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HomeMy WebLinkAboutInv# 2024-00001152 - Fidelity Security Life Insurance Company - 11/21/2024 (3)EyeMed 4000 LUXOTTICA PL MASON OH 45040-8114 Forwarding Service Requested 5,480 THE CITY OF DANIA BEACH I.INDA GONZ.AI.F.Z. 100 W DANIA BEACH BLVD. DANIA BEACH FL 33004 BILLING PERIOD: November, 2024 FULL MONTH COVERAGE TIER A n711 nun,.rW r, J 17D I548014 orb Inai-ns� SUMMARY INVOICE FOR: The City of Dania Beach GROUP ID: 5000543 SUBGROUP ID: 1001 INVOICE NUMBER: 166509295 COUNT RATE TOTAL Benefit Level 1 Employee Only 115 $4.39 $504.85 Employee + 1 67 $8.33 $558.11 Employee + Family 56 $12.24 $685.44 FULL MONTH TOTAL $1,748.40 RETROACTIVE ADJUSTMENTS Retro 10/2024 ($11.79) RETRO ADJUSTMENT TOTAL ($11.79) CURRENT BILLING PERIOD TOTAL $1,736.61 _ - PAYMENT IS DUE IN FULL UPON RECEIPT ' --� THE INVOICE CALCULATION IS BASED ON MEMBERSHIP AS OF 10/20/24 PLEASE DETACH AND RETURN Remit To: FIDELITY SECURITY LIFE INSURANCE CO. PO BOX 632530 CINCINNATI OH 45263-2530 THE CITY OF DANIA BEACH LINDA GONZALEZ GROUP ID: 5000543 100 W. DANIA BEACH BLVD. DANIA BEACH FL 33004 SUBGROUP ID: 1001 INVOICE NUMBER: 166509295 TOTAL INVOICE AMOUNT DUE: $1,736.61 UeADak.Olentlat V S-. NVV Wmltl NEIGH EYEMED Imoite gEWN THWAS Pay BeW µl Thcry✓mMa eeaaM1 V Lltlt Shen PoGe, BILUNGPERVER,retenbxoN INVO¢ENSONGS t65e51M6 Values IMwenxa renloN..xvnxm rwi W1L RN TOTAL EmpbMa VISION PLAN UP+ ACM&RAFAEL ].% 16A ]214 µGS pafpEL GM -LNGBY RNSPLO SI SR.Ia $0. AOAMG, LOU 0.A 368 43N LDPo GPN,-My Ymfl[IeMI IR. ($ODL) AU, RIM ].% 36]8 3234 LLI A., OVA, --a y 513.H VE0 AL%IIXI%.1011 L39 134 TED 8.. µy1RH LW Fmpu,eel Me 1.1 RII $AO1 A2CAN4AIElAI1DP0 0.A 368 93q ALONG NE41UP0 Fnplgre wy m-e 1ONG1 .11 (%A3) MGRf651. B1AXCAMANA 0.A 169 4.38 'T FE-.1 M1XGOT inV BALNE.TOAMYR I.% 1A18 1L.4 ]pVMY Flm+e. Fa ly RselRleMl SOON $GILD BATUTA ElAVD1A im 10.18 12.24 RATTA F,mly VSNGONN1 W.. w0 BWT51$EVE 0.A 3b9 4.38 FdIINS EVE OnV GN, 9aNI., W, ($DDl) D.U.S.,..L 0.A 3.N 4.38 p1VID .,V,., .,.I Ol.I EA,, ($MOI) Sr-.. .... I D.PE 3.68 I38 WIEi, OW, Aly %q, (WL) BROWN, EDGE. L. E. TOR 834 PWPIOI OV0,'1 AN,NL P,U W. BROWNS, KRINGERRAN 1.R4 L% TOD E. 4 6POM11E XNPEAMW fi p .l AVSGALNNI W33 $0A1 CNEPIG l,TOwsl O.A . 4.38 Etmlorye CFly H,l ($D.-) CAXOAL.".PN5 1.i4 1.. 7.0 834 EARS.Fy{PM AiYYote•t SSND.I H.11 $DD1 CaNHA OV...M 0.A 3.69 43B EA. GPI. VGGIS IN. I ..PP ($AD1) .,Veketry, AING LIRA 1.H ].% EN 44Tt 1 ANEA $p.1 $D.. UrvmX; µEn1oE 0.A S. 438 DM -y N.1 H.N ($AD1) CXEN, MICHAELC 131 Em ].% 834 EURN Dgyppe.i %,G $D.DI ODUJNS,RDGERIJG 134 1.34 ]lp 834 EDULPS POSER SIGIVIt .I S..O $D.. CODE, RONALDL 1.% I0.28 12.24 . A. Drys -Wmly MM l S1134 $LID] CmnAeu; Tymne 0.A 3.68 438 CONNI. D -Oy H.TV (o..) coGrA,NATNANI L% 1D.. 12.24 lgTA IYTYN Fn{1gee.f-ly LmCY 4rvd1 11. $0.02 C FORA RUPERT L% ]0.38 ]2N RNGT Fn{Igre.Family A-. 1.1 CROaS1E0.RYLYN 0.N 3.88 0.38 OMS IFggttM Olggae My NSGUNNI, DMISS,WixoY L% ... rz24 GidoSn•Famiy sn.0 ED. Danld,taurcMa 6A SLAB 9.38 GVASrSe-A .1.1 H.H ($ODl) DANLA SOME ].% ]O.iB 12.24 F.tyigx.FamllY .1.1 G12.24 $O.W DAW,,IOYCFI 6A SER 4.38 Oly4gre0Ay PWitimll H3V ($D.Ol) DEK%S, GA RIEL 134 I.H ].O] 834 Frtygie.l SI,,E $GIGS DEMAGG%TAN. 1.GP ]O.A 12.24 iAVARA Dry4o/ee. famRy PaM[Ird1 SIiN O.CO Dbmi, .FRANCL L% ]p18 ]2.3. FmlAryee.FemllY SR.x4 $D.pT p.m A38 FNEIpLLOE DryA SSNPINGNI, Bamt.1 Hap ($AOl) .SDeaMtalmO DDMINGUE3. MARUM LN ].H 7. 834 .1 GS ,e.l i 5p.)) DOISIIN.O.J 6A SLAB S. 4.38 RgIEY Gylgee MY 54.39 E ($AOl) EKUE,NOBERl 0.J0 369 4.3U EDGE fMAPl6 Gpyre ertll H.39 ($D.DI) ECLE,R,AAA pA 4.38 WY WY RNGNR HIM (�O1) GAN`A.. ].39 1. 7.RARE J.U] AVA .lryl SODS ,PRU GMIDNER. CAIAF L% ]1.R. 2.. ]4.39 Nµq SGNNG -1 Fm0,-, 9y NNES., Pael1.1 P. S.31 SODWO GA,.OH,JoseA 1.. SLAB 4.38 GIL EAS,-y ($O1) GRANTINENElL W 0.A 3.® 4.3.E4 O4AgapJy HD %. ($AOt) GRANT MKO1ELLV P. ]34 ].W 8H .1 NITEXFLL Fmplyx.l .1.1 $ODl Grt EARL FmP.ry .Fly E.11 SILN ENE,C GREZ. .,YEUAP ].% A.28 12.N EnA,-Family er Z. GtGN ,YUMY ].% M1a 1230 SFINY DppL, a FamI1Y SILN $1. SACS HUA.. XUMAREACY {.39 1.. ],CO l n H,ll IXDL XUCC.MICXAEL 1.% 10.1B 2.. NYIµq SAAmG Gp4pe. sliN Z. Z. XVCNES,ANASEAOAq L% 303B 122I E2. IA GpRgte. Fanoly 1-1, t slx.xa $Ow IONNWTHOSY L l% 10.M 1134 MOOCUR R10LL EgAga.fly $I;N IRDI.Af4T11ONY 0.A 38G 4.% µ111XX1Y GNgrePrly pmeft IIN.I H.IG -L 1$Om) IGIESIASWTIFR0.Ej MV010 6A 3.H 4.3B 16YiDMFgIR NWp AryIya CFly 1.1 H.A ($Om IAGUE'TlO1W,AIN L% 10.28 1x24 Gglgre. F,imq t n HLN $DLO] IAMEE,TAMeRa I.N 139 ]m 8H TANGS Fugga•1 tIedI H.n $D.DI LAMES. rAMMIED 131 I.H ]m 8H Ggo/ee•1 net rr H.. $D.m 1.% L. AAM fx4l g.1.0,HIGHS a n.1 SII.N $11.% JOHNSON JR,U IOXNSCN IANTOINE L% ]D18 U.. 1234 GHLITRESSAS XFMIITN GWgee. Family ei er SO.l4 $DLO] pA 4% ANGLES nei H.A ($0.01) JOHNSON, BRANDO 6WNDOX O.A 3.68 SIR 0.38 M4NiA4 RRµiOX GM ANY FnaVORACY pll L.I ($SDI) JOXNSCN, IOLY.CORY 1.