New Client QuestionnaireOwnership IssuesDoes the company own any other business?YesNoIf 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?YesNoIf 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?YesNoIf 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?YesNoIf yes, please list name, ownership percentage, type of business, relationship between the businesses (e.g. subsidiary) and whether the other business has employees:Employee IssuesDoes the company have any union or leased employees?YesNoIf yes, please list employees:Does the company employ any family members of the company’s owners (spouse, child, parent, or grandparent)?YesNoIf 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?YesNoIf yes, please list name and type of plan:Other IssuesDoes the company have any other tax qualified retirement plan(s)?YesNoIf yes, please list name and type of plan:Has the company ever had any other tax qualified retirement plan(s) in the past?YesNoIf 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.)YesNoIf 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?YesNoIf 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” CorporationSole ProprietorLLC (taxed as Sole Prop)LLC (taxed as S-Corp)“Sub-S” CorporationPartnershipLLPHave there ever been any changes in the company’s legal structure?YesNoIf 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 FormName of FirmAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail FaxTax ID NumberFirm's Fiscal YearPlan ID NumberPlan's Fiscal YearEntity Inception Date MM DD YYYYPlan Inception Date MM DD YYYYKey ContactNAIC CodeTrusteesInvestment Advisor's Name and FirmAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneAccountant's Name and FirmAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneAttorney's Name and FirmAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCaptcha*Δ