Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
1 of 8
Owner Only 401(k)
Plan Design Questionnaire
Please call Prime Plan Solutions at (888) 445‐0031, Option 4, if you have any questions regarding this Plan Design
Questionnaire (Monday‐Friday from 8:30 AM to 6:00 PM Eastern Time).
I. GENERAL PLAN SPONSOR INFORMATION
1. PLAN SPONSOR: _______________________________________________
(Legal Name of Business or Organization Establishing the Plan)
2. STREET ADDRESS: _______________________________________________
CITY / STATE / ZIP: _______________________________________________
COUNTY: _______________________________________________
3. MAILING ADDRESS: (if different) _______________________________________________
CITY / STATE /ZIP: _______________________________________________
4. PRIMARY CONTACT: Name: ___________________________________ Title: _______________________________
Phone: (_____)_____‐_____ Fax: (_____)_____‐_____
E‐mail*:_______________________________________________
SECONDARY CONTACT: Name: ___________________________________ Title: ___________________
Phone: (_____)_____‐_____ Fax: (_____)_____‐_____
E‐mail*:_______________________________________________
*Plan Contact E‐mail address is required. Prime Plan Solutions uses e‐mail as the primary method of communication
regarding your plan.
5. PAYROLL CONTACT: Name: ___________________________________ E‐mail: _____________________
Phone: (_____)_____‐_____ Fax: (_____)_____‐_____
6. COMPANY TAX YEAR‐END: ___________________________________
7. PLAN YEAR‐END: ___________________________________ (Month)
8. PLAN SPONSOR’S COMPANY TAX ID NUMBER:(1) ___________________________________ (1)The Sponsor must have its own Employer Tax ID. Sole Proprietors may not use their personal Social Security
Numbers to sponsor a plan.
9. SIX‐DIGIT IRS CODE: (this should match the code on the business’ tax return) ___________________
10. BUSINESS STRUCTURE: Corporation S Corp. Partnership Sole Proprietorship
L.L.C. L.L.P. Other (please specify) ___________________
2 of 8
11. BUSINESS FORMATION DATE: _____/_____/_____
12. HAS THE COMPANY EVER SPONSORED OR PARTICIPATED IN A QUALIFIED PLAN (Profit Sharing, 401(k), Money Purchase
Pension Plan)? Yes No (If No, Skip to Question 13)
CURRENT ADMINISTRATOR INFORMATION:
Firm Name of Administrator: ___________________________________
Contact Name: ___________________________________
Street Address: ___________________________________ Phone: (_____)_____‐_____
City / State / Zip: ___________________________________ Fax: (_____)_____‐_____
E‐mail Address: ___________________________________
PROVIDE CURRENT PLAN’S TRUST ID NUMBER: ___________________________________
PROVIDE CURRENT PLAN’S EFFECTIVE DATE: _____/_____/_____
DOES THIS PLAN HAVE ASSETS? Yes No
WAS THIS PLAN FORMALLY TERMINATED WITH THE IRS? Yes No
If Yes, please provide a copy of the Plan Termination Notice and Board Resolution.
13. TRUSTEES: (Two trustees are recommended, if possible)
(a) ___________________________________ E‐mail: ___________________________________
(b) ___________________________________ E‐mail: ___________________________________
14. OWNERS AND OWNERSHIP (ADDITIONAL INFORMATION MAY BE NEEDED IF THE BUSINESS OWNERS ARE NOT
INDIVIDUALS/OWNERSHIP PERCENTAGE SHOULD TOTAL 100%):
Names Ownership % Family Relationship(s) to Other Owners
___________________________________ _____ ___________________________________
___________________________________ _____ ___________________________________
___________________________________ _____ ___________________________________
15. OWNERSHIP
IS THIS COMPANY PART OF A CONTROLLED GROUP OR AFFILIATED SERVICE GROUP? Yes No
If yes, you are not eligible for this plan design. Please contact us to discuss our Choice and Choice Plus plans.
*** Please contact your attorney or CPA to assist you in determining whether you are part of a Controlled
group or affiliated service group. See Exhibit A. ***
IS THIS COMPANY OWNED IN WHOLE OR IN PART BY A FOREIGN ORGANIZATION? Yes No
If yes, please read Exhibit B and attach a signed copy to the completed Questionnaire.
3 of 8
II. OWNER ONLY Plan Information ($300 annual fee and $150 setup fee)
1. ELIGIBILITY REQUIREMENTS AND ENTRY DATES: (Specify an age, if desired and an Entry Date option) Service: One Year; 1,000 Hours Entry Dates: Specify Age: _____ Monthly (You may select any age up to and including age 21. If this line is Quarterly left blank, your plan will not have an age requirement.) Semi‐Annually
2. DEFERRAL ELECTION CHANGES (2) ALLOWED: (Same frequency as Entry Dates is recommended) Election Change Allowed Monthly Election Change Allowed Quarterly Election Change Allowed Semi‐Annually
(2)This election change only applies to the percentage of a participant’s deferred compensation. Changes in Fund elections and in asset allocation may be requested at any time.
