B i l l i n g R e g i s t e r for FOOD DISTRIBUTORS, INC. 127 05 06 36 ...
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B i l l i n g R e g i s t e r
for FOOD DISTRIBUTORS, INC. 127
05
06
36
07
14
20
23
24
26
10
12
11
Department 007
ALSOBROOKS, CAROL A
433864445
01/01/1992
16.50
.55
1.50
3.75
66.39
3.09
.75
3.80
.40
BRITT, LARRY G
240337195
01/01/1992
16.50
2.50
1.50
3.75
27.95
3.09
.75
3.80
.40
BRITT, LESTER G
242524622
01/01/1992
16.50
2.50
.55
1.50
3.75
66.39
3.09
.75
3.80
.40
CARLISLE, GEORGE W
238405541
01/01/1992
16.50
2.50
1.50
3.75
27.95
3.09
.75
3.80
.40
CARLISLE, JOSEPH J
242218343
01/01/1992
16.50
1.50
3.75
27.95
3.09
.75
9.50
1.00
CARLISLE, PEGGY H
237526246
01/01/1992
16.50
2.50
1.50
3.75
27.95
3.09
.75
3.80
.40
FIELDS, JONATHAN TRACY
250358351
01/01/1992
16.50
2.50
.55
1.50
3.75
27.95
3.09
.75
3.80
.40
GODWIN, WILLIAM E
242600035
01/01/1992
16.50
1.50
3.75
66.39
3.09
.75
3.80
.40
ROWE, DEBORAH C
239332032
01/01/1992
16.50
1.50
3.75
66.39
3.09
.75
3.80
.40
Department Totals
GROUP TOTALS
05
9
$148.50
Administrative Fees - Medical
05
139
$2,293.50
Administrative Fees - Medical
06
5
$12.50
Administrative Fees - Dental
06
97
$242.50
Administrative Fees - Dental
36
3
$1.65
Administrative Fees - Disability
36
83
$46.65
Administrative Fees - Disability
07
9
$13.50
Hospital Review Fee
07
139
$208.50
Hospital Review Fee
14
9
$33.75
PPO Fee
14
139
$521.25
Local Service Fee
20
5
$139.75
Specific Stop Loss Premium - S
20
91
$2,543.45
Specific Stop Loss Premium - S
23
4
$265.56
Specific Stop Loss Premium - F
23
48
$3,186.72
Specific Stop Loss Premium - F
24
9
$27.81
Aggregate Stop Loss Premium
24
139
$429.51
Aggregate Stop Loss Premium
26
9
$6.75
Aggregate Accomodation
26
139
$104.25
Aggregate Accomodation
10
9
$39.90
Basic Life Insurance
10
134
$566.20
Basic Life Insurance
12
9
$4.20
Basic AD&D
12
134
$59.60
Basic AD&D
11
Dependent Life
11
46
$67.62
Dependent Life
