Civic Intelligence
Filing

Chevron Stations Inc. Group Insurance Plan

Chevron Stations Inc. • EIN 84-0618607 • Plan year 2003

Company ProfileSource Archive
Filing Insights

Participants

Down

7,078 → 4,974

-2,104 • -29.73%

Assets

No comparison

- → -

No earlier value available.

Investment Management Fee

-

Admin expenses - • Total expenses -

Filing Details

Context

No event flags were generated for this filing.

Status Flags

Fidelity bond in place

Not reported

Limited-scope audit performed

Not reported

Contributions transmitted on time

Not reported

Participant loans in default

Not reported

Leases in default

Not reported

Reportable party-in-interest issues

Not reported

Loss discovered during year

Not reported

Assets with undetermined value

Not reported

Non-cash contributions

Not reported

Assets held for investment

Not reported

5% transactions reported

Not reported

All plan assets distributed

Not reported

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

Not reported

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
202424,092$46,617,168$5,216,117$1,275iApproximate average salary by contribution assumption: employee only about $31,868 at 4% or $21,245 at 6%; with 50% employer match about $21,245 at 4% or $14,163 at 6%; with 100% employer match about $15,934 at 4% or $10,623 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-4,092$46,617,168$5,216,117$1,275iApproximate average salary by contribution assumption: employee only about $31,868 at 4% or $21,245 at 6%; with 50% employer match about $21,245 at 4% or $14,163 at 6%; with 100% employer match about $15,934 at 4% or $10,623 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,213---
202323,216$39,616,983$4,297,141$1,336iApproximate average salary by contribution assumption: employee only about $33,404 at 4% or $22,270 at 6%; with 50% employer match about $22,270 at 4% or $14,846 at 6%; with 100% employer match about $16,702 at 4% or $11,135 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-3,102$39,616,983$4,297,141$1,385iApproximate average salary by contribution assumption: employee only about $34,632 at 4% or $23,088 at 6%; with 50% employer match about $23,088 at 4% or $15,392 at 6%; with 100% employer match about $17,316 at 4% or $11,544 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,216---
202223,240$31,922,071$3,777,899$1,166iApproximate average salary by contribution assumption: employee only about $29,150 at 4% or $19,434 at 6%; with 50% employer match about $19,434 at 4% or $12,956 at 6%; with 100% employer match about $14,575 at 4% or $9,717 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-3,152$31,922,071$3,777,899$1,199iApproximate average salary by contribution assumption: employee only about $29,964 at 4% or $19,976 at 6%; with 50% employer match about $19,976 at 4% or $13,317 at 6%; with 100% employer match about $14,982 at 4% or $9,988 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,240---
202123,011$35,923,295$3,621,032$1,203iApproximate average salary by contribution assumption: employee only about $30,065 at 4% or $20,043 at 6%; with 50% employer match about $20,043 at 4% or $13,362 at 6%; with 100% employer match about $15,033 at 4% or $10,022 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,883$35,923,295$3,621,032$1,256iApproximate average salary by contribution assumption: employee only about $31,400 at 4% or $20,933 at 6%; with 50% employer match about $20,933 at 4% or $13,955 at 6%; with 100% employer match about $15,700 at 4% or $10,467 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,011---
202022,849$30,120,297$3,275,416$1,150iApproximate average salary by contribution assumption: employee only about $28,742 at 4% or $19,161 at 6%; with 50% employer match about $19,161 at 4% or $12,774 at 6%; with 100% employer match about $14,371 at 4% or $9,581 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,559$30,120,297$3,275,416$1,280iApproximate average salary by contribution assumption: employee only about $31,999 at 4% or $21,333 at 6%; with 50% employer match about $21,333 at 4% or $14,222 at 6%; with 100% employer match about $15,999 at 4% or $10,666 at 6%.
Chevron Stations Inc. Group Insurance Plan-2,849---
201923,361$26,263,306$2,809,339$836iApproximate average salary by contribution assumption: employee only about $20,897 at 4% or $13,931 at 6%; with 50% employer match about $13,931 at 4% or $9,287 at 6%; with 100% employer match about $10,448 at 4% or $6,966 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,955$26,263,306$2,809,339$951iApproximate average salary by contribution assumption: employee only about $23,768 at 4% or $15,845 at 6%; with 50% employer match about $15,845 at 4% or $10,563 at 6%; with 100% employer match about $11,884 at 4% or $7,923 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,361---
