Conversion 401k Plan Order Form

CONVERSION PLAN ORDER FORM
for converting existing 401k or another qualified retirement plan into a Small 401k plan
Note: Though SARSEPs have many 401k characteristics, including a payroll deduction feature, they cannot be converted to 401k plans under current IRS regulations.

1.Will this be your company's first 401k plan, or are you replacing an already-existing plan?

First 401k plan (STOP!!! Please use our New/First Plan Order Form instead of this Conversion Plan Order Form. Thank You.)
Already-existing 401k plan to be converted to a Small 401k plan.

2.Company name

3.Contact person

4.Title

5.Phone

6.Fax

7.E-mail

8.Your 401k decision-making role

Sole decision maker
Making recommendation
Leading committee to gather information
Member of committee to evaluate options
Interested employee
Unsure. Please contact me with help regarding this item.

9.Company address

10.City

11.State

	Zip Code

12.Company mail-to address

Use address listed above as mail-to address
Use other address	.

13.Federal ID Number

14.Date business commenced

15.Type of entity

Please indicate your company's type:
C Corporation
Professional Service Corporation
S Corporation
Limited Liability Company taxed as (check one)...

Partnership or Sole Proprietorship
Corporation
S Corporation

Sole Proprietorship
Partnership
Other:

Is your company a member of a controlled group?

Yes No Unsure. Please contact me regarding this question.

Is your company a member of an affiliated service group?

Yes No Unsure. Please contact me regarding this question.

16.# of employees on payroll

17.Fiscal year on which business is run

18.Computer system

PART II: PLAN INFORMATION...

Note:

Complete the below ONLY if your company already has a retirement plan and will be having Small 401k replace that plan.
the Small 401k plan will be your company's first retirement plan ever, please use our New Plan Order Form instead of this Conversion Plan Order Form. Thank You.

19.Type of plan do you want converted into a Small 401k plan:

Profit-sharing plan (without 401k features)
Defined benefit plan
Other (please describe):
Unsure. Please contact me with help regarding this item.

Exact name of your current plan as listed on your current plan documents

20.Approximate size, in assets, of your existing plan:

No retirement plan (STOP!!! Please use our First Plan Order Form instead of this Plan Conversion Order Form. Thank You.)
Less than $250,000
$250,001-$500,000
$500,001-$10,000,000
More than $10,000,000
Unsure. Please contact me regarding this item.

21.Potential size, in number of employees, of your Small 401k plan:

Please name your company's in-house plan administrator (that is, the person at your company who has been handling any 401(k)-related matters and interacting with the outside administrator servicing your plan). Please include his/her title (such as "Controller"), if applicable:

Administrator's phone number: ,

and e-mail address is .

22.Existing plan's in-house Plan Administrator:

Administrator's phone number: ,

and e-mail address is .

23....and for your Small 401k plan:

Will the same person serve as Plan Administrator for your Small 401k plan?

Yes

No will serve as Plan Administrator for our Small 401k plan.

His/her phone number is ,

and e-mail address is .

His/her title is .

24.Existing plan's Trustee(s):

Please name your existing plan's Trustee(s), including his/her/their title(s) (such as "CFO"), as applicable:

Current plan's Trustee(s) phone number(s):

25....and for your Small 401k plan:

Will the same person(s) serve as Trustee(s) for your Small 401k plan?
Yes
No

If "No", please name the Trustee(s) for your Small 401k plan. Please list each new Trustee's name, title and phone number:

26.Compliance test history for your existing plan:

Did your plan pass last year's compliance tests?
Yes
No
Unsure. Please contact me regarding this item.

Does your plan limit the definition of Highly-Compensated Employees to "the top 20% of employees"?
Yes
No
Unsure. Please contact me regarding this item.

Do you want to change this definition for your Small 401k plan?
Yes
No
Unsure. Please contact me regarding this item.

Is your plan currently top-heavy?
Yes
No
Unsure. Please contact me regarding this item.

Date of last battery of compliance tests:
Unsure. Please contact me regarding our last battery of compliance tests.

27.5500 Series filing:

For what year was your last plan 5500 series filing with the IRS?
Unsure. Please contact me regarding our last 5500 series filing year.

Date filed (month, year):

Unsure. Please contact me regarding our last 5500 series filing date.

28.Plan Year for your existing plan:

On what Plan Year does your existing plan operate?

Calendar year (January 1 - December 31)

Other:

Unsure. Please contact me regarding this item.

29.Plan inception date for your existing plan:

When was your current plan established?

Month: Year:

Unsure. Please contact me regarding this item.

30.Age requirement used for participation in your existing plan:

What age requirement is currently being used for participation in your existing company plan?
None
20 1/2
21
Other (please specify):
Unsure. Please contact me regarding this item.

