Mercer s Executive Benefits and Perquisites Survey for Tax-Exempt Organizations

Transcription

1 Mercer s Executive Benefits and Perquisites Survey for Tax-Exempt Organizations Welcome to the Mercer Executive Benefits and Perquisites Survey for Tax-Exempt Organizations. Thank you for agreeing to participate. This survey is for non-health care organizations. If you are a health care organization and would like to participate, please follow this link. In this survey you will be asked to provide some general information about your organization. Then you will be asked to answer a series of questions about the following: Executive Severance Qualified Retirement Plans Nonqualified Retirement Plans Life Insurance Short-term Disability Insurance (Salary Continuation) Long-term Disability Insurance Long-term Care Insurance Medical Insurance Executive Perquisites If you are unable to sufficiently describe your benefits based on the questions provided, you will have the opportunity to provide additional comments at the end of each questions and attach documents at the end of the survey. If you have any questions as you complete the survey, please contact Christina Watts by telephone at or by at Christina.Watts@mercer.com. If you would like to view a PDF of the questionnaire to use as reference as you complete the survey, click here.

2 Please click here to see the Confidentiality and Data Protection details. Your agreement to participate in this study is conditional upon our terms for confidentiality and data protection, as follows: Confidentiality and Data Protection: Both Mercer and you ( Client ) are likely from time to time to disclose information and advice to the other party in the course of the provision of the survey. The party receiving the information ( the Receiving Party ) shall not divulge or communicate such information to any person, other than a person whose business requires that person to have the information to enable the services to be provided. This restriction does not apply to information which the Receiving Party must by law disclose, or to information which is either already in the public domain or enters the public domain through no fault of the receiving party. The Client acknowledges that Mercer will from time to time be required to disclose information relating to the survey or the Client to third parties, such as regulators. The Client also agrees that, notwithstanding the provisions of the previous paragraph, Mercer may disclose information about the terms of participation in the survey (and the survey) to any holding company of Mercer or any subsidiary of any holding company of Mercer. The Client also agrees that Mercer may use data provided by the Client and Mercer s other clients to build databases for use by Mercer staff; these databases are intended to benefit all clients by improving the quality of Mercer advice, but Mercer shall not disclose them to any third party in a manner which allows particular clients or individuals to be identified. This Agreement is made on the basis that each party is entitled to assume that the other has complied and will continue to comply with its obligations arising from the data protection and privacy laws in force from time to time to the extent that those obligations are relevant to this Agreement. To the extent that Mercer processes personal data controlled by the Client, Mercer confirms that it will act only on the instructions of the Client. Mercer also confirms that it has taken appropriate technical and organizational measures against unauthorized or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data. Mercer ensures all data collected in this questionnaire will be deemed confidential. The data will be incorporated into Mercer s database and utilized to produce aggregated statistics and analyses for various reports, including custom analyses. Mercer will maintain the highest levels of data security and ensure confidentiality of all data submitted. Your organization s name may appear in a list of participating organizations for these reports.

3 How would you like to proceed? Generate a password for me and start the survey. Use my password to continue the survey from where I left off. Please provide your name and address. Password enables you to log in to the survey many times until you submit it. You will receive your password by . *Required Company Name*: *: Contact Name*: Contact Information * Required Organization Name:* Contact:* Title:* * Phone Number:* Address:* City:* Zip:*

4 Table of Contents Contact Information Executive Severance Qualified Retirement Plans - Defined Contribution Qualified Retirement Plans - Defined Benefit Nonqualified Plans - 457(b) Nonqualified Plans - Defined Contribution Restoration Nonqualified Plans - Defined Contribution SERP Nonqualified Plans - Defined Benefit Restoration Nonqualified Plans - Defined Benefit SERP Broad-based Life Insurance Executive Life Insurance Broad-based Short-term Disability Insurance Executive Short-term Disability Insurance Broad-based Long-term Disability Insurance Executive Long-term Disability Insurance Broad-based Long-term Care Insurance Executive Long-term Care Insurance Broad-based Medical Insurance Executive Medical Insurance Executive Perquisites Additional Comments Thank You page

