First Name: Middle Name/Initial: Last Name:

Email Address (required) :

Mailing Address

Street: City: State: Postal Code:

Age:

Gender:MaleFemaleOther

Marital Status: MarriedSingleWidowedDivorcedLife Partner

Company Name:

Describe the company's industry or operations:

Type of Entity:
C CorporationS CorporationLimited Liability Company (LLC)General PartnershipLimited PartnershipLimited Liability PartnershipLimited Liability Limited PartnershipSole Proprietorship

Your company is organized under the laws of which state:

Year in which your company was created or began operations:

If different than the year above, in what year did you first quire ownership?:

Average time that you spend working for the company (choose one):

hours per day hours per week weeks per month

Do you own 100% of the company, either individually or with your spouse/partner?YesNo

If you answered "No", what percentage of the company do you own (include your spouse or partner if they are an owner):%

Number of company employees:

Does your company have key employees?YesNo

Please provide the following information for each Key Employee:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Name:

Job Title:

Enter the key employee's hire date:

Have you identified a successor owner at this time?YesNo

(If successor has been selected)

You wish to transfer the business to (select one):
ChildChildrenKey Employee (One Only)Key Employee Group (Two or More)Co-OwnerCo-OwnersOutside Third Party

Successor owner's name(s):

How much of your ownership interest do you want to transfer?AllSomeNoneUndecided

If you answered "some" to the above, what % of ownership interest do you want to retain in the company after the completion of your planned transfer?

Fixed

Amount:

Range

% Range:

What is the date on which you would like to start the transfer of ownership?

What is the date on which you would like to complete the transfer of ownership?

Is it your intention to work for the company indefinitely?YesNo

If you answered "yes" to the above, do you want the ability to leave the company for extended periods of time?YesNo

What is the date on which you wish to begin your departure from the company?

What is the date on which you wish to complete you departure from the company?

Is the business real estate located:On a single business locationOn multiple business locations

(If single location)

Describe the ownership of real property on which the business operates (select one).

The business real estate is leased from an unrelated third partyYou own the propery, in whole or in part, individually (i.e., not through an entity)An entity in which you have all or partial ownershipYour company owns the property on which the business operatesOther

If you share ownership with another individual or entity, indicate the name(s) of the other owner(s) and types of ownership by completing the following sentence:

"The property on which the business operates is owned by you and..."

If you selected "other" above, please complete the following sentence:

"The business real estate is owned by an entity, which is owned:

If leased, what year does the current leas term expire?

(For multiple business locations)

Please list addresses and ownership type (leased, owner-owned, entity-owned, company-owned, other):

Does your company have any benefit plans, profit sharing plans, bonus plans, or any other plans in place (such as cash bonus plans, retirement plans, stock ownership plans, NQDC, etc.)?YesNo

If there are any in place

Type of Plan (Please Describe)

Non-Qualified Deferred Compensation

Informal (Discretionary) Cash Bonus

Formal Cash Bonus Plan

Stock Appreciation Rights Plan

Phantom Stock Plan

Stock Option Plan

Stock Bonus Plan

Company Vehicle

401(k)

Pension Plan

Other Retirement Plan

Group Life Insurance

Group Disability Insurance

Other

Do you want to include a Gap Analysis in this Value Driver Report?YesNo

The "Gap Analysis" represents the results of preliminary estimates of the current value of the business, the target-value of the business the owner is trying to achieve and the difference betwee nthe two (i.e., the "gap").

Current esitmated value of 100% of the business? $

Target value of 100% of the business? $

Number of years to achieve target business value: years.

Annual required growth rate for business value to meet target value objective:

% per year (relative to each previous year)

$ per year

Provide the following information to support the estimates of current and target business value.

