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Inv# 165479905 - Fidelity Security Life Insurance Company - 10/20/2022 (2)
FULL MONTH LIST EM Subscriber ID Last Name First Name Billing Tier Plan Rate Division Code Location Code Company Code Total 26265734500 ACOSTA RAFAEL Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265766300 ADAMS LORI Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265784900 ALPHONSE LOU Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26918422000 ANAYA ALEXANDRA Employee Only Benefit Level 1 $4.39 4.38 $0.01 27619023300 AZCANO ALEJANDRO Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265787900 BALDIE TOMMY Employee + Family Benefit Level 1 $12.24 12.24 $0.00 27805779400 BATISTA CLAUDIA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265784500 BORDY KATIA Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265793500 Borgos Luis Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265734000 BOUTSIS EVE Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265783800 BROWN RODRICK Employee + 1 Benefit Level 1 $8.33 12.24 ($3.91) 26265754300 BROWN LOUIS Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265753200 BROWN ERIC Employee + Family Benefit Level 1 $12.24 8.34 $3.90 27498160300 BROWNE JOHNATHAN Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265792000 Cangialosi Joseph Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265749600 Chen Michael Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265778100 CIGUENE MAUDELINE Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265757500 CLAYTON ERIKA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265786300 Collins Roger Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265787600 COOK RONALD Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265771800 COSTA NATHAN Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265788400 CRAWFORD RUPERT Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265743800 CROSS JERRYLYN Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265776000 DAMIS WINDY Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265788900 DAVILA EDDA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265766900 Davis Joyce Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265737000 DE JESUS Gabriel Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265777700 DIPAOLO FRANK Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265736100 DONNELLY COLIN Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265763800 DOTSON RICKEY Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265776900 DRUMMOND TAMARA Employee Only Benefit Level 1 $4.39 4.38 $0.01 27498159900 EKLE ROBERT Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265782200 FLORENCE TARIF Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265790200 GAINES TANEISHA Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265789700 GARDNER KALA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265769700 GRANT MITCHELL Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265779500 GREENE DARREN Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265764900 HARRIS WILLIAM Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265740800 HENLEY ALICE Employee Only Benefit Level 1 $4.39 4.38 $0.01 27523150200 HIRSCH STACY Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 28173567200 HOGGINS ERNEST Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265770900 HUCK MICHAEL Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265788700 HUGHES ANASTACIA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265789100 ICENHOUR RACHEL Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265742400 IFEDI ANTHONY Employee Only Benefit Level 1 $4.39 4.38 $0.01 27644267300 IGLESIAS GUTIERREZ CLAUDIO Employee Only Benefit Level 1 $4.39 4.38 $0.01 INVOICE NUMBER:165479905 To view dependent members, please see the Enrollment Report at eyemed.com/eyemanage ROSTER REPORT FULL ROSTER ROSTER LISTING FOR:The City of Dania Beach BILLING PERIOD:October, 2022 26265784600 JAMES TAMARA Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265759300 JAMES TAMMIE Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265775500 JELASO MEGAN Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265774300 JOHNSON BRANDON Employee Only Benefit Level 1 $4.39 8.34 ($3.95) 26265791600 JOHNSON ANTOINE Employee Only Benefit Level 1 $4.39 4.38 $0.01 27371199000 JOHNSON JR KENNITH Employee + 1 Benefit Level 1 $8.33 4.38 $3.95 26265791100 JOLLY CORY Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265782700 JOSEPH PATRICK Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265737900 KALLICHARAN CARL Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265765000 LAJOIE CORINNE Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265793700 LARIOS IBARGUEN IBEL Employee Only Benefit Level 1 $4.39 4.38 $0.01 28173565800 Lawson Rachelle Employee + Family Benefit Level 1 $12.24 12.24 $0.00 27712664100 Lima Marilane Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265739100 LOTTIER CHRISTINE Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265730200 Martin Ralph Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265775100 MARTINEZ GABRIEL Employee Only Benefit Level 1 $4.39 4.38 $0.01 27344168300 MCDOWELL KEITH Employee Only Benefit Level 1 $4.39 4.38 $0.01 27551170900 MCFARLANE DARRYL Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265747300 MCHELLON DONIAL Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265774800 McLaren Kristen Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265760800 McNabb Kenneth Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265780800 MCNEAL GREGORY Employee + Family Benefit Level 1 $12.24 12.24 $0.00 27975939200 MCPHEE JOYCE Employee Only Benefit Level 1 $4.39 4.38 $0.01 27551171500 MERCADO KARLA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 27571061000 MILES FELICIA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26340914900 Morrell Paula Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) same as howard 26265785200 MYKOO SHANESA Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265783200 NORENA ELEANOR Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265758300 ODMAN LAUREN Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265793100 OSTROFSKY WARREN Employee + Family Benefit Level 1 $12.24 $0.00 take out Warren 26265786100 Ozaydin Dincer Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265774500 PECORARO SHERRY Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265773100 PEGUERO ULYSSES Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265776400 PEIRCE LOGAN Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265774100 PEREZ FRANK Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265769600 PETERSON TERRY Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265770000 POLLARD ALBERLEAN Employee + Family Benefit Level 1 $12.24 12.24 $0.00 27475095000 QUINTERO JOHN Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265791900 REYES EDDIE Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265750100 RODRIGUEZ MICHAEL Employee + Family Benefit Level 1 $12.24 4.38 $7.86 26265778500 RODRIGUEZ HAROLD Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265737300 RODRIGUEZ FERNANDO Employee Only Benefit Level 1 $4.39 12.24 ($7.85) 26265773800 RODRIGUEZ RICHARD Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265756100 SABINO DEBORAH Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265782500 SALGADO JOSE Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265755700 Salvino Marco Employee Only Benefit Level 1 $4.39 4.38 $0.01 28173564600 Salz Benjamin Employee + Family Benefit Level 1 $12.24 12.24 $0.00 27431566000 SANCHEZ CLAUDIA Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265792200 SANTANA TORRES JULIO Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265789400 SAUNDERS JANICE Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265771300 SCHNEIDER THOMAS Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265780600 SEGAL ADAM Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265747900 SHELEY CHERIE Employee Only Benefit Level 1 $4.39 4.38 $0.01 26505006400 Singh Maxine Employee Only