% ]0.28 ]2N 0TY EryYga.gmlly ev SRN T.. W. IOSEPX.PAT0.1IX 3b8 0.38 ES,P P11PKK GNerye OMY nei er H.A ($OEU) D. 368 0.38 GANU 4!LL Fngorye OMY ei H.N ($DD1) X.VGGXARAX.URL i.A . 3.88 0.38 Ggv/re OMy nei er (0. OUCIE,, OU WOE, CORINNE, LN 139 ].% l34 Fngiya.] �[IeMI W. W. $DDl LWK6IBOAGUI IBELE AA 9.38 LULAGEAMES WY IhN INS INS FmggreOMy ($Do, RAOIEl1E Imo, 1.% .28 O. ]229 IAGE, O fiµ, Fanny NNAl M. SIT. SACS FISH, LONELIER,L 1.% L. L ]2.N y FPUMY F Fmggee. Family .1.I $l2N ].RA 1.H ].% O LOU Fnylryre•1 .1 ENGI Pavl1.I S3.N SOf0 HODS UAGA,S ALANDORI UMA MAPIIANER O.A 3.88 G34 0.38 W�l I.WIWiE Fmd%F Orly meN[IeuNl H.R 1$p0S1 IO , my O.A 3.88 4.38 I., 5Mga LMY ANNV, d1 SE" (HAO) LOTER.CNRISTINEA ]34 139 ].O] 834 UG,T. N..E ROGHS L-SI SAIL M. LUWe. TYyala 0.A 38B 4.38 OLDS, ETE. OW, OMy ANNE'S , SAl9 ($0.O1) Mad,,, leas. ].% 3A]R TE. AVOIEY .1. Emdgee. 1.4, .1.11 MA.N,.. L% ]038 ]2.. µUTJ1 pNPN FanP, F-T, .1.I $IY24 $O.CD MARTINEZ GARGEL 6A 3.68 4.38 WFELAPPI6 Fmggee Only G Vt.I HA ($AOI) MODIIAN,MaMAIR I.% ]O.A E224 x[0XY➢ NARW1 GG,G,.Family ANNGLerdf SIYN $A0 M00Wf11.CESIN A]D SN G.S. N6VM➢S NOM E N, Only RmeNLLctlI H.A (%,0) AR.E,OAMYL 6A 3.611 4.3q M3AR1A1@ pµNtt 6nplgee Cnly IlerUf HA 1$ODl1 MCNELLCN,DIXIIAL L% ]0.20 1224 HL.p0N14 FmdMee'Famlly A-L.NI S11N $D. MCIAPEN, KRISTEN M L. 10]8 32.24 NIIARp Xp61D1 Fmp'q,e. Famly PpClt.I SR.N $0.0 MCNGL. GREGORY 1. ]0.]8 E2.N mOGEN 1. Emdv/ee. Famgy A-Lt.I SILN $DD] AA.W, KiIN A]O 268 DISH AVOgSIN MYIA ENvM1e ONY Ra. 1AVAI %. ($DN) MIve;Ann AA 3.N 4.3q Fmggre Only ANSI W.I H.N ($AO]) ARRANDASNANESA 0.]D 3.% 4.3q W. 9lx[SP UNA,-y ..I H.I9 $0.0) Monks.Pryel 0.]O 3.65 43q xD1. GWgee BmefltlsAl H.]9 ($OAR) Mox6.l,E pA 3.68 4.3q ApPR15 GV, F Pty GMNNMI HI9 ($ADS) NMENNdN,G OR I.% 3A]H liM . 6OMp ,, GnNLI SL HFµ Notl[e... ].% 1628 ]224 W,Yre-1.1, PmtlI HONNI $12H u $0.0 O]AYOH. OINCEBA UN 0.A 3.W 4.3q ..1 ONMIX U.ANGE, U. W,yee. V, Fmpoyee SnlY .I MI H.I9 Pa...S 0.A 3DB P.NA ASIILO Fn{ioya O1 ENNS H.N UE.) ($SIN) PECAVALO,SUFRgY f.RS 1A28 ]234 ,, Ef. SMFARY Emg,IAL,mnY .1.I Still PEI0.(E, 0.35 ]A4 1 ppgO Eepvrye Onty PeMIle,N1 NNNAONMl H.A S- (SGER tm OGUA Penatt RANK Oelmb E.BR ]NB 4 ]2H PEWTEpIXNE SFVNs Emggee. Family GnA1.1 $1214 PERM"U'R.FRANK 1.H 134 JFD 6N PETS FMM RlnElgm.I ,m11I1 %.,I $O,OI 5"0 PET.OPS,, 1.34 t39 ]ltl PERSUR tEPRi ES,F,Il GI RreRt.I $0N PEEP6t1p, VAUNSIN ALEN i.