Employer Demographics Questionnaire


The answers provided in the following Employer Demographics Questionnaire will be used by Compliancedashboard to customize its services and provide material relevant to an individual plan sponsor (employer). Compliancedashboard will rely on the answers to the questions below to establish a compliance calendar and provide compliance reminders to this employer.

There are four sections to this questionnaire:

Section 1: Build and Define Employer
Section 2: Build and Define Benefit Plan(s)
Section 3: Build and Define User(s)
Section 4: Getting Started

Click Here to go to Section 1: Build and Define Employer

Additional Employer Questions for Health & Welfare Plan Compliance

Employers that have access to Protected Health Information (PHI), beyond summary health information and enrollment information, must comply with HIPAA Privacy and Security requirements. Typically, a fully insured plan does not have access to PHI and a self-funded plan does have access to PHI, although this can vary by employer.
An employer is generally subject to COBRA if it employed 20 or more full-time equivalent employees on a typical business day during the preceding calendar year.
Answer "Yes" if the employer sponsors a stand-alone retiree-only medical plan (whether insured or self-funded) that covers no current employees.

Employer Size

Some federal laws apply to an employer or an employer's benefit plan based on the number of employees that are in the plan or work for the employer. Please read this section carefully because each question may ask for slightly different information.

Include all employees who received a W-2 from the employer in the preceding calendar year.
For this question only, the definition of full-time is defined as any employee who is considered full-time by the employer.
Full-time and part-time employees each count as one employee.
Full-time and part-time employees each count as one employee.
Full-time and part-time employees each count as one employee.
Full-time and part-time employees each count as one employee.
Full-time and part-time employees each count as one employee.

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Click Here to go to Section 2: Build and Define Benefit Plans

Build Group Health Plan

This section will ask for basic information about the group health plan.

Plan Funding

Plan Funding
Indicate below how this plan is funded.
A self-insured plan does not use insurance to pay health benefits. However, the plan or its sponsor may purchase stop-loss insurance.
A fully insured plan provides benefits solely through health insurance coverage. (Click "No" if this plan is a combination of self-insured and fully insured)
This plan provides benefits through both heath insurance coverage and through its own funds or the funds of the plan sponsor.
If this a combination of self and fully insured funding, please provide additional information on this funding arrangement.
Other Group Health Plan Information
Select the plan anniversary date of the group health plan from the drop down list. This is in a MM/DD format
Count employee participants and former employee participants (such as COBRA participants), but do not include spouses or dependents.
This is sometimes referred to as a "Premium Only Plan" (POP).
Trusts may be established to separate employer or employee funds that are used by the group benefit plans. However, most employers do not establish trusts and simply pay plan expenses out of their general assets.

Define Group Health Plan

In this section you will define the status, provisions and coverage available through the group health plan.

Under the Affordable Care Act (ACA), group health plans must declare whether they are "Grandfathered" or "Non-Grandfathered."
Answer "Yes" If the group health plan provides either mental health or substance use disorder benefits in addition to medical/surgical benefits.
Answer "Yes" if the plan reimburses participants for costs related to maternity care, including hospital stays in connection with childbirth.
Answer "Yes" if the employer offers access to an on-site health clinic (even if the clinic is not located on the employer's premises) as part of its benefits package.
Other Welfare Benefit Plans
Compliance activities can be added for other group welfare benefits, such as dental, vision, life and disability. These activities should only be added if the welfare plan has a different plan anniversary than the group health plan. These activities reminder the employer to complete:

  1. the Open Enrollment;
  2. Form 5500;

    3. or

  3. Summary Annual Report

    4. if they are required for this welfare benefit plan.

Remember: only add another welfare benefit plan if it has a different anniversary than the group health plan.

Click Here to Add Compliance Activities

The Open Enrollment compliance activity reminds the employer to perform enrollment activities, such as distributing enrollment materials, summary plan descriptions and other required notices.
Please note: Enter this activity ONLY if the other welfare benefit plan(s) has a different plan anniversary than the group health plan.

The Open Enrollment compliance activity reminds the employer to perform enrollment activities, such as distributing enrollment materials, summary plan descriptions and other required notices.
To add this activity, indicate the plan anniversary dates that apply to the other welfare benefit plan(s). If two plans have the same anniversary date, you simply need to mark the date one. For example, If your Dental and Vision Plans both have an April 1 plan anniversary date, click "Yes" below Open Enrollment: April 1 Anniversary. Mark all of the anniversary dates that apply to your other welfare benefit plans
Please note: Add this activity ONLY if the other welfare benefit plan(s) has a different plan anniversary than the group health plan.

