ANNUAL LIMITED LIABILITY COMPANY QUESTIONNAIRE

To assist our firm in preparing your annual member consent, please provide us with information concerning the matters identified below. (If you would prefer not to provide information concerning any of these matters, please write “N/A” in the space provided). Please attach copies of any applicable documents that you would like referenced in the consent. PLEASE BE AS SPECIFIC AS POSSIBLE WITH RESPECT TO NAMES, DATES, AND AMOUNTS. The information you provide should apply only to actions taken during the past year, except as otherwise indicated.

LLC NAME

CURRENT MAILING ADDRESS:

NAME OF PERSON TO CONTACT:

CURRENT TELEPHONE NUMBER:

Date:Fiscal Year End:

(month/day)

1.Election of LLC Managers:

Are there any changes in the managers? Yes _____No _____

If yes, please provide the names of all of the managers:

2.Changes in Membership:

Did the company issue any new membership interests or purchase the membership interests of any existing member, or did any member transfer his or her interests to someone else?

Yes _____No _____

If yes, please provide information regarding the changes in membership interests. (*If you have previously advised our firm of all changes in membership interests during the past year, please disregard this question.)

3.Has the company made a contribution to any of its existing retirement plans for the current fiscal year? Yes _____ No _____

If yes, please provide the following information:

Type of Plan / Newly Adopted Plan? / Contribution Amount
Yes/No / $
Yes/No / $

4.Has the company borrowed any money from the members, banks or any other institution? Yes _____ No _____

If yes, please provide the following information regarding the loan to the company:

Lender:

Amount: Date:

Terms:

(i.e., interest rate, loan term, payments)

Purpose/Use of funds:

  1. Has the company loaned any money to the members, employees or any other persons?

Yes _____No _____

If yes, please provide the following information regarding the loan from the company:

Borrower:

Amount: Date:

Terms:

(i.e., interest rate, loan term, payments)

  1. Has the company purchased ___ or leased ___ [mark whichever is applicable] any personal property (such as automobiles, equipment, furniture, etc.) or real property where the amount of the purchase/lease EXCEEDS $1,000?

Property Description:

Purchase Price:ORLease Obligation Amount:

Purpose/Use by Company:

7.Please describe any other significant actions taken, or decisions made, by the company during the past year. These may include opening of new bank accounts, employing professional advisors, leasing or purchasing any property or equipment, securing new insurance, adopting any new benefit plans for key employees, etc.

SignatureDate

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LLC QUESTIONNAIRE (annual).doc