% ]NB 12,19 pEIPWR VILLAGE Fn4XmI�e•GmRY BaMttcdt 111 S2N $S.0 PWARO. NBEALEMS v56 late lz.x9 PCWRO uIPLfAN Endgae. Fmnny Miem leMl W.N $O.m PaxeR.OepinelP a]O 3.6e 43e mNDt oAA4£ Fmp%ae PYr Melltleell Hie 1$0.011 WINIEP0.104IN a]O 368 4.39 µWIFAD lmd Fmpgre PYy Imil H.N 1$a011 ROM EOOIE 139 l34 7.00 e.39 pE18 ME Eml4yae•1 eep1.1 Va. M. Rka.EbnR ai0 H. 438 R ELOM Empv..Pre., B I., H. ($OAl) RCGPIWE�PERNANOO a]O . 438 CORI61k2 fflWIW 5iMy,ar., I., H.39 ($O.Ol) RCONGLEx.NAR01B 1.% I.R. 1214 ..D Fmplgre. FamlI, " SIi.N M. RCORIGUG%MICNAELS lm IO.. 1. pL4RryLE µp4FL 6Mgre. FnMy HLN $II.W RCORIGLEx.RICNMO I.% . 12H R.Rp Eraeee. HmRy adear.I Hx.N. $O.W Harrigan,.... 0.)O 3.68 4.38 pCORIGIR 92¢}IE finlbryegly RWltleyell H.3e Rpn.M[R..Idl Rr L% lai8 12N Emp'yae. Fmnly S..14 $O.W WINO.OEBORNI 1.34 2.34 ).W 8.39 O. 6nlegae.l &Welt LLr91 $p.N $OAI MLVINO,MARCOSR 0.)O 3.68 438 WYNO AUREO Fmplorye.' E-lL 1. 1 ($0.01( Sand -I Perez, And-P O.]O 3.68 4.38 YOpEA Opz,ae-N -zeI 51.N (Sq.GL) WI)ANF iOflflES.I000MIP 0.]O 3.H 4.38 AAb Onplgae ,Fly Hie ($O.OI) SAUNOE., I.I. L 1.N {.H ).W 8.34 SAIRRIM1WEE Ololyee.l $131 m.01 ...'Seen 0.J0 3.68 4.38 se iedz Cnly H.19 ($.Ol) fiaOryx. MRh.IIdM 134 E. ).W 834 I.Wpa18 Glp'gee•1 .1.1 H]I m.01 SXELEY.ENEPIE 0.J0 3.68 rd.11 EmAryreptly .1-.1 H.19 ($0.0I) 51NGX. MAIiXEA DEG 3.H 4.38 SYGI MpYIRE fn¢y[e Gry .1.1 Sl.le 1$ .) .RI4 Par 0.J0 3.H 438 FmlxgeepRy H.19 ($0.01) Rlomory Garda 0.J(I 3.60 438 ARtltl11 Eneigsgtly .1.1 WR (eA.01) SPEM. MRLEP 0.]O 3.W 438 DMzt E Ogla$ee-lr arIert LddI H.fl ($ Ol) SPENCER, WILLIE 139 1.14 J.W &M M1111E Orylgee. t ¢3I $V.01 S]vRM MUPMY a70 3.68 4.3a Lpgte Only 6neAt 1eM1 H.N ($OA1) 5MEENS.TANIAA 1'.L. J.W .4 TAIMr 6pgs.a Qaafi[1er41 H.11 $0.0l TAYLOR. CORRYG qze 3.58 4.38 Enylyre Only MCEt LerdI H.lg (WEE) TERMNS. MMIGRM L% IO.. 1x.N AV a. flglgee. Rear, . add I S11N $O.W Tmorza% Im. L% IO.xO {x34 AMID E,,ze,ee. R,rdl 1-dI S11N $0.W Thmmas.RomaM 0.70 3.69 4.38 IIbME4 OryIga OAy bNittedI Thwnpson. Geotge 139 L. Jm &H d.EEpgee•1 Pmrt 1.1 H3) $Om UROW. BPBGM LA LN Jm &34 IAYFN MiMM "'Fe" 1 treft dead san $0.0{ VASTA MICNARI 0.70 HER 4.30 Enor'-dr .1.11.1 H39 ($OA{( WebECAImI L% Wx8 lx.N Or Epgtt.-Re MreRtleadI 511i1 W..W Wesk AfNeYM 334 LN JA9 &H Fmpleyre.I p Rt Ld,rl H.11 $O.W L% 10.x8 ]x.x4 Eryegae.Evnfly Ln LLrell HL24 $0.., .EN,.ERIC1 WMEINGP WORA Gz"L. &% FmMgm Otxy Dr Mcfir,ddl H.N (So. W/S.GCHHUNI&WILLISB L% 10.x0 2.