201823,266$20,393,688$2,420,334$741iApproximate average salary by contribution assumption: employee only about $18,527 at 4% or $12,351 at 6%; with 50% employer match about $12,351 at 4% or $8,234 at 6%; with 100% employer match about $9,263 at 4% or $6,176 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,954$20,393,688$2,420,334$819iApproximate average salary by contribution assumption: employee only about $20,484 at 4% or $13,656 at 6%; with 50% employer match about $13,656 at 4% or $9,104 at 6%; with 100% employer match about $10,242 at 4% or $6,828 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,266---
201723,227$20,949,284$2,082,574$645iApproximate average salary by contribution assumption: employee only about $16,134 at 4% or $10,756 at 6%; with 50% employer match about $10,756 at 4% or $7,171 at 6%; with 100% employer match about $8,067 at 4% or $5,378 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-453$20,949,284$2,082,574$4,597iApproximate average salary by contribution assumption: employee only about $114,932 at 4% or $76,622 at 6%; with 50% employer match about $76,622 at 4% or $51,081 at 6%; with 100% employer match about $57,466 at 4% or $38,311 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,227---
201623,202$18,341,190$1,935,022$604iApproximate average salary by contribution assumption: employee only about $15,108 at 4% or $10,072 at 6%; with 50% employer match about $10,072 at 4% or $6,715 at 6%; with 100% employer match about $7,554 at 4% or $5,036 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-511$18,341,190$1,935,022$3,787iApproximate average salary by contribution assumption: employee only about $94,668 at 4% or $63,112 at 6%; with 50% employer match about $63,112 at 4% or $42,075 at 6%; with 100% employer match about $47,334 at 4% or $31,556 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,202---
201523,792$16,477,936$1,744,302$460iApproximate average salary by contribution assumption: employee only about $11,500 at 4% or $7,667 at 6%; with 50% employer match about $7,667 at 4% or $5,111 at 6%; with 100% employer match about $5,750 at 4% or $3,833 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-500$16,477,936$1,744,302$3,489iApproximate average salary by contribution assumption: employee only about $87,215 at 4% or $58,143 at 6%; with 50% employer match about $58,143 at 4% or $38,762 at 6%; with 100% employer match about $43,608 at 4% or $29,072 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,792---
201422,744$16,696,009$1,727,560$630iApproximate average salary by contribution assumption: employee only about $15,739 at 4% or $10,493 at 6%; with 50% employer match about $10,493 at 4% or $6,995 at 6%; with 100% employer match about $7,870 at 4% or $5,246 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-511$16,696,009$1,727,560$3,381iApproximate average salary by contribution assumption: employee only about $84,519 at 4% or $56,346 at 6%; with 50% employer match about $56,346 at 4% or $37,564 at 6%; with 100% employer match about $42,259 at 4% or $28,173 at 6%.
Chevron Stations Inc. Group Insurance Plan-2,744---
201323,106$15,532,243$1,728,015$556iApproximate average salary by contribution assumption: employee only about $13,909 at 4% or $9,272 at 6%; with 50% employer match about $9,272 at 4% or $6,182 at 6%; with 100% employer match about $6,954 at 4% or $4,636 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-488$15,532,243$1,728,015$3,541iApproximate average salary by contribution assumption: employee only about $88,525 at 4% or $59,017 at 6%; with 50% employer match about $59,017 at 4% or $39,345 at 6%; with 100% employer match about $44,263 at 4% or $29,508 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,106---
201223,766$14,974,578$1,777,390$472iApproximate average salary by contribution assumption: employee only about $11,799 at 4% or $7,866 at 6%; with 50% employer match about $7,866 at 4% or $5,244 at 6%; with 100% employer match about $5,899 at 4% or $3,933 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-576$14,974,578$1,777,390$3,086iApproximate average salary by contribution assumption: employee only about $77,144 at 4% or $51,429 at 6%; with 50% employer match about $51,429 at 4% or $34,286 at 6%; with 100% employer match about $38,572 at 4% or $25,715 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,766---
201123,722$13,405,428$1,737,573$467iApproximate average salary by contribution assumption: employee only about $11,671 at 4% or $7,781 at 6%; with 50% employer match about $7,781 at 4% or $5,187 at 6%; with 100% employer match about $5,835 at 4% or $3,890 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-558$13,405,428$1,737,573$3,114iApproximate average salary by contribution assumption: employee only about $77,848 at 4% or $51,899 at 6%; with 50% employer match about $51,899 at 4% or $34,599 at 6%; with 100% employer match about $38,924 at 4% or $25,949 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,722---