5 Please select the state: AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee

6 TX - Texas UT - Utah VT - Vermont VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming PR - Puerto Rico

7 General Information Organization type: * * Required Association Charity College/University Foundation Research Other, please specify: If you are a health care organization, please click here to complete the health care version of the survey. Number of full-time (or full-time equivalent) employees:* * Required Please specify the following: * Required Operating Expenses/Budget:* Round to the nearest million without a dollar sign or comma (e.g., $250,100,000 is entered as 250): All fiscal expenditures made (excluding capital expenditures) by the organization during the most recently completed fiscal year. Dollar Amount (in millions): Please specify the following: * Required Round to the nearest million without a dollar sign or comma (e.g., $250,100,000 is entered as 250) Assets:* millions USD

8 Executive Severance Does the organization have a formal or informal severance plan in which executives participate OR are severance benefits included in an employment contract?* * Required Yes No Please select the response that best describes the eligible group. CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) What types of termination trigger severance? CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director Tier 2 Executives (direct reports to Tier 1 Executives) Single trigger (Change in Control, regardless of termination) Double trigger (Change in Control in conjunction with involuntary termination) Nonrenewal of contract Involuntary termination without cause Involuntary termination with cause Good reason

9 Please complete the following: CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) What is the severance period in months? How is severance paid? Lump sum Pay continued Please complete the following: What elements of cash compensation are continued? CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Base salary Base salary and annual bonus Base salary, annual bonus and long-term incentive

10 If included, how is annual incentive pay determined? CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Most recent bonus paid Target bonus Average bonus for a select number of years Pro-rated for months eligible If average bonus for a select number of years is selected, please specify number of years: CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Number of years Are benefits continued during severance period? CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Yes No

11 If so, which benefits are continued? Health Dental Vision Life Longterm Disability Retirement Perquisites Other CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Are health benefits continued during the severance period for all employees that receive severance or just executives? All employees Executives only CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please describe perquisites: CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please describe other types of benefits: CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives)

12 Are severance benefits contingent upon a non-compete/non-solicitation agreement? CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Yes No Are the severance benefits enhanced upon a change-in-control? Yes CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) No If the severance benefits are enhanced, please describe: CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Does the severance agreement/plan provide for mitigation (i.e., If employed during the severance period, do benefits end or get reduced)? Yes No CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives)

13 If yes, how is mitigation handled? CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) The employee is provided with a minimum number of months of compensation How is mitigation handled? The employee is provided with a minimum number of months of compensation, however there is an offset once the employee is reemployed Other If other, please specify: Please provide any additional comments you may have regarding your severance benefits:

14 Qualified Retirement Plans - Defined Contribution Please answer the following questions for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization sponsor a qualified defined contribution (DC) retirement or savings plan (401(a), 403(b), OR 401(k)) for salaried employees, including executives?* * Required Yes No Please select the response(s) that best represents the employer contribution to the plan. Check all that apply No employer contributions (employee voluntary deferrals only) Matching Contribution (e.g., 100% 100% of the first 4% of earnings deferred, 100% of the first 3% of earnings deferred; 50% of the next 2% of earnings deferred) % of the first: % of earnings deferred: % of earnings: % of earnings deferred: Discretionary Contribution (e.g., 5% of earnings) Non-Matching Contribution (e.g., 5% of earnings) Other please specify (e.g., 3% for years 1-4, 5% for years 5-9, etc.): % of the next: % of earnings deferred: % of earnings for most recent year: Please select the components used for the definition of earnings for the DC plan. Base earnings Annual bonus Long-term incentive What are the vesting provisions (i.e., the conditions under which benefits are available to participants) of the plan? Immediate Cliff (vests after a period of time), please specify years: Graded (vests over a period of time), please specify years: Other, please specify:

15 Please provide any additional comments you may have regarding your qualified DC benefits:

16 Qualified Retirement Plans - Defined Benefit Please answer the following questions for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization sponsor a qualified defined benefit (DB) pension plan (formula driven (e.g., % x pay x service), cash balance, etc.) for salaried employees, including executives?* * Required Yes No Please select the one response that is most representative of the benefit formula for your DB pension plan: Non-Integrated Final Pay Formula (please complete specifics below): Integrated Final Pay Formula Cash Balance Formula (please complete specifics below, e.g., 5% of annual earnings; years 1-4, etc.) Other, please specify: Please complete specifics below for Non-Integrated Final Pay Formula: % X Final Average Earnings (FAE) X years of service: Maximum number of years of service (if no max, enter 1000): Please complete specifics below for Integrated Final Pay Formula: % X Final Average Earnings (FAE) up to covered compensation X years of service: % X FAE over Covered Compensation X years of service: Maximum number of years of service (if no max, enter 1000): Please select the criteria on which the cash balance formula is based: Age only Service only Age + service

17 Please complete the cash balance contribution schedule: Contribution Rate Criteria Minimum How is mitigation handled? Criteria Maximum Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers Possible answers: Possible answers: or No maximum % % % % % % % % % % % Please specify the interest crediting rate for cash balance plan (e.g., 30-year treasury, minimum 4%, etc.) Please select the component used for the definition of earnings for the DB plan. Check all that apply Base earnings Annual bonus Long-term incentive

18 What are the vesting provisions (i.e., the conditions under which benefits are available to participants) of the plan? Immediate Cliff (vests after a period of time), please specify years: Graded (vests over a period of time), please specify years: Other, please specify: Please describe the following components of the DB plan: Final Average Earnings: # of years included in averaging period (if applicable) Possible answers: 1 5 or Career Earliest age to receive unreduced benefits: Earliest age to received reduced benefits: Reductio n Formula (e.g., 0.5% per month from age 62) Life annuity Life with 5-year certain Normal form of payment for single employee: Life with 10-year certain Life with 15-year certain Life with 20-year certain 50% joint & survivor 75% joint & survivor 100% joint & survivor Lump sum Please provide any additional comments you may have regarding your qualified DB benefits:

19 Nonqualified Plans - 457(b) Please answer the following questions for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization provide a 457(b) plan to executives (i.e., a plan that allows voluntary employee deferrals and employer contributions up to $17,500 for 2014)?* Yes No Please select the response(s) that best describe the eligible group(s). Check all that apply CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please answer the following questions: Does it allow for employee voluntary deferrals? CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Yes No Amount of Employer Contribution, if applicable. If not, please enter None Base salary Definition of earnings Base salary and annual bonus Base salary, annual bonus, and long-term incentives

20 If contributions exceed the 457(e)(15) limit ($17,500 in 2014), what happens to the excess? Contributions capped at 457(e)(15) limit (that is no excess contributions given) Excess contributions are paid to a 457(f) plan Excess contributions are paid in cash Please provide any additional comments you may have regarding your 457(b) plan:

21 Nonqualified Plans - Defined Contribution Restoration Please answer the following question for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization provide a nonqualified DC restoration plan to executives (i.e., a plan that restores employer contribution or match from the qualified DC plan for executives who are restricted due to benefit/earning limits)?* Yes No Please select the response(s) that best describes the eligible group(s). Executives who are limited due to IRS benefit/earnings limits CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please select the components used for the definition of earnings for the DC plan. Base earnings Annual bonus Long-term incentive Please select the response that best describes the interest credited to the account: Declared rate (Please specify as a whole number, e.g., 6% as 6): Floating rate (e.g., Prime, Treasury rate, Moody's) (please describe floating rate): Investment options (e.g., mutual funds) Other, please specify: What are the vesting provisions of the plan (i.e., the conditions under which benefits are available to participants)? Immediate Based on age (specify age): Based on service (specify service): Based on a combination of age AND service Based on age OR service: Other, please specify: Varies by individual participant, please specify:

22 Based on a combination of age AND service Please specify age AND service: Specify age: Specify service: Based on age OR service: Please specify age OR service: Age requirement (specify age): Service requirement (specify service): Is vesting service based on all service with the organization or plan participation service (i.e., years as a participant in the plan)? All service is considered Only plan participation service is considered Does the plan permit vesting on voluntary termination upon satisfaction of a noncompete or non-solicitation agreement? Yes No Please select the response that best describes the benefit distribution (after substantial risk of forfeiture no longer applies): Distribute only the portion of the benefit needed to cover taxes Distribute the entire accrued vested benefit Is the benefit increased, or is a tax adjustment provided, to compensate for early taxation upon vesting? Yes, please specify: No Please provide any additional comments you may have regarding your DC restoration benefits:

23 Nonqualified Plans - Defined Contribution SERP Please answer the following question for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization provide a nonqualified supplemental DC plan to its executives (i.e., a plan that provides more generous employer contributions than the qualified or restoration DC plans or targets a specified benefit at retirement (e.g., a target benefit DC plan))?* Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please answer the following questions. CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) If nonmatching contribution, provide % of pay(e.g., enter 6 for 6% of pay) If target benefit provided through a DC plan (e.g., 60% of pay), please describe If other, please describe Base salary Definition of earnings Base salary and annual bonus Base salary, annual bonus, and longterm incentives

24 Please describe any offsets to the benefit. Qualified defined benefit Qualified defined contribution 100% Social Security 50% Social Security Nonqualified defined benefit Nonqualified defined contribution None Please select the one response that best describes the interest credited to the account. Declared rate (Please specify as a whole number e.g., 6% as 6): Floating rate (e.g., Prime, Treasury rate, Moody's) (please describe floating rate): Investment options (e.g., mutual funds) Other, please specify: What are the vesting provisions of the plan (i.e., the conditions under which benefits are available to participants)? Immediate Based on a combination of age AND service Varies by individual participant, please specify: Based on age (specify age): Based on service (specify service): Based on age OR service Other, please specify: Based on a combination of age AND service Please specify age AND service: Specify age: Specify service: Based on age OR service: Please specify age OR service: Age requirement (specify age): Service requirement (specify service): Is vesting service based on all service with the organization or plan participation service (i.e., years as a participant in the plan)? All service is considered Only plan participation service is considered

25 Does the plan permit vesting on voluntary termination upon satisfaction of a noncompete or non-solicitation agreement? Yes No Please select the response that best describes the benefit distribution (after substantial risk of forfeiture no longer applies): Distribute only the portion of the benefit needed to cover taxes Distribute the entire accrued vested benefit Is the benefit increased, or is a tax adjustment provided, to compensate for early taxation upon vesting? Yes (please describe): No Please provide any additional comments you may have regarding your DC SERP benefits:

26 Nonqualified Plans - Defined Benefit Restoration Please answer the following question for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization provide a nonqualified DB Restoration plan to its executives (i.e., a plan that restores benefits for executives whose qualified DB plan benefits are restricted due to benefit/earnings limits)?* Yes No Please select the response(s) that best describes the eligible group(s). Executives who are limited due to IRS benefit/earnings limits CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please select the components used for the definition of earnings for the DC plan. Base earnings Annual bonus Long-term incentive What are the vesting provisions of the plan (i.e., the conditions under which benefits are available to participants)? Immediate Based on a combination of age AND service Varies by individual participant, please specify: Based on age (specify age): Based on service (specify service): Based on age OR service Other, please specify: Based on a combination of age AND service Please specify age AND service: Specify age: Specify service: Based on age OR service: Please specify age OR service: Age requirement (specify age): Service requirement (specify service):

