• Benefits Profile Information

    Information about your health and retirement benefits

  • ABOUT THIS DATA FORM:

    Please review this information carefully.  The information provided on this form will be used in our firm client database and tax reporting. 

    Estimated Time to Complete:  5-15 minutes

  • Click on "Go to Next Page" to continue with your questionnaire. Need more Time? Click "Save for Later" only if you need to save your data and return later. If you do click Save for Later, you will receive an email with a link so you can return to it for completion.

  • Health and Medical Benefits

  • COVERAGE TYPE: What type of Health Coverage do you have?

  • Note about your Health Share/Medi Share Payments:
    All Health Share Plans/Medi Share Plans are not recognized as true Insurance, therefore your payment to these plans are NOT TAX DEDUCTIBLE.

    If you wish, please inquire with your assigned Advisor on the true cost of your Medi Share plan vs Health Insurance.

  • PLAN NAME: Your Health Insurance Plan or Health Coverage is in what name?
  • HOW IS IT PAID: How do you pay for your Health Coverage?
  • HSA ACCOUNTS (Health Savings Account): Is your health insurance coverage HSA Eligible?

  • Retirement Account Plans

  • Please indicate any/all retirement accounts you currently have. Mark ALL that apply.
  • Is funding your retirement account a priority to you?
  • Are you interested in funding a SELF DIRECTED RETIREMENT ACCOUNT?

  • Employee Benefits Information

  • Do you have other Employees? (other than yourself, spouse, and your children)

  • Health/Medical Benefits - Employees:

    Please review ALL questions abut YOUR EMPLOYEES health coverage
  • EMPLOYEE COVERAGE: Do you provide health insurance coverage for employees?
  • EMPLOYEE HSA (Health Savings Accounts): Do you contribute to your employees HSA account funding?

  • Retirement Benefits - Employees:

    Please review ALL questions about YOUR EMPLOYEES retirement plans.
  • EMPLOYEE RETIREMENT PLAN: Do you provide a retirement account plan for your employees?
  • EMPLOYEE COVERAGE: Are all ELIGIBLE employees covered by your current company retirement plan?
  • Please indicate the type of retirement plan your business currently has in place.

  • You are almost DONE!  Review the two items below.

    1. SUBMIT YOUR ANSWERS:  Once complete, click "Submit Answers" to transmit your response to our office. Select "Save for Later" if you'd like to edit responses prior to submitting.  

    2. YOUR ANSWERS WILL BE REVIEWED:  We will review your submission to determine next steps.
     
    Thank you for your time in completing this form!

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