Retirement Readiness Report (TR3) Intake

C-Suite Profile and Organization Information

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IP Address Tracking

This Retirement Readiness Report is to be completed for:*

First Name Last Name

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ScheduleOnce First Name

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ScheduleOnce Last Name

C-Suite Profile and Organization Information

's email address is:*

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ScheduleOnce Email

C-Suite Profile and Organization Information

's job title/role is:*

Other*

C-Suite Profile and Organization Information

The name of the organization represents is:*

Is a government agency?*

C-Suite Profile and Organization Information

Which best describes ?*

C-Suite Profile and Organization Information

How many locations does have?

If unsure, you can leave this field blank.

C-Suite Profile and Organization Information

The estimated annual revenue of is:

(Please provide a Total Dollar Amount Ex. $10,500,000). If unsure, you can leave this field blank.

C-Suite Profile and Organization Information

is located in the city of:*

C-Suite Profile and Organization Information

is located in the state of:*

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is located in the state of:*

C-Suite Profile and Organization Information

was hired by on:*

C-Suite Profile and Organization Information

has been in their current role since:*

Organization: | City/State: ,

C-Suite Profile and Organization Information

's birthday (DOB) is:*

C-Suite Profile and Organization Information

Name of person completing this form/request:*

First Last

Name of person completing this form/request:*

First Last

Are you completing this questionnaire, ?

Yes, I am.

C-Suite Profile and Organization Information

's job title/role is:*

Other*

C-Suite Profile and Organization Information

's mobile phone number is:*

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ScheduleOnce Phone

C-Suite Profile and Organization Information

's email address is:*

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ScheduleOnce Guest Email

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Current Total Rewards Package - Readiness Review

's current base salary is: *

(Please provide a Total Dollar Amount Ex. $250,000).

Current Total Rewards Package - Readiness Review

's current annual incentive bonus target:

(Please provide a Total Dollar Amount Ex. $50,000).

Current Total Rewards Package - Readiness Review

's incentive bonus is based on: (optional)

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Does your organization offer a 401(k) Plan?

A 401(k) Plan is a qualified retirement and savings plan that can be offered in both for-profit and non-profit businesses.

401(k)*

Audience: Typically offered to all full-time employees as a core retirement plan.

Contribution Cap: Employees can contribute up to $20,500 + $6,500 Catch-up for those Age 50+, EE+ER Contribution Cap = $61,000 (2022 IRS Limits)

Tax Treatment: Typically, contributions go in pre-tax, grow tax-deferred and come out taxable as ordinary income. (option to add Roth contributions)

Eligibility: If offered, employer must provide the plan to all full-time employees

Discrimination Testing: Yes, the plan must provide equalized benefits for all eligible employees and pass discrimination testing.

Current account balance (401k):

(Please provide a Total Dollar Amount Ex. $350,000).

What is the contribution formula? - 401(k)*

(Select all the may apply, common if multiple plan options).

Match %

Contribution %

Contribution $

Target Benefit

Unknown

Other

Match % - 401(k):

Match % - 401(k) funded by:

Employer

Employee

Contribution % - 401(k):

Contribution % - 401(k) funded by:

Employer

Employee

Contribution $ - 401(k):

Contribution $ - 401(k) funded by:

Employer

Employee

Other (please provide details/notes):

Does your organization offer a 403(b) Plan?

A 403(b) Plan is a qualified retirement and savings plan that is typically offered in non-profit organizations.

403(b)*

Audience: Typically offered to all full-time employees as a core retirement plan.

Contribution Cap: Employees can contribute up to $20,500 + $6,500 Catch-up for those Age 50+, EE+ER Contribution Cap = $61,000 (2022 IRS Limits)

Tax Treatment: Typically, contributions go in pre-tax, grow tax-deferred and come out taxable as ordinary income. (option to add Roth contributions)

Eligibility: If offered, employer must provide the plan to all full-time employees

Discrimination Testing: While not subject to ADP test, the plan must still provide equalized benefits for all eligible employees and pass discrimination testing.

Current account balance (403b):

(Please provide a Total Dollar Amount Ex. $350,000).

What is the contribution formula? - (403b)*

(Select all the may apply, common if multiple plan options).

Match %

Contribution %

Contribution $

Target Benefit

Unknown

Other

Match % - 403(b):

Match % - 403(b) funded by:

Employer

Employee

Contribution % - 403(b):

Contribution % - 403(b) funded by:

Employer

Employee

Contribution $ - 403(b):

Contribution $ - 403(b) funded by:

Employer

Employee

Other (please provide details/notes):

Does your organization offer a 457(b) Plan?

A 457(b) Plan is a pre-tax retirement plan that is oftentimes used in conjunction with 401(k) or 403(b) plans to increase total pre-tax deferral limits for highly compensated employees.