3. ROTH ELECTIVE DEFERRALS: Yes No The plan may allow Roth after tax contributions to be made by participating employees. These contributions are made at the employee’s discretion. Roth after tax contributions are NOT excluded from taxable income at the time of deferral. Distributions of Roth after tax contributions (and earnings) may not be included as taxable income at the time of distribution if certain criteria are met.
4. EMPLOYEE DEFERRAL LIMIT: Eligible employees may defer up to 100% of compensation, not to exceed the limit in effect at the beginning of the calendar year. Participants age 50 or older may make an additional “catch‐up” contribution. The limits for 2013 are $17,500 for Elective Deferral and $5,500 for Catch Up.
5. PROFIT SHARING: Yes No The plan will include a discretionary pro‐rata non‐integrated formula with an equal percentage of compensation for each eligible participant.
6. VESTING SCHEDULE: Immediate 100% vesting.
7. HARDSHIPS: Yes No Hardship distributions are allowed from Pre‐tax Salary Deferral Contributions only (not including earnings).
8. IN‐SERVICE DISTRIBUTIONS: Yes No In‐Service Distributions may be allowed after age 59 ½ from all contribution sources except Roth Elective Deferrals.
9. EMPLOYER MATCHING AND SAFE HARBOR PROVISIONS: A traditional 401(k) plan is subject to annual compliance testing to demonstrate that the Highly Compensated Employees do not benefit substantially more than the Non‐Highly Compensated Employees. This testing often limits the amount of salary deferrals the business owner is able to deposit each year. By establishing our Owner Only plan with a required Safe Harbor match, we are protecting the plan sponsor’s ability to continue contributing to the plan as the business grows to include employees. ENHANCED SAFE HARBOR MATCHING CONTRIBUTION: Plan Sponsor will calculate a Safe Harbor matching contribution on behalf of each eligible participant equal to 100% of the Elective Contribution (Salary Deferrals) not to exceed 6% with a minimum of 4% of compensation. Plan Sponsor elects to match Salary Deferrals at % of each employee’s compensation.
4 of 8
III. INVESTMENTS Please indicate which funds to include in the plan’s investment lineup by placing a “X” to the left of each fund. A maximum of 15 mutual funds are allowed. Plans are required to select a default investment (mark with a ‘D’) and are strongly encouraged to choose one of the highlighted funds since they meet the criteria of a Qualified Default Investment Alternative. Please consult your financial advisor for investment advice.
LORD ABBETT INVESTMENTS ONLY; MADE IN SHARE CLASS: (check one) Class A Class R3
Advisors: Please refer to your firm’s share class guidelines since certain share classes may be restricted. If Class A shares are selected for Lord Abbett funds, is a letter of intent attached? Yes No
Class A share purchases may be subject to a front‐end sales charge. Certain purchases of Class A shares made without a front‐end sales charge may be subject to a contingent deferred sales charge (CDSC) of 1% if shares are redeemed within 12 months of purchase.
Class R3 shares are purchased at Net Asset Value (NAV) with no front‐end sales charge and no CDSC when redeemed. They are subject to on‐going service fees.
Domestic Equities
American Century Heritage A
Columbia Small Cap Core A
Delaware Small Cap Value A
Federated Max Cap Index R
JPMorgan Equity Income A
JPMorgan Large Cap Growth A
MFS Growth R3
MFS New Discovery R3
MFS Research R3
Nuveen Santa Barbara Dividend Growth A
Fixed Income
American Century Inflation Adj Bond A
Columbia Global Bond A
Columbia Limited Duration Credit A
Janus Flexible Bond S
Eaton Vance Floating Rate A
JPMorgan Core Bond A
JPMorgan Government Bond A
JPMorgan High Yield A
Lord Abbett Bond Debenture A/R3
Lord Abbett Income A/R3
Lord Abbett Short Duration Income A/R3
Lord Abbett Total Return A/R3
Lord Abbett Us Government Money Market A
MFS Bond R3
MFS Emerging Markets Debt R3
Alternatives
Blackrock Natural Resources A
Janus Global Real Estate S
Please note: Prime Plan Solutions selection of funds may be subject to change. Visit our website for the most current lineup of funds.
