HomeMy WebLinkAboutInv# 2024-00000739 - FLORIDA MUNICIPAL INSURANCE TRUST - 08/28/2024PREMIUMS ADJUSTMENTS TOTAL
Medical UHC Plan 2 Employee + 1 37 $56,591.50 $1,529.50 $58,121.00
Medical UHC Plan 2 Employee + Family 48 $112,659.36 $0.00 $112,659.36
Medical UHC Plan 2 Employee Only 88 $68,259.84 $0.00 $68,259.84
Medical UHC Plan 5 Employee + 1 0 $0.00 $0.00 $0.00
Medical UHC Plan 5 Employee + Family 1 $2,027.96 $0.00 $2,027.96
Medical UHC Plan 5 Employee Only 10 $6,702.10 $0.00 $6,702.10
$0.00 $0.00
$246,240.76 $1,529.50 $247,770.26 Aug Inv
:$448,967.55
:-$242,639.58 June Pmt
:$246,240.76
:$1,529.50
:$454,098.23
Gen Date: 07-19-2024 $247,770.26 Aug Due
TERMED W/ADJ
DANIA BEACH Due Date: 08-01-2024
FMIT # FH0129
SUMMARY BILLING PAGE
COVERAGE
TOTAL DUE
BALANCE FORWARD
PAYMENTS
CURRENT PREMIUMS
ADJUSTMENTS
8/27/24
STATUS COVERAG PLAN NAME TIER PREMIUM ADJUSTMEN TOTAL
ACOSTA RAFAEL A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
ADAMS LORI A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
ALI RICKY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
ALPHONSE LOU A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
AZCANO ALEJANDRO A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BALDELOMAR-FARACH A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BALDIE TOMMY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
BATISTA CLAUDIA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
BOUTSIS EVE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BRATHWAITE DAVID A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BROWN LOUIS A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BROWN MELISSA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BROWN RODRICK A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
BROWNE JOHNATHAN A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
CANGIALOSI JOSEPH A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
CASERTA CHRISTINA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
CASTLEBERRYAISHA A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
CHAPMAN PORJESSICA A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
CHAVARRIA ALBERTO A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
CHEN MICHAEL A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
COLLINS ROGER A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
COOK RONALD A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
CORNILEUS TYRONE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
COSTA NATHAN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
CRAWFORD RUPERT A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
CROSS JERRYLYN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
DAMIS WINDY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
DAVILA EDDA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
DAVIS JOYCE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
DE JESUS GABRIEL A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
DEMASSIS TAMARA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
DIPAOLO FRANK A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
DIXON DEANDRALOE A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
DOMINGUEZ MARIA A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
DONNELLY COLIN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
DOS SANTOS ERICK A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
DOTSON RICKEY A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
EDGE CHARLES A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
EKLE ROBERT A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
GARDNER KALA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
GORDON SHARINA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
GRANT MITCHELL A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
GREENE DARREN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
GUZMAN YEIMY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
HIRSCH STACY A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
HUCK MICHAEL A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
HUGHES ANASTACIA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
ICENHOUR RACHEL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
IFEDI ANTHONY A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
IGLESIAS GUT CLAUDIO A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
JACKSON JOHNATHAN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
JAMES TAMARA A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
JAMES TAMMIE A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
JELASO MEGAN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
JOHNSON ANTOINE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
JOHNSON BRANDON A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
JOHNSON JR KENNITH A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
JOLLY CORY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
JOSEPH PATRICK A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
KALLICHARAN CARL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
KNUDSON THEODORE A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
LAJOIE CORINNE A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
LARIOS IBARG IBEL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
LAWSON RACHELLE A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
LAZO FRANKY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
LEWELLEN LORI A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
LIMA MARILANE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
LOBO YAMIL A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
LOPEZ JERRY A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
DANIA BEACH Due Date: 08-01-2024
Gen Date: 07-19-2024
EMPLOYEE NAME
Printed Date: 8/27/2024
LOTTIER CHRISTINE A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
LUPOE TYLYSIA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MACKEY JESSICA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
MARTIN RALPH A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
MARTINEZ GABRIEL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MCDONALD MARVIN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
MCDOWELL KEITH A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
MCFARLANE DARRYL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MCHELLON DONIAL A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
MCLAREN KRISTEN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
MCNEAL GREGORY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
MIEREZ ANN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MIRANDA SHANESA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MORALES ANGEL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MORRIS JAMAL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
NORENA ELEANOR A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
NOTICE JADEEN A Medical UHC Plan 5 Employee + Family $2,027.96 $0.00 $2,027.96
OZAYDIN DINCER A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
