Employers & Laborers Locals 100 & 397

EMPLOYERS & LABORERS LOCALS 100 & 397

SUPPLEMENTAL ANNUITY FUND

4940 Washington Boulevard

St. Louis, MO 63108

(314) 367-6555

In the Rollover Section of your distribution form, elect a Direct Rollover to a Qualified Retirement Plan. (See attached copy of IRS Determination Letter which shows this is a qualified plan.)

Plan Name: Employers’ and Laborers’ Locals 100 & 397

Supplemental Annuity Fund

Plan Address: 4940 Washington Boulevard

St. Louis, MO 63108

Make Check Payable to: Employers’ and Laborers’ Locals 100 & 397

Supplemental Annuity Fund

FBO: “fill in name of participant”

Mail Check to: Employers’ and Laborers’ Locals 100 & 397

Supplemental Annuity Fund

4940 Washington Boulevard

St. Louis, MO 63108