What Is the 401k Summary Annual Report (SAR)?
The Summary Annual Report (SAR) is a one-page summary of Form 5500 and the plan’s finances that gets distributed to a plan’s participants. The SAR gets its name from the Form 5500, often called the Annual Report. Almost all of the information in your SAR will come from this plan document. Like the Form 5500, the SAR and it’s prompt distribution are mandated by the Employee Retirement Income Security Act of 1974 (ERISA).
What is important about getting the SAR?
The SAR, like Form 5500, is required by ERISA. Under this act, plan participants must be kept informed of important plan details - and that is exactly the point of distributing the SAR.
When it comes down to it, the SAR is a relatively simple document, and simply quickly summarizes the important information from your Form 5500, and reminds participants of their rights.
Here are the basic summary annual report requirements for disclosure:
- Basic plan financial information
- Plan expenses (including administrative)
- Value of plan assets
- Employer and employee contribution amounts
- Participant’s rights to information
- Funding standards and compliance
- Right to receive a copy of Form 5500 or the SAR
The point of the SAR is to get the important benefit or pension plan information to participants in a simplified notice.
SUMMARY ANNUAL REPORT FOR COORDINATED CARE SERVICES, INC. EMPLOYEE BENEFITS PLAN
This is a summary of the annual report of the COORDINATED CARE SERVICES, INC. EMPLOYEE BENEFITS
PLAN, a health, life insurance, dental, vision and long-term disability plan (Employer
Identification Number 22-2573042, Plan Number 503), for the plan year 01/01/2022 through
12/31/2022. The annual report has been filed with the Employee Benefits Security Administration, as
required under the Employee Retirement Income Security Act of 1974 (ERISA).
Insurance Information
The plan has insurance contracts with EXCELLUS BLUE CROSS BLUE SHIELD, METROPOLITAN LIFE INSURANCE
COMPANY, VISION SERVICE PLAN INSURANCE, GUARDIAN and EMPLOYEE NETWORK, INC to pay certain Health,
Prescription drug, Dental, Vision, Life insurance, Temporary disability, Long-term disability,
ACCIDENT, VOLUNTARY SPECIFIED DISEASE, OPTIONAL LIFE, EAP claims incurred under the terms of the
plan. The total premiums paid for the plan year ending 12/31/2022 were $2,996,208.
Because they are so called "experience-rated" contracts, the premium costs are affected by, among
other things, the number and size of claims. Of the total insurance premiums paid for the plan year
ending 12/31/2022, the premiums paid under such "experience-rated" contracts were $2,637,567 and
the total of all benefit claims paid under these experience-rated contracts during the plan year
was $2,448,163.
Your Rights to Additional Information
You have the right to receive a copy of the full annual report, or any part thereof, on request.
The items listed below are included in that report:
1. Insurance information, including sales commissions paid by insurance carriers.
To obtain a copy of the full annual report, or any part thereof, write, call or email, the CCSI Benefits team, benefits@ccsi.org, the representative of the plan administrator, at 1099 JAY STREET BUILDING J, ROCHESTER, NY 14611 and phone number, 585-745-0073.
You also have the legally protected right to examine the annual report at the main office of the
plan: 1099 JAY STREET BUILDING J, ROCHESTER, NY 14611, and at the U.S. Department of Labor in
Washington, D.C., or to obtain a copy from the U.S. 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, U.S. Department of Labor, 200 Constitution Avenue, N.W.,
Washington, D.C. 20210.
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to
respond to a collection of information unless such collection displays a valid Office of Management
and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or
sponsor a collection of information unless it is approved by OMB under the PRA, and displays a
currently valid OMB control number, and the public is not required to respond to a collection of
information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also,
notwithstanding any other provisions of law, no person shall be subject to penalty for failing to
comply with a collection of information if the collection of information does not display a
currently valid OMB control number. See 44 U.S.C.
3512.
The public reporting burden for this collection of information is estimated to average less than
one minute per notice (approximately 3 hours and 11 minutes per plan). Interested parties are
encouraged to send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the U.S. Department of Labor,
Office of the Chief Information Officer, Attention: Departmental Clearance Officer, 200
Constitution Avenue, N.W., Room N-1301, Washington, DC 20210 or email DOL_PRA_PUBLIC@dol.gov and
reference the OMB Control Number 1210-0040.
OMB Control Number 1210-0040 (expires 07/31/2023)