Count employee participants and former employee participants (such as COBRA participants), but do not include spouses or dependents.
Trusts may be established to separate employer or employee funds that are used by the group benefit plans. However, most employers do not establish trusts and simply pay plan expenses out of their general assets.

Form 5500 - Other Welfare Benefit Plans

The Form 5500 compliance activity reminds the employer to complete and submit the Form 5500 to the Department of Labor on an annual basis.
To add this activity, indicate the plan anniversary dates that apply to the other welfare benefit plan(s). If two plans have the same anniversary date, you simply need to mark one date. For example, If your Dental and Vision Plans both have a April 1 plan anniversary date, click "Yes" below Form 5500: April 1 Anniversary. Mark all of the anniversary dates that apply to your other welfare benefit plans
Please note: Add this activity ONLY if the other welfare benefit plan(s) has a different plan anniversary than the group health plan. In addition, a separate Form 5500 DOES NOT need to be filed if a plan is combined with the health plan in a "mega-wrap" or "umbrella" document, which allows all combined plans to be filed under a single Form 5500.

If this plan is fully insured or a combination of self-funded and fully insured, click "No."
If this plan is a combination of self-funded and fully insured, click "No."

Summary Annual Report (SAR) - Other Welfare Benefit Plans

The SAR is a written summary of the Form 5500. The SAR compliance activity reminds the employer to distribute this form to employees and participants. To add this activity, indicate the plan anniversary dates that apply to the other welfare benefit plan(s). If two plans have the same anniversary date, you simply need to mark one date. For example, If your Dental and Vision Plans both have a April 1 plan anniversary date, click "Yes" below Form 5500: April 1 Anniversary. Mark all of the anniversary dates that apply to your other welfare benefit plans. Please note: Add this activity ONLY if the other welfare benefit plan(s) has a different plan anniversary than the group health plan. In addition, a SAR only need to be distributed if a Form 5500 was filed and the plan is fully insured.
Count employee participants and former employee participants (such as COBRA participants), but do not include spouses or dependents.
For example, one class of employees may be offered a self-funded plan and another class is offered a fully insured plan.
This is sometimes referred to as a "Premium Only Plan" (POP).
Trusts may be established to separate employer or employee funds that are used by the group benefit plans. However, most employers do not establish trusts and simply pay plan expenses out of their general assets.
Enter an additional plan ONLY if it has a different plan anniversary than the group health plan or the previous other welfare benefit plan. This is the last welfare benefit plan that you can enter.

Build 401(k) Plan

This section will ask for basic information about the 401(k) plan.

Select the plan anniversary date of the group health plan from the drop down list. This is in a MM/DD format.
Compliancedashboard will send out a reminder to the employer after a payroll to help ensure the employer's timely deposits of any deferral and/or matching contributions. These reminders can be aligned with the payroll cycles listed below.

Click Here for Weekly/Bi-Weekly Payroll Reminders

Click Here for Monthly/Semi-Monthly Payroll Reminders

Notice of Distribution Options

Compliancedashboard will send out a reminders to the employer to ensure the employer provides terminated employees who are plan participants with a notice that includes a general description of the various distribution options offered under the plan.

Click Here for Monthly Notice Reminders

Click Here for Quarterly Notice Reminders

Define 401(k) Plan

In this section you will define the provisions and type of 401(k) plan.

Plan Documents

Plan sponsors may utilize different options to ensure the plan document is written to comply with all requirements in the Internal Revenue Code. Indicate below the method used by this plan sponsor (employer) for creating and maintaining plan documents.
For example, a prototype document or a volume submitter plan document.

Indicate Cycle to File Request for Determination Letter

End of Cycle: January 31, 2012
End of Next Cycle: January 31, 2017
Last Digit of Plan Sponsor EIN: 1 or 6
and plans under special Cycle A controlled group election
End of Cycle: January 31, 2013
End of Next Cycle: January 31, 2018
Last Digit of Plan Sponsor EIN: 2 or 7
and multiple employer plans
End of Cycle: January 31, 2014
End of Next Cycle: January 31, 2019
Last Digit of Plan Sponsor EIN: 3 or 8
and governmental plans
End of Cycle: January 31, 2015
End of Next Cycle: January 31, 2020
Last Digit of Plan Sponsor EIN: 4 or 9
and multiemployer plans
End of Cycle: January 31, 2016
End of Next Cycle: January 31, 2021
Last Digit of Plan Sponsor EIN: 5 or 0
and multiemployer plans
You have not selected any of the plan cycles above. Please indicate the plan cycle in the text box below.

Traditional or Safe Harbor Plan

In this section you will define the status, provisions and coverage available through the group health plan.

