Best Interest Contract (BIC) Exemption: Acknowledgement and Documentation

John and Jane Doe

Jesse James, CFP®

01/01/1900

The proposal recommended by your advisor will be analyzed against your current plan and a reasonable alternative. If you are already considering an alternative, please inform the advisor assisting you. If not, a reasonable alternative will be selected for analysis purposes based on the needs you have expressed. If qualitative and quantitative information for the alternative you are considering is not available, the advisor assisting you may need to make assumptions based on reasonable industry standards and benchmarks.

Are you required to move your assets from your current plan? YES / NO

Qualitative Analysis:

Current / Proposed *pending analysis / Alternative
Certified Financial Planner (CFP®) / YES
Level Fee / YES
3(38) FiduciaryI / YES
Registered with SEC / YES
Financial Planning Services Available / YES

The DOL’s conflict of interest final rule and related exemptions are designed to protect investors by requiring all who provide retirement investment advice to plans, plan fiduciaries and IRAs to abide by a "fiduciary" standard—putting their clients' best interest before their own profits. In order for a recommendation to constitute fiduciary investment advice, it must be rendered for a fee or other compensation. Level fee fiduciaries who wish to take advantage of streamlined exemptive conditions will be required to disclose their fiduciary status to retirement investors, and document the reasons for the recommendation of a rollover from an ERISA plan to an IRA, or from another IRA or from a commission-based account to a fee-based account.

A 3(21) investment fiduciary is a paid professional who provides investment recommendations to a retirement plan sponsor/trustee. The sponsor/trustee retains ultimate decision-making authority for the investments. Both 3(21) and 3(38) investment managers have fiduciary responsibility. The key distinction – and advantage – of appointing of a 3(38) investment manager is the shifting of fiduciary responsibility. By appointing a 3(38) investment manager, the plan sponsor and all other plan fiduciaries are relieved of all fiduciary responsibility for the investment decisions made by the investment manager.

What is the dollar value of the retirement plan in question? $______

What are the annual administrative expenses of your current plan? $______OR ______%

Does your employer pay for all of some of the plan’s expenses? YES / NO

If yes, how much? $______OR ______%

*If your current plan’s administrative expenses are not available, a reasonable benchmark relative to your plan will be used to estimate.

Quantitative Analysis:

These figures are only as accurate as the sources from which they are derived. Fees and operating expense ratios may be subject to change.

Current / Proposed *pending analysis / Alternative
Investment Vehicle/s / Stocks/mutual funds/ bonds/CDs/ Annuities/ Cash/ etc. / Mutual Funds/ Bonds/ CDs/ Cash
Annual Assets Under Management Fee/ Administrative Expense / 0.25% - 0.75%
*Benchmark if current plan fees are unavailable
Commissions as Dollar or Percent / N/A
Net Operating Expense of Portfolio
Additional Fees / Hourly Financial Planning –
(Upon Request)
Services Provided / Investment management & quarterly portfolio reviews.
(Education, tax, insurance, retirement, & estate planning upon request – additional fees apply)

Recommendation:

Based on quantitative and qualitative analysis

KMH Wealth Management, LLC is a level-fee fiduciary. In order to provide retirement investment advice as a level-fee fiduciary and maintain compliance with the Department of Labor, the above information will be documented and recorded to support any recommendation regarding the transfer or rollover of any retirement plan or IRA. This information has been developed by the U.S. Department of Labor, Employee Benefits Security Administration. For more information, please visit:

By signing, I agree that I believe this information to be true and accurate to the best of by knowledge.

Client/ Prospect ______Date______

Advisor ______Date______