% 12.N OX IR 11.GM En4Iyx. Mnpr MCRIIctlI 51]14 WES].CMENYAO LDRL. Wi8 12.N EDGE 9mefltlerAl S1WN SE.W WESmERRr.AN50Hl L% 10.x0 I2.N NSx6EARr AIEOIIrA Read,--1, Eprya•hmnr HLN $O.W SD. WNRe,HdaT GIGLU 3.fi0 Olxy MzIL dI eme8Irdzdl H.H ($O.W( WMCaIy AGm 134 LN J.W &H E.. NMIISCN werre fm'.l SB.11 WIWMIS.BRY 4.3.N PmPloyre ONy ..itL.1 emeli .19 oz ($O.W( Rum DM1115 L% 1. 0.a 10.x8 ]4.35 MRLtWS Pamr,"' Eamlly emNt LLrell .I 1 51LN $O.W .nma' WRRlfi,Rz US O.JO 4.3B Fm1Ygtt O1 rvNl H.N ($O.W( J.W 1. 834 WATA MORIM pnplvFp.l aded imeAt LeMt H.11 $O.W GGddTMMLOX fined TMil `RGHzS]&W 1. 1111.41 ].]m.W $IJ] 40.20x0 ]JBA3 i13,H $R3fl® eWtt p M27 -rl ($1149I Learn &Blanum.Ed $1.)3&]8 ROSTER REPORT n.Otz dpareeeeza W.m�Gr.la1 ieaw.rs To eN. EepenE t membeM pinu zee tM 4w11ment Report at eye '..pemw, 1159E1]6Rf0 C4W61L 1MY15 YreR[Icdl f0/a/]Ne 10/I1/W11 laL9e N.T r]6Ai/YO IRWAIRry IµE Buaf[tnNl 14/OI/1R1 falll]IR1 1p/ffi1 IY.v) ReR�m MMS)B25m Nla➢p ME BennflL LnNI to/OI IIOH IOII N.19 4Wn suawo .w¢ a<.al zme lama foimu ry1z.M R.u� •.w a-.ua-- i. u. van. w..mx.. rr IS11./1I �Y� FULLROSIER ROSTER LHTIRG FOR: BILIJNG PERIOD: INVOICE NUMBER: TM1e CIty of Dank Beaty Nweml r, 2024 1"SoG95 ROSTER REPORT To view dependent members, please see the Enrollment Report at eyemedcomleyemanage FULLMONm UST Al11Np.Tkr M652N509 ACOSTA MFAEL Employee . Family BeMM1 Le:elt $12.24 M6576400 ADWAS Low Employee Only Benefit Lcre 1 $4.]9 26Z6MI. All RICKY Empbyee. Family Benefit Level1 $12.24 ZAAEADRRYp ALPHONSE Lou Empkyee.1 Beneft LCM1 $8.33 27619MM AZCANO ALEJANDRO Employee Only Beneft LevelI X.39 262W87KA RAtWE TOADY Emplyee•FAmty Benefi[1.11 $1224 ZOLUT VDR BATISTA CLAUDIA Empkyee. Family S-61 Level $12.24 MR`O4tl0 BOU1515 EVE Employee Only BenelR LevelI $a.]9 303653,0500 BRAIN. MO Employee Only Benefit levelt $a.39 J29B]06a300 BROWN MEUSSA EWI,-Only Rene. Leaelt S4.19 2EDLOPLAR BROWN RODRICN Employee .) Benefit Levelt $R.3J 21498160300 UDARE JOHMTHAN Enrylyree.t Bment LeveiI $B.33 335 336900 CMVBELL TRAVIS Employee Only Benefit Level S4.39 MZ6 10R) MNGIALM JOSEPH Emphwee.l BeNflt Leel1 $R.:3 28272983000 CASE. CXRISTIM Empbyee Only Benefit level1 $A.]9 AAWW95. EASREBERRY ALSHA Employee.1 .1H Leve11 R.33 ]WZ.A695C0 CHAVARWA ALBERTO Employee Only Benefit Level Sa.m 2Q657660) OXEN NJCEAEL Enpkyee.l Benefit Levelt $B.]] 262657.. COLLINS ROGER Employee .t Benefit LeyelI $8.33 MZ65T826p0 C00K RONALD "I"aa-Family Rncefll Levelt