Your Annual Valuation Statement provides information which may help you complete Form 5500-SF. Consult your tax advisor or the EBSA (Employee Benefits Security Administration) with any questions.
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= CollapseAnnual Valuation Statement
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Investment Earnings
Investment Earnings reports total interest, dividends, and other related distributions received in 2008. Changes in account value due to other factors, such as market fluctuation, contributions, and distributions made by the plan, are not reflected.
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Distributions
Distributions reports total distributions made by the plan, whether made directly to the participant (or beneficiary) or as direct rollovers to another plan.
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Cash Contributions
Cash Contributions include only those contributions made to the plan during 2008.
Form 5500 - For plans with multiple plan participants
Use the following information together with the Instructions for Form 5500 provided by the IRS to complete the form.
Part II, page 1
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1a Name of plan
Enter the formal name of your company retirement plan.
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1b Three-digit plan number (PN)
Enter your plan number (for example, your first plan is 001, your second is 002, etc.). You, the employer, assign the plan number.
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1c Effective date of Plan
Enter the effective month, day, and year of the plan. The effective date is generally the first day of the plan year in which the plan was established. If the employer's business was not yet established on that date, the effective date will be the date on which the business was established.
Part II, page 2
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2a Plan sponsor's name and address
The plan sponsor is the employer offering the plan. Do not enter a Fidelity entity, e.g., Fidelity Investments or Fidelity Management Trust Company.
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2b Employer Identification Number (EIN)
Enter your nine-digit Employer (Tax) Identification Number (EIN). If you do not have an EIN currently, please call the IRS at 1-800-829-4933 for information on how to obtain one. Enter the EIN on this form. Do not enter your Social Security Number.
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3a Plan administrator's name and address
Enter the plan administrator name and address. If the same as the employer, enter "same."
Part II, page 4
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8a Pension benefits
For the Fidelity Retirement Plan, check this box. If you are filing this report for your Profit Sharing Plan, enter "2E" and "2G" in the boxes below. If you have a 401(k) feature on your Profit Sharing Plan, also enter "2J." If you are filing this report for your Money Purchase Pension Plan, enter "2C" and "2G" in these boxes. Be sure to refer to the Instructions for Form 5500 for complete instructions to determine what other codes may apply to your plan.
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8b Welfare benefits
Leave this section blank.
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9a Plan funding arrangement
Check box (3) Trust if the plan is fully funded by its Fidelity account.
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9b Plan benefit arrangement
Check box (3) Trust for your Fidelity Retirement Plan.
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10a - b Schedules attached
Under the voluntary simplified reporting option, plans with less than 25 employees must complete and attach Schedules R and I. In addition, complete and attach Schedule SSA, if applicable. Please see the IRS Instructions for Form 5500 for more information concerning additional schedules that may apply to your plan.
