Annual Business Questionnaire

Please verify/complete (blank areas) and update (if applicable) and return this form even if no data changes have occurred from last year.

Please complete one of the following

How have you selected to be taxed?

Does Employer currently maintain any other retirement or cafeteria (section 125) plan?

Did the Employer ever maintain another retirement plan, whether or not terminated?

Do you have any leased employees?

Do you have any independent contractors?

Do you have any collectively bargained employees?

Name of All Owners, Shareholders, Partners or Officers Officer
Yes/No
Officer Title Owned (%)
Total Ownership Interest (must total 100%) 0

Does any person, or business concern listed above, or any spouse of any person listed above have ANY ownership in any OTHER business entity?

Are you a member of a Controlled Group or Affiliated Service Group of businesses?



Miscellaneous

Investment Broker/Agent

Accountant

YesNo
Attorney

I certify that the above information and all enclosures are accurate and complete.