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Comprehensive Fact FinderPrepared for:Prepared by:Financial Brokerage, Inc.Gary Peterson, CLU, ChFC2837 s 156 cirOmaha, NE 68130Office: (402) 697-9998Office: (800) 397-9999gpeterson@fb-inc.comApril 15, 2008ContentsPagePersonal Information2Professional Advisors2Family Information3 -4Assets5Income and Capital Needs6Insurance7Investment Feelings and Preferences8Required Documents9Employee Benefit Programs Questionnaire10 - 11Business Information Questionnaire12 –16Employee Census17Important Information18Comprehensive Fact Finder for1

Personal InformationName (File No.):Address (Home):Address (Business):Phone (Home):Client:Spouse:Phone (Cell):Client:Spouse:Phone (Business):Client:Spouse:E-Mail Address:Client:Spouse:Dates of Sessions:Referred By:Professional AdvisorsNameAddressPhoneInsurance AgentP&C AgentAttorneyAccountantTrust OfficerOther Bank OfficerStockbrokerOtherComprehensive Fact Finder for2

Family InformationNameDate ofBirthCitizenshipOccupationHealthProblems orSpecialNeedsNo. and Ageof GrandchildrenAmount ofSupport rs, * Indicate if by prior marriage, adopted or stepchildComprehensive Fact Finder for3

Family InformationClient/Spouse Background DataCovered by Social pouse:YesNoYesHave Social Security Benefits been reviewed lately?SingleMARITALNoDivorcedWidowedMarriedDate married, divorced, widowed:Any former marriages? If yes, give details regarding alimony, child support, etc.Have you lived in another state? If so, where? Give details.Have you or your spouse ever made any gifts?CUSTODIANSHIPSNoWho is custodian?YesWho are the donees?NoAmounts?Are you or any of your immediate family beneficiaries of a trust?TRUSTBENEFICIARYYesNoIf so, whom? Include details.Are any family members likely to receive any gifts or inheritances?GIFTS ORIf yes, give details of who, what, when and from whom.INHERITANCESWhat is educational level?EDUCATION &MILITARYClient:Spouse:Any military service?YesNoIf yes, from toWILLS & MARITALAGREEMENTSDo you have a will?YesDoes your spouse have a will?YesHave you named guardians for children?Who?NoDate of Will:NoDate of Will:YesDo you have a pre- or post-nuptial agreement?If yes, provide details of the agreement.TRUSTSNoYesWho?NoHave any trusts been created by:ClientSpouseIf yes, give details of type, who is trustee and beneficiary.Salary:ANNUAL INCOMEClient Spouse Other:Client Spouse sets”pageonthisform.Comprehensive Fact Finder for4

ASSETS(Other than Life Insurance and Business Interests)ASSETSCURRENTVALUECOST OROTHERBASISOWNERSHIP % denceSecondaryResidenceOther RealEstateBonds -CorporateBonds -MunicipalBonds -GovernmentStocks -ListedStocks -UnlistedMutualFundsBank Accts - SavingsBalanceCheckingPersonalPropertyAutos andBoatsCollections - HobbyJewelry –Furs - ArtInterests inTrustsMortgages &NotesOtherAssets* H Husband; W Wife; C Children; For Jointly Owned Property, Indicate % Under AppropriateColumnComprehensive Fact Finder for5

Income and Capital NeedsIncome Needs at DeathWhat is your estimate of the monthly income that will be needed Client’sDeath:(1)B.Adjustment Period (adjustment of standard of living without your incomeduring the transitional period following your death)( ) years (2)Until your youngest child is self-supporting (3)To provide life income for surviving spouse after youryoungest child is self-supporting Client and Family:(1)(2)To provide family income in the event of you areseriously disabled Lifetime retirement income beginning at age Capital Needs at DeathEmergency Fund Final Expenses Mortgage Cancellation Fund Notes and Loans Payable Estate Taxes/Administrative Costs Accrued Taxes (income, real estate, etc.) Education Expense TOTAL Will Basic Health Care and Major Medical Coverage be continued for family after yourdeath?For you:Spouse and Children:Comprehensive Fact Finder forAfter Retirement?6