SIZ.24 33688965 M CORHILEUS I .0 Employee Only Be it level1 $A.39 26265nIRC0 COSTA NATHAN Emplayee. Family Benefit Levelt $12.24 .65o. CMWFORO RUPERT Employee . Family Benefit Level $,A.. 2UW43M CROSS JEARYLYN Employee Only BI tesdI SA.l9 Z,SW 26D]D OMITS WINoy Employee. Fa dy Benefit Lerch $12.24 3]685035Z1p DAHIEL LAURENDA Emplryx Only BeMIl LNd1 $4.39 26207RIM DAVILA EDDA Employee. Family Benefit L.-I1 $12H 26265766900 MIS IOSCE Empluyee0nly Berchi LevA1 uJ M657]lOT OE 'BUS GABRIEL Empigee.1 BmefllUVI1 $8.31 2Q65Z76900 OEAV.SSIS TAIMM FARAUPee.F1MY BereAtbe ' SIL24 262652222C0 DIPAOLO FMHK Empl%ee. Family Benefit Le.1 $12.24 ]MRGI.. DMH DORDMLOE FPw' eOnly BenentteVell $A.19 29550B51ILO DOAUNGUEZ AAADA Employee.I Benefit LeM1 %.]] 2QW63M OOISON RICKEY Em mOniy Benefit LasM1 $439 2.81.0LC0 EDGE CHMB Employee Only Be -.,toy I 27498159900 ENLE B. Empoyee Only Ba ,fit loneI $I W 335Z51582C0 GARCIA ANA EnnAoyee.t Benefi[L"M1 $8.13 Z6Z65Z09Z1p CANDHER KAU RpLa ee.Eamily Remlll Lovell $12.24 32809B1II00 GIL 1. ElnPlgee Only Benefit Lem St. 396942MC0 GORWH SOASLW, E.VW-Only BemFt LaVIR1 N.39 Z6Z65]69ZIp GRANT MITCHELL EmTAoyee.I ReWll tovNI $R.33 33430943300 GUM CARL FInTAgee. Famly hWX Level1 W.24 26265Z195C0 GRCENE DARK. Ennpto ce.Family Benefitlevelt $12.24 Z6Z65R41C0 GIIWNL VERY EmrAgee.FMty BereHl Lovell $12.24 275231502L0 NIRYX STACY FInTAcyee.l Benefit tell Eitm Z62657n. NOTE WCHAEL EmTAoyee.Fanuly Reneffitmell $12.24 26L65211B2C0 HUGHES ANASTAUA EmptWee'nordy Re-Ift Lovell Su.. 26265269100 ICENHOUR RACHEL Fmggee. Family Benefit Lovell $17.M 26207424W IRDI ANTHONY Emggm Only Beneft L-PtI $4.39 22644MZ3W IGLMMGMERREZ CLAUDIO EnPW ee Only BnmFlt LoVelI 54.39 2626521V4W JACKSON IUXHATHAN ETIAsVeo. Family Beefit Level $t2Z4 2QWBALW J. TAVARA Emplgee.l RmeXl lmll 9.33 26Z65259. IMES T.E CnPlayee.1 ReneNl LevelI SR. ZQASTT 500 JELASO W.AH Fmpkytt. Family Benefit Lovell $line 262652916W I ... SO. ANTmNE E.,W,Only Benefit Level .ESTAA. JOHNSON BRANDON Employee Only BeWlt Lerelt $a.]9 27n1199000 .... IR NENNRH Employee•Feral, Benefit Lavetl $12.24 M..Tl180 XRLY CORY Employre•Family Benefit tevel1 $12.24 26265782700 IMEPH PATRICH Employee Only Benefit Levels $4.39 26265]3Mp MUCHARPH CARL Employee Only BeMM1l)mall $4.39 333134193M NAMOUL ANN. Employee0nly Beneft Level) SC39 26207.SAX0 LAWIE CONNNE Employee .1 Benefl ievell SAM 262657932C0 LANOS Ill... IBR Employee Only Benefit