Fidelity bond in place
Not reported
Filing
Check Point Software Technologies Inc. Welfare Plan
Check Point Software Technologies Inc. • EIN 94-3229135 • Plan year 2000
Filing Insights
Participants
Up371 → 439
68 • 18.33%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
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 / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2024 | 2 | 1,522 | $285,429,642 | $34,836,573 | $22,889iApproximate average salary by contribution assumption: employee only about $572,217 at 4% or $381,478 at 6%; with 50% employer match about $381,478 at 4% or $254,319 at 6%; with 100% employer match about $286,109 at 4% or $190,739 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,522 | $285,429,642 | $34,836,573 | $22,889iApproximate average salary by contribution assumption: employee only about $572,217 at 4% or $381,478 at 6%; with 50% employer match about $381,478 at 4% or $254,319 at 6%; with 100% employer match about $286,109 at 4% or $190,739 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,488 | - | - | - |
| 2023 | 2 | 1,501 | $239,176,838 | $30,900,599 | $20,587iApproximate average salary by contribution assumption: employee only about $514,667 at 4% or $343,111 at 6%; with 50% employer match about $343,111 at 4% or $228,741 at 6%; with 100% employer match about $257,333 at 4% or $171,556 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,501 | $239,176,838 | $30,900,599 | $20,587iApproximate average salary by contribution assumption: employee only about $514,667 at 4% or $343,111 at 6%; with 50% employer match about $343,111 at 4% or $228,741 at 6%; with 100% employer match about $257,333 at 4% or $171,556 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,209 | - | - | - |
| 2022 | 2 | 1,363 | $190,333,422 | $28,159,071 | $20,660iApproximate average salary by contribution assumption: employee only about $516,491 at 4% or $344,327 at 6%; with 50% employer match about $344,327 at 4% or $229,551 at 6%; with 100% employer match about $258,245 at 4% or $172,164 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,363 | $190,333,422 | $28,159,071 | $20,660iApproximate average salary by contribution assumption: employee only about $516,491 at 4% or $344,327 at 6%; with 50% employer match about $344,327 at 4% or $229,551 at 6%; with 100% employer match about $258,245 at 4% or $172,164 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,363 | - | - | - |
| 2021 | 2 | 1,202 | $212,175,699 | $23,731,547 | $19,743iApproximate average salary by contribution assumption: employee only about $493,585 at 4% or $329,056 at 6%; with 50% employer match about $329,056 at 4% or $219,371 at 6%; with 100% employer match about $246,792 at 4% or $164,528 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,195 | $212,175,699 | $23,731,547 | $19,859iApproximate average salary by contribution assumption: employee only about $496,476 at 4% or $330,984 at 6%; with 50% employer match about $330,984 at 4% or $220,656 at 6%; with 100% employer match about $248,238 at 4% or $165,492 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,202 | - | - | - |
| 2020 | 2 | 1,198 | $180,506,390 | $23,557,333 | $19,664iApproximate average salary by contribution assumption: employee only about $491,597 at 4% or $327,731 at 6%; with 50% employer match about $327,731 at 4% or $218,488 at 6%; with 100% employer match about $245,799 at 4% or $163,866 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,196 | $180,506,390 | $23,557,333 | $19,697iApproximate average salary by contribution assumption: employee only about $492,419 at 4% or $328,279 at 6%; with 50% employer match about $328,279 at 4% or $218,853 at 6%; with 100% employer match about $246,210 at 4% or $164,140 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,198 | - | - | - |
| 2019 | 2 | 1,209 | $147,680,279 | $20,163,916 | $16,678iApproximate average salary by contribution assumption: employee only about $416,954 at 4% or $277,970 at 6%; with 50% employer match about $277,970 at 4% or $185,313 at 6%; with 100% employer match about $208,477 at 4% or $138,985 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,209 | $147,680,279 | $20,163,916 | $16,678iApproximate average salary by contribution assumption: employee only about $416,954 at 4% or $277,970 at 6%; with 50% employer match about $277,970 at 4% or $185,313 at 6%; with 100% employer match about $208,477 at 4% or $138,985 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,197 | - | - | - |
| 2018 | 2 | 1,202 | $114,744,891 | $18,759,624 | $15,607iApproximate average salary by contribution assumption: employee only about $390,175 at 4% or $260,117 at 6%; with 50% employer match about $260,117 at 4% or $173,411 at 6%; with 100% employer match about $195,088 at 4% or $130,058 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,202 | $114,744,891 | $18,759,624 | $15,607iApproximate average salary by contribution assumption: employee only about $390,175 at 4% or $260,117 at 6%; with 50% employer match about $260,117 at 4% or $173,411 at 6%; with 100% employer match about $195,088 at 4% or $130,058 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,133 | - | - | - |
| 2017 | 2 | 1,097 | $113,474,219 | $16,700,504 | $15,224iApproximate average salary by contribution assumption: employee only about $380,595 at 4% or $253,730 at 6%; with 50% employer match about $253,730 at 4% or $169,153 at 6%; with 100% employer match about $190,297 at 4% or $126,865 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,097 | $113,474,219 | $16,700,504 | $15,224iApproximate average salary by contribution assumption: employee only about $380,595 at 4% or $253,730 at 6%; with 50% employer match about $253,730 at 4% or $169,153 at 6%; with 100% employer match about $190,297 at 4% or $126,865 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,097 | - | - | - |
| 2016 | 2 | 1,040 | $89,090,309 | $12,845,434 | $12,351iApproximate average salary by contribution assumption: employee only about $308,784 at 4% or $205,856 at 6%; with 50% employer match about $205,856 at 4% or $137,238 at 6%; with 100% employer match about $154,392 at 4% or $102,928 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 1,040 | $89,090,309 | $12,845,434 | $12,351iApproximate average salary by contribution assumption: employee only about $308,784 at 4% or $205,856 at 6%; with 50% employer match about $205,856 at 4% or $137,238 at 6%; with 100% employer match about $154,392 at 4% or $102,928 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 1,040 | - | - | - |
| 2015 | 2 | 924 | $76,488,212 | $11,160,842 | $12,079iApproximate average salary by contribution assumption: employee only about $301,971 at 4% or $201,314 at 6%; with 50% employer match about $201,314 at 4% or $134,209 at 6%; with 100% employer match about $150,985 at 4% or $100,657 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 924 | $76,488,212 | $11,160,842 | $12,079iApproximate average salary by contribution assumption: employee only about $301,971 at 4% or $201,314 at 6%; with 50% employer match about $201,314 at 4% or $134,209 at 6%; with 100% employer match about $150,985 at 4% or $100,657 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 920 | - | - | - |
| 2014 | 2 | 806 | $73,291,396 | $7,705,063 | $9,560iApproximate average salary by contribution assumption: employee only about $238,991 at 4% or $159,327 at 6%; with 50% employer match about $159,327 at 4% or $106,218 at 6%; with 100% employer match about $119,495 at 4% or $79,664 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 765 | $73,291,396 | $7,705,063 | $10,072iApproximate average salary by contribution assumption: employee only about $251,799 at 4% or $167,866 at 6%; with 50% employer match about $167,866 at 4% or $111,911 at 6%; with 100% employer match about $125,900 at 4% or $83,933 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 806 | - | - | - |
| 2013 | 2 | 710 | $67,457,194 | $7,416,725 | $10,446iApproximate average salary by contribution assumption: employee only about $261,152 at 4% or $174,102 at 6%; with 50% employer match about $174,102 at 4% or $116,068 at 6%; with 100% employer match about $130,576 at 4% or $87,051 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 710 | $67,457,194 | $7,416,725 | $10,446iApproximate average salary by contribution assumption: employee only about $261,152 at 4% or $174,102 at 6%; with 50% employer match about $174,102 at 4% or $116,068 at 6%; with 100% employer match about $130,576 at 4% or $87,051 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 698 | - | - | - |
| 2012 | 2 | 682 | $53,651,664 | $7,434,440 | $10,901iApproximate average salary by contribution assumption: employee only about $272,523 at 4% or $181,682 at 6%; with 50% employer match about $181,682 at 4% or $121,122 at 6%; with 100% employer match about $136,262 at 4% or $90,841 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 682 | $53,651,664 | $7,434,440 | $10,901iApproximate average salary by contribution assumption: employee only about $272,523 at 4% or $181,682 at 6%; with 50% employer match about $181,682 at 4% or $121,122 at 6%; with 100% employer match about $136,262 at 4% or $90,841 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 651 | - | - | - |
| 2011 | 2 | 630 | $42,716,861 | $7,096,424 | $11,264iApproximate average salary by contribution assumption: employee only about $281,604 at 4% or $187,736 at 6%; with 50% employer match about $187,736 at 4% or $125,157 at 6%; with 100% employer match about $140,802 at 4% or $93,868 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 630 | $42,716,861 | $7,096,424 | $11,264iApproximate average salary by contribution assumption: employee only about $281,604 at 4% or $187,736 at 6%; with 50% employer match about $187,736 at 4% or $125,157 at 6%; with 100% employer match about $140,802 at 4% or $93,868 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 628 | - | - | - |
| 2010 | 2 | 629 | $40,142,949 | $6,957,761 | $11,062iApproximate average salary by contribution assumption: employee only about $276,541 at 4% or $184,360 at 6%; with 50% employer match about $184,360 at 4% or $122,907 at 6%; with 100% employer match about $138,270 at 4% or $92,180 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 629 | $40,142,949 | $6,957,761 | $11,062iApproximate average salary by contribution assumption: employee only about $276,541 at 4% or $184,360 at 6%; with 50% employer match about $184,360 at 4% or $122,907 at 6%; with 100% employer match about $138,270 at 4% or $92,180 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 560 | - | - | - |
| 2009 | 3 | 678 | $31,286,496 | $6,444,798 | $9,506iApproximate average salary by contribution assumption: employee only about $237,640 at 4% or $158,427 at 6%; with 50% employer match about $158,427 at 4% or $105,618 at 6%; with 100% employer match about $118,820 at 4% or $79,213 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 678 | $31,286,496 | $6,444,798 | $9,506iApproximate average salary by contribution assumption: employee only about $237,640 at 4% or $158,427 at 6%; with 50% employer match about $158,427 at 4% or $105,618 at 6%; with 100% employer match about $118,820 at 4% or $79,213 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 673 | - | - | - |
| CHECK POINT SOFTWARE TECHNOLOGIES, INC. FLEXIBLE BENEFITS PLAN | - | 0 | - | - | - |
| 2008 | 3 | 588 | $20,541,110 | $5,602,330 | $9,528iApproximate average salary by contribution assumption: employee only about $238,194 at 4% or $158,796 at 6%; with 50% employer match about $158,796 at 4% or $105,864 at 6%; with 100% employer match about $119,097 at 4% or $79,398 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 588 | $20,541,110 | $5,602,330 | $9,528iApproximate average salary by contribution assumption: employee only about $238,194 at 4% or $158,796 at 6%; with 50% employer match about $158,796 at 4% or $105,864 at 6%; with 100% employer match about $119,097 at 4% or $79,398 at 6%. |
| CHECK POINT SOFTWARE TECH FBP | - | 551 | - | - | - |
| Check Point Software Technologies Inc. Welfare Plan | - | 580 | - | - | - |
| 2007 | 3 | 620 | $28,123,223 | $6,391,710 | $10,309iApproximate average salary by contribution assumption: employee only about $257,730 at 4% or $171,820 at 6%; with 50% employer match about $171,820 at 4% or $114,547 at 6%; with 100% employer match about $128,865 at 4% or $85,910 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 620 | $28,123,223 | $6,391,710 | $10,309iApproximate average salary by contribution assumption: employee only about $257,730 at 4% or $171,820 at 6%; with 50% employer match about $171,820 at 4% or $114,547 at 6%; with 100% employer match about $128,865 at 4% or $85,910 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 609 | - | - | - |
| CHECK POINT TECHNOLOGIES MEDICAL EXPENSE REIMBURSMENT PLAN | - | 572 | - | - | - |
