A two page guide designed by Unified Trust.

1. Unified Trust Company, N.A.
Fiduciary Monitoring Checklist
Previously, we, as the _____________________ <Plan Sponsor> for ____________________________ <Plan Name>
determined that hiring a fiduciary service provider was prudent and in the best interest of the plan, participants and
beneficiaries. The purpose of this checklist is to assist in evaluating the performance of the appointed fiduciary to
determine whether it continues to be prudent to retain this fiduciary.
Check each of these when completed, and attach supporting documentation as appropriate.
I.
N a m e o f Fi d u c i a r y : Unified Trust Company, N.A.
I I . T y p e o f Fi d u c i a r y S e r v i c e P r o v i d e r : ERISA §403(a)(1) Discretionary Corporate Trustee
I I I . R e v i e w Q u e sti o ns :
1 ) Does this party acknowledge its fiduciary status in writing?
c Yes
c No
2 ) Has the party provided or made accessible to the plan sponsor, upon request, a stan-
c Yes
c No
(Typically fiduciary status would be explicitly stated in the provider’s annual §408(b)(2) fee disclosure notice)
dard due diligence binder? Information to be included would be:
a. Records of a successful audit by the appropriate agency (SEC, FINRA, OCC,
etc.)
c
b. Certificate of insurance coverage verifying appropriate E&O and/or Fiduciary
Liability Insurance Coverage
c
c. Financial records demonstrating financial condition(ex. balance sheet)
c
d. Verification that the party, or its personnel have not been convicted of crimes
prohibiting their appointment under ERISA §411 (see checklist)
c
e. Notice of any pending or current claims, lawsuits or litigation against it
c
f. An organization chart and biographies of key personnel and professional staff
c
3 ) Are the fees and services being delivered consistent with what has been previously
c Yes
c No
c Yes
c No
a. A copy of the party’s ERISA §408(b)(2) fee disclosure notice.
c Yes
c No
b. Current Investment Policy Statement
c Yes
c No
c. Written policy of procedures and practices to avoid ERISA violations, prohibited
transactions and conflicts of interest.
c Yes
c No
d. Policy on how revenue sharing from investments is handled
c Yes
c No
c N/A
e. Safe Harbor notice
c Yes
c No
c N/A
f. Qualified Default Investment Alternative (QDIA) notice
c Yes
c No
c N/A
g. Intention to comply with ERISA §404(c) notice; and participants informed
c Yes
c No
c N/A
h. ERISA §404(a)(5) participant fee disclosure notice
c Yes
c No
c N/A
agreed upon?
The plan sponsor confirms that it believes that these fees are reasonable for the
services provided.
4 ) The plan sponsor has been provided with the following notices and policies as
applicable:
c N/A

2. Fiduciary Monitoring Checklist (cont.)
5 ) Investments
The plan sponsor receives regular (at least quarterly), written reports:
a. The report provides investment results for the quarter and trailing years.
c
b. Confirms that Investment Policy Statement is being adhered to including specific
identification of funds that are on the ‘Watch’ or ‘Replacement’ list
c
c. Contains economic outlook and other commentary
c
d. The report contains the expenses associated with each investment and appropriate
benchmark for comparison
c
I V . C o n c l u si o ns :
The plan sponsor confirms that it has prudently monitored the party identified in Section I. of this report and has drawn the
following conclusion. Check one:
c
The plan sponsor confirms that the engagement of Unified Trust Company, N.A. remains prudent and will continue.
c
The plan sponsor has concluded that Unified Trust Company must improve in the following areas or be subject to
termination or replacement. Specify matters requiring improvement, and the time to be allowed to demonstrate
improvement.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_________________________________________________________________
___________________________________
Plan Sponsor Signature (authorized signer)
_____/_____/_______
Date
Your goals are our goals.
www.unifiedtrust.com