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Your Retirement Plan Online Annual Questionnaire

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Your

Retirement Plan

Online Annual Questionnaire

A. Company Information

1. Corporation Name:

2. Franchise Name and/or Business Type: 3. Contact Person Name:

4. Business Address: 5. Mailing Address: 6. Telephone: 7. Email:

8. Principal Business Activity Code: (As reflected on your Form 1120 Section K other information) line 2a:

9. FAIR MARKET VALUE (FMV): (please select option A or B)

*NOTE: Unless your corporation's tax year includes 12 months of gross receipts on Form 1120 Income Section line 1a, Option B is not available. If you do not meet this requirement, select Option A and answer questions 11 and 12.

If your corporation's tax year includes 12 months of gross receipts on Form 1120 Income Section line 1a, Benetrends can assist with the Fair Market Value calculation (Option B). If you choose option B, answer questions 13 and 14. You may still choose to provide the FMV by selecting Option A and answer questions 11 and 12. (A) will be provided by myself or my accountant. , or B) Please have Benetrends assist in calculating my Fair Market Value)

A) will be provided by myself or my accountant.

10. If option A selected for question 10, please provide the name and title of the person providing the FMV:

11. If option A selected for question 10, please provide the Fair Market Value Amount of your corporation, as of the last day of the plan year:(*by providing this amount you are

confirming you have all supporting financials and

documentation to substantiate this value in the event of an IRS/DOL audit/investigation of your Retirement Plan. If your C-Corporation has any percentage ownership in any other company, please ensure that the FMV you provide to us takes into consideration that ownership.)

12. If option B selected for question 10, please provide the amount listed on your Form 1120 Income Section line 1c ("Balance") for your Corporation's Tax Year that ended during the Plan Year. [Note line 1c is equal to line 1a "Gross Receipts and Sales" less line 1b "Returns and Allowances.] 13. If option B selected for question 10, please also provide the

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NAICS Code (North American Industry Classification System) specific to your business.

B. Corporate Questionnaire - The next section of questions will be referring strictly to your Corporation. Please respond to all questions as if you were answering on behalf of your C Corporation.

1.

What type of entity is your business? (C-Corporation (Benetrends originally set up your company as a C-Corp), S-Corporation, LLC, Sole Proprietorship, or Other (Please contact your Retirement Plan Analyst))

C-Corporation (Benetrends originally set up your company as

a C-Corp) 2.

What is your Corporation's Tax Year End? *Please confirm with your accountant. If the tax year has changed in the past year, an amendment to the plan may be needed. (January 1/31, February 2/28, March 3/31, April 4/30, May 5/31, June 6/30, July 7/31, August 8/31, September 9/30, October 10/31, November 11/30, or December 12/31)

January 1/31

3.

Does the corporation sponsor any other retirement plan? *Corporate Retirement Plans include but are not limited to a SIMPLE 401(k), SIMPLE IRA, SARSEP, Profit Sharing

Plan, Defined Benefit and 401(k). (Yes (Please contact your Retirement Plan Analyst), or No)

Yes (Please contact your Retirement Plan Analyst)

4.

What is the date your Corporate Federal Tax return was, or will be filed? *If you are not sure, please enter TO BE DETERMINED

5.

Have there been any changes to the Officers and/or Directors for the Corporation? (Yes, or No) Yes 6.

If YES for question 5, please list the Directors/Officers to be ADDED (include Name and Title): 7.

If YES for question 5, please list the Directors/Officers to be DELETED (include Name and Title) C. Ownership - Please provide all shareholders and shares, including the Retirement Plan

1.

Please list the Retirement Plan name that owns shares of the corporation: 2.

Please list the NUMBER of shares owned by the above listed Retirement Plan: 3.

How many individuals own Personal Shares? (Personal Shares = Direct Personal Investment) (1, 2, 3, 4, 5, 6, or 0 - NONE)

1 4.

FIRST Individual - Please list the name of the individual who personally owns shares of the Corporation: 5.

FIRST Individual - Please list the number of shares the individual above owns personally: 6.

SECOND Individual - Please list the name of the individual who personally owns shares of the Corporation: 7.

SECOND Individual - Please list the number of shares the individual above owns personally: 8.

