Employee Benefits Survey strives to provide valuable, comprehensive and affordable benefits for our employees. Periodically, we review our current programs to ensure they live up to these goals and meet our employees’ needs. Please take a few moments to complete this survey and help us with our annual benefits review process. Your input is important to us regardless of whether or not you currently participate in any of the programs. Please return the completed survey to [insert contact details]. 1. Are you currently enrolled in the employee health care plan? Yes No 2. Are you enrolled in any other benefits through ? If so, please list them below. 3. How would you rate the benefits options you receive from ? Excellent Above average Average Below average Poor 4. What are your primary motivations for enrolling in benefits through ? Check all that apply. To support my family For my physical health To better care for someone For my overall well-being To save money For my safety 5. If you could choose any benefits offerings, what would they be? 6. Would you be willing to pay more to receive benefits more valuable to you? Yes No 7. If you answered yes to question 6, how much would you be willing to pay? Assume the benefits would include at least one from your response to question 5. 8. Please provide any additional comments here: 15