Please fill out this form only if you have an existing Plan.
About The Company
Name:
Address:
Name of Person Interviewed:
Title:
Who is the ultimate decision makers?
Type of Business:
Corporation Subchapter-S Corporation Partnership Governmental
Non-Profit Other
If Other,please specify:
Years in Business:
Number of Employees:
Are any employees leased? Yes No
Are any employees union members? Yes no
Name of Attorney:
Name of Accountant:
About The Plan
What type of plan is it?
Profit Sharing Money Purchase Define Benefit
Target Benefit SEP 401(k) Other
What is the total value of the plan's assets?
As at:
What amount is there in:
Cash Equivalents:
Equities:
Company Stock:
GICs:
Other:
Are you, as employer, statisfied with the amount you and your key employees can put into the plan? Yes No
How many employees are eligible?
How many are participating?
What amount is contributed to the plan each year?
From the employee contributions:
From employer matching contributions:
From employer profit-sharing contributions:
Total contributed:
What is the vesting schedule on employer contributions?
Profit-sharing:
Match money:
What is the ADP%:
About The Plan's Performance
Who currently manages the assets in your plan?
How do you feel about your plan's performance?
Above expectations
Below expectations
As expected
Additional comments on plan performance:

What level of performance do you expect?
Is your portfolio monitored? Yes No
Do you receive regular updates? Yes No
How often?
About Investing
Who controls the investment (employer or plan participant) of:
Employerr Participant
Employee contributions
Employer matching contributions
Employer profit-sharing contributions
If there are investments that are not liquid (e.g., GICs), what are they?
Are there any surrender charges? Yes No
Do you invest in any of the following types of funds?
Number of funds
in this catagory
No
Would like to
Growth Funds
Income Funds
Growth and Income Funds
Fixed-Income Funds
Asset Allocation Funds
International Funds
Are you satisfied with the number and catagories of investment choices?
Yes No
If No, why?
Too few choices
Too many choices
Selection not broad enough (e.g., style, size, asdset class)

How are the assets allocated?
Fund
%
1.
2.
3.
4.
5.
6.
Do you know how your employees are investing? Yes No
Are you satisfied with the way participants are investing? Yes No
How often can participants transfer among funds?
In selecting funds, what do you consider most important?
A well-known brand name
The fund manager
A fund that minimizes fees
Do you feel investment knowledge of plan participants to be:
Elementary
Sophisticated
In between
About Administration
How do you feel about the frequency of account valuation?
How frequently are plan participants' accounts valued?
Daily Monthly Quarterly Other
If Other, please specify:
Who provides the plan's recordkeeping?
Who Prepares:
TPA
Investment Provider
Compliance forms
Participant tax forms
Plan Document and
Summary Plan Description
Are you satisfied with your current plan administration? Yes No
What type of feedback do you receive from your participants?
Positive
Negative
No feedback
How long does it take
For participants to receive their statements?
For investment changes to take place in the participants' accounts after the changes have been authorized?
How are participants' transactions, such as investment changes, initiated? For Instance...
Hard copy
IVR
Other (specify)
Are loans to be offered? Yes No
Would you continue to permit withdrawals for hardship? Yes No
Who administers loans?
What are the annual fees for:
Recordkeeping:
Trusteeship:
Compliance (e.g. form 5500):
Plan Document/SPD:
If more than one location, is data to be remitted on the same date? Yes No
What is the employee contribution frequency?
What date would work best for your conversion to a new plan provider?
About Communicationg With Participants
How do you feel about the current participant communication program?
Who looks after communications with participants?
Do you believe participants are satisfied? Yes No
Can you identify any obvious or recurring problems? Yes No
Do you feel your participants receive sufficient information to make sound investment decisions? Yes No
Describe your investment communications program
Frequency:
Quality:
How often do participants receive statements?
Monthly Quarterly Semi-annually Other (specify)
Can participants access account information by Internet? Yes No
Do you want telephone access available to participants? Yes No
Do you want Internet access available to participants? Yes No
About Client Expectations
In general...
What are the strengths of your current provider?
Where in your current plan do you see the most opportunity for improvement?

Your Email Address: