Retirement Planning
Name of Plan Sponsor Organization:
Nature of Business:
Primary contact:
State of Organization's Headquarters:
Other locations?
If yes, list states, if known:
 Yes  No
Startup (New) Plan:  Yes  No
Conversion Plan:  Yes  No
Existing Client:  Yes  No
Re-Bid:  Yes  No
Number of employees:
Average compensation per employee:
For conversion plan only: (complete all)
Number of participants with balances:
Number of participants currently contributing:
Total plan assets:
Total liquid plan assets:
Plan Type Combination:
(check all that apply)
Contribution Types:
(check all that apply)
 Employee Salary Deferrals
 Employee After-Tax
 Profit Sharing
 Employer Match
Number of payroll sites:
Frequency of remittances:
Estimated annual withdrawals from plan:
Does plan have outside funds?  Yes  No
Expiration Date: (mm/dd/yyyy)
Employer Stock?  Yes  No
Is Stock traded on the open domestic market?  Yes  No
Additional Information
Type of Service:
(Check only one)
 Full Service
 Third Party Administrator (TPA)
 Investment Only (Single record arrangement)
Trustee:  Officers of Employer
List of Shares:  Z Assets
 at NAV
Is use of Education & Enrollment Team anticipated?  Yes  No
Standard Requirements:
Education and Enrollment Team
  Minimum $1M in assets
  Minimum 15 participants per location
Number of sites:
Number of participants per site:
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