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TAX YEAR END
toyou?
COMPANY NAME
YOUR ROLE
ADDRESS
CITY STATE ZIP
ProposalQuestionnaire
PHONE NUMBER FAX NUMBER
NUMBER OF ELIGIBLE EMPLOYEES
CONTACT PERSON
Takeover Plan (complete below for Takeover plans)
STARTUP OR EXISTING PLAN
Startup Plan (complete below for Startup Plans)
ESTIMATED ANNUAL CONTRIBUTIONS
TAKEOVER ASSETS
TAX FILING ENTITY
PLAN TYPE DESIRED
DESIRED RECORDKEEPER FOR PROPOSAL
ANNUAL CONTRIBUTIONS
NUMBER OF EMPLOYEES WITH ACCOUNT BALANCE
HOW CAN WE HELP YOU? Has your business ever maintained a retirement plan before?
YES NO
YES NO
YES NO
NOT SURE
NOT SURE
Will you be making employer contributions if necessary for optimal plan design?
Are you looking to maximize contributions for owners/certain key employees?
Do business owner(s) have ownership in any other companies? Please provide details below:
Does your company perform prevailing wage work?
YES NO
If yes, please explain:
**Completing the Census, located on the next page, is optional. However, this information will help us to determine the most appropriate plan design for your company.
Instructions for Completing the Census QuestionnaireSSN
First Name
Last Name
Owner (Y/N)
Ownership %
DOB
DOH
Total Compensation
Officer (Y/N)
Key (Y/N)
Relation to Owners
Census Subgroup
Please complete employee social security number (this field is not required)
Employee's First Name
Employee's Last Name
Please indicated whether an employee is an owner of the company (only indicate Yes answers)
If an employee has ownership in the company, please include their ownership % here (required)
Employee's date of birth (required)
Employee's date of hire (required)
Employees gross wages including any cafeteria plan deductions or 401(k) deductions
Please indicate whether an employee is an officer of the corporation
Do not complete this column (internal use only)
If any employee is related to an owner, please indicate their relationship to the owner here
Do not complete this column (internal use only)
Return completed form to: Advanced Plan Designs 620 W Republic Rd, #105
Springfield, MO 65807OR
Email to: [email protected] OR
Fax to: 417-885-0198
Sponsor's Name:
SSN First Name Last NameOwner?
(Y/N)Owner-
ship % DOB DOHTotal
CompensationOfficer (Y/N)
Key (Y/N)
Relation to Owners
Census SubGroup
Attach additional sheets if necessary.
