Company's Contribution

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1 RETIREMEMT BENEFITS Employee Savings & Protection Plan - Salary Deferral Source XYZ's Tax Deferred ES&P Plan allows you to save for your retirement through convenient payroll deductions on a pretax basis. You can choose to invest in any or all of 17 investments funds. YOUR TOTAL COMPENSATION STATEMENT You can choose to defer, in whole percentages, from 1% to 50% of your compensation up to an annual maximum of $16,500 in 20xx. Once you reach age 50, you may be eligible for "catch-up" contributions which allows an increase in your maximum dollar amount. Your savings and their investment earnings are free from Federal Income Taxes until they are withdrawn. X Y As of December 31, 20xx, your balance was $155,512 and your 20xx Plan contribution was $3,121. Prepared For: Z Employee Savings & Protection Plan - Employer Source Each year that you are eligible to share in contributions, XYZ will contribute to the Plan on your behalf an amount equal to 6% of your compensation up to $245,000 in 20xx. Your account will be credited annually with a share of the investment earnings or losses of the trust fund. $9,609 JOHN T. SAMPLE 123 MAIN STREET ANY TOWN, NY XXXXX For 20xx, XYZ made a contribution to your plan in the amount of $9,609. Once you have completed five years of service, and met all eligibility requirements, you may be 100% vested and have a permanent right to your account balance under the Plan, even if you leave the Company before retirement. For further information regarding this plan, please call Fidelity Investments at or visit their website at Employee Savings & Protection Plan Projections The following projections illustrate what your account (including employee and employer contributions) might be worth in 5 years, 15 years, and at age 67 (your normal retirement age) based on your current total retirement account balance of $155,512 and annual investment growth rate assumptions of 3%, 6%, and 9%. The projections assume that your pay, your current contribution rate of 9%, ES&PP 6% Employer, and the Plan provisions will remain the same in the future. Annual Investment Growth Rates 3% 6% 9% 1,620,889 Dear John, I am very pleased to present your Total Compensation Statement. Each year XYZ Company makes significant contributions toward your personal benefits which are an important component of your total compensation. This statement outlines the total income opportunity and benefits provided to you by XYZ as well as the cost of those benefits. This statement is a convenient way to keep track of your benefit elections and is a useful financial planning tool. Please review this statement and retain it with your other important documents. Sincerely, David Smith President 940,195 1,013, , , , , , ,691 How This Statement Was Prepared Your Total Compensation Statement reflects your benefit elections and your total compensation as of December 31, 20xx. 5 Years 15 Years Age 67 Note: The information presented has been rounded to the nearest whole number. Every effort has been taken to ensure that the information in this statement is accurate; however, no warranty of guarantee is implied or intended. If a discrepancy is found to exist between your benefit statement and the benefit summary plan descriptions, the provisions of those documents will govern. Your Personal Information The information in this statement is based on XYZ's records. Should you have any questions concerning the information represented in this Total Compensation Statement, please contact your HR Department. Hire Date: 4/1/1996 Base Salary: $100,000 POMCO Group Toll free

2 With Commission NO Commission Total Benefit Costs Paid Time Off Pay for Time Worked Total Compensation Company Health Care Benefits $14,932 Survivor Benefits $563 Income Protection Benefits $860 (24%) Social Security and Medicare Benefits $10,620 Retirement Benefits $9,609 Commissions Paid in 20xx SUMMARY OF 20XX TOTAL COMPENSATION $36,584 $15,384 $92,061 $9,500 $153,529 HEALTH CARE BENEFITS Your 20xx benefits, including paid time off, represent approximately 34% of your total compensation. Medical Benefits XYZ Company provides you with health care coverage to minimize the potential financial impact of medical costs for you and your eligible family members. The plan provides coverage for preventive care, physician services, hospital services, and prescription drugs. You are currently enrolled in the medical plan with family coverage. Dental Benefits In addition to medical coverage, XYZ Company offers a dental plan to help reduce your out-ofpocket dental care costs. The plan is designed to encourage preventive care which will diminish your need for costly corrective treatment in the future. You are currently enrolled in the dental plan with family coverage. Flexible Spending Accounts (FSA) XYZ's Flexible Spending Accounts allow you to pay for unreimbursed medical and dependent care expenses with pre-tax dollars. Taxable earnings are reduced so you pay less taxes on earnings and your take home pay is increased. You may elect to have up to $2,500 ($5,000 if married, filing separately) deducted pre-tax per year for eligible dependent care expenses and up to $2,500 deducted pre-tax per year for eligible health care expenses. You are currently contributing $2,000 annually to your medical care account and $1,000 to your dependent care account. (6%) (10%) (60%) $13,241 $1,637 $54 INCOME PROTECTION BENEFITS Short Term Disability XYZ Company provides employees with Short Term Disability Insurance. This insurance is designed to stabilize your income in the event that you are disabled due to a non-work related injury or illness. Benefits are calculated at 66.67% of your average weekly salary, up to a maximum of $542. Should you become disabled, you may be eligible for payments of $542 per week for maximum of 26 weeks. Long Term Disability Under the Long Term Disability plan, if you are disabled for more than 90 days, you may receive 60% of your average monthly earnings up to $10,000 until the age of 65, or until your disability ends, as defined in the contract. If you were to become disabled, you may be eligible to receive up to $5,000 per month. Please be aware that this benefit is integrated with statutory disability benefits such as Workers' Compensation and Social Security. Unemployment Insurance XYZ Company makes contributions to the state unemployment insurance fund. Should you become unemployed through no fault of your own, you may be eligible for weekly unemployment benefits. Check with your local unemployment office for more details as benefits vary from state to state. Workers' Compensation In the event of a disability due to a work related injury or illness, you may be eligible to receive a weekly benefit up to the state maximum, depending on the nature of the disability or accident. These benefits are generally paid for as long as the disability exists. SOCIAL SECURITY AND MEDICARE BENEFITS XYZ Company contributes an amount equal to your own Social Security and Medicare contribution. Monthly Social Security benefits may go to you and/or your dependents when you retire, become severely disabled, or die. The amount of any benefits will depend on prior earnings, adjusted to account for changes in wages since The Social Security Administration will mail you an annual "Earnings and Benefit Estimate Statement" verifying the earnings credited to your account. For complete information on your actual Social Security benefits, consult the local Social Security Administration office. PAID TIME OFF Prepared for John T. Sample $66 $195 $14 $585 $10,620 SURVIVOR BENEFITS Basic Life And Accidental Death & Dismemberment Insurance XYZ Company provides you with Life and Accidental Death and Dismemberment Insurance benefit equal to 1.5 times your base annual salary up to a maximum of $400,000. Your beneficiary may be entitled to receive $115,000 in the event of your death. If you injured in an accident, you or your beneficiary may receive an additional $115,000 for loss of life or dismemberment. $561 Vacation Days 20.0 Holidays 13 Personal Days 2 Sick Days 5.0 ADDITIONAL BENEFITS $15,384 Supplemental Life And Accidental Death & Dismemberment Insurance XYZ Company offers you the option to purchase Supplemental Life Insurance coverage for yourself, your spouse and/or dependent child(ren), at favorable group rates, through payroll deduction. You have elected to purchase $50,000 of additional coverage on yourself. Business Travel & Accident Insurance XYZ Company offers a Business Travel & Accident Policy in the amount of $200,000 of insurance in the event of death or disability while traveling on company business. This benefit is provided to you at no cost and is in addition to the Group Term Life Insurance you have. $2 Other benefits of significant value that you may be utilizing, but are not included in the Company benefits cost, include the following: Attendance Incentive Educational Assistance Program Salary Continuation Jury Duty Referral Bonus Bereavement Leave Direct Deposit for Paycheck Military Leave Employee Assistance Program Adjusted Work Week March - Nov.

3 YOUR PERSONAL STATEMENT OF BENEFITS Dear Jane, We are pleased to present to you this personalized statement of benefits. The benefits you enjoy represent a significant portion of your total compensation package. This annual statement was prepared so that you may have a better understanding of the benefits provided by XYZ Corporation. I encourage you to review your benefit statement carefully and keep it in a safe place for future reference. If you have any questions about this statement or require additional information on any of the benefits offered, please contact Human Resources. Sincerely, Susan Smith President Jane M. Sample 15 Main Street New York, NY Your benefits, including paid time off and bonus, represent approximately 28% of your total compensation. YOUR TOTAL COMPENSATION Pay For Time Worked $31,895 Pay For Time Off $3,105 Bonus $3,000 Total Other Benefits $6,187 Total Compensation $44,187 ANNUAL BENEFITS S HEALTH CARE BENEFITS Medical Insurance Your Medical Plan: Your Medical Coverage Level: Your Annual : Dental Insurance Your Dental Plan: Your Dental Coverage Level: Your Annual : Flexible Spending Accounts Your Annual : INCOME PROTECTION Short Term Disability Weekly Benefit: Long Term Disability Monthly Benefit: Workers Compensation Good Medicine Family $1,344 $480 Happy Teeth Family $252 $156 $103 $2,500 $444 $175 $1,750 $193 $346 SURVIVOR BENEFITS Group Life Insurance Benefit Amount: $70,000 Group AD&D Insurance Benefit Amount: $70,000 Supplemental Life & AD&D Insurance Your Benefit Amount: $200,000 Your Spouses Benefit Amount: $100,000 Your 401(k) : XYZ s 401(k) Match: $294 Your Child(ren)s Benefit Amount: $10,000 RETIREMENT BENEFITS Future Value Amount: (estimated value at retirement) SOCIAL SECURITY AND MEDICARE Your Annual : PAID TIME OFF Holiday Pay : Vacation Pay: $2,100 $1,050 $681,151 $2,430 $2,430 $1,215 $1,890 $3,105 Note: Your Total Compensation Statement reflects your benefit elections and your total target compensation as of 12/31/20XX. Annual totals are projections based on Company records as of this date and assumes perfect eligibility. Every effort has been taken to ensure that the information in this statement is accurate; however, no warranty or guarantee is implied or intended. If a discrepancy is found to exist between your benefit statement and the benefit booklets or summary plan descriptions, the provisions of those documents will govern.

4 Dear Jane, Jane M. Sample 15 Main Street New York, NY YOUR PERSONAL STATEMENT OF BENEFITS We are pleased to present to you this personalized statement of benefits. The benefits you enjoy represent a significant portion of your total compensation package. This annual statement was prepared so that you may have a better understanding of the benefits provided by XYZ Corporation. I encourage you to review your benefit statement carefully and keep it in a safe place for future reference. If you have any questions about this statement or require additional information on any of the benefits offered, please contact Human Resources. Sincerely, Susan Smith President Your benefits, including paid time off and bonus, represent approximately 28% of your total compensation. YOUR TOTAL COMPENSATION Bonus $3,000 Total Other Benefits $6,435 Pay For Time Off $3,096 Pay For Time Worked $31,904 Total Compensation $44,435 Medical Insurance XYZ Corporation provides eligible employees with health care coverage to minimize the potential financial impact of medical costs for you and your eligible family members. The Company offers you a PPO or HMO for your medical plan options. You are currently enrolled in the PPO plan with Family coverage. Dental Insurance In addition to medical insurance, XYZ Corporation offers a dental program to help reduce your out of pocket dental care costs. This plan is offered to encourage preventative care which will diminish the need for costly corrective procedures in the future. You are currently enrolled in the Smile Saver dental plan with Family coverage. Flexible Spending Accounts XYZ Corporation provides eligible employees with the opportunity to participate in Flexible Spending Accounts that allow you to pay your share of unreimbursed medical expenses and dependent care expenses with pre-tax dollars. You may elect to have up to $5,000 deducted pre-tax per year for eligible dependent care expenses and up to $3,000 deducted pre-tax per year for eligible medical and dental care expenses. You are currently contributing $1,000 to your dependent care and $1,500 to your medical care accounts annually. Short Term Disability HEALTH CARE BENEFITS INCOME PROTECTION BENEFITS XYZ Corporation provides eligible employees with Short Term Disability Insurance. This insurance is designed to stabilize your income in the event that you are disabled due to an off-the-job injury or illness. Beginning on the 8th day of illness or injury, you may be eligible for payments of $444 (66% of your average weekly earnings) per week, for a maximum of 26 weeks. Long Term Disability Under the Long Term Disability Plan, if you are disabled for more than 90 days, you may receive 60% of your base salary up to $6,000 per month until the age of 65, or until your disability ends, as defined in the contract. Please be aware that this benefit is integrated with statutory disability benefits such as Workers' Compensation and Social Security. If you were to become disabled or injured, you may be eligible to receive benefits of $1,750 per month. Workers Compensation In the event of a disability due to a work related injury or illness, you may be eligible for a weekly benefit up to the state maximum depending on the nature of the disability or accident. These benefits are generally paid for as long as the disability exists. $1,344 $252 $103 $175 $193 $346

5 401(k) Retirement Savings Plan RETIREMENT BENEFITS XYZ Corporation encourages you to save for your future retirement by offering a 401(k) Retirement Savings Plan. All employees are eligible to participate in this plan after attaining age 21 and after one year of service in which 1,000 hours have been worked. You may contribute a percentage of your compensation up to the IRS limitation each year. You are always 100% vested in your contributions. The Company will match 50% of your contributions up to 6% of your pay for a total of 3% of your gross compensation. You become 100% vested in the Company s contributions to your account after six (6) years of service. You are currently 100% vested in XYZ Corporation s contributions to your account. As of December 31, 2012, you were contributing 6% of your salary to your 401(k) Retirement Savings Plan. The Company s match is anticipated to be $1,050. Your total account balance as of December 31, 2012 was $34,125. If you and the Company continue to contribute at the current rate, and your account grows at a modest rate of 6%, your account balance is estimated to be $681,151 at retirement age 65. Your 401(k) can be extremely helpful to you by increasing your retirement assets. increase your contribution. SOCIAL SECURITY & MEDICARE XYZ Corporation contributes an amount equal to your own Social Security and Medicare contributions. Monthly Social Security benefits may go to you and/or your dependents when you retire, become severely disabled, or die. The amount of any benefits will depend on prior earnings, adjusted to account for changes in wages since The Social Security Administration will annually mail you an "Earnings and Benefit Estimate Statement" verifying the earnings credited to your account. For complete information on your actual Social Security benefits, consult the local Social Security Administration Office. SURVIVOR BENEFITS Life Insurance and Accidental Death & Dismemberment Insurance XYZ Corporation provides eligible employees with Life and Accidental Death and Dismemberment Insurance. Your beneficiary may be entitled to receive a benefit in the amount of $70,000 in the event of your death. If you die or are injured by an accident, you or your beneficiary may be entitled to receive an additional benefit. PAID TIME OFF Holidays: 9 Vacation Days: 14 You may wish to Voluntary Life and Accidental Death & Dismemberment Insurance "In addition, the Company offers you the opportunity to purchase Supplemental Life and Accidental Death & Dismemberment Insurance for yourself, your spouse and your dependent child(ren) through the Farmington Company." $1,050 $2,678 $294 $3,096 SPECIAL PROGRAMS Employee Stock Purchase Plan (ESPP) Direct Deposit Federal Credit Union Tuition Reimbursement Note: The information presented has been rounded to the nearest whole number. Your Total Compensation Statement reflects your benefit elections and your total target compensation as of 12/31/2012. Annual totals are projections based on Company records as of this date and assumes perfect eligibility. Every effort has been taken to ensure that the information in this statement is accurate; however, no warranty or guarantee is implied or intended. If a discrepancy is found to exist between your benefit statement and the benefit booklets or summary plan descriptions, the provisions of those documents will govern. POMCO Group Toll free

