Design Questionnaire

Advisor Information

Name(Required)

Business Information

Principal Contact Name(Required)
Address
Additional Contacts
Click on the + icon to add more rows.
Name
Email Address
 
Type of Business Entity(Required)
File as Sub Chapter “S” Corporation:
Corporate Profit Last Two Years:
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.
Name
Ownership %
Title
 
Family members of Officers, Owners, Directors
If 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.
Name
Relative of
Relation
 

Related 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?
Is this employer affiliated with any other employer as part of an affiliated service group?

Employee Information

Do you have any employees who perform services for another company and who get W2 from another company or leasing company?
If “yes,” provide us with the name and phone number of the contact of the leasing companies:
Name
Is the Primary Employer or any Related Employer a member of a Professional Employer Organization (PEO)?
If “yes” provide us with the name and phone number of the contact at the PEO:
Name
If “yes", has the Primary Employer or a Related Employer adopted the PEO’s qualified retirement Plan?
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?
If “yes” provide us with the name and phone number of the contact at the PEO:
Name
If there are union employees, do you want to exclude these employees from the plan design?
Do you have employees who perform services in Puerto Rico?

Prior or Existing Plan Information

Did the Primary Employer or a Related Employer sponsor a qualified plan in the past? If “Yes”, Identify below:
Pension
Click on the + icon to add more rows.
Status
Amount of Last Annual Deposit
Voluntary Contributions
Total Trust Asset Value
Trust Asset Value As of
 
Profit Sharing
Click on the + icon to add more rows.
Status
Amount of Last Annual Deposit
Voluntary Contributions
Total Trust Asset Value
Trust Asset Value As of
 
Is the Primary Employer or a Related Employer currently contributing for employees in any qualified plan now in operation?
If yes, please complete the following:
Type
Pension
Click on the + icon to add more rows.
Status
Amount of Last Annual Deposit
Voluntary Contributions
Total Trust Asset Value
Trust Asset Value As of
 
Profit Sharing
Click on the + icon to add more rows.
Status
Amount of Last Annual Deposit
Voluntary Contributions
Total Trust Asset Value
Trust Asset Value As of
 
The 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.

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.

K-1 INCOME INFORMATION

We 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 Information
Click on the + icon to add more rows.
Name
Previous Year K-1 Income (line 14 form 1065)
 

Attestation

Name
MM slash DD slash YYYY
Consent(Required)

Addendum I

If related employers exist, this addendum must be completed for each additional employer that will have W-2 employees.

Business Information

Principal Contact Name
Address
Additional Contacts
Click on the + icon to add more rows.
Name
Email
 
Type of Business Entity:
File as Sub Chapter “S” Corporation:
Corporate Profit Last Two Years:
Officers, Owners, Directors
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.
Name
Ownership %
Title
 
List
If 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.
Name
Relative of
Relation