Preliminary Client Questionnaire Company Name:*How did you hear about us?*Contact Information Company Contact Name:*Company Contact Phone:*Company Contact Email:*Employees and Classification Enter the number of W-2s issued to:Full Time Employees:*Part Time Employees:*Other Employees:*Do you have Temp Staff?*YesNoDo you have Seasonal Staff?*YesNoFor the purposes of this questionnaire, seasonal employees are ones that are only employed for a portion of the year; an employee that works all year but has periodic times of increased hours (such as a retail employees during the holiday season) is not considered seasonal.Do you have Variable-Hour Staff?*YesNoFor the purposes of this questionnaire, a variable-hour employee is one who works dramatically different hours from week-to-week, so that the 30 hour/week threshold for full-time employment is not regularly exceeded. Example: a waitress working 15 hours one week and 45 the next is variable-hour; a mechanic working 38 hours one week and 45 the next is not.Medical Insurance Information Do you offer medical insurance to your employees?*YesNoGeneral Information: Describe how employees pay for coverage:*Explain coverage as if you were telling a new hire about your benefit plan.Does the company have any other related companies?*YesNoWith Common OwnershipHave you had any major changes to your plan in the past 12 months?*YesNoSuch as a new or cancelled plan, a new or sold company, dramatic overhaul of benefits offered or cost structure at renewal, etc.Anything else we should know, or concerns?