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Illustrated Explanation of Form 5500-SF

Your Annual Valuation Statement provides information which may help you complete Form 5500-SF. Consult your tax advisor or the Department of Labor (DOL), Employee Benefits Security Administration (EBSA) with any questions.

Annual Valuation Statement




Form 5500-SF - For plans with less than 100 participants, including most one-participant plans.
Use the following information together with the Instructions for Form 5500-SF provided by the DOL to complete Form 5500-SF.

According to the Form 5500-SF Instructions, one-participant plans need only complete the following questions on the form:

  • Part I, lines A, B, and C
  • Part II, lines 1a - 5b
  • Part III, lines 7a-c, and 8a
  • Part IV, line 9a
  • Part V, line 10g
  • Part VI, lines 11-12e

Part I & Part II

Part I, Annual Report Identification Information

See the Form 5500-SF Instructions for Line A to determine whether your plan is a single-employer plan (most Premiere Select® Retirement plans are single-employer plans), (single-employer plans), a multiple-employer plan or a one-participant plan. In addition, select the one-participant box if appropriate. Select applicable boxes in Lines B or C.

Part II, Basic Plan Information











Part III, Financial Information








Part IV & Part V

Part IV, Plan Characteristics



Part V, Compliance Questions

According to the Form 5500-SF Instructions, one-participant plans should complete only question 10g.

If you have a multi-participant plan answer all of the Compliance Questions and provide the amounts for any of the questions that you have answered "Yes."

Part VI & Part VII

Part VI, Pension Funding Compliance



Part VII, Trust Information



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