201023,824$12,549,253$1,647,938$431iApproximate average salary by contribution assumption: employee only about $10,774 at 4% or $7,182 at 6%; with 50% employer match about $7,182 at 4% or $4,788 at 6%; with 100% employer match about $5,387 at 4% or $3,591 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,455$12,549,253$1,647,938$671iApproximate average salary by contribution assumption: employee only about $16,781 at 4% or $11,188 at 6%; with 50% employer match about $11,188 at 4% or $7,458 at 6%; with 100% employer match about $8,391 at 4% or $5,594 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,824---
200944,773$11,577,275$1,713,402$359iApproximate average salary by contribution assumption: employee only about $8,974 at 4% or $5,983 at 6%; with 50% employer match about $5,983 at 4% or $3,989 at 6%; with 100% employer match about $4,487 at 4% or $2,991 at 6%.
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,449$11,577,275$1,676,605$685iApproximate average salary by contribution assumption: employee only about $17,115 at 4% or $11,410 at 6%; with 50% employer match about $11,410 at 4% or $7,607 at 6%; with 100% employer match about $8,558 at 4% or $5,705 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-0-$36,797-
Chevron Stations Inc. Group Insurance Plan-4,773---
Master Trust of the Chevron Stations Inc. Thrift Plans-0---
200844,832$16,859,823$3,197,180$662iApproximate average salary by contribution assumption: employee only about $16,542 at 4% or $11,028 at 6%; with 50% employer match about $11,028 at 4% or $7,352 at 6%; with 100% employer match about $8,271 at 4% or $5,514 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$9,698,760$1,719,988-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,462$7,161,063$1,477,192$600iApproximate average salary by contribution assumption: employee only about $15,000 at 4% or $10,000 at 6%; with 50% employer match about $10,000 at 4% or $6,667 at 6%; with 100% employer match about $7,500 at 4% or $5,000 at 6%.
Chevron Stations Inc. Group Insurance Plan-4,832---
Chevron Stations Inc. Thrift Plan for Exempt Employees-40---
200744,490$18,716,316$2,905,837$647iApproximate average salary by contribution assumption: employee only about $16,179 at 4% or $10,786 at 6%; with 50% employer match about $10,786 at 4% or $7,191 at 6%; with 100% employer match about $8,090 at 4% or $5,393 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$10,876,621$1,530,135-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-1,975$7,839,695$1,375,702$697iApproximate average salary by contribution assumption: employee only about $17,414 at 4% or $11,609 at 6%; with 50% employer match about $11,609 at 4% or $7,740 at 6%; with 100% employer match about $8,707 at 4% or $5,805 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-44---
Chevron Stations Inc. Group Insurance Plan-4,490---
200644,303$19,601,980$2,920,990$679iApproximate average salary by contribution assumption: employee only about $16,971 at 4% or $11,314 at 6%; with 50% employer match about $11,314 at 4% or $7,543 at 6%; with 100% employer match about $8,485 at 4% or $5,657 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$9,800,990$1,460,495-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-1,994$7,055,421$1,325,809$665iApproximate average salary by contribution assumption: employee only about $16,622 at 4% or $11,082 at 6%; with 50% employer match about $11,082 at 4% or $7,388 at 6%; with 100% employer match about $8,311 at 4% or $5,541 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-37$2,745,569$134,686$3,640iApproximate average salary by contribution assumption: employee only about $91,004 at 4% or $60,669 at 6%; with 50% employer match about $60,669 at 4% or $40,446 at 6%; with 100% employer match about $45,502 at 4% or $30,335 at 6%.
Chevron Stations Inc. Group Insurance Plan-4,303---
200544,377$17,515,922$2,690,330$615iApproximate average salary by contribution assumption: employee only about $15,366 at 4% or $10,244 at 6%; with 50% employer match about $10,244 at 4% or $6,829 at 6%; with 100% employer match about $7,683 at 4% or $5,122 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$8,757,961$1,345,165-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-1,962$6,342,268$1,228,421$626iApproximate average salary by contribution assumption: employee only about $15,653 at 4% or $10,435 at 6%; with 50% employer match about $10,435 at 4% or $6,957 at 6%; with 100% employer match about $7,826 at 4% or $5,218 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-27$2,415,693$116,744$4,324iApproximate average salary by contribution assumption: employee only about $108,096 at 4% or $72,064 at 6%; with 50% employer match about $72,064 at 4% or $48,043 at 6%; with 100% employer match about $54,048 at 4% or $36,032 at 6%.
Chevron Stations Inc. Group Insurance Plan-4,377---