Benefit Level 1 $4.39 4.38 $0.01 28173567800 SPEAR MITZIE Employee Only Benefit Level 1 $4.39 4.38 $0.01 8.34 Somers - counted as Paula 26265743300 SPENCER WILLIE Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265733300 STEINER MURRAY Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265781200 STEVENS TANIA Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265790400 TAYLOR CORRY Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265781900 TERRAZAS MONICA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265748900 THOMAS AHMAD Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265733000 UROW BARBARA Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265737500 VASTA MICHAEL Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265779300 WALTON ERIC Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265769400 WAREN CASSANDRA Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265785400 WASHINGTON JR WILLIS Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265794500 WEEKES KATHLEEN Employee + 1 Benefit Level 1 $8.33 8.34 ($0.01) 26265760300 WEST COKENYA Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265781600 WESTBERRY ANSON Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265763500 WHITE GEORGE Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265746500 WHITE DEON Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265778800 Williams Darius Employee + Family Benefit Level 1 $12.24 12.24 $0.00 26265775300 WRITER CYRUS Employee Only Benefit Level 1 $4.39 4.38 $0.01 26265785800 ZAPATA MARLON Employee Only Benefit Level 1 $4.39 4.38 $0.01 Payroll remove Paula and put in retiree Location Total: $974.64 962.16 $0.24 962.16 ($12.48) Somers hit retiree 26265741800 Adams Laura Employee Only Benefit Level 1 $4.39 Retiree $12.48 Warren Ostrosky not to pay + .24 variance 26265753100 ANSBRO THOMAS Employee + Family Benefit Level 1 $12.24 Retiree 962.16 26265756800 BAKER ERIC Employee Only Benefit Level 1 $4.39 Retiree 26265758800 BAKER JAMES Employee Only Benefit Level 1 $4.39 Retiree 26265744800 BERNARDO MICHAEL Employee + 1 Benefit Level 1 $8.33 Retiree 27551170300 Bertino Barbara Employee Only Benefit Level 1 $4.39 Retiree 26265772700 BERTUCCIO JOSEPH Employee + 1 Benefit Level 1 $8.33 Retiree 26265752100 BLOCKER CHRISTY Employee Only Benefit Level 1 $4.39 Retiree 26265750000 Blust James Employee + 1 Benefit Level 1 $8.33 Retiree 26265744200 BOLTON CHESTER Employee Only Benefit Level 1 $4.39 Retiree 26265761200 BRANDES GLORIA Employee + 1 Benefit Level 1 $8.33 Retiree 26265740100 BRAVE JOANN Employee Only Benefit Level 1 $4.39 Retiree 26265791500 Brown Kenneth Employee Only Benefit Level 1 $4.39 Retiree 26265755200 BROWN MICHAEL Employee + 1 Benefit Level 1 $8.33 Retiree 26265735800 CARUSO BRUCE Employee + 1 Benefit Level 1 $8.33 Retiree 26265786600 Chandler Christopher Employee + Family Benefit Level 1 $12.24 Retiree 26265792500 CHERIAN DANIEL Employee + 1 Benefit Level 1 $8.33 Retiree 26265770200 Cook Dorothy Employee Only Benefit Level 1 $4.39 Retiree 26265754100 CRANDON FRANK Employee + 1 Benefit Level 1 $8.33 Retiree 27304666100 Dara Michael Employee Only Benefit Level 1 $4.39 Retiree 26265751400 DENNY NANCI Employee Only Benefit Level 1 $4.39 Retiree 26265764600 DUBISKY WILLIAM Employee + 1 Benefit Level 1 $8.33 Retiree 26265765400 FONDO GAIL Employee Only Benefit Level 1 $4.39 Retiree 26265759600 GARCIA GONZALO Employee + Family Benefit Level 1 $12.24 Retiree 26265764100 GARDNER EULA Employee Only Benefit Level 1 $4.39 Retiree 26265732300 Gennaro Joseph Employee Only Benefit Level 1 $4.39 Retiree 26265732500 Giaquinto Ralph Employee + 1 Benefit Level 1 $8.33 Retiree 26265770400 GILMOND RUSSELL Employee Only Benefit Level 1 $4.39 Retiree 26265760000 Grammer Thomas Employee Only Benefit Level 1 $4.39 Retiree 26265766500 Green Jack Employee Only Benefit Level 1 $4.39 Retiree 26265733600 Hansen Donald Employee + 1 Benefit Level 1 $8.33 Retiree 26265769300 Hess Robert Employee + 1 Benefit Level 1 $8.33 Retiree 26265747100 HOLDEN LlOYD Employee + 1 Benefit Level 1 $8.33 Retiree 