Client Sponsored Retirement Plan Setup Form (New Clients)

1
Company Information * This field is required.
Company Name
FEIN
2
Primary Contact * This field is required.
First Name
Last Name
3
Primary Contact Email * This field is required.
4
Date of 1st Payroll with Vensure
Date
Month
Day
Year
5
Current Retirement Vendor * This field is required.
6
Current Retirement Plan Type* This field is required.
401(k)
403(b)
457
SIMPLE IRA
SEP IRA
State Plan
Other
7
State Plan Type:* This field is required.
8
Is your company part of a Controlled Group of related / commonly owned businesses?* This field is required.
Yes
No
9
Related Business Name(s)* This field is required.If applicable
10
Plan Eligibility - Age* This field is required.
None
18
21
Other
11
Plan Eligibility - Service* This field is required.
None
__ Months
12 Months
12 Months & 1,000 Hours
Other
12
Month(s) of Service:* This field is required.# of months for "___ Months" answer above
13
Plan Eligibility - Entry Date* This field is required.
Immediate
Monthly
Quarterly
Semi-Annual
Other
14
Employer Contribution (Per Pay Period Only)* This field is required.
None
Basic Safe Harbor Match
Enhanced Safe Harbor Match 4%
Enhanced Safe Harbor Match 5%
Enhanced Safe Harbor Match 6%
Fixed Match
Safe Harbor Non-Elective %
SIMPLE IRA 3% Match
SIMPLE IRA 2% Non-Elective
Other
15
Please select all applicable excluded types of compensation according to your plan's definition of compensation* This field is required.
None
Bonuses
Commissions
Fringe Benefits
Company Car
Moving Expenses
Overtime
Post Severance Compensation
Pre-Entry Compensation
Other
16
DISCLOSURES

Vensure operates Client Sponsored Retirement Plans solely in a payroll provider capacity. Employee retirement contributions and loan repayments will be credited back to the Client's invoice each pay period, allowing the Client to remit period contributions directly to their retirement plan provider.

The Client shall retain responsibility for monitoring and reporting employee eligibility to Vensure such as when to enroll or stop participation for employees and identifying potentially excluded employee classifications such as Highly Compensated Employees (HCE). In any event, Vensure shall enroll employees based on Client direction, with the presumption that Eligibility criteria provided on the Client Sponsored Retirement Plan Setup Form is complete and accurate.

Employee election changes and new retirement loan setups should be sent to 401k@vensure.com two business days in advance of payroll when possible to allow sufficient time to be applied in advance of payroll. Election changes sent less than two business days in advance may result in being made effective the following pay period.
17
Signature
Clear
18
Signature* This field is required.
Clear
19
Print Name* This field is required.
First Name
Last Name
Should be Empty: