| U.S. Department of Energy | ||||||
| Report of Contractor Expenditures for Employee Supplemental Compensation | ||||||
| Compensation & Benefits Profile Report for Calendar Year 2014 | ||||||
| Status: Date Submitted | (DD/MM/YY) | |||||
| Status: Date Approved | (DD/MM/YY) | |||||
| Enter or select data in cells with yellow background. | ||||||
| Field Office | ||||||
| Facility (Site) | ||||||
| Contractor | ||||||
| Contract Number: | ||||||
| PART ONE - EMPLOYMENT PER CONTRACT - IF FULL YEAR ENTER 52 WEEKS OTHERWISE ENTER NUMBER OF WEEKS BELOW | ||||||
| Number of Employees | No. of Employees | Enter Number of Weeks or 52 below | ||||
| Exempt: | ||||||
| Bargaining Unit: | If Contract Less than a Year Enter Start Date and/or End Date Below | |||||
| Nonexempt Nonbargaining Unit: | Start Date: | |||||
| Total Employees (Not Retired) | 0 | Finish Date: | ||||
| Retirees: | 0 | |||||
| PART TWO - GROSS PAY | ||||||
| Types of Expenditure | Total | Bargaining | Total Nonbarg | Exempt | Non Exempt | |
| Gross Payroll | 0 | 0 | 0 | 0 | 0 | |
| Annual Base Pay | 0 | 0 | 0 | 0 | 0 | |
| Straight-Time Pay Worked: | 0 | 0 | ||||
| Paid-Time off: | 0 | 0 | 0 | 0 | 0 | |
| Vacation Pay | 0 | 0 | ||||
| Vacation Pay in Lieu: | 0 | 0 | ||||
| Holiday Pay: | 0 | 0 | ||||
| Holiday Pay in Lieu: | 0 | 0 | ||||
| Sick Leave Pay: | 0 | 0 | ||||
| Personal Leave Bank: | 0 | 0 | ||||
| Personal Leave Pay: | 0 | 0 | ||||
| Parental Leave: | 0 | 0 | ||||
| Supplemental Pay: | 0 | 0 | ||||
| Other Paid Leave Pay: | 0 | 0 | ||||
| Overtime Pay: | 0 | 0 | 0 | 0 | 0 | |
| Straight Time Portion: | 0 | 0 | 0 | |||
| Premium Portion: | 0 | 0 | 0 | |||
| Types of Expenditure | Total | Bargaining | Total Nonbarg | Exempt | Non Exempt | |
| Severance Pay: | 0 | 0 | 0 | 0 | 0 | |
| Other Pay: | 0 | 0 | 0 | 0 | 0 | |
| Shift Differential: | 0 | 0 | ||||
| Lump Sum Payment: | 0 | 0 | ||||
| Performance Incentive Compensation: | 0 | 0 | ||||
| Cash Award: | 0 | 0 | ||||
| Non Performance-Based Bonuses: | 0 | 0 | ||||
| Facility Closing Retention Bonus: | 0 | 0 | ||||
| Voluntary Separation Bonus: | 0 | 0 | ||||
| Relocation/Housing Allowance-Direct: | 0 | 0 | ||||
| Relocation/Housing Allowance-Other: | 0 | 0 | ||||
| Remote/Isolation Pay: | 0 | 0 | ||||
| Hazard Duty Pay: | 0 | 0 | ||||
| Expatriate Allowance: | 0 | 0 | ||||
| Education Allowance-Pay: | 0 | 0 | ||||
| Other Overtime Payment: | 0 | 0 | ||||
| Geographic Differential Pay: | 0 | 0 | ||||
| Dependent Care: | 0 | 0 | ||||
| Miscellaneous (MISC). Compensation: | 0 | 0 | ||||
| PART TWO - LEGAL REQUIRED | Total | Bargaining | ||||
| Legally Required Insurance: | 0 | 0 | ||||
| Social Security: | ||||||
| Other Retirement Insurance: | ||||||
| Unemployment: | 0 | 0 | ||||
| Unemployment - Federal: | ||||||
| Unemployment - State: | ||||||
| Occupational Injury & Illness: | 0 | 0 | ||||
| Workers' Compensation: | ||||||
| Benefits Under EEOICPA - Subtitle D: | ||||||
| Other Legacy Benefits / Health Studies: | ||||||
| Other Legally Required Insurance: | ||||||
| PART TWO LIFE/DEATH | Total | Bargaining | ||||
| Life/Death Benefits: | 0 | 0 | ||||
| Life Insurance: | ||||||
| Death Benefits: | ||||||
| PART TWO - MEDICAL | Total | Bargaining | ||||
