Employee Benefits Cost Analysis

Completing this form allows Elite Capital Management Group to create a customized Employee Benefits Cost Analysis for your credit union. All results are held in strict confidentiality.

Credit Union Information

Name of Credit Union

Date

Address

Address Line 1

City

State

Zip Code

Contact Person

Telephone

Asset Size

Number of Full Time Employees

Do you expect to see a significant increase in the number of covered employees?

If yes, how many?

When do you expect this will occur?

Projected Annual Health Benefit Increase (as a percentage)

Projected Annual Pay Increase to Employees (as a percentage)

Current Yield on Average Investment

Current Net Worth

For the data below, please indicate the calendar year from which the data was obtained

Employee Benefits Offered to Credit Union Employees

Health Related Benefit Costs (Annual)

Health Care

Dental Program

Vision Program

Long Term Care Insurance

Post-Retirement Healthcare

Health Savings Account (HSA) Contribution

Salary Dependent Benefit Costs (Annual)

Employer Paid 401(k) Match

Pension Contribution

Long Term Disability

Short Term Disability

Group Life, AD&D Insurance

Split Dollar Premiums

Split Dollar Premium Type

Select either Single or Annual

Split Dollar Premium Amount

Number of Payments Remaining

Executive 457(f) Deferred Compensation Plan

Plan Type

Select either Single or Annual

Deposit Amount

Number of Payments Remaining