31....and for your Small 401k plan:

What age requirement do you want use for your Small 401k plan?
Keep existing plan's age requirement for Small 401k plan.
Change age requirement to "None" for Small 401k plan.
Change age requirement to "20 1/2" for Small 401k plan.
Change age requirement to "21" for Small 401k plan.
Change age requirement to for our Small 401k plan.
Unsure. Please contact me with help regarding our Small 401k plan age requirement.

32.Length of Service requirement for participation in your current plan:

What length of service requirement is currently being used for participation in your existing company plan?
None
Three (3) months of service with the company
Six (6) months of service with the company
One (1) year of service with the company
Other (please specify):
Unsure. Please contact me regarding our Small 401k plan length of service requirement.

33....and for your Small 401k plan:

What length of service requirement do you want use for your Small 401k plan?

	Keep existing plan's length of service requirement for our Small 401k plan.
	Change length of service requirement to "None" for our Small 401k plan.
	Change length of service requirement to "Three (3) months" for our Small 401k plan.
	Change length of service requirement to "Six (6) months" for our Small 401k plan.
	Change length of service requirement to "One (1) year" for our Small 401k plan.
	Change length of service requirement to "" for our Small 401k plan.
	Unsure. Please contact me regarding our Small 401k plan length of service requirement.

34.Participation exclusions in your existing plan:

Does your current plan exclude any categories of employees from participation?
Yes
No
Unsure. Please contact me regarding participation exclusions used in our existing company plan.

If "Yes", please identify the classes of employees currently excluded from participation in your existing company plan: (check all that apply)
Union members
Non-resident aliens
Other:

35....and for your Small 401k plan:

Do you want your Small 401k plan to exclude any categories of employees from participation?
Yes
No
Unsure. Please contact me regarding participation exclusions for our Small 401k plan.

If "Yes", please identify the classes of employees you'd like excluded from participation in your Small 401k plan: (check all that apply)
Union members
Non-resident aliens
Unsure. Please contact me regarding what participation exclusions to use for our Small 401k plan.

36.Automatic enrollment in your existing plan:

Does your plan currently use automatic enrollment? (click for more information)
Yes
No
Unsure. Please contact me regarding this item.

If "Yes", what would you like the default contribution rate to be for automatically enrolled participants?
Not applicable. Do not want auto enrollment used in our Small 401k plan.
3% 4% 5%
Unsure. Please contact me regarding using auto enrollment in our Small 401k plan.

37....and for your Small 401k plan:

Do you want your Small 401k plan to use automatic enrollment? (click for more information)
Yes
No
Unsure. Please contact me regarding this item.

If "Yes", what would you like the default contribution rate to be for automatically enrolled participants?
Not applicable. Do not want auto enrollment used in our Small 401k plan.
3% 4% 5%
Unsure. Please contact me regarding using auto enrollment in our Small 401k plan.

38.Employer contributions in your existing plan:

Your company can contribute to plan participants' accounts in either (or both) of two ways: (1) matching contributions and/or (2) profit-sharing contributions. Matching contributions are defined in terms of participant contributions (e.g., 50¢ contributed by the employer for each dollar contributed by the plan participant), whereas profit-sharing contributions are tied to some other variable, such as compensation.

1) What MATCHING CONTRIBUTION formula is currently being used in your existing company plan?
No employer matching contributions are being made.
Our company makes matching contributions at a rate of % (e.g., 50%) to each dollar our participants defer into the plan.
Our company makes matching contributions at a rate of % (e.g., 50%) to each dollar our participants defer into the plan, up to a maximum annual matching contribution of $ per participant per year.

Other:
Unsure. Please contact me regarding our existing plan's matching contribution formula.

2) Has your company made any PROFIT-SHARING CONTRIBUTIONS in your existing company plan?
No profit-sharing contributions have been or are being made in our existing plan.
Yes, our company has made/does make profit-sharing contributions in our existing plan.
Unsure. Please contact me regarding profit-sharing contributions made to our existing plan.

39....and for your Small 401k plan:

1) Do you want to use a different MATCHING CONTRIBUTION formula for your Small 401k plan?

	Use our existing plan's matching contribution formula for our Small 401k plan.
	Change our matching contribution formula for our Small 401k plan to "None".
	Change our matching contribution formula for our Small 401k plan to a rate of % (e.g., 50%) to each dollar our participants defer into the plan.
	Change our matching contribution formula for our Small 401k plan to a rate of % (e.g., 50%) to each dollar our participants defer into the plan, up to a maximum annual matching contribution of $ per participant per year.
	Change our matching contribution formula for our Small 401k plan to the following: .
	Unsure. Please contact me regarding the matching formula for our Small 401k plan.

