PSCA’s 57th Annual Survey Worksheet

Below is a list of questions from the upcoming questionnaire that you will need to look up. The second page is ournew “bonus” question on plan fees.

5. Estimate the total number of active US employees in your company at the end of the 2013 plan year.______

6. How many employees listed in question 5were eligible to participate in this plan as of December 31, 2013? ______

7. How many employed participants had an account balance as of December 31, 2013? (Number should be equal to or less you’re your answer to question 7.) ______

8. How many non-employed participants (i.e. terminated vested employees, etc.) had an account balance as of December 31, 2013? ______

10. What was the total market value of plan assets as of December 31, 2013 (including outstanding plan loans)? ______

11. What was the total (gross) annual payroll of the eligible employees reported in question 6, before any employee salary deferrals? ______

24. What was the total company contribution to the plan for 2013 for matching and/or non-matching contributions (if you make both, please break it out by type of contribution, if available).

Matching contribution: ______☐N/A

Non-matching contribution: ______☐N/A

Total contribution: ______☐N/A

27. If your plan permits participant contributions, how many participants(employed as of December 31, 2013) contributed to the plan in2013? ______

28. Please list the number of participants (employed as of December 31, 2013) that made each of the following types of contributions in 2013and the total dollar value of contributions for the year by those participants. (The total should equal or exceed the answer to question 24 above.)

Number of Participants / Gross 2013 Contribution
Pre-tax contributions:
Roth after-tax contributions:
401(m) after-tax contributions:

29. For non-safe harbor plans, what was the average percentage of deferred (ADP/ACP results) for the following types of contributions?

Pre-tax / Roth after-tax / 401(m) after-tax
By the highly compensated:
By the non-highly compensated:

41. You will need a list of plan investments and the 2013 year-end fund balance for each.

79f. How many participants had loans outstanding at the end of the plan year? ______

79g. What was the total dollar amount of outstanding plan loans at the end of the plan year? ______

80c.How many participants took a hardship withdrawal in 2013 (when allowed)? ______

Bonus Question:

Please complete the below section on plan fees to receive a fee benchmarking report, published separately from the Annual Survey. If you skip these questions, you will still receive a free copy of the 57th Annual Survey, but not the fee benchmarking report. There is an excel version of this question available at

A. If you pay a flat rate for your plan, please list what that rate is, and then check the items below that are included in that fee. If you pay a fee per item/service, please indicate what you have and what the charge is. If you have a combination of the two, please list both.

Note: We are looking for the total plan cost, regardless of who pays the fees.

Overall total plan cost (basis points, percentage of assets, per participant, etc.): ______

Fee ItemIncludedN/AFee

Administration and Recordkeeping☐☐______

Participant Education☐☐______

Compliance Testing☐☐______

Form 5500 Reporting☐☐______

Audit Fees☐☐______

Investment Management☐☐______

Investment and other Consulting Fees☐☐______

Legal Fees ☐☐______

Trustee Fees☐☐______

Other: ______☐☐______

Other: ______☐☐______

Other: ______☐☐______

B. Please complete the below fee chart or include a list of your plan funds that includes the below information (can be used for the list of funds/assets in question 41 as well). Include additional funds on a separate sheet if they do not fit below.

Fund Name or Ticker / Actively Managed or Indexed / Investment Type / Asset Total / Gross Annual Expense Ratio / Revenue Sharing / Other Investment Fees
Mutual Fund / Co-mingled / Separate Account
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %
$ / % / % / %