IPS - Data Questionnaire Retirement Plan Participant Directed

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1 This questionnaire is meant to cover all the information required for the IPS. Step 1: Organize - Enter Basic Client Information Client Name: Client Status: Current Prospective Client Subtype (Choose One): Corporate Defined Contribution Public Defined Contribution Taft-Hartley Defined Contribution ERISA Exempt (403b) (457) Optional Client Information: Plan Address: Plan Address 2: City: State: Zip Code: Committee Member Details: Name Title Third Party Information: Plan Administrator: Accountant: Attorney: Custodian: Load Waived A, N, & T Shares: Yes fi360 Inc. Page 1 13

2 Step 2: Formalize Create Investment Policy Statement Background Information Fiduciary Standard Care: Corporate Defined Contribution Subtype ( choice ERISA is only option) Public Defined Contribution Subtype (Choose one): ERISA MPERS UPIA State Code Taft-Hartley Defined Contribution Subtype ( choice ERISA is only option) ERISA Exempt (403b) (457) Subtype: Other Define: Safe Harbor Compliance Options: Corporate DC, Public DC, and Taft Hartley DC Subtypes (Choose all that apply): Follow 404(c) Safe Harbor Follow QDIA Safe Harbor Follow Fiduciary Advisor Safe Harbor ERISA Exempt Subtypes: Follow "Safe Harbor" Compliance Options Current Plan Assets: Number Plan Participants: Estimated Annual Contribution: Tax ID: Plan Start Date: IPS Approval Date: Investment Options (See Exhibit 1 to select investment options) Selection and Monitoring/Watch List Criteria IPS - Data Questionnaire Criteria Utilize for Selection Utilize for Monitoring/ Watch List fi360 Fiduciary Score <= 25 fi360 Fiduciary Score Average (3 year) <=25 Custom Due Diligence Criteria (see Exhibit 4) fi360 Inc. Page 2 13

3 Other Options Provide Socially and Environmentally Responsible Investment Options? Yes (Choose One) Use fi360 default language: Evaluate all investments according to the objective economic criteria established in this Investment Policy and if there are equally attractive investments, social factors may be considered. Create your own language Define: Utilize Investment Advisor? Yes Utilize Separate Account Manager? Yes Utilize Variable Annuity Sub-accounts? Yes Utilize Fiduciary Adviser? (Does not apply to ERISA Exempt subtype) Yes Include Appendix A: Risk/Return Modeled Assumptions Broad Asset Classes used in the Optimizer? Yes Step 3a: Implement Select Client Holdings Use Exhibit 2 to record the Account holdings. Use Exhibit 3 to record any Custom holdings. o Securities such as stocks, bonds, and money market funds are not tracked in the fi360 Toolkit. Use Exhibit 5 to record Model Portfolios. Step 3a: Implement Select Fees and Expenses Use Exhibit 6 to record the Plan Level, Operational and Shareholder Fees and Expenses. fi360 Inc. Page 3 13

4 Exhibit 1 - IPS Investment Options Add Add Add : Peer Group : Peer Group : Peer Group Aggressive Allocation Intermediate Government Muni Single State Short Bank Loan Intermediate-Term Bond Natural Resources Bear Market Japan Stock ntraditional Bond China Region Large Blend Pacific/Asia ex-japan Stk Commodities Agriculture Large Growth Real Estate Commodities Broad Basket Large Value Retirement Income Commodities Energy Latin America Stock Short Government Commodities Industrial Metals Leveraged Net Long Short-Term Bond Commodities Miscellaneous Long Government Small Blend Commodities Precious Metals Long/Short Equity Small Growth Communications Long-Term Bond Small Value Conservative Allocation Managed Futures Stable Value Consumer Cyclical Market Neutral Target Date Consumer Defensive Mid-Cap Blend Target Date Convertibles Mid-Cap Growth Target Date Currency Mid-Cap Value Target Date Diversified Emerging Mkts Miscellaneous Sector Target Date Diversified Pacific/Asia Moderate Allocation Target Date Emerging Markets Bond Money Market Tax Free Target Date Equity Energy Money Market Taxable Target Date Equity Precious Metals Multialternative Target Date Europe Stock Multisector Bond Target Date Financial Muni California Intermediate Technology Foreign Large Blend Muni California Long Trading-Inverse Commodities Foreign Large Growth Muni Massachusetts Trading-Inverse Debt Foreign Large Value Muni Minnesota Trading-Inverse Equity Foreign Small/Mid Blend Muni National Interm Trading-Leveraged Commodities Foreign Small/Mid Growth Muni National Long Trading-Leveraged Debt Foreign Small/Mid Value Muni National Short Trading-Leveraged Equity Global Real Estate Muni New Jersey Trading-Miscellaneous Health Muni New York Intermediate Ultrashort Bond High Yield Bond Muni New York Long Utilities High Yield Muni Muni Ohio Volatility India Equity Muni Pennsylvania World Allocation Industrials Muni Single State Interm World Bond Inflation-Protected Bond Muni Single State Long World Stock fi360 Inc. Page 4 13

