Proposed Retirement Plan Fee Disclosure Notice

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1 Proposed Retirement Plan Fee Disclosure Notice The ABC Company 401(k) Plan (the Plan ) Contract Number For Services Provided by United of Omaha Life Insurance Company ( United of Omaha ), a Mutual of Omaha Insurance Company subsidiary, its Affiliates and Subcontractors Why Are You Receiving this Fee Disclosure Notice? The Department of Labor recently finalized a regulation under ERISA 408(b)(2) to assist the Responsible Plan Fiduciary in determining the reasonableness of arrangements between an employee benefit plan and its service providers. The regulation generally requires entities contracting directly with a plan for certain services to make written disclosures to the Responsible Plan Fiduciary in order to describe the compensation paid and the services received by the plan. Because United of Omaha provides services to the Plan, United of Omaha is providing you, the Responsible Plan Fiduciary, with this Fee Disclosure Notice. Herein you will find a description of the services performed for the Plan by United of Omaha, its Affiliates and its Subcontractors, as well as a description of the compensation paid to each party in exchange for those services. If the Plan has contracted with other service providers for additional services, including investment options outside of the United of Omaha product investment platform, you should request a summary of the fees related to their services directly from those providers. What is a Bundled Product? The retirement product offered by United of Omaha is commonly referred to as a bundled product ; a bundled product offers the advantage of receiving multiple services from one provider. The Plan pays fees to United of Omaha, and United of Omaha, in turn, pays other vendors for the services provided to the Plan. Accordingly, except where specifically noted, the fees disclosed in this Fee Disclosure Notice are paid out of the fees the Plan pays to United of Omaha. Table of Contents Terms used in this Fee Disclosure Notice are defined in the Glossary of Terms. Fee Summary... 2 Plan Demographics... 2 Estimated Annual Fees... 2 Administrative Fee Summary... 3 Investment Fee Summary... 3 Fees Paid by United of Omaha... 8 Value of Recordkeeping Services... 8 Optional and Transaction Based Fees... 9 Fees Charged Upon Termination of Services... 9 Services Provided to the Plan Investment Performance, Fees and Expenses, and Trading Restrictions Annuity Options Glossary of Terms In the event you have any questions about the information contained in this Fee Disclosure Notice, please contact Sales Desk at or Date: 04/16/2012 Full Service Sample Page 1

2 FEE SUMMARY Plan Demographics The fees provided in this Fee Disclosure Notice are based upon the following demographics for the Plan, (Assets reflected are Plan Assets), as provided to United of Omaha by either the Plan or the Plan s advisor. The fees may change if the demographics change; please request an updated Fee Disclosure Notice if these demographics are incorrect. Estimated Transferred Assets $2,000,000 Estimated annual deposits $100,000 Number of participants with an account balance 100 Administrative Fee % Estimated Annual Fees 1. Net Administrative Fee 2 $0 2. Advisor Compensation 3 $7, Investment Fees 4 17,630 Less: Pricing credit ($1,025) Adjusted Investment Fees $16,605 Sub-total: Asset Based Fees 5 $23, Recordkeeping Fees Plan Recordkeeping Fee $0 Participant Recordkeeping Fees $3,000 Supplemental services fees $0 Sub-total: Recordkeeping Fees $3,000 Total Dollar Cost to Plan $26,780 Total Cost to the Plan as a Percentage of Plan Assets 1.31% Total Average Cost Per Participant $268 Unless otherwise indicated herein, the Administrative Fee and the Investment Fees are netted from the investment return, and the Recordkeeping Fees are billed to the Plan. Fees are subject to change as provided in the Contract or Recordkeeping Services Agreement; however, once the Contract and Recordkeeping Services Agreement are effective, advance notification of changes will be provided to the Plan. Advisor Compensation shown above is a recurring Asset Based Fee. In addition to this amount, the advisor is paid 0.67% on deposits made to the Contract in the first 12 months; this Deposit Based Fee is paid to the advisor for services provided to the Plan in transitioning the Plan to United of Omaha. 1 The Administrative Fee is equal to the sum of the Net Administrative Fee plus the Advisor Compensation stated in this Fee Disclosure Notice, and is the same as the administrative fee stated in Section 5.01 of the Contract. 2 Net Administrative Fee is based upon Plan Demographics as stated above. 3 Additional information regarding Advisor Compensation, if applicable, may be found under Fees Paid by United of Omaha section of this Fee Disclosure Notice, as well as the Commission Acknowledgement, if applicable, within the Fiduciary Acceptance Package. 4 Investment Fee illustrated is an average, based on equal investment of Plan Assets in all investment options illustrated in this Fee Disclosure Notice. Actual Investment Fees will differ depending on investment options selected and asset levels within each investment option. See the section of this Fee Disclosure Notice entitled Investment Fee Summary for additional information. Dollar amount calculated by multiplying Average Investment Fee from Investment Fee Summary by the sum of Transferred Assets plus one-half of the annual deposits, as stated in Plan Demographics section above. 5 Calculation based upon Transferred Assets plus one-half of the annual deposits, as stated in Plan Demographics section above. Date: 04/16/2012 Full Service Sample Page 2

3 Administrative Fee Summary Initial Administrative Fee 0.30% Administrative Fee Schedule: Contract Assets Administrative Fee $0-$249, % $250,000-$499, % $500,000-$999, % $1,000,000 and above 0.30% Note: Plan Assets are subject to one rate; Administrative Fee is not step-rated. Administrative Fee, as illustrated, includes Advisor Compensation. The Plan s Administrative Fee will be determined according to the schedule above. The initial Administrative Fee percentage is determined based on the estimated Transferred Assets, as stated in the Plan Demographics section above. The Plan s Administrative Fee may be adjusted according to this schedule once within the first twelve (12) months of the Contract term to reflect the actual total amount of Transferred Assets deposited to the Contract. United of Omaha will provide advance written notice of any adjustment in the Administrative Fee. Investment Fee Summary Each investment option identified below is available as a designated investment option for the Plan. United of Omaha has obtained the Management Fee Charged by Investment Manager from third-party sources. United of Omaha believes this thirdparty information to be reliable, but United of Omaha cannot guarantee the accuracy or completeness of such information. Additional investment information may be obtained from the investment prospectus, the collective trust, the Contract or the fund profiles. 6 The Investment Manager may pay a portion of the Management Fee Charged by Investment Manager to United of Omaha as revenue sharing for the services United of Omaha provides to the Investment Manager in recordkeeping the Plan s investments. If United of Omaha receives shareholder service fees from an Investment Manager, United of Omaha has lowered the United of Omaha Product Charge applicable to the investment. Such information is footnoted as applicable. Investment Option Managed Accounts Actively Managed Portfolios Stadion Capital Preservation Portfolio Stadion Conservative Portfolio Stadion Balanced Portfolio Stadion Moderate Growth Portfolio Stadion Growth Portfolio Investment Manager Stadion Money Stadion Money Stadion Money Stadion Money Stadion Money Shareholder Service Fee 7 paid to United of Omaha Management Fee Charged + by Investment Manager 8 United of Omaha Product Charge = Total Investment Fee 0.00% 0.17% % = 0.74% 0.00% 0.17% % = 0.74% 0.00% 0.18% % = 0.75% 0.00% 0.20% % = 0.77% 0.00% 0.17% % = 0.74% 6 Visit support for information about the investments available to the Plan. This link includes documents and information to help you evaluate the expenses associated with Plan investments, however United of Omaha makes no representation as to the completeness or accuracy of the information provided by the investment providers. 7 Shareholder Service Fee is paid by the Investment Manager to either United of Omaha or Matrix Settlement and Clearing Services, and is included in the Management Fee Charged by Investment Manager. 8 Percentage may change from time to time, as determined by the Investment Managers. United of Omaha will provide an updated Investment Fee Summary to the Plan each calendar year, if any expense changes occur during such year. In the meantime, you may find the most current Management Fee Charged by Investment Manager at https// Date: 04/16/2012 Full Service Sample Page 3

4 Professional Investment Portfolios Risk Based Portfolios Mutual Directions 1 9 Conservative 0.00% 0.13% % = 0.53% 30% - Bond Index State Street Global 0.00% 0.021% 0.126% 20% - Stock Market Index State Street Global 0.00% 0.012% 0.046% 50% - Stable Value Ameriprise Trust Company 0.00% 0.100% 0.125% Mutual Directions 2 - Moderately Conservative 0.01% 0.26% % = 0.70% 30% - Bond Index State Street Global 0.00% 0.021% 0.126% 15% - Stock Market Index State Street Global 0.00% 0.009% 0.035% 30% - Stable Value Ameriprise Trust Company 0.00% 0.060% 0.075% 5% - Growth RCM Capital 0.00% 0.021% 0.024% Management L.L.C. 5% - Small Company Wellington Management 0.00% 0.030% 0.024% Company, LLP 5% - Strategic Value Goldman Sachs Asset Management, L.P. 0.00% 0.020% 0.024% 5% - Artio International Artio Global Equity II 0.005% % 0.013% 5% - Causeway Causeway Capital International Value 0.00% 0.049% 0.018% Mutual Directions 3 Moderate 0.01% 0.33% % = 0.82% 40% - Bond Index State Street Global 0.00% 0.028% 0.168% 15% - Stock Market Index State Street Global 0.00% 0.009% 0.035% 10% - Growth RCM Capital 0.00% 0.042% 0.048% 10% - Small Company Management L.L.C. Wellington Management Company, LLP 10% - Strategic Value Goldman Sachs Asset Management, L.P. 7.5% - Artio International Artio Global Equity II 7.5% - Causeway Causeway Capital International Value Mutual Directions 4 Moderately Aggressive 20% - Bond Index State Street Global 15% - Stock Market Index State Street Global 15% - Growth RCM Capital Management L.L.C. 15% - Small Company Wellington Management 0.00% 0.060% 0.048% 0.00% 0.040% 0.048% 0.007% 0.080% 0.020% 0.00% 0.074% 0.026% 0.01% 0.40% % = 0.90% 0.00% 0.014% 0.084% 0.00% 0.009% 0.035% 0.00% 0.063% 0.072% 0.00% 0.090% 0.072% Company, LLP 15% - Strategic Value Goldman Sachs Asset Management, L.P. 0.00% 0.060% 0.072% 7.5% - Artio International Artio Global 0.007% 0.080% 0.020% 9 The average fee retained by Investment Manager is for illustrative purposes only and has been constructed according to the target allocations for each subaccount. Actual fees accrue according to each underlying offering s position each day and are subject to change. The management fee retained by Investment Manager displayed for each underlying manager is the product of the manager's fee multiplied by the target allocation for the fund. 10 Investment Manager pays Shareholder Service Fee to Matrix Settlement and Clearing Services; Matrix Settlement and Clearing Services retains 10% of this amount and pays United of Omaha 90% of this amount. Date: 04/16/2012 Full Service Sample Page 4

5 Equity II 7.5% - Causeway Causeway Capital International Value 0.00% 0.074% 0.026% 5% - Emerging Markets Causeway Capital Index 0.00% 0.010% 0.018% Mutual Directions 5 Aggressive 0.01% 0.51% % = 1.01% 15% - Stock Market Index State Street Global 0.00% 0.009% 0.035% 20% - Growth RCM Capital Management L.L.C. 0.00% 0.084% 0.096% 20% - Small Company Wellington Management 0.00% 0.120% 0.096% Company, LLP 20% - Strategic Value Goldman Sachs Asset Management, L.P. 0.00% 0.080% 0.096% 10% - Artio International Artio Global Equity II 0.01% 0.106% 0.026% 10% - Causeway Causeway Capital 0.00% 0.098% 0.035% International Value 5% - Emerging Markets Index Time Based Portfolios Mutual GlidePath 2005 Mutual GlidePath 2010 Mutual GlidePath 2015 Mutual GlidePath 2020 Mutual GlidePath 2025 Mutual GlidePath 2030 Mutual GlidePath 2035 Mutual GlidePath 2040 Mutual GlidePath 2045 Mutual GlidePath 2050 Mutual GlidePath 2055 Income Causeway Capital 0.00% 0.010% 0.018% 0.00% 0.53% % = 0.88% 0.00% 0.55% % = 0.90% 0.00% 0.56% % = 0.91% 0.00% 0.58% % = 0.93% 0.00% 0.57% % = 0.92% 0.00% 0.57% % = 0.92% 0.00% 0.55% % = 0.90% 0.00% 0.55% % = 0.90% 0.00% 0.55% % = 0.90% 0.00% 0.55% % = 0.90% 0.00% 0.55% % = 0.90% 0.00% 0.17% % = 0.52% 0.00% 0.16% % = 0.51% 0.00% 0.17% % = 0.52% 0.00% 0.18% % = 0.53% 0.00% 0.18% % = 0.53% 0.00% 0.19% % = 0.54% 0.00% 0.19% % = 0.54% 0.00% 0.19% % = 0.54% 0.00% 0.19% % = 0.54% 0.00% 0.19% % = 0.54% Date: 04/16/2012 Full Service Sample Page 5

6 Fixed Income / Bond s BlackRock High Yield Bond BlackRock Advisors Portfolio LLC 0.00% 0.59% % = 0.94% Bond Index State Street Global 0.00% 0.07% % = 0.49% Goldman Sachs High Yield Goldman Sachs Asset Management, L.P. 0.05% 0.71% % = 1.01% Guaranteed Account 11 United of Omaha 0.00% 0.00% % = 0.00% Lifetime Guaranteed Income United of Omaha Account % 0.00% % = 0.00% Metropolitan West Total Return Bond Metropolitan West Asset Management 010% 0.43% % = 0.78% LLC. PIMCO Total Return Pacific Investment Management Co LLC 0.00% 0.46% % = 0.81% Templeton Global Total Return Franklin Advisers, Inc. 0.15% % % = 1.00% Domestic Stock s (Equities) AllianceBernstein Small/Mid Cap AllianceBernstein LP Value 0.10% 0.85% % = 1.10% Allianz NFJ Dividend Value Allianz Global Inv Mgmt LLC 0.10% 0.71% % = 0.96% BlackRock Capital Appreciation BlackRock Advisors LLC 0.25% 0.72% % = 0.82% Dreyfus/The Boston Company Dreyfus Corp Small/Mid Cap Growth Portfolio 0.35% 0.81% % = 0.81% Goldman Sachs Small Cap Value Goldman Sachs Asset Management, L.P. 0.10% 1.04% % = 1.29% Growth RCM Capital Management L.L.C. 0.00% 0.42% % = 0.90% Growth Stock Index State Street Global 0.00% 0.05% % = 0.38% Harbor Capital Appreciation Harbor Capital 0.00% 0.67% % = 1.02% John Hancock Disciplined Value Mid Cap Lord Abbett Developing Growth Lord Abbett Value Opportunities MFS Value Mid Cap Stock Index Royce Total Return Small Cap Stock Index Small Company Stock Market Index Strategic Value T Rowe Price Growth Stock Target Small Capitalization Value Portfolio Value Stock Index Advisors Inc John Hancock Investment Mgt Svcs, LLC Lord, Abbett & Co LLC Lord, Abbett & Co LLC Massachusetts Financial Services Co State Street Global Royce & Associates, LLC State Street Global Wellington Management Company, LLP State Street Global Goldman Sachs Asset Management, L.P. T. Rowe Price Associates, Inc. Prudential Investments LLC State Street Global 0.10% 1.00% % = 1.25% 0.10% 0.74% % = 0.99% 0.10% 0.99% % = 1.24% 0.10% 0.69% % = 0.95% 0.00% 0.06% % = 0.41% 0.10% 1.17% % = 1.37% 0.00% 0.06% % = 0.43% 0.00% 0.60% % = 1.08% 0.00% 0.06% % = 0.29% 0.00% 0.40% % = 0.88% 0.15% 0.70% % = 0.90% 0.00% 0.76% % = 1.11% 0.00% 0.05% % = 0.38% 11 Monthly declared interest rates apply to the Guaranteed Account; declared interest rates are net of all fees. 12 Monthly declared interest rates apply to the Lifetime Guaranteed Income Account; declared interest rates are net of all fees. 13 Investment Manager pays Shareholder Service Fee directly to United of Omaha. Date: 04/16/2012 Full Service Sample Page 6

