Page 1 of 3
PLAN NAME:
PLAN YEAR:
Social Security Date of Date of Date of Date of Y-T-D Employee Employer Gross Excluded
Number First Name Last Name Sex Birth Hire Termination Rehire Hours Deferral Match Compensation Compensation
001-23-4567 Joe Sample M 1/1/1950 1/1/1995 12/15/1998 1/1/1999 999 10,000.00 10,000.00 160,000.00 10,000.00
5d36cc0d-bb05-4da9-a81e-e2b0104b6178.xls
Page 2 of 3
PLAN NAME:
PLAN YEAR:
Social Security Date of Date of Date of Date of Y-T-D Employee Employer Gross Excluded
Number First Name Last Name Sex Birth Hire Termination Rehire Hours Deferral Match Compensation Compensation
001-23-4567 Joe Sample M 1/1/1950 1/1/1995 12/15/1998 1/1/1999 999 10,000.00 10,000.00 160,000.00 10,000.00
5d36cc0d-bb05-4da9-a81e-e2b0104b6178.xls
Page 3 of 3
PLAN NAME:
PLAN YEAR:
Social Security Date of Date of Date of Date of Y-T-D Employee Employer Gross Excluded
Number First Name Last Name Sex Birth Hire Termination Rehire Hours Deferral Match Compensation Compensation
001-23-4567 Joe Sample M 1/1/1950 1/1/1995 12/15/1998 1/1/1999 999 10,000.00 10,000.00 160,000.00 10,000.00
5d36cc0d-bb05-4da9-a81e-e2b0104b6178.xls