Professional Employment Organization (PEO) Questionnaire All information provided in this report and any documents ancillary thereto ("Report") are provided for information purposes only. Although the information found in this Report is believed to be reliable, no warranty, expressed or implied, is made regarding the accuracy, adequacy, completeness, legality, reliability, or suitability of any information, either isolated or in the aggregate. All information is provided "as is." Changes may be periodically made to the information contained in this Report. No notice is required with respect to any changes. If you find any errors or omissions, we encourage you to report them by e- mail to: administration@insurancedragon.com. Under no circumstances will Dragon Services, Inc., or its directors, officers, agents, contractors, employees or assigns be liable for any direct, consequential, indirect, special or punitive damages whatsoever arising out of your access to or use of this Report.
General G1. How long have you been in business? G2. How many employees do you have? G3. What is the largest client group that you have? G4. How many client groups with over 500 employees do you have? G5. Do you have any other clients that are similar in type of employees and size? G6. Please provide references of clients who have been with you for more than 3 years? G7. Will you provide us with a bond protecting us against non-payment of payroll tax liabilities, both state and federal? G8. What is your company s current financial situation? G9. Please provide a copy of the last two years financials. G10. Do you now or have you ever had any legal action taken against you for non-payment of your financial obligations? 2
Payroll P1. What payroll system do you use? Do you work on a PC platform or an A/S 400 platform or something else? P2. Are you registered with the following states for withholding taxes and/or workers compensation coverage? California. P3. Do you have direct deposit available and if so is there a charge for its use? P4. With what bank do you do business for your payroll checks? P5. On what day of the week do you send your ACH file to your bank? What is the amount of your average ACH file transfer each week? Have you ever experienced problems with ACH files not going through properly, in whole or in part? P6. Can I have my checks delivered by Thursday morning if I can t get you my payroll information until Tuesday noon? P7. Can you print multiple checks for an employee for a single pay period? If so how do we communicate this to you? If so, will your system know not to take benefits deductions from the extra checks? P8. Will our employee s check have our name somewhere on the check or stub? P9. Can I have the choice of receiving my payroll check sealed or unsealed? 3
P10. Can I have my checks sorted alphabetically but broken into sub-groups (i.e. sales, corporate, and hourly by separate location)? P11. If I have mid-week terminations, how do you deal with this? P12. Can we have different pay periods and pay cycles for different pay groups? P13. What data is required from us for you to build your data base? 4
Administrative A1. Will we have online or Internet access to our employee s files, both personnel related and payroll history? A2. If we wanted to, could we make online changes to our employee s personnel files? If so, must we make the changes or can we choose to have you do this? A3. Can we run reports online for local printing? Can we create custom reports or can you create custom reports for us? A4. What do your invoices look like? A5. Can I get multiple invoices by pay group with detail of regular pay, overtime pay, vacation pay, other taxable pay, other non-taxable pay, advances deduction, W/C, employer taxes, benefit deductions by type, fees and other misc. items? A6. How much will you charge me for overnight delivery to my office? A7. Can you do one-day turnaround on holiday weeks if we have our files to you by 8 a.m.? A8. Can I e-mail you my files? A9. Can I send you some files in data format and some in Excel format? If so, can you use the format I already have configured for will I have to hire a programmer to write another conversion to match your system s needs? A10. Can you provide weekly reports with month-to-date, quarter-to-date and year-to-date information for each employee? 5
A11. Can you produce a weekly report in Excel with 401(k) contribution and 401(k) loan payments by employee with their SS#, name and amount of contribution and/or loan payment? A12. Can you produce the yearly 401(k) required discrimination reports needed by our 401(k) company? A13. Do you allow us to continue our health benefits, with payroll deductions, if we do not choose to participate in your health benefit program? A14. Do you require all new payroll forms to be completed before our employees switch to your PEO (i.e. W-4, I-9, state withholding forms, direct deposit, and basic personal information)? If so, what forms will you require and will you administration the collection of these forms with our employees or are we expected to do this? A15. When do you expect our payment for our weekly payroll liability to reach you? Can we wire the payroll funds to you? A16. Do you require any kind of deposit for payroll? A17. How often will someone from your company be at our location(s)? A18. If we have several separate companies, does this create a problem for you? 6
Workers Compensation WC1. Are you self-insured for W/C? If so, what is the limit of your bond? WC2. What is your deductible limit? Does your contract require that we be financially responsible for your deductible, should you fail to make deductible payments on our account? WC3. Is your workers compensation program administered through an HCO/MPN? WC4. Is the HCO/MPN front loaded (fee based) or back loaded (commission based)? WC5. What is the monthly fee for the HCO/MPN service? WC6. For how long will our WC rates be guaranteed once we sign up? One Year? Until next renewal? WC7. What is the required deposit for the WC insurance? How may it be paid? WC8. Do you use an A rated carrier or better? Who? 7
WC9. How do you handle your claims? Do we get a choice of claims administrator? What is the experience of the claims administrator(s)? WC10. How often do you provide the insured with loss runs? WC11. Are you and your carrier registered in California to provide workers compensation insurance coverage? WC12. Are you reporting client information to the WCIRB? If so, since when? WC13. Please provide 3 references of employers that have left your PEO to return to the traditional market for workers compensation coverage, to allow us to determine that we can readily be accepted back into that marketplace. WC14. How much notice must you give us that you intend to stop providing service? minimum). (60 days 8
WC15. Do you require that we implement Return To Work on every claim? What if we can t accommodate a particular claimant? WC16. Are we required to indemnify the PEO for any particular injuries? WC17. Will we receive our own policy or be part of a master policy? responsible for the losses of other insured s in the PEO? Could we ever be WC18. Will the certificates of insurance show an insurance company? Can you issue Waiver of Subrogation wording? Can you name others Additional Insured? WC19. Do you have a safety incentive plan included in your pricing? If so, how does it operate? 9
Other Services OS1. Do you offer medical, dental, vision, life and disability or other benefit plans for our employee s? If so, please explain - OS2. Do you offer a 401(k) plan for our employees to participate in? If so, is their a required employer match? If so, is the match fixed or can the match be customize for our group? What are the eligibility requirements and the vesting schedule? OS3. Will you handle COBRA / HIPPA administration? OS4. Will you handle FMLA claims for us? OS5. Will you handle unemployment claims? How will the process work? OS5. Do you provide any kind of EPLI insurance that protects us against employee claims? If so, who is the insurance company? What is the Best rating for the EPLI insurance company? Does your EPLI insurance have an employer deductible? If so, what is the amount of the deductible? OS6. Do you have a program for Independent Contractors, if any, to be covered with workers compensation and possibly payroll? If so how does it work? 10
Cost Questions: 1. What will be the charge for SUTA? Will you use the client s SUTA percentage? Will you use your own SUTA percentage? If so, what is that? If so, what is that? 2. Will you only charge for FUTA the.80% against the first $7,000? of each employee s annual payroll for Social Security? (I.e. you commit NOT to charge for payroll above $7,000.) 3. FICA: Will you agree not to charge the 6.2% against annual payroll that exceeds $106,800? 11