InsuranceLife InsuranceSuggestion: Review policies and most recent policy anniversary premium notices.InsurerInsuredDeath BenefitPremium Amount and ModeDate of IssueType PolicyOwner of Policy/Premium PayorPolicy NumberCash Value and DateLoans OutstandingAre any of the above policies issued other than on a standard or preferred basis?YesNoDisability Income emium Amount and ModeDate of IssueType Policy (Non-Can, G.R., other)Owner of Policy/Premium PayorPolicy NumberAny Health/Occupation ExclusionsDefinition of DisabilityHealth Care InsuranceInsurer or Service Type PlanInsuredBenefits (Rm & Bd., Overall Max)Premium Amount and ModeDate of IssueType Policy (Hosp., Major Med)Premium PayorPolicy NumberAny Health/Occupation ExclusionsLong-Term Care InsuranceInsurerInsuredCovered Services/Where PayableBenefit Amount/DurationPremium Amount and ModeElimination (Waiting) PeriodMaximum Lifetime Benefit?Guaranteed Renewable?Inflation Adjustment?Date of IssuePremium PayorPolicy NumberProperty & Casualty InsuranceInsurerTypePremium Amount and ModeDeductibleRenewal DatePolicy NumberComprehensive Fact Finder for7

Investment Feelings and PreferencesPlease indicate which of the following are closest to your investment feelings.I am very conservative. I am willing to give up a potentially higher rate ofgrowth in exchange for knowing my money will be available when needed.I am a moderate risk taker. I would like an investment that is aimed atprotecting my money but, at the same time, would offer some growthpotential.I believe in a balanced investment portfolio with some of my moneyguaranteed and some of it in higher risk/return investments.I am very aggressive. I am willing to seek very high growth even with thepossibility of high loss.From the following list of investment objectives, indicate your preferences in order (1through 8) of those most important to you.Liquidity (availability of cash when needed)Income Tax Deferral/ReliefCurrent IncomeCapital GrowthFuture IncomeSafety of PrincipalInflation Protection (protecting purchasing power)Other:Please indicate your preference for savings and investment vehicles by rating thefollowing list on a scale of 1 to 5, with 1 being strong preference and 5 slight. (Lineout those investments or savings devices you do not prefer at all.)PreferenceCheck If NowUsingCheck IfUnfamiliarSavings AccountCash Value of Life InsuranceGovernment BondsCorporate BondsTax-Exempt BondsMutual FundsVariable AnnuitiesCommon StocksReal EstateTax SheltersOther (specify)Comprehensive Fact Finder for8

Required DocumentsData RequiredPERSONAL DATA:ItemsNeededReceiptPERSONAL DATAYour WillYour WillSpouse’sWillSpouse’sWillTrust Agreement(s)Trust Agreement(s)Tax Returns (latest plusprevious 4 years)Tax Returns (latest plusprevious 4 years)Insurance PoliciesInsurance PoliciesCompanyPolicyNumberCompanyInformation Booklet –Pension PlanOther Employee BenefitsBookletsOther Employee BenefitsBookletsEmployment ContractEmployment ContractDeferred Compensationand/or IncomeContinuation ContractDeferred Compensationand/or Income ContinuationContractBUSINESS DATA:BUSINESS DATA:Buy-Sell AgreementBuy-Sell AgreementBalance Sheet (latest plusprevious 4 years)Balance Sheet (latest plusprevious 4 years)P&L Statement (latest plusprevious 4 years)P&L Statement (latest plusprevious 4 years)Insurance PoliciesInsurance PoliciesPolicyNumberCompanyClient InitialWhenReturnedPolicyNumberInformation Booklet –Pension PlanCompanyInitialPolicyNumberReceived by:Date:Comprehensive Fact Finder forDate:9

