401(k) SURVEY FORM

TO: ______________________________

We are reviewing the possibility of establishing a 401(K) PLAN. Briefly, the 401(k) plan would provide you:

• The opportunity to make DEDUCTIBLE CONTRIBUTIONS to your account in the plan of up to $0, or $0 if 50 or older.

• An available deduction which is GREATER THAN an IRA DEDUCTION.
• TAX FREE GROWTH on your funds until you withdraw them. Funds may also be rolled over, preserving tax free growth, after a separation from service.

• ACCESS TO YOUR FUNDS when you retire, terminate employment, become disabled, or need a loan.

• The possibility of an ADDITIONAL MATCHING CONTRIBUTION to your account by your employer.

• The ability to INVEST YOUR OWN ACCOUNT.

To help us decide if the 401(K) PLAN would have sufficient employee participation, please ANSWER THE TWO FOLLOWING QUESTIONS AS ACCURATELY as possible, and return the completed form.

1. Check the approximate amount of your salary that you would contribute to your account in the plan per pay period:

 
     ___0%   ___2.5%   ___5%   ___7.5%   ___10%  _____ other amount 
  
 

2. A "Matching Contribution" is one that the Employer makes on your behalf, based on some percentage of your 401(k) contribution. Would you increase your contribution in question 1 above, if your employer made a matching contribution to your account?

                                              ____ Yes      ____ No 
 

THANK YOU FOR YOUR HELP.