5 Exhibit 2 Mutual Fund, ETF, SMA, and VA Holdings Type (Fund, SMA, VA or GRPA) Ticker or Investment Name $ Value (if selected) Watch List tes (if applicable) Action (if applicable) (Watch or Replace) fi360 Inc. Page 5 13

6 Exhibit 3 Custom Holdings te: Before entering a client to input the $ value (if applicable), create your custom holding within the Custom Holdings Directory available in the User Settings area. Investment Name Peer Group 3 Month Return YTD Return 1 Year Return 3 Year Return 5 Year Return 10 Year Return 2011 Year Return 2010 Year Return 2009 Year Return 2008 Year Return 2007 Year Return Standard Deviation (3 year) Prospectus Net Expense Ratio 12b-1 Fee(max. fee) Front Load Deferred Load Exhibit 4 Custom Due Diligence fi360 Inc. Page 6 13

7 Factor Threshold Required or Optional? Periods evaluated: Missing Data Treatment Example: Top 25% peer group Example: Required 3 4 Pass Example: 5 Year Return fi360 Inc. Page 7 13

8 Exhibit 5 Model Portfolios If the Plan fers model portfolio options to participants, record the portfolio details here. Model 1 Model Name Rebalancing Frequency $ Assets(current) # Participants Peer Group Investment Name Allocation % Model 2 Model Name Rebalancing Frequency $ Assets(current) # Participants Peer Group Investment Name Allocation % Model 3 fi360 Inc. Page 8 13

9 Model Name Rebalancing Frequency $ Assets(current) # Participants Peer Group Investment Name Allocation % Model 4 Model Name Rebalancing Frequency $ Assets(current) # Participants Peer Group Investment Name Allocation % Model 5 Model Name Rebalancing Frequency $ Assets(current) # Participants Peer Group Investment Name Allocation % fi360 Inc. Page 9 13

10 Exhibit 6 Client Fees and Expenses Plan Level Expenses Name Party Paid Circle Below Assessed? Payment Frequency Fee Amount Paid? (see below) Advisory Fee Adv/Cust/Inv Provider Mo/Qty/Semi/Ann Communication Adv/Cust/Inv Provider Mo/Qty/Semi/Ann Compliance Adv/TPA/RK Mo/Qty/Semi/Ann Tax Forms TPA/RK/Inv Provider Mo/Qty/Semi/Ann Load Administration TPA/Cust/RK Mo/Qty/Semi/Ann Participant Education Adv Mo/Qty/Semi/Ann Plan Amendment TPA/Cust/Inv Provider Mo/Qty/Semi/Ann Recordkeeping RK/Inv Provider Mo/Qty/Semi/Ann Start-up Expense TPA/Cust/RK Mo/Qty/Semi/Ann Termination Expense TPA/Cust/RK Mo/Qty/Semi/Ann Trustee Expense Cust/Inv Provider Mo/Qty/Semi/Ann Wrap Fee Adv/Inv Provider Mo/Qty/Semi/Ann Other: Adv/TPA/Cust/RK Mo/Qty/Semi/Ann Party Paid Assessment Options: Payment Options: Paid? BPS/$$ Advisor % assets / Flat Fee / Per Participant Mo/Qty/Semi/Ann Broker % assets / Flat Fee / Per Participant Mo/Qty/Semi/Ann Custodian % assets / Flat Fee / Per Participant Mo/Qty/Semi/Ann Investment Mgr. % assets / Flat Fee / Per Participant Mo/Qty/Semi/Ann Recordkeeper % assets / Flat Fee / Per Participant Mo/Qty/Semi/Ann TPA % assets / Flat Fee / Per Participant Mo/Qty/Semi/Ann fi360 Inc. Page 10 13

11 Investment Expenses: Operational Fee IPS - Data Questionnaire Investment Name 12b-1 (max.) 12b-1 Sales Sales Rebate 12b-1 Service Service Rebate Sub-TA Agency Fee Sub- TA Rebate Paid? (see below) Wrap Fee Paid? bps $value fi360 Inc. Page 11 13

12 Investment Expenses: Shareholder Fees IPS - Data Questionnaire Investment Name Front Load Waived? Deferred Load Waived? Finder s Fee Paid? (see below) Redemption Fee Redemption Days Exchange Fee Other Fee Paid? bps $valu e fi360 Inc. Page 12 13

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