27 Is vesting service based on all service with the organization or plan participation service (i.e., years as a participant in the plan)? All service is considered Only plan participation service is considered Does the plan permit vesting on voluntary termination upon satisfaction of a noncompete or non-solicitation agreement? Yes No Please select the response that best describes the benefit distribution (after substantial risk of forfeiture no longer applies): Distribute only the portion of the benefit needed to cover taxes Distribute the entire accrued vested benefit Is the benefit increased, or is a tax adjustment/gross up provided, to compensate for early taxation upon vesting? Yes, please specify: No Please provide any additional comments you may have regarding your DB restoration benefits:

28 Nonqualified Plans - Defined Benefit SERP Please answer the following question for active plans only (i.e., plans that are available to new hires, not those that are closed to new participants or have no future benefit accruals). Does the organization provide a nonqualified supplemental DB plan to its executives (i.e., a plan that provides more a generous benefit accrual than the qualified DB plan or restoration)?* Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please answer following questions. CEO/President/ Executive Director Tier 1 Executives (direct reports to CEO/ President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Percent of final average pay(e.g., enter 2 for 2%) Maximum years of service(if, no max, enter 1000) Base salary Definition of earnings Base salary and annual bonus Base salary, annual bonus, and long-term incentives

29 Please describe the following components of the DB plan: Final Average Earnings: # of years included in averaging period (if applicable) Possible answers: 1 5 or Career Earliest age to receive unreduced benefits: Earliest age to received reduced benefits: Reductio n Formula (e.g., 0.5% per month from age 62) Life annuity Life with 5-year certain Normal form of payment for single employee: Life with 10-year certain Life with 15-year certain Life with 20-year certain 50% joint & survivor 75% joint & survivor 100% joint & survivor Lump sum Please describe any offsets to the benefit. Qualified defined benefit Qualified defined contribution 100% Social Security 50% Social Security Nonqualified defined benefit Nonqualified defined contribution None

30 What are the vesting provisions of the plan (i.e., the conditions under which benefits are available to participants)? Immediate Based on a combination of age AND service Varies by individual participant, please specify: Based on age (specify age): Based on service (specify service): Based on age OR service Other, please specify: Based on a combination of age AND service Please specify age AND service: Specify age: Specify service: Based on age OR service: Please specify age OR service: Age requirement (specify age): Service requirement (specify service): Is vesting service based on all service with the organization or plan participation service (i.e., years as a participant in the plan)? All service is considered Only plan participation service is considered Does the plan permit vesting on voluntary termination upon satisfaction of a noncompete or non-solicitation agreement? Yes No Please select the response that best describes the benefit distribution (after substantial risk of forfeiture no longer applies): Distribute only the portion of the benefit needed to cover taxes Distribute the entire accrued vested benefit Is the benefit increased, or is a tax adjustment/gross-up provided, to compensate for early taxation upon vesting? Yes (please describe): No Please provide any additional comments you may have regarding your DB SERP benefits:

31 Broad-based Life Insurance Does the organization provide employer-paid broad-based life insurance coverage to salaried employees?* Yes No What coverage is provided? Active coverage Retiree coverage Please select the components used for the definition of earnings. Base earnings Annual bonus Long-term incentive Please specify the type and level of active employer-paid coverage provided to salaried employees. If executives receive a higher level of coverage please indicate on the next question: Multiple of Pay (e.g., 100% of base salary) Flat dollar amount, please specify: $ Other, please specify: Specify the percentage of pay: Is benefit subject to a maximum dollar amount? Yes, please specify: $ No Please provide any additional comments you may have regarding your broad-based life insurance benefits:

32 Executive Life Insurance Does the organization provide employer-paid executive life insurance (i.e., a plan that provides executives with benefits in excess of what other salaried employees receive)? This can be a higher level of coverage through an executive class in the group term plan or a separate plan that covers executives only. This also includes coverage through an executive flexible benefits allowance.* Answer NO if executives receive the same coverage level as other salaried employees. Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) What coverage does the plan provide? Active coverage Retiree coverage Please select the components used for the definition of earnings. Base earnings Annual bonus Long-term incentive Please specify the type and level of active employer-paid coverage? Multiple of Pay (e.g., 100% of base salary) Flat Dollar Amount (e.g., $50,000) Other, please specify:

33 Please specify for Multiple of Pay: Please define percentage of pay (e.g. 100%): If percentage of pay benefit is subject to a maximum (e.g. $1,000,000), please specify, if not please type None : CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/ Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please specify the flat dollar amount (e.g. $1,000,000): CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) If other employer paid coverage amount is offered, please specify: CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Is the benefit provided in this plan in addition to or offset by the benefit provided in the broad-based life insurance plan? In addition to broad-based life insurance plan Offset by or in lieu of broad-based life insurance plan Please provide any additional comments you may have regarding your executive life insurance benefits:

34 Broad-based Short-Term Disability Insurance (Salary Continuation Benefits) Do salaried employees receive short-term disability (salary continuation benefits)?* Yes, through an employer-sponsored plan Yes, through a state plan No, allowed to accrue PTO in lieu of short-term disability No Other, please describe: What is the waiting period before short-term disability commences? Enter the number: Is the benefit provided as a percentage of salary or a flat dollar amount? Percent of pay for a number of weeks (i.e. 80% of pay for the first 6 weeks, then 60% of pay for the next 6 weeks). Please specify: Flat dollar amount (i.e. $1,000 per week), please specify amount: Other, please specify: Please complete the schedule below. If the benefit varies by service, please summarize the maximum amount available: Text answer Text answer Text answer Text answer Percent of Pay Number of Weeks Possible answers: Weekly Maximum Dollar Amount % % % % Please provide any additional comments you may have regarding your broad-based short-term disability benefits:

35 Executive Short-Term Disability Insurance (Salary Continuation Benefits) Does the organization provide employer-paid executive short-term disability coverage (salary continuation benefits) for executives (i.e., a plan or agreement that provides executives with benefits in excess of what other salaried employees receive)? This can be a higher level of coverage through an executive class in the group term plan, a separate plan that covers executives only, or an agreement to continue pay. This also includes coverage through an executive benefits allowance.* Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please select the components used for the definition of earnings. Base earnings Annual bonus Long-term incentive What is the employer-paid benefit expressed as a percentage of covered pay (for 100%, enter 100)? Enter the percentage: Please provide any additional comments you may have regarding your executive salary continuation benefits:

36 Broad-based Long-term Disability Insurance Does the organization provide employer-paid broad-based long-term disability to salaried employees, including executives?* Yes No Please select the components used for the definition of earnings. Base earnings Annual bonus Long-term incentive What is the employer-paid benefit expressed as a percentage of covered pay (for 60%, enter 60)? Enter the percentage: Is there a maximum monthly plan benefit? Yes (please specify the maximum monthly plan benefit amount): No Please provide any additional comments you may have regarding your broad-based longterm disability benefits:

37 Executive Long-term Disability Insurance Does the organization provide employer-paid executive long-term disability (i.e., a plan that provides executives with benefits in excess of what other salaried employees receive)? This can be a higher level of coverage through an executive class in the group term plan or a separate plan that covers executives only. This also includes coverage through an executive flexible benefits allowance.* Answer NO if executives receive the same coverage level as other salaried employees. Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Please select the components used for the definition of earnings. Base earnings Annual bonus Long-term incentive What is the employer-paid benefit expressed as a percentage of covered pay? Enter the percentage: Is there a maximum monthly plan benefit? Yes (please specify the monthly plan benefit amount): No Is the benefit provided in this plan in addition to or offset by the benefit provided in the broad-based long-term disability plan? In addition to broad-based long-term disability plan Offset by or in lieu of broad-based long-term disability plan Please provide any additional comments you may have regarding your executive longterm disability benefits:

38 Broad-based Long-term Care Insurance Does the organization provide a broad-based long-term care insurance plan to salaried employees including executives?* Yes No Is the plan paid for by the organization, by the employee, or by both the organization and the employee? Organization Employee Both - Organization and Employee Please provide any additional comments you may have regarding your broad-based longterm care benefits:

39 Executive Long-term Care Insurance Does the organization have an executive long-term care plan (i.e., a plan that provides executives with benefits in excess of a plan covering all employees)? Includes coverage through an executive flexible benefits plan.* Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) Is the plan paid for by the organization, by the executive, or by both the organization and the executive? Organization Executive Both - Organization and Executive Please provide any additional comments you may have regarding your executive longterm care benefits:

40 Broad-based Medical Insurance Does the organization have a broad-based medical plan?* Yes No What coverage does the broad-based plan provide? Active coverage Retiree coverage (Pre-Medicare eligible) Retiree coverage (Post-Medicare eligible) Please provide annual employer premiums for active coverage for the most prevalent medical plan: Employee Only: Employee + Child: Employee + Spouse: Family: Please provide any additional comments you may have regarding your broad-based medical benefits:

41 Executive Medical Insurance Does the organization have an executive medical plan (i.e., a plan that provides executives with benefits in excess of the broad-based plan covering all employees)?* Yes No Please select the response(s) that best describes the eligible group(s). CEO/President/Executive Director Tier 1 Executives (direct reports to CEO/President/Executive Director) Tier 2 Executives (direct reports to Tier 1 Executives) What coverage does the plan provide? Active coverage Retiree coverage (Pre-Medicare eligible) Retiree coverage (Post-Medicare eligible) What coverage is provided to the executive s spouse? No coverage Active coverage Retiree coverage (Pre-Medicare eligible) Retiree coverage (Post-Medicare eligible) What type(s) of executive medical benefits do you provide? Increased employer subsidy to cover cost of broad-based plan Reimbursement of expenses not covered by broad-based plan Enhanced executive-only plan with richer benefits than broad-based plan Other, please describe: Please provide any additional comments you may have regarding your executive medical benefits:

42 Executive Perquisites Does the organization offer executive perquisites (i.e., perquisites not offered to all employees)?* Yes No Does the organization provide a perquisite allowance in lieu of individual perquisites? Yes No Please provide the annual dollar amount or percentage of pay of a perquisite allowance: CEO/President/Executive Director Tier 1 Executives Tier 2 Executives Provide annual dollar amount or percentage of pay

43 Indicate the perquisites that the organization provides, and provide annual dollar values where requested. Company car Car allowance CEO/Pres ident/ Executive Director Perquisite provided? CEO/Presi dent/ Executive Director Annual value? Tier 1 Executives Perquisite provided? Tier 1 Executi ves Annual value? Tier 2 Executives Perquisite provided? Country club Financial counseling Tax advice/ preparation Physical examination Spouse travel Housing/ housing allowance Luncheon/ dinner club Health/ fitness club First class air travel Dependent college tuition Sabbatical Legal services Driver/ chauffeur Other Tier 2 Executive s Annual value?

44 Does the organization provide executive vacation (more generous vacation accrual than other employees receive)? Yes No Please describe the additional executive vacation accrual: CEO/President/Executive Director Tier 1 Executives Tier 2 Executives Please describe, other perquisites CEO/President/Executive Director Tier 1 Executives Tier 2 Executives Please provide any additional comments you may have regarding your executive perquisites:

45 Additional comments Please provide any additional comments you may have regarding your benefits overall: If you would like to attach any supporting plan documents or SPDs, please do so below. Please attach document 1 here: Please attach document 2 here: Please attach document 3 here: Please attach document 4 here: Please attach document 5 here: If you have any questions, please contact Christina Watts by telephone at or by at Christina.Watts@mercer.com.

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