First Name/Middle Initial/Last Name
Address (Street, City, State, ZIP)
Home Phone Work Phone
Directions: Answer each question “yes” or “no.” For each “no” answer, a point
value will be given. This score will give us a baseline for assisting you.
Mistake #1: “I know what my business is worth.” YES NO
Have I ever had the company value appraised by an outside resource?
Have I had an appraisal reviewed within the last three years?
Do I have a buy/sell agreement?
Is my buy/sell agreement funded?
Does my buy/sell agreement adequately protect my heirs, my business and my
Has my buy/sell agreement been reviewed within the last three years?
Do I perform a yearly review of my estate and business plans?
Mistake #2: “I’m too busy running the company.” YES NO
Do I have a will?
Is my will up to date?
Do I have an estate tax plan beyond a simple will and buy/sell agreement?
Does my estate tax plan include the proper trusts?
Do I know what my current estimated estate taxes are?
Do I have a funding vehicle in place for paying estate taxes?
Mistake #3: “That’ll never happen to me.” YES NO
Do I have a succession plan in place?
Does my succession plan have a provision for disability?
Have I involved both key employees and family members in my succession
Do I discuss financial results, marketing plans, financing, and operations openly
with key employees and family members?
Do I have personal disability income insurance coverage?
Do I have business overhead expense coverage?
Do I have personal disability income insurance buy-out coverage?
Mistake #4: “There’s plenty of time for that.” YES NO
Do I know when I want to retire?
Do I know how much income I will need?
Am I committed to a retirement plan?
Do I know how much control in the business I must maintain in order to secure
my retirement income?
Have I started creating replacement income from other sources?
Mistake #5: “My business is my retirement.” YES NO
Do I have investment vehicles other than my business?
Is 50% or less of my business assets a part of my retirement plan?
Will my retirement funding come from more than four sources?
Am I currently using an asset allocation model?
Do I review my retirement plan yearly?
Mistake #6: “You can’t beat Uncle Sam.” YES NO
Have I determined my financial goals?
Do I have a team of financial experts working with me?
Does my financial plan include vehicles to minimize or avoid taxes?
Will any sources of my retirement income be received tax free?
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