B i l l i n g R e g i s t e r for FOOD DISTRIBUTORS, INC. 127 05 06 36 ...

2262 users shared this document! click

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

Comments