Fidelity bond in place
Yes
FilingOne Adp BoulevardMail Stop 433Roseland, NJ 07068-1728
Automatic Data Processing Employee Welfare Benefit
AUTOMATIC DATA PROECESSING INC • EIN 22-1467904 • Roseland, NJ • Plan year 2012
Filing Insights
Participants
Up29,169 → 31,733
2,564 • 8.79%
Assets
Down$70,511,216 → $68,715,678
-$1,795,538 • -2.55%
Investment Management Fee
26.25%$18,274,157
Admin expenses $18,274,157 • Total expenses $337,305,150
Filing Details
Context- Net investment result
- $-1,795,538
- Accountant opinion
- Unqualified opinion
Status Flags
Limited-scope audit performed
Not reported
Contributions transmitted on time
No
Participant loans in default
No
Leases in default
No
Reportable party-in-interest issues
No
Loss discovered during year
No
Assets with undetermined value
No
Non-cash contributions
No
Assets held for investment
Yes
5% transactions reported
Yes
All plan assets distributed
No
Benefits paid when due
No
Plan blackout period
No
Plan termination resolution adopted
No
Counterparties
Known direct compensation$18,272,35826.25%
| Provider | Services | Location | Direct Compensation | Related |
|---|---|---|---|---|
| AETNAEIN 06-6033492 | Appraisal, Auditing, Service code 49 | - | $10,270,45814.75% | AETNA LIFE INSURANCE COMPANY SEPARATE ACCOUNT NUMBER 174 |
| UNITED HEALTHCAREEIN 36-2739571 | Appraisal, Service code 49 | - | $4,269,2966.13% | Southern Tier Insulation |
| HEALTHYROADS INCEIN 33-0783504 | Auditing | - | $2,681,4573.85% | - |
| EXPRESS SCRIPTS INCEIN 22-3461740 | Appraisal, Auditing, Service code 49 | - | $476,7990.68% | Merck Medco Managed Care LLC |
| MERCEREIN 13-2834414 | Actuarial | - | $306,5360.44% | Mercer Us Inc. |
| MCDERMOTT, WILL & EMERYEIN 36-1453176 | Managed account services | - | $138,9900.20% | Mcdermott, Will & Emery |
| OPTUM HEALTHEIN 47-0858534 | Appraisal | - | $73,0470.10% | - |
| COHNREZNICK LLPEIN 22-1478099 | Accounting | - | $37,7750.05% | Jh Cohn LLP |
| SEGAL COMPANYEIN 13-1835864 | Service code 49 | - | $18,0000.03% | - |
| COHNREZNICK LLPEIN 22-1478099 | Accountant, Unqualified opinion | - | - | Jh Cohn LLP |
| PRUDENTIAL INSURANCEEIN 22-1211670 | Appraisal, Auditing, Service code 49 | - | - | Callaway Golf |
Company Timeline
This filing is highlighted inside the broader sponsor history.
| Year / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2024 | 3 | 34,516 | $9,188,170,399 | $946,809,049 | $27,431iApproximate average salary by contribution assumption: employee only about $685,775 at 4% or $457,184 at 6%; with 50% employer match about $457,184 at 4% or $304,789 at 6%; with 100% employer match about $342,888 at 4% or $228,592 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 34,516 | $7,263,696,267 | $545,367,502 | $15,800iApproximate average salary by contribution assumption: employee only about $395,011 at 4% or $263,340 at 6%; with 50% employer match about $263,340 at 4% or $175,560 at 6%; with 100% employer match about $197,505 at 4% or $131,670 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 9,395 | $1,751,944,267 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 34,063 | $172,529,865 | $401,441,547 | $11,785iApproximate average salary by contribution assumption: employee only about $294,632 at 4% or $196,421 at 6%; with 50% employer match about $196,421 at 4% or $130,947 at 6%; with 100% employer match about $147,316 at 4% or $98,211 at 6%. |
| 2023 | 3 | 34,557 | $8,248,780,194 | $899,837,123 | $26,039iApproximate average salary by contribution assumption: employee only about $650,980 at 4% or $433,987 at 6%; with 50% employer match about $433,987 at 4% or $289,325 at 6%; with 100% employer match about $325,490 at 4% or $216,993 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 34,557 | $6,329,049,479 | $523,574,558 | $15,151iApproximate average salary by contribution assumption: employee only about $378,776 at 4% or $252,517 at 6%; with 50% employer match about $252,517 at 4% or $168,345 at 6%; with 100% employer match about $189,388 at 4% or $126,259 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 10,049 | $1,743,547,182 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 34,539 | $176,183,533 | $376,262,565 | $10,894iApproximate average salary by contribution assumption: employee only about $272,346 at 4% or $181,564 at 6%; with 50% employer match about $181,564 at 4% or $121,043 at 6%; with 100% employer match about $136,173 at 4% or $90,782 at 6%. |
| 2022 | 3 | 33,407 | $7,016,295,219 | $873,097,090 | $26,135iApproximate average salary by contribution assumption: employee only about $653,379 at 4% or $435,586 at 6%; with 50% employer match about $435,586 at 4% or $290,391 at 6%; with 100% employer match about $326,689 at 4% or $217,793 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 33,407 | $5,250,023,503 | $480,117,896 | $14,372iApproximate average salary by contribution assumption: employee only about $359,294 at 4% or $239,530 at 6%; with 50% employer match about $239,530 at 4% or $159,686 at 6%; with 100% employer match about $179,647 at 4% or $119,765 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 10,502 | $1,591,257,729 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 33,407 | $175,013,987 | $392,979,194 | $11,763iApproximate average salary by contribution assumption: employee only about $294,084 at 4% or $196,056 at 6%; with 50% employer match about $196,056 at 4% or $130,704 at 6%; with 100% employer match about $147,042 at 4% or $98,028 at 6%. |
| 2021 | 3 | 31,257 | $8,421,768,076 | $796,139,285 | $25,471iApproximate average salary by contribution assumption: employee only about $636,769 at 4% or $424,513 at 6%; with 50% employer match about $424,513 at 4% or $283,008 at 6%; with 100% employer match about $318,384 at 4% or $212,256 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 31,257 | $6,122,934,941 | $436,819,764 | $13,975iApproximate average salary by contribution assumption: employee only about $349,378 at 4% or $232,918 at 6%; with 50% employer match about $232,918 at 4% or $155,279 at 6%; with 100% employer match about $174,689 at 4% or $116,459 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 11,269 | $2,146,621,225 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 31,113 | $152,211,910 | $359,319,521 | $11,549iApproximate average salary by contribution assumption: employee only about $288,721 at 4% or $192,481 at 6%; with 50% employer match about $192,481 at 4% or $128,321 at 6%; with 100% employer match about $144,361 at 4% or $96,240 at 6%. |
| 2020 | 3 | 30,924 | $7,448,315,919 | $727,132,761 | $23,514iApproximate average salary by contribution assumption: employee only about $587,839 at 4% or $391,892 at 6%; with 50% employer match about $391,892 at 4% or $261,262 at 6%; with 100% employer match about $293,919 at 4% or $195,946 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 30,887 | $5,275,995,623 | $382,244,397 | $12,376iApproximate average salary by contribution assumption: employee only about $309,389 at 4% or $206,260 at 6%; with 50% employer match about $206,260 at 4% or $137,506 at 6%; with 100% employer match about $154,695 at 4% or $103,130 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 12,324 | $2,046,395,397 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 30,924 | $125,924,899 | $344,888,364 | $11,153iApproximate average salary by contribution assumption: employee only about $278,819 at 4% or $185,880 at 6%; with 50% employer match about $185,880 at 4% or $123,920 at 6%; with 100% employer match about $139,410 at 4% or $92,940 at 6%. |
