Illustrated Explanation of Form 5500-SF

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• Investment Earnings
  

  Investment Earnings report total interest, dividends, and other related distributions received in 2011. Changes in account value due to other factors, such as market fluctuation, contributions, and distributions made by the plan, are not reflected.

• Distributions
  

  Distributions report total distributions made by the plan during 2011, whether made directly to the participant (or beneficiary) or as direct rollovers to another plan.

• Cash Contributions
  

  Cash Contributions include only those contributions made to the plan during 2011.

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• 1a Name of plan

  Enter the formal name of your company retirement plan.

• 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.

• 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.

• 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. Enter the employer’s name and address.

• 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 a Form SS-4. Enter the EIN on this form. Do not enter your Social Security Number.

• 2c Plan sponsor's telephone number

  Enter the employer's telephone number

• 2d Business code

  Enter the appropriate business code from the list on pp. 22-24 in the Form 5500-SF Instructions.

• 3a Plan administrator's name and address

  Enter the plan administrator's name, address, etc. If they are the same as the employer's, enter "same."

• 5a-c Total number of participants

  See the Form 5500-SF Instructions for a description of a “participant.”

• 6a & b Plan Eligibility

  If the answers to 6a and 6b are “yes,” you may file with Form 5500-SF. See the Form 5500-SF Instructions for further information.

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• 7 Plan Assets and Liabilities & 8 Income, Expenses, and Transfers for this Plan Year.

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

• 7a Total plan assets at the beginning and end of the plan year

  Your Fidelity Annual Valuation Statement reports your plan’s assets on a cash basis rather than on a modified cash or accrual basis. You must use one method consistently. Consult your tax advisor.

• 7b Total plan liabilities at the beginning and end of the plan year

  Plans using cash basis should have no liabilities.

• 8a Contributions received (or receivable if using accrual basis)

  Include the total cash contributions received by the plan. Report employer contributions on 8a(1) and any other contributions (including rollovers from other plans) on 8a(3).

• 8b Other income (loss)

  Include investment earnings net gain or loss from the sale of assets, and other income, such as unrealized appreciation (depreciation) in plan assets. (See the Form 5500-SF Instructions for more details)

• 8d Benefits paid

  Provide distributions made to, or on behalf of, plan participants, including eligible rollover distributions.

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• 9a Pension benefits

  If you are filing this report for your Fidelity Defined Benefit Plan, enter "1A" and "3D" along with any other appropriate codes for your plan. Refer to the Form 5500-SF Instructions, pp. 20-21, for complete instructions to determine what other codes may apply to your plan.

• 9b Welfare benefits

  Leave blank.

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• 11 Is this a defined benefit plan subject to minimum funding requirements?

  For Fidelity Defined Benefit plans, answer “Yes,” and attach a completed and signed Schedule SB (Form 5500)

• 12 Is this a defined contribution plan subject to the minimum funding requirement

  For Fidelity Defined Benefit plans, answer “no.”