Prosperity Plus™ Business Owner Intake

412(e)(3) / Fully-Insured Defined Benefit Plan — streamlined “one form” questionnaire

Purpose: Collect the key items commonly requested for plan design + proposal (company data + census). This is an intake worksheet only. Final design is confirmed with plan documents and carrier/TPA review.

Representatives do not provide tax or legal advice. Please consult your tax advisor/attorney.

1) Contact + Company Basics

Required

Best Contact Name

Best Contact (Email)

Best Contact (Phone)

Financial Professional (optional)

Legal Company Name

Employer EIN

Business Address

County (optional)

Nature of Business / IRS Business Code (optional)

Tax Year Ends (MM/DD) (optional)

2) Entity Type + Ownership Structure

Required

Company Legal Structure

Plan compensation rules vary by entity type; accuracy here matters.

Plan Year (for proposal)

Controlled Group / Affiliated Service Group: If the business or owners have stakes in other businesses, it can affect eligibility, coverage testing, and plan design.

Any ownership in other businesses?

How many other businesses?

Notes (names / entity types) (optional)

3) Existing Retirement Plans + History

Required

Why we ask: If a plan already exists (401(k), SEP, SIMPLE, etc.), it impacts design and next steps.

Existing retirement plan?

Type(s) (check all that apply)

Existing Plan Notes (provider, plan #, active/inactive)

4) Profitability Snapshot

Helpful

Corporate profit before federal income tax (last 2 years) (optional)

Plans generally work best with consistent, predictable annual income.

Owner target retirement age (optional)

5) Employee Census (for Proposal)

Required

Please list everyone on payroll (owners + employees). This mirrors the common proposal census fields: name, DOB, hire date, officer/director, ownership %, comp, hours, job title, tobacco use, underwriting class, relationship to owner. :contentReference[oaicite:4]{index=4}

Name	DOB	Hire Date	Officer?	Owner?	% Owned	Annual Comp	Hours Code	Job Title	Tobacco?	UW Class	Relationship

6) Professional Contacts (Optional)

Optional

Accountant / CPA (name + email)

Attorney (name + email)

7) Intake Summary (Preview)

Auto

People Listed

Total Annual Compensation

Owners Listed

Your TPA supports plan design, documents, testing, and filings (including Form 5500 and other compliance items). :contentReference[oaicite:5]{index=5}