Contributions under a traditional 401(k) plan must meet specific nondiscrimination requirements.
This includes the Actual Deferral Percentage (ADP) and Actual Contribution Percentage (ACP) tests to verify that deferral contributions and employer matching contributions do not discriminate in favor of highly compensated employees.
Contributions under a traditional 401(k) plan must meet specific nondiscrimination requirements.

Automatic Enrollment

Automatic enrollment allows an employer to automatically deduct elective deferrals from an employee's wages, unless the employee makes an election to not contribute or to contribute a different amount.

The Qualified Default Investment Alternative (QDIA) enables employers to limit liability when they select default investments for workers who do not direct their own investments.

Investment Direction

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Click Here to go to Section 3: Build and Define Users

Define User (1)

You may enter four types of users on Compliancedashboard:
1. The BENEFIT ADMINISTRATOR is responsible for completing compliance activities, such as distributing notices, administering plan provisions, etc. This user WILL receive emails from Compliancedashboard notifying him or her that it is time to complete an activity.
2. The HR MANAGER oversees the compliance activities of the Benefit Administrator(s) and has certain administrative tools to run reports, update profiles, etc. This user will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
3. The BLENDED USER will function as a Benefit Administrator and will also have access to the administrative tools of the HR Manager.
4. The RESEARCH ONLY USER can access the site to perform research, but will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
You will be given the option of entering multiple users for each user type.

Mark the appropriate user type below. You may only mark one user type for each user.
Please Note: If this employer only has one user, the user must be a Blended User. See the definitions above if you need more information on user types.

Compliance Activity Setup (User 1)

An employer's Dashboard calendar is set up according to its plan year. You must elect how a Benefit Administrator or Blended User will handle activities that fall between the beginning of the plan year and the user’s start date. For example, if the beginning of the plan year is January 1 and the user's start date is May 1, the Dashboard will show compliance activities for the entire plan year, including those that fall before the user's start date (Jan., Feb., Mar. & Apr.).

Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Prior To Start" status indicating no response is required from the user. However, the user can review the activities at any time. Please note that a user will not receive email reminders from the Dashboard until he or she accepts the User's Agreement after the first login.
Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Past Due" status indicating a response is required from the user. After the user logs in and accepts the user agreement, he or she will begin receiving email reminders to complete the past due activities. The user will continue to receive these emails until the activities are marked as complete.

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Click Here to Add a 2nd User

Define User (2)

You may enter four types of users on Compliancedashboard:
1. The BENEFIT ADMINISTRATOR is responsible for completing compliance activities, such as distributing notices, administering plan provisions, etc. This user WILL receive emails from Compliancedashboard notifying him or her that it is time to complete an activity.
2. The HR MANAGER oversees the compliance activities of the Benefit Administrator(s) and has certain administrative tools to run reports, update profiles, etc. This user will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
3. The BLENDED USER will function as a Benefit Administrator and will also have access to the administrative tools of the HR Manager.
4. The RESEARCH ONLY USER can access the site to perform research, but will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
You will be given the option of entering multiple users for each user type.

Mark the appropriate user type below. You may only mark one user type for each user. If an employer only has two users, one user must be a Benefit Administrator or a Blended User; and the other user must be an HR Manager or a Blended User.
Beyond this restriction, you may enter multiple users for each user type.

Compliance Activity Setup (User 2)

An employer's Dashboard calendar is set up according to its plan year. You must elect how a Benefit Administrator or Blended User will handle activities that fall between the beginning of the plan year and the user’s start date. For example, if the beginning of the plan year is January 1 and the user's start date is May 1, the Dashboard will show compliance activities for the entire plan year, including those that fall before the user's start date (Jan., Feb., Mar. & Apr.).

Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Prior To Start" status indicating no response is required from the user. However, the user can review the activities at any time. Please note that a user will not receive email reminders from the Dashboard until he or she accepts the User's Agreement after the first login.
Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Past Due" status indicating a response is required from the user. After the user logs in and accepts the user agreement, he or she will begin receiving email reminders to complete the past due activities. The user will continue to receive these emails until the activities are marked as complete.

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Click Here to Add a 3rd User

Define User (3)

You may enter four types of users on Compliancedashboard:
1. The BENEFIT ADMINISTRATOR is responsible for completing compliance activities, such as distributing notices, administering plan provisions, etc. This user WILL receive emails from Compliancedashboard notifying him or her that it is time to complete an activity.
2. The HR MANAGER oversees the compliance activities of the Benefit Administrator(s) and has certain administrative tools to run reports, update profiles, etc. This user will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
3. The BLENDED USER will function as a Benefit Administrator and will also have access to the administrative tools of the HR Manager.
4. The RESEARCH ONLY USER can access the site to perform research, but will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
You will be given the option of entering multiple users for each user type.

This user may be any user type listed below. You may only mark one user type for each user.

