Plan Name. Mainstream Base Period: CY '93 Plan Number: Rate Period: 6/96 - 9/97 County: Riverside Capitation Payable: End of Month Aid Code: Child
Plan Name. Mainstream Base Period: CY '93 Plan Number: Rate Period: 6/96 - 9/97 County: San Bernardino Capitation Payable: End of Month Aid Code: Disabled Phys Pharm HIP HOP LTC Other Total Units per 1,000 eligibles 7.452 23.494 1.498 4.212 1.440 28.577 Age/sex Adjustment 1.005 .979 .990 1.011 1.011 1.008 Aid Code Adjustment .994 1.003 .983 .993 .999 1.004 Adjusted Units 7.444 23.070 1.458 4.229 1.454 28.921 Average Cost Per Unit 43.31 32.19 511.29 18.05 108.27 10.65 Area Adjustment 1.013 1.000 1.000 1.000 1.000 1.000 Adjusted Cost $ 43.87 $ 32.19 $ 511.29 $ 18.05 $ 108.27 $ 10.65 Interest Adjustment .995 .999 .991 .993 .999 .996 Contract Cost per Eligible $ 324.94 $ 741.88 $ 738.75 $ 75.80 $ 157.27 $ 306.78 $ 2,345.42 Benefit Adjustments FY 94/95 1.003 .852 1.036 1.003 1.042 1.001 FY 95/96 1.000 .724 1.018 1.000 1.020 1.000 Trend Adjustment 7/93 - 1/97 1.160 1.270 .981 1.065 .991 1.327 Annual Cost Per Eligible $ 378.06 $ 581.19 $ 764.32 $ 80.97 $ 165.65 $ 407.50 $ 2,377.69 Mental Health Adjustment 7.8% 18.8% 11.7% 2.4% 1.3% 1.4% Eyewear Adjustment .9% Cost Excluding Mental Health $ 348.57 $ 471.93 $ 674.89 $ 79.03 $ 163.50 $ 398.18 $ 2,136.10 Preliminary Monthly Rate $ 178.01 Adj. for Fee-for-Service Limitation -2.0% $ -3.56 CHDP .00 Final Rate $ 174.45 Attachment I
Plan Name. Enter the name of the Health Plan.
Examples of Plan Name in a sentence
Here’s a sample UnitedHealthcare member ID card to show you what yours will look like: Your UnitedHealthcare Plan Name (XXX) Sample A.
Individual assigned by Contractor to ensure Contractor's compliance with MFD Subcontractor Performance Plan: Name: Title: Address: City: State: Zip: Phone Number: Fax Number: Email: B.
Other Insurance Company / Dental Benefit Plan Name, Address, City, State, ZIP Code 33.
GENERAL INFORMATION Case Number: (Obtain this information from your Pension Plan Administrator)The Plan Sponsor of (Legal Plan Name as stated on the Program Agreement Face Page)wishes to add the following fund(s) as investment option(s) to the Plan.
Employee Labor CategoryWage per HourName of Health Insurance Provider(s) and Plan Name* (e.g. ABC Insurer, Inc.
More Definitions of Plan Name
Plan Name. Mainstream Base Period: CY '93 Plan Number: Rate Period: 6/96 - 9/97 County: San Bernardino Capitation Payable: End of Month Aid Code: Child Phys Pharm HIP HOP LTC Other Total Units per 1,000 eligibles 3.791 3.907 .361 1.620 .000 1.882 Age/sex Adjustment 1.184 1.019 1.227 1.087 1.000 1.109 Aid Code Adjustment 1.011 .993 1.025 1.010 1.000 .998 Adjusted Units 4.538 3.953 .454 1.779 .000 2.083 Average Cost Per Unit 69.47 11.05 901.25 22.20 .00 40.13 Area Adjustment 1.013 1.000 1.000 1.000 1.000 1.000 Adjusted Cost $ 70.37 $ 11.05 $ 901.25 $ 22.20 $ .00 $ 40.13 Interest Adjustment .996 .999 .990 .994 .998 .995 Contract Cost per Eligible $ 318.06 $ 43.64 $ 405.08 $ 39.26 $ .00 $ 83.17 $ 889.21 Benefit Adjustments FY 94/95 1.003 .852 1.031 1.003 1.042 1.001 FY 95/96 1.000 .724 1,018 1.000 1.020 .976 Trend Adjustment 7/93 - 1/97 1.047 1.330 .807 .878 1.000 1.285 Annual Cost Per Eligible $ 334.01 $ 35.80 $ 343.10 $ 34.57 $ .00 $ 104.41 $ 851.89 Mental Health Adjustment 1.6% 4.6% 13.4% 2.9% 3.4% 3.6% Eyewear Adjustment .9% Cost Excluding Mental Health $ 328.67 $ 34.15 $ 297.12 $ 33.57 $ .00 $ 99.75 $ 793.26 Preliminary Monthly Rate $ 66.11 Adj. for Fee-for-Service Limitation -2.0% $ -1.32 CHDP 2.38 Final Rate $ 67.17 Attachment I Plan Name: Mainstream Base Period: CY '93 Plan Number: Rate Period: 6/96 - 9/97 County: San Bernardino Capitation Payable: End of Month Aid Code: Aged Phys Pharm HIP HOP LTC Other Total Units per 1,000 eligibles 4.280 19.624 1.476 1.310 2.880 14.314 Age/sex Adjustment .986 1.004 .995 .987 1.031 1.005 Aid Code Adjustment .936 1.021 .968 .931 1.007 1.016 Adjusted Units 3.950 20.116 1.422 1.204 2.990 14.616 Average Cost Per Unit 44.28 28.65 265.64 16.35 76.99 6.95 Area Adjustment 1.013 1.000 1.000 1.000 1.000 1.000 Adjusted Cost $ 44.86 $ 28.65 $ 265.64 $ 16.35 $ 76.99 $ 6.95 Interest Adjustment .994 1.000 .990 .991 .998 .996 Contract Cost per Eligible $ 176.13 $ 576.32 $ 373.96 $ 19.51 $ 229.74 $ 101.17 $ 1,476.83 Benefit Adjustments FY 94/95 1.003 .852 1.036 1.003 1.042 1.001 FY 95/96 1.000 .724 1.018 1.000 1.020 1.000 Trend Adjustment 7/93 - 1/97 1.486 1.278 .896 1.127 1.075 1.565 Annual Cost Per Eligible $ 262.51 $ 454.33 $ 353.38 $ 22.05 $ 262.49 $ 158.49 $ 1,513.25 Mental Health Adjustment .3% 3.2% .7% .9% .4% .0% Eyewear Adjustment 2.1% Cost Excluding Mental Health $ 261.72 $ 439.79 $ 350.91 $ 21.85 $ 261.44 $ 155.16 $ 1,490.87 Preliminary Monthly Rate $ 124.24 Adj. for Fee-for-Service Limitation -2.0% $ -2.48 CHDP .00 Final Rate $ 121...
Plan Name shall be HAMPSHIRE GROUP, LIMITED AND SUBSIDIARIES 401(k) RETIREMENT SAVINGS PLAN.
Plan Name shall be Interpath Communications, Inc. 401(k) Retirement Savings Plan.
Plan Name. IRA Custodial Account FFN: 50143000000-007 Case: 9070037 EIN: 00-0000000 Letter Serial No: D111853b NEW ENGLAND MUTUAL LIFE INSURANCE CO. 000 XXXXXXXX XXXXXX XXXXXX, XX 00000 DEPARTMENT OF THE TREASURY
Plan Name. PSW Profit Sharing Plan ("Plan") The Employer should use this form to notify Fidelity of its intention to designate the above-referenced plan as an ERISA Section 404(c) plan. The Employer should refer to the ERISA Section 404(c) Information Guide before making an election below. Check one: |X| The Employer designates the Plan as an ERISA Section 404(c) plan. Fidelity will include the Notice of Limited Liability in the Plan Highlights brochure and Summary Plan Description. |_| The Employer does not designate the Plan as a 404(c) plan. o "Employer" By: /s/ Xxxxxxx Xxxxx Xxxx Date: 9/26/96 Title: President Please return to Fidelity with executed Adoption Agreement. [LOGO] ================================================================================ [Stamp] SEP 27 1996 ================================================================================ The CORPORATEplan FOR RETIREMENT(SM) Request for Waiver of Sales Charge
Plan Name. The ConAgra 2009 Stock Plan (the “Plan”) Type of Option: Non-qualified Expiration Date: Term of Option:
Plan Name. Weiner's Stores, Inc. 2000 Executive Retention Plan Plan Sponsor: Weiner's Stores, Inc. Source of Contributions to the Plan: Company payments from corporate assets Plan Sponsor's IRS I.D. Number: 76-0355003 Plan Number: __________ Plan Administrator: Weiner's Stores, Inc. Retention Plan Committee c/o Chief Executive Officer 6005 Westview Drive Houston, Texas 77050 (000) 000-0000 Xxxxx xxx Xxxxxxx xx Legal Process: Raxxxxx X. Xxxxxr Weiner's Stores, Inc. 6005 Westview Drive Houston, Texas 77050 (000) 000-0000