Request a Proposal - Standard Illustration

Referral Source

Email*

Type*

Name*

First Last

Firm*

Zip*

Phone*

Optional for Proposal

(however, would be needed prior to plan installation)

Address

Street Address Address Line 2 City State ZIP Code

Plan Sponsor Information

Company's Legal Name*

Type of Business Entity*

Fiscal Year End*

Nature of Business*

(e.g., manufacturing; retail sales; etc.)

Optional for Proposal

(however, would be needed prior to plan installation)

Federal Employer Tax ID# (EIN)

Contact Name

Contact Title

Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

Fax

Year Established

Investment Platform to Quote

Platform:*

You will receive a call-back to discuss investment options.

Existing/Prior Plan(s)

Current Plan Type(s)*

Current Plan Type(s)

Please enter your current plan type.

Plan Year End*

Was there a prior terminated Defined Benefit or 401(k) plan?*

Yes
No

Assumptions for Proposal

First Year with Benetech*

Choose One:*

Start-up a new plan
Takeover of existing plan

Plan Year End*

e.g., 12/31; 11/30; etc.

Current Assets*

Expected Contributions*

Total Number of Employees*

Number of Eligible Employees*

Number of Participants with Account Balances*

Plan Design to Quote

Profit Sharing?*

Standard
Tiered/New Comparability
None

Plan Objectives

Objective of Owner?*

Basic 401(k) only
Maximize at $53k/$59k (Tiered 401k)
Maximize above $59k (DB+401k)

Basic Plan Provisions

Service Requirements*

12 months
3 months
0 months

Entry Dates:*

Twice a year (e.g., 1/1 & 7/1)
Quarterly
Monthly

Safe Harbor Provisions:*

None
Safe Harbor Basic Match
Safe Harbor Enhanced 4% Match
Safe Harbor 3% Non-elective Contribution

Profit Sharing Allocation Method:*

Standard (integrated)
Tiered/New Comparability

Confidential Employee Census - Required for Illustration

Employee Information*

To submit your employee census data please choose ONE of the following options.

Online Entry - recommended for plans with 5-10 participants only
Request Census Form - recommended for plans with 10 or fewer participants

List ALL employees paid during the year, including part-time & those terminated during the year.

Sole Proprietors and Partners use net earned income as “Total Annual Compensation.” Corporate owners use W-2 wages only.
Indicate “Family Relationships” by designating the type of relationship and employee number (example: “Child of #3”).
Indicate any employee who earned more than $115,000 in the prior plan year; this information helps to define Highly Compensated Employees in the current plan year (assumes a plan year ending 12/31/15).
The term “officer” has an important functional definition for the purposes of the plan. An employee who does not have the title of an officer but who does have the authority of an administrative executive is an “officer” for the purposes of the plan. Similarly, an employee with the title of an officer but who does not have the authority of an administrative executive.

Download Employee Census Form
A pre-formatted excel spreadsheet link will also be sent to your email address entered above. Please use this form to enter in your employee data and email back to proposals@benetechinc.com.

Employee #1

Name

First Last

Officer?

Yes
No

Ownership Percentage

Please enter a value greater than or equal to 1.

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a second employee?

Yes
No

Employee #2

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a third employee?

Yes
No

Employee #3

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a fourth employee?

Yes
No

Employee #4

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a fifth employee?

Yes
No

Employee #5

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a sixth employee?

Yes
No

Employee #6

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a seventh employee?

Yes
No

Employee #7

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add an eighth employee?

Yes
No

Employee #8

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a ninth employee?

Yes
No

Employee #9

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

Do you need to add a tenth employee?

Yes
No

Employee #10

Name

First Last

Officer?

Yes
No

Ownership Percentage

Date of Birth

MM

DD

YYYY

Date of Hire

MM

DD

YYYY

Date of Termination

MM

DD

YYYY

Family Relationships

Employee to work LESS THAN 1,000 hours this fiscal year?

Yes
Yes, but more than 1000 in a prior year
No

Expected Current Year Total Annual Compensation

Total W2 Greater Than $115,000 in Prior Plan Year?

Yes
No

If you need to add more than 10 employees, please submit this form with your first 10, then fax or email a list of your additional employee information to: Fax: 888-484-6870 or email: proposals@benetechinc.com
If you need additional assistance, please contact our proposal/quote request department at 800-573-8706 or by email at proposals@benetechinc.com

Special Arrangements

Incorrectly answering these questions may significantly change the fees, plan design options, &/or illustration (if an illustration is provided).

Does the company, its owner or spouse of owners – together or separately – own 80% or more of another company (or otherwise form a “Controlled Group” of related companies as defined by IRS)?*

Yes
No

Does the company provide management services on a regular and contining basis for another company or group of related companies?*

Yes
No

Does the company provide "Professional Services" (as defined by IRS, e.g., medical, legal, etc.) in conjunction with another Professional Services company in which there is any common ownership (or otherwise form an “Affiliated Service Group” of related companies as defined by IRS)?*

Yes
No

Does the company use independent contractors?*

Yes
No

Does the company use leased or shared employees?*

Yes
No

Has owner received income in current year as an employee of another business?*

Yes
No

Does the company employ anyone other than the owner or spouse (including part-time employees & relatives)?*

Yes
No

If you answered “YES” to any of the above, please describe the arrangement(s).

Proposal Request Form

Company with Employees: Contribution Illustration and Quote

Referral Source

Optional for Proposal

Plan Sponsor Information

Optional for Proposal

Investment Platform to Quote

Existing/Prior Plan(s)

Assumptions for Proposal

Plan Design to Quote

Plan Objectives

Basic Plan Provisions

Confidential Employee Census - Required for Illustration

Employee #1

Employee #2

Employee #3

Employee #4

Employee #5

Employee #6

Employee #7

Employee #8

Employee #9

Employee #10

Special Arrangements