HomeMy WebLinkAboutInv# 4729230 - AMERIFLEX - 06/20/2025Ameriflex
P.O. Box 870217
Kansas City, MO 641870217
AMERIFLEX CLAIM INVOICE
Toll Free: 844.423.4636
Group Date Invoice #
City of Dania Beach 06/20/2025 4729230
Description Amount
Claims activity from 06/13/2025 to 06/19/2025 $1,269.35
Plan Year Type Location Name Social Security
Number Claim Date Transaction
Date
Transaction
Type Amount
Current FSA YEIMY
GUZMAN XXXXX3854 06/11/2025 06/12/2025 CARD $30.00
Current FSA YEIMY
GUZMAN XXXXX3854 06/11/2025 06/12/2025 CARD $218.61
Current FSA Travis Campbell XXXXX6883 06/13/2025 06/15/2025 CARD $714.00
Current FSA CORINNE
LAJOIE XXXXX7765 05/29/2025 06/18/2025 Manual
Claim $30.00
Current FSA CORINNE
LAJOIE XXXXX7765 01/15/2025 06/18/2025 Manual
Claim $20.00
Current FSA CORINNE
LAJOIE XXXXX7765 05/29/2025 06/18/2025 Manual
Claim $25.84
Current FSA Subtotal $1,038.45
Current DCA Jessica Mackey XXXXX6015 10/01/2024 06/13/2025 Manual
Claim $208.33
Current DCA Subtotal $208.33
Total $1,246.78
Processing $22.57
Grand Total $1,269.35
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