401(k) PLAN FEE DISCLOSURE FORM Total Plan Expenses Role(s ...

401(k) PLAN FEE DISCLOSURE FORM

For Services Provided by Ascensus

Total Plan Expenses

Role(s) performed by service provider

? Custodian/Trustee

Investment

? Professional

? Record Keeper

Other

(Describe):

?

Third-Party Administrator

Assumptions

Total Plan Assets

$4,881,263.08

Eligible Employees

27

Annual Fees

Fund Name

AllianceBern Discovery Value A ABASX

BlackRock Basic Value Inv A MDBAX

BlackRock Capital Appreciation Inv A MDFGX

BlackRock Global Allocation Inv A MDLOX

BlackRock High Yield Bond Inv A BHYAX

Federated Capital Preservation Fd CL SP FCSPT

Franklin Moderate Allocation A FMTIX

Hartford Equity Income R4 HQISX

Invesco Equity and Income Fund A ACEIX

Invesco Real Estate Fund A IARAX

Invesco Small Cap Discovery A VASCX

Ivy High Income Y WHIYX

Ivy Mid Cap Growth Y WMGYX

John Hancock Bond Fund A JHNBX

Oakmark International Fund OARIX

Pioneer Oak Ridge Small Cap Growth A ORIGX

Putnam Capital Opportunities A PCOAX

Sentinel Government Securities A SEGSX

GM AB Discovery Value A (GMABASX)

GM BlackRock Capital Appreciation Inv A

(GMMDFGX)

GM

Federated Capital Preservation CL SP (GMFCSPT)

GM Hartford Equity Income R4 (GMHQISX)

GM Invesco Small Cap Discovery A (GMVASCX)

GM Ivy Mid Cap Growth Y (GMWMGYX)

GM John Hancock Bond Fund A (GMJHNBX)

GM Oakmark International Fund (GMOARIX)

GM Putnam Capital Opportunities A (GMPCOAX)

GM Sentinel Government Securities A (GMSEGSX)

Fund

Expenses(1)

Fund

Balance

Provider

%(2)

Provider

Fees

1.22%

0.83%

1.09%

1.14%

0.98%

0.95%

1.25%

1.08%

0.80%

1.25%

1.34%

0.95%

1.27%

1.03%

1.34%

1.40%

1.25%

0.85%

1.22%

1.09%

0.95%

1.08%

1.34%

1.27%

1.03%

1.34%

1.25%

0.85%

$341,740.95

$251,953.73

$290,710.60

$467,917.49

$187.24

$433,382.12

$24,316.17

$194,130.22

$85,855.55

$58,955.99

$91,747.13

$156,588.10

$217,596.25

$139,590.01

$615,724.76

$155,986.82

$578,139.48

$82.74

$48,650.86

$137,229.17

$15,918.65

$160,347.92

$33,449.57

$39,842.92

$85,026.66

$158,849.99

$38,828.24

$58,513.75

0.30%

0.25%

0.25%

0.25%

0.25%

0.10%

0.25%

0.25%

0.25%

0.25%

0.25%

0.25%

0.25%

0.30%

0.00%

0.25%

0.25%

0.20%

0.30%

0.25%

0.00%

0.25%

0.25%

0.25%

0.30%

0.00%

0.25%

0.20%

$1,025.22

$629.88

$726.78

$1,169.79

$0.47

$433.38

$60.79

$485.33

$214.64

$147.39

$229.37

$391.47

$543.99

$418.77

$0.00

$389.97

$1,445.35

$0.17

$145.95

$343.07

$0.00

$400.87

$83.62

$99.61

$255.08

$0.00

$97.07

$117.03

Provider fees paid from investment funds

$9,855.06

Provider fees deducted from participant accounts or paid by employer

$3,775.00

Total Fees

$13,630.06

(1)

Fund Expenses include the fund¡¯s expense ratio plus any ¡°wrap¡± fee charged by the provider. The expense ratio is determined

through an annual calculation, where a fund's operating expenses are divided by the average dollar value of its assets under

management. Fund expenses are taken out of a fund's assets and lower investor returns.

(2)

Provider % includes revenue sharing paid to the provider by the investment fund or wrap fees added by the provider. These

expenses lower investor returns.

401(k) PLAN FEE DISCLOSURE FORM

For Services Provided by Employee Fiduciary

Total Plan Expenses

Role(s) performed by service provider

Custodian/Trustee

Investment

? Professional

Record Keeper

Third-Party Administrator

Other (Describe):

Assumptions

Total Plan Assets

$4,881,263.08

Eligible Employees

27

Annual Fees

Fund Name

Vanguard Prime Money Market Fund(1)

Vanguard Total Bond Market Index Fund(1)

Vanguard 500 Index Fund(1)

Vanguard Extended Market Index Fund(1)

Vanguard Total International Stock Index Fund(1)

Vanguard Target Retirement Income Fund(1)

Vanguard Short-Term Gov¡¯t Bond Index Fund(1)

Vanguard Total International Bond Index Fund(1)

Vanguard Growth Index Fund(1)

Vanguard Value Index Fund(1)

Vanguard Target Retirement 2010 Fund(1)

Vanguard Target Retirement 2015 Fund(1)

Vanguard Target Retirement 2020 Fund(1)

Vanguard Target Retirement 2025 Fund(1)

Vanguard Target Retirement 2030 Fund(1)

Vanguard Target Retirement 2035 Fund(1)

Vanguard Target Retirement 2040 Fund(1)

Vanguard Target Retirement 2045 Fund(1)

Vanguard Target Retirement 2050 Fund(1)

Vanguard Target Retirement 2055 Fund(1)

Vanguard Target Retirement 2060 Fund(1)

Fund

Expenses(2)

0.17%

0.20%

0.05%

0.14%

0.14%

0.16%

0.12%

0.20%

0.10%

0.10%

0.16%

0.16%

0.16%

0.17%

0.17%

0.18%

0.18%

0.18%

0.18%

0.18%

0.18%

Provider fees paid from investment funds

Fund

Balance

Provider

%(3)

Provider

Fees

Balances

are

irrelevant.

Employee

Fiduciary

retains no

revenue

sharing!

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

Provider fees deducted from participant accounts or paid by employer

$5,405.01

Total Fees

$5,405.01

(1)

(2)

Fund represents an example of the low cost funds available at Employee Fiduciary.

Fund Expenses include the fund¡¯s expense ratio plus any ¡°wrap¡± fee charged by the provider. The expense ratio is determined

through an annual calculation, where a fund's operating expenses are divided by the average dollar value of its assets under

management. Fund expenses are taken out of a fund's assets and lower investor returns.

(3)

Provider % includes revenue sharing paid to the provider by the investment fund or wrap fees added by the provider. These

expenses lower investor returns.

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