THIRD Individual - Please list the name of the individual who personally owns shares of the Corporation: 9.

THIRD Individual - Please list the number of shares the individual above owns personally: 10. FOURTH Individual - Please list the name of the individual

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who personally owns shares of the Corporation: 11.

FOURTH Individual - Please list the number of shares the individual above owns personally: 12.

FIFTH Individual - Please list the name of the individual who personally owns shares of the Corporation: 13.

FIFTH Individual - Please list the number of shares the individual above owns personally: 14.

SIXTH Individual - Please list the name of the individual who personally owns shares of the Corporation: 15.

SIXTH Individual - Please list the number of shares the individual above owns personally: 16.

Does anyone with ownership in your corporation or any family member of any of the owners have ownership in another company? (Yes (please provide information on other company(ies) in next section), or No)

Yes (please provide information on other company(ies) in next

section) 17.

Does your corporation provide any services to, or receive services from, any other related company or company under common ownership? (Yes (please provide information on other company(ies) in next section), or No)

Yes (please provide information on other company(ies) in next

section) 18.

Do you or your corporation provide management services for another company? (Yes (please provide information on other company(ies) in next section), or No)

Yes (please provide information on other company(ies) in next

section) 19.

Does your corporation have ownership in any other company(ies)? (Yes (please provide information on other company(ies) in next section), or No)

Yes (please provide information on other company(ies) in next

section) D. Controlled and Affiliated Service Group (If no additional ownership skip to Section E)

1.

BUSINESS "1" (1st add'l Co. Owned) EMPLOYER NAME: 2.

Business 1 - Address:

3.

Business 1 - EIN:

4.

Business 1 - Phone Number:

5.

Business 1 - Form of Business: (Sole Proprietor, C Corporation, LLC (taxed as a partnership), LLC (taxed as a corporation), S Corporation, Limited Liability Partnership, or Other)

Sole Proprietor

6.

Business 1 - Service/Management Relationship, if any, of company to Sponsoring Employer: 7.

Business 1 - Number of Employees:

8.

Business 1 - Date of Incorporation:

9.

Business 1 - Member of Controlled Group or Affiliated Service Group (Yes, or No) Yes 10.

Business 1 - Participating Employer: (Yes, or No) Yes 11.

Business 1 - Please provide the FIRST Shareholder/Owner NAME, RELATIONSHIP,(Spouse, Business Partner, Family, Corporation, etc) & Ownership

PERCENTAGE(total ownership % must be equal to 100%)

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12.

Business 1 - Please provide the SECOND Shareholder/Owner NAME, RELATIONSHIP, & Ownership PERCENTAGE:

13.

Business 1 - Please provide the THIRD Shareholder/Owner NAME, RELATIONSHIP, & Ownership PERCENTAGE: 14.

Business 1 - Please provide the FOURTH Shareholder/Owner NAME, RELATIONSHIP, & Ownership PERCENTAGE:

15.

Business 1 - Please provide the FIFTH Shareholder/Owner NAME, RELATIONSHIP, & Ownership PERCENTAGE: Up to 4 additional Business can be reported

E. Retirement Plan Questionnaire - The next questions will be referring strictly to the Retirement Plan. Please respond to all questions as the Plan Administrator for the Retirement Plan.

1.

Have there been any changes to the Trustee(s) of the Retirement Plan? (Yes, or No) Yes 2.

If YES for question 1, please list the Trustee(s) Name(s) & Email Address(es) of all ADDED to the plan: 3.

If YES for question 1, please list the Trustee(s) Name(s) & Email Address(es) of all REMOVED from the plan: 4.

Has there been a termination or appointment of any custodian, brokerage company, brokerage company, CPA, or Plan Administrator? (Yes, or No)

Yes 5.

If YES for question 4, please explain changes: 6.

Do you authorize Benetrends to contact your CPA, if necessary? (Yes, or No) Yes 7.

Please provide Name and Contact information of your CPA: F. Plan Transactions & Other Activities

1.

Were any assets of the Retirement Plan transferred to another Retirement Plan? (Yes, or No) Yes 2.

Was the Retirement Plan merged with another Retirement Plan? (Yes, or No) Yes 3.