6 Dear Jane, Jane Doe We are pleased to present to you this personalized statement of benefits. The benefits you enjoy represent a significant portion of your total compensation package. This annual statement was prepared so that you may have a better understanding of the benefits provided by XYZ Company. I encourage you to review your benefit statement carefully and keep it in a safe place for future reference. If you have any questions about the statement or require additional information on any of the benefits offered, please contact Human Resources. Your benefits, including paid time off, represent approximately 33% of your total compensation. YOUR TOTAL COMPENSATION Pay for Time Worked: $31,635 Paid Time Off: Other Benefits: Total Compensation: Sincerely, Alex Smith President and CEO $3,365 $12,108 $47,108 Medical Insurance Health Benefits XYZ Company provides you with a comprehensive health care plan that includes prescription drug coverage to minimize the potential financial impact of medical costs for you and your eligible family members. The Company offers a choice between two plans, Plan A and Plan B. You are currently enrolled in medical Plan A with Employee and Family coverage. XYZ s $6,000 Dental Insurance In addition to medical coverage, XYZ Company offers a dental plan to help reduce your out-ofpocket dental care costs. You are currently enrolled in the dental plan with Employee and Family coverage. XYZ s $420 Flexible Spending Plan XYZ's Flexible Spending Accounts allow you to pay for unreimbursed medical and dependent care expenses with pre-tax dollars. All administrative expenses are paid by XYZ. You are currently participating in the medical care and dependent care flexible spending accounts. XYZ s $98 Income Protection Benefits Short Term Disability XYZ Company provides eligible employees with short term disability insurance, which is designed to stabilize your income in the event that you are disabled due to an off-the-job injury or illness. In the event of an off-the-job disability, you could be eligible for payments up to $500 per week for a maximum of 26 weeks. XYZ s $88 Long Term Disability Under the long term disability plan, if you are disabled for more than 180 days, you may be eligible to receive up to $1,750 (60% of your monthly earnings up to $6,000) per month until the age of 65, or until your disability ends, as defined in the contract. Please be aware that this benefit is integrated with statutory disability benefits such as Workers' Compensation and Social Security. XYZ s $193 Workers Compensation In the event of disability due to a work related injury or illness, you may be eligible for a weekly benefit up to the State maximum depending on the nature of the disability or accident. These benefits are generally paid for as long as the disability exists. XYZ s $671

7 Retirement Benefits XYZ Company maintains a 401(k) Savings Plan for eligible employees to assist you during your retirement years. In order to participate in the plan, you must be at least twenty-one years of age, have completed one full year of service, and have worked at least 1,000 hours during the plan year. The plan consists of two parts: You can set aside a percentage of your total wages up to the IRS limitation each year. Your contributions are made with pre-tax dollars and grow tax-deferred in your account. You are currently contributing 10% of your salary to your 401(k) Plan. XYZ Company will match 50% of your contributions not to exceed 6% of your total compensation. You will be fully vested in the company s contributions after five years of service. XYZ annual match is anticipated to be $1,750. XYZ s $1,750 Paid Time Off You are eligible for the following paid time off: Vacation Days Holidays XYZ s $3,365 Special Programs Direct Deposit Tuition Reimbursement Employee Assistance Program (EAP) Social Security & Medicare XYZ Company contributes an amount equal to your own total Social Security and Medicare contributions. A monthly Social Security benefit may go to you and/or your dependents when you retire, become severely disabled, or die. The amount of any benefits will depend on prior earnings, adjusted to account for changes in wages since XYZ s $2,678 Survivor Benefits XYZ Company provides eligible employees with Life & Accidental Death and Dismemberment Insurance. Your beneficiary may be entitled to receive $50,000 in the event of your death. If you are injured in an accident, your beneficiary may receive an additional $50,000 for loss of life or dismemberment. In addition, the Company offers you the option to purchase Voluntary Life Insurance coverage for yourself, spouse and dependent child(ren) through payroll deduction. You elected to purchase $50,000 of additional coverage on yourself, $25,000 on your spouse, and $10,000 of coverage on your child(ren). XYZ s $210 NOTE: Every effort has been taken to ensure that the information in this statement is accurate; however, no warranty or guarantee is implied or intended. Calculations are based on benefit plan provisions and your compensation as of 12/31/20XX. If a discrepancy is found to exist between your benefit statement and the benefit booklets or summary plan descriptions, the provisions of those documents will govern. Your Personal Benefit Statement X Y Z Jane Doe 123 Main Street Any Town, NY 15555

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