Compa ny Informa tion Form - s17279.pcdn.co · Pleas 1. N T P 2. C (A C P 3. C P A P (B P (4. E 8....
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Pleas 1. N T P 2. C ( A C P 3. C P A P ( B P ( 4. E 8. E 9. I 10. D 11. D 12. N se thoroughl Name of perso Title Phone: Company nam (*Use full leg Address: City, State & Phone: Company Con Phone: Administrativ Phone: (*The person Billing Contac Phone: (*If different f Employer EIN Entity Classif If LLC or LLP Date incorpor Date business Nature of busi C ly and accura on completing me*: gal name as s Zip: ntact (Executi ve (Day-to-Da who will be h ct:* from Adminis N 5. Fisc ication: P, specify fed rated (if applic commenced iness: Compa ately complet g this form: shown on tax ive): ay) Plan Cont handling day strative Plan C cal Year End Regul S Corp Partne Sole P deral tax elect cable): : any In te this form. returns – plea tact:* y-to-day items Contact) (MM/YY) ar Corporatio poration ership Proprietorship tion: forma This inform E-mail: ase indicate i Fax: E-mail: E-mail: s needed for th E-mail: 6. Plan Y on p Corporation State in ation mation will be if doing busin he plan, and t Year End (MM *6-digit c LLC LLP Tax-Exemp Other (spec n n which incor Form e used to dra ness as (DBA) the annual D M/YY) 7. code, found on pt cify) Partnership rporated: ft your Plan ), etc.) ata Request.) . IRS Busines your company p Document. ) ss Code* y tax return.
Transcript of Compa ny Informa tion Form - s17279.pcdn.co · Pleas 1. N T P 2. C (A C P 3. C P A P (B P (4. E 8....
Pleas 1. N
T P
2. C (
A
C
P
3. C
P
A
P
(
B
P
(
4. E
8. E 9. I 10. D 11. D 12. N
se thoroughl
Name of perso
Title
Phone:
Company nam(*Use full leg
Address:
City, State &
Phone:
Company Con
Phone:
Administrativ
Phone:
(*The person
Billing Contac
Phone:
(*If different f
Employer EIN
Entity Classif
If LLC or LLP
Date incorpor
Date business
Nature of busi
Cly and accura
on completing
me*: gal name as s
Zip:
ntact (Executi
ve (Day-to-Da
who will be h
ct:*
from Adminis
N 5. Fisc
fication:
P, specify fed
rated (if applic
commenced
iness:
Compaately complet
g this form:
shown on tax
ive):
ay) Plan Cont
handling day
strative Plan C
cal Year End
Regul S Corp Partne Sole P
deral tax elect
cable):
:
any Inte this form.
returns – plea
tact:*
y-to-day items
Contact)
(MM/YY)
ar CorporatioporationershipProprietorship
tion:
forma
This inform
E-mail:
ase indicate if
Fax:
E-mail:
E-mail:
s needed for th
E-mail:
6. Plan Y
on
p
Corporation
State in
ation mation will be
if doing busin
he plan, and t
Year End (MM
*6-digit c
LLC LLP Tax-ExempOther (spec
n
n which incor
Form e used to dra
ness as (DBA)
the annual D
M/YY) 7.
code, found on
pt cify)
Partnership
rporated:
ft your Plan
), etc.)
ata Request.)
. IRS Busines
your company
p
Document.
)
ss Code*
y tax return.
13. Owners/Principals:*
Name Title Ownership %
*Attach additional names and ownership percentages as necessary. Be sure to list all owners including any trusts, estates, partnerships, corporations, etc. Ownership should total 100%. If equity or profit ownership is different from above percentages, please contact us.
14. Accountant Do Not Have
Name:
Firm:
Address:
Phone: E-mail:
15. Attorney Do Not Have
Name:
Firm:
Address:
Phone: E-mail:
16. Investment Advisor/Broker Do Not Have
Name:
Firm:
Address:
Phone: E-mail:
17. Plan Trustee(s):
18. Is the Employer a member of a “controlled group” or “affiliated service group”? For example, does the Employer and another business entity share common ownership or regularly perform services together for third parties?
Controlled Group: Yes (If yes, please provide a list of names of companies,
owners and ownership percentages.) No Uncertain (Please contact us immediately.) Affiliated Service Group: Yes (If yes, please provide a list of names of companies and
their relationship.) No Uncertain (Please contact us immediately.)
Total:
19. Subsidiary and Affiliated Corporations:
List the name of each subsidiary and affiliate and indicate relationship.
20. Does the Company employ any family members of an owner/shareholder?
No Yes. Please provide names and relationship below.
21. Do any of the owners/shareholders of the employer own all or a part of any other trade or business?
No Yes. Please provide details below.
Owner/Shareholder Name of Entity % Ownership
22. Has the employer issued stock options or does any individual have an option to purchase stock?
No Yes
23. Does the Employer or any member of the Controlled/Affiliated Service Group sponsor any other retirement plan
(including SEPs and SIMPLEs) that will not be administered by Kravitz? No Yes
If yes, please provide name(s) and type of plan(s).
24. Are there employees in addition to those shown on the employee census listing, for example, employees terminated in current year, union employees or leased employees (including employees from a management company/PEO)?
No Yes (If “Yes,” attach list of other employees and specify classification.)
25. Predecessor organization(s) (if any): Name: Date incorporated or date business commenced: Type of Entity (see Item 8): Date of transfer: 26. Has the Company, any Predecessor Organization, or any member of a controlled group or affiliated service group
ever maintained any pension, 401(k) or profit sharing plan (including SIMPLEs or SEPs)? No Yes. Please provide details below. Company Name Plan Type Date Terminated
pac g:\kra docx
