Civic Intelligence
Filing

Check Point Software Technologies Inc. Welfare Plan

Check Point Software Technologies Inc. • EIN 94-3229135 • Plan year 2004

Company ProfileSource Archive
Filing Insights

Participants

Up

447 → 605

158 • 35.35%

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
202421,522$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---
202321,501$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---
202221,363$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---
202121,202$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---
202021,198$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---
201921,209$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---
201821,202$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---
201721,097$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---
201621,040$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---
20152924$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---
20142806$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---
20132710$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---
20122682$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---
20112630$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---
20102629$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---
20093678$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---
20083588$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---
20073620$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---
20063538$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---
20053549$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---
20044608$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 PlanCurrent605---
CHECK POINT TECHNOLOGIES MEDICAL EXPENSE REIMBURSMENT PLAN-391---
Checkpoint Software Technologies Inc. 401K Plan-0-$599,978-
20033433$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---
20022516$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---
20013534$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---
20001439$0$0-
Check Point Software Technologies Inc. Welfare Plan-439---
19992361$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
84037258480045
Form Id
61679023
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
4010375258480040002
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
946120000
Ins Broker Comm Pd 01 Amount
$87,140
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 2
Filing Id
84037258480045
Form Id
61679027
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
4010375258480040006
Ins Broker 01 Name
SITZMANN MORRIS & LAVIS, INC.
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
946120000
Ins Broker Comm Pd 01 Amount
$1,875
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 3
Filing Id
84037258480045
Form Id
61679026
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
4010375258480040005
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
946120000
Ins Broker Comm Pd 01 Amount
$6,811
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 4
Filing Id
84037258480045
Form Id
61679025
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
4010375258480040004
Ins Broker 01 Name
SITZMANN MORRIS & LAVIS, INC
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
946120000
Ins Broker Comm Pd 01 Amount
$18,551
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 5
Filing Id
84037258480045
Form Id
61679024
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
4010375258480040003
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
946120000
Ins Broker Comm Pd 01 Amount
$21,164
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
3
Row 6
Ins Carrier Name: KAISER FOUNDATION HEALTH PLAN
Filing Id
84037258480045
Form Id
61679026
Schedule A EIN
94-3229135
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2004-01-01
Schedule A Tax Period
20041231
Ins Carrier Name
KAISER FOUNDATION HEALTH PLAN
Ins Carrier EIN
94-1340523
Ins Carrier Naic Code
00000
Ins Contract Num
36394
Ins Prsn Covered End of year Count
30
Ins Policy From Date
2004-01-01
Ins Policy To Date
2004-12-31
Ins Broker Comm Total Amount
$6,811
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
HEALTH CARE SERVICE
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
$117,027
Wlfr Acquis Cost Amount
$0
Row 7
Ins Carrier Name: AETNA INC.
Filing Id
84037258480045
Form Id
61679025
Schedule A EIN
94-3229135
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2004-01-01
Schedule A Tax Period
20041231
Ins Carrier Name
AETNA INC.
Ins Carrier EIN
23-2229683
Ins Carrier Naic Code
00000
Ins Contract Num
217728
Ins Prsn Covered End of year Count
271
Ins Policy From Date
2004-01-01
Ins Policy To Date
2004-12-31
Ins Broker Comm Total Amount
$18,551
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
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
$721,181
Wlfr Acquis Cost Amount
$0
Row 8
Ins Carrier Name: AETNA LIFE INSURANCE COMPANY
Filing Id
84037258480045
Form Id
61679023
Schedule A EIN
94-3229135
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2004-01-01
Schedule A Tax Period
20041231
Ins Carrier Name
AETNA LIFE INSURANCE COMPANY
Ins Carrier EIN
06-6033492
Ins Carrier Naic Code
60054
Ins Contract Num
100245
Ins Prsn Covered End of year Count
605
Ins Policy From Date
2004-01-01
Ins Policy To Date
2004-12-31
Ins Broker Comm Total Amount
$87,140
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
$3,581,024
Wlfr Acquis Cost Amount
$0
Row 9
Ins Carrier Name: GUARDIAN LIFE INSURANCE COMPANY OF AMERICA
Filing Id
84037258480045
Form Id
61679024
Schedule A EIN
94-3229135
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2004-01-01
Schedule A Tax Period
20041231
Ins Carrier Name
GUARDIAN LIFE INSURANCE COMPANY OF AMERICA
Ins Carrier EIN
13-5123390
Ins Carrier Naic Code
64246
Ins Contract Num
317165
Ins Prsn Covered End of year Count
423
Ins Policy From Date
2004-01-01
Ins Policy To Date
2004-12-31
Ins Broker Comm Total Amount
$21,164
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
DEFM
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
$186,013
Wlfr Acquis Cost Amount
$0
Row 10
Ins Carrier Name: VISION SERVICE PLAN
Filing Id
84037258480045
Form Id
61679027
Schedule A EIN
94-3229135
Schedule A Plan Num
503
Schedule A Plan Year Begin Date
2004-01-01
Schedule A Tax Period
20041231
Ins Carrier Name
VISION SERVICE PLAN
Ins Carrier EIN
94-1632821
Ins Carrier Naic Code
00000
Ins Contract Num
12045952
Ins Prsn Covered End of year Count
422
Ins Policy From Date
2004-01-01
Ins Policy To Date
2004-12-31
Ins Broker Comm Total Amount
$1,875
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
$52,295
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$52,295
Wlfr Claims Paid Amount
$37,243
Wlfr Incr Reserve Amount
$-1,981
Wlfr Incurred Claim Amount
$35,262
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$1,875
Wlfr Ret Admin Amount
$8,367
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
$10,242
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$9,311
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0