<p>Scott Simmonds CPCU, ARM Learning About Your Bank</p><p>We have started the insurance review process. Thanks for your trust and faith. Now, I need to get to know your bank. The following questions have proven to help. Some give me info. Some prompt me to ask more questions. Don’t worry about making this pretty. I’m looking for the info so I can help you improve your insurance.</p><p>Contact me if you have any questions. Part of the service you are paying for from me is information and advice. I see my role as including education. I am only a phone call or email away.</p><p>By the way, as with all my work, the information you provide here is strictly confidential. This form will never be shared with an insurance agent or an insurance company – this info is for my eyes only.</p><p>← Scott Simmonds, CPCU, ARM ← Insurance Assurance Consulting ← Phone: 207-284-0085 ← [email protected] </p><p>General / Operational Issues </p><p>Provide a list of all of your corporate entities - indicate the ownership of the entity and the operations of each entity - include holding companies, banks, subsidiaries, joint ventures, charitable foundations, real estate holding companies, etc. </p><p>Entity Activity Ownership of Entity</p><p>Who in your team will be involved in the meeting where we review the insurance issues I identify? Names and role/title please. </p><p>Describe the ownership of the holding company or primary (# stockholders, closely held, mutual savings bank…) </p><p>Page 1 of 6 V9-16-2014 Estimated Number of Shareholders: ______</p><p>Any single person or entity own more than 20% of the Stock? ___ Yes ___ No </p><p>Are any “major” holders of bank stock not represented on the board? ___ Yes ___ No </p><p>Any private-equity investors in the bank? ___ Yes ___ No </p><p>Any contentious shareholders or shareholder anxiety percolating? ___ Yes ___ No </p><p>Do you have a charitable foundation that is funded by you? ___ Yes ___ No</p><p>Any regulatory actions taken against you in the past 2 years? ___ Yes ___ No</p><p>Are you operating under any kind of regulatory restrictions? ___ Yes ___ No</p><p>Please describe any construction projects or renovations planned for the next two years. </p><p>Please provide contact info for your insurance agent(s) - including email. </p><p>Please describe your relationship with your current insurance agent(s) </p><p>Would you consider changing insurance agents under the right set of circumstances?</p><p>Any mergers or acquisitions planned? ___ Yes ___ No If so, describe </p><p>Are you closing any locations? ___ Yes ___ No If so, describe </p><p>Any new locations planned? ___ Yes ___ No If so, describe </p><p>Any new ventures planned? ___ Yes ___ No If so, describe </p><p>Any joint ventures with other organizations? ___ Yes ___ No If so, describe </p><p>Any layoffs planned? ___ Yes ___ No If so, describe </p><p>Page 2 of 6 Do you have any leased employees? ___ Yes ___ No If so, describe </p><p>Are any of your employees attorneys? ___ Yes ___ No If so, describe </p><p>Do you have a courier who delivers mail, supplies, etc. between branches? ___ Yes ___ No </p><p>If so, is the courier an employee or contractor? ___ Contractor ___ Employee</p><p>Which of the following services do you provide:</p><p>___ Telefacsimile Funds Transfer ___ Voice Funds Transfer ___ Internet Banking Funds Transfer ___ Automated Voice Funds Transfer ___ Remote Deposit ___ Internet Banking Bill Pay ___ Auto Loans ___ Auto Leasing ___ Equipment Leasing ___ Recreational Vehicle Loans ___ Trust Services ___ Safe Deposit Boxes ___ Investments/Investment Advice ___ Life Insurance ___ Disability Insurance ___ Auto of Home Insurance ___ Crop Insurance ___ Travel Services </p><p>Does your bank serve as a trustee for any Irrevocable Life Insurance Trusts? ___ Yes ___ No</p><p>Do you provide "back-room" services to other banks? ___ Yes ___ No If so, describe </p><p>Do you manage real estate for anyone besides the bank? ___ Yes ___ No If so, describe </p><p>Do you have ATMs at non-bank locations? ___ Yes ___ No</p><p>Do you have safe deposit boxes at non-bank locations? ___ Yes ___ No</p><p>Do you have an exposure to foreign currency losses? ___ Yes ___ No If so, describe </p><p>Page 3 of 6 V9-16-2014 Do you have Bank Owned Life Insurance (BOLI) policies? ___ Yes ___ No If so, describe </p><p>Your Board:</p><p>How many board members do you have? </p><p>___ Management Board Members </p><p>___ Stockholder Board Members (Other Than Officers) </p><p>___ Outsider Board Members </p><p>Is insurance / directors’ and officers’ insurance an issue of worry by the board? ___ Yes ___ No </p><p>If so, describe how I can help. Would a conference call with the board help answer questions and allay fears? </p><p>Was this insurance review project initiated at the direction of the board? ___ Yes ___ No </p><p>Insurance Issues:</p><p>What are your specific insurance concerns and questions? </p><p>When was the last time you bid your insurance? </p><p>Do you have any claims that are pending or that you are worried about? </p><p>Property Issues:</p><p>Are any of your buildings built to "green" or LEED standards? ___ Yes ___ No If so, describe</p><p>Do you own a portable generator, tractors, mowers, or other portable equipment? (One of my bank clients has their own $3,000 BBQ smoker. Another owns two $6,000 inflatable pigs used in marketing.)? ___ Yes ___ No If so, describe </p><p>Do you own a mobile ATM unit? ___ Yes ___ No If so, describe </p><p>Page 4 of 6 Please provide a list of all real estate the bank owns or leases - include branch locations, offices, vacant land, ATM locations, foreclosed property </p><p>Do you receive rental income at any of your locations? ___ Yes ___ No If so, describe </p><p>General Liability & Auto Issues:</p><p>Do you charge employees or customers for parking? ___ Yes ___ No If so, describe </p><p>Does your bank own any airplanes, boats, or other such property? ___ Yes ___ No If so, describe </p><p>Does your bank (or any employees) lease or use airplanes, boats, or other such property in bank business? ___ Yes ___ No If so, describe </p><p>Workers' Compensation Issues:</p><p>In what states do you have employees? </p><p>Are any of your employees residents of other states? </p><p>Do any employees work full or part time from home offices? ___ Yes ___ No If so, describe</p><p>Contractual Liability Issues:</p><p>Send me any contracts you want me to review for indemnification language and / or insurance requirements - leases, rental agreements, website maintenance, e-banking provider, core processors.</p><p>Let me know if you have any questions or if anything is not clear. I'm always a phone call or email away.</p><p>Person Completing This Form: Date: </p><p>Contact me if you have any questions. I am always available for my clients. Page 5 of 6 V9-16-2014 ← Scott Simmonds, CPCU, ARM ← Insurance Assurance Consulting ← Phone: 207-284-0085 ← [email protected] </p><p>Page 6 of 6 </p>