Pennsylvania Dental Association Insurance Services, Inc. Adopting Employer 401(k) Survey

1. Pennsylvania Dental Association Insurance Services, Inc. Adopting Employer Interest 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. 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

4. 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

5. Demographic Information

Demographic Information Number of full-time employees:
Number of part-time employees:
Gross Annual Payroll:

6. Are you interested in a Fiduciary Warranty?

Are you interested in a Fiduciary Warranty? Yes

N/A

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

Is this company a subsidiary of any other company? Yes

N/A

8. Do you understand all of the fees you and your participants are paying for your 401(k) plan?

Do you understand all of the fees you and your participants are paying for your 401(k) plan? Yes

N/A

9. 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

N/A

10. Is increased plan participation important to you at this time?

Is increased plan participation important to you at this time? Yes

N/A

11. Is business succession planning important to you at this time?

Is business succession planning important to you at this time? Yes

N/A

12. Would you be interested in an excess deferral plan for your highly compensated employees?

Would you be interested in an excess deferral plan for your highly compensated employees? Yes

N/A

13. Do you pay for a plan audit?

Do you pay for a plan audit? Yes

N/A

14. Do you feel you are receiving the appropriate services from your current plan provider?

Do you feel you are receiving the appropriate services from your current plan provider? Yes

N/A

15. Are you satisfied with the investment choices currently available through your current plan provider?

Are you satisfied with the investment choices currently available through your current plan provider? Yes

N/A

16. What do you see as the main reason(s) to offer a plan?

What do you see as the main reason(s) to offer a plan? Personal savings to owner(s)

Reduce turnover

Competitive requirement

Help employees save for retirement

Other

17. Thank you for taking the survey. Please provide any additional information.

Thank you for taking the survey. Please provide any additional information.