2) Would your company like to have the option of being able to make DISCRETIONARY EMPLOYER CONTRIBUTIONS (i.e., profit-sharing contributions) to employees' accounts?

	No, we do not want the option of even possibly making profit-sharing contributions.
	Yes, our company will POSSIBLY make profit-sharing contributions in an amount to be determined by our company. AND DOES NOT want contribution amounts to be limited to current or accumulated net profit. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)
	Yes, our company will POSSIBLY make profit-sharing contributions in an amount to be determined by our company AND DOES want contribution amounts to be limited to current or accumulated net profit. (Checking this option in no way obligates your company to making any actual contributions, it simply leaves open the possibility that you might.)
	Unsure. Please contact me regarding profit-sharing contributions.

40.Vesting of employer contributions in your existing plan:

1) What vesting formula is currently being applied to any EMPLOYER MATCHING CONTRIBUTIONS being made in your existing company plan?

Not applicable (no matching contributions being made) (SKIP TO NEXT SECTION: Loans)

2) What vesting formula is currently being applied to any EMPLOYER PROFIT-SHARING CONTRIBUTIONS being made in your existing company plan?

Not applicable (no profit-sharing contributions being made) (SKIP TO NEXT SECTION: Loans)

41....and for your Small 401k plan:

"Vesting" refers to ownership. For instance, if you pick Schedule D below and a plan participant leaves your company after 2 years, he or she will only be entitled to 20% of any relevant employer contributions made by your company to his or her account. The remainder will go into a pool that your company can choose to use for employer contributions owed to other participants.

What vesting formula do you want to use for any employer contributions? Mark your choice for any profit-sharing contributions in column P-S Contribs and for any matching contributions in column Match Contribs.

P-S Contribs	Match Contribs	Vesting Schedules
		Not applicable (no employer contributions, so no vesting)
		SCHEDULE A:	100% immediate vesting
		SCHEDULE B:	0-2 years 3 years	= =	0% vested 100% vested
		SCHEDULE C: WARNING: not recommended due to likelihood of causing top heavy testing problems.	0-4 years 5 years	= =	0% vested 100% vested
		SCHEDULE D:	0-1 years 2 years 3 years 4 years 5 years 6 years	= = = = = =	0% vested 20% vested 40% vested 60% vested 80% vested 100% vested
		SCHEDULE E:	1 year 2 year 3 year 4 year	= = = =	25% vested 50% vested 75% vested 100% vested
		SCHEDULE F:	1 year 2 year 3 year 4 year 5 year	= = = = =	20% vested 40% vested 60% vested 80% vested 100% vested
		Other: .
Unsure. Please contact me regarding the vesting schedule(s) to use for our 401k plan.

42.Loans:

Does your existing plan currently allow for 401(k) loans? (click for more information)
Yes (approximate number of outstanding loans: ).
No.
Unsure. Please contact me regarding this item.

43.and for your Small 401k plan:

Do you want your Small 401k plan to allow for new 401k loans? (click for more information)
Yes
No
Unsure. Please contact me regarding this item.

44.Investments offered in your existing plan:

Please list the investments currently being offered within your company plan:

45....and for your Small 401k plan:

Do you want to continue offering these investments within your Small 401k plan, or would you prefer to have 401k deferrals from the plan conversion date forward go into a different set of investments (existing deferrals will stay in the funds in which they are currently invested):
Unsure. Please contact me regarding investment offerings for our Small 401k plan.
Continue with existing plan investments (SKIP TO SAFE HARBOR)
Have new deferrals go to a new set of investments, as defined in your responses to items 46 and 47, below.

46.Small 401k plan Investments:
INVESTMENT TYPE
(view investment listings)

Please indicate the type of investments you want for your Small 401k plan: (click for a pop-up window about your Small 401k investment options)
Self-Directed Brokerage Accounts only
No-Load Mutual Funds only
Load Mutual Funds only
Unsure. Please contact me regarding the type of investments to offer within our Small 401k plan.

47.Small 401k plan Investments:
INVESTMENT FAMILY
(view investment listings)

Please indicate the family of mutual funds and/or the brokerage account you wish to offer within your Small 401k plan (for example, T. Rowe Price mutual funds or Charles Schwab OneSource brokerage accounts). If you have not already done so, you should look through our investment listings to view your options. Alternately, you can contact us for help by clicking the "Unsure..." button below.
Self-Directed Brokerage Accounts only
No-Load Mutual Funds only
Load Mutual Funds only
Unsure. Please contact me regarding the type of investments to offer within our Small 401k plan.

48.Safe Harbor Designations:

The IRS allows 401k plan sponsors an alternative to subjecting their 401k plans to annual discrimination testing. The safe harbor method of plan operation lets employers instead make certain contributions to the plan, with immediate vesting of the contributions to employees' 401k accounts. (click for more information)

Do you want to operate your Small 401k plan as a safe harbor 401k plan?
Yes
No (you can skip the rest of this section 48)
Unsure. Please contact me regarding operating our 401k plan as a safe harbor plan.

If you are choosing to operate your Small 401k plan as a safe harbor plan, which employer contribution formula would you like to employ?

	Not applicable (don't want to use the safe harbor method)
	Make a qualified nonelective contribution equal to 3% of compensation to each eligible employee's account. (Note: Qualified nonelective contributions are made to ALL eligible employees accounts, regardless of whether the persons participate in the company 401k plan.)
	Make a dollar-for-dollar matching contribution to non-highly-compensated employees on salary deferrals up to 3% of compensation and 50¢ to the dollar matching contributions to non-highly compensated employees on salary deferrals of 3% to 5% of compensation, making sure not to exceed these rates in any matching contributions made to highly compensated employees. (Note: Matching contributions, because they're based upon salary deferral amounts, are made only to currently-participating employees' 401k accounts.)
	Unsure. Please contact me regarding the type of 401k safe harbor contribution to make.

If you are choosing to operate your 401k plan as a safe harbor MATCHING CONTRIBUTION plan, how often do you want your employer matching contributions to be made?
Not applicable (don't want to use the safe harbor method)
Annually
Per payroll period
Per month
Per quarter
Unsure. Please contact me regarding the frequency of making our 401k safe harbor employer contributions.

PART III: PURCHASE INFORMATION...

49.The price of your Small 401k system: (Small 401k is licensed on a calendar year basis, which requires the purchase of a new license at the beginning of each calendar year)

PLAN SIZE (in number of eligible employees)	ANNUAL FEE for your custom 401k plan and plan administration system
2-4 eligible employee	$1195 per year
5-10 eligible employees	$1295 per year
11-15 eligible employees	$1495 per year
16-20 eligible employees	$1695 per year
21-25 eligible employees	$1895 per year
26-30 eligible employees	$2095 per year
31-35 eligible employees	$2395 per year
36-40 eligible employees	$2695 per year
41-45 eligible employees	$2995 per year
46-50 eligible employees	$3295 per year
more than 50 eligible employees	($3295 plus $275 for each additional 5 eligible employees

50. FIRST-YEAR-ONLY setup fee
(Remember, this fixed fee, unlike the above money-back guaranteed Annual Fee, is NONREFUNDABLE, though generally tax rebatable. We encourage prospective clients to try our free Product Demo to make sure they like Small 401k before they have us set up a customized a system for them.)

50a.Plan Data Conversion Fee:
There may be a charge for converting your company's historical plan data to our format. To keep per customer costs as low as possible, this conversion fee is determined on a case by case basis. Your Small 401k representative will provide you with the numbers regarding your specific plan.

51.TOTAL (system price + setup fee):

PART IV: PAYMENT PREFERENCE...

52.NO PAYMENT IS DUE AT THIS TIME.
We will contact you within 24 hours of receiving your order to confirm your designations and answer any questions you have.

Do you prefer to be contacted regarding your order by telephone or e-mail?
Contact by phone
Contact by e-mail

53.When your Small 401k representative calls you to go over any items about which you marked "Unsure..." and to collect additional information needed for your plan's official Summary Plan Description (SPD) and Prototype Plan Adoption Agreement, you will be able to pay your Small 401k customization fee using your Visa, Mastercard, American Express Card*, or by check through the mail; there is a five-day holding period on all check orders.

As soon as we receive your payment we will customize your software, prepare official documents for your review, then send out your customized system. You can have your 401k up and running within two weeks — or less.

Please indicate at right your payment preference. (*Note: We do not add credit card processing fees to Mastercard or Visa transactions but do add a $25 processing fee to all American Express transactions.)
credit card* via phone
check

Part V: How did you hear about us?

54.One last thing before you submit your order: Please tell us how your heard about Small 401k...

	Financial planning professional, friend or colleague. Please list the person and/or company name:
	Linked to the Small 401k web site from another web site. Please tell us the name of the site and/or company sponsoring it:
	Web search. Please list the browser and search term(s), if you remember them (e.g., Netscape, 401k software):
	Business or trade publication. Please give the name of the publication:
	Other. Please explain:

55.Now please look over our User's Agreement, then submit your order or inquiry. (Submitting an order acknowledges that you have read and accept our User's Agreement but in no way obligates you to making any purchase.)

Tell a friend about Small 401k^TM.

Become a 401k Referral Partner

Earn $$$ for every company you refer to us that adopts a Small 401k self-service 401k plan.
Contact us to sign up!