New Client Questionnaire

Ownership Issues
Does the company own any other business?
- Yes
- No
If yes, please list name of other business, type of business, ownership percentage, relationship between the businesses (e.g. subsidiary) and whether the other business has employees:
Does any owner of the company own 50% or more of any other business?
- Yes
- No
If yes, please list owner’s name, type of business, ownership percentage, relationship between the businesses (e.g. subsidiary) and whether the other business has employees:
Does any owner’s family member (spouse, child, parent or grandparent) own 50% or more of any other business?
- Yes
- No
If yes, please list family member’s name, ownership percentage, type of business and relationship to owner:
Is the company owned in whole or in part by another business?
- Yes
- No
If yes, please list name, ownership percentage, type of business, relationship between the businesses (e.g. subsidiary) and whether the other business has employees:
Employee Issues
Does the company have any union or leased employees?
- Yes
- No
If yes, please list employees:
Does the company employ any family members of the company’s owners (spouse, child, parent, or grandparent)?
- Yes
- No
If yes, please list name and relationship to the owner:
Are any of the company’s employees, including union employees, covered under any other tax qualified retirement plan(s), other than those administered by our firm?
- Yes
- No
If yes, please list name and type of plan:
Other Issues
Does the company have any other tax qualified retirement plan(s)?
- Yes
- No
If yes, please list name and type of plan:
Has the company ever had any other tax qualified retirement plan(s) in the past?
- Yes
- No
If yes, please list name, type of plan and dates:
Is the company a member of an affiliated service group as that term is defined in Section 414(m) of the Internal Revenue Code? (We suggest that you check with your accountant.)
- Yes
- No
If yes, name of group:
If an existing plan, please list all retirement plan assets. Please list accounts and account numbers and provide us with copies of statements for the full plan year. Not applicable for new plans.
Does the company have a fidelity bond for at least 10% of total plan assets at the beginning of the plan year?
- Yes
- No
If yes, please list name of insurance company, expiration date and coverage amount (also please send a copy of the policy’s face page):
If no, please obtain a fidelity bond and provide us with a copy of the policy’s face page.
What is the company's current legal structure?
- “C” Corporation
- Sole Proprietor
- LLC (taxed as Sole Prop)
- LLC (taxed as S-Corp)
- “Sub-S” Corporation
- Partnership
- LLP
Have there ever been any changes in the company’s legal structure?
- Yes
- No
If yes, please explain:
Please list the owners of the company and their ownership percentage:
Please list the officers of your company and their title:
Do you anticipate any significant changes in your business in the near future, e.g. retire in 5 years, open a second location, etc.? If yes, please explain:
Any expansion or contraction of 20% or more of the workforce? If yes, please explain:
What other employee benefits do you provide, for example Sec. 125 Cafeteria Plan? Please list all:
Case Data Form
Name of Firm
Address
Street Address City State ZIP Code
Phone
Email
Fax
Tax ID Number
Firm's Fiscal Year
Plan ID Number
Plan's Fiscal Year
Entity Inception Date
MM
DD
YYYY
Plan Inception Date
MM
DD
YYYY
Key Contact
NAIC Code
Trustees
Investment Advisor's Name and Firm
Address
Street Address City State ZIP Code
Phone
Accountant's Name and Firm
Address
Street Address City State ZIP Code
Phone
Attorney's Name and Firm
Address
Street Address City State ZIP Code
Phone
Captcha*

New Client Questionnaire

Ownership Issues

Employee Issues

Other Issues

Case Data Form