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Filing

Automatic Data Processing Employee Welfare Benefit

AUTOMATIC DATA PROECESSING INC • EIN 22-1467904 • Plan year 2000

Company ProfileSource Archive
Filing Insights

Participants

Up

22,716 → 29,823

7,107 • 31.29%

Assets

Down

$32,677,257 → $24,265,165

-$8,412,092 • -25.74%

Investment Management Fee

0.00%

$0

Admin expenses $10,375,714 • Total expenses $92,629,094

Filing Details

Context
Net investment result
$-10,723,714

Status Flags

Fidelity bond in place

Yes

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

Yes

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

No

Counterparties
ProviderServicesLocationDirect CompensationRelated
DELOITTE & TOUCHEEIN 13-3891517Accountant---

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
2024334,516$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%.
2023334,557$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%.
2022333,407$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%.
2021331,257$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%.
2020330,924$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%.
2019332,235$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%.
2018332,065$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%.
2017333,347$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%.
2016331,952$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%.
2015330,106$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%.
2014335,998$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%.
2013336,107$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%.
2012335,812$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-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%.
2011334,226$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%.
2010332,605$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%.
2009431,495$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---
2008446,505$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---
2007446,000$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---
2006546,000$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---
2005546,000$107,797,512$427,726,257$9,298iApproximate average salary by contribution assumption: employee only about $232,460 at 4% or $154,973 at 6%; with 50% employer match about $154,973 at 4% or $103,316 at 6%; with 100% employer match about $116,230 at 4% or $77,487 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---
Automatic Data Processing Retirement Savings Plan-33,638---
Automatic Data Processing Inc Pension Retirement Plan-26,269---
2004544,000$2,294,089,247$353,087,691$8,025iApproximate average salary by contribution assumption: employee only about $200,618 at 4% or $133,745 at 6%; with 50% employer match about $133,745 at 4% or $89,164 at 6%; with 100% employer match about $100,309 at 4% or $66,873 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$44,044,670$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---
Automatic Data Processing Employee Welfare Benefit-30,727---
2003531,739$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---
2002531,271$457,898,968$63,256,593$2,023iApproximate average salary by contribution assumption: employee only about $50,571 at 4% or $33,714 at 6%; with 50% employer match about $33,714 at 4% or $22,476 at 6%; with 100% employer match about $25,286 at 4% or $16,857 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%.
Adp Business Travel Accidental Death & Dismemberme-28,448---
Automatic Data Processing Employee Welfare Benefit-29,475---
SAVINGS PLAN FOR FORMER EMPLOYEES OF VINCAM HUMAN RESOURCES INC-0---
Automatic Data Processing Retirement Savings Plan-31,271---
2001740,000$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---
2000641,000$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 BenefitCurrent29,823$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---
1999440,000$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
Filing Id
84037170308312
Form Id
16901563
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060066
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 2
Filing Id
84037170308312
Form Id
16901544
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060047
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 3
Filing Id
84037170308312
Form Id
16901545
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060048
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 4
Filing Id
84037170308312
Form Id
16901547
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060050
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 5
Filing Id
84037170308312
Form Id
16901549
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060052
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 6
Filing Id
84037170308312
Form Id
16901551
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060054
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 7
Filing Id
84037170308312
Form Id
16901554
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060057
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 8
Filing Id
84037170308312
Form Id
16901555
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060058
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 9
Filing Id
84037170308312
Form Id
16901556
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060059
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 10
Filing Id
84037170308312
Form Id
16901557
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060060
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 11
Filing Id
84037170308312
Form Id
16901559
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060062
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 12
Filing Id
84037170308312
Form Id
16901572
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060075
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 13
Filing Id
84037170308312
Form Id
16901501
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060004
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 14
Filing Id
84037170308312
Form Id
16901503
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060006
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 15
Filing Id
84037170308312
Form Id
16901505
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060008
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 16
Filing Id
84037170308312
Form Id
16901507
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060010
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 17
Filing Id
84037170308312
Form Id
16901509
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060012
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 18
Filing Id
84037170308312
Form Id
16901511
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060014
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 19
Filing Id
84037170308312
Form Id
16901512
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060015
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 20
Filing Id
84037170308312
Form Id
16901514
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060017
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 21
Filing Id
84037170308312
Form Id
16901518
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060021
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 22
Filing Id
84037170308312
Form Id
16901520
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060023
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 23
Filing Id
84037170308312
Form Id
16901522
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060025
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 24
Filing Id
84037170308312
Form Id
16901524
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060027
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 25
Filing Id
84037170308312
Form Id
16901525
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060028
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 26
Filing Id
84037170308312
Form Id
16901538
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060041
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 27
Filing Id
84037170308312
Form Id
16901540
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060043
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 28
Filing Id
84037170308312
Form Id
16901527
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060030
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 29
Filing Id
84037170308312
Form Id
16901528
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060031
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 30
Filing Id
84037170308312
Form Id
16901530
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060033
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 31
Filing Id
84037170308312
Form Id
16901531
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060034
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 32
Filing Id
84037170308312
Form Id
16901532
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060035
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 33
Filing Id
84037170308312
Form Id
16901534
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060037
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 34
Filing Id
84037170308312
Form Id
16901535
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060038
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 35
Filing Id
84037170308312
Form Id
16901536
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060039
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 36
Filing Id
84037170308312
Form Id
16901570
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060073
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 37
Filing Id
84037170308312
Form Id
16901561
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060064
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 38
Filing Id
84037170308312
Form Id
16901566
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060069
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 39
Filing Id
84037170308312
Form Id
16901567
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060070
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 40
Filing Id
84037170308312
Form Id
16901568
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060071
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 41
Filing Id
84037170308312
Form Id
16901499
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060002
Ins Broker 01 Name
DOUG P COX
Ins Broker 01 Street Addr
SUITE 280 7011 KOLL CENTER PARKWAY
Ins Broker 01 City
PLEASANTON
Ins Broker 01 State
CA
Ins Broker 01 ZIP Code
94566
Ins Broker Comm Pd 01 Amount
$114,571
Ins Broker Fees Pd 01 Amount
$0
Ins Broker Fees Pd 01 Text
SALES AND SERVICE COMPENSATION
Ins Broker 01 Code
3
Row 42
Filing Id
84037170308312
Form Id
16901500
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060003
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 43
Filing Id
84037170308312
Form Id
16901502
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060005
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 44
Filing Id
84037170308312
Form Id
16901504
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060007
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 45
Filing Id
84037170308312
Form Id
16901506
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060009
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 46
Filing Id
84037170308312
Form Id
16901508
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060011
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 47
Filing Id
84037170308312
Form Id
16901510
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060013
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 48
Filing Id
84037170308312
Form Id
16901513
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060016
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 49
Filing Id
84037170308312
Form Id
16901515
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060018
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 50
Filing Id
84037170308312
Form Id
16901517
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060020
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 51
Filing Id
84037170308312
Form Id
16901519
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060022
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 52
Filing Id
84037170308312
Form Id
16901521
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060024
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 53
Filing Id
84037170308312
Form Id
16901523
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060026
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 54
Filing Id
84037170308312
Form Id
16901526
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060029
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 55
Filing Id
84037170308312
Form Id
16901529
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060032
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 56
Filing Id
84037170308312
Form Id
16901537
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060040
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 57
Filing Id
84037170308312
Form Id
16901539
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060042
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 58
Filing Id
84037170308312
Form Id
16901541
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060044
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 59
Filing Id
84037170308312
Form Id
16901543
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060046
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 60
Filing Id
84037170308312
Form Id
16901546
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060049
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 61
Filing Id
84037170308312
Form Id
16901548
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060051
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 62
Filing Id
84037170308312
Form Id
16901550
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060053
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 63
Filing Id
84037170308312
Form Id
16901553
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060056
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 64
Filing Id
84037170308312
Form Id
16901558
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060061
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 65
Filing Id
84037170308312
Form Id
16901560
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060063
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 66
Filing Id
84037170308312
Form Id
16901562
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060065
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 67
Filing Id
84037170308312
Form Id
16901564
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060067
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 68
Filing Id
84037170308312
Form Id
16901565
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060068
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 69
Filing Id
84037170308312
Form Id
16901569
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060072
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 70
Filing Id
84037170308312
Form Id
16901571
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060074
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 71
Filing Id
84037170308312
Form Id
16901516
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060019
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 72
Filing Id
84037170308312
Form Id
16901533
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060036
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 73
Filing Id
84037170308312
Form Id
16901542
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060045
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 74
Filing Id
84037170308312
Form Id
16901552
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060055
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 75
Ins Carrier Name: PRUDENTIAL HEALTHCARE
Filing Id
84037170308312
Form Id
16901500
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL HEALTHCARE
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
17900-1
Ins Prsn Covered End of year Count
27
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$130,986
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AB
Wlfr Premium Rcvd Amount
$41,019
Wlfr Unpaid Due Amount
$89,967
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$130,986
Wlfr Claims Paid Amount
$108,781
Wlfr Incr Reserve Amount
$9,796
Wlfr Incurred Claim Amount
$118,577
Wlfr Claims Chrgd Amount
$118,577
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$10,440
Wlfr Ret Taxes Amount
$1,969
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$12,409
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$130,986
Wlfr Acquis Cost Amount
$0
Wlfr Acquis Cost Text
THE PREMIUM RATES TAKE INTO ACCOUNT PAST EXPERIENCE OF THIS GROUP AS WELL AS OVERALL EXPERIENCE OF SIMIL
Row 76
Ins Carrier Name: PRUDENTIAL HEALTHCARE
Filing Id
84037170308312
Form Id
16901501
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL HEALTHCARE
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
17900-5
Ins Prsn Covered End of year Count
13,498
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$2,365,641
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
BC
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$2,365,641
Wlfr Acquis Cost Amount
$0
Wlfr Acquis Cost Text
THE PREMIUM RATES ARE BASED ON OVERALL INSURANCE CO EXPERIENCE WITH SIMILAR RISK CHARACTERISTICS
Row 77
Ins Carrier Name: PRUDENTIAL HEALTHCARE
Filing Id
84037170308312
Form Id
16901502
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL HEALTHCARE
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
179001-Y
Ins Prsn Covered End of year Count
2,327
Ins Policy From Date
2000-01-01
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$14,834
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
A
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$14,834
Wlfr Acquis Cost Amount
$0
Wlfr Acquis Cost Text
THE PREMIUM RATES ARE BASED ON OVERALL INSURANCE CO EXPERIENCE ON GROUPS WITH SIMILAR RISK CHARACTERISTI
Row 78
Ins Carrier Name: PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
84037170308312
Form Id
16901503
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211671
Ins Carrier Naic Code
68241
Ins Contract Num
0017900-1
Ins Prsn Covered End of year Count
14,538
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-03-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
D
Wlfr Premium Rcvd Amount
$15,232
Wlfr Unpaid Due Amount
$-6,113
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$9,119
Wlfr Claims Paid Amount
$10,072
Wlfr Incr Reserve Amount
$-6,113
Wlfr Incurred Claim Amount
$3,959
Wlfr Claims Chrgd Amount
$3,959
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$1,273
Wlfr Ret Taxes Amount
$97
Wlfr Ret Charges Amount
$125
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$1,495
Wlfr Refund Indicator
No
Wlfr Refund Amount
$3,665
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$1
Wlfr Acquis Cost Amount
$0
Row 79
Ins Carrier Name: PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
84037170308312
Form Id
16901504
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
0017900-2
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-03-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
D
Wlfr Premium Rcvd Amount
$446,220
Wlfr Unpaid Due Amount
$272,189
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$718,409
Wlfr Claims Paid Amount
$110,829
Wlfr Incr Reserve Amount
$272,189
Wlfr Incurred Claim Amount
$383,018
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$50,998
Wlfr Ret Taxes Amount
$7,961
Wlfr Ret Charges Amount
$3,659
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$62,618
Wlfr Refund Indicator
No
Wlfr Refund Amount
$272,773
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 80
Ins Carrier Name: PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
84037170308312
Form Id
16901505
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
0017900-3
Ins Prsn Covered End of year Count
85
Ins Policy From Date
2000-04-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
D
Wlfr Premium Rcvd Amount
$342,502
Wlfr Unpaid Due Amount
$108,741
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$451,243
Wlfr Claims Paid Amount
$307,217
Wlfr Incr Reserve Amount
$61,827
Wlfr Incurred Claim Amount
$369,044
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$44,091
Wlfr Ret Taxes Amount
$9,723
Wlfr Ret Charges Amount
$28,385
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$82,199
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 81
Ins Carrier Name: PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
84037170308312
Form Id
16901506
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
0017900-4
Ins Prsn Covered End of year Count
27,835
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$2,878,869
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
D
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$2,878,869
Wlfr Acquis Cost Amount
$0
Row 82
Ins Carrier Name: PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
84037170308312
Form Id
16901507
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
0017900-5
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$4,199,040
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
No
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$4,199,040
Wlfr Acquis Cost Amount
$0
Row 83
Ins Carrier Name: AETNA US HEALTHCARE
Filing Id
84037170308312
Form Id
16901508
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
AETNA US HEALTHCARE
Ins Carrier EIN
23-2229683
Ins Carrier Naic Code
95287
Ins Contract Num
005017
Ins Prsn Covered End of year Count
283
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$1,303,939
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
M
Wlfr Type Bnft Oth Text
PREPAID COMPREHENSIVE
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$1,303,939
Wlfr Acquis Cost Amount
$28,598
Row 84
Ins Carrier Name: PRUDENTIAL HEALTHCARE
Filing Id
84037170308312
Form Id
16901509
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL HEALTHCARE
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
74619
Ins Prsn Covered End of year Count
3,094
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$4,497,874
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
A
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$4,497,874
Wlfr Acquis Cost Amount
$0
Wlfr Acquis Cost Text
THE PREMIUM RATES ARE BASED ON OVERALL INSURANCE CO EXPERIENCE ON GROUPS WITH SIMILARE RISK CHARACTERIST
Row 85
Ins Carrier Name: CIGNA HEALTHCARE OF AZ-PHEONIX
Filing Id
84037170308312
Form Id
16901510
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CIGNA HEALTHCARE OF AZ-PHEONIX
Ins Carrier EIN
86-0334392
Ins Carrier Naic Code
95125
Ins Contract Num
1569
Ins Prsn Covered End of year Count
38
Ins Policy From Date
2000-01-01
Ins Policy To Date
2001-01-01
Ins Broker Comm Total Amount
$730
Ins Broker Fees Total Amount
$125,022
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$125,022
Wlfr Acquis Cost Amount
$0
Row 86
Ins Carrier Name: HEALTHNET
Filing Id
84037170308312
Form Id
16901511
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HEALTHNET
Ins Carrier EIN
36-3097810
Ins Carrier Naic Code
95206
Ins Contract Num
09912991
Ins Prsn Covered End of year Count
24
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$43,682
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$43,682
Wlfr Acquis Cost Amount
$0
Row 87
Ins Carrier Name: KAISER PERMANENTE
Filing Id
84037170308312
Form Id
16901512
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER PERMANENTE
Ins Carrier EIN
94-1340523
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$15,409
Wlfr Acquis Cost Amount
$0
Row 88
Ins Carrier Name: KAISER PERMANENTE
Filing Id
84037170308312
Form Id
16901513
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER PERMANENTE
Ins Carrier EIN
94-1340523
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$1,055,528
Wlfr Acquis Cost Amount
$0
Row 89
Ins Carrier Name: KAISER PERMANENTE
Filing Id
84037170308312
Form Id
16901514
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER PERMANENTE
Ins Carrier EIN
94-1340523
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$1,339,245
Wlfr Acquis Cost Amount
$0
Row 90
Ins Carrier Name: KEISER PERMANENTE
Filing Id
84037170308312
Form Id
16901515
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KEISER PERMANENTE
Ins Carrier EIN
94-1340523
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$14,935
Wlfr Acquis Cost Amount
$0
Row 91
Ins Carrier Name: HMO COLORADO
Filing Id
84037170308312
Form Id
16901516
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HMO COLORADO
Ins Carrier Naic Code
00000
Ins Contract Num
C12130
Ins Prsn Covered End of year Count
2
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$4,989
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$4,989
Wlfr Acquis Cost Amount
$0
Row 92
Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN OF COLORADO
Filing Id
84037170308312
Form Id
16901517
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER FOUNDATION HEALTH PLAN OF COLORADO
Ins Carrier EIN
84-0591617
Ins Carrier Naic Code
95669
Ins Contract Num
2497
Ins Prsn Covered End of year Count
178
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$166,011
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$166,011
Wlfr Acquis Cost Amount
$0
Row 93
Ins Carrier Name: PHS HEALTH PLANS
Filing Id
84037170308312
Form Id
16901518
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PHS HEALTH PLANS
Ins Carrier EIN
22-3241303
Ins Carrier Naic Code
95351
Ins Contract Num
035032
Ins Prsn Covered End of year Count
206
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$273,823
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$273,823
Wlfr Acquis Cost Amount
$0
Row 94
Ins Carrier Name: OXFORD HEALTH PLANS
Filing Id
84037170308312
Form Id
16901519
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
OXFORD HEALTH PLANS
Ins Carrier EIN
06-1118515
Ins Carrier Naic Code
01182
Ins Contract Num
AD)8001
Ins Prsn Covered End of year Count
407
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$757,681
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$757,681
Wlfr Acquis Cost Amount
$0
Row 95
Ins Carrier Name: NEIGHBORHOOD HEALTH PARTNERSHIP
Filing Id
84037170308312
Form Id
16901520
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
NEIGHBORHOOD HEALTH PARTNERSHIP
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$379,658
Wlfr Acquis Cost Amount
$0
Row 96
Ins Carrier Name: KAISER PERMANENTE
Filing Id
84037170308312
Form Id
16901521
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER PERMANENTE
Ins Carrier EIN
58-1592076
Ins Carrier Naic Code
96237
Ins Contract Num
ADP072
Ins Prsn Covered End of year Count
233
Ins Policy From Date
1999-11-30
Ins Policy To Date
2001-04-30
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$221,125
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$221,125
Wlfr Acquis Cost Amount
$0
Row 97
Ins Carrier Name: BLUECROSS BLUESHIELD OF GEORGIA INC
Filing Id
84037170308312
Form Id
16901522
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
BLUECROSS BLUESHIELD OF GEORGIA INC
Ins Carrier EIN
58-0469845
Ins Carrier Naic Code
96962
Ins Contract Num
1013259
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$12,844
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$12,844
Wlfr Claims Paid Amount
$74,040
Wlfr Incr Reserve Amount
$17,770
Wlfr Incurred Claim Amount
$91,810
Wlfr Claims Chrgd Amount
$74,040
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$19,267
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$21,116
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$40,383
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 98
Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN INC
Filing Id
84037170308312
Form Id
16901523
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER FOUNDATION HEALTH PLAN INC
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$11,374
Wlfr Acquis Cost Amount
$0
Wlfr Acquis Cost Text
B
Row 99
Ins Carrier Name: SECURECARE OF IOWA INC
Filing Id
84037170308312
Form Id
16901524
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
SECURECARE OF IOWA INC
Ins Carrier EIN
42-1426311
Ins Carrier Naic Code
95830
Ins Contract Num
100460
Ins Prsn Covered End of year Count
13
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$21,843
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$21,843
Wlfr Acquis Cost Amount
$0
Row 100
Ins Carrier Name: COVENTRY HEALTH CARE
Filing Id
84037170308312
Form Id
16901525
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
COVENTRY HEALTH CARE
Ins Carrier EIN
42-1244752
Ins Carrier Naic Code
95241
Ins Contract Num
10141402
Ins Prsn Covered End of year Count
119
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$173,377
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$173,377
Wlfr Acquis Cost Amount
$0
Row 101
Ins Carrier Name: UNITEDHEALTHCARE
Filing Id
84037170308312
Form Id
16901526
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNITEDHEALTHCARE
Ins Carrier EIN
36-3280214
Ins Carrier Naic Code
95776
Ins Contract Num
301886/06920/11
Ins Prsn Covered End of year Count
46
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$2,875
Ins Broker Fees Total Amount
$83,062
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$83,062
Wlfr Acquis Cost Amount
$0
Row 102
Ins Carrier Name: HMO ILLINOIS
Filing Id
84037170308312
Form Id
16901527
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HMO ILLINOIS
Ins Carrier EIN
36-1236610
Ins Carrier Naic Code
70670
Ins Contract Num
H06201
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$303,866
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$303,866
Wlfr Acquis Cost Amount
$0
Row 103
Ins Carrier Name: HUMANA INC
Filing Id
84037170308312
Form Id
16901528
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HUMANA INC
Ins Carrier EIN
61-0647538
Ins Carrier Naic Code
62189
Ins Prsn Covered End of year Count
49
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$179,413
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$179,413
Wlfr Acquis Cost Amount
$0
Row 104
Ins Carrier Name: UNICARE
Filing Id
84037170308312
Form Id
16901529
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNICARE
Ins Carrier EIN
36-3897076
Ins Carrier Naic Code
59505
Ins Contract Num
838001/56B10N
Ins Prsn Covered End of year Count
105
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$266,618
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$266,618
Wlfr Acquis Cost Amount
$0
Row 105
Ins Carrier Name: KAISER FOUNDATION HEALTH PLAND OF KANSAS
Filing Id
84037170308312
Form Id
16901530
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER FOUNDATION HEALTH PLAND OF KANSAS
Ins Carrier EIN
48-0924402
Ins Carrier Naic Code
95032
Ins Contract Num
10641
Ins Prsn Covered End of year Count
27
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$39,179
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$39,179
Wlfr Acquis Cost Amount
$0
Row 106
Ins Carrier Name: TUFTS ASSOCIATED HEALTH PLANS
Filing Id
84037170308312
Form Id
16901536
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
TUFTS ASSOCIATED HEALTH PLANS
Ins Carrier EIN
04-2674079
Ins Carrier Naic Code
95688
Ins Contract Num
04437-000
Ins Prsn Covered End of year Count
99
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$469,028
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$469,028
Wlfr Acquis Cost Amount
$0
Row 107
Ins Carrier Name: CHC OF KANSAS/WICHITA
Filing Id
84037170308312
Form Id
16901531
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CHC OF KANSAS/WICHITA
Ins Carrier EIN
48-0840330
Ins Carrier Naic Code
95489
Ins Contract Num
101403
Ins Prsn Covered End of year Count
2
Ins Policy From Date
2000-11-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$6,621
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$6,621
Wlfr Acquis Cost Amount
$0
Row 108
Ins Carrier Name: HUMANA INC
Filing Id
84037170308312
Form Id
16901532
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HUMANA INC
Ins Carrier EIN
61-0647538
Ins Carrier Naic Code
62189
Ins Contract Num
D9204
Ins Prsn Covered End of year Count
35
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$183,458
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$183,458
Wlfr Acquis Cost Amount
$0
Row 109
Ins Carrier Name: UNITEDHEALTHCARE OF KENTUCKY
Filing Id
84037170308312
Form Id
16901533
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNITEDHEALTHCARE OF KENTUCKY
Ins Carrier EIN
62-1240316
Ins Carrier Naic Code
96644
Ins Contract Num
10400
Ins Prsn Covered End of year Count
295
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$357,391
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$357,391
Wlfr Acquis Cost Amount
$0
Row 110
Ins Carrier Name: CIGNA HEALTHCARE OF MA
Filing Id
84037170308312
Form Id
16901534
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CIGNA HEALTHCARE OF MA
Ins Carrier EIN
02-0402111
Ins Carrier Naic Code
95493
Ins Contract Num
0002801
Ins Prsn Covered End of year Count
94
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$198,488
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$198,488
Wlfr Acquis Cost Amount
$0
Row 111
Ins Carrier Name: FALLON COMMUNITY HEALTH PLAN
Filing Id
84037170308312
Form Id
16901535
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
FALLON COMMUNITY HEALTH PLAN
Ins Carrier EIN
23-7442369
Ins Carrier Naic Code
95541
Ins Contract Num
2255644
Ins Prsn Covered End of year Count
58
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$220,603
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
J
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$220,603
Wlfr Acquis Cost Amount
$0
Row 112
Ins Carrier Name: UNIEDHEALTHCARE OF MID-ATLANTIC
Filing Id
84037170308312
Form Id
16901541
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNIEDHEALTHCARE OF MID-ATLANTIC
Ins Carrier EIN
52-1130183
Ins Carrier Naic Code
95025
Ins Contract Num
60012
Ins Prsn Covered End of year Count
123
Ins Policy From Date
2000-03-01
Ins Policy To Date
2001-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$193,796,314
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$193,796,314
Wlfr Acquis Cost Amount
$0
Row 113
Ins Carrier Name: CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC
Filing Id
84037170308312
Form Id
16901555
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC
Ins Carrier Naic Code
00000
Ins Contract Num
000468
Ins Prsn Covered End of year Count
4
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$27,221
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$27,221
Wlfr Acquis Cost Amount
$0
Row 114
Ins Carrier Name: HARVARD PILGRIM HEALTHCARE
Filing Id
84037170308312
Form Id
16901537
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HARVARD PILGRIM HEALTHCARE
Ins Carrier EIN
04-2452600
Ins Carrier Naic Code
96911
Ins Contract Num
062903
Ins Prsn Covered End of year Count
99
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$204,835
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
J
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$204,835
Wlfr Acquis Cost Amount
$0
Row 115
Ins Carrier Name: BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS INC
Filing Id
84037170308312
Form Id
16901538
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
BLUE CROSS & BLUE SHIELD OF MASSACHUSETTS INC
Ins Carrier EIN
04-1045815
Ins Carrier Naic Code
53228
Ins Contract Num
1003343
Ins Prsn Covered End of year Count
245
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
ADJ
Wlfr Premium Rcvd Amount
$330,286
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$330,286
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 116
Ins Carrier Name: OPTIMUM CHOICE
Filing Id
84037170308312
Form Id
16901539
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
OPTIMUM CHOICE
Ins Carrier EIN
52-1518174
Ins Carrier Naic Code
96940
Ins Contract Num
96940
Ins Prsn Covered End of year Count
132
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$216,535
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$216,535
Wlfr Acquis Cost Amount
$0
Row 117
Ins Carrier Name: KAISER PERMANENTE
Filing Id
84037170308312
Form Id
16901540
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER PERMANENTE
Ins Carrier EIN
52-0954463
Ins Carrier Naic Code
95639
Ins Contract Num
7593-0
Ins Prsn Covered End of year Count
91
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$304,889
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$304,889
Wlfr Acquis Cost Amount
$0
Row 118
Ins Carrier Name: BLUE CARE NETWORK
Filing Id
84037170308312
Form Id
16901542
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
BLUE CARE NETWORK
Ins Carrier EIN
38-2359234
Ins Carrier Naic Code
95610
Ins Contract Num
89231-000
Ins Prsn Covered End of year Count
198
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$345,632
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$345,632
Wlfr Acquis Cost Amount
$0
Row 119
Ins Carrier Name: HEALTH ALLIANCE PLAN
Filing Id
84037170308312
Form Id
16901543
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HEALTH ALLIANCE PLAN
Ins Carrier EIN
38-2242827
Ins Carrier Naic Code
95844
Ins Contract Num
94111-AA/94111-
Ins Prsn Covered End of year Count
126
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$221,819
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$221,819
Wlfr Acquis Cost Amount
$0
Row 120
Ins Carrier Name: M-CARE
Filing Id
84037170308312
Form Id
16901544
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
M-CARE
Ins Carrier EIN
38-2649504
Ins Carrier Naic Code
95449
Ins Contract Num
005000 0000
Ins Prsn Covered End of year Count
108
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$177,955
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$177,955
Wlfr Acquis Cost Amount
$0
Row 121
Ins Carrier Name: CARE CHOICES
Filing Id
84037170308312
Form Id
16901545
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CARE CHOICES
Ins Carrier EIN
38-2694901
Ins Carrier Naic Code
95452
Ins Contract Num
100592-0001
Ins Prsn Covered End of year Count
50
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$93,066
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJK
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$93,066
Wlfr Acquis Cost Amount
$0
Row 122
Ins Carrier Name: THE WELLNESS PLAN
Filing Id
84037170308312
Form Id
16901546
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
THE WELLNESS PLAN
Ins Carrier EIN
38-2008890
Ins Carrier Naic Code
95471
Ins Contract Num
0006040604
Ins Prsn Covered End of year Count
115
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$152,375
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$152,375
Wlfr Acquis Cost Amount
$0
Row 123
Ins Carrier Name: UNITEDHEALTHCARE OF THE MIDWEST
Filing Id
84037170308312
Form Id
16901547
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNITEDHEALTHCARE OF THE MIDWEST
Ins Carrier EIN
43-1361841
Ins Carrier Naic Code
96385
Ins Contract Num
105969/26233
Ins Prsn Covered End of year Count
52
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$99,755
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$99,755
Wlfr Acquis Cost Amount
$0
Row 124
Ins Carrier Name: PARTNERS NATIONAL HEALTH PLANS OF NC INC
Filing Id
84037170308312
Form Id
16901548
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PARTNERS NATIONAL HEALTH PLANS OF NC INC
Ins Carrier EIN
56-1526375
Ins Carrier Naic Code
95300
Ins Contract Num
6191
Ins Prsn Covered End of year Count
52
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$1,140
Ins Broker Fees Total Amount
$81,657
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$81,657
Wlfr Acquis Cost Amount
$0
Row 125
Ins Carrier Name: HORIZON HMO
Filing Id
84037170308312
Form Id
16901549
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HORIZON HMO
Ins Carrier Naic Code
00000
Ins Contract Num
85006
Ins Prsn Covered End of year Count
112
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$430,823
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$430,823
Wlfr Acquis Cost Amount
$0
Row 126
Ins Carrier Name: BLUECROSS BLUESHIELD
Filing Id
84037170308312
Form Id
16901550
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
BLUECROSS BLUESHIELD
Ins Carrier Naic Code
55107
Ins Contract Num
12750-001
Ins Prsn Covered End of year Count
25
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$91,187
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$91,187
Wlfr Acquis Cost Amount
$0
Row 127
Ins Carrier Name: BLUE CROS & BLUE SHIELD OF WESTERN NEW YORK
Filing Id
84037170308312
Form Id
16901551
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
BLUE CROS & BLUE SHIELD OF WESTERN NEW YORK
Ins Carrier EIN
16-1105741
Ins Carrier Naic Code
55204
Ins Contract Num
00301659
Ins Prsn Covered End of year Count
79
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$127,356
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AHJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$127,356
Wlfr Acquis Cost Amount
$127,356
Row 128
Ins Carrier Name: JOHN CRANE INC
Filing Id
84037170308312
Form Id
16901552
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
JOHN CRANE INC
Ins Carrier EIN
16-1072821
Ins Carrier Naic Code
95595
Ins Contract Num
AH72/A001
Ins Prsn Covered End of year Count
8
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$13,494
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$13,494
Wlfr Acquis Cost Amount
$0
Row 129
Ins Carrier Name: UNIVERA HEALTH CARE
Filing Id
84037170308312
Form Id
16901553
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNIVERA HEALTH CARE
Ins Carrier EIN
16-1057746
Ins Carrier Naic Code
95496
Ins Contract Num
605
Ins Prsn Covered End of year Count
29
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$53,809
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$53,809
Wlfr Acquis Cost Amount
$0
Row 130
Ins Carrier Name: CNY DIVISION OF EXCELLUS HEALTH PLAN INC
Filing Id
84037170308312
Form Id
16901554
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CNY DIVISION OF EXCELLUS HEALTH PLAN INC
Ins Carrier EIN
16-1313845
Ins Carrier Naic Code
95495
Ins Contract Num
450388
Ins Prsn Covered End of year Count
22
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$13,485
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$13,485
Wlfr Acquis Cost Amount
$0
Row 131
Ins Carrier Name: HEALTH PLAN OF NEW YORK
Filing Id
84037170308312
Form Id
16901556
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HEALTH PLAN OF NEW YORK
Ins Carrier EIN
13-1828492
Ins Carrier Naic Code
55247
Ins Contract Num
100922E-000
Ins Prsn Covered End of year Count
72
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$113,482
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$113,482
Wlfr Acquis Cost Amount
$0
Row 132
Ins Carrier Name: CIGNA HEALTHCARE OF NEW YORK
Filing Id
84037170308312
Form Id
16901557
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CIGNA HEALTHCARE OF NEW YORK
Ins Carrier EIN
11-2758941
Ins Carrier Naic Code
95488
Ins Contract Num
1117
Ins Prsn Covered End of year Count
12
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$2,272
Ins Broker Fees Total Amount
$56,797
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$56,797
Wlfr Acquis Cost Amount
$0
Row 133
Ins Carrier Name: UNITED HEALTHCARE OF NEW YORK SYRACUSE
Filing Id
84037170308312
Form Id
16901558
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNITED HEALTHCARE OF NEW YORK SYRACUSE
Ins Carrier Naic Code
95085
Ins Contract Num
205172
Ins Prsn Covered End of year Count
1
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$174
Ins Broker Fees Total Amount
$4,352
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$4,352
Wlfr Acquis Cost Amount
$0
Row 134
Ins Carrier Name: INDEPENDENT HEALTH
Filing Id
84037170308312
Form Id
16901559
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
INDEPENDENT HEALTH
Ins Carrier EIN
16-1080163
Ins Carrier Naic Code
95308
Ins Contract Num
30944H
Ins Prsn Covered End of year Count
43
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$51,397
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$51,397
Wlfr Acquis Cost Amount
$0
Row 135
Ins Carrier Name: PACIFICARE OF OHIO
Filing Id
84037170308312
Form Id
16901560
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PACIFICARE OF OHIO
Ins Carrier EIN
31-1098026
Ins Carrier Naic Code
95940
Ins Contract Num
N0100
Ins Prsn Covered End of year Count
75
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$274,875
Wlfr Acquis Cost Amount
$0
Row 136
Ins Carrier Name: KAISER PERMANENTE-NORTHWEST REGION
Filing Id
84037170308312
Form Id
16901561
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KAISER PERMANENTE-NORTHWEST REGION
Ins Carrier EIN
93-0798039
Ins Carrier Naic Code
95540
Ins Prsn Covered End of year Count
638
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$930,469
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$930,469
Wlfr Acquis Cost Amount
$0
Row 137
Ins Carrier Name: REGENCE HMO
Filing Id
84037170308312
Form Id
16901562
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
REGENCE HMO
Ins Carrier EIN
93-0681889
Ins Carrier Naic Code
95699
Ins Contract Num
010081001
Ins Prsn Covered End of year Count
107
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$385,466
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$385,466
Wlfr Acquis Cost Amount
$0
Row 138
Ins Carrier Name: QUALMED PLANS FOR HEALTH OF PENNSYLVANIA INC
Filing Id
84037170308312
Form Id
16901563
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
QUALMED PLANS FOR HEALTH OF PENNSYLVANIA INC
Ins Carrier EIN
23-2348627
Ins Carrier Naic Code
95079
Ins Contract Num
121700
Ins Prsn Covered End of year Count
118
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$118,964
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$118,964
Wlfr Acquis Cost Amount
$0
Row 139
Ins Carrier Name: KEYSTONE HEALTH PLAN WEST
Filing Id
84037170308312
Form Id
16901564
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
KEYSTONE HEALTH PLAN WEST
Ins Carrier EIN
25-1522457
Ins Carrier Naic Code
54771
Ins Contract Num
5811130
Ins Prsn Covered End of year Count
49,494
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$172,846
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$172,846
Wlfr Acquis Cost Amount
$0
Row 140
Ins Carrier Name: HUMANA HEALTH PLANS OF PUERTO RICO
Filing Id
84037170308312
Form Id
16901565
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HUMANA HEALTH PLANS OF PUERTO RICO
Ins Carrier EIN
66-0406896
Ins Carrier Naic Code
84603
Ins Contract Num
3311
Ins Prsn Covered End of year Count
63
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
J
Wlfr Premium Rcvd Amount
$72,016
Wlfr Unpaid Due Amount
$-517
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$71,499
Wlfr Claims Paid Amount
$69,379
Wlfr Incr Reserve Amount
$15,341
Wlfr Incurred Claim Amount
$84,720
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 141
Ins Carrier Name: COORDINATED HEALTH PARTNERS
Filing Id
84037170308312
Form Id
16901566
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
COORDINATED HEALTH PARTNERS
Ins Carrier EIN
05-0413436
Ins Carrier Naic Code
95057
Ins Contract Num
008050000/7U44-
Ins Prsn Covered End of year Count
132
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$184,526
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJK
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$184,526
Wlfr Acquis Cost Amount
$0
Row 142
Ins Carrier Name: UNITEDHEALTHCARE OF UTAH
Filing Id
84037170308312
Form Id
16901567
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
UNITEDHEALTHCARE OF UTAH
Ins Carrier EIN
41-1488563
Ins Carrier Naic Code
95501
Ins Contract Num
100537/15090
Ins Prsn Covered End of year Count
159
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$212,152
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$212,152
Wlfr Acquis Cost Amount
$0
Row 143
Ins Carrier Name: IHC HEALTH PLANS
Filing Id
84037170308312
Form Id
16901568
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
IHC HEALTH PLANS
Ins Carrier EIN
87-0409820
Ins Carrier Naic Code
95153
Ins Contract Num
21520
Ins Prsn Covered End of year Count
110
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$210,530
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$210,530
Wlfr Acquis Cost Amount
$0
Row 144
Ins Carrier Name: GROUPHEALTHOPTIONS
Filing Id
84037170308312
Form Id
16901569
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
GROUPHEALTHOPTIONS
Ins Carrier EIN
91-1467158
Ins Carrier Naic Code
47055
Ins Contract Num
5701500
Ins Prsn Covered End of year Count
11
Ins Policy From Date
2000-01-01
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$1,576
Ins Broker Fees Total Amount
$43,590
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJK
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$43,590
Wlfr Acquis Cost Amount
$0
Row 145
Ins Carrier Name: PREMERA BLUE CROSS
Filing Id
84037170308312
Form Id
16901570
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PREMERA BLUE CROSS
Ins Carrier EIN
91-0499247
Ins Carrier Naic Code
47570
Ins Contract Num
B1789
Ins Prsn Covered End of year Count
14
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$60,600
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AHJ
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$60,600
Wlfr Acquis Cost Amount
$0
Row 146
Ins Carrier Name: HUMANA INC
Filing Id
84037170308312
Form Id
16901571
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
HUMANA INC
Ins Carrier EIN
01-0647538
Ins Carrier Naic Code
62189
Ins Contract Num
H3834
Ins Prsn Covered End of year Count
1
Ins Policy To Date
2000-12-31
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$2,965
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
AJK
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$2,965
Wlfr Acquis Cost Amount
$0
Row 147
Ins Carrier Name: CONTINENTAL CASUALTY COMPANY
Filing Id
84037170308312
Form Id
16901572
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
CONTINENTAL CASUALTY COMPANY
Ins Carrier EIN
36-2114545
Ins Carrier Naic Code
20443
Ins Contract Num
SR-83081728
Ins Policy From Date
2000-01-01
Ins Policy To Date
2001-01-01
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
M
Wlfr Type Bnft Oth Text
ACCIDENTAL DEATH & DISMEMBERMENT
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 148
Ins Carrier Name: PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
84037170308312
Form Id
16901499
Schedule A EIN
22-1467904
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2000-01-01
Schedule A Tax Period
20001231
Ins Carrier Name
PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
0096692-1/P
Ins Prsn Covered End of year Count
20,811
Ins Policy From Date
2000-04-01
Ins Policy To Date
2000-03-31
Ins Broker Comm Total Amount
$114,571
Ins Broker Fees Total Amount
$2,615,460
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension Type Alloc Cntrct Indicator
3
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0

Schedule C

Schedule C Provider

Provider 1

Provider details

Source fields
Row 1
Filing Id
84037170308312
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372170308060076
Provider 01 Name
PRUDENTIAL HEALTHCARE
Provider 01 EIN
22-1211670
Provider 01 Position
CONTRACT ADMINISTRATOR
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$4,982,503
Provider 01 Srvc Code
12

Schedule C Provider

Provider 2

Provider details

Source fields
Row 2
Filing Id
84037170308312
Page Id
1
Page Seq
0
Page Row Num
2
Row Num
1
Image Form Id
20372170308060076
Provider 01 Name
RX ADMINISTRATIVE FEES
Provider 01 EIN
95-3204551
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$109,912
Provider 01 Srvc Code
12

Schedule C Provider

Provider 3

Provider details

Source fields
Row 3
Filing Id
84037170308312
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
2
Image Form Id
20372170308060076
Provider 01 Name
AETNA US HEALTHCARE
Provider 01 EIN
06-6033492
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$4,834,234
Provider 01 Srvc Code
12

Schedule C Provider

Provider 4

Provider details

Source fields
Row 4
Filing Id
84037170308312
Page Id
2
Page Seq
0
Page Row Num
2
Row Num
3
Image Form Id
20372170308060076
Provider 01 Name
REED GROUP LTD
Provider 01 EIN
84-0733950
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$300,000
Provider 01 Srvc Code
99

Schedule C Provider

Provider 5

Provider details

Source fields
Row 5
Filing Id
84037170308312
Page Id
2
Page Seq
0
Page Row Num
3
Row Num
4
Image Form Id
20372170308060076
Provider 01 Name
VISION SERVICE PLAN
Provider 01 EIN
22-2586639
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$16,693
Provider 01 Srvc Code
12

Schedule C Provider

Provider 6

Provider details

Source fields
Row 6
Filing Id
84037170308312
Page Id
2
Page Seq
1
Page Row Num
1
Row Num
5
Image Form Id
20372170308060076
Provider 01 Name
FORMS SPECIALISTS
Provider 01 EIN
22-2909281
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$12,364
Provider 01 Srvc Code
99

Schedule C Provider

Provider 7

Provider details

Source fields
Row 7
Filing Id
84037170308312
Page Id
2
Page Seq
1
Page Row Num
2
Row Num
6
Image Form Id
20372170308060076
Provider 01 Name
AT&T
Provider 01 EIN
22-2473192
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$20,181
Provider 01 Srvc Code
99

Schedule C Provider

Provider 8

Provider details

Source fields
Row 8
Filing Id
84037170308312
Page Id
2
Page Seq
1
Page Row Num
3
Row Num
7
Image Form Id
20372170308060076
Provider 01 Name
PERIPHONICS
Provider 01 EIN
11-2699509
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$62,317
Provider 01 Srvc Code
99

Schedule C Provider

Provider 9

Provider details

Source fields
Row 9
Filing Id
84037170308312
Page Id
2
Page Seq
2
Page Row Num
1
Row Num
8
Image Form Id
20372170308060076
Provider 01 Name
DELOITTE & TOUCHE
Provider 01 EIN
13-5133500
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$37,510
Provider 01 Srvc Code
10

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$24,265,165-$8,412,092 change

Balance Sheet

Beginning and end of plan year.

Total assets$32,677,257$24,265,165Decrease -$8,412,092 (-25.74%)
Total liabilities$0$2,311,622Increase +$2,311,622
Net assets$32,677,257$21,953,543Decrease -$10,723,714 (-32.82%)

Contributions

Employer contributions$52,621,206
Participant contributions$26,902,823
Other contributions$0
Total contributions$79,524,029

Income & Investment Result

Total income$81,905,380
Interest$2,632,436
Dividends$0
Net income$-10,723,714

Expenses & Fees

Benefits paid$82,253,380
Investment management$0
Administrative expenses$10,375,714
Total expenses$92,629,094

Accountant

FirmDELOITTE & TOUCHE
Firm EIN13-3891517

Compliance

Fidelity bondYes
Fidelity bond amount$75,000,000
Participant loans$0
Late contributionsNo
Schedule H source fields
Financial summary
Total assets at beginning of year: $32,677,257Total assets at end of year: $24,265,165Total liabilities at end of year: $2,311,622Net income or loss: $-10,723,714
Filing Id
84037170308312
Schedule H EIN
22-1467904
Schedule H Plan number
503
Schedule H Plan Year Begin Date
2000-01-01
Schedule H Tax Period
20001231
Non Interest Bear Cash Beginning of year Amount
$245,571
Employer Contribution Beginning of year Amount
$0
Participants Contribution Beginning of year Amount
$0
Other Receivables Beginning of year Amount
$27,031
Interest Bear Cash Beginning of year Amount
$3,505,588
Govt Sec Beginning of year Amount
$0
Corp Debt Preferred Beginning of year Amount
$0
Corp Debt Other Beginning of year Amount
$28,899,067
Pref Stock Beginning of year Amount
$0
Common Stock Beginning of year Amount
$0
Joint Venture Beginning of year Amount
$0
Real Estate Beginning of year Amount
$0
Other Loans Beginning of year Amount
$0
Participant loans at beginning of year
$0
Interest Common Tr Beginning of year Amount
$0
Interest Pool Sep Account Beginning of year Amount
$0
Interest Master Tr Beginning of year Amount
$0
Interest 103 12 Investment Beginning of year Amount
$0
Interest in registered investment companies at beginning of year
$0
Ins Co Gen Account Beginning of year Amount
$0
Oth Investment Beginning of year Amount
$0
Employer Sec Beginning of year Amount
$0
Employer Prop Beginning of year Amount
$0
Bldgs Used Beginning of year Amount
$0
Total assets at beginning of year
$32,677,257
Bnfts Payable Beginning of year Amount
$0
Oprtng Payable Beginning of year Amount
$0
Acquis Indbt Beginning of year Amount
$0
Other Liability Beginning of year Amount
$0
Total liabilities at beginning of year
$0
Net assets at beginning of year
$32,677,257
Non Interest Bear Cash End of year Amount
$0
Employer Contribution End of year Amount
$0
Participants Contribution End of year Amount
$0
Other Receivables End of year Amount
$20,058
Interest Bear Cash End of year Amount
$2,633,533
Govt Sec End of year Amount
$0
Corp Debt Preferred End of year Amount
$0
Corp Debt Other End of year Amount
$21,611,574
Pref Stock End of year Amount
$0
Common Stock End of year Amount
$0
Joint Venture End of year Amount
$0
Real Estate End of year Amount
$0
Other Loans End of year Amount
$0
Participant loans at end of year
$0
Interest Common Tr End of year Amount
$0
Interest Pool Sep Account End of year Amount
$0
Interest Master Tr End of year Amount
$0
Interest 103 12 Investment End of year Amount
$0
Interest in registered investment companies at end of year
$0
Ins Co Gen Account End of year Amount
$0
Oth Investment End of year Amount
$0
Employer Sec End of year Amount
$0
Employer Prop End of year Amount
$0
Bldgs Used End of year Amount
$0
Total assets at end of year
$24,265,165
Bnfts Payable End of year Amount
$0
Oprtng Payable End of year Amount
$0
Acquis Indbt End of year Amount
$0
Other Liability End of year Amount
$2,311,622
Total liabilities at end of year
$2,311,622
Net assets at end of year
$21,953,543
Employer contributions
$52,621,206
Participant contributions
$26,902,823
Oth Contribution Rcvd Amount
$0
Non Cash Contribution Bs Amount
$0
Total contributions
$79,524,029
Interest Bear Cash Amount
$168,935
Interest On Govt Sec Amount
$0
Interest On Corp Debt Amount
$2,072,173
Interest On Oth Loans Amount
$0
Interest on participant loans
$0
Interest On Oth Investment Amount
$391,328
Total interest income
$2,632,436
Divnd Pref Stock Amount
$0
Divnd Common Stock Amount
$0
Total dividend income
$0
Total Rents Amount
$0
Aggregate Proceeds Amount
$0
Aggregate Costs Amount
$0
Net gain or loss on sale of assets
$0
Unrealized Apprctn Re Amount
$-251,085
Unrealized Apprctn Oth Amount
$0
Net unrealized appreciation or depreciation
$-251,085
Gain Loss Com Trust Amount
$0
Gain Loss Pool Sep Amount
$0
Gain Loss Master Tr Amount
$0
Gain Loss 103 12 Investment Amount
$0
Gain or loss on registered investments
$0
Other Income Amount
$0
Total income
$81,905,380
Participant distributions
$73,649,484
Ins Carrier Bnfts Amount
$8,603,896
Oth Bnft Payment Amount
$0
Total benefit distributions
$82,253,380
Total Corrective Distribution Amount
$0
Total Dm Distribution Ptcp Lns A
0
Total Interest Expense Amount
$0
Professional Fees Amount
$37,510
Contract Admin Fees Amount
$9,943,342
Investment management fees
$0
Other Admin Fees Amount
$394,862
Total administrative expenses
$10,375,714
Total expenses
$92,629,094
Net income or loss
$-10,723,714
Total Transfers To Amount
$0
Transfers from other plans
$0
Accountant Opinion Type Indicator
Yes
Accountant firm name
DELOITTE & TOUCHE
Accountant firm EIN
13-3891517
Failed to transmit participant contributions on time
No
Fail Transmit Contribution Amount
$0
Participant loans in default
No
Loans In Default Amount
$0
Leases in default
No
Leases In Default Amount
$0
Nonexempt transactions with parties in interest
No
Party In Interest Not Reported Amount
$0
Fidelity bond in place
Yes
Fidelity bond amount
$75,000,000
Loss discovered during year
No
Loss Discovered Dur Year Amount
$0
Assets with undetermined value
No
Asset Undeterm Valuation Amount
$0
Non-cash contributions reported
No
Non Cash Contribution Amount
$0
Assets held for investment
Yes
Reportable 5% transactions
Yes
All plan assets distributed
Yes
Resolution to terminate plan adopted
No
Res Terminate Plan Adpt Amount
$0