7 Vanguard Morgan Growth 0.00% 0.44% % = 0.79% Vanguard Windsor II 0.00% 0.35% % = 0.55% Waddell & Reed New Concepts Waddell & Reed Investment 0.00% 1.04% % = 1.39% Management Co William Blair Small-Mid Cap William Blair & Growth I Company L.L.C. 0.15% 1.10% % = 1.30% International Stock s (Equities) Artio International Equity II Artio Global 0.10% 1.06% % = 1.32% Causeway International Value Causeway Capital 0.00% 0.98% % = 1.33% Dodge & Cox International Stock Dodge & Cox 0.10% 0.65% % = 0.91% Emerging Markets Index State Street Global 0.00% 0.20% % = 0.55% Franklin International Small Cap Franklin Advisers, Inc. 0.15% 0.95% % = 1.15% Growth Harbor International International Developed Countries 50% - Artio International Equity II 50% - Causeway International Value International Emerging Markets International Stock Index Wells Fargo Advantage Emerging Markets Equity Specialty s Cohen & Steers Institutional Realty Shares (Real Estate) Harbor Capital Advisors Inc. Artio Global Causeway Capital SSgA s Management Inc State Street Global Wells Fargo s Management LLC Cohen & Steers Capital Management Inc. 0.00% 0.79% % = 1.14% 0.05% 1.02% % = 1.33% 0.050% 0.530% 0.130% 0.000% 0.490% 0.175% 0.00% 1.04% % = 1.39% 0.00% 0.09% % = 0.48% 0.15% 1.31% % = 1.53% 0.10% 0.75% % = 1.01% Franklin Growth (Equities) Franklin Advisers, Inc. 0.15% 0.70% % = 0.90% Lord Abbett amental Equity Lord, Abbett & Co LLC (Equities) 0.10% 0.76% % = 1.01% Nuveen Tradewinds Global All- Nuveen Cap (Equities) Advisors, Inc. 0.10% 0.99% % = 1.25% Oppenheimer Global Oppenheimers, (Equities) Inc. 0.15% 0.83% % = 1.03% Stadion Tactical (Tactical Stadion Money Asset Allocation) % 0.57% % = 1.51% Vanguard Global Equity (Equities) 0.00% 0.44% % = 0.79% Average Before Reduction 0.54% % = 0.86% Pricing Credit (0.05%) Average Investment Fee % % = 0.81% Visit for more information on all of the investment options available. 14 United of Omaha, and its Affiliate, Retirement Marketing Solutions, Inc. ( RMS ), receive indirect compensation from Stadion Money ( Stadion ) in exchange for marketing and distribution services United of Omaha and RMS provide for Stadion. Stadion pays United of Omaha 0.275% of Plan Assets invested in the funds managed by Stadion, and Stadion pays RMS 0.125% of Plan Assets invested in the funds managed by Stadion. 15 Simple average. Calculation assumes equal investment of Plan Assets in each investment option, including the Guaranteed Account and the Lifetime Guaranteed Income Account. Actual Average Investment Fee will differ depending on investment options selected and Assets within each investment option. An updated Fee Disclosure Notice will be provided to the Responsible Plan Fiduciary during the plan installation process, which will include an updated Investment Fee Summary based upon investment options selected for the Plan and estimated Assets within each investment option. Date: 04/16/2012 Full Service Sample Page 7

8 Fees Paid by United of Omaha United of Omaha pays the following fees to its Affiliates, Subcontractors and others, as indicated, out of the Administrative Fee and the Investment Fees United of Omaha collects as illustrated on Page 2, because United of Omaha offers a bundled product. If these fees were not paid by United of Omaha, the Plan would be charged directly for these services. For a description of the services provided by each payee, see the section of this Fee Disclosure Notice entitled Services Provided to the Plan. Payee Relationship to United of Fee Type Amount Omaha Ascensus, Inc. Subcontractor Plan Recordkeeping $1,350 Fee Ascensus, Inc. Subcontractor Flat fee $250 Ascensus, Inc. Subcontractor Recordkeeping Fee Subsidy $1,900 ($19 per participant) Ascensus, Inc. Subcontractor Installation and $1,500 Conversion Fees Matrix Settlement & Subcontractor Asset Based Fee 0.03% Clearing Services (MSCS) 16 Mesirow Financial Subcontractor Asset Based Fee 0.02% Investment Management, Inc. Retirement Marketing Solutions, Inc. Affiliate Deposit Based Fee (24 Months) 2.0% Advisor Compensation At the Plan s direction, United of Omaha will pay Advisor Compensation to John Smith, for services provided to the Plan by such advisor. The amount of the Advisor Compensation is detailed on page 2 of this Fee Disclosure Notice. The Plan s advisor will make a separate disclosure to the Plan regarding additional compensation, if any, the advisor receives and a description of services the advisor provides to the Plan. The advisor is neither an Affiliate nor a Subcontractor of United of Omaha. Value of Recordkeeping Services United of Omaha reasonably expects to provide recordkeeping services and subsidize the costs of the recordkeeping services to the Plan which means the Plan is not charged the full cost for Recordkeeping Services. The Department of Labor requires United of Omaha to provide you with a reasonable and good faith estimate of the cost of the Recordkeeping Services the Plan would pay if such costs weren t being offset by other compensation received by United of Omaha. If United of Omaha did not receive a portion of the Investment Fees, United of Omaha reasonably estimates the Plan would pay the following amounts instead of the Recordkeeping Fees listed on page 2: Plan Recordkeeping Fee** $1,800 Installation and/or conversion fee $1,500 Recordkeeping Fee Subsidy per participant $19 Loan processing and establishment fee $125 These amounts are the actual amounts charged to United of Omaha by its Subcontractor, Ascensus, Inc., for similar recordkeeping services provided to a plan with a similar number of covered participants and beneficiaries as the Plan. For a description of the recordkeeping services, see the section of this Fee Disclosure Notice entitled Services Provided to the Plan. **Each year, the Recordkeeping Fees will be the greater of $3,000 or the total of the Plan Recordkeeping Fee plus the total Participant Recordkeeping Fees. 16 As part of the compensation it receives for trustee and/or custodial services provided to the Plan, MG Trust, an affiliate of MSCS, retains any interest earned on the amounts in its disbursement account until checks are presented for payment, and interest earned in its contribution account until the amounts are invested. This interest is commonly known as float and is paid by the bank at which MG Trust maintains such accounts and/or the investments in which MG Trust invests in such accounts. These accounts generally earn interest at a rate between the money market rate and that of U.S. Treasury Notes, although the rate payable may differ from time to time. Date: 04/16/2012 Full Service Sample Page 8

9 Optional and Transaction Based Fees The fees on the chart set forth below are for optional services. For each service requested by the Plan or by a participant, the following fees are charged: Service Amount How Amount is Paid Loan processing and establishment fee $125 per loan Deducted from participant s account Distribution processing fee $50 per distribution Deducted from participant s account Prototype plan document amendment $400 per amendment Billed to Plan Volume submitter plan document Billed to Plan Initial preparation Annual fee Amendment IRS Determination Letter $1,300 $350 $500 per amendment $300-$2,300, depending on scope Special services and plan corrections $225/hour Billed to Plan Participant locator service $7 per participant Billed to Plan Plan or service termination $750 Billed to Plan Company stock unitization annual fee $3,000 Billed to Plan Custody of frozen plan asset annual fee $300 for single report $100 per participant for Billed to Plan Annuity purchase charge Participant investment guidance and/or advice offered by Stadion Money Self-directed brokerage services provided by TD Ameritrade Annual Plan fee multiple reports $250 for deferred annuity $450 for immediate annuity Deducted from participant s account 0.075% Deducted from participant s account $250 Billed to Plan Annual per participant fee $125 Deducted from participant s account Fees Charged Upon Termination of Services If the Plan terminates its Contract and/or the Recordkeeping Services Agreement with United of Omaha, the following fees may be charged: 1. Liquidation Charge. The liquidation charge is a Transaction Based Fee that may be imposed if the Plan terminates the Contract. This fee applies to any withdrawal from either the Guaranteed Account or the Lifetime Guaranteed Income Account, prior to the end of the account term, that does not qualify as a participant directed transfer, an annuity purchase withdrawal or a plan benefit withdrawal, as further detailed in the Contract. The amount is determined based upon a comparison of (a) the guaranteed interest rate in effect for new contributions as of the date of the withdrawal plus a rate not to exceed 1.25%, and (b) the guaranteed rate in effect for the five (5) year maturity term for the month of the withdrawal. If, as of any date, you would like to know whether a liquidation charge applies to the Plan and/or the amount of this charge, please contact us. 2. Recordkeeping Termination Charge. The recordkeeping termination charge is a Transaction Based Fee that may be imposed if the Plan terminates the Recordkeeping Services Agreement. The amount of the recordkeeping termination charge is $750. This charge is invoiced to the Plan during the termination process and covers the cost of the wire transfer, data feed to the new service provider and final reporting. Date: 04/16/2012 Full Service Sample Page 9

10 SERVICES PROVIDED TO THE PLAN Several entities provide services to the Plan. Set forth below is a description of the services performed for the Plan by United of Omaha, its Affiliates and its Subcontractors, as well as by certain investment managers. If the Plan has contracted directly with other service providers for additional services, you should request a description of those services and a summary of the fees related thereto directly from those providers. Provider United of Omaha Life Insurance Company* (some or all services subcontracted to Ascensus, Inc.) Description of Service Issues the Plan the Contract under which contributions and withdrawals are made; administers benefits under the Contract; provides an investment platform, including oversight of the guaranteed account investment; arranges services available under the bundled product. Provides recordkeeping services, including: General Services Client service team and toll-free phone number Plan administration guide Contribution calculation and processing Distribution processing Loan processing Plan sponsor website Annual Plan Review Qualified Default Investment Alternative (QDIA) investment options 5500 Audit package, if required ERISA 404(c) notice and checklist Plan installation and conversion Plan termination and deconversion Eligibility determination Participant Services Participant website Toll-free assistance exchanges Participant communication and education materials Personalized retirement savings planner projections (gap analysis) Web, phone and/or hard-copy enrollment English and Spanish enrollment services Quarterly participant statements 1099 service for distributions Government Filings and Plan Compliance Services Plan compliance testing, including ADP/ACP, 402(g), 415, and top heavy testing Legislative updates and required Plan amendments Form 5500 annual reports Prototype plan document and amendments Summary Plan Description for prototype plan documents Plan compliance assistance Matrix Settlement & Clearing Services (MSCS) Mesirow Financial Investment Management, Inc.** Consulting Services Legislative education Research/technical assistance Executes investment trades through the NSCC each day that the primary stock exchange is open; oversees cash settlement of executed trades; provides banking services for retirement plan assets, including contributions, disbursements and tax withholding and remittance to the IRS Optional service that offers co-fiduciary investment monitoring for plan sponsors under ERISA 3(21). Fee applies to Mesirow Elite List investment options only. Date: 04/16/2012 Full Service Sample Page 10

