Automotive Parts & Services Association 401(k) Survey

1. Survey Completed By:

Survey Completed By:

2. General Information:

General Information: Today's Date:
Company Name:
Primary Contact Person:
Company Address:
City, State, Zip:
Phone:
Fax:
E-mail Address:
Web site Address:

3. Type of Business Entity:

Type of Business Entity: C Corp.

S Corp.

Partnership

Sole Proprietor

LLC.

LLP.

Non Profit

4. Select Contact Preference:

Select Contact Preference: Call Client Directly

Call MEP Sponsor Contact

Call Other Contact

Preferred Contact Name/Phone

5. Does your Company have a 401(k) or Retirement Plan? Please select the type of plan, or select no plan.

Does your Company have a 401(k) or Retirement Plan? Please select the type of plan, or select no plan. SEP

SIMPLE

Profit Sharing Only

Profit Sharing with 401(k)

401(k) Only

No Plan

6. Has the company ever sponsored a Qualified Retirement Plan?

Has the company ever sponsored a Qualified Retirement Plan? Yes

7. Does the company have an old plan it wants to merge?

Does the company have an old plan it wants to merge? Yes

8. Is this company a subsidiary of any other company?

Is this company a subsidiary of any other company? Yes

9. Is the company part of a controlled group?

Is the company part of a controlled group? Yes

10. Do any owners, spouses or minor children own any part of any other business with the Employer?

Do any owners, spouses or minor children own any part of any other business with the Employer? Yes

11. Will the company consider making a matching and/or profit sharing contribution to the plan?

Will the company consider making a matching and/or profit sharing contribution to the plan? Yes

12. Have you been part of a professional employer organization's retirement plan?

Have you been part of a professional employer organization's retirement plan? Yes

13. Are there any assets and participants currently on this plan?

Are there any assets and participants currently on this plan? Yes, if yes, please state estimated assets and participants below

List est. assets and # of participants

14. Demographic Information

Demographic Information Number of Full-time Employees:
Number of Part-time Employees:
Gross Annual Payroll:

15. Does payroll include owners?

Does payroll include owners? Yes

16. Will owners participate in the Plan?

Will owners participate in the Plan? Yes

17. What are the Main Reasons to Set Up a Plan?

What are the Main Reasons to Set Up a Plan? Personal savings

Reduce turnover

Competitive requirement

Help employees save for retirement

18. List all owners of the company with 5% or more ownership in the current and prior year:

List all owners of the company with 5% or more ownership in the current and prior year: Name
Name
Name
Name
Name
Name

19. List all lineal relatives of each owner who are on the company payroll: (i.e. grandparent, parent, spouse, or children)

List all lineal relatives of each owner who are on the company payroll: (i.e. grandparent, parent, spouse, or children) Name of Relative/Relationship to Owner
Name of Relative/Relationship to Owner
Name of Relative/Relationship to Owner
Name of Relative/Relationship to Owner
Name of Relative/Relationship to Owner
Name of Relative/Relationship to Owner

20. Number of employees of the company who earned, with the employer, in excess of $105,000 in the prior year:

Number of employees of the company who earned, with the employer, in excess of $105,000 in the prior year:

1. APSA of Illinois 401(k) Survey