Acuff & Dunger, Inc.

GASB Survey

1. Please indicate the kind of government entity you represent:

2. Do you offer Medical Benefits to retirees?

Yes No

If Yes:	a) Do you offer Medical Benefits up to Medicare age only?	Yes No
	b) Do you offer Medical Benefits past Medicare age?	Yes No
	c) Does the retiree pay part of the cost?	Yes No
	d) Is your plan self-insured/self-funded?	Yes No
	e) If the answer for 2d above is no, is your medical plan fully insured?	Yes No
	f) If the answer for 2d above is no and retirees have the same benefit as actives, do you pay the same premiums for retirees as active?	Yes No

3. Do you have retirees on Cobra?	Yes No
4. Do you offer life insurance benefits to retirees?	Yes No
5. Do you offer other benefits to retirees?	Yes No

Your Name:

Your Email:

Thank you for responding to this questionnaire.