| 2019 | 3 | 32,235 | $6,486,300,186 | $690,657,497 | $21,426iApproximate average salary by contribution assumption: employee only about $535,643 at 4% or $357,095 at 6%; with 50% employer match about $357,095 at 4% or $238,063 at 6%; with 100% employer match about $267,821 at 4% or $178,548 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 32,235 | $4,562,570,022 | $368,063,534 | $11,418iApproximate average salary by contribution assumption: employee only about $285,453 at 4% or $190,302 at 6%; with 50% employer match about $190,302 at 4% or $126,868 at 6%; with 100% employer match about $142,727 at 4% or $95,151 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 13,297 | $1,829,291,675 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 32,223 | $94,438,489 | $322,593,963 | $10,011iApproximate average salary by contribution assumption: employee only about $250,282 at 4% or $166,855 at 6%; with 50% employer match about $166,855 at 4% or $111,237 at 6%; with 100% employer match about $125,141 at 4% or $83,427 at 6%. |
| 2018 | 3 | 32,065 | $5,593,248,171 | $711,418,328 | $22,187iApproximate average salary by contribution assumption: employee only about $554,669 at 4% or $369,779 at 6%; with 50% employer match about $369,779 at 4% or $246,520 at 6%; with 100% employer match about $277,334 at 4% or $184,890 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 32,065 | $3,834,086,240 | $366,774,637 | $11,438iApproximate average salary by contribution assumption: employee only about $285,962 at 4% or $190,641 at 6%; with 50% employer match about $190,641 at 4% or $127,094 at 6%; with 100% employer match about $142,981 at 4% or $95,321 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 14,998 | $1,658,244,023 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 31,910 | $100,917,908 | $344,643,691 | $10,800iApproximate average salary by contribution assumption: employee only about $270,012 at 4% or $180,008 at 6%; with 50% employer match about $180,008 at 4% or $120,005 at 6%; with 100% employer match about $135,006 at 4% or $90,004 at 6%. |
| 2017 | 3 | 33,347 | $6,581,592,567 | $710,630,991 | $21,310iApproximate average salary by contribution assumption: employee only about $532,755 at 4% or $355,170 at 6%; with 50% employer match about $355,170 at 4% or $236,780 at 6%; with 100% employer match about $266,377 at 4% or $177,585 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 33,347 | $4,385,385,475 | $342,945,026 | $10,284iApproximate average salary by contribution assumption: employee only about $257,103 at 4% or $171,402 at 6%; with 50% employer match about $171,402 at 4% or $114,268 at 6%; with 100% employer match about $128,552 at 4% or $85,701 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 18,815 | $2,116,665,189 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 33,327 | $79,541,903 | $367,685,965 | $11,033iApproximate average salary by contribution assumption: employee only about $275,817 at 4% or $183,878 at 6%; with 50% employer match about $183,878 at 4% or $122,585 at 6%; with 100% employer match about $137,908 at 4% or $91,939 at 6%. |
| 2016 | 3 | 31,952 | $5,631,245,859 | $639,272,891 | $20,007iApproximate average salary by contribution assumption: employee only about $500,182 at 4% or $333,455 at 6%; with 50% employer match about $333,455 at 4% or $222,303 at 6%; with 100% employer match about $250,091 at 4% or $166,727 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 31,952 | $3,732,822,452 | $315,452,222 | $9,873iApproximate average salary by contribution assumption: employee only about $246,817 at 4% or $164,545 at 6%; with 50% employer match about $164,545 at 4% or $109,697 at 6%; with 100% employer match about $123,409 at 4% or $82,272 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 21,467 | $1,841,747,390 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 31,768 | $56,676,017 | $323,820,669 | $10,193iApproximate average salary by contribution assumption: employee only about $254,832 at 4% or $169,888 at 6%; with 50% employer match about $169,888 at 4% or $113,259 at 6%; with 100% employer match about $127,416 at 4% or $84,944 at 6%. |
| 2015 | 3 | 30,106 | $5,265,993,378 | $611,271,463 | $20,304iApproximate average salary by contribution assumption: employee only about $507,599 at 4% or $338,400 at 6%; with 50% employer match about $338,400 at 4% or $225,600 at 6%; with 100% employer match about $253,800 at 4% or $169,200 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 30,106 | $3,408,986,491 | $300,214,214 | $9,972iApproximate average salary by contribution assumption: employee only about $249,298 at 4% or $166,198 at 6%; with 50% employer match about $166,198 at 4% or $110,799 at 6%; with 100% employer match about $124,649 at 4% or $83,099 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 25,740 | $1,802,979,137 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 29,932 | $54,027,750 | $311,057,249 | $10,392iApproximate average salary by contribution assumption: employee only about $259,803 at 4% or $173,202 at 6%; with 50% employer match about $173,202 at 4% or $115,468 at 6%; with 100% employer match about $129,902 at 4% or $86,601 at 6%. |
| 2014 | 3 | 35,998 | $5,327,539,614 | $651,124,900 | $18,088iApproximate average salary by contribution assumption: employee only about $452,195 at 4% or $301,463 at 6%; with 50% employer match about $301,463 at 4% or $200,976 at 6%; with 100% employer match about $226,098 at 4% or $150,732 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 35,998 | $3,378,994,809 | $306,626,764 | $8,518iApproximate average salary by contribution assumption: employee only about $212,947 at 4% or $141,965 at 6%; with 50% employer match about $141,965 at 4% or $94,643 at 6%; with 100% employer match about $106,474 at 4% or $70,982 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 30,006 | $1,889,401,993 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 29,497 | $59,142,812 | $344,498,136 | $11,679iApproximate average salary by contribution assumption: employee only about $291,977 at 4% or $194,652 at 6%; with 50% employer match about $194,652 at 4% or $129,768 at 6%; with 100% employer match about $145,989 at 4% or $97,326 at 6%. |
| 2013 | 3 | 36,107 | $5,393,108,926 | $638,025,430 | $17,670iApproximate average salary by contribution assumption: employee only about $441,760 at 4% or $294,507 at 6%; with 50% employer match about $294,507 at 4% or $196,338 at 6%; with 100% employer match about $220,880 at 4% or $147,253 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 36,107 | $3,552,315,383 | $291,191,575 | $8,065iApproximate average salary by contribution assumption: employee only about $201,617 at 4% or $134,411 at 6%; with 50% employer match about $134,411 at 4% or $89,608 at 6%; with 100% employer match about $100,809 at 4% or $67,206 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 29,992 | $1,780,193,456 | - | - |
| Automatic Data Processing Employee Welfare Benefit | - | 35,976 | $60,600,087 | $346,833,855 | $9,641iApproximate average salary by contribution assumption: employee only about $241,018 at 4% or $160,678 at 6%; with 50% employer match about $160,678 at 4% or $107,119 at 6%; with 100% employer match about $120,509 at 4% or $80,339 at 6%. |
| 2012 | 3 | 35,812 | $4,569,104,049 | $681,820,330 | $19,039iApproximate average salary by contribution assumption: employee only about $475,972 at 4% or $317,315 at 6%; with 50% employer match about $317,315 at 4% or $211,543 at 6%; with 100% employer match about $237,986 at 4% or $158,657 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 35,812 | $2,818,776,418 | $271,363,857 | $7,577iApproximate average salary by contribution assumption: employee only about $189,436 at 4% or $126,291 at 6%; with 50% employer match about $126,291 at 4% or $84,194 at 6%; with 100% employer match about $94,718 at 4% or $63,145 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 29,047 | $1,681,611,953 | $75,000,000 | $2,582iApproximate average salary by contribution assumption: employee only about $64,551 at 4% or $43,034 at 6%; with 50% employer match about $43,034 at 4% or $28,689 at 6%; with 100% employer match about $32,275 at 4% or $21,517 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | Current | 31,733 | $68,715,678 | $335,456,473 | $10,571iApproximate average salary by contribution assumption: employee only about $264,280 at 4% or $176,187 at 6%; with 50% employer match about $176,187 at 4% or $117,458 at 6%; with 100% employer match about $132,140 at 4% or $88,093 at 6%. |
| 2011 | 3 | 34,226 | $3,994,837,019 | $692,291,495 | $20,227iApproximate average salary by contribution assumption: employee only about $505,677 at 4% or $337,118 at 6%; with 50% employer match about $337,118 at 4% or $224,745 at 6%; with 100% employer match about $252,838 at 4% or $168,559 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 34,226 | $2,465,834,853 | $239,792,189 | $7,006iApproximate average salary by contribution assumption: employee only about $175,154 at 4% or $116,769 at 6%; with 50% employer match about $116,769 at 4% or $77,846 at 6%; with 100% employer match about $87,577 at 4% or $58,385 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 27,945 | $1,458,490,950 | $125,000,000 | $4,473iApproximate average salary by contribution assumption: employee only about $111,827 at 4% or $74,551 at 6%; with 50% employer match about $74,551 at 4% or $49,701 at 6%; with 100% employer match about $55,913 at 4% or $37,276 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 28,769 | $70,511,216 | $327,499,306 | $11,384iApproximate average salary by contribution assumption: employee only about $284,594 at 4% or $189,729 at 6%; with 50% employer match about $189,729 at 4% or $126,486 at 6%; with 100% employer match about $142,297 at 4% or $94,865 at 6%. |
| 2010 | 3 | 32,605 | $3,623,768,942 | $580,138,607 | $17,793iApproximate average salary by contribution assumption: employee only about $444,823 at 4% or $296,549 at 6%; with 50% employer match about $296,549 at 4% or $197,699 at 6%; with 100% employer match about $222,412 at 4% or $148,274 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 32,605 | $2,293,337,115 | $210,761,978 | $6,464iApproximate average salary by contribution assumption: employee only about $161,602 at 4% or $107,735 at 6%; with 50% employer match about $107,735 at 4% or $71,823 at 6%; with 100% employer match about $80,801 at 4% or $53,867 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 26,829 | $1,270,577,076 | $75,000,000 | $2,795iApproximate average salary by contribution assumption: employee only about $69,887 at 4% or $46,591 at 6%; with 50% employer match about $46,591 at 4% or $31,061 at 6%; with 100% employer match about $34,944 at 4% or $23,296 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 31,343 | $59,854,751 | $294,376,629 | $9,392iApproximate average salary by contribution assumption: employee only about $234,803 at 4% or $156,535 at 6%; with 50% employer match about $156,535 at 4% or $104,357 at 6%; with 100% employer match about $117,401 at 4% or $78,268 at 6%. |
| 2009 | 4 | 31,495 | $3,081,704,633 | $645,201,507 | $20,486iApproximate average salary by contribution assumption: employee only about $512,146 at 4% or $341,431 at 6%; with 50% employer match about $341,431 at 4% or $227,620 at 6%; with 100% employer match about $256,073 at 4% or $170,715 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 31,495 | $1,934,768,054 | $200,526,637 | $6,367iApproximate average salary by contribution assumption: employee only about $159,173 at 4% or $106,116 at 6%; with 50% employer match about $106,116 at 4% or $70,744 at 6%; with 100% employer match about $79,587 at 4% or $53,058 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 26,990 | $1,087,225,895 | $150,000,000 | $5,558iApproximate average salary by contribution assumption: employee only about $138,940 at 4% or $92,627 at 6%; with 50% employer match about $92,627 at 4% or $61,751 at 6%; with 100% employer match about $69,470 at 4% or $46,313 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 29,137 | $59,710,684 | $294,674,870 | $10,113iApproximate average salary by contribution assumption: employee only about $252,836 at 4% or $168,557 at 6%; with 50% employer match about $168,557 at 4% or $112,371 at 6%; with 100% employer match about $126,418 at 4% or $84,279 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 0 | - | - | - |
| 2008 | 4 | 46,505 | $2,473,177,146 | $565,230,011 | $12,154iApproximate average salary by contribution assumption: employee only about $303,854 at 4% or $202,570 at 6%; with 50% employer match about $202,570 at 4% or $135,046 at 6%; with 100% employer match about $151,927 at 4% or $101,285 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 34,536 | $1,588,962,016 | $208,458,107 | $6,036iApproximate average salary by contribution assumption: employee only about $150,899 at 4% or $100,599 at 6%; with 50% employer match about $100,599 at 4% or $67,066 at 6%; with 100% employer match about $75,450 at 4% or $50,300 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 27,027 | $840,203,628 | $100,000,000 | $3,700iApproximate average salary by contribution assumption: employee only about $92,500 at 4% or $61,667 at 6%; with 50% employer match about $61,667 at 4% or $41,111 at 6%; with 100% employer match about $46,250 at 4% or $30,833 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 31,944 | $44,011,502 | $256,771,904 | $8,038iApproximate average salary by contribution assumption: employee only about $200,955 at 4% or $133,970 at 6%; with 50% employer match about $133,970 at 4% or $89,313 at 6%; with 100% employer match about $100,477 at 4% or $66,985 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 46,505 | - | - | - |
| 2007 | 4 | 46,000 | $3,002,800,525 | $488,278,934 | $10,615iApproximate average salary by contribution assumption: employee only about $265,369 at 4% or $176,913 at 6%; with 50% employer match about $176,913 at 4% or $117,942 at 6%; with 100% employer match about $132,684 at 4% or $88,456 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 34,350 | $1,990,291,854 | $203,201,508 | $5,916iApproximate average salary by contribution assumption: employee only about $147,890 at 4% or $98,594 at 6%; with 50% employer match about $98,594 at 4% or $65,729 at 6%; with 100% employer match about $73,945 at 4% or $49,297 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 25,661 | $963,159,219 | $50,000,000 | $1,948iApproximate average salary by contribution assumption: employee only about $48,712 at 4% or $32,475 at 6%; with 50% employer match about $32,475 at 4% or $21,650 at 6%; with 100% employer match about $24,356 at 4% or $16,237 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 31,344 | $49,349,452 | $235,077,426 | $7,500iApproximate average salary by contribution assumption: employee only about $187,498 at 4% or $124,999 at 6%; with 50% employer match about $124,999 at 4% or $83,332 at 6%; with 100% employer match about $93,749 at 4% or $62,499 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 46,000 | - | - | - |
| 2006 | 5 | 46,000 | $2,876,830,682 | $469,460,225 | $10,206iApproximate average salary by contribution assumption: employee only about $255,141 at 4% or $170,094 at 6%; with 50% employer match about $170,094 at 4% or $113,396 at 6%; with 100% employer match about $127,571 at 4% or $85,047 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 34,428 | $1,952,351,957 | $195,929,649 | $5,691iApproximate average salary by contribution assumption: employee only about $142,275 at 4% or $94,850 at 6%; with 50% employer match about $94,850 at 4% or $63,233 at 6%; with 100% employer match about $71,137 at 4% or $47,425 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 28,355 | $864,355,725 | $20,000,000 | $705iApproximate average salary by contribution assumption: employee only about $17,634 at 4% or $11,756 at 6%; with 50% employer match about $11,756 at 4% or $7,837 at 6%; with 100% employer match about $8,817 at 4% or $5,878 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 33,708 | $60,123,000 | $253,530,576 | $7,521iApproximate average salary by contribution assumption: employee only about $188,034 at 4% or $125,356 at 6%; with 50% employer match about $125,356 at 4% or $83,571 at 6%; with 100% employer match about $94,017 at 4% or $62,678 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 33,708 | - | - | - |
| Adp Business Travel Accidental Death & Dismemberme | - | 46,000 | - | - | - |
| 2005 | 5 | 46,000 | $2,566,548,411 | $612,621,533 | $13,318iApproximate average salary by contribution assumption: employee only about $332,946 at 4% or $221,964 at 6%; with 50% employer match about $221,964 at 4% or $147,976 at 6%; with 100% employer match about $166,473 at 4% or $110,982 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 33,638 | $1,702,937,713 | $184,888,189 | $5,496iApproximate average salary by contribution assumption: employee only about $137,410 at 4% or $91,607 at 6%; with 50% employer match about $91,607 at 4% or $61,071 at 6%; with 100% employer match about $68,705 at 4% or $45,803 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 26,269 | $755,813,186 | $7,087 | $0iApproximate average salary by contribution assumption: employee only about $7 at 4% or $4 at 6%; with 50% employer match about $4 at 4% or $3 at 6%; with 100% employer match about $3 at 4% or $2 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 31,600 | $54,289,961 | $231,623,108 | $7,330iApproximate average salary by contribution assumption: employee only about $183,246 at 4% or $122,164 at 6%; with 50% employer match about $122,164 at 4% or $81,443 at 6%; with 100% employer match about $91,623 at 4% or $61,082 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 31,600 | $53,507,551 | $196,103,149 | $6,206iApproximate average salary by contribution assumption: employee only about $155,145 at 4% or $103,430 at 6%; with 50% employer match about $103,430 at 4% or $68,953 at 6%; with 100% employer match about $77,572 at 4% or $51,715 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 46,000 | - | - | - |
| 2004 | 5 | 44,000 | $2,338,179,145 | $538,524,176 | $12,239iApproximate average salary by contribution assumption: employee only about $305,980 at 4% or $203,986 at 6%; with 50% employer match about $203,986 at 4% or $135,991 at 6%; with 100% employer match about $152,990 at 4% or $101,993 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 33,418 | $1,518,560,443 | $166,259,448 | $4,975iApproximate average salary by contribution assumption: employee only about $124,379 at 4% or $82,919 at 6%; with 50% employer match about $82,919 at 4% or $55,279 at 6%; with 100% employer match about $62,189 at 4% or $41,460 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 25,121 | $731,484,134 | $42,417,090 | $1,689iApproximate average salary by contribution assumption: employee only about $42,213 at 4% or $28,142 at 6%; with 50% employer match about $28,142 at 4% or $18,761 at 6%; with 100% employer match about $21,106 at 4% or $14,071 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 30,727 | $44,089,898 | $185,436,485 | $6,035iApproximate average salary by contribution assumption: employee only about $150,874 at 4% or $100,583 at 6%; with 50% employer match about $100,583 at 4% or $67,055 at 6%; with 100% employer match about $75,437 at 4% or $50,291 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 30,727 | $44,044,670 | $144,411,153 | $4,700iApproximate average salary by contribution assumption: employee only about $117,495 at 4% or $78,330 at 6%; with 50% employer match about $78,330 at 4% or $52,220 at 6%; with 100% employer match about $58,748 at 4% or $39,165 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 44,000 | - | - | - |
| 2003 | 5 | 31,739 | $1,986,287,354 | $351,152,640 | $11,064iApproximate average salary by contribution assumption: employee only about $276,594 at 4% or $184,396 at 6%; with 50% employer match about $184,396 at 4% or $122,931 at 6%; with 100% employer match about $138,297 at 4% or $92,198 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 31,739 | $1,293,741,154 | $141,132,646 | $4,447iApproximate average salary by contribution assumption: employee only about $111,167 at 4% or $74,111 at 6%; with 50% employer match about $74,111 at 4% or $49,407 at 6%; with 100% employer match about $55,583 at 4% or $37,056 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 24,051 | $636,122,664 | $86,253,393 | $3,586iApproximate average salary by contribution assumption: employee only about $89,657 at 4% or $59,771 at 6%; with 50% employer match about $59,771 at 4% or $39,847 at 6%; with 100% employer match about $44,828 at 4% or $29,886 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 30,759 | $56,423,536 | $123,766,601 | $4,024iApproximate average salary by contribution assumption: employee only about $100,594 at 4% or $67,063 at 6%; with 50% employer match about $67,063 at 4% or $44,708 at 6%; with 100% employer match about $50,297 at 4% or $33,531 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 30,325 | - | - | - |
| Automatic Data Processing Retirement Savings Plan | - | 31,739 | - | - | - |
| 2002 | 5 | 31,271 | $1,565,800,945 | $348,810,613 | $11,154iApproximate average salary by contribution assumption: employee only about $278,861 at 4% or $185,907 at 6%; with 50% employer match about $185,907 at 4% or $123,938 at 6%; with 100% employer match about $139,431 at 4% or $92,954 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 31,271 | $1,041,677,934 | $134,878,042 | $4,313iApproximate average salary by contribution assumption: employee only about $107,830 at 4% or $71,887 at 6%; with 50% employer match about $71,887 at 4% or $47,924 at 6%; with 100% employer match about $53,915 at 4% or $35,943 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 24,624 | $457,898,968 | $63,256,593 | $2,569iApproximate average salary by contribution assumption: employee only about $64,222 at 4% or $42,815 at 6%; with 50% employer match about $42,815 at 4% or $28,543 at 6%; with 100% employer match about $32,111 at 4% or $21,407 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 29,475 | $66,224,043 | $149,512,513 | $5,073iApproximate average salary by contribution assumption: employee only about $126,813 at 4% or $84,542 at 6%; with 50% employer match about $84,542 at 4% or $56,361 at 6%; with 100% employer match about $63,406 at 4% or $42,271 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 28,448 | - | - | - |
| SAVINGS PLAN FOR FORMER EMPLOYEES OF VINCAM HUMAN RESOURCES INC | - | 0 | - | $1,163,465 | - |
| 2001 | 7 | 40,000 | $1,710,652,562 | $290,911,860 | $7,273iApproximate average salary by contribution assumption: employee only about $181,820 at 4% or $121,213 at 6%; with 50% employer match about $121,213 at 4% or $80,809 at 6%; with 100% employer match about $90,910 at 4% or $60,607 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 31,597 | $1,205,995,201 | $137,850,899 | $4,363iApproximate average salary by contribution assumption: employee only about $109,070 at 4% or $72,713 at 6%; with 50% employer match about $72,713 at 4% or $48,475 at 6%; with 100% employer match about $54,535 at 4% or $36,357 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 23,424 | $461,868,990 | $31,444,299 | $1,342iApproximate average salary by contribution assumption: employee only about $33,560 at 4% or $22,373 at 6%; with 50% employer match about $22,373 at 4% or $14,916 at 6%; with 100% employer match about $16,780 at 4% or $11,187 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 30,010 | $38,050,497 | $120,139,138 | $4,003iApproximate average salary by contribution assumption: employee only about $100,083 at 4% or $66,722 at 6%; with 50% employer match about $66,722 at 4% or $44,481 at 6%; with 100% employer match about $50,041 at 4% or $33,361 at 6%. |
| SAVINGS PLAN FOR FORMER EMPLOYEES OF VINCAM HUMAN RESOURCES INC | - | 207 | $4,737,874 | $1,477,524 | $7,138iApproximate average salary by contribution assumption: employee only about $178,445 at 4% or $118,963 at 6%; with 50% employer match about $118,963 at 4% or $79,309 at 6%; with 100% employer match about $89,222 at 4% or $59,482 at 6%. |
| AUTO DATA PROCESSING - HEALTH CARE PLUS SPENDING | - | 0 | - | - | - |
| Adp Employee Assistance Program | - | 40,000 | - | - | - |
| Adp Business Travel Accidental Death & Dismemberme | - | 27,228 | - | - | - |
| 2000 | 6 | 41,000 | $493,283,229 | $114,203,273 | $2,785iApproximate average salary by contribution assumption: employee only about $69,636 at 4% or $46,424 at 6%; with 50% employer match about $46,424 at 4% or $30,949 at 6%; with 100% employer match about $34,818 at 4% or $23,212 at 6%. |
| Automatic Data Processing Inc Pension Retirement Plan | - | 21,865 | $469,018,064 | $34,679,244 | $1,586iApproximate average salary by contribution assumption: employee only about $39,652 at 4% or $26,434 at 6%; with 50% employer match about $26,434 at 4% or $17,623 at 6%; with 100% employer match about $19,826 at 4% or $13,217 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 29,823 | $24,265,165 | $79,524,029 | $2,667iApproximate average salary by contribution assumption: employee only about $66,663 at 4% or $44,442 at 6%; with 50% employer match about $44,442 at 4% or $29,628 at 6%; with 100% employer match about $33,332 at 4% or $22,221 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 26,051 | - | - | - |
| Adp Business Travel Accidental Death & Dismemberme | - | 26,051 | - | - | - |
| Adp Employee Assistance Program | - | 41,000 | - | - | - |
| Automatic Data Processing Retirement Savings Plan | - | 32,626 | - | - | - |
| 1999 | 4 | 40,000 | $1,185,512,112 | $182,077,074 | $4,552iApproximate average salary by contribution assumption: employee only about $113,798 at 4% or $75,865 at 6%; with 50% employer match about $75,865 at 4% or $50,577 at 6%; with 100% employer match about $56,899 at 4% or $37,933 at 6%. |
| Automatic Data Processing Retirement Savings Plan | - | 30,301 | $1,152,834,855 | $112,518,675 | $3,713iApproximate average salary by contribution assumption: employee only about $92,834 at 4% or $61,889 at 6%; with 50% employer match about $61,889 at 4% or $41,260 at 6%; with 100% employer match about $46,417 at 4% or $30,945 at 6%. |
| Automatic Data Processing Employee Welfare Benefit | - | 22,366 | $32,677,257 | $69,558,399 | $3,110iApproximate average salary by contribution assumption: employee only about $77,750 at 4% or $51,833 at 6%; with 50% employer match about $51,833 at 4% or $34,556 at 6%; with 100% employer match about $38,875 at 4% or $25,917 at 6%. |
| Adp Business Travel Accidental Death & Dismemberme | - | 26,278 | - | - | - |
| Adp Employee Assistance Program | - | 40,000 | - | - | - |
Schedule Details
Schedule A
- Row 1
- Form Id
- 6
- Ins Broker Name
- MERCER HEALTH AND BENEFITS LLC
- Ins Broker US Address1
- 1166 AVENUE OF THE AMERICAS
- Ins Broker US City
- NEW YORK
- Ins Broker US State
- NY
- Ins Broker US ZIP
- 10036
- Ins Broker Comm Pd Amount
- $47,699
- Ins Broker Code
- 3
- Row 2
- Form Id
- 7
- Ins Broker Name
- MERCER HEALTH AND BENEFITS LLC
- Ins Broker US Address1
- 1166 AVENUE OF THE AMERICAS
- Ins Broker US City
- NEW YORK
- Ins Broker US State
- NY
- Ins Broker US ZIP
- 10036
- Ins Broker Comm Pd Amount
- $186,238
- Ins Broker Code
- 3
- Row 3
- Form Id
- 20
- Ins Broker Name
- MARSH EXECUTIVE BENEFITS INC
- Ins Broker US Address1
- PO BOX 27447
- Ins Broker US City
- NEW YORK
- Ins Broker US State
- NY
- Ins Broker US ZIP
- 10087
- Ins Broker Comm Pd Amount
- $12,558
- Ins Broker Code
- 3
- Row 4
- Form Id
- 21
- Ins Broker Name
- MERCER HEALTH AND BENEFITS LLC
- Ins Broker US Address1
- 4565 PAYSPHERE CIRCLE
- Ins Broker US City
- CHICAGO
- Ins Broker US State
- IL
- Ins Broker US ZIP
- 60674
- Ins Broker Comm Pd Amount
- $52,629
- Ins Broker Code
- 3
- Row 5
- Form Id
- 26
- Ins Broker Name
- MERCER HEALTH AND BENEFITS
- Ins Broker US Address1
- 1166 AVENUE OF THE AMERICAS
- Ins Broker US City
- NEW YORK
- Ins Broker US State
- NY
- Ins Broker US ZIP
- 10036
- Ins Broker Comm Pd Amount
- $3,400
- Ins Broker Code
- 3
- Row 6
- Form Id
- 21
- Ins Broker Name
- SEABURY & SMITH INC
- Ins Broker US Address1
- PO BOX 310072
- Ins Broker US City
- DES MOINES
- Ins Broker US State
- IA
- Ins Broker US ZIP
- 50331
- Ins Broker Comm Pd Amount
- $47,702
- Ins Broker Code
- 3
- Row 7
- Ins Carrier Name: NATIONAL UNION/CHARTIS
- Form Id
- 7
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- NATIONAL UNION/CHARTIS
- Ins Carrier EIN
- 25-0687550
- Ins Carrier Naic Code
- 19445
- Ins Contract Num
- PAI 9125478
- Ins Prsn Covered End of year Count
- 25,111
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $186,238
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- ACCIDENTAL DEATH AND DISMEMBERMENT
- Wlfr Total Charges Paid Amount
- $1,241,588
- Ins Fail Provide Info Indicator
- No
- Row 8
- Ins Carrier Name: EXCELLUS BLUECROSS BLUESHIELD PLAN
- Form Id
- 8
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- EXCELLUS BLUECROSS BLUESHIELD PLAN
- Ins Carrier EIN
- 15-0329043
- Ins Carrier Naic Code
- 55107
- Ins Contract Num
- 12750/07453
- Ins Prsn Covered End of year Count
- 15
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Drug Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $141,206
- Ins Fail Provide Info Indicator
- No
- Row 9
- Ins Carrier Name: HAWAII MEDICAL SERVICE ASSOC
- Form Id
- 9
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- HAWAII MEDICAL SERVICE ASSOC
- Ins Carrier EIN
- 99-0040115
- Ins Carrier Naic Code
- 49948
- Ins Contract Num
- 94020
- Ins Prsn Covered End of year Count
- 37
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Ppo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $96,410
- Ins Fail Provide Info Indicator
- No
- Row 10
- Ins Carrier Name: HORIZON HEALTHCARE OF NJ INC
- Form Id
- 10
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- HORIZON HEALTHCARE OF NJ INC
- Ins Carrier EIN
- 22-2651245
- Ins Carrier Naic Code
- 95529
- Ins Contract Num
- 85006
- Ins Prsn Covered End of year Count
- 23
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $191,871
- Ins Fail Provide Info Indicator
- No
- Row 11
- Ins Carrier Name: HORIZON HEALTHCARE SERVICES INC
- Form Id
- 11
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- HORIZON HEALTHCARE SERVICES INC
- Ins Carrier EIN
- 22-0999690
- Ins Carrier Naic Code
- 55069
- Ins Contract Num
- 85006
- Ins Prsn Covered End of year Count
- 23
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Drug Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $94,405
- Ins Fail Provide Info Indicator
- No
- Row 12
- Ins Carrier Name: INDEPENDENT HEALTH
- Form Id
- 12
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- INDEPENDENT HEALTH
- Ins Carrier EIN
- 16-1483784
- Ins Carrier Naic Code
- 47034
- Ins Contract Num
- 30944G
- Ins Prsn Covered End of year Count
- 182
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $923,953
- Ins Fail Provide Info Indicator
- No
- Row 13
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF COLORADO, INC
- Form Id
- 13
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF COLORADO, INC
- Ins Carrier EIN
- 84-0591417
- Ins Carrier Naic Code
- 95669
- Ins Contract Num
- 02497
- Ins Prsn Covered End of year Count
- 74
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $474,902
- Ins Fail Provide Info Indicator
- No
- Row 14
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC
- Form Id
- 14
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC
- Ins Carrier EIN
- 58-1592076
- Ins Carrier Naic Code
- 96237
- Ins Contract Num
- 394
- Ins Prsn Covered End of year Count
- 708
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $2,682,920
- Ins Fail Provide Info Indicator
- No
- Row 15
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF HAWAII
- Form Id
- 15
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF HAWAII
- Ins Carrier EIN
- 94-1340523
- Ins Carrier Naic Code
- 60053
- Ins Contract Num
- 32402
- Ins Prsn Covered End of year Count
- 13
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $46,835
- Ins Fail Provide Info Indicator
- No
- Row 16
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC STATES INC
- Form Id
- 16
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC STATES INC
- Ins Carrier EIN
- 52-0954463
- Ins Carrier Naic Code
- 95639
- Ins Contract Num
- 7593
- Ins Prsn Covered End of year Count
- 81
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $475,597
- Ins Fail Provide Info Indicator
- No
- Row 17
- Ins Carrier Name: AETNA LIFE INSURANCE CO
- Form Id
- 1
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- AETNA LIFE INSURANCE CO
- Ins Carrier EIN
- 06-6033492
- Ins Carrier Naic Code
- 60054
- Ins Contract Num
- 800201
- Ins Prsn Covered End of year Count
- 7,492
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Dental Indicator
- Yes
- Wlfr Premium Rcvd Amount
- $1,535,606
- Wlfr Total Earned Prem Amount
- $1,535,606
- Wlfr Claims Paid Amount
- $1,125,888
- Wlfr Incr Reserve Amount
- $-42,993
- Wlfr Incurred Claim Amount
- $1,082,895
- Wlfr Claims Chrgd Amount
- $1,236,450
- Wlfr Ret Oth Expense Amount
- $377,213
- Wlfr Ret Taxes Amount
- $35,692
- Wlfr Ret Oth Chrgs Amount
- $-182
- Wlfr Ret Total Amount
- $412,723
- Wlfr Refund Cash Indicator
- Yes
- Wlfr Refund Amount
- $113,567
- Wlfr Total Charges Paid Amount
- $2,373,439
- Ins Fail Provide Info Indicator
- No
- Row 18
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA INC
- Form Id
- 18
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA INC
- Ins Carrier EIN
- 94-1340523
- Ins Contract Num
- 104221
- Ins Prsn Covered End of year Count
- 1,579
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $6,624,612
- Ins Fail Provide Info Indicator
- No
- Row 19
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA INC
- Form Id
- 19
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF CALIFORNIA INC
- Ins Carrier EIN
- 94-1340523
- Ins Contract Num
- 20971
- Ins Prsn Covered End of year Count
- 615
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $3,233,272
- Ins Fail Provide Info Indicator
- No
- Row 20
- Ins Carrier Name: METROPOLITAN LIFE INSURANCE COMPANY
- Form Id
- 20
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- METROPOLITAN LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 13-5581829
- Ins Carrier Naic Code
- 65978
- Ins Contract Num
- 0138830
- Ins Prsn Covered End of year Count
- 58
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $12,558
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- INDIVIDUAL DISABILITY INSURANCE
- Wlfr Total Charges Paid Amount
- $127,300
- Ins Fail Provide Info Indicator
- No
- Row 21
- Ins Carrier Name: PRUDENTIAL INSURANCE CO. OF AM.
- Form Id
- 21
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- PRUDENTIAL INSURANCE CO. OF AM.
- Ins Carrier EIN
- 22-1211670
- Ins Carrier Naic Code
- 68241
- Ins Contract Num
- 17900-1
- Ins Prsn Covered End of year Count
- 35,234
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $100,331
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Life Insur Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $3,792,592
- Ins Fail Provide Info Indicator
- No
- Row 22
- Ins Carrier Name: PRUDENTIAL INSURANCE CO. OF AM.
- Form Id
- 22
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- PRUDENTIAL INSURANCE CO. OF AM.
- Ins Carrier EIN
- 22-1211670
- Ins Carrier Naic Code
- 68241
- Ins Contract Num
- 17900-5
- Ins Prsn Covered End of year Count
- 31,704
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Long Terminate Disab Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $6,302,601
- Ins Fail Provide Info Indicator
- No
- Row 23
- Ins Carrier Name: TRIPLE-S SALUD, INC
- Form Id
- 23
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- TRIPLE-S SALUD, INC
- Ins Carrier EIN
- 66-0555677
- Ins Carrier Naic Code
- 55816
- Ins Contract Num
- SP0003562
- Ins Prsn Covered End of year Count
- 47
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Drug Indicator
- Yes
- Wlfr Bnft Ppo Indicator
- Yes
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- MAJOR MEDICAL
- Wlfr Total Charges Paid Amount
- $344,672
- Ins Fail Provide Info Indicator
- No
- Row 24
- Ins Carrier Name: TUFTS HEALTHPLAN
- Form Id
- 24
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- TUFTS HEALTHPLAN
- Ins Carrier EIN
- 04-2674079
- Ins Carrier Naic Code
- 95688
- Ins Contract Num
- 76960000
- Ins Prsn Covered End of year Count
- 272
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $1,946,895
- Ins Fail Provide Info Indicator
- No
- Row 25
- Ins Carrier Name: VISION SERVICE PLAN
- Form Id
- 25
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- VISION SERVICE PLAN
- Ins Carrier EIN
- 06-1227840
- Ins Carrier Naic Code
- 39616
- Ins Contract Num
- 12057040
- Ins Prsn Covered End of year Count
- 22,935
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Vision Indicator
- Yes
- Wlfr Premium Rcvd Amount
- $3,963,927
- Wlfr Total Earned Prem Amount
- $3,963,927
- Wlfr Claims Paid Amount
- $3,648,716
- Wlfr Incr Reserve Amount
- $57,669
- Wlfr Incurred Claim Amount
- $3,706,385
- Wlfr Claims Chrgd Amount
- $3,706,385
- Wlfr Ret Admin Amount
- $356,753
- Wlfr Ret Total Amount
- $356,753
- Wlfr Claims Reserve Amount
- $912,179
- Ins Fail Provide Info Indicator
- No
- Row 26
- Ins Carrier Name: NATIONAL UNION/CHARTIS
- Form Id
- 26
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- NATIONAL UNION/CHARTIS
- Ins Carrier EIN
- 25-0687550
- Ins Carrier Naic Code
- 19445
- Ins Contract Num
- GTP 9129187
- Ins Prsn Covered End of year Count
- 34,761
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $3,400
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- ACCIDENTAL DEATH AND DISMEMBERMENT
- Wlfr Total Charges Paid Amount
- $17,000
- Ins Fail Provide Info Indicator
- No
- Row 27
- Ins Carrier Name: CONNECTICUT GENERAL LIFE INSURANCE CO
- Form Id
- 27
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- CONNECTICUT GENERAL LIFE INSURANCE CO
- Ins Carrier EIN
- 06-0303370
- Ins Carrier Naic Code
- 62308
- Ins Contract Num
- 04678A
- Ins Prsn Covered End of year Count
- 20
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Dental Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $277,604
- Ins Fail Provide Info Indicator
- No
- Row 28
- Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF NORTHWEST
- Form Id
- 17
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- KAISER FOUNDATION HEALTH PLAN OF NORTHWEST
- Ins Carrier EIN
- 93-0798039
- Ins Carrier Naic Code
- 95540
- Ins Contract Num
- 2939
- Ins Prsn Covered End of year Count
- 465
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $2,501,870
- Ins Fail Provide Info Indicator
- No
- Row 29
- Ins Carrier Name: AETNA HEALTH INC
- Form Id
- 2
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- AETNA HEALTH INC
- Ins Carrier EIN
- 76-0189680
- Ins Carrier Naic Code
- 95490
- Ins Contract Num
- US394668
- Ins Prsn Covered End of year Count
- 1,012
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $5,374,763
- Ins Fail Provide Info Indicator
- No
- Row 30
- Ins Carrier Name: BLUE CARE NETWORK OF MICHIGAN
- Form Id
- 3
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- BLUE CARE NETWORK OF MICHIGAN
- Ins Carrier EIN
- 22-1467904
- Ins Carrier Naic Code
- 95610
- Ins Contract Num
- 00115293/0001
- Ins Prsn Covered End of year Count
- 395
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Drug Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $1,725,733
- Ins Fail Provide Info Indicator
- No
- Row 31
- Ins Carrier Name: BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GA INC
- Form Id
- 4
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GA INC
- Ins Carrier EIN
- 58-1638390
- Ins Carrier Naic Code
- 96962
- Ins Contract Num
- 1013259001
- Ins Prsn Covered End of year Count
- 328
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $2,450,280
- Ins Fail Provide Info Indicator
- No
- Row 32
- Ins Carrier Name: BLUE CROSS BLUE SHIELD OF ILLINOIS
- Form Id
- 5
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- BLUE CROSS BLUE SHIELD OF ILLINOIS
- Ins Carrier EIN
- 36-1236610
- Ins Carrier Naic Code
- 70670
- Ins Contract Num
- H06201
- Ins Prsn Covered End of year Count
- 230
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Hmo Indicator
- Yes
- Wlfr Total Charges Paid Amount
- $1,120,353
- Ins Fail Provide Info Indicator
- No
- Row 33
- Ins Carrier Name: NATIONAL UNION/CHARTIS
- Form Id
- 6
- Schedule A Plan Year Begin Date
- 2012-01-01
- Schedule A Plan Year End Date
- 2012-12-31
- Schedule A Plan Num
- 503
- Schedule A EIN
- 22-1467904
- Ins Carrier Name
- NATIONAL UNION/CHARTIS
- Ins Carrier EIN
- 25-0687550
- Ins Carrier Naic Code
- 19445
- Ins Contract Num
- BSC 9125477
- Ins Prsn Covered End of year Count
- 34,812
- Ins Policy From Date
- 2012-01-01
- Ins Policy To Date
- 2012-12-31
- Ins Broker Comm Total Amount
- $47,699
- Ins Broker Fees Total Amount
- $0
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Ded Amount
- $0
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- ACCIDENTAL DEATH AND DISMEMBERMENT
- Wlfr Total Charges Paid Amount
- $317,991
- Ins Fail Provide Info Indicator
- No
Schedule C
Schedule C Provider
PRUDENTIAL INSURANCE
MEDICAL ADMINISTRATOR • EIN 22-1211670
Direct compensation$10,270,458
AppraisalAuditingService code 49
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 1
- Service code: Appraisal
- Service code
- Appraisal
- Row 2
- Service code: Auditing
- Service code
- Auditing
- Row 3
- Service code: Service code 49
- Service code
- Service code 49
- PRUDENTIAL INSURANCE
- Eligible provider name
- PRUDENTIAL INSURANCE
- Eligible provider EIN
- 22-1211670
- AETNA
- Other provider name
- AETNA
- Other provider EIN
- 06-6033492
- Relationship to employer or plan
- MEDICAL ADMINISTRATOR
- Direct compensation
- $10,270,458
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
UNITED HEALTHCARE
CLAIMS PROCESSOR • EIN 36-2739571
Direct compensation$4,269,296
AppraisalService code 49
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 6
- Service code: Appraisal
- Service code
- Appraisal
- Row 7
- Service code: Service code 49
- Service code
- Service code 49
- UNITED HEALTHCARE
- Other provider name
- UNITED HEALTHCARE
- Other provider EIN
- 36-2739571
- Relationship to employer or plan
- CLAIMS PROCESSOR
- Direct compensation
- $4,269,296
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
HEALTHYROADS INC
MEDICAL ADMINISTRATOR • EIN 33-0783504
Direct compensation$2,681,457
Auditing
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 9
- Service code: Auditing
- Service code
- Auditing
- HEALTHYROADS INC
- Other provider name
- HEALTHYROADS INC
- Other provider EIN
- 33-0783504
- Relationship to employer or plan
- MEDICAL ADMINISTRATOR
- Direct compensation
- $2,681,457
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
EXPRESS SCRIPTS INC
MEDICAL ADMINISTRATOR • EIN 22-3461740
Direct compensation$476,799
AppraisalAuditingService code 49
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 11
- Service code: Appraisal
- Service code
- Appraisal
- Row 12
- Service code: Auditing
- Service code
- Auditing
- Row 13
- Service code: Service code 49
- Service code
- Service code 49
- EXPRESS SCRIPTS INC
- Other provider name
- EXPRESS SCRIPTS INC
- Other provider EIN
- 22-3461740
- Relationship to employer or plan
- MEDICAL ADMINISTRATOR
- Direct compensation
- $476,799
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
MERCER
ACTUARY • EIN 13-2834414
Direct compensation$306,536
Actuarial
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 15
- Service code: Actuarial
- Service code
- Actuarial
- MERCER
- Other provider name
- MERCER
- Other provider EIN
- 13-2834414
- Relationship to employer or plan
- ACTUARY
- Direct compensation
- $306,536
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
MCDERMOTT, WILL & EMERY
LEGAL • EIN 36-1453176
Direct compensation$138,990
Managed account services
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 17
- Service code: Managed account services
- Service code
- Managed account services
- MCDERMOTT, WILL & EMERY
- Other provider name
- MCDERMOTT, WILL & EMERY
- Other provider EIN
- 36-1453176
- Relationship to employer or plan
- LEGAL
- Direct compensation
- $138,990
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
OPTUM HEALTH
CLAIMS PROCESSOR • EIN 47-0858534
Direct compensation$73,047
Appraisal
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 19
- Service code: Appraisal
- Service code
- Appraisal
- OPTUM HEALTH
- Other provider name
- OPTUM HEALTH
- Other provider EIN
- 47-0858534
- Relationship to employer or plan
- CLAIMS PROCESSOR
- Direct compensation
- $73,047
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
COHNREZNICK LLP
ACCOUNTANTS • EIN 22-1478099
Direct compensation$37,775
Accounting
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 21
- Service code: Accounting
- Service code
- Accounting
- COHNREZNICK LLP
- Other provider name
- COHNREZNICK LLP
- Other provider EIN
- 22-1478099
- Relationship to employer or plan
- ACCOUNTANTS
- Direct compensation
- $37,775
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
SEGAL COMPANY
SERVICE PROVIDER • EIN 13-1835864
Direct compensation$18,000
Service code 49
Indirect compensationNo
Formula-based compensationNo
Source fields
- Row 23
- Service code: Service code 49
- Service code
- Service code 49
- SEGAL COMPANY
- Other provider name
- SEGAL COMPANY
- Other provider EIN
- 13-1835864
- Relationship to employer or plan
- SERVICE PROVIDER
- Direct compensation
- $18,000
- Indirect compensation reported
- No
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
Provider 10
Provider details
Source fields
- Row 25
- Excluded provider reported
- Yes
Schedule H
Schedule H Financial Statement
Large plan result
Assets, contributions, fees, audit, and compliance fields reported for this large-plan filing.
End-of-year assets$68,715,678-$1,795,538 change
Balance Sheet
Beginning and end of plan year.
Total assets$70,511,216$68,715,678Decrease -$1,795,538 (-2.55%)
Net assets$70,511,216$68,715,678Decrease -$1,795,538 (-2.55%)
Contributions
Employer contributions$210,926,372
Participant contributions$122,347,364
Other contributions$2,182,737
Total contributions$335,456,473
Income & Investment Result
Total income$335,509,612
Interest$53,139
Net income$-1,795,538
Expenses & Fees
Benefits paid$319,030,993
Administrative expenses$18,274,157
Total expenses$337,305,150
Accountant
FirmCOHNREZNICK LLP
Firm EIN22-1478099
OpinionUnqualified opinion
Compliance
Fidelity bondYes
Fidelity bond amount$390,000,000
Late contributionsNo
Schedule H source fields
- Financial summary
- Total assets at beginning of year: $70,511,216Total assets at end of year: $68,715,678Net income or loss: $-1,795,538
- Schedule H Plan Year Begin Date
- 2012-01-01
- Schedule H Tax Period
- 2012-12-31
- Schedule H Plan number
- 503
- Schedule H EIN
- 22-1467904
- Non Interest Bear Cash Beginning of year Amount
- $74
- Employer Contribution Beginning of year Amount
- $1,257,853
- Interest Bear Cash Beginning of year Amount
- $69,253,289
- Total assets at beginning of year
- $70,511,216
- Net assets at beginning of year
- $70,511,216
- Non Interest Bear Cash End of year Amount
- $698
- Employer Contribution End of year Amount
- $2,184,552
- Interest Bear Cash End of year Amount
- $66,530,428
- Total assets at end of year
- $68,715,678
- Net assets at end of year
- $68,715,678
- Employer contributions
- $210,926,372
- Participant contributions
- $122,347,364
- Oth Contribution Rcvd Amount
- $2,182,737
- Total contributions
- $335,456,473
- Interest Bear Cash Amount
- $53,139
- Total interest income
- $53,139
- Total income
- $335,509,612
- Participant distributions
- $269,865,606
- Ins Carrier Bnfts Amount
- $49,165,387
- Total benefit distributions
- $319,030,993
- Other Admin Fees Amount
- $18,274,157
- Total administrative expenses
- $18,274,157
- Total expenses
- $337,305,150
- Net income or loss
- $-1,795,538
- Accountant opinion type
- Unqualified opinion
- Account Performed Limited Audit Indicator
- No
- Accountant firm name
- COHNREZNICK LLP
- Accountant firm EIN
- 22-1478099
- Failed to transmit participant contributions on time
- No
- Participant loans in default
- No
- Leases in default
- No
- Nonexempt transactions with parties in interest
- No
- Fidelity bond in place
- Yes
- Fidelity bond amount
- $390,000,000
- Loss discovered during year
- No
- Assets with undetermined value
- No
- Non-cash contributions reported
- No
- Assets held for investment
- Yes
- Reportable 5% transactions
- Yes
- All plan assets distributed
- No
- Failed to provide benefits when due
- No
- Blackout period occurred
- No
- Comply Blackout Notice Indicator
- No
- Resolution to terminate plan adopted
- No
Filing received by DOL Oct 14, 2013