Investment Earnings reports total interest, dividends, and other related distributions received in 2010. Changes in account value due to other factors, such as market fluctuation, contributions, and distributions made by the plan, are not reflected.

Distributions report total distributions made by the plan, whether made directly to the participant (or beneficiary) or as direct rollovers to another plan.

Cash Contributions include only those contributions made to the plan during 2010.

Enter the formal name of your company retirement plan.

Enter your plan number (for example, your first plan is 001, your second is 002, etc.). You, the employer, assign the plan number.

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.

Enter the employer name and address.

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.

Enter the employer's telephone number.

Enter the appropriate business code from the list on pp. 7 – 9 in the Form 5500-EZ Instructions.

Enter the plan administrator name and address. If the same as the employer, enter "same," and leave blank the remainder of 3a, 3b, and 3c.

Complete these sections, if applicable.

Note that Form 5500-EZ may only be used by one-participant plans that are required to file an annual return, and are not eligible or choose not to file the annual return electronically on Form 5500-SF. See the 5500-EZ Instructions for more information.

Count your spouse (and your partners' spouses) only if they work in the business.

Complete using your own records, your Premiere Select account statements, and Annual Valuation Statements as appropriate.

Total plan assets include rollovers and transfers from other plans, unrealized gains and losses such as appreciation/depreciation in assets. Your Annual Valuation Statement reports your plan's assets on a cash basis rather than an accrual basis. You may use either method, but should be consistent from year to year. Consult your tax advisor.

Plans using cash basis should have no liabilities. Do not include the value of future distributions that will be made to participants.

Include the total cash contributions received by the plan from the employer (line 7a) and the plan participant (line 7b).

Enter the total of all other contributions, including transfers or rollovers received from other plans valued on the date of contribution.

If you are filing this report for your Profit Sharing Plan, enter "2E," "2R," and "3D." 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," "2R," and "3D." Be sure to refer to p. 6 of the Form 5500-EZ Instructions to determine what other codes may apply to your plan.

If your plan is a Money Purchase Plan, answer "yes" and complete lines 11a or 11b, 11c, 11d, and 11e, as applicable. If you have a Profit Sharing or a Self-Employed 401(k) plan, the answer to question 11 is "no."