Retirement Plan Questionnaire*

*Required Fields

Section I - Company Information

* Name of Company:

* Address:

* Web Address:

* City, State ZIP:

* Primary Contact:

* Email :

* Phone :

Fiscal Year End (month/day)

Date Business Established (month/year)

Business Structure

C Corporation

S Corporation

Partnership

LLP

Sole Proprietor

LLC

(is taxed as a

Corporation or a

Partnership? Please check one)

Any predecessor business entities

Yes

* Number of Employees :

Does the company currently have or ever had a plan?

Yes

(if yes, Please complete Sections II & V)

Do the owners of this company or their spouses own any other company(ies)?

Yes

(If yes, please provide details on ownership and Fiscal Year End in comments section.)

Does the company have prevailing wage projects?

Yes

If yes, How much?

Does the company have union employees?

Yes

If yes, will they be excluded from the plan?

Yes

Does the company have leased employees?

Yes

What is the average annual turnover rate among employees?

What is the average tenure of employees?

Does the company provide any supplemental executive retirement plans (SERP) for key employees?

Yes

Section II - Existing/Prior Retirement Plan Information

What is the existing plan type?

SEP

Money Purchase

Defined Benefit Pension

401(k)

Simple IRA

Simple 401(k)

403(b)

Safe Harbor 401(k)

Other

Profit Sharing (check one):

Basic (includes integrated)

Age Weighted

Comparability

Plan Year End:

Existing Plan Assets:

Number of Employees:

Eligible:

Participating:

Estimated Annual Contributions

Employee:

Employer:

Contribution Frequency

weekly

monthly

other

Method of transmission to record keeper

Institution where existing assets are invested

What was the prior plan type?

Money Purchase

SEP

Profit Sharing

Defined Benefit Pension

Simple IRA

Simple 401(k)

Other

401(k) if checked, date assets distributed:

Please provide Plan Document, Adoption Agreement, Summary Plan Description and most recent 5500 Filing

Section III - Financial Information

		Increasing	Stable	Declining	Fluctuating
1.	What has been the cash flow trend during the past five years?
2.	What is the outlook for cashflow available for SERP plan contributions?
3.	What is the owner's annual pre-tax retirement savings need?
4.	What is the maximum amount the business could have afforded to contribute to a qualified plan for the last fiscal year?
5.	What is the projected maximum amount the business could have afforded to contribute to a qualified plan for the fiscal year?
6.	Is the owner willing to make a commitment to fund annual contribution :	Yes No

Please provide previous two years financial statements.

Section IV - Employment Benefit Objectives

PERSONAL OBJECTIVES	Not Important	Somewhat Important	Very Important
Maximize Tax Benefits for Owners
Maximize Benefits for Owners
Meet Retirement Income Objective
Provide Estate Liquidity

BUSINESS OBJECTIVES
Reduce Corporate Income Tax
Reward Valued/Key Employees
Recruit New Employees
Reduce Employee Turnover

ALTRUISTIC OBJECTIVES
Promote Employee Savings for Retirement
Provide Employees with a flexible plan
Share Business Profits with Employees
Share Business Ownership with Employees

Section V - Retirement Plan Evaluator

How would you evaluate each of the following components of your existing plan? Please check appropriate box with "*" as worst and "****" as best.

	*	**	***	****
Communication to Participants
Flexibility of Fund Offering
Internal Administration
Performance of Investment Options
Cost to Company
Cost to Participant
Administer Company Stock
Self Directed Brokerage
Accuracy/Timeliness of Administration
Fiduciary and 404(c) Concerns

Section VI - Additional Comments

Securities & Investment Advisory Services offered through Registered Representatives of MML Investors Services, Inc.

Supervisory Office: 530 Fifth Avenue, 14th Floor, New York, NY 10036 Phone: 212.536.6000

Patterson Smith Associates, LLC is not an affiliate or subsidiary of MML Investors Services, Inc.

Phone (800) 572-8859 • Fax: (888) 469-1922 • Email: info@psabenefits.com
Licensing • Privacy Policy • Disclaimers