Full Company Profile

Company Profile
Organization Legal Name*
DBA*
FEIN*
Years In Business*
Street Address*
City, State, ZIP*
SIC CODE*
Lookup: https://siccode.com/sic-code-lookup-directory
NAICS Code*
Lookup: https://www.naics.com/code-search
Please list any owners and their percentage ownership*
Business Type*
Number of Full Time Employees*
Number of Part Time Employees*
Number of Seasonal Employees*
States with Employees*
To select multiple items, hold down the Shift or Command key while clicking each item.
Does your company operate under or process payroll using any additional EINs (Employer Identification Numbers)?

YesNo
Please list all additional EINs below along with the corresponding company or entity name(s) they associated with.

Payroll Information
Estimated Gross Yearly Payroll*
Pay Cycle*
Day Employees Are Paid*
Employee Census*

Download the template at: http://www.tilsonhr.com/wp-content/uploads/2024/09/Gradient-Census_Exhibit-A-Health-Template-1.xlsx
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State Unemployment Rate

Employers can find their State Unemployment Insurance (SUI) by visiting their state's unemployment insurance agency website or logging into their account with the agency. Each state sets SUI rates and provides access to this information through its specific portal. Typically, employers also receive this information in a yearly notice from their state's Department of Labor.
Are you currently with a PEO?*

YesNo
State Unemployment Rates*

Please upload a snapshot of your state agency's website or the notice from the DOL. If you have any questions, please contact your Tilson Business Development Representative.
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DWD Letter of Clearance*

If you have any employees in Indiana, please upload your DWD Letter of Clearance. Instructions: Log into your DWD Employer Self-Service Account at https://uplink.in.gov/ESS/ESSLogon.htm. Select "Request" then "Request Clearance Certificate". The system will then issue the certificate if there is no balance on the account.
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Benefits Review
Health Policy Review
Do you currently offer an employer sponsored health plan?*

YesNo
Carrier*
Renewal Date*

MonthDayYear
Date
How much do you currently contribute to your employees coverage?*
Do you offer more than one health plan option?*

No, just 1 plan optionYes, 2 plan optionsYes, 3 plan options
Most Recent Renewal*

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Most Recent Invoice*

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SBC Option 1*

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SBC Option 2

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SBC Option 3

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Ancillary Benefits Review
Do you currently offer dental benefits to your employees?*

YesNo
Do you currently offer vision benefits to your employees?*

YesNo
Do you currently offer STD or LTD benefits to your employees?*

YesNo
Are you satisfied with your current benefit offerings, or is there anything you would change?

Company Profile