Business Owner Financial Assessment

We'd like to help you identify those areas of your business that may need attention. Please complete, checking all that apply for each statement. Thank you.

Do you know who will operate your business if you die, become disabled or retire?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you have a formal succession plan for continuing your business?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Does your successor, family and key employees all know about your future plans or succession plan for the business?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you have a buy-sell agreement in place?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Have you funded your buy-sell agreement?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Have you reviewed your buy-sell agreement and funding arrangement in the last 2 years?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Have you completed an independent business valuation?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

If so, when

Will your life insurance be sufficient to cover the debts, taxes, and estate settlement costs that may be due on your estate, which includes both personal and business assets?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

If your heirs have to sell the business in order to cover debts, taxes, and costs, will your family have an alternate source of income?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you offer a retirement plan, life insurance, disability insurance, or other employee benefits in addition to health/medical insurance benefits?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you maximize your annual retirement plan contributions?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Is your business receiving a tax deduction for contributions to the plan?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Are you satisfied with your company sponsored retirement plan?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you have employees whose experience, skills or business knowledge are a key contributor to success and would be hard to replace if they left for a competitor?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you have employees who are critical to day-to-day operations or manage the business when you are not there?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Do you do anything special for key employees to recognize their contributions, or are all employees treated the same?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Are your key employees critical to the continuation of your business if you were to step down, and would they stay with your designated successor?

Rows	Yes	No	Not Applicable	Let's Discuss
Response

Succession Planning: to provide a smooth transition of ownership and control.Retirement Planning: to help you ensure you have sufficient income.Estate Planning: to help protect your legacy.Key Employee Planning: to retain and reward your most important employees, including you!Other

Client full name*

Business name*

Phone*

Email*

example@example.com

Date