| 2006 | 3 | 538 | $0 | $0 | - |
| CHECK POINT TECHNOLOGIES MEDICAL EXPENSE REIMBURSMENT PLAN | - | 501 | - | - | - |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 538 | - | - | - |
| Check Point Software Technologies Inc. Welfare Plan | - | 512 | - | - | - |
| 2005 | 3 | 549 | $18,036,861 | $3,947,750 | $7,191iApproximate average salary by contribution assumption: employee only about $179,770 at 4% or $119,847 at 6%; with 50% employer match about $119,847 at 4% or $79,898 at 6%; with 100% employer match about $89,885 at 4% or $59,923 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 543 | $18,036,861 | $3,947,750 | $7,270iApproximate average salary by contribution assumption: employee only about $181,756 at 4% or $121,171 at 6%; with 50% employer match about $121,171 at 4% or $80,781 at 6%; with 100% employer match about $90,878 at 4% or $60,585 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 549 | - | - | - |
| CHECK POINT TECHNOLOGIES MEDICAL EXPENSE REIMBURSMENT PLAN | - | 530 | - | - | - |
| 2004 | 4 | 608 | $14,826,819 | $5,173,485 | $8,509iApproximate average salary by contribution assumption: employee only about $212,726 at 4% or $141,817 at 6%; with 50% employer match about $141,817 at 4% or $94,545 at 6%; with 100% employer match about $106,363 at 4% or $70,909 at 6%. |
| Check Point Software Technologies Inc 401(K) Retirement Plan | - | 608 | $14,826,819 | $4,573,507 | $7,522iApproximate average salary by contribution assumption: employee only about $188,055 at 4% or $125,370 at 6%; with 50% employer match about $125,370 at 4% or $83,580 at 6%; with 100% employer match about $94,028 at 4% or $62,685 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 605 | - | - | - |
| CHECK POINT TECHNOLOGIES MEDICAL EXPENSE REIMBURSMENT PLAN | - | 391 | - | - | - |
| Checkpoint Software Technologies Inc. 401K Plan | - | 0 | - | $599,978 | - |
| 2003 | 3 | 433 | $10,265,757 | $2,723,917 | $6,291iApproximate average salary by contribution assumption: employee only about $157,270 at 4% or $104,847 at 6%; with 50% employer match about $104,847 at 4% or $69,898 at 6%; with 100% employer match about $78,635 at 4% or $52,423 at 6%. |
| Checkpoint Software Technologies Inc. 401K Plan | - | 387 | $10,265,757 | $2,723,917 | $7,039iApproximate average salary by contribution assumption: employee only about $175,964 at 4% or $117,309 at 6%; with 50% employer match about $117,309 at 4% or $78,206 at 6%; with 100% employer match about $87,982 at 4% or $58,655 at 6%. |
| CHECK POINT TECHNOLOGIES MEDICAL EXPENSE REIMBURSMENT PLAN | - | 425 | - | - | - |
| Check Point Software Technologies Inc. Welfare Plan | - | 433 | - | - | - |
| 2002 | 2 | 516 | $7,118,624 | $2,777,307 | $5,382iApproximate average salary by contribution assumption: employee only about $134,559 at 4% or $89,706 at 6%; with 50% employer match about $89,706 at 4% or $59,804 at 6%; with 100% employer match about $67,280 at 4% or $44,853 at 6%. |
| Checkpoint Software Technologies Inc. 401K Plan | - | 505 | $7,118,624 | $2,777,307 | $5,500iApproximate average salary by contribution assumption: employee only about $137,490 at 4% or $91,660 at 6%; with 50% employer match about $91,660 at 4% or $61,107 at 6%; with 100% employer match about $68,745 at 4% or $45,830 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 516 | - | - | - |
| 2001 | 3 | 534 | $6,393,637 | $2,739,439 | $5,130iApproximate average salary by contribution assumption: employee only about $128,251 at 4% or $85,501 at 6%; with 50% employer match about $85,501 at 4% or $57,000 at 6%; with 100% employer match about $64,125 at 4% or $42,750 at 6%. |
| Checkpoint Software Technologies Inc. 401K Plan | - | 534 | $6,393,637 | $2,739,439 | $5,130iApproximate average salary by contribution assumption: employee only about $128,251 at 4% or $85,501 at 6%; with 50% employer match about $85,501 at 4% or $57,000 at 6%; with 100% employer match about $64,125 at 4% or $42,750 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 520 | - | - | - |
| CHECK POINT TECHNOLOGIES FLEXIBLE BENEFIT PLAN | - | 326 | - | - | - |
| 2000 | 1 | 439 | $0 | $0 | - |
| Check Point Software Technologies Inc. Welfare Plan | Current | 439 | - | - | - |
