Is your retirement plan in compliance with the law and is it being administered properly? For a complimentary evaluation, complete the form below. We will provide you with some suggestions to improve your plan.

1. Review of Employer Status

A. Is your company a member of a controlled or affiliated service group?: Yes No Don't Know

B. If the answer to A. is yes, have all employees been taken into account in determining the Plan's qualification?: Yes No Don't Know

2. Review of Plan Documents

A. Has the Plan recently been approved by the IRS?: Yes No Don't Know

B. Latest date of IRS approval of Plan document:

C. Is a Plan amendment needed to comply with recent laws?: Yes No Don't Know

D. Have Participants and the Department of Labor been given a Summary Plan Description? : Yes No Don't Know

E. Have Participants completed enrollment, beneficiary designation and, where applicable, pre-retirement survivor annuity forms?: Yes No Don't Know

F. Have loan agreements been properly prepared?: Yes No Don't Know

3. Review of Annual Administration

A. Have series 5500 forms been submitted to the IRS in a timely manner? : Yes No Don't Know

B. Has a Summary Annual Report been given to participants?: Yes No Don't Know

C. Have participants been given a benefit statement?: Yes No Don't Know

D. Have contributions and benefits been determined in accordance with the Plan Document and deposited to the plan in a timely fashion?: Yes No Don't Know

E. Have all required tests been made on contributions/benefits, especially those with regarding qualification under Code Sections 401 and 410, deductions under Section 404, the maximums allowed under Section 415 and the top-heavy requirements under Section 416?: Yes No Don't Know

F. Have distributions been properly distributed to participants including the completion of election forms, spousal consent forms, if applicable, and have 1099 forms for the IRS been prepared?: Yes No Don't Know

G. Are loans being repaid properly?: Yes No Don't Know

4. Review of Servicing the Plan

A. Are you satisfied with the servicing of your plan?:

B. Have services been performed in a timely manner?: Yes No Don't Know

C. Have mistakes been made by the service provider?: Yes No Don't Know

D. Has the service provider kept you informed of all changes in the laws that may affect your Plan?: Yes No Don't Know

E. Has the service provider provided frequent reviews of your plan to see if it is meeting its objectives?: Yes No Don't Know

F. Has the service provider been responsive to your concerns?: Yes No Don't Know

Your Name

Company Name

Phone Number

E-mail Address

Please describe the issues that are the most important to you regarding the administration of your pension plan and provide any other comments you feel are appropriate.