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HomeMy WebLinkAboutInv# 4718086 - AMERIFLEX - 06/06/2025Ameriflex  P.O. Box 870217  Kansas City, MO 64187­0217 AMERIFLEX CLAIM INVOICE  Toll Free: 844.423.4636  Group Date Invoice # City of Dania Beach 06/06/2025 4718086 Description Amount Claims activity from 05/30/2025 to 06/05/2025 $1,055.33 Plan Year Type Location Name Social Security Number Claim Date Transaction Date Transaction Type Amount Current FSA BARBARA UROW XXX­XX­8608 05/28/2025 05/29/2025 CARD $30.00 Current FSA MONICA TERRAZAS XXX­XX­2257 05/28/2025 05/29/2025 CARD $15.00 Current FSA MONICA TERRAZAS XXX­XX­2257 05/30/2025 05/31/2025 CARD $15.00 Current FSA KENNITH JOHNSON JR XXX­XX­0217 05/30/2025 05/31/2025 CARD $5.48 Current FSA BARBARA UROW XXX­XX­8608 05/30/2025 06/02/2025 CARD $30.00 Current FSA BARBARA UROW XXX­XX­8608 06/01/2025 06/02/2025 CARD $15.00 Current FSA JERRYLYN CROSS XXX­XX­3296 06/02/2025 06/03/2025 CARD $30.00 Current FSA BARBARA UROW XXX­XX­8608 06/03/2025 06/04/2025 CARD $31.43 Current FSA BARBARA UROW XXX­XX­8608 06/02/2025 06/04/2025 CARD $30.00 Current FSA Subtotal $201.91 Current LPF Sean Schutten XXX­XX­1001 05/28/2025 05/29/2025 CARD $218.00 Current LPF Sean Schutten XXX­XX­1001 06/03/2025 06/04/2025 CARD $200.00 Current LPF Subtotal $418.00 Current DCA Jessica Mackey XXX­XX­6015 10/01/2024 05/30/2025 Manual Claim $208.33 Current DCA CASSANDRA WAREN XXX­XX­6299 06/02/2025 06/03/2025 CARD $208.33 Current DCA Subtotal $416.66 Total $1,036.57 Processing $18.76 Grand Total $1,055.33 Page 1 / 2 Ameriflex P.O. Box 870217 Kansas City, MO 64187­0217 AMERIFLEX CLAIM INVOICE Toll Free: 844.423.4636 Group Date Invoice #City of Dania Beach 06/06/2025 4718086Description AmountClaims activity from 05/30/2025 to 06/05/2025 $1,055.33Plan Year Type Location Name Social SecurityNumber Claim Date TransactionDate TransactionType AmountCurrentFSABARBARA UROW XXX­XX­8608 05/28/2025 05/29/2025 CARD $30.00CurrentFSAMONICATERRAZASXXX­XX­2257 05/28/2025 05/29/2025 CARD $15.00CurrentFSAMONICATERRAZASXXX­XX­2257 05/30/2025 05/31/2025 CARD $15.00CurrentFSAKENNITHJOHNSON JR XXX­XX­0217 05/30/2025 05/31/2025 CARD $5.48CurrentFSABARBARA UROW XXX­XX­8608 05/30/2025 06/02/2025 CARD $30.00CurrentFSABARBARA UROW XXX­XX­8608 06/01/2025 06/02/2025 CARD $15.00CurrentFSAJERRYLYN CROSS XXX­XX­3296 06/02/2025 06/03/2025 CARD $30.00CurrentFSABARBARA UROW XXX­XX­8608 06/03/2025 06/04/2025 CARD $31.43CurrentFSABARBARA UROW XXX­XX­8608 06/02/2025 06/04/2025 CARD $30.00CurrentFSASubtotal$201.91CurrentLPFSean Schutten XXX­XX­1001 05/28/2025 05/29/2025 CARD $218.00CurrentLPFSean Schutten XXX­XX­1001 06/03/2025 06/04/2025 CARD $200.00CurrentLPFSubtotal$418.00CurrentDCAJessica Mackey XXX­XX­6015 10/01/2024 05/30/2025 ManualClaim $208.33CurrentDCACASSANDRA WAREN XXX­XX­6299 06/02/2025 06/03/2025 CARD $208.33 Current DCA Subtotal $416.66 Total $1,036.57 Processing $18.76 Grand Total $1,055.33 Page 2 / 2