrator's EIN
3c
Administrator's telephone number
(802) 861-1177
2 Main St.
3a
2b
VT 05055
X Same as Plan Sponsor Name
Plan administrator's name and address
311900
Same as Plan Sponsor Address
4
If the name and/or EIN of the plan sponsor has changed since the last return/report filed for this plan, enter the
name, EIN, and the plan number from the last return/report.
4b
EIN
a
5a
b
c
Sponsor's name
PN
Total number of participants at the end of the plan year
4c
5a
5b
Number of participants with account balances as of the end of the plan year (defined benefit plans do not
complete this item)
5c
6a
b
Total number of participants at the beginning of the plan year
5
5
5
Were all of the plan's assets during the plan year invested in eligible assets? (See instructions.)
X Yes
No
Are you claiming a waiver of the annual examination and report of an independent qualified public accountant (IQPA)
under 29 CFR 2520.104-46? (See instructions on waiver eligibility and conditions.)
X Yes
No
If you answered "No" to either line 6a or line 6b, the plan cannot use Form 5500-SF and must instead use Form 5500.
c
Yes
If the plan is a defined benefit plan, is it covered under the PBGC insurance program (see ERISA section 4021)?
No
Not determined
Caution: A penalty for the late or incomplete filing of this return/report will be assessed unless reasonable cause is established.
Under penalties of perjury and other penalties set forth in the instructions, I declare that I have examined this return/report, including, if applicable, a Schedule
SB or Schedule MB completed and signed by an enrolled actuary, as well as the electronic version of this return/report, and to the best of my knowledge and
belief, it is true, correct, and complete.
SIGN
HERE Signature of plan administrator
SIGN
HERE Signature of employer/plan sponsor
Top Dog, President
Date
Enter name of individual signing as plan administrator
Top Dog, President
Date
Enter name of individual signing as employer or plan sponsor
Preparer's name (including firm name, if applicable) and address; include room or suite number (optional)
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500-SF.
Preparer's telephone number (optional)
Form 5500-SF (2013)
v.130118
Page 2
Form 5500-SF 2013
Part III Financial Information
7 Plan Assets and Liabilities
a Total plan assets
b Total plan liabilities
c Net plan assets (subtract line 7b from line 7a)
8 Income, Expenses, and Transfers for this Plan Year
a Contributions received or receivable from:
b
c
d
(a) Beginning of Year
7a
(b) End of Year
215,072
353,740
7b
7c
215,072
353,740
(a) Amount
(1) Employers
8a(1)
(2) Participants
8a(2)
(3) Others (including rollovers)
8a(3)
Other income (loss)
8b
Total income (add lines 8a(1), 8a(2), 8a(3), and 8b)
Benefits paid (including direct rollovers and insurance premiums
to provide benefits)
8c
(b) Total
71,250
52,100
1,590
13,728
138,668
8d
8e
e Certain deemed and/or corrective distributions (see instructions)
8f
f Administrative service providers (salaries, fees, commissions)
8g
g Other expenses
8h
h Total expenses (add lines 8d, 8e, 8f, and 8g)
138,668
8i
i Net income (loss) (subtract line 8h from line 8c)
8j
j Transfers to (from) the plan (see instructions)
Part IV Plan Characteristics
9a If the plan provides pension benefits, enter the applicable pension feature codes from the List of Plan Characteristic Codes in the instructions:
2A
b
2E
2F
2G
2J
2T
3D
If the plan provides welfare benefits, enter the applicable welfare feature codes from the List of Plan Characteristic Codes in the instructions:
Part V Compliance Questions
10 During the plan year:
a Was there a failure to transmit to the plan any participant contributions within the time period described in
Yes
No
29 CFR 2510.3-102? (See instructions and DOL's Voluntary Fiduciary Correction Program)
10a
X
Were there any nonexempt transactions with any party-in-interest? (Do not include transactions reported
on line 10a.)
10b
X
Was the plan covered by a fidelity bond?
10c
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud
or dishonesty?
10d
X
e
Were any fees or commissions paid to any brokers, agents, or other persons by an insurance carrier,
insurance service, or other organization that provides some or all of the benefits under the plan? (See
instructions.)
10e
X
f
Has the plan failed to provide any benefit when due under the plan?
10f
X
g
h
Did the plan have any participant loans? (If "Yes," enter amount as of year end.)
10g
X
If this is an individual account plan, was there a blackout period? (See instructions and 29 CFR
2520.101-3.)