Compliance Activity Setup (User 3)

An employer's Dashboard calendar is set up according to its plan year. You must elect how a Benefit Administrator or Blended User will handle activities that fall between the beginning of the plan year and the user’s start date. For example, if the beginning of the plan year is January 1 and the user's start date is May 1, the Dashboard will show compliance activities for the entire plan year, including those that fall before the user's start date (Jan., Feb., Mar. & Apr.).

Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Prior To Start" status indicating no response is required from the user. However, the user can review the activities at any time. Please note that a user will not receive email reminders from the Dashboard until he or she accepts the User's Agreement after the first login.
Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Past Due" status indicating a response is required from the user. After the user logs in and accepts the user agreement, he or she will begin receiving email reminders to complete the past due activities. The user will continue to receive these emails until the activities are marked as complete.

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Click Here to Add a 4th User

Define User (4)

You may enter four types of users on Compliancedashboard:
1. The BENEFIT ADMINISTRATOR is responsible for completing compliance activities, such as distributing notices, administering plan provisions, etc. This user WILL receive emails from Compliancedashboard notifying him or her that it is time to complete an activity.
2. The HR MANAGER oversees the compliance activities of the Benefit Administrator(s) and has certain administrative tools to run reports, update profiles, etc. This user will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
3. The BLENDED USER will function as a Benefit Administrator and will also have access to the administrative tools of the HR Manager.
4. The RESEARCH ONLY USER can access the site to perform research, but will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
You will be given the option of entering multiple users for each user type.

This user may be any user type listed below. You may only mark one user type for each user.

Compliance Activity Setup (User 4)

An employer's Dashboard calendar is set up according to its plan year. You must elect how a Benefit Administrator or Blended User will handle activities that fall between the beginning of the plan year and the user’s start date. For example, if the beginning of the plan year is January 1 and the user's start date is May 1, the Dashboard will show compliance activities for the entire plan year, including those that fall before the user's start date (Jan., Feb., Mar. & Apr.).

Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Prior To Start" status indicating no response is required from the user. However, the user can review the activities at any time. Please note that a user will not receive email reminders from the Dashboard until he or she accepts the User's Agreement after the first login.
Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Past Due" status indicating a response is required from the user. After the user logs in and accepts the user agreement, he or she will begin receiving email reminders to complete the past due activities. The user will continue to receive these emails until the activities are marked as complete.

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Click Here to Add a 5th User

Define User (5)

You may enter four types of users on Compliancedashboard:
1. The BENEFIT ADMINISTRATOR is responsible for completing compliance activities, such as distributing notices, administering plan provisions, etc. This user WILL receive emails from Compliancedashboard notifying him or her that it is time to complete an activity.
2. The HR MANAGER oversees the compliance activities of the Benefit Administrator(s) and has certain administrative tools to run reports, update profiles, etc. This user will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
3. The BLENDED USER will function as a Benefit Administrator and will also have access to the administrative tools of the HR Manager.
4. The RESEARCH ONLY USER can access the site to perform research, but will NOT be required to complete compliance activities and will not receive emails from Compliancedashboard.
You will be given the option of entering multiple users for each user type.

This user may be any user type listed below. You may only mark one user type for each user.

Compliance Activity Setup (User 5)

An employer's Dashboard calendar is set up according to its plan year. You must elect how a Benefit Administrator or Blended User will handle activities that fall between the beginning of the plan year and the user’s start date. For example, if the beginning of the plan year is January 1 and the user's start date is May 1, the Dashboard will show compliance activities for the entire plan year, including those that fall before the user's start date (Jan., Feb., Mar. & Apr.).

Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Prior To Start" status indicating no response is required from the user. However, the user can review the activities at any time. Please note that a user will not receive email reminders from the Dashboard until he or she accepts the User's Agreement after the first login.
Activities that fall between the beginning of the plan year and the user’s start date will reflect a "Past Due" status indicating a response is required from the user. After the user logs in and accepts the user agreement, he or she will begin receiving email reminders to complete the past due activities. The user will continue to receive these emails until the activities are marked as complete.

Do You Have More Than 5 Users?

You can add as many users as necessary for this employer; however, you can only add a total of 5 users through this online tool. To add additional users, simply click on this email link to generate an email to our administrative staff: admin@compliancedashboard.net

In the body of the email include:

  1. Your name
  2. Your email address
  3. The employer's name
  4. The total number of users you wish to add for this employer
You will be contacted to gather the information necessary to add more users.

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CLICK HERE to go to Section 4: Getting Started

You Have Now Completed All Four Sections!

Click the button below to submit the employer information. You can also scroll up to review and/or change the information you have entered.
Indicate Anniversary Date below in MM/DD format
Indicate Anniversary Date below in MM/DD format