HomeMy WebLinkAboutInv# 2025-00000599 - FLORIDA MUNICIPAL INSURANCE TRUST - 06/01/2025 (2)PREMIUMS ADJUSTMENTS TOTAL
Medical UHC Plan 2 Employee + 1 33 $47,647.05 $0.00 $47,647.05
Medical UHC Plan 2 Employee + Family 50 $110,781.50 $2,215.63 $112,997.13
Medical UHC Plan 2 Employee Only 96 $70,295.04 $732.24 $71,027.28
Medical UHC Plan 5 Employee + 1 0 $0.00 $0.00 $0.00
Medical UHC Plan 5 Employee + Family 1 $1,914.39 $0.00 $1,914.39
Medical UHC Plan 5 Employee Only 14 $8,857.52 $0.00 $8,857.52
$0.00 $0.00
$239,495.50 $2,947.87 $242,443.37 June
:$470,879.53
:-$233,599.76 April Paid
:$239,495.50
:$2,947.87
:$479,723.14
Gen Date: 05-20-2025 $237,279.77 May Paid
TOTAL DUE
BALANCE FORWARD
PAYMENTS
CURRENT PREMIUMS
ADJUSTMENTS
TERMED W/ADJ
DANIA BEACH Due Date: 06-01-2025
FMIT # FH0129
SUMMARY BILLING PAGE
COVERAGE
6/27/25
STATUS COVERAG PLAN NAME TIER PREMIUM ADJUSTME TOTAL
ACOSTA RAFAEL A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
ADAMS EMILEE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
ADAMS LORI A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
ALI RICKY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
ALPHONSE LOU A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
AZCANO ALEJANDRO A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BACAROSSI BIANCAMARIA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BALDIE TOMMY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
BATISTA CLAUDIA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
BOUTSIS EVE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BRATHWAITE DAVID A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BROWN MELISSA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BROWN NICKESHIA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BROWN RODRICK A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
BROWNE JOHNATHAN A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
CAMPBELL TRAVIS A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
CASTLEBERRY AISHA A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
CHAVARRIA ALBERTO A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
CHAVEZ FRANK A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
CHEN MICHAEL A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
CIGUENE MAUDELINE A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
COLLINS ROGER A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
CONWAY ASHLEY A Medical UHC Plan 2 Employee Only $732.24 $732.24 $1,464.48
COOK RONALD A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
CORNILEUS TYRONE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
CORTES ALVARO A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
COSTA NATHAN A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
CRAWFORD RUPERT A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
CROSS JERRYLYN A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
CUERVO ALEJANDRA A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
DAMIS WINDY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
DANIEL LAURENDA A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
DAVILA EDDA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
DAVIS JOYCE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
DE JESUS GABRIEL A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
DEMASSIS TAMARA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
DESIDERIO ZAIRA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
DIXON DEANDRALOE A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
DOMINGUEZ MARIA A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
DOTSON RICKEY A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
EDGE CHARLES A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
EKLE ROBERT A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
ESPINOSA JESSE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
FAGUY NICOLE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
FIGUEREDO LUIS A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
GARCIA ANA A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
GARDNER KALA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
GRANT MITCHELL A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
GREENE DARREN A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
GUZMAN YEIMY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
HAINES AMANDA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
HIRSCH STACY A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
HOPE JEANNETTE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
HUCK MICHAEL A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
HUGHES ANASTACIA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
ICENHOUR RACHEL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
IFEDI ANTHONY A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
IGLESIAS GUTIERCLAUDIO A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
JACKSON JOHNATHAN A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
JAMES TAMMIE A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
JELASO MEGAN A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
JOHNSON ANTOINE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
JOHNSON BRANDON A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
JOHNSON JR KENNITH A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
JOLLY CORY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
JOSEPH PATRICK A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
KALLICHARAN CARL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
KARAGUL ANIL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
KATTAK EDMUND A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
KNUDSON THEODORE A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
LAJOIE CORINNE A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
LANE-ROZEA AUSTIN A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LARIOS IBARGUE IBEL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LAWSON RACHELLE A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
LAZO FRANKY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
DANIA BEACH Due Date: 06-01-2025
Gen Date: 05-20-2025
EMPLOYEE NAME
Printed Date: 6/27/2025
LEWELLEN LORI A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
LIMA MARILANE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LOBO YAMIL A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
LOPEZ JERRY A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LOTTIER CHRISTINE A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
LUPOE TYLYSIA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MACKEY JESSICA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
MARTIN RALPH A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
MARTINEZ GABRIEL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MCDONALD MARVIN A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
MCDOWELL KEITH A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
MCFARLANE DARRYL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MCHELLON DONIAL A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
MCLAREN KRISTEN A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
MCNEAL GREGORY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
MICHELIN KAYLA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MIEREZ ANN A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MIRANDA SHANESA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MORALES ANGEL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MORRIS JAMAL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
NIBBS LUCIANO A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
NORENA ELEANOR A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
NOTICE JADEEN A Medical UHC Plan 5 Employee + Family $1,914.39 $0.00 $1,914.39
PAUL ASHLEY A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
PECORARO SHERRY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
PENATE ROQUE DELMIS A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
PEREZ FRANK A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
PETERSON TERRY A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
PETRISOR VALENTIN A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
POWELL DELAINE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RAMBEAU JABARI A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
REYES EDDIE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RIERA ELORA A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
RODRIGUEZ FERNANDO A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RODRIGUEZ HAROLD A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
RODRIGUEZ MICHAEL A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RODRIGUEZ RICHARD A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
RODRIGUEZ SUSSETTE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RYAN ARCHIBALD A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
SABINO DEBORAH A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
SALVINO MARCO A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SANDOVAL PERE ANDREA A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SANTANA TORREJULIO A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SCHUTTEN SEAN A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
SHAHRYAR MICHELLE A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
SINGH KEVIN A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SINGH MAXINE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SMITH ANDRE A Medical UHC Plan 2 Employee + Family $2,215.63 $2,215.63 $4,431.26
SMITH ROY A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SOLOMON GARCIA A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
SPEAR MITZIE A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
SPENCER WILLIE A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
STEVENS TANIA A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
STEWART KHIRY A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
TAYLOR CORRY A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
TERRAZAS MONICA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
THOMAS AHMAD A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
THOMAS ROMARIO A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
THOMPSON GEORGE A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
TORRES DULZAIDRANDEL A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
UROW BARBARA A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
VLASIC ASHLEY A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
WALL CHRISTINA A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
WALTON ERIC A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
WASHINGTON WILLIS A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
WEST COKENYA A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
WESTBERRY ANSON A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
WHITE DEON A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
WHITSON ADAM A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
WILLIAMS BRYSHAWN A Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
WILLIAMS DARIUS A Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
WISE DILLION A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
WRITER CYRUS A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
YANY MEGAN A Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
ZAPATA MARLON A Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
$242,443.37
$197,965.54
Printed Date: 6/27/2025
STATUS COVERAG PLAN NAME TIER PREMIUM ADJUSTME TOTAL
BROWN KENNETH R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BROWN LOUIS R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
BRUNNEMER MIKAL R Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
CARUSO BRUCE R Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
CHANDLER CHRISTOPHER R Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
CONNOLLY ROBERT R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
DARA MICHAEL R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
GARCIA GONZALO R Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
GONZAGA LIVANIA R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
HENG PETER R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
HUSOSKY JOSEPH R Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
JOHNSON ANTHONY R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
KENON FLOYD R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LAVINA ARMENIO R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LEXA JOHN R Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
LIEM BRUCE R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
LORBER RICHARD R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MACE ANGELINA R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MARIANI JENNIFER R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MCDONALD MARY R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
MUSTELIER LISA R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
NEAL TODD R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
PARRA ROBERT R Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
PATTERSON DIANNA R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
PELLECER SERGIO R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
PETRUZZELLI JAMES R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
PHIPPS BRIAN R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
QUIGLEY TIMOTHY R Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
REBOUR JEAN-PAUL R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
REID JAMES R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RIVIERE LETICIA R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
ROSE MARY R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
ROSS LUISA R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
RUDBECK BENJAMIN R Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
SALGADO JOSE R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
SATTERFIELD NICKI R Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
SIEB RICHARD R Medical UHC Plan 5 Employee Only $632.68 $0.00 $632.68
SNELL ARNOLD R Medical UHC Plan 2 Employee + Family $2,215.63 $0.00 $2,215.63
STUBBS DANIEL R Medical UHC Plan 2 Employee + 1 $1,443.85 $0.00 $1,443.85
SULLIVAN DARIN R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
URTECHO JOSE R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
WALTERS IRISH R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
WENTWORTH JEAN R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
WILLIAMSON JOHN R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24
$242,443.37
$44,477.83
DANIA BEACH Due Date: 06-01-2025
Gen Date: 05-20-2025
EMPLOYEE NAME
Printed Date: 6/27/2025