NCIF Passthrough "*" indicates required fields Legal Company Name* Ownership Breakdown* Enter the name(s) of the owner(s) of the company and their ownership percentage (e.g. Jane Doe 80%; John Smith 20%) Address* Street Address City State ZIP / Postal Code Business Phone* Number Type*What type of number is this? Cell Number Direct Line Main Fax Main Contact Name* First Last Main Contact must be authorized signer for the Company Prefix Suffix Designations Main Contact's Official Job Title Main Contact Email Main Contact Phone Number Number TypeWhat type of number is this? Cell Number Direct Line Main Assign an Additional Contact for Day-to-Day (Administrative) Correspondence* Yes No Daily Contact Name* First Last Daily Contact's Official Job Title* Daily Contact Email* Daily Contact Phone Number Number TypeWhat type of number is this? Cell Number Direct Line Main Type of Entity*Select One S Corporation C Corporation Partnership Sole Proprietorship Professional Corporation - C Corp Professional Corporation - S Corp LLC/LLP Taxed as a C Corp LLC/LLP Taxed as an S Corp LLC/LLP taxed as a Sole Prop/Partnership PLLC Taxed as a C Corp PLLC Taxed as an S Corp PLLC taxed as a Sole Prop/Partnership Non-Profit Employer Tax Identification Number (EIN)* DO NOT enter a Social Security Number (SSN) here. If the business does not have an EIN yet, enter 99-9999999. Employer Fiscal Year-end*December November October September August July June May April March February January Select the final month of the fiscal year (most entities are on a calendar year end, and therefore would select "December") Business/NAICS Code More info: https://www.census.gov/naics/ Payroll Provider* Examples Include ADP, Paychex, QuickBooks, N/A, etc. Email for Internal Contact Responsible for Payroll (if different than contacts already provided) Invoices shall be emailed to* Name of Invoice Recipient (if different than Daily Contact) During the current year, have any of the company’s owners had ownership interests in other entities? Yes No Please explain the above response During the current year, have any family members of the company’s owners had ownership interests in other entities? Yes No Please explain the above response Does the company receive or provide management services from/to another entity? Yes No Please explain the above response Does the company employ any relatives of the owners? Yes No Has the company ever sponsored a retirement plan that was terminated? Yes No i.e. SEP, SIMPLE IRA, 401(k), Profit Sharing, Defined Benefit, etc. Please explain the above response Does the company currently sponsor a retirement plan?* Yes No Name of Existing Retirement Plan* Type of Existing Retirement Plan*Select One 401(k) Plan Profit Sharing Plan Cash Balance Plan Defined Benefit Plan (Traditional) 403(b) Plan SIMPLE IRA SEP Plan Number e.g. 001 Original Effective Date of Existing Retirement Plan Financial Institution for Existing Retirement Plan Name of Individual Completing this Form* First Last Title Statement of Accuracy Check this box to acknowledge that the information provided in this form is accurate to the best of your knowledge. Information provided herein will be used to inform plan design decisions, legal plan documents, etc. Inaccurate or missing information may lead to incorrect results. The information provided herein is accurate to the best of my knowledge For Internal Use Only Info for PPD-Administered Plans Client Number* Client-Level Category (Squad Assignment)* Combo Plan*Select One Yes No Yes Other TPA Plan Name* Client Servicing Level (on Plan Record)* Plan Type*Select One 401(k) Cash Balance Cash Balance SB Only Defined Benefit Defined Benefit SB Only Profit Sharing 403(b) Money Purchase Plan Number* e.g. 001 Owner(s) Only Plan* Yes No Tax ID Number (TIN) Original Plan Effective Date* Trustee(s) Investment ArrangementSelect One Pooled (DB plans always pooled) Recordkeeper SDBA (Self-directed Brokerage Accts) Add a Second Plan Yes No Only Select 'Yes' if PPD will administer it Plan Name* Client Servicing Level (on Plan Record)* Plan Type*Select One 401(k) Cash Balance Cash Balance SB Only Defined Benefit Defined Benefit SB Only Profit Sharing 403(b) Money Purchase Plan Number* e.g. 001 Owner(s) Only Plan* Yes No Tax ID Number (TIN) Original Plan Effective Date* Trustee(s) Investment ArrangementSelect One Pooled (DB plans always pooled) Recordkeeper SDBA (Self-directed Brokerage Accts) Add a Third Plan Yes No Only Select 'Yes' if PPD will administer it Plan Name* Client Servicing Level (on Plan Record)* Plan Type*Select One 401(k) Cash Balance Cash Balance SB Only Defined Benefit Defined Benefit SB Only Profit Sharing 403(b) Money Purchase Plan Number* e.g. 001 Owner(s) Only Plan* Yes No Tax ID Number (TIN) Original Plan Effective Date* Trustee(s) Investment ArrangementSelect One Pooled (DB plans always pooled) Recordkeeper SDBA (Self-directed Brokerage Accts) Plan Details - DC Document Written/Provided by PPD Other Can participants direct their own investments? Yes (most common) No Recordkeeper?Select One Yes (+DV) No (DPRF Implications) Name of Recordkeeper (Select)Select One Alerus American Funds (Plan Premier) American Funds (Recordkeeper Direct) American Trust Ascensus Ascensus Vanguard at Ascensus Aspire Empower (Ready Select) Empower (Select) Fidelity John Hancock (Enterprise) John Hancock (FutureStep) John Hancock (Signature) J.P. Morgan Lincoln (Alliance) Lincoln (Director) Nationwide Principal Principal (Simply) RPA RKPR RPG Consultantss T Rowe Price The Standard TIAA Transamerica TruStage Vanguard Vestwell Voya (MAP Plus) Voya (MAP Select) Voya (Framework) *Other* Name of *Other* Recordkeeper Name Non-RKPR Custodian (if known) Safe Harbor Yes No Valuation Frequency Annual Other Audited? Yes No Mega Backdoor Roth? Yes No Notes Plan Details - DB Document Written/Provided by PPD Other Recordkeeper? (Full Admin Only)Select One Yes No (DPRF Implications) Name of Recordkeeper Valuation Frequency Beginning of Year (BOY) End of Year (EOY) PBGC Covered Yes No - Exclusively for substantial owners > 10% No - Professional Service < 26 employees Unsure - Code in WF as 'Yes' and leave a (1) Plan, and (2) New Client Setup Project Note for the PC "Unsure; Please Verify" Audited? Yes No Notes PPD Services Document*Select One New Document Amend & Restate Amendment Existing Document/Takeover No Document Services Doc Preparer (if different than default [TL for DC; AF for DB]) Admin Type*Select One Full Administration SB Only Document Only Consulting Only Owens & Bondell - Consulting Arrangement Service Effective On* Notes Referral Source Referral Source* Workflow If referred by an Other TPA, select if they are also the Plan's “Main Contact” If referred by an Other TPA, select if they are also the Plan's “Group” Select if the referral source is also the “Category” Client Search Text Plan Search Text Projects to Launch in Workflow All* New Client Setup Service Agreement Consent Form Fee Schedule (SB Only) Annual Admin for Retroactive Plan Year Plan Setup in ASC Non PPD Plan Doc Review Participant 404a-5 Disclosure Periodic Benefit Stmts (Not-Owner-Only SDBA plans) Revenue Sharing Appendix (RKPR w/ Rev Share) PBGC - New Plan (select if starting up a PBGC-covered plan) PBGC - Prior Year (select if taking over a retroactive admin year) Asset Transfer (assign to TL) Plan Document Preparation - DC Plan Document Preparation - DB (Full Admin) Plan Document Preparation - DB (SB Only) S2 Operations 'Checklist' - DC Startup Form SS-4 Preparation (Full Admin Startups, Not RKPR Plans) Form 2848/SS-4 Preparation (SB Only Startups) Fidelity Bond (Full Admin Startups, Not Owner Only) Obtain Business EIN for a Sole Proprietor (Special One-off Project) Takeover Takeover DB/CB Plan (Reassign Project to Illustrator) Takeover DC Plan Onboarding The Engagement Service Agreement/Fee Schedule Delivered Service Agreement/Fee Schedule Received Consent Form Delivered Consent Form Received Upfront Fees (Fees for Document, TKO, Consulting, etc.)* Base Fee* Per Participant Fee* Does a Non-discrimination Testing Fee Apply?* Yes No Non-discrimination Testing Fee* Participant Count* Total Recurring Fees* Biller* DC Plans Only: Who pays loan/distribution fees? Plan Sponsor Participants The Relationship PC Client Communication Contact After OnBoarding Reviewer Actuary Quality Control Assembly Coordinator Admin Person for the corresponding Squad Distribution Coordinator Default is Sherry Hibbs Add a Participating Employer? Yes No Participating Employer #1 Legal Company Name Ownership Breakdown Address Street Address City State / Province / Region ZIP / Postal Code Type of EntitySelect One S Corporation C Corporation Partnership Sole Proprietorship Professional Corporation - C Corp Professional Corporation - S Corp LLC/LLP Taxed as a C Corp LLC/LLP Taxed as an S Corp LLC/LLP taxed as a Sole Prop/Partnership PLLC Taxed as a C Corp PLLC Taxed as an S Corp PLLC taxed as a Sole Prop/Partnership Non-Profit Employer Tax Identification Number (EIN) Has Employees? Yes No Add Another Participating Employer? Yes No Participating Employer #2 Legal Company Name Ownership Breakdown Address Street Address City State / Province / Region ZIP / Postal Code Type of EntitySelect One S Corporation C Corporation Partnership Sole Proprietorship Professional Corporation - C Corp Professional Corporation - S Corp LLC/LLP Taxed as a C Corp LLC/LLP Taxed as an S Corp LLC/LLP taxed as a Sole Prop/Partnership PLLC Taxed as a C Corp PLLC Taxed as an S Corp PLLC taxed as a Sole Prop/Partnership Non-Profit Employer Tax Identification Number (EIN) Has Employees? Yes No Notes Doc Signer NCIF Preparer* Carrie Curtis Meredith Alford Other Preparer's Notes NCIF Reviewer* TL CC Other Reviewer's Notes Notes for Onboarding Phase
