RETIREMENT PLAN REVIEW-PLAN INVESTMENT

Is your retirement plan accomplishing its investment objectives? To get an idea of how well your retirement plan is meeting these goals, fill out the short form below. We will provide you with some suggestions on what you can do to make it work better.

1. Overall satisfaction with investment of plan assets: Select from listVery satisfiedModerately satisfiedSomewhat satisfiedSomewhat dissatisfiedUnhappy

2. Are Plan assets earning enough?: Select from listVery satisfiedModerately satisfiedSomewhat satisfiedSomewhat dissatisfiedUnhappy

3. Are plan assets diversified enough by type?: Select from listVery diversifiedModerately diversifiedSomewhat diversifiedDiversified very littleNot diversified at all

A. Cash as a % of total assets: under 10% 10-25% over 25%

B. Stocks as a % of total assets: under 10% 10-25% over 25%

C. Bonds as a % of total assets: under 10% 10-25% over 25%

D. Other assets as a % of total assets: under 10% 10-25% over 25%

4. Have plan investments been reviewed for possible prohibited transactions?: Yes No Don't Know

5. Have the Trustees addressed their fiduciary responsibilities with respect to plan investments?: Yes No Don't Know

Your Name

Company Name

Phone Number

E-mail Address

Please describe the issues that are most important to you with respect to plan investments and provide any other comments you feel are appropriate.