Unclaimed Property Services

Audit Risk Assessment Questionnaire

Thank you for taking the time to complete this confidential Unclaimed Property Audit Risk Assessment Questionnaire. Your answers will allow us to conduct a high-level assessment of your company's risk of facing and effectively surviving a state unclaimed property audit. After completing the assessment you will receive:

• Keane’s White Paper entitled “Audit Risk Red Flags - The Inside Story"
• An Audit Risk Summary Report based on your company’s unique situation
• Up to 30 minutes of complementary consultation with one of our unclaimed property experts
• A Starbucks Gift Card to thank you for participating

IMPORTANT: Your response is completely confidential. Your e-mail address and any other information collected in response to this survey will remain confidential and will not be distributed to any other company.

1) In which industry is your company classified? (i.e. Manufacturing, Pharmaceutical, Finance)

2) In which state is your company (parent and operating subsidiaries, as applicable) currently incorporated?

Please provide the date(s) of incorporation.

3) Was there ever a change in the state(s) of incorporation?

If yes, please identify the entity, the state(s) and the date(s) of the change.

4) Are the books and records for your organization centralized or decentralized?

If decentralized, please identify the number of decentralized processes.

5) Does your company file unclaimed property reports annually?*

If yes, to which states have reports been submitted?

6) What is the approximate total dollar value reported by your company for each of the last three (3) years?

2006

2007

2008

7) Is your company filing negative or zero unclaimed property reports with the states with the hope of triggering a statute of limitation when a liability may exist?*

8) Does your company contract with third-parties for the administration of payroll, benefits, workers’ compensation, rebates and/or gift cards?*

9) Has your company been audited for unclaimed property?*

If yes, by which states?

10) Has your company previously filed Voluntary Disclosure Agreements (VDAs) with any states?*

If yes, to which states?

11) Does your company have written policies and procedures for handling unclaimed property, including procedures for handling uncashed checks, void checks?*

12) What is the approximate volume of checks or drafts written by your company on an annual basis?

13) Does your company have an unclaimed property liability reserve established on your books pursuant to FAS 5?*

14) Does your company take advantage of statutory unclaimed property exemptions and deductions?*

15) Has your company applied any unclaimed property remediation efforts to proactively reduce your liability (for instance, identifying and excluding accounting errors, performing due diligence to contact lost property owners)?*

16) Are all company bank accounts and general ledger accounts reconciled monthly?

17) Do the company’s accounting records correctly identify overpayments, credit balances, unapplied receipts, refunds due to customers or voided checks as a liability?*

18) Has your company engaged in practices, policies or procedures that resulted in unrecorded liabilities, such as old outstanding checks being written off to income, expense or bad debt?*

19) Please provide your contact information:

Full Name:*

Title

Company Name*

Email Address*

Phone Number*

Address*

City*

State*

ZipCode*

* Required