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Section I.
Changes to Company's Legal Status
Has the name of the company changed? Yes No
Do you used an Assumed Name? Yes No
If yes, is the Assumed Name registered with the Secretary of State? Yes No
Is the assumed name registered with the Department of Labor and Industry? Yes No
Did you change the Registered Address of the Company? Yes No
If yes, what is the new address:
Did you change the principal place of business or office location? Yes No
If yes, what is the new address:
Is there a change in ownership of the Company? Yes No
If yes, what?
Is there a change in the directors/governors of the Company? Yes No
If yes, what?
Is there a change in Officers of the Company? Yes No
If yes, what?
What is the name of each owner and their ownership percentage?
What is the name of each of the directors/governors?
What is the name of each officer of the company?
President:
VP:
Treasurer:
Secretary:
Other:
Did you amend the Articles of Incorporation/Organization? Yes No
If yes, what?
Did you amend the By-Laws? Yes No
If yes, what?
Section II.
Actions Affecting Owners
Do you have a Buy/Sell Agreement? Yes No
If yes, when was it last reviewed?
Was a life insurance and/or disability insurance policy purchased or renewed? Yes No
What is the current value of the company for the purposes of the Buy/Sell?
How is it determined?
Was any stock/ownership share sold or purchased? Yes No
Do the owners have a will? Yes No
If Yes, when was it last reviewed?
Section III.
Employee Benefits
Was a group term life or medical plan adopted, modified, or discontinued? Yes No
Did the company adopt a 401(k), profit sharing, ESOP, pension, SEP IRA or other retirement plan? Yes No
Did the company make a contribution to a 401(k), profit sharing, or other retirement plan? Yes No
Did the company adopt any fringe benefits for directors/governors or officers? Yes No
If yes, what?
Did you, or will you, pay a distribution of profits to owners? Yes No
If yes, how are they being distributed?
Is a salary being paid to directors/governors or officers? Yes No
If Yes, how much is being paid for each?
Is a bonus being paid to directors/governors or officers? Yes No
If Yes, how much is being paid for each?
Section IV.
Actions Involving Finances
Did the company open or close a bank account? Yes No
Was money borrowed from any source? Yes No
If Yes, for what and how much?
Did the company make a loan to any owner, director/governor, officer, or employee? Yes No
If Yes, to who and how much?
Was any company property sold, purchased, leased, exchanged, or pledged as security for a loan or other Yes No
If yes, what?
Did the company enter into any Employee Agreement, Management Agreement, Consulting Agreement, Non-Compete Agreement, Confidentiality Agreement, etc.? Yes No
If yes, what?
Are there any other changes to the company that you think that we should know?