200443,756$17,598,168$3,547,844$945iApproximate average salary by contribution assumption: employee only about $23,615 at 4% or $15,743 at 6%; with 50% employer match about $15,743 at 4% or $10,495 at 6%; with 100% employer match about $11,807 at 4% or $7,872 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$8,799,084$1,773,922-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,092$6,531,782$1,657,062$792iApproximate average salary by contribution assumption: employee only about $19,802 at 4% or $13,202 at 6%; with 50% employer match about $13,202 at 4% or $8,801 at 6%; with 100% employer match about $9,901 at 4% or $6,601 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-27$2,267,302$116,860$4,328iApproximate average salary by contribution assumption: employee only about $108,204 at 4% or $72,136 at 6%; with 50% employer match about $72,136 at 4% or $48,091 at 6%; with 100% employer match about $54,102 at 4% or $36,068 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,756---
200344,974$21,386,982$4,256,040$856iApproximate average salary by contribution assumption: employee only about $21,391 at 4% or $14,261 at 6%; with 50% employer match about $14,261 at 4% or $9,507 at 6%; with 100% employer match about $10,696 at 4% or $7,130 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$10,693,491$2,128,020-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-2,926$8,029,126$2,006,542$686iApproximate average salary by contribution assumption: employee only about $17,144 at 4% or $11,429 at 6%; with 50% employer match about $11,429 at 4% or $7,620 at 6%; with 100% employer match about $8,572 at 4% or $5,715 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-32$2,664,365$121,478$3,796iApproximate average salary by contribution assumption: employee only about $94,905 at 4% or $63,270 at 6%; with 50% employer match about $63,270 at 4% or $42,180 at 6%; with 100% employer match about $47,452 at 4% or $31,635 at 6%.
Chevron Stations Inc. Group Insurance PlanCurrent4,974---
200247,078$16,437,765$4,084,811$577iApproximate average salary by contribution assumption: employee only about $14,428 at 4% or $9,619 at 6%; with 50% employer match about $9,619 at 4% or $6,412 at 6%; with 100% employer match about $7,214 at 4% or $4,809 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$9,466,559$2,102,318-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-3,393$6,971,206$1,982,493$584iApproximate average salary by contribution assumption: employee only about $14,607 at 4% or $9,738 at 6%; with 50% employer match about $9,738 at 4% or $6,492 at 6%; with 100% employer match about $7,304 at 4% or $4,869 at 6%.
Chevron Stations Inc. Group Insurance Plan-7,078---
Chevron Stations Inc. Thrift Plan for Exempt Employees-49---
200144,094$15,998,642$3,973,997$971iApproximate average salary by contribution assumption: employee only about $24,267 at 4% or $16,178 at 6%; with 50% employer match about $16,178 at 4% or $10,785 at 6%; with 100% employer match about $12,134 at 4% or $8,089 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$9,455,793$2,047,449-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-731$6,542,849$1,926,548$2,635iApproximate average salary by contribution assumption: employee only about $65,887 at 4% or $43,925 at 6%; with 50% employer match about $43,925 at 4% or $29,283 at 6%; with 100% employer match about $32,944 at 4% or $21,962 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-32---
Chevron Stations Inc. Group Insurance Plan-4,094---
200043,515$17,135,710$3,322,930$945iApproximate average salary by contribution assumption: employee only about $23,634 at 4% or $15,756 at 6%; with 50% employer match about $15,756 at 4% or $10,504 at 6%; with 100% employer match about $11,817 at 4% or $7,878 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$8,567,855$1,661,465-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-694$5,290,076$1,546,169$2,228iApproximate average salary by contribution assumption: employee only about $55,698 at 4% or $37,132 at 6%; with 50% employer match about $37,132 at 4% or $24,755 at 6%; with 100% employer match about $27,849 at 4% or $18,566 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-31$3,277,779$115,296$3,719iApproximate average salary by contribution assumption: employee only about $92,981 at 4% or $61,987 at 6%; with 50% employer match about $61,987 at 4% or $41,325 at 6%; with 100% employer match about $46,490 at 4% or $30,994 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,515---
199943,891$16,620,038$1,843,104$474iApproximate average salary by contribution assumption: employee only about $11,842 at 4% or $7,895 at 6%; with 50% employer match about $7,895 at 4% or $5,263 at 6%; with 100% employer match about $5,921 at 4% or $3,947 at 6%.
Master Trust of the Chevron Stations Inc. Thrift Plans-0$8,310,019$921,552-
Chevron Stations Inc. Thrift Plan for Non-Exempt Employees-805$4,805,605$834,900$1,037iApproximate average salary by contribution assumption: employee only about $25,929 at 4% or $17,286 at 6%; with 50% employer match about $17,286 at 4% or $11,524 at 6%; with 100% employer match about $12,964 at 4% or $8,643 at 6%.
Chevron Stations Inc. Thrift Plan for Exempt Employees-3$3,504,414$86,652$28,884iApproximate average salary by contribution assumption: employee only about $722,100 at 4% or $481,400 at 6%; with 50% employer match about $481,400 at 4% or $320,933 at 6%; with 100% employer match about $361,050 at 4% or $240,700 at 6%.
Chevron Stations Inc. Group Insurance Plan-3,891---
Schedule Details