International/Global Equities
Blackrock Emerging Markets A
Janus International Equity S
MFS Global Equity R3
MFS International Value R3
Thornburg Global Opportunities R4
Thornburg International Value R4
Managed Strategies
American Century One Choice 2015 A
American Century One Choice 2025 A
American Century One Choice 2035 A
American Century One Choice 2045 A
American Century One Choice 2050 A
American Century One Choice 2055 A
American Century Strat Allc Conservative A
Benefit FCI Life Strategy Conservative Growth
Benefit FCI Life Strategy Growth D
Benefit FCI Life Strategy Moderate Growth D
Columbia Balanced A
Columbia Income Builder A
Columbia Thermostat A
Lord Abbett Multi‐Asset Balanced Opportunity A/R3
Lord Abbett Multi‐Asset Income A/R3
Lord Abbett Multi‐Asset Growth A/R3
Manning & Napier Target Income K
MFS Aggressive Growth Allocation R3
MFS Conservative Allocation R3
MFS Diversified Income R3
MFS Growth Allocation R3
MFS Lifetime 2010 R3
MFS Lifetime 2020 R3
MFS Lifetime 2030 R3
MFS Lifetime 2040 R3
MFS Lifetime Retirement Income R3
MFS Moderate Allocation R3
Templeton Global Balanced A
DST Systems, Inc. may receive compensation with respect to plan investments, including, but not limited to, transfer agent, recordkeeping, shareholder servicing, 12b‐1 or other fees.
5 of 8
Please read and consider the prospectuses for risks, applicable sales charges, conditions for purchases without a front‐end sales charge, and conditions for which a CDSC is applied. To obtain a literature on any of the funds, please contact your Investment Professional or visit www.primeplansolutions.com. Read the prospectus carefully before investing.
IV. OWNER ONLY PLAN NOTICE The following business types are eligible for the Prime Plan Solutions Owner Only 401(k) product:
Sole proprietor without eligible employees*
Partnership or LLP without eligible employees*
Corporation, S Corporation or LLC with one owner (or husband/wife owners) without eligible employees*
In addition to the above, the entity may not be part of a controlled group of companies, an affiliated service group, or a group of businesses under common control.
*Eligible employees include employees who are not excluded from plan participation based on the following criteria:
Union employees who are covered by a collective bargaining agreement, under which retirement benefits were subject to good‐faith bargaining.
Non‐resident aliens who receive no earned income from you that constitutes income from sources within the United States.
Not eligible because they do not yet meet the plan’s Minimum Age or Years of Service requirements.
As soon as eligible employees are hired, it is the responsibility of the plan sponsor to notify Prime Plan Solutions so government filing requirements for plans that cover non‐owner employees can be fulfilled.
V. ENROLLMENT MEETING
E‐mail a copy of the Enrollment Kit to: Plan Sponsor Broker
Please allow 3‐5 business days for Prime Plan Solutions to create an Enrollment Kit.
VI. FINANCIAL ADVISOR / BROKER
Financial Advisor Name: _____________________________________
Dealer Firm: _____________________________________ Branch #: __________________
Branch Street Address: _____________________________________
City / State / Zip: _____________________________________ Rep #: __________________
Phone: (_____)_____‐_____ Fax: (_____)_____‐_____
E‐mail: _____________________________________
VII. BANKING INFORMATION / ACH AUTHORIZATION
Please indicate the type of bank account: Checking Account Savings Account
If the bank account is for an affiliated company, please provide the company name: ____________________
Bank Name: ________________________________________________
Bank Phone Number: (_____)_____‐_____
Bank Routing Number / ABA # : ________________________________________________
Bank Account Number: ________________________________________________
Bank Account Registration*: ________________________________________________ * Typically the first line listed on a check / deposit slip.
Example: ABC Company401(k) Plan ________________________________________________
A voided check must be attached if establishing a checking account. Please attach a savings deposit slip if creating a savings account.
6 of 8
VIII. PLAN DESIGN QUESTIONNAIRE CERTIFICATION
I submit the enclosed Questionnaire as the design requirements for the Employer named on Page 1, along with the first year’s annual fee of $300 and the one time set‐up fee of $150. I understand there may be additional charges if changes are requested after the final plan documents have been produced.
I certify, to the best of my knowledge, that the information provided on this Questionnaire is true and correct and the employer company named above does not currently have eligible employees. I understand if any of the data provided is later discovered to be incorrect, false, or misleading the plan may be subject to penalties and fines up to and including plan disqualification. I certify that my current or any prior plan was in full compliance, in form and in operation including timely filing of all required Annual Reporting with all applicable Department of Labor and Internal Revenue Service requirements. The plan trustees retain sole responsibility for the qualified status of that Plan.
Plan Sponsor Name: ____________________________________________________
Plan Sponsor Signature: ________________________________________ Date: _____/_____/_____
IX. RECORD KEEPER CONTACT INFORMATION
Regular Mail: Prime Plan Solutions Overnight Mail: Prime Plan Solutions
P.O. Box 219162 330 W. 9th Street
Kansas City, MO 64121‐9162 Kansas City, MO 64105
Web Address: www.primeplansolutions.com
E‐mail: [email protected]
Phone: (888) 445‐0031
Fax: (816) 218‐0079
7 of 8
Exhibit A
A related group can consist of a controlled group of businesses, a business under common control or an affiliated service
group.