Were there any changes to Plan Provisions during the plan year? (Yes, or No) Yes 4.

If YES to any of the above three questions, please provide explanation: G. Plan Contributions

1.

Are you interested in making an Employer Contribution to the Retirement Plan this Plan Year End? (If No Please call your Retirement Plan Analyst) (Yes, or No)

Yes 2.

If YES for question 1, are you interested in making a dollar amount or percentage of compensation contribution? *We will provide you with a report reflecting the allocation

of the contribution among all ELIGIBLE Employees based

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on your Plan Document specifications. We can only provide this report once you have submitted the complete CENSUS information for your Plan Year End. (Dollar Amount, or Percentage of compensation)

3.

If you chose DOLLAR Amount, please provide the amount you would like to contribute: 4.

If you chose PERCENTAGE of compensation in question 2, please select the percentage amount you would like to contribute: (1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, or 25%)

1%

H. Retirement Plan Assets 1.

Other than the company stock, were there any other assets held in the retirement plan's name during the plan year? (Yes, or No)

Yes 2.

Please provide the name of the Financial Institution where plan assets are held: 3.

Were any additional rollover contributions made to the Retirement Plan during the plan year? (Yes, or No) Yes I. 5500 Reporting Information

1.

Were there any Employer stock purchases/sales made by the Retirement Plan during the Plan Year? (Yes, or No) Yes 2.

Did you withdraw any money from the Retirement Plan/Trust during the Plan Year? (Yes, or No) Yes 3.

Did you make any required minimum distributions, if applicable? (Yes, or No) Yes 4.

Was there a failure to transmit any employee contributions within the prescribed time period? (Yes *Please contact your Retirement Plan Analyst, No, or N/A)

Yes *Please contact your Retirement Plan Analyst 5.

Do you have a 401(k) Safe Harbor Plan? (Yes, or No) Yes 6.

Did any participants take a new loan from the retirement plan during this Plan Year? (Yes, or No) Yes 7.

Was there a failure to transmit to the plan any participant loan repayments within the prescribed time period? (Yes *Please contact your Retirement Plan Analyst, or No)

Yes *Please contact your Retirement Plan Analyst 8.

Were any loans by the plan or fixed income obligation due to the plan or leases, in Default as of the close of the plan year or classified during the year as uncollectible? (Yes, or No)

Yes 9.

Did the Retirement Plan acquire or hold any real property? (Yes, or No) Yes 10.

Was there any sale, exchange, or lease of property between the plan and the Employer, any fiduciary, any employee or the employer, any owner of 10% or more, or relative of such person? (Yes, or No)

Yes

11.

Has any plan fiduciary had a financial interest in excess of 10% in any party providing services to the plan or received anything of value from any such party? (Yes, or No)

Yes 12. Did the plan have a loss, whether or not reimbursed by the Yes

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plan's fidelity bond, that was caused by fraud or dishonesty? (Yes, or No)

13.

Were there any noncash contributions made to the plan the value of which was set without an appraisal by an independent third party? (Yes, or No)

Yes 14.

Did the plan at any time hold 20% or more of its assets in any single security, debt, mortgage, parcel, or real estate, or partnership/joint venture interests? (excluding employer securities) (Yes, or No)

Yes

15.

Has the plan failed to provide any benefit when due under the terms of the plan? (Yes, or No) Yes 16.

If you answered YES to any of the questions in section I., please provide explanation: J. DOL Compliance and Filing

1.

Do you have a Fidelity Bond? *The Department of Labor requires you have a Fidelity Bond for your Retirement Plan. (Yes, or No *to obtain a

bond, please contact Colonial Surety Company / ERISA Department. Email: Erisadept@colonialsurety.com, phone: 888-383-3313)

Yes

2.

If YES above, please provide Bond information, including: SURETY COMPANY NAME, Bond AMOUNT, Issue DATE, Expiration DATE

3.

Please provide Name and Title of the individual completing this questionnaire: 4.

By checking "agree", you are stating the following: I certify that all the information I have provided on all pages of this questionnaire is true and accurate to the best of my

knowledge. I understand that any misrepresentations or incorrect information provided to Benetrends can result in inaccurate filing with government agencies, and may void the Benetrends guarantee. (or I Agree)

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