16 WASHINGTON COMMUNITY COLL. PDC: 120 541-25-0645 PS0210 1
BRAD ARBAUGH 01/20/04
9054 CRESCENT BAR RD NW
YAKIMA WA 98848-8965
DEAR EMPLOYEE:
THIS STATEMENT CONTAINS A SUMMARY OF YOUR CURRENT INSURANCE COVERAGES AND
RETIREMENT PROGRAMS. READ THIS CAREFULLY. IF THIS STATEMENT DISAGREES WITH YOUR
EXPECTED ENROLLMENT OR YOU WISH TO MAKE INFORMATION OR COVERAGE CHANGES, PLEASE
CONTACT YOUR BENEFITS ADMINISTRATOR.
YOUR BIRTH DATE IS 08/10/44 . YOUR COMPUTED MONTHLY SALARY IS $4,777.50
AND YOUR LIFE INSURANCE SALARY BASE IS $.00 .
EFFECTIVE 05/01/01 YOU AND YOUR SPOUSE/PARTNER ARE ENROLLED
IN THE MEDICAL PLAN PROVIDED BY GROUP HEALTH
YOUR MONTHLY PAYROLL CONTRIBUTION FOR THE MEDICAL PLAN IS -------------- $69.00
YOU HAVE THE FOLLOWING COVERAGES PROVIDED BY YOUR EMPLOYER:
DENTAL COVERAGE FOR YOU AND YOUR SPOUSE/PARTNER
IS PROVIDED BY UNIFORM DENTAL
$25,000 BASIC LIFE AND $5,000 ACCIDENTAL DEATH AND DISMEMBERMENT
BASIC LONG TERM DISABILITY BENEFIT IS $50 MONTHLY MINIMUM OR $240 MONTHLY
MAXIMUM WITH A 90 DAY ELIMINATION PERIOD
THE FOLLOWING OPTIONAL LIFE INSURANCE COVERAGES ARE AVAILABLE AND YOU HAVE SELECTED
THE COVERAGES THAT ARE INDICATED (NO OPTIONAL LIFE INSURANCE):
PART B $2500 ON SPOUSE AND $2500 ON EACH ELIGIBLE CHILD -- NOT SELECTED
PART B (SUPPLEMENTAL) ---------------------------------------- NOT SELECTED
PART C OPTIONAL LIFE ----------------------------------------- NOT SELECTED
PART D SUPPLEMENTAL LIFE ------------------------------------- NOT SELECTED
PART E VOLUNTARY AD&D ---------------------------------------- NOT SELECTED
*** YOU HAVE NOT SELECTED OPTIONAL LONG TERM DISABILITY COVERAGE ***
EFFECTIVE 05/01 THE RETIREMENT PLAN YOU ARE ENROLLED IN IS
TIAA/CREF 10% RED
YOUR RETIREMENT PLAN PREMIUM IS 10.00 % OF YOUR GROSS PAY
YOUR OPTIONAL TAX DEFERRED ANNUITY/DEFERRED COMPENSATION PLANS ARE:
085: DEFERRED COMP $1225.00
101: SRA TIAA/CREF $1192.26
***** KEEP THIS DOCUMENT WITH YOUR PERMANENT RECORDS *****
16 WASHINGTON COMMUNITY COLL. PDC: 130 547-48-1401 PS0210 2
LARRY ASHLOCK 01/20/04
MEYERS RD
YAKIMA WA 98948
DEAR EMPLOYEE:
THIS STATEMENT CONTAINS A SUMMARY OF YOUR CURRENT INSURANCE COVERAGES AND
RETIREMENT PROGRAMS. READ THIS CAREFULLY. IF THIS STATEMENT DISAGREES WITH YOUR
EXPECTED ENROLLMENT OR YOU WISH TO MAKE INFORMATION OR COVERAGE CHANGES, PLEASE
CONTACT YOUR BENEFITS ADMINISTRATOR.
YOUR BIRTH DATE IS 12/22/60 . YOUR COMPUTED MONTHLY SALARY IS $3,290.84
AND YOUR LIFE INSURANCE SALARY BASE IS $.00 .
EFFECTIVE 12/01/01 YOU, YOUR SPOUSE/PARTNER AND ELIGIBLE DEPENDENTS ARE ENROLLED
IN THE MEDICAL PLAN PROVIDED BY GROUP HEALTH
YOUR MONTHLY PAYROLL CONTRIBUTION FOR THE MEDICAL PLAN IS -------------- $91.00
YOU HAVE THE FOLLOWING COVERAGES PROVIDED BY YOUR EMPLOYER:
DENTAL COVERAGE FOR YOU, YOUR SPOUSE/PARTNER AND ELIGIBLE DEPENDENTS
IS PROVIDED BY UNIFORM DENTAL
$25,000 BASIC LIFE AND $5,000 ACCIDENTAL DEATH AND DISMEMBERMENT
BASIC LONG TERM DISABILITY BENEFIT IS $50 MONTHLY MINIMUM OR $240 MONTHLY
MAXIMUM WITH A 90 DAY ELIMINATION PERIOD
THE FOLLOWING OPTIONAL LIFE INSURANCE COVERAGES ARE AVAILABLE AND YOU HAVE SELECTED
THE COVERAGES THAT ARE INDICATED
PART B $2500 ON SPOUSE AND $2500 ON EACH ELIGIBLE CHILD -- NOT SELECTED
PART B (SUPPLEMENTAL) ---------------------------------------- NOT SELECTED
PART C OPTIONAL LIFE ----------------------------------------- NOT SELECTED
PART D SUPPLEMENTAL LIFE ------------------------------------- NOT SELECTED
PART E VOLUNTARY AD&D ---------------------------------------- NOT SELECTED
*** YOU HAVE NOT SELECTED OPTIONAL LONG TERM DISABILITY COVERAGE ***
EFFECTIVE 03/96 THE RETIREMENT PLAN YOU ARE ENROLLED IN IS
TIAA/CREF 7.5% RED
YOUR RETIREMENT PLAN PREMIUM IS 7.50 % OF YOUR GROSS PAY
***** KEEP THIS DOCUMENT WITH YOUR PERMANENT RECORDS *****
16 WASHINGTON COMMUNITY COLL. PDC: 120 553-67-0764 PS0210 3
FLOYD BENDER 01/20/04
517 CAYUSE ST
YAKIMA WA 99362
DEAR EMPLOYEE:
THIS STATEMENT CONTAINS A SUMMARY OF YOUR CURRENT INSURANCE COVERAGES AND
RETIREMENT PROGRAMS. READ THIS CAREFULLY. IF THIS STATEMENT DISAGREES WITH YOUR
EXPECTED ENROLLMENT OR YOU WISH TO MAKE INFORMATION OR COVERAGE CHANGES, PLEASE
CONTACT YOUR BENEFITS ADMINISTRATOR.
YOUR BIRTH DATE IS 07/07/56 . YOUR COMPUTED MONTHLY SALARY IS $7,625.00
AND YOUR LIFE INSURANCE SALARY BASE IS $91,500.00 .
EFFECTIVE 08/01/03 YOU AND YOUR SPOUSE/PARTNER ARE ENROLLED
IN THE MEDICAL PLAN PROVIDED BY UNIFORM MEDICAL
YOUR MONTHLY PAYROLL CONTRIBUTION FOR THE MEDICAL PLAN IS -------------- $82.00
YOU HAVE THE FOLLOWING COVERAGES PROVIDED BY YOUR EMPLOYER:
DENTAL COVERAGE FOR YOU AND YOUR SPOUSE/PARTNER
IS PROVIDED BY UNIFORM DENTAL
$25,000 BASIC LIFE AND $5,000 ACCIDENTAL DEATH AND DISMEMBERMENT
BASIC LONG TERM DISABILITY BENEFIT IS $50 MONTHLY MINIMUM OR $240 MONTHLY
MAXIMUM WITH A 90 DAY ELIMINATION PERIOD
THE FOLLOWING OPTIONAL LIFE INSURANCE COVERAGES ARE AVAILABLE AND YOU HAVE SELECTED
THE COVERAGES THAT ARE INDICATED ("NON-SMOKERS" PREMIUM RATE):
PART B $2500 ON SPOUSE AND $2500 ON EACH ELIGIBLE CHILD -- NOT SELECTED
PART B (SUPPLEMENTAL) ---------------------------------------- NOT SELECTED
PART C OPTIONAL LIFE (BASE SALARY ROUNDED UP TO NEXT THOUSAND) $92,000
COVERAGE WILL INCREASE WITH SALARY INCREASES
MONTHLY DEDUCTION AMOUNT ------------------------------ $13.80
PART D SUPPLEMENTAL LIFE ------------------------------------- $92,000
MONTHLY DEDUCTION AMOUNT ------------------------------ $13.80
PART E VOLUNTARY AD&D ---------------------------------------- NOT SELECTED
EFFECTIVE 08/01/03 YOU ARE ENROLLED FOR OPTIONAL LONG TERM DISABILITY COVERAGE
YOUR WAITING PERIOD IS 120 DAYS AND YOUR MONTHLY DEDUCTION AMOUNT IS $32.79
EFFECTIVE 07/03 THE RETIREMENT PLAN YOU ARE ENROLLED IN IS
TIAA/CREF 7.5% RED
YOUR RETIREMENT PLAN PREMIUM IS 7.50 % OF YOUR GROSS PAY
***** KEEP THIS DOCUMENT WITH YOUR PERMANENT RECORDS *****
16 WASHINGTON COMMUNITY COLL. PDC: 130 540-67-6375 PS0210 50
JON ZIMMERMANN 01/20/04
N RIVER RD
YAKIMA WA 99350
DEAR EMPLOYEE:
THIS STATEMENT CONTAINS A SUMMARY OF YOUR CURRENT INSURANCE COVERAGES AND
RETIREMENT PROGRAMS. READ THIS CAREFULLY. IF THIS STATEMENT DISAGREES WITH YOUR
EXPECTED ENROLLMENT OR YOU WISH TO MAKE INFORMATION OR COVERAGE CHANGES, PLEASE
CONTACT YOUR BENEFITS ADMINISTRATOR.
YOUR BIRTH DATE IS 05/12/53 . YOUR COMPUTED MONTHLY SALARY IS $3,928.34
AND YOUR LIFE INSURANCE SALARY BASE IS $47,140.00 .
EFFECTIVE 01/01/03 YOU AND YOUR SPOUSE/PARTNER ARE ENROLLED
IN THE MEDICAL PLAN PROVIDED BY GROUP HEALTH
YOUR MONTHLY PAYROLL CONTRIBUTION FOR THE MEDICAL PLAN IS -------------- $69.00
YOU HAVE THE FOLLOWING COVERAGES PROVIDED BY YOUR EMPLOYER:
DENTAL COVERAGE FOR YOU AND YOUR SPOUSE/PARTNER
IS PROVIDED BY UNIFORM DENTAL
$25,000 BASIC LIFE AND $5,000 ACCIDENTAL DEATH AND DISMEMBERMENT
BASIC LONG TERM DISABILITY BENEFIT IS $50 MONTHLY MINIMUM OR $240 MONTHLY
MAXIMUM WITH A 90 DAY ELIMINATION PERIOD
THE FOLLOWING OPTIONAL LIFE INSURANCE COVERAGES ARE AVAILABLE AND YOU HAVE SELECTED
THE COVERAGES THAT ARE INDICATED ("NON-SMOKERS" PREMIUM RATE):
PART B $2500 ON SPOUSE AND $2500 ON EACH ELIGIBLE CHILD --
MONTHLY DEDUCTION AMOUNT ------------------------------ $0.65
PART B (SUPPLEMENTAL) ---------------------------------------- $25,000
MONTHLY DEDUCTION AMOUNT ------------------------------ $5.75
PART C OPTIONAL LIFE (BASE SALARY ROUNDED UP TO NEXT THOUSAND) $48,000
COVERAGE WILL INCREASE WITH SALARY INCREASES
MONTHLY DEDUCTION AMOUNT ------------------------------ $11.04
PART D SUPPLEMENTAL LIFE ------------------------------------- $50,000
MONTHLY DEDUCTION AMOUNT ------------------------------ $11.50
PART E VOLUNTARY AD&D ---------------------------------------- $250,000
MONTHLY DEDUCTION AMOUNT ------------------------------ $6.00
*** YOU HAVE NOT SELECTED OPTIONAL LONG TERM DISABILITY COVERAGE ***
EFFECTIVE 01/03 THE RETIREMENT PLAN YOU ARE ENROLLED IN IS
TIAA/CREF 10% RED
YOUR RETIREMENT PLAN PREMIUM IS 10.00 % OF YOUR GROSS PAY
***** KEEP THIS DOCUMENT WITH YOUR PERMANENT RECORDS *****
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