The definition of controlled group can be found in Internal Revenue Code (IRC) Section 414(b). These provisions provide
specific details regarding the types of controlled groups that may arise, which interests may be disregarded, a definition
of effective control, etc. Also, IRC Section 318 and 1563 provide guidance on the attribution rules for Highly
Compensated Employees (HCE) and when ownership of separate entities is considered to be one employer, respectively.
Businesses under common control can be found in IRC Section 414 (c). In situations where there is insufficient common
ownership to satisfy the controlled group requirements, an affiliated service group (ASG) may exist. The employees of
each member entity are treated as if they were employed by a single employer. IRC Section 414(m) provides specific
direction in addressing ASG issues.
Listed below are several questions that an employer will want to consider and if appropriate, obtain legal advice in
regard to related groups issues.
Does the ownership interest of a single individual, or the combined ownership interests of 5 or fewer people,
equal 80% or more of the equity interests in the employer? If yes, do any of such individuals have ownership
interests in other businesses?
Do family members (parents, grandparents, children) of any owners of the employer have ownership interests in
the employer or in other businesses?
Does a trust own any part of the employer?
Does a foreign corporation or business entity own any interest in the business?
Does the employer have an ownership interest in other businesses (e.g. stock ownership in another
corporation)?
Does the prospective plan sponsor provide services to another business in which the employer has an ownership
interest or in which any highly compensated employee of the employer has an ownership interest?
Does the employer provide or receive services to or from another business/company in which the employer has
an ownership interest, or in which any highly compensated employee of the employer has an ownership
interest?
Does the employer provide or receive management services to/from another company?
Is the proposed plan sponsor engaged in providing professional services, particularly if the professional services
are provided jointly with any other business entity? Some examples are medical, legal, accounting, actuarial and
engineering services.
Is the employer a partnership that has any partners who are separately incorporated?
8 of 8
Exhibit B
Date: _____/ _____/_____
Employer Name: ____________________________________________________
Plan Name: ____________________________________________________
As authorized individual of the above named employer (“Employer”) and on behalf of and in the name of such Employer,
I have been asked, by Prime Plan Solutions (“the Provider”), to review with my attorney the above business’ eligibility to
establish and make contributions to a qualified retirement plan under Section 401(a) of the Internal Revenue Code (“the
Code”).
Based on such review, the Employer hereby instructs the Provider to proceed with the establishment and administration
of this qualified retirement plan. The Employer hereby accepts full responsibility, both legal and financial, should the
Internal Revenue Service, the United States Department of Labor, any other United States governmental entity or
authority, any financial advisor or attorney determine that the above Employer, including its successors or assigns, was
not eligible to provide a qualified retirement plan on behalf of its employees, including owner employees, partners,
members of a Limited Liability Corporation or Partnership because the Employer failed to include employees of any
related firm.
The Employer acknowledges that Provider accepts no responsibility for the determination of Employer’s status regarding
controlled group or affiliated service group classification, or its exemption from regulations regarding a controlled group
of companies or an affiliated service group as defined by Sections 414(b), 414(c) and 414(m) (or any other related
section) of the Internal Revenue Code. Employer acknowledges that such responsibility is and remains solely that of the
Employer and that Provider’s responsibility is limited solely to the services set forth in the agreements between
Employer and the Provider.
The Employer agrees to indemnify and hold harmless the Provider, its officers, partners, board members from any and
all loss, damage, costs, charges, interest, penalties, liability or expenses resulting from any claim, action, demand or suit
which may arise out of, be connected with, or made due by the Employer’s failure to include employees of any related
firm in the qualified plan or defined benefit plan or which may be incurred by a Provider to enforce this indemnification
in event of a failure or undue delay by the Employer to fulfill the Employer’s obligations hereunder.
Employer shall, at its own expense and risk, defend or settle any such claim, demand or suit that is covered by this
indemnification and brought against the Providers and the Employer shall satisfy any judgment or assessment that may
be rendered against Providers in respect to any such claim, demand or suit.
____________________________________________________
Name of Authorized Individual
____________________________________________________
Title of Authorized Individual
____________________________________________________
Signature of Authorized Individual
© 2013 DST Systems, Inc. The information provided herein is intended as general information and is not, and should not be considered or relied upon, as legal, tax or retirement planning advice. Neither DST Systems, its
affiliates or their respective control persons have been authorized to give legal, tax or retirement‐planning advice. For tax and retirement planning, employers and their plan participants should consult a financial advisor.
Participants should read the relevant fund prospectus before making any decisions about allocating investments in their 401(k) plan.