Method of determining current business value:

Method of determining projected total personal financial needs:

Method of determining non-business asset/investment value(expected at time of sale of business):

If you are unable to work due to illness or injury:

Written and signed agreements control payments to youThere is "an understanding" about how you will be treated

Has the Company paid for or supported any of your family members (who are not Company employees) travel or use of Company-owned vehicles?YesNo

You can produce written documents related to (check all that apply):

Election of officersApproval of major Company decisions and contractsAuthorization of distributions and dividends

Significant aspects of your business operations include (check all that apply):

ServicesManufacturingAssemblyInventoryPublishing/Printing/DuplicationRecords Management and MaintenanceResearch and Development

Your facilities and the organization of your physical operating space:

Evolved, expanded and grew over timeWere organized strategically in a comprehensive process

Can you identify all of your direct and indirect competitors? YesNo

Your competitors: are no of concern because your business is uniqueare a constant source of stress and challenge for youhave occasionally gotten the better of you in ways you felt might have been avoided

Can you think of more than one incident during the past 12 months in which an employee made an error that cost the Company significant money? YesNo

Has any employee error occurred more than once during hte past 12 months (even if the error was made by different employees)? YesNo

Does any single customer represent more than 5% of the Company's sales during the past 12 months?YesNo

Would a downturn in any single industry negatively impact a broad cross-section of your customers?YesNo

Are any of your customers currently buying product/services that you sell from other sources (your competitors)?YesNo

How often do you approach existing customers to remind or inform them of additional products or services that you offer?

at least quarterlyat least twice per yearat least annuallynot on any specific schedulecustomers are encouraged or expected to communicate their needs when and how they are comfortable doing so (a low pressure approach)not sure

The Company has excess capacity in the form of (check all that apply):

empty offices or work stationsidle equipmentemployees who have "down time"warehouse or storage spaceunused software licensesvehicles not busy enoughoperations not active maximum number of possible hours per daynone of the above

If you sales team could bring in additional sales, how difficult would it be to expand operations to meet the increased demand?Not Very DifficultSomewhat DifficultVery Difficult

Do you offer any high-end or premium products or services?YesNo

Have you been disappointed by sales results for your most valuable product or service offerings?YesNo

Are you aware of any competing or complimentary businesses that are (formally or informally) available for sale?YesNo

If you became aware of a valuable opportunity to acquire a competing or complimentary business that would add significant value to your existing business, are you in a position to make a financial commitment involving either a lump sum payment or payments over time?YesNo

You will consider your business "successful" (check all that apply)

when a specific annual sales target can be consistently achievedwhen you are able to penetrate a particularly difficult marketwhen the Company is able to secure an especially elusive contractwhen the Company is able to expand to a certain number of locationswhen the Company has at least a certain number of employeeswhen you consistently receive a specific minimum financial benefit or payment from the Companynot sure

If asked, would a significant majority of your employees be able to describe accurately the long-term goals of the Company?YesNo

Can most or all of your employees accurately describe what the Company does?YesNo

Can most or all of your employees accurately describe the Company's unique competitive advantage?YesNo

Customer complaints are addressed (check all that apply):

as they ariseafter several SIMILAR complaints are receivedon a fixed scheduleonly when they are deemed to be validwith an immediate acknowledgement and a prompt resolutionindividually by each employee as he or she receives the complaintnot in any manner that can be easily described

Customer suggestions and requests for new products, features or services are (check all that apply):

collected, documented and archivedreviewed and evaluated individually as they are madeusually not able to be accommodated due to financial or operational constraintsdiscussed and evaluated in regularly scheduled meetingsnot addressed in any consistent manner

Describe the vendors or suppliers who are essential to your ability to provide your most important products or services:

there are numerous vendors/suppliers, all with similar pricing, quality and availabilitythere are a limited number of vendors/suppliers who can meet the Company's pricing, quality, and availability needs

If one of your primary vendors or suppliers unexpectedly raised its prices, changed its payment requirements, changed its quality standards, or stopped offering the products or services you need, would the Company experience a short-term or long-term negative impact?YesNo

