Implementation Summary
Client Name
Contact 1
Role, FN LN, email, phone #
Contact 2
Role, FN LN, email, phone #
Contact 3
Role, FN LN, email, phone #
Contact 4
Role, FN LN, email, phone #
HRC
PA
BDM
First Payroll
mm/dd/yyyy
Pay Period
Weekly
Bi-Weekly
Semi-Monthly
Monthly
Other
Payroll Start Date
mm/dd/yyyy
Payroll End Date
mm/dd/yyyy
Worker's Compensation?
Yes
No
Additional Locations (1)
Benefits
Benefits Effective
mm/dd/yyyy
Waiting Period
30 Days
60 Days
First of Month
Applicable Large Employer?
Yes
No
Medical
Trust
Non Trust
No Medical
Other
Medical COBRA eligible?
Yes
No
PSF?
Yes
No
Benefit Groups/Contribution
*
Tier
Medical Plan Name 1
Medical Plan Name 2
Medical Plan Name 3
Medical Plan Name 4
Contribution Strategy
Benefits to be administered by Axcet
Dental
Vision
FSA
HSA
10K Life
STD
LTD
Voluntary Life
Dental Contribution
Vision Contribution
HSA Contribution?
Yes
No
HSA Contribution Amount
HSA Contribution Frequency
Per pay period
First of Year
Other
Owner knows pre-tax benefit eligibility. (HSA/FSA)
Yes
No
N/A
Benefit Dollars?
Yes
No
Benefit Dollars Amount
Benefit Dollars will apply to
Medical Only
All Plans
Other
Please indicate all other benefits to be administered by the client:
401(K)
Axcet 401(k)?
Yes
No
Effective Date
mm/dd/yyyy
Wait/Service Requirement:
90 days
6 months
1 year
Other
SH
Yes
No
Non-elective
Yes
No
Match (%)
Transfer
Yes
No
Client 401(k) setup?
One-Time Waiver?
Yes
No
Business Type:
C-Corp
S-Corp
LLC taxed as Corporation
LLC taxed as Partnership
Partnership
Date of Incorporation/Business Establishment:
What type of business is company (i.e. manufacturing, financial services)?
401(k) Plan Notes:
Pre-Orientation
Orientation Date, Time, and Location
Orientation Meeting Type
Online Orientation
Paper Orientation
Employee Registration Required?
Yes
No
Dress Code
Casual
Business Casual
Business
MIA Strategy
Medical
Medical, Dental, Vision
Other
Benefit Enrollment Due
mm/dd/yyyy
Payroll Entry Completion
mm/dd/yyyy
Clipboards
Yes
No
Translator
Yes
No
Orientation Notes
Full Time Packets
Part Time Packets
State Forms Needed
KS, MO
Other
I-9's Needed
Yes
No
Direct Deposit
Alternate
Normal
Post Accident in packet?
Yes
No
Email packet for approval to:
Mail packet to:
Compliance
Federal Posters:
FMLA
Non FMLA
State Posters:
KS
MO
Other
Handbooks
WC Name and Title 1
WC Name and Title 2
Hubspot/Sold Case
Hubspot
Complete
Sold Case
Complete
Workers' Comp
NAICS Code
SIC Code
State:
Code:
Wagees:
# of Employees:
State:
Code:
Wagees:
# of Employees:
State:
Code:
Wagees:
# of Employees:
Submit
Should be Empty: