Retirement Plan Proposal Request Form

Retirement Plan

Proposal Request Form

Please return completed form to:

Alliance Benefit Group

456 Fulton Street, Suite 345

Peoria, IL 61602

Phone: (800)242-2356Fax: (309)671-9933

E-mail:

Today’s date / Date of presentation / Number of proposal copies required
month/day/year / month/day/year
1 / Financial Advisor Information
Is Financial Advisor the primary contact person? YES NO
If NO, is Financial Advisor carbon copied on all correspondence? YES NO
Advisor name (please specify: Mr. or Ms.)
Firm name
Address
City / State / Zip
Phone # / () / Fax # / ()
E-mail address
2 /

Client / Prospect Information

Company name
Executive contact (please specify: Mr. or Ms.)
Address
City / State / Zip
Phone # / () / Fax # / ()
E-mail address
Operations contact (please specify: Mr. or Ms.)
E-mail address
If address is different from Executive Contact above, please complete:
Address
City / State / Zip
Phone # / () / Fax # / ()
Type of business:
C-Corp / S-Corp / Partnership/LLP/LLC / Sole proprietor / Other
Controlled group:
Does your business own any interest in another business? / Yes* / No
Do any of the owners, participants or their family members own any interest in another business? / Yes* / No
*If YES, is the other employer(s) a participating employer in this plan? / Yes / No
* If YES, do the other employers sponsor any other plans? / Yes / No
Other plans maintained by client:
Any plans terminated within the past year? / Yes* / No / *If YES, when:
Payroll:
In-house / Outside payroll provider  Name of provider:
Centralized processing / Multiple locations processed independently  # of locations:
3 /

Current Plan Evaluation(existing plans only)

Rate the Plan’s Current Performance in the Following Areas:
(1=Often exceeds expectations; 2=Meets expectations; 3=Does not meet expectations)
Administration & Recordkeeping:
Plan consultant & design / Phone access to account information
Contribution processing / Accuracy of participant statements
Disbursement processing / Timeliness of participant statements
Loan Processing / Overall quality of participant statements
Integration with payroll service / Compliance (ADP testing, 5500, etc.)
Internet access to account information / Overall ease of administration
Employee Communication & Related Issues:
Employee participation / Availability of investment education/advice
Frequency of employee meetings / Overall employee understanding of plan
Investments:
Investment Performance / Investment choices
Rate the Plan’s Total plan costs in the following Areas
(1-Getting more than your money’s worth; 2=Fees paid are reasonable; 3=Not getting your money’s worth)
Costs:
Administrative costs / Investment choices
Recordkeeping costs / Employee education costs
Investment costs
4 /

Plan Objectives

Rank the following six items in order of priority:
(1=Top Priority; 6=Lowest Priority)
Lowest cost to company
Lowest cost to participants
Investment flexibility
Investment performance
Investment expense
Participant education
5 / Plan Information
Plan Name (as it appears in plan document):
Status of plan:
New plan setup / Existing plan takeover
Total plan asset size: / Estimated annual additions:
$ / (existing plans only) / $
Please check the following, if applicable: (existing plans only)
Assets currently with:
Illiquid assets (If checked, please describe any illiquid assets in Section 6 “Additional Information”)
Surrender charges (If checked, please describe any surrender charges in Section 6 “Additional Information”)
Plan type:
401(k) / Profit Sharing / Profit Sharing Only / 403(b) / New Comparability
401(k) SafeHarbor / Defined Benefit / Other:
Employee data:
Total employees / Eligible employees / Active participants
Number of account balances maintained for terminated/retired employees (existing plans only):
Plan data and takeover date:
Plan year end / Target takeover date
(month/day/year) / (month/day/year)
Current provider information: (existing plans only)
Current Recordkeeper/TPA Provider
Current investment choices: (existing plans only)
Total number of investment choices offered
Please provide name and ticker symbol of the investment choices currently available in your plan:
If more than 12 offered, please list additional choices in Section 6 “Additional Information”
Fund / Ticker /

Fund

Ticker

1. / 7.
2. / 8.
3. / 9.
4. / 10.
5. / 11.
6. / 12.
Are there any current investment choices which must be retained in the plan? / Yes * / No
* If YES, please list choices, as well as any new funds, under Installation Information “New Investment Choices”
6 /

Proposed Plan Features

Recordkeeper/TPA Provider Selection
Advisor compensation method:
Fee Based RIA / Registered Rep./Broker Dealer
Plan Document Type:
Prototype / Individually Designed / Volume Submitter
(New comparability or multiple employer)
Trusteeship:
Self Trustee / Corporate Trustee
Statement / Reporting frequency:
Monthly Quarterly Semi-annually Annually
First report
Contribution type(s) allowed:
Profit sharing / Salary deferral / Matching* / SafeHarbor / After tax *
* Will these contributions differ by employee type or class? / Yes No
Contribution processing frequency:
Weekly / Bi-weekly / Semi-monthly / Monthly
Direction of plan assets:
Participants / Plan Sponsor / Trustee / Hybrid
Participant / Plan services: (Select all that apply)
Participant hotline / VRU / Internet access / Participant newsletters
Spanish materials / VRU / Loans  for existing plans, number outstanding:
Other investment choices:
Stable value products
Company stock: (Check one)  / Publicly traded / Privately held
Self-directed brokerage accounts
Life insurance  Number of policies: / Ins. Co.:
None

7 Additional Plan Information

Notes: Please provide any information about the Plan Sponsor’s goals or needs as well as any other relevant information you deem important.

Word/n/shared/retirement plan proposal request form 3/12/02