Employee Benefit Programs QuestionnaireCurrent Employee Benefit Plans(If both spouses work, use a separate sheet for each.)Whenever possible, agreements and supporting documents should be secured for review.A.Life, Health and Disability Insurance PlansIndividual PoliciesGroup InsuranceInsurance Company(s)Association PlanOther Carriers (past 5 years)?Describe Plan –(Eligibility, Benefits, Employee Contributions, Cost, etc.)B.Retirement PlansKeogh PlanIRAPension PlanTSAOtherProfit-Sharing Plan:401(k)Thrift PlanDate(s) Established?Who Provides Administration?Describe Plan –(Eligibility, Benefits, Cost, Employee Contributions, Vesting)C.Selective Benefit PlansSplit DollarSalary ContinuationNon-Qualified RetirementDeferredCompensationTravel AccidentOtherSick Pay Plan:Describe Plan –(Eligibility, Benefits, Cost, Employee Contributions, Vesting)Comprehensive Fact Finder for10

Employee Benefit Programs QuestionnaireClient Profile - Employee Benefits(If both spouses work, use a separate sheet for each.)A.What do you like most/least about your present employee benefit program?B.Regarding other employee benefit programs that your firm has either had in effectbut discontinued or considered and decided not to adopt, what were the mainreasons for such action?C.If your company was to consider adopting a new employee benefit program now orin the future, what would be your thinking and priorities regarding the following?Current Tax DeductionAbility to Pick and Choose ParticipantsCurrent OutlayEase of AdministrationUltimate CostFlexibility in DepositsCompany Control of FundsAmount of Govt. Reporting/DisclosureEmployee ContributionsD.Assuming a plan were designed to your satisfaction, how much would you like toallocate to such a program?After TaxBefore Tax Per Year% of rentmarginalincome tax bracket?%Other Comments:Comprehensive Fact Finder for11

Business Information QuestionnaireI. GENERAL INFORMATIONA.NAME OF FIRMAddressTelephoneFaxInterview WithNameTitleExtensionName of Secretary/ReceptionistB.NATURE OF pS CorporationP CorporationExtensionPublicCorporationClose CorporationTax-ExemptLimited Liability Co.Originally:History of Business, etc.Date Established:Date of Change:Future:Incorporate?Merge?Go Public?Sell to Associates?Give to Children?Date Change Expected:Accounting Year EndMethod:CashAccrualMonth/DayNumber of Employees:HourlySalariedOtherD.NowLast Year5 Years AgoEstimate2 Years FutureADVISORS:AttorneyAccountantBankerInvestment AdvisorInsurance AdvisorOtherComprehensive Fact Finder for12

Business Information QuestionnaireII. OWNERSHIP INFORMATIONA. PROPRIETORSHIP/PARTNERSHIP/LIMITED LIABILITY COMPANYOwnersDate ofBirthPositionHealth% OwnershipCost Basis forInterestDateAcquiredLast Dividendper ShareDate LastDividend1.2.3.4.5.B. CORPORATION ckSharesAuthorizedSharesIssued# of VotingSharesOtherNotesSTOCKHOLDERS(List common and preferred stock separately. Use additional sheet if teAcquiredPositionHealth* Voting or NonvotingComprehensive Fact Finder for13

Business Information QuestionnaireIII. COMPANY RETENTION OR DISPOSITIONA.Is there in existence a Buy-Sell Agreement relative to the disposition of yourbusiness rning the Agreement: per share or foryour entire interest.(1) Type:MandatoryOptionFirst Offer(2) Operative at:DeathDisabilityRetirement(3) Purchaser:Surviving Stockholders or PartnersKey EmployeeOther:Corporation (Redemption)TotalPartnership (Entity)Other(4) Is the purchase pricedetermined by:Dollar AmountPartial (Sec. 303)Formula*Book Value(5) Does purchase price realistically reflect value of business?(6) Does purchase price reflect good will?(7) Is Agreement funded?YesNoIf yes, indicate below:Life Insurance Amount Disability Buy-Out Amount Disability Income Amount Other (explain) (8) Does Agreement restrict lifetime transfer of your stock/business interest?(9) Date Agreement SignedMost Recent Review(10) Does Agreement conform with your present objectives? If not, provide detailsin“Remarks.”D.If your business is not currently incorporated, do you plan to incorporate?When?E.Are there any other Agreements concerning your business interest in effect?Please explain* Indicate formula used in determining purchase price.Comprehensive Fact Finder for14