Schedule A

Row 1
Filing Id
91037334206814
Form Id
54376391
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030008
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 2
Filing Id
91037334206814
Form Id
54376385
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030002
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 3
Filing Id
91037334206814
Form Id
54376386
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030003
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 4
Filing Id
91037334206814
Form Id
54376387
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030004
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 5
Filing Id
91037334206814
Form Id
54376388
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030005
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 6
Filing Id
91037334206814
Form Id
54376389
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030006
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 7
Filing Id
91037334206814
Form Id
54376390
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
3040374295494030007
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Row 8
Ins Carrier Name: STARBRIDGE
Filing Id
91037334206814
Form Id
54376385
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
STARBRIDGE
Ins Carrier EIN
59-2213662
Ins Carrier Naic Code
97055
Ins Contract Num
N/A
Ins Prsn Covered End of year Count
553
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
AK
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
$702,656
Wlfr Acquis Cost Amount
$0
Row 9
Ins Carrier Name: OSCHNER
Filing Id
91037334206814
Form Id
54376386
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
OSCHNER
Ins Carrier EIN
72-1279235
Ins Carrier Naic Code
95642
Ins Contract Num
C15101
Ins Prsn Covered End of year Count
1
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
AK
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
$215,350
Wlfr Acquis Cost Amount
$0
Row 10
Ins Carrier Name: THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
91037334206814
Form Id
54376387
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
39206-LTD
Ins Prsn Covered End of year Count
519
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
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
$92,023
Wlfr Acquis Cost Amount
$0
Row 11
Ins Carrier Name: THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Filing Id
91037334206814
Form Id
54376388
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
22-1211670
Ins Carrier Naic Code
68241
Ins Contract Num
39206-1
Ins Prsn Covered End of year Count
3,776
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
DM
Wlfr Type Bnft Oth Text
ACCIDENTAL DEATH AND 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
$225,475
Wlfr Acquis Cost Amount
$0
Row 12
Ins Carrier Name: KASISER HAWAII
Filing Id
91037334206814
Form Id
54376389
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
KASISER HAWAII
Ins Carrier EIN
94-1340523
Ins Carrier Naic Code
0
Ins Contract Num
30849
Ins Prsn Covered End of year Count
125
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
ABK
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
$154,292
Wlfr Acquis Cost Amount
$0
Row 13
Ins Carrier Name: AETNA LIFE INSURANCE COMPANY
Filing Id
91037334206814
Form Id
54376390
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
AETNA LIFE INSURANCE COMPANY
Ins Carrier EIN
06-6033492
Ins Carrier Naic Code
60054
Ins Contract Num
100219
Ins Prsn Covered End of year Count
1,616
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
$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
$1,294,384
Wlfr Acquis Cost Amount
$0
Row 14
Ins Carrier Name: AETNA/US HEALTHCARE, INC. AND SUBSIDIARIES
Filing Id
91037334206814
Form Id
54376391
Schedule A EIN
84-0618607
Schedule A Plan Num
697
Schedule A Plan Year Begin Date
2003-01-01
Schedule A Tax Period
20031231
Ins Carrier Name
AETNA/US HEALTHCARE, INC. AND SUBSIDIARIES
Ins Carrier EIN
23-2229683
Ins Carrier Naic Code
95003
Ins Contract Num
213932
Ins Prsn Covered End of year Count
1,457
Ins Policy From Date
2003-01-01
Ins Policy To Date
2003-12-31
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
$4,427,713
Wlfr Acquis Cost Amount
$0