| 1999 | 2 | 361 | $4,131,722 | $1,576,875 | $4,368iApproximate average salary by contribution assumption: employee only about $109,202 at 4% or $72,801 at 6%; with 50% employer match about $72,801 at 4% or $48,534 at 6%; with 100% employer match about $54,601 at 4% or $36,401 at 6%. |
| Checkpoint Software Technologies Inc. 401K Plan | - | 229 | $4,131,722 | $1,576,875 | $6,886iApproximate average salary by contribution assumption: employee only about $172,148 at 4% or $114,765 at 6%; with 50% employer match about $114,765 at 4% or $76,510 at 6%; with 100% employer match about $86,074 at 4% or $57,383 at 6%. |
| Check Point Software Technologies Inc. Welfare Plan | - | 361 | - | - | - |
Schedule Details
Schedule A
- Row 1
- Filing Id
- 84037085072282
- Form Id
- 13853823
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030004
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $58,519
- Ins Broker Fees Pd 01 Amount
- $0
- Row 2
- Filing Id
- 84037085072282
- Form Id
- 13853821
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030002
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $2,021
- Ins Broker Fees Pd 01 Amount
- $0
- Row 3
- Filing Id
- 84037085072282
- Form Id
- 13853822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030003
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $15,460
- Ins Broker Fees Pd 01 Amount
- $0
- Row 4
- Filing Id
- 84037085072282
- Form Id
- 13853824
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030005
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 5
- Filing Id
- 84037085072282
- Form Id
- 13853825
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030006
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $4,021
- Ins Broker Fees Pd 01 Amount
- $0
- Row 6
- Filing Id
- 84037085072282
- Form Id
- 13853826
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030007
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $2,254
- Ins Broker Fees Pd 01 Amount
- $0
- Row 7
- Filing Id
- 84037085072282
- Form Id
- 13853827
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030008
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $551
- Ins Broker Fees Pd 01 Amount
- $0
- Row 8
- Filing Id
- 84037085072282
- Form Id
- 13853828
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030009
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 9
- Filing Id
- 84037085072282
- Form Id
- 13853829
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030010
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $11,098
- Ins Broker Fees Pd 01 Amount
- $0
- Row 10
- Filing Id
- 84037085072282
- Form Id
- 13853830
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 20372085072030011
- Ins Broker 01 Name
- SITZMANN MORRIS & LAVIS
- Ins Broker 01 Street Addr
- ONE KAISER PLAZA, SUITE 1101
- Ins Broker 01 City
- OAKLAND
- Ins Broker 01 State
- CA
- Ins Broker 01 ZIP Code
- 94612
- Ins Broker Comm Pd 01 Amount
- $13,469
- Ins Broker Fees Pd 01 Amount
- $0
- Row 11
- Ins Carrier Name: VISION SERVICE PLAN
- Filing Id
- 84037085072282
- Form Id
- 13853821
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- VISION SERVICE PLAN
- Ins Carrier EIN
- 94-1632821
- Ins Carrier Naic Code
- 0
- Ins Contract Num
- 12045952
- Ins Prsn Covered End of year Count
- 463
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $2,021
- 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
- C
- 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
- $56,642
- Wlfr Acquis Cost Amount
- $0
- Row 12
- Ins Carrier Name: THE GUARDIAN
- Filing Id
- 84037085072282
- Form Id
- 13853822
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- THE GUARDIAN
- Ins Carrier EIN
- 13-5123390
- Ins Carrier Naic Code
- 64246
- Ins Contract Num
- 317165
- Ins Prsn Covered End of year Count
- 698
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $15,460
- 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
- BDFM
- Wlfr Type Bnft Oth Text
- AD&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
- $181,019
- Wlfr Acquis Cost Amount
- $0
- Row 13
- Ins Carrier Name: CALIFORNIA PHYSICIANS' SERVICE
- Filing Id
- 84037085072282
- Form Id
- 13853823
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- CALIFORNIA PHYSICIANS' SERVICE
- Ins Carrier EIN
- 94-0360524
- Ins Carrier Naic Code
- 47732
- Ins Contract Num
- H10650 930156
- Ins Prsn Covered End of year Count
