Fillable Form 1: Life in Business Planning Questionnaire

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Form 1: Life in Business Planning Questionnaire

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1
AGENT INFORMATION
Name & Approved Designations: ____________________________ Agent Code: ______________
G.O. Name: ________________________________ Approved Phone: _____________________
Approved Address: _____________________________________________________________
City, State, Zip: _________________________________ CA/AR Insurance #: ________________
Approved Email: ________________________________________________________________
BUSINESS INFORMATION
Business name:
________________________________________________________
Business location: City: ______________________________ State: ______________________
Principal business
activity: _____________________________________________________________
Business type: Partnership ☐ LLC taxed as C Corp
S Corporation ☐ Sole Proprietorship
C Corporation ☐ LLP
LLC taxed as partnership ☐ Nonprofit
LLC taxed as S Corp ☐ Other ___________________________
What is the estimated value of the business? $
Has there been a formal business valuation?  Yes  No
If yes, when? ___________________________ What was the value?
Average annual net business income: $
How many years has the business been operating?  Less than 3  3-5  6-10  11+
Describe the current growth trend of the business:
AGENT USE ONLY. This material is a general overview for the purpose of gathering data. It does not set forth solutions to individual
issues. New York Life Insurance Company, its agents and employees may not provide legal, tax or accounting advice. Individuals
should consult their own professional advisors before implementing any planning strategies.
© 2017 New York Life Insurance Company. All rights reserved. SMRU 1737548 (exp. 5.15.2019)
Life in Business
Planning Questionnaire
1
Name Approved Designations
Agent Code
GO Name
Approved Phone
Approved Address
City State Zip
CA AR Insurance
Approved Email 1
Business Name
City1
State
Principal business activity
List all owners of the business:
Are all of the owners insurable?* Yes  No
*
The Life in Business analysis focuses on insurance-based solutions and may not be appropriate if one or all owners are not insurable
IF ONE OR MORE OWNERS ARE NOT INSURABLE, CALL APG PRIOR TO SUBMITTING THIS FACT FINDER
Does business have a written buy-sell agreement? Yes  No
If yes, Date executed: ___________________ Date last reviewed: _________________________
Is the agreement funded?  Yes  No If yes, how? ______________________________
Type:  Cross Purchase  Redemption  Wait & See  Other
Parties: _______________________________________________________________
Event triggering buyout:  Retirement  Disability  Death  Other
Total number of employees in the business:  1-9  10-25  25-49  50-100  100+
List key employees whose death or disability would jeopardize company profits:
Name
Age
Position
Total
Compensation
Key Person
Insurance?

 Yes  No
Amount: _____

 Yes  No
Amount: _____

 Yes  No
Amount: _____

 Yes  No
Amount: _____
Name Age
Ownership %
Total
compensation
Indicate family
relationships
Voting Non-Voting





AGENT USE ONLY
2
List all business owned life insurance policies:
Policy Type Insured Death Benefit Cash Value Purpose




PERSONAL INFORMATION
What is owner’s total net worth (including their business interest)? _____________________________
Is there substantial liquidity in the owner’s estate that could be used to pay estate taxes?  Yes  No

Is the business the main source of income for owner’s family?  Yes  No
Do owner and owner’s family feel financially prepared if something happens to owner?  Yes  No
Does owner’s estate plan contain provisions regarding disposition of the business?  Yes  No
If so, who will inherit the business under owner’s will/trust? _______________________________
List owner’s immediate family members (spouse, children):
Name
Age
Relation
Active in the
business?
Potential successor
owner?

Yes / No
☐☐
Yes / No
☐☐

Yes / No
☐☐
Yes / No
☐☐

Yes / No
☐☐
Yes / No
☐☐

Yes / No
☐☐
Yes / No
☐☐

Yes / No
☐☐
Yes / No
☐☐
3
AGENT USE ONLY
UNDERSTANDING YOUR PRIORITIES
Answer the questions below and check owner’s top 1-2 concerns: Top
Concern?
Business Succession Planning
Want to establish a formal, funded plan to transfer the business at a definite
time period to a specific party for an established price?
Yes / No
☐☐
☐
Key Employee Retention
Interested in establishing an executive benefit plan to help recruit, reward,
and retain key employees?
Yes / No
☐☐
☐
Key Person Insurance
In the event of the death or disability of a key employee, would the business
suffer a negative economic impact?
Yes / No
☐☐
☐
Retirement Planning for Owners
Concerned about adequately funding retirement?
Yes
/
No
☐☐

☐
BUSINESS SUCCESSION PLANNING
Who will the business be transferred to/how will it be disposed of at owner’s:
Retirement
Disability Death
Family Member(s)
☐ ☐ ☐
Other Owners
☐ ☐ ☐
Key Employee(s)
☐ ☐ ☐
Competitor/Outside Party
☐ ☐ ☐
Liquidated
☐ ☐ ☐
Undecided
☐ ☐ ☐
Other (explain below):
☐ ☐ ☐
_______________________________________________________
If a transfer to a family member or key employee is the most likely succession plan:
Has a successor owner or owners been identified?  Yes  No
If yes, please provide the information on the Successor Owners below:
Name Age Relation to Owner Position in Company
Years
Employed
4
AGENT USE ONLY
Other (explain below)
If liquidation is the most likely succession plan:
What is the value of the business as a going concern? ____________________________________
The value of the business assets if liquidated? _________________________________________
What arrangements has owner made, if any, to make up the difference? _______________________
________________________________________________________________________
When considering a succession plan, rank the following from high to low in terms of their importance, with
“
1” being the most important and “6” being the least important:
1. ________ A. Making the arrangement as tax efficient as possible
2. ________ B. Keeping the arrangement as simple as possible
3. ________ C. Minimizing plan costs
4. _______ D. Providing for the owners’ retirement
5. _______ E. Providing for the financial security of the owners’ surviving spouse
6. _______ F. Equalizing the inheritances of the owners’ children or other family members
who will not participate in the business
KEY EMPLOYEE RETENTION & PROTECTION
What arrangements does the business have for the retention of key employees?
___________________________________________________________________________
___________________________________________________________________________
Retirement/Executive Benefits:
All Employees Targeted at Key Employees
Pension  Have  Interested In  Have  Interested In
Profit Sharing  Have  Interested In  Have  Interested In
401(k)  Have  Interested In  Have  Interested In
Nonqualified Deferred Comp.  Have  Interested In  Have  Interested In
Executive Bonus Plan  Have  Interested In  Have  Interested In
Split Dollar Plan  Have  Interested In  Have  Interested In
5
AGENT USE ONLY
When considering employee retention options, rank the following from high to low in terms of their importance
“1” being the most important and “6” being the least important:
1. ________ A. Control by the company of any assets used to fund the plan
2. ________ B. Minimizing plan costs
3. ________ C. Keeping the arrangement as simple as possible
4. _______ D. Creating the greatest incentive for key employees to remain with the company
5. _______ E. Providing key employees with the best benefit possible to them
6. _______ F. Creating a direct incentive for key employees to increase the value of company
stock
OWNER RETIREMENT
At what age does owner plan to retire? _________________________________________________
Is owner currently saving for retirement?  Yes  No
Planned source of retirement income:  Sale of Business  Qualified Plans  Personal Savings
 Unsure  Other: ______________________________
ADDITIONAL NOTES FOR APG
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_______________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_______________________
________________ __________________________ __________________________ ________________
6
AGENT USE ONLY
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Form 1: Life in Business Planning Questionnaire

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Completed 22 April 2021

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