___ Health Coverage

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Point-of-Service Plan (POS)
• Indemnity Plan
• Other: ____________________

___ Vacation

___ Holidays

___ Sick Leave

___ Personal Days

___ Family Leave

___ Unpaid Leave

___ Flexible Spending Account (FSA)

___ Dental Coverage

___ Life Insurance

___ Disability Insurance

___ Educational Benefits

___ Employee Assistance Program

___ On-site Child Care

___ Retirement Plan

• Traditional Pension Plan
• 401(k) or 403(b) Plan
• Profit-Sharing Plan
• Simplified Employee Pension Plan (SEP)

___ Other (such as adoption assistance, wellness programs, legal assistance)