Energi Pension Systems - Qualified retirement and employee benefit plans

Companies have different needs when it comes to 401(k) plan services. If you would like a proposal based on your needs, please complete the questionnaire. If you would like a proposal on any other plans, just complete section I and we will contact you.

Section I

Name		*
Title
Company
Address

Phone		*
Email		*

Employees working 1000 hours a year
(about 20 hours a week) or more:

Total payroll $

Section II

Enrollment/Education

What would you prefer?
Online enrollment
an advisor to explain the plan in person to employees

We would like our participants to receive retirement plan education:
On their own
Information brochure mailed to residence
Information brochure presented by a professional at a company meeting

Administration

	We would like to do as much as possible online and would be satisfied communicating day to day issues via email and/or
	Our Company wants to fully outsource services. We would like you to assign us a service representative we can talk to as needed.

Participant Distributions and Loans

We would like you to interface directly with employees
We would like paperwork to go through us

Investments

	We will accept a pre-packaged bundled investment program from an insurance company
	We want to go direct to mutual funds with a Trust Company as Custodian rather than an Insurance Company.

We would like our participants to receive investment education:
On their own
Investment brochure mailed to residence
Investment brochure presented by a professional at a company meeting

If you don't have an existing plan submit your request, otherwise go to Section III below.

Section III

Existing Plan Information

Name of plan
Number of employees
Number of plan participants

Total assets
Annualized contributions

Administration company
Investment company

What are the names of the mutual funds your plan provides?
(list multiple funds in each box if necessary)

We match participant deferrals. Our formula is
We contribute to a profit sharing plan.
We have centralized company payroll.

We have locations
Number of loans outstanding (if applicable)

In-house knowledge of retirement plan administration:

Beginner (first timer)
Novice (limited knowledge)
Intermediate (several years of hands on experience)
Advanced (only need help on advanced issues)

Complaint about current situation:

We need more assistance from our provider and we're not getting it.
Provider makes mistakes
It takes too long to get participant statements
Compliance tests are not being completed or are not timely
Investments are not performing to our expectations
We would like more investments (mutual funds) to choose from
Our provider doesn't offer Internet trading or account information

Comments:

We would like to make the change effective