11 Ameriprise Trust Company*** Stadion Money *** Wellington Management Company, LLP*** *** Selects and monitors the securities and other assets underlying an investment option to meet specified investment guidelines and objectives Selects and monitors the securities and other assets underlying an investment option to meet specified investment guidelines and objectives Selects and monitors the securities and other assets underlying an investment option to meet specified investment guidelines and objectives Selects and monitors the securities and other assets underlying an investment option to meet specified investment guidelines and objectives *s deposited under the Contract that are held in United of Omaha s Separate Account K are deemed to be Plan Assets. Thus, United of Omaha is a fiduciary under ERISA but solely with respect to its custody of the funds in Separate Account K. All other services provided by United of Omaha and its Affiliates, including its record keeping and administrative services, are carried out solely at the direction of a Plan fiduciary, participant or investment manager, are ministerial in nature and are not provided as a fiduciary under ERISA. **Mesirow Financial Investment Management, Inc. is registered as an investment advisor under the Investment Advisors Act of 1940 and provides the optional ERISA 3(21) services as a co-fiduciary to the Plan. ***Investment Manager is a covered service provider, is registered as an investment advisor under the Investment Advisors Act of 1940, and provides services to the Plan in a fiduciary capacity with respect to the Plan s assets held in the account managed by such investment manager, as detailed in the Investment Manager Appointment and Acceptance form. Date: 04/16/2012 Full Service Sample Page 11

12 INVESTMENT PERFORMANCE, FEES AND EXPENSES, AND TRADING RESTRICTIONS The following information regarding the investment options offered by the Plan is provided to you, in order to assist you in complying with the requirements of the participant fee disclosure requirements of the regulation under ERISA 404(a). This table illustrates the performance of the investment options offered by the Plan and allows you to compare them with an appropriate benchmark. Applicable benchmarks and benchmark performance are listed below each fund, are italicized, and do not include any fees. There are no redemption fees, maximum sales charges, or deferred sales charges for any investment option. Trading restrictions, if any, that apply to an investment option are footnoted. Past performance does not guarantee how the investment option will perform in the future. Investments may lose money. This table also illustrates fee and expense information for each investment option offered by the Plan. Please visit for information about an investment option s issuer, objectives or goals, principal strategies, principal risks and portfolio turnover rate, as well as more current performance information. Investment Returns Net of 0.30% Administrative Fee Fees and Expenses Investment Option (inception date, if less than 10 years) Performance as of 12/31/11 Net Total Operating Expenses (Actual) Gross Total Annual Operating Expenses 1 year 5 year 10 year Since As a % Per As a % Per Benchmark inception $1,000 $1,000 Managed Accounts Actively Managed Portfolios Stadion Capital Preservation Portfolio 3.06% n/a n/a 3.26% 1.45% $ % $24.50 (08/31/07) S&P % n/a n/a 3.26% n/a n/a n/a n/a Stadion ConservativePortfolio (08/31/07) 3.06% n/a n/a 3.26% 1.45% $ % $24.50 S&P % n/a n/a 3.26% n/a n/a n/a n/a Stadion Balanced Portfolio (08/31/07) 3.06% n/a n/a 3.26% 1.45% $ % $24.50 S&P % n/a n/a 3.26% n/a n/a n/a n/a Stadion Moderate Growth Portfolio 3.06% n/a n/a 3.26% 1.45% $ % $24.50 (08/31/07) S&P % n/a n/a 3.26% n/a n/a n/a n/a Stadion Growth Portfolio (08/31/07) 3.06% n/a n/a 3.26% 1.45% $ % $24.50 S&P % n/a n/a 3.26% n/a n/a n/a n/a Professional Investment Portfolios Risk Based Portfolios Mutual Directions 1 S&P % 2.43% 3.26% n/a n/a n/a n/a n/a Mutual Directions 2 S&P % 2.43% 3.26% n/a n/a n/a n/a n/a Mutual Directions 3 S&P % 2.43% 3.26% n/a n/a n/a n/a n/a Mutual Directions 4 S&P % 2.43% 3.26% n/a n/a n/a n/a n/a Mutual Directions 5 S&P % 2.43% 3.26% n/a n/a n/a n/a n/a Risk Based Portfolios Mutual GlidePath 2005 (07/01/07) Mutual GlidePath 2010 (07/01/07) Mutual GlidePath 2015 (07/01/07) Mutual GlidePath 2020 (07/01/07) Date: 04/16/2012 Full Service Sample Page 12

13 Mutual GlidePath 2025 (07/01/07) Mutual GlidePath 2030 (07/01/07) Mutual GlidePath 2035 (07/01/07) Mutual GlidePath 2040 (07/01/07) Mutual GlidePath 2045 (07/01/07) Mutual GlidePath 2050 (10/01/09) Mutual GlidePath 2055 (10/01/09) Income % 2.43% n/a 3.61% 1.45% $ % $24.50 (10/27/03) % 2.43% n/a 3.61% 1.45% $ % $24.50 (10/27/03) % 2.43% n/a 3.61% 1.45% $ % $24.50 (06/07/06) % 2.43% n/a 3.61% 1.45% $ % $24.50 (10/27/03) % 2.43% n/a 3.61% 1.45% $ % $24.50 (06/07/06) % 2.43% n/a 3.61% 1.45% $ % $24.50 (10/27/03) % 2.43% n/a 3.61% 1.45% $ % $24.50 (06/07/06) % 2.43% n/a 3.61% 1.45% $ % $24.50 (10/27/03) % 2.43% n/a 3.61% 1.45% $ % $24.50 (06/07/06) % n/a n/a 3.61% 1.45% $ % $24.50 (08/18/10) S&P % n/a n/a 3.26% n/a n/a n/a n/a 17 RESTRICTION: participants who redeem, transfer or exchange any amount out of this investment option must wait 60 calendar days before transferring or exchanging any amount back into this investment option. Date: 04/16/2012 Full Service Sample Page 13