457(b)*

Audience: Typically offered to executive leadership teams and provider groups to supplement a 401(k) or 403(b) Plan

Contribution Cap: Employer + Employee Contributions must equal $20,500 or less (2022 IRS Cap)

Tax Treatment: Contribution goes in pre-tax, grows tax-deferred and comes out taxable as ordinary income

Eligibility: Top Hat Group Only: Managerial, Supervisory or Highly Compensated

Discrimination Testing: None, can be offered to only one employee or all Top Hat Group employees, even at varying contribution levels (Top Hat Group: Managerial, Supervisory or Highly Compensated)

Important Note: All 457(b) Plan assets must be deemed an asset of the enterprise and can be subject to creditors of the organization in the event of a fully adjudicated bankruptcy.

What is the contribution formula?*

Employer contribution $ - 457(b):

Employee contribution $ - 457(b):

Does your organization offer a 457(f)/SERP Plan?

A 457(f)/SERP Plan is a pre-tax retirement plan that is generally provided to select executive leaders. There are no IRS caps on ER contributions but the amounts must still meet fairness opinion testing. Distributions are generally provided in a lump sum and taxable as ordinary income.

457(f)/SERP*

Audience: Typically offered to specific executive leaders

Contribution Cap: None, must be deemed fair and reasonable

Tax Treatment: Contribution goes in pre-tax, grows tax-deferred and distributions are taxable as ordinary income

Eligibility: Top Hat Group Only: Managerial, Supervisory or Highly Compensated

Discrimination Testing: None, can be offered to only one employee or all Top Hat Group employees, even at varying contribution levels. (Top Hat Group: Managerial, Supervisory or Highly Compensated)

Important Note: All 457(f) Plan assets must be deemed an asset of the enterprise and can be subject to creditors of the organization in the event of a fully adjudicated bankruptcy.

What is the contribution formula?*

Employer contribution $ - 457(f):

Employee contribution $ - 457(f):

Does your organization offer a 162(b) Bonus Plan?

A 162(b) Bonus Plan is an After-Tax plan that is generally provided as a supplemental retirement benefit for highly compensated employees. There are no IRS caps on ER contributions but the amounts must still meet fairness opinion testing. Participants can enjoy the benefit of tax-free retirement income.

162(b) Bonus Plan*

Audience: Typically offered to executives and/or providers, but can be offered to all employees

Contribution Cap: None, must be deemed fair and reasonable

Tax Treatment: Contribution goes in after tax, grows tax-deferred and comes out tax-free

Eligibility: Any employee can be offered this plan

Discrimination Testing: None, can be offered to only one employee or all employees, even at varying contribution levels

What is the contribution formula?*

Current account balance (162b):

Does your organization offer a Loan Regime Split Dollar Plan?

A Loan Regime Split Dollar Plan is a supplemental retirement plan generally provided to select executive leaders at an organization. There are no IRS caps on ER contributions but the amounts must still meet fairness opinion testing. Offers improved optics with no Form 990 Schedule J Reporting. Organization will also recover 100% of all contributions, with interest at a later date. Provides Tax-Free retirement income to the participant.

Loan Regime Split Dollar*

Audience: Typically offered to specific executive leaders

Contribution Cap: None, must be deemed fair and reasonable

Tax Treatment: Tax-Free Benefit for Executive

Eligibility: Any employee can be offered this plan

Discrimination Testing: None, can be offered to only one employee or all Top Hat Group employees, even at varying contribution levels (Top Hat Group: Managerial, Supervisory or Highly Compensated)

What is the contribution formula?*

Annual loan amount (LRSD):

Today's Date*

MM slash DD slash YYYY

Just a few more questions...

Benefits

Does provide and pay for Short Term Disability for ?*

What is the benefit?

What is the Maximum Monthly Benefit?

Benefits

Does provide and pay for Long Term Disability for ?*

What is the benefit?

What is the maximum monthly benefit?

What is the policy type? - LTD

Benefits

Does provide and pay for Life Insurance for ?*

What is the coverage amount?*

What is the policy type? - LI

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Comments

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The Retirement Readiness Report (TR3) Intake Questionnaire

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

C-Suite Profile and Organization Information

You’re doing great. Just a little bit more to go!

Current Total Rewards Package - Readiness Review

Current Total Rewards Package - Readiness Review

Current Total Rewards Package - Readiness Review

Nice! You're almost done!

Does your organization offer a 401(k) Plan?

Does your organization offer a 403(b) Plan?

Does your organization offer a 457(b) Plan?

Does your organization offer a 457(f)/SERP Plan?

Does your organization offer a 162(b) Bonus Plan?

Does your organization offer a Loan Regime Split Dollar Plan?

Just a few more questions...

Benefits

Benefits

Benefits

Great Job! Now it’s time to schedule your review session.

The Retirement Readiness Report (TR3)
Intake Questionnaire