Document Excerpt

Summary Annual Report for (name of plan)

This is a summary of the annual Report of the (name of plan, EIN and type of welfare plan) for (period covered by this report). The annual report has been filed with the Employee Benefits Security Administration, as required under the Employee Retirement Income Security Act of 1974 (ERISA).

Link
https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/health-plans