26265747600 HUMPHREY JAMES Employee + 1 Benefit Level 1 $8.33 Retiree 26265752700 HUSOSKY JOSEPH Employee + Family Benefit Level 1 $12.24 Retiree 26265759000 JOHNSON ANTHONY Employee Only Benefit Level 1 $4.39 Retiree 26265787100 JOHNSON STANLEY Employee Only Benefit Level 1 $4.39 Retiree 26265742000 JOHNSON CHARLENE Employee + 1 Benefit Level 1 $8.33 Retiree 26265738400 JONES KRISTEN Employee Only Benefit Level 1 $4.39 Retiree 26265751000 KENON FLOYD Employee Only Benefit Level 1 $4.39 Retiree 26265747000 KIMMICH ROBERT Employee + 1 Benefit Level 1 $8.33 Retiree 26265762000 KIRBY DONNA Employee + 1 Benefit Level 1 $8.33 Retiree 26265738300 KOCH KENNETH Employee Only Benefit Level 1 $4.39 Retiree 26265752400 LAND KENNETH Employee + 1 Benefit Level 1 $8.33 Retiree 26265752800 LEXA JOHN Employee + Family Benefit Level 1 $12.24 Retiree 26265744500 Liem Bruce Employee Only Benefit Level 1 $4.39 Retiree 26265736600 Lorber Richard Employee Only Benefit Level 1 $4.39 Retiree 26265754500 MACE EUGENE Employee + Family Benefit Level 1 $12.24 Retiree 26265767100 MARIANI MARK Employee + Family Benefit Level 1 $12.24 Retiree 26265766100 MASON LINDA Employee Only Benefit Level 1 $4.39 Retiree 26265748300 MCDONALD MARY Employee Only Benefit Level 1 $4.39 Retiree 26265751900 MIKES ROBERT Employee Only Benefit Level 1 $4.39 Retiree 26265751700 Miller Miles Employee Only Benefit Level 1 $4.39 Retiree 26265753400 Molina Debbie Employee Only Benefit Level 1 $4.39 Retiree 26265773300 MORRIS GLENN Employee + 1 Benefit Level 1 $8.33 Retiree 26265753600 Mulford James Employee Only Benefit Level 1 $4.39 Retiree 26265773500 MUSTELIER JR ENRIQUE Employee Only Benefit Level 1 $4.39 Retiree 26265794800 ORLANDO DOMINIC Employee + 1 Benefit Level 1 $8.33 Retiree 27146264200 Palm Grace Employee Only Benefit Level 1 $4.39 Retiree 26265768900 PATELLARO LOU ANN Employee Only Benefit Level 1 $4.39 Retiree 26265758100 PATTERSON DIANNA Employee Only Benefit Level 1 $4.39 Retiree 26265740600 PELLECER SERGIO Employee Only Benefit Level 1 $4.39 Retiree 27831637800 Phipps Brian Employee Only Benefit Level 1 $4.39 Retiree 26265749500 Pink Nelson Employee + 1 Benefit Level 1 $8.33 Retiree 26265735300 Rigo Rudolf Employee + 1 Benefit Level 1 $8.33 Retiree 26265763100 RIVIERE JOSEPH Employee + 1 Benefit Level 1 $8.33 Retiree 26265745600 Roberson Charlene Employee + 1 Benefit Level 1 $8.33 Retiree 26265745100 Rodriguez Jose Employee Only Benefit Level 1 $4.39 Retiree 26265757000 ROSE PERRY Employee + Family Benefit Level 1 $12.24 Retiree 26265765700 ROSS FRANK Employee + 1 Benefit Level 1 $8.33 Retiree 27917802900 Rudbeck Benjamin Employee Only Benefit Level 1 $4.39 Retiree 26265761500 RUETH RICHARD Employee + 1 Benefit Level 1 $8.33 Retiree 26265767400 SATTERFIELD NICKI Employee + 1 Benefit Level 1 $8.33 Retiree 26265745200 SAVAGE JAMES Employee + 1 Benefit Level 1 $8.33 Retiree 27786125000 Sieb Richard Employee Only Benefit Level 1 $4.39 Retiree 26265746000 SLADE CURTIS Employee Only Benefit Level 1 $4.39 Retiree 26265753500 SMITH MICHAEL Employee Only Benefit Level 1 $4.39 Retiree 26265762500 Snell Arnold Employee + Family Benefit Level 1 $12.24 Retiree 26265792800 SOMERS HOWARD Employee + 1 Benefit Level 1 $8.33 Retiree 26265753700 STUBBS DANIEL Employee + 1 Benefit Level 1 $8.33 Retiree 26265795200 Sullivan Darin Employee Only Benefit Level 1 $4.39 Retiree 26265742900 TARMEY EDWARD Employee + 1 Benefit Level 1 $8.33 Retiree 26265750700 TUBRIDY THOMAS Employee + 1 Benefit Level 1 $8.33 Retiree 26340925000 URTECHO JOSE Employee Only Benefit Level 1 $4.39 Retiree 26265776600 WALTERS LEROY Employee + 1 Benefit Level 1 $8.33 Retiree 26265788200 WARWICK PANSY Employee Only Benefit Level 1 $4.39 Retiree 26265746700 WENTWORTH JEAN Employee Only Benefit Level 1 $4.39 Retiree 26265771500 Whitaker Stephen Employee Only Benefit Level 1 $4.39 Retiree 26265768600 WILLIAMS LEO Employee + 1 Benefit Level 1 $8.33 Retiree 26265750300 Zidar Matthew Employee + 1 Benefit Level 1 $8.33 Retiree Location Retiree Total: $603.65 Full Month Total: $1,578.29