HomeMy WebLinkAboutInv# 2023-00000503 - FLORIDA MUNICIPAL INSURANCE TRUST - 06/01/2023 (2)PREMIUMS ADJUSTMENTS TOTAL
Medical Plan 2 Employee + 1 32 $49,538.56 $762.98 $50,301.54
Medical Plan 2 Employee + Family 45 $106,901.10 $0.00 $106,901.10
Medical Plan 2 Employee Only 86 $67,518.60 $0.00 $67,518.60
Medical Plan 5 Employee + 1 0 $0.00 $0.00 $0.00
Medical Plan 5 Employee + Family 0 $0.00 $0.00 $0.00
Medical Plan 5 Employee Only 7 $4,748.45 $0.00 $4,748.45
-$2,333.18 -$2,333.18
$228,706.71 -$1,570.20 $227,136.51 June Due
:$467,704.25
:-$236,620.22
:$228,706.71
:-$1,570.20
:$458,220.54
$231,084.03 May Paid
TOTAL DUE
Gen Date: 05-19-2023
BALANCE FORWARD
PAYMENTS
CURRENT PREMIUMS
ADJUSTMENTS
TERMED W/ADJ
DANIA BEACH Due Date: 06-01-2023
FMIT # FH0129
SUMMARY BILLING PAGE
COVERAGE
STATUS COVERAG PLAN NAME TIER PREMIUM ADJUSTMETOTAL
ACOSTA RAFAEL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
ADAMS LORI A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
ALI RICKY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
ALPHONSE LOU A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
ANAYA ALEXANDRA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
AZCANO ALEJANDRO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BALDIE TOMMY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BATISTA CLAUDIA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BORDY KATIA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BOUTSIS EVE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BROWN ERIC A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BROWN LOUIS A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BROWN RODRICK A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
BROWNE JOHNATHAN A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
CANGIALOSI JOSEPH A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
CHEN MICHAEL A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
COLLINS ROGER A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
COOK RONALD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
COSTA NATHAN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
CRAWFORD RUPERT A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
CROSS JERRYLYN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DAMIS WINDY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DAVILA EDDA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DAVIS JOYCE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DE JESUS GABRIEL A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
DIPAOLO FRANK A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DOMINGUEZ MARIA A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
DONNELLY COLIN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DOTSON RICKEY A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DRUMMOND TAMARA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
EDGE CHARLES A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
EKLE ROBERT A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GAINES TANEISHA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GARDNER KALA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GRANT MITCHELL A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
GREENE DARREN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
GUZMAN YEIMY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
HARRIS WILLIAM A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
HENLEY MOKIETA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HIRSCH STACY A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
HOGGINS ERNEST A Medical Plan 2 Employee + 1 $1,548.08 $762.98 $2,311.06
HUCK MICHAEL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
HUGHES ANASTACIA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
ICENHOUR RACHEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
IFEDI ANTHONY A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
IGLESIAS GUTI CLAUDIO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JACKSON JOHNATHAN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JAMES TAMARA A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JAMES TAMMIE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JELASO MEGAN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
JOHNSON ANTOINE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JOHNSON BRANDON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JOHNSON JR KENNITH A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JOLLY CORY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
JOSEPH PATRICK A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
KALLICHARAN CARL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
KNUDSON THEODORE A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
LAJOIE CORINNE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
LARIOS IBARG IBEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LAWSON RACHELLE A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
LEWELLEN LORI A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
LIMA MARILANE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LOBO YAMIL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
LOTTIER CHRISTINE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
MARTIN RALPH A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MARTINEZ GABRIEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MCDONALD MARVIN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCDOWELL KEITH A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
MCFARLANE DARRYL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DANIA BEACH Due Date: 06-01-2023
Gen Date: 05-19-2023
EMPLOYEE NAME
Printed Date: 6/21/2023
MCHELLON DONIAL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCLAREN KRISTEN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCNABB KENNETH A Plan 2 $0.00 #######-$1,548.08
MCNEAL GREGORY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCPHEE JOYCE A Plan 2 $0.00 -$785.10 -$785.10
MERCADO KARLA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MIEREZ ANN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MIRANDA SHANESA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
NORENA ELEANOR A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
OZAYDIN DINCER A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
PECORARO SHERRY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
PEGUERO ULYSSES A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PEIRCE LOGAN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PEREZ FRANK A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
PERRY LEONARD A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PETERSON TERRY A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
POLLARD ALBERLEAN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
QUINTERO JOHN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
REYES EDDIE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RIERA ELORA A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
RODRIGUEZ FERNANDO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RODRIGUEZ HAROLD A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
RODRIGUEZ MICHAEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RODRIGUEZ RICHARD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
RYAN ARCHIBALD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SABINO DEBORAH A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SALGADO JOSE A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SALVINO MARCO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SANTANA JULIO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SAUNDERS JANICE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SEGAL ADAM A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SHAHRYAR MICHELLE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SHELEY CHERIE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SINGH KEVIN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SINGH MAXINE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SPEAR MITZIE A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
SPENCER ANGELA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SPENCER WILLIE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
STEVENS TANIA A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
TAYLOR CORRY A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
TERRAZAS MONICA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
THOMAS AHMAD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
UROW BARBARA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
VASTA MICHAEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WALTON ERIC A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WASHINGTON WILLIS A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WEEKES KATHLEEN A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
WEST COKENYA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WESTBERRY ANSON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WHITE DEON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WILLIAMS BRYSHAWN A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
WILLIAMS DARIUS A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WILLIAMS HAN CHARLES A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WRITER CYRUS A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
ZAPATA MARLON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
$176,265.20
Printed Date: 6/21/2023
STATUS COVERAG PLAN NAME TIER PREMIUM ADJUSTMETOTAL
ANSBRO NOAH R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BAKER ERIC R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BERTUCCIO JOSEPH R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
BROWN KENNETH R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
CARUSO BRUCE R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
CHANDLER CHRISTOPHER R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DARA MICHAEL R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GARCIA GONZALO R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
GONZAGA LIVANIA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HANSEN DONALD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HENG PETER R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HUSOSKY JOSEPH R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
JOHNSON ANTHONY R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JOHNSON STANLEY R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
KENON FLOYD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LAVINA ARMENIO R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LEXA JOHN R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
LIEM BRUCE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LORBER RICHARD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MACE ANGELINA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MARIANI JENNIFER R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MCDONALD MARY R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MUSTELIER JR ENRIQUE R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
NEAL TODD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PATELLARO LOUANN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PATTERSON DIANNA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PELLECER SERGIO R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PHIPPS BRIAN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RIVIERE JOSEPH R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
RODRIGUEZ JOSE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
ROSE MARY R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
ROSS LUISA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RUDBECK BENJAMIN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RUETH PATRICIA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SATTERFIELD NICKI R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SIEB RICHARD R Medical Plan 5 Employee Only $678.35 $0.00 $678.35
SLADE CURTIS R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SMITH MICHAEL R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SNELL ARNOLD R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SOMERS PATRICIA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
STUBBS DANIEL R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SULLIVAN DARIN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
TARMEY LORI R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
TRAVAGLIO-W CHER R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
URTECHO JOSE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WALTERS IRISH R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WENTWORTH JEAN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WILLIAMSON JOHN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
50,871.31 - 50,871.31
DANIA BEACH Due Date: 06-01-2023
Gen Date: 05-19-2023
EMPLOYEE NAME
Printed Date: 6/21/2023