14 Fixed Income / Bond s BlackRock High Yield Bond Portfolio BarCap US Corporate High Yield 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Bond Index BarCap US Govt/Credit 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Goldman Sachs High Yield BarCap US Corporate High Yield 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Guaranteed Account US Treasury T-Bill Constant Maturity Rate 3 Year 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Lifetime Guaranteed Income Account US Treasury T-Bill Constant Maturity Rate 3 Year 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Metropolitan West Total Return Bond BarCap US Aggregate Bond 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a PIMCO Total Return BarCap US Aggregate Bond 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Templeton Global Total Return 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 BarCap Multiverse 3.06% 2.43% n/a 3.26% n/a n/a n/a n/a Domestic Stock s (Equities) AllianceBernstein Small/Mid Cap Value Russell 2500 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Allianz NFJ Dividend Value Russell 1000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a BlackRock Capital Appreciation Russell 1000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Dreyfus/The Boston Company Small/Mid Cap Growth Portfolio Russell 2500 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Goldman Sachs Small Cap Value Russell 2000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Growth Russell 1000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Growth Stock Index Russell 1000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Harbor Capital Appreciation Russell 1000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a John Hancock Disciplined Value Mid Cap Russell Midcap Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Lord Abbett Developing Growth Russell 2000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Lord Abbett Value Opportunities 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 (12/30/05) Russell 2500 Value 3.06% 2.43% n/a 3.26% n/a n/a n/a n/a MFS Value (04/01/05) 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 Russell 1000 Value 3.06% 2.43% n/a 3.26% n/a n/a n/a n/a Mid Cap Stock Index S&P Midcap % 2.43% 3.26% n/a n/a n/a n/a n/a Date: 04/16/2012 Full Service Sample Page 14

15 Royce Total Return Russell 2500 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Small Cap Stock Index Russell % 2.43% 3.26% n/a n/a n/a n/a n/a Small Company Russell % 2.43% 3.26% n/a n/a n/a n/a n/a Stock Market Index S&P % 2.43% 3.26% n/a n/a n/a n/a n/a Strategic Value Russell 1000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a T. Rowe Price Growth Stock Russell 1000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Target Small Capitalization Value Portfolio Russell 2000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Value Stock Index Russell 1000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Vanguard Morgan Growth Russell 1000 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Vanguard Windsor II Russell 1000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Waddell & Reed New Concepts Russell Midcap Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a William Blair Small-Mid Cap Growth I Russell 2500 Growth 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a International Stock s (Equities) Artio International Equity II MSCI AC World Ex USA 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Causeway International Value MSCI EAFE 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Dodge & Cox International Stock MSCI EAFE 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Emerging Markets Index (10/01/03) 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 MSCI Emerging Markets 3.06% 2.43% n/a 3.26% n/a n/a n/a n/a Franklin International Small Cap Growth 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 (10/15/02) MSCI EAFE Small Cap 3.06% 2.43% n/a 3.26% n/a n/a n/a n/a Harbor International MSCI EAFE 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a International Developed Countries MSCI EAFE 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a International Emerging Markets MSCI Emerging Markets 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a International Stock Index MSCI EAFE 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Wells Fargo Advantage Emerging Markets Equity MSCI Emerging Markets 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Specialty s Cohen & Steers Institutional Realty Shares FTSE NAREIT Equity REITs 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Date: 04/16/2012 Full Service Sample Page 15

16 Franklin Growth Russell % 2.43% 3.26% n/a n/a n/a n/a n/a Lord Abbett amental Equity Russell 3000 Value 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Nuveen Tradewinds Global All-Cap 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 (03/28/06) MSCI AC World 3.06% 2.43% n/a 3.26% n/a n/a n/a n/a Oppenheimer Global MSCI World 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Vanguard Global Equity MSCI AC World 3.06% 2.43% 3.26% n/a n/a n/a n/a n/a Stadion Tactical (01/15/08) 3.06% 2.43% n/a 3.26% 1.45% $ % $24.50 The cumulative effect of fees and expenses can substantially reduce the growth of a participant s account. Fees and expenses are only one of several factors that Plan participants should consider when making investment decisions. Visit the Department of Labor s web site for an example showing the long-term effect of fees and expenses at A glossary of investment terms relevant to investment options available in the Plan is available at This glossary is intended to help you and your participants better understand your investment options. ANNUITY OPTIONS One of the investment options available under the Contract, for investment by participants, is the Lifetime Guaranteed Income Account ( LGIA ). The LGIA is an investment option that permits participants or beneficiaries to allocate contributions toward the current purchase of a stream of retirement income payments guaranteed by United of Omaha. Guarantees of an insurance company are subject to the company s long-term financial strength and claims-paying ability. The following chart provides more information regarding the LGIA or you may visit for more information. Investment Option Objectives / Goals Pricing Factors Restrictions / Fees Lifetime Guaranteed Income Account ( LGIA ) To provide guaranteed retirement income for life. In addition, this investment option builds an account value by guaranteeing principal and paying a fixed rate of interest during the accumulation phase. Participants can elect to receive either the account balance at retirement or the guaranteed income for life commencing no earlier than age 65 The guaranteed income amount is calculated by multiplying contributions and transfers to the LGIA by agespecific annuity purchase factors. Annuity purchase factors for each age are based on mortality and interest rate assumptions. The participant's total guaranteed income is the sum of all guaranteed income amounts purchased at each age, adjusted for any withdrawals or transfers from the LGIA. Withdrawals from the LGIA reduce the guaranteed income amount by the percentage of the account value withdrawn. Contributions to this account cannot be made for 60 days following any withdrawal or transfer out. Payout amounts are calculated and displayed as a single-life annuity with payments guaranteed for 20 years. Other actuarially equivalent payout options are also available. If a participant elects to receive the guaranteed lifetime income payments, the account value will be used to purchase those income benefits and will no longer be available to the participant. A liquidation charge may be assessed on any employer-directed withdrawals. Date: 04/16/2012 Full Service Sample Page 16

17 GLOSSARY OF TERMS Administrative Fee an Asset Based Fee equal to the sum of the Net Administrative Fee plus Advisor Compensation; fee is based upon the expected total amount of Transferred Assets received by United of Omaha pursuant to the Contract. Actual Administrative Fee could differ as Plan Asset levels change during the term of the Contract. See Administrative Fee section of this Fee Disclosure Notice. Advisor Compensation Asset Based Fees that the Plan directs United of Omaha to pay to the advisor, or the advisor s firm. Affiliate an entity directly controlled by United of Omaha, or an officer, director, employee or partner of such entity, who provides services to the Plan. Asset Based Fee a type of fee that is calculated by multiplying the rate by the amount of Assets in the Plan or in an investment option within the Plan, as applicable. Assets - market value of monies invested in the Contract. Contract the unregistered group variable annuity product contract to be issued to the Plan. Deposit Based Fee - a type of fee that is calculated by multiplying the rate by the amount of deposits made by the Plan into the Plan s investments; assessed for a certain period of time, such as 12 months or 24 months. Investment Fees Asset Based Fees that vary based upon the funds selected by the Plan for investment by participants, as listed in the Investment Fee Summary; portion retained by investment manager and portion paid to United of Omaha. Mutual of Omaha Insurance Company the ultimate parent company of United of Omaha and Retirement Marketing Solutions, Inc. Net Administrative Fee - an Asset Based Fee equal to the Administrative Fee less Advisor Compensation; fee is based upon the expected total amount of Transferred Assets received by United of Omaha pursuant to the Contract. Equal to the administrative fee stated in Section 5.01 of the Contract. Participant Recordkeeping Fee a flat fee used to pay for participant-related recordkeeping services; this fee is based upon the number of participants with an account balance in the Plan. Plan The ABC Company 401(k) Plan. Plan Recordkeeping Fee a flat fee used to pay for Plan-level recordkeeping services. Recordkeeping Fees the total of the Plan Recordkeeping Fee, the Participant Recordkeeping Fees and the Recordkeeping Fee Subsidy; charged in exchange for the services provided to the Plan and the participants pursuant to the Recordkeeping Services Agreement. Recordkeeping Fee Subsidy an Asset Based Fee used to subsidize the Plan Recordkeeping Fee and the Participant Recordkeeping Fees; the amount varies by investment option and can range from 0.1% to 0.2% of the Plan Assets in a given fund. This fee is limited to a maximum of $19 per participant across all plans contracted with United of Omaha. Recordkeeping Services Agreement the agreement between the Plan and United of Omaha detailing the services related to maintaining participant accounts and processing participant transactions. Responsible Plan Fiduciary a fiduciary with authority to cause the Plan to enter into, extend or renew, the Contract. Retirement Marketing Solutions, Inc.- an indirect wholly-owned subsidiary of Mutual of Omaha Insurance Company. Separate Account K an insurance company separate account established by United of Omaha which reflects the investment experience of the assets allocated to it, is unaffected by any gains or losses in United of Omaha s general asset account or any other separate account, and is maintained in accordance with the laws of the State of Nebraska. Shareholder Service Fee - a type of fee paid for administrative services provided on an investment option s behalf representing a portion of the administrative fees that would otherwise be incurred by the investment option, including maintenance of individual plan and participant accounts. Subcontractor any person or entity, or their affiliate, who has entered into a contract with United of Omaha or an Affiliate of United of Omaha to provide services to the Plan. Date: 04/16/2012 Full Service Sample Page 17

18 Transaction Based Fee a type of fee that is based on the execution of a specific service or transaction only as requested by the Plan or a participant. Transferred Assets includes (i) monies paid to United of Omaha by the Plan as a single sum on a nonrecurring basis from existing Plan assets within the first twelve (12) months immediately following the first deposit date and directed to the maturity accounts or subaccounts under the Contract, or (ii) monies paid to United of Omaha as a result of participant directed rollovers which monies are directed to the maturity accounts or subaccounts under the Contract. The term Transferred Assets shall not include: (a) interest earned on deposits; (b) monies refunded to a Plan which either exceed contribution maximums as stated in the Contract or exceed any limitation imposed by federal or state regulation; (c) principal and interest maturing under a maturity account of the Contract which is directed to a new maturity account of the Contract; (d) monies directed to the holding account or activity account; or (e) monies received by United of Omaha in error. United of Omaha United of Omaha Life Insurance Company. A wholly-owned subsidiary of Mutual of Omaha Insurance Company. Date: 04/16/2012 Full Service Sample Page 18

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