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401(k) Plan Participant

Re: Important Notice regarding Investment Advice

In an effort to assist you with 401(k) plan investing, we have enlisted the expertise of our consultant, Deschutes Investment Consulting LLC to assist you in planning for retirement.

Before you utilize these services, please read the following notice.

You acknowledge and understand that this client profile questionnaire is meant to be a general guide for allocation of 401(k) plan investments. In addition, you acknowledge that in making recommendations, Deschutes is a Registered Investment Advisor (RIA) and is acting in an independent capacity to the plan and the plan or its representatives do not specifically approve/disapprove of the suggestions made by the RIA. The Plan is intended to operate under the guidelines and protections of Section 404(C) of ERISA. (For a full description of 404(c) please refer to your summary plan description (SPD)).

This financial analysis compares your investments and savings strategy with your financial priorities and concerns. It provides a broad, general guideline that may be helpful in shaping your financial thinking about investment objectives and risk tolerance. The reports and graphs are dependent upon the quality and accuracy of the data you supply.

Calculations illustrating investment performance are estimates only. Past performance is not a guarantee of future results. This analysis is for estimating purposes only and must be reviewed periodically. Your accountant and attorney should be consulted regarding legal and tax implications. A current prospectus should be read carefully when considering any investment securities.

No liability is assumed resulting from the use of this information contained in this analysis. You ultimately assume responsibility for your financial decisions and it is important to revise your plans periodically in light of your experiences and changing goals.

Retirement Assistance Questionnaire

Personal Information:

Children/Grandchildren (Names and birthdates):

Investment Experience
Have Experience
Net Worth (less primary residence)

1. Disability Insurance

2. Long Term Health Care

3. Updated Will

4. Expected Inheritances

If Yes,How much and When?

Type Balance Rate Payment Balance Term
$ % $ $
$ % $ $
$ % $ $
$ % $ $
$ % $ $
$ % $ $
  1. When would you like to retire? Your age Spouses age
  2. How much do you think you would like to spend during retirement? $(per year after tax)
  3. What is your current 401k account balance? $$
  4. How much are you deferring, per month, to your 401k? $
  5. How much is your employer contributing to your 401k? $$
  6. How much are you currently saving, per month, in additional funds? $
  7. What are your other sources of retirement income? (rental income, pensions, etc.)

  8. Attach your latest social security statement or retrieve your estimate online at www.ssa.gov/estimator.
  9. Tell us about your investments (IRAs, CDs, rental properties, etc.). Please provide copies of recent statements
    •  $

    •  $

    •  $

    •  $

    •  $

    •  $

Other Notes :

Privacy Notice

We, like other professionals who advise on personal financial matters are required to inform our clients of our policies regarding the privacy of client information.

In the course of providing our clients with certain advice, we may receive nonpublic personal financial information from our clients, their accountants and other representatives, such as financial statements, tax and income information and other personal financial information. All nonpublic personal information that we receive regarding our clients or former clients is held in strict confidence in accordance with our professional obligations, and is not released to people outside the Firm, except with your consent or as required by law or to explain our actions to professional organizations that we are members of. We may share certain information with non-affiliated third parties who assist us in providing our services to you (such as administrative and client service functions) or marketing services, to advise you of our services, subject to the obligation of these third parties not to use or disclose such information for any other purpose.

We retain records relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases to comply with professional guidelines. In order to guard your nonpublic personal information from unauthorized disclosure, we maintain physical, electronic and procedural safeguards.

Our company’s business practices are described in our firm’s Form ADV Part 2. If you would like a current copy of this disclosure document, please call or write and we will be happy to send you one.

If your financial situation, goals, risk tolerance or investment time horizon has changed since you last spoke with us please contact us immediately. We need to know the details of your financial life to provide you with the individualized expert services you have come to expect from us.