New Client Intake FormPlease enter employer information below. All form info will be emailed directly to O‘Connell Pension Consulting after clicking submit. Plan Sponsor's Legal Name * EIN * Please do not include dashes. Address (No P.O. Boxes, Please) * Please enter "United States" for Country Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing Address (If Different from Above) Address 1 Address 2 City State/Province Zip/Postal Code Country Type of Entity * C Corp. S Corp. LLC LLP Partnership Sole Proprietorship Non Profit, 501 (c)(3) Day to Day Contact * First Name Last Name Day to Day Contact's Email * Day to Day Contact's Phone * (###) ### #### Payroll Contact * First Name Last Name Payroll Contact's Email * Payroll Contact's Phone Number * (###) ### #### Payroll Schedule * Next Pay Day: * Date Business Began * Date Incorporated * Fiscal Year End * What is your Business Activity? * Any Predecessor Entity(ies)? * Yes No If Yes, Name(s) of Predecessors Date(s) Predecessors Begun: Prior Plan History * Does the entity of the owners now have, or ever had any other retirement programs? Keoghs, SEP's, SIMPLE, Money Purchase, DB, CB, etc.? Yes No If Yes, List Plan Name: Officership and Ownership of Entity: * List all owners and officers AND percentages of ownership. Please email data@gopensions.com with any additional pages as required. Family Members of Any Owner Employed by Employer/Plan Sponsor Please list first and last name(s) AND relationship to owner(s). Accountant Name * First Name Last Name Accountant's Email * Company Name Company Address Address 1 Address 2 City State/Province Zip/Postal Code Country Company Phone Number (###) ### #### Does anyone with more than 5% ownership have an ownership interest in other entity(ies)? * Yes No If Yes, please provide information and percentages Specify the Individuals to be Names as Plan Trustees (include his/her social security number): * Name of Person Who Completed This Form: * First Name Last Name Thank you!