| Medical/Medically Related: | 0 | 0 | ||||
| Insured Active Medical - Including Prescription Drugs: | ||||||
| Self-Insured Active Medical - Including Prescription Drugs: | ||||||
| Dental Active: | ||||||
| Vision Active: | ||||||
| Misc. Medical Active: | ||||||
| Insured Retiree Medical - Including Prescription Drugs: | ||||||
| Self-Insured Retiree Medical - Including Prescripton Drugs: | ||||||
| Dental-Retiree: | ||||||
| Vision Retiree: | ||||||
| Misc. Medical-Retiree: | ||||||
| Short-Term Disability: | ||||||
| Long-Term Disability: | ||||||
| Displaced Worker: | ||||||
| PART TWO - RETIREMENT | Total | Bargaining | ||||
| Retirement: | 0 | 0 | ||||
| Defined Contribution, Employer Contribution: | ||||||
| Defined Benefit, Employer Contribution: | ||||||
| Disbursements: | ||||||
| Expenses: | ||||||
| PART TWO - OTHER | Total | Bargaining | ||||
| Other: | 0 | 0 | ||||
| Vacation/Holiday Funds: | ||||||
| Dependent Care: | ||||||
| Employee Assistance Program: | ||||||
| Misc. Benefits: | ||||||
| PART THREE - PAID HOURS | Total | Bargaining | Total Nonbarg | Exempt | Non Exempt | |
| Paid Hours | 0 | 0 | 0 | 0 | 0 | |
| Straight Hours | 0 | 0 | ||||
| Overtime Hours | 0 | 0 | ||||
| Premium Hours | 0 | 0 | ||||
| Vacation Hours | 0 | 0 | ||||
| Holiday Hours | 0 | 0 | ||||
| Sick Leave Hours | 0 | 0 | ||||
| Personal Leave Bank Hours | 0 | 0 | ||||
| Personal Leave Hours | 0 | 0 | ||||
| Other Paid Leave Hours | 0 | 0 | ||||
| Average Hours per Week | 41 | |||||
| PART FOUR - HEALTH CARE PLANS | ||||||
| 1. Indicate whether the employer (contractor) provides a flexible benefits program by entering a Yes or No | ||||||
| 2. Provide the number of medical plans by category (If a type of medical plan is not provided, enter "0." This field must not be blank: | ||||||
| Group Indemnity Health Insurance | ||||||
| Health Maintenance Organization (HMO) | ||||||
| Preferred Provider Organization ( PPO) | ||||||
| Point of Service Plan (POS) | ||||||
| Consumer Driven Health Plan (CDHP) | ||||||
| Other | ||||||
| 3. Provide the percentage of contribution the employees required to contribute to any medical plan(s) provided by employer (contractor). | ||||||
| Use an average percentage if contributions vary among multiple plans. Include both bargaining and nonbargaining in your average. | ||||||
| Percent Active Single | ||||||
| Percent Active Family | ||||||
| 4. Provide the percentage the retirees are required to contribute to any medical Plan(s) provided by the Employer (contractor). | ||||||
| Use an average percentage of contributions vary among multiple plans. | ||||||
| Percent Under 65 Retiree | ||||||
| Percent 65 & Older Retiree | ||||||
| 5. Provide the number of retirees who are enrolled in a Retiree Medical Plan (exclude spouse and/or dependents). | ||||||
| Retirees in Medical Plan Under 65: | ||||||
| Retirees in Medical Plans 65 and older | ||||||
| PART FIVE - | ||||||
| Comments: | ||||||
| Misc. Benefits include Health Care Spending Account, Match, FMLA Salary Continuance & FMLA Illness. | ||||||
| Methodology: Place Methodology Here; | ||||||
| File Type | application/vnd.ms-excel |
| Author | Hallfra |
| Last Modified By | whitacr |
| File Modified | 2015-04-06 |
| File Created | 2012-09-19 |