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Health Care Costs per Employee per Month for the Calendar Year of: _________
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(Formulas are included)
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Medical Insurance Dental Insurance Any Other Total Health Total Number Total Health
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Premiums PaidPremiums Paid Health Care Care Costs of Employees Care Costs
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by Employerby EmployerCosts Paid Paid by Paid by
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by EmployerEmployer Employer
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per Employee
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January$0#DIV/0!
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February0#DIV/0!
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March0#DIV/0!
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April0#DIV/0!
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May0#DIV/0!
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June0#DIV/0!
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July0#DIV/0!
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August0#DIV/0!
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September0#DIV/0!
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October0#DIV/0!
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November0#DIV/0!
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December0#DIV/0!
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ANNUAL (uses average number of employees for the year)
$0$0$0$00٫0#DIV/0!
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