Design Questionnaire Advisor InformationName(Required) First Last Email PhoneBusiness InformationLegal Name of Firm(Required) EIN Principal Contact Name(Required) First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneFaxAdditional ContactsClick on the + icon to add more rows.NameEmail Address Add RemoveType of Business Entity(Required) Corporation Partnership Sole Proprietorship File as Sub Chapter “S” Corporation: Yes No Fiscal Year End Business Code Corporate Profit Last Two Years:Year Profit Amount Year Profit Amount Officers, Owners, Directors(Required)Please enter in the spaces below the name of each owner, officer and director of the Primary Employer. Click on the + icon to add more rows.NameOwnership %Title Add RemoveFamily members of Officers, Owners, DirectorsIf any of the owners, officers or directors listed above employ any family members who received W-2 earned income from the primary employer, please list them below. Required, if applicable Click on the + icon to add more rows.NameRelative ofRelation Add RemoveRelated Employer Determination The IRS considers all employers that are part of a controlled group or affiliated service organization as a single employer (even if you are self-employed and own stock/shares or are affiliated with another “related” business). It is extremely important you provide us with information about all employers that are related, particularly if they have employees. We recommend that you consult with your tax attorney/CPA before answering the following questions if you are unclear about the answers to the questions below.Is the Primary Employer a member of a controlled group of businesses? Yes No Is this employer affiliated with any other employer as part of an affiliated service group? Yes No Business Name Employee InformationDo you have any employees who perform services for another company and who get W2 from another company or leasing company? Yes No If “yes,” provide us with the name and phone number of the contact of the leasing companies:Name First Last PhoneIs the Primary Employer or any Related Employer a member of a Professional Employer Organization (PEO)? Yes No If “yes” provide us with the name and phone number of the contact at the PEO:Name First Last PhoneIf “yes", has the Primary Employer or a Related Employer adopted the PEO’s qualified retirement Plan? Yes No Are any employees or group of employees of the Primary Employer, or of a Related Employer, subject to a good-faith collective bargaining agreement, i.e., union employees? Yes No If “yes” provide us with the name and phone number of the contact at the PEO:Name First Last PhoneIf there are union employees, do you want to exclude these employees from the plan design? Yes No Do you have employees who perform services in Puerto Rico? Yes No Prior or Existing Plan InformationDid the Primary Employer or a Related Employer sponsor a qualified plan in the past? If “Yes”, Identify below: Yes No PensionClick on the + icon to add more rows.StatusAmount of Last Annual DepositVoluntary ContributionsTotal Trust Asset ValueTrust Asset Value As of Add RemoveProfit SharingClick on the + icon to add more rows.StatusAmount of Last Annual DepositVoluntary ContributionsTotal Trust Asset ValueTrust Asset Value As of Add RemoveIs the Primary Employer or a Related Employer currently contributing for employees in any qualified plan now in operation? Yes No If yes, please complete the following:Type SEP SARSEP 401(k) Profit Sharing Simple-IRA Defined Benefit Cash Balance PensionClick on the + icon to add more rows.StatusAmount of Last Annual DepositVoluntary ContributionsTotal Trust Asset ValueTrust Asset Value As of Add RemoveProfit SharingClick on the + icon to add more rows.StatusAmount of Last Annual DepositVoluntary ContributionsTotal Trust Asset ValueTrust Asset Value As of Add RemoveNature of the BusinessThe nature of the business has an impact on the deduction amount(s) we can illustrate on plan designs for your entity. Please include a short description below of the services your business provides.Business Website (if applicable) Professional Licenses (if applicable) Additional Questions for PBGC Coverage Determination (to be answered by the client/ authorized person)Please understand the questions below are important for us to make an initial determination on the plan's PBGC Coverage Status. Your plan's coverage status has a tremendous impact on the amount of contributions you may be able to fund for certain types of plans.1. What are your designations?2. Do you have any degrees (post high school education)? If so, which degrees do you have?3. Please describe how many years of experience you have in your line of work and the type of clientele you serve (including the affluence / wealth of clientele).4. Do you have any continued education requirements?K-1 INCOME INFORMATIONWe ask that you provide us with K-1 Income for the previous year as this will help us determine the deduction amount we can propose and also the plan compensation that is feasible for the plan.K1 InformationClick on the + icon to add more rows.NamePrevious Year K-1 Income (line 14 form 1065) Add RemoveAttestationName First Last Company name Date MM slash DD slash YYYY Consent(Required) I agree to the privacy policy.I hereby confirm that the above (and the information on any addendum) is complete and accurate. I hereby understand that this information will be used to determine the PBGC Coverage status of the plan (when necessary) and that I agree with Pension Services's initial Determination of such. Furthermore, I understand that my PBGC Coverage status will affect the deductible funding amounts for certain plans.Addendum I If related employers exist, this addendum must be completed for each additional employer that will have W-2 employees.Business InformationLegal Name of Firm EIN Principal Contact Name First Last Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneFaxAdditional ContactsClick on the + icon to add more rows.NameEmail Add RemoveType of Business Entity: Corporation Partnership Sole Proprietorship File as Sub Chapter “S” Corporation: Yes No Fiscal Year End Business Code Corporate Profit Last Two Years:Year Profit Amount Year Profit Amount Officers, Owners, DirectorsPlease enter in the spaces below the name of each owner, officer and director of the Primary Employer. Click on the + icon to add more rows.NameOwnership %Title Add RemoveListIf any of the owners, officers or directors listed above employ any family members who received W-2 earned income from the primary employer, please list them below. Click on the + icon to add more rows.NameRelative ofRelation Add Remove Δ