- 709
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $58,519
- 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
- AH
- 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
- $1,170,373
- Wlfr Acquis Cost Amount
- $0
- Row 14
- Ins Carrier Name: KAISER PERMANENTE
- Filing Id
- 84037085072282
- Form Id
- 13853824
- Schedule A EIN
- 94-3229135
- 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 Carrier Naic Code
- 0
- Ins Contract Num
- 36394-7000
- 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
- $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
- 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
- $1,013
- Wlfr Acquis Cost Amount
- $0
- Row 15
- Ins Carrier Name: KAISER PERMANENTE
- Filing Id
- 84037085072282
- Form Id
- 13853825
- Schedule A EIN
- 94-3229135
- 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 Carrier Naic Code
- 0
- Ins Contract Num
- 36394-0000
- 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
- $4,021
- 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
- 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
- $56,929
- Wlfr Acquis Cost Amount
- $0
- Row 16
- Ins Carrier Name: CLAREMONT BEHAVIORAL SERVICES
- Filing Id
- 84037085072282
- Form Id
- 13853826
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- CLAREMONT BEHAVIORAL SERVICES
- Ins Carrier EIN
- 94-3129474
- Ins Carrier Naic Code
- 0
- Ins Contract Num
- 0110
- Ins Prsn Covered End of year Count
- 358
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $2,254
- 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
- EMPLOYEE ASSISTANCE PROGRAM
- 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
- $22,538
- Wlfr Acquis Cost Amount
- $0
- Row 17
- Ins Carrier Name: CIGNA WORLDWIDE INSURANCE COMPANY
- Filing Id
- 84037085072282
- Form Id
- 13853827
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- CIGNA WORLDWIDE INSURANCE COMPANY
- Ins Carrier EIN
- 23-2088429
- Ins Carrier Naic Code
- 90859
- Ins Contract Num
- DE 5370 277
- Ins Prsn Covered End of year Count
- 3
- Ins Policy From Date
- 1999-10-01
- Ins Policy To Date
- 2000-09-30
- Ins Broker Comm Total Amount
- $551
- 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
- ABDFM
- Wlfr Type Bnft Oth Text
- AD&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
- $6,882
- Wlfr Acquis Cost Amount
- $0
- Row 18
- Ins Carrier Name: REGENCECARE
- Filing Id
- 84037085072282
- Form Id
- 13853828
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- REGENCECARE
- Ins Carrier EIN
- 91-1328366
- Ins Carrier Naic Code
- 95648
- Ins Contract Num
- 009295
- 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
- $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
- 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
- $74,825
- Wlfr Acquis Cost Amount
- $0
- Row 19
- Ins Carrier Name: PRUDENTIAL HEALTH CARE
- Filing Id
- 84037085072282
- Form Id
- 13853829
- Schedule A EIN
- 94-3229135
- Schedule A Plan Num
- 503
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- PRUDENTIAL HEALTH CARE
- Ins Carrier EIN
- 22-1211670
- Ins Carrier Naic Code
- 68241
- Ins Contract Num
- 63600
- Ins Prsn Covered End of year Count
- 1,003
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $11,098
- 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
- B
- 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
- $272,421
- Wlfr Acquis Cost Amount
- $0
- Row 20
- Ins Carrier Name: BLUE CROSS BLUE SHIELD
- Filing Id
- 84037085072282
- Form Id
- 13853830
- Schedule A EIN
- 94-3229135
- 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
- Ins Carrier EIN
- 36-1236610
- Ins Carrier Naic Code
- 70670
- Ins Contract Num
- 57267
- Ins Prsn Covered End of year Count
- 88
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $13,469
- 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
- $307,204
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $307,204
- Wlfr Claims Paid Amount
- $156,515
- Wlfr Incr Reserve Amount
- $73,729
- Wlfr Incurred Claim Amount
- $230,244
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $46,081
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $30,880
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $76,961
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $73,728
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0