10h
X
i
If 10h was answered "Yes," check the box if you either provided the required notice or one of the
exceptions to providing the notice applied under 29 CFR 2520.101-3
10i
b
c
d
Part VI
Amount
100,000
X
Pension Funding Compliance
11
Is this a defined benefit plan subject to minimum funding requirements? (If "Yes," see instructions and complete Schedule SB (Form
5500) and line 11a below)
11a
12
Enter the unpaid minimum required contribution for current year from Schedule SB (Form 5500) line 39
Yes X No
11a
Is this a defined contribution plan subject to the minimum funding requirements of section 412 of the Code or section 302 of ERISA?
Yes X No
(If "Yes," complete line 12a or lines 12b, 12c, 12d, and 12e below, as applicable.)
a
If a waiver of the minimum funding standard for a prior year is being amortized in this plan year, see instructions, and enter the date of the letter ruling
Month
Day
Year
granting the waiver
If you completed line 12a, complete lines 3, 9, and 10 of Schedule MB (Form 5500), and skip to line 13.
b
Enter the minimum required contribution for this plan year
12b
Form 5500-SF 2013
Page 3-
c
d
Enter the amount contributed by the employer to the plan for this plan year
12c
Subtract the amount in line 12c from the amount in line 12b. Enter the result (enter a minus sign to the left of a
negative amount)
12d
e
Will the minimum funding amount reported on line 12d be met by the funding deadline?
Yes
Part VII
Plan Terminations and Transfers of Assets
13a Has a resolution to terminate the plan been adopted in any plan year?
Yes
If "Yes," enter the amount of any plan assets that reverted to the employer this year
b
c
No
N/A
X No
13a
Were all the plan assets distributed to participants or beneficiaries, transferred to another plan, or brought under the control
of the PBGC?
Yes
X No
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.)
13c(1) Name of plan(s):
Part VIII
13c(2) EIN(s)
13c(3) PN(s)
Trust Information (optional)
14a Name of trust
Sample Company, Inc. 401(k) Profit
14b Trust's EIN
12-3456789
SUMMARY ANNUAL REPORT
for
Sample Company, Inc. 401(k) Profit Sharing Plan
This is a summary of the annual report for Sample Company, Inc. 401(k) Profit Sharing Plan, 03-0713777/001 for 01/01/2014 through
12/31/2014. The annual report has been filed with the Employee Benefits Security Administration, formerly known as the Pension and
Welfare Benefits Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).
Basic Financial Statement
Plan expenses were $0. These expenses included $0 in administrative expenses, $0 in benefits paid to participants and beneficiaries, and
$0 in other expenses. A total of 5 persons were participants in or beneficiaries of the plan at the end of the plan year, although not all of
these persons had yet earned the right to receive benefits.
The value of plan assets, after subtracting liabilities of the plan was $353,740 as of 12/31/2014 compared to $215,072 as of 01/01/2014.
During the plan year the plan experienced an increase in its net assets of $138,668. This increase includes unrealized appreciation or
depreciation in the value of plan assets; that is, the difference between the value of the plan's assets at the end of the year and the value of
the assets at the beginning of the year or the cost of assets acquired during the year. The plan had total income of $138,668, including
employer contributions of $71,250, employee contributions of $53,690 and earnings from investments of $13,728.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request.
To obtain a copy of the full annual report, or any part thereof, write or call the office of Sample Company, Inc., who is Plan
Administrator at 2 Main St., Smallville, VT, 05055. The charge to cover copying cost will be $4.00 for the full annual report, or $0.25
per page for any part thereof.
You also have the right to receive from the plan administrator, on request and at no charge, a statement of the assets and liabilities of the
plan and accompanying notes, if any, or a statement of income and expenses of the plan and accompanying notes, if any, or both. If you
request a copy of the full annual report from the plan administrator, these two statements and accompanying notes, if any, will be
included as part of that report. The charge to cover copying costs given above does not include a charge for copying of these portions of
the report because these portions are furnished without charge.
You also have the legally protected right to examine the annual report at the main office of the plan at 2 Main St., Smallville, VT, 05055
and at the US Department of Labor in Washington DC, or obtain a copy from the US Department of Labor upon payment of copying
costs. Requests to the Department should be addressed to: Public Disclosure Room, Room N-1513, Employee Benefits Security
Administration, US Department of Labor, 200 Constitution Avenue, NW, Washington DC 20210.

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