Proposal Request Form - Impact Pensions

Proposal Request Form

Name

This field is for validation purposes and should be left unchanged.

Employer Name(Required)

Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Entity(Required)

C-Corp (W2)

S-Corp (W2)

Partnership (K-1)

Sole Proprietor (net Schedule C)

LLP

LLC Partnership

LLC Corporation

LLC Sole Proprietor

Fiscal Year(Required)

Desired Contribution $(Required)

Please enter a number from 0 to 100000000.

Anticipated Retirement Age of Owner(Required)

Please enter a number from 0 to 150.

Plan Design Proposals(Required)

Traditional Defined Benefit Plan

412 Fully Insured Defined Benefit Plan

Profit Sharing

401(k) Profit Sharing Plan

Safe Harbor 401(k) Profit Sharing Plan

Cash Balance Plan

Does the employer now have or ever had a retirement plan?(Required)

Yes

No

if yes, please describe(Required)

Do the owners have ownership interest in other businesses?(Required)

Yes

No

if yes, please describe(Required)

Is the employer a controlled group or affiliated service group?(Required)

Yes

No

if yes, please describe(Required)

Does the employer use leased employees, union employees or independent contractors? If yes, indicate in census.(Required)

Yes

No

Please list all current employees and submit census using list below. Use the plus sign to add additional employees.

Census(Required)

Employee Name

Date of Birth

Date of Hire

Annual Salary

Ownership % or Family Relationship to Owner

Job Title

Annual Hours Worked

Additional Comments/Information

Δ

Comments

This field is for validation purposes and should be left unchanged.

Employer Name(Required)

Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Entity(Required)

C-Corp (W2)

S-Corp (W2)

Partnership (K-1)

Sole Proprietor (net Schedule C)

LLP

LLC Partnership

LLC Corporation

LLC Sole Proprietor

Fiscal Year(Required)

Desired Contribution $(Required)

Please enter a number from 0 to 100000000.

Anticipated Retirement Age of Owner(Required)

Please enter a number from 0 to 150.

Plan Design Proposals(Required)

Traditional Defined Benefit Plan

412 Fully Insured Defined Benefit Plan

Profit Sharing

401(k) Profit Sharing Plan

Safe Harbor 401(k) Profit Sharing Plan

Cash Balance Plan

Does the employer now have or ever had a retirement plan?(Required)

Yes

No

if yes, please describe(Required)

Do the owners have ownership interest in other businesses?(Required)

Yes

No

if yes, please describe(Required)

Is the employer a controlled group or affiliated service group?(Required)

Yes

No

if yes, please describe(Required)

Does the employer use leased employees, union employees or independent contractors? If yes, indicate in census.(Required)

Yes

No

Please list all current employees and submit census using list below. Use the plus sign to add additional employees.

Census(Required)

Employee Name

Date of Birth

Date of Hire

Annual Salary

Ownership % or Family Relationship to Owner

Job Title

Annual Hours Worked

Additional Comments/Information

Δ