PAUL ASHLEY A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PECORARO SHERRY A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
PEIRCE LOGAN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PENATE ROQUDELMIS A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PEREZ FRANK A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
PETERSON TERRY A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
PETRISOR VALENTIN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
POLLARD ALBERLEAN A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
QUINTERO JOHN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
REYES EDDIE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
RIERA ELORA A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
RODRIGUEZ FERNANDO A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
RODRIGUEZ HAROLD A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
RODRIGUEZ MICHAEL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
RODRIGUEZ RICHARD A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
RODRIGUEZ SUSSETTE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
RYAN ARCHIBALD A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
SABINO DEBORAH A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
SALGADO JOSE A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
SALVINO MARCO A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SANDOVAL PE ANDREA A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SANTANA TOR JULIO A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SAUNDERS JANICE A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
SCHUTTEN SEAN A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
SEGAL ADAM A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
SHAHRYAR MICHELLE A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
SHELEY CHERIE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SINGH KEVIN A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SINGH MAXINE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SMITH ROY A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SOLOMON GARCIA A Medical UHC Plan 2 Employee + 1 $1,529.50 $1,529.50 $3,059.00
SPEAR MITZIE A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
SPENCER WILLIE A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
STEVENS TANIA A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
TAYLOR CORRY A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
TERRAZAS MONICA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
THOMAS AHMAD A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
THOMPSON GEORGE A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
UROW BARBARA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
VASTA MICHAEL A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
VLASIC ASHLEY A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
WALTON ERIC A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
WASHINGTON WILLIS A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
WEST COKENYA A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
WESTBERRY ANSON A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
WHITE DEON A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
WHITSON ADAM A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
WILLIAMS BRYSHAWN A Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
WILLIAMS DARIUS A Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
WRITER CYRUS A Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
ZAPATA MARLON A Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
$198,348.66
Printed Date: 8/27/2024
STATUS COVERAG PLAN NAME TIER PREMIUM ADJUSTMEN TOTAL
BAKER ERIC R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BROWN KENNETH R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
BRUNNEMER MIKAL R Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
CARUSO BRUCE R Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
CHANDLER CHRISTOPHERR Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
CONNOLLY ROBERT R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
DARA MICHAEL R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
GARCIA GONZALO R Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
GONZAGA LIVANIA R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
HENG PETER R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
HUSOSKY JOSEPH R Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
JOHNSON ANTHONY R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
KENON FLOYD R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
LAVINA ARMENIO R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
LEXA JOHN R Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
LIEM BRUCE R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
LORBER RICHARD R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MACE ANGELINA R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MARIANI JENNIFER R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MCDONALD MARY R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
MUSTELIER LISA R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
NEAL TODD R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PARRA ROBERT R Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
PATTERSON DIANNA R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PELLECER SERGIO R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PERRY LEONARD R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PETRUZZELLI JAMES R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
PHIPPS BRIAN R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
QUIGLEY TIMOTHY R Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
RIVIERE JOSEPH R Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
ROSE MARY R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
ROSS LUISA R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
RUDBECK BENJAMIN R Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
RUETH PATRICIA R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SATTERFIELD NICKI R Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
SIEB RICHARD R Medical UHC Plan 5 Employee Only $670.21 $0.00 $670.21
SLADE CURTIS R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
SNELL ARNOLD R Medical UHC Plan 2 Employee + Family $2,347.07 $0.00 $2,347.07
STUBBS DANIEL R Medical UHC Plan 2 Employee + 1 $1,529.50 $0.00 $1,529.50
SULLIVAN DARIN R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
TARMEY LORI R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
TRAVAGLIO-W CHER R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
URTECHO JOSE R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
WALTERS IRISH R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
WENTWORTH JEAN R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
WILLIAMSON JOHN R Medical UHC Plan 2 Employee Only $775.68 $0.00 $775.68
$49,421.60
DANIA BEACH Due Date: 08-01-2024
Gen Date: 07-19-2024
EMPLOYEE NAME
Printed Date: 8/27/2024