Do you have an organizational chart for the company? YesNo

The sequence of activities, actions, and responsibilities that must occur within the Company in order to generate revenue:

flows directly from one person or position to the next through the organizational chartis not reflected by the organizational chart because it primarily illustrates reporting and management responsibilities

If a customer asks the same question of two different employees within the Company:

they will always get the same information, level of responsiveness, and quality of attentiontheir experience will vary depending on the individual employee

Do all front-line employees who interact with customers or prospective customers have written scripts to guide them through the most common conversations or questions? YesNo

How often do you find yourself participating in the activities or responsibilities of an employee you hired to perform that particular task?NeverOnly during training or evaluation of an employeeOccasionallyOften

What percentage of your time do you spend responding to customer complaints, following up on employee activities, putting out fires, completing administrative tasks, and/or participating in the close of a sale?

NoneLess than 5%5% to 15%15% to 40%40% to 60%60% to 80%80%+

Do you suspect or know that one or more of your employees is not as productive as he or she should be?YesNo

Does each employee have clear incentives to be as productive as possible and know consequences for a lack of productivity?YesNo

Can every employee of the Company accurately describe how he or she can positively or negative impact the success of the business?YesNo

Do you have any employees who play a purely supportive role and do not participate directly or indirectly in the success of the Company?YesNo

Training of new employees is (check all that apply)

usually handled by several people within the Companyusually handled by the same person within the Company (which may be a different person for each position)usually achieved by "on the job" training techniques rather than formal training in a less realistic environmentnot necessary for Company employees

Did every employee hired by the Company in the past 12 months receive the same orientation, training, and observation as every other employee hired for the same position because written training materials and schedules are in place?YesNoNot Sure

How often do you review the current status of the Company's key financial indicators?

DailyWeeklyMonthlyQuarterlyAnnuallyNever - financial indicators are not relevant to the CompanyDon't have or don't know the key financial indicators

You use Company financial information to (check all that apply):

budget for the remainder of the current monthbudget for the current yearmeasure Company performance and compare it to performance in other periods of timemeasure the effectiveness of specific activities or initiativesdon't use financial information for any particular purpose

Does the Company currently or frequently carry what you consider to be a significant debt obligation?YesNo

Do Company debt obligations tie up cash flow that could be used for a more beneficial purpose?YesNo

Your regular, consistent budgeting activities include (check all that apply):

creating a forward_looking budget for all major categories of revenue and expenses at least annually, if not more oftencomparing budget items to actual revenue and expense items at least annuallyconfirming the minimum volume of sales necessary to sustain the Companyidentifying expenditures that will be necessary in the event of Company growthidentifying the cost reductions that will be available if Company performance is low

If you become aware of a valuable business opportunity that will require a significant financial investment by the Company 12 to 18 months in the future, what is your ability to accurately forecast the Company's potential to make that investment?

You can predict the Company's ability with a high degree of accuracyYou can predict the Company's ability with a moderate degree of accuracyYou cannot predict the Company's ability with any accuracy

Do you know what proportions of your products and services are being purchased by each of your top 20 customers by volume?
YesNo

Can you identify the types of customers or the market segments that are most successful for the Company and/or present the greatest potential opportunity for the Company?YesNo

Can you describe the aspects of your business that are considerably stronger than the characteristics of your industry competitors?
YesNo

How often do you receive and analyze information and updates related to the performance of companies across your industry?

Never - No such industry data existsNever - Industry data is not helpfulMore than once per yearOnce per yearOnce every few years

Can you identify an drank your top 5 sales activities in terms of revenue generation?YesNo

Do you communicate with your sales personnel and base their compensation (at least in part) on specific activity level expectations and the resulting sales expectations? YesNo

Do you currently monitor and report on the percentage of your customers who return to buy your products or services within a 12 month period? YesNoNot applicable - our business does not typically serve repeat customers

Do any employees have responsibility for retaining customers and a compensation structure that encourages them to successfully retain those customers? YesNo

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