ESOP Feasibility Questionnaire
Company
*
Name
Name
*
First
Last
Job Title
*
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
Phone
Phone
*
-
###
-
###
####
Extension
Email
*
How many TOTAL W-2 employees are in the organization(s) that is considering an ESOP?
*
Must be a number greater than or equal to
10
.
If considering an ESOP, when?
*
Not applicable
Immediately
Within 3 months
Within 6 months
Within 1 year
Within 2 years
Over 2 years
Which best describes your interest in an ESOP?
*
Considering an ESOP
Have an ESOP
ESOP and Menke client
Advisor - client considering an ESOP
Advisor - client has an ESOP
Description of Business:
*
Fiscal Year End:
*
Type of Corporation:
*
C
S
Prof.
LLP
LLC
N/A
Headquarter Location:
*
How many shareholders are there?
*
Minority/Woman-Owned Business?
*
No
Yes
Is there more than one class of stock?
*
No
Yes
Do you have a 401k or SIMPLE IRA?
*
No
Yes
If yes, is there a company match?
*
No
Yes
Do you have a profit sharing program?
*
No
Yes
Number of full-time employees:
Do you have a union?
*
No
Yes
Do you have any Foreign Subsidiaries with employees?
*
No
Yes
Approximate Annual Revenues:
*
Please rank the following in order of importance (1 = most important):
A. Selling part or all of my stock now
*
A. Selling part or all of my stock now
1
2
3
4
Not important
B. Selling part or all of my stock within 10 years
*
B. Selling part or all of my stock within 10 years
1
2
3
4
Not important
C. Buying back stock from other shareholders
*
C. Buying back stock from other shareholders
1
2
3
4
Not important
D. Increasing employee incentive and productivity
*
D. Increasing employee incentive and productivity
1
2
3
4
Not important
Are you interested in attending an upcoming ESOP Seminar?
->Click to Download the Seminar Brochure
Are you interested in attending an upcoming ESOP Seminar?
->Click to Download the Seminar Brochure
Yes
If so, which seminar?
->Download the Seminar Brochure
8:45AM-1:00PM -- Oct. 12 -- Washington, DC -- Janney Montgomery Scott Offices -- 1255 23rd Street North West, Suite 810 -- (410) 885-2531
8:45AM-1:00PM -- Oct. 12 -- Milwaukee, WI -- Doubletree by Hilton Milwaukee Downtown -- 611 West Wisconsin Avenue -- (414) 273-2950
8:45AM-1:00PM -- Oct. 18 -- Woodmeer, OH -- Marsh Berry Headquarters -- 28601 Chagrin Boulevard, Suite 400 -- (410) 885-2531
8:45AM-1:00PM -- Oct. 19 -- Irvine, CA -- Hilton Irvine/Orange County Airport -- 18800 MacArthur Boulevard -- (949) 833-9999
8:45AM-1:00PM -- Oct. 19 -- Grand Rapids, MI -- Crown Plaza Grand Rapids Airport -- 5700 28th Street SE -- (616) 957-1770
8:45AM-1:00PM -- Oct. 20 -- Phoenix, AZ -- Hilton Phoenix Airport Hotel -- 2435 South 47th Street -- (480) 894-1600
8:45AM-3:30PM -- Oct. 24 -- Omaha, NE -- Doubletree by Hilton Omaha Downtown -- 1616 Dodge Street -- (402) 346-7600
8:45AM-1:00PM -- Oct. 24 -- San Jose, CA -- San Jose Marriott -- 301 South Market Street -- (408) 280-1300
8:45AM-3:30PM -- Oct. 25 -- Kansas City, MO -- The Westin Kansas City at Crown Center -- 1 East Pershing Road -- (816) 474-4400
8:45AM-1:00PM -- Oct. 25 -- Charlotte, NC -- R.W. Chapman Headquarters -- 1338 Hundred Oaks Drive, Suite D -- (410) 885-2531
8:45AM-1:00PM -- Oct. 25 -- Minneapolis, MN -- Crown Plaza-Bloomington -- 5401 Green Valley Drive -- (952) 831-8000
8:45AM-3:30PM -- Oct. 26 -- Tulsa, OK -- Doubletree by Hilton at Warren Place -- 6110 South Yale Avenue -- (918) 495-1000
8:45AM-3:30PM -- Oct. 30 -- Austin, TX -- The Driskill Hotel -- 604 Brazos Street -- (512) 439-1234
8:45AM-3:30PM -- Oct. 31 -- Denver, CO -- Denver Marriott City Center -- 1701 California Street -- (303) 297-1300
8:45AM-3:30PM -- Nov. 01 -- Birmingham, AL -- Hyatt Regency/The Wynfrey Hotel -- 1000 Riverchase Galleria -- (205) 705-1234
8:45AM-3:30PM -- Nov. 02 -- Tampa, FL -- Tampa Airport Marriott -- Tampa International Airport -- (813) 879-5151
8:45AM-3:30PM -- Nov. 02 -- Nashville, TN -- Hilton Nashville Downtown -- 121 Fourth Avenue South -- (615) 620-1000
8:45AM-1:00PM -- Nov. 02 -- Indianapolis, IN -- Hilton Indianapolis Hotel & Suites -- 120 West Market Street -- (317) 972-0600
8:45AM-3:30PM -- Nov. 03 -- Orlando, FL -- Orlando Airport Marriott Lakeside -- 7499 Augusta National Drive -- (407) 851-9000
8:45AM-3:30PM -- Nov. 06 -- Atlanta, GA -- The Westin Atlanta Airport -- 4736 Best Road -- (404) 762-7676
8:45AM-3:30PM -- Nov. 07 -- Dallas, TX -- Omni Mandalay Las Colinas -- 221 E. Las Colinas Boulevard -- (972) 556-0800
8:45AM-1:00PM -- Nov. 07 -- New York, NY -- The Penn Club -- 30 W 44th Street -- (212) 403-6533
8:45AM-3:30PM -- Nov. 08 -- Houston, TX -- Sheraton North Houston at George Bush Intercontinental -- 15700 John F. Kennedy Boulevard -- (281) 442-5100
8:45AM-1:00PM -- Nov. 08 -- Providence, RI -- Hassett Wealth Management -- One Turks Head Place, Suite 700 -- (410) 885-2531
8:45AM-1:00PM -- Nov. 09 -- Boston, MA -- Hilton Boston Downtown/Faneuil Hall -- 89 Broad Street -- (617) 556-0006
8:45AM-1:00PM -- Nov. 15 -- Chicago, IL -- Embassy Suites by Hilton O’Hare-Rosemont -- 5500 North River Road -- (847) 928-7620
8:45AM-1:00PM -- Nov. 16 -- Philadelphia, PA -- The Graham Company Headquarters -- 30 South 15th Street, 25th Floor -- (410) 885-2531
Comments: