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Company Name
State
Number of Employees
Pay Period
Employee Avg. Annual income




Qualified Employees
$




Total Pre-Tax Premium $

Company Gross Savings $

Less Admin Fee $

NET Savings Per-Pay-Period $

Employee Paycheck Increase Per Pay Period
$
Employee Paycheck Increase Per Month
$

Current Paycheck Example
Employee 1
Required Deductions
Pay Period Weekly
Gross Pay $00.00
Marital Status Married Filing Jointly
Allowances 2
Dependents Amount $0
Additional Withholding -
Pre-tax -
After-Tax -
401k $161.54
Major Medical $115.38
Net Taxable Income 00.00
Federal Income Tax $00.00
State Tax $00.00
Medicare $00.00
Social Security $00.00
SDI -
NET PAY $00.00


PAY TO THE ORDER OF: Employee 1 $00.00

Employee Paycheck Increase Per Pay Period
$
Employee Paycheck Increase Per Month
$

Capstone Plus Benefit
Employee 1
Required Deductions
Pay Period
Gross Pay $00.00
Marital Status Married Filing Jointly
Allowances 2
Dependents Amount $0
Additional Withholding -
Pre-tax -
Premium $00.00
After-Tax -
401k $161.54
Major Medical $115.38
Net Taxable Income $00.00
Federal Income Tax $00.00
State Tax $00.00
Medicare $00.00
Social Security $00.00
SDI -
Claim Payment $00.00
Post-tax Premium -
NET PAY $00.00
PAY TO THE ORDER OF: Employee 1 $00.00

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Savings
Avg. Emp. Increase Per Pay
$0.00
Avg. Emp. Increase Annually
$00.00
% of Qualified Employees
93%
Avg. Employer Savings PEPY
$00.00