levelI $e.39 2B1]3565MO LAµSOH RACHELLE EmployeeFamily Benefil Level1 $12.24 32719A531100 LAZO FRRNNY EmployeeFamily BeneR Levelt $12.24 29524268700 LEWELLEH LORI Emplgee.I Bemn, Level1 $8.33 2]] .N. L. NARNANE Employee Only Bereft levelI S4.39 Ji.L6N. tOPE2 JEW EmplgAm Only Benefil teveli 54.39 26207391M LOTIIER CHRISIINE Employee .t Benefit Levelt 58.33 332861 WPOE MYmA Employee Only BeMfiY LevelI U.. 3328567.000 AV.CNEY JERUCA Employee • Family Benefit level $12.24 262657302W AWNIN MPH Empl%re. Family Benefil level1 $12.1e 26265775100 AURfINE2 GABRIEL Employee Only BeneFtlevell $4.39 Zaa 2:RS400 AI OOM. 65ANVIH Emplyee. Family Benefil levelt $i2.24 117Wl6BLp NLOOMIL NEITH Employee Only Benefil lerell N.39 275511703W A'GFARtANE OARRYL Emnmee0nly Benefit Lonal1 Z6265]1]300 AICHELLON OONIAL EmAWee• Family Benefit Lewl1 $12.24 16JNYPCt N0 WARREN KRISTEN EnV(o m •FaMly Benefili lI $1LN 26265I80100 NCNML GREGORY Em7Ag Family Benefit LeYel1 $12H 13LIZA161M MICHELIN MYM Emplgre Only Benefit love)) lSAA.R9M0 WEREZ ANN Ertglwee Only Benellt Level1 KIP 26265]8520] WMNOA SHANESA Ertbtl y-O"I Benefit Lerell 3152076a400 APORALES ANGEL EWImm Only Benefit Lavel1 $I,A 3YJB09656W N s JNML Erylgee Only Benefil L-11 $4.39 2626WRJ200 IMEM ELMHOR Employee. Family Benefit Lcelt 512.H 33233314361 NOTICE LAUREH Empoyee•family Becefll Unel1 $12 4 162657B6100 OZAYOIN OINCER Empeyee Only Benefit Level $4.39 n913399WO PAUL ASBURY EmLI%x Only fe-fit Lee11 $4.39 26265774500 PECORARO SHERRY Emploee• Family benefit Le e11 $1224 267ES]76400 FORCE LOGAN Eryloyee Only Bemflt LeM1 $4.39 2WOB369tlq PENATE ROQUE OELBIS EmNoYee. Family Benefil LIelt $12.. 26265]]4f00 PEALS FRANK E1M%ee.I Beefit tonal $9.33 2616576B. PETERSEN TERRY Employee •1 Berefil Level1 $B.JJ R6154BBW PETIUSOR VALEMIN Favatma. FVNIy MneNl LerelI 512.24 2626517MM POIINW ALBERLEAH FASAoy- Family BereFt L-11 $1L24 315ss11. Fo. KILAINE Employm Onb BeeflL Leve11 $4.39 lt7V.5000 QUIIRERO JOHN Employee Only Benefit Levels $4.H 26265791900 REYE, EOOIE EmdWee.I Benefil LevN1 $B.33 296]398ZJ0] RIEM ELOM Employee Only Berefil Level1 $4.39 16265]3]300 ROORWUEZ FERNAN00 EmplgreOnly MMH LevN1 262657785M ROONCLEZ HAROLO EmplAy- +Family Berefil Level $ti24 2616575m. ROOBOUE2 WCHAEL Employee. Famlyy Berefil level1 $12.24 M6ST 3BM RODRIGUEZ RICHARD Employee. Family Benefit Le I 511.14 309684761100 ROONGUE1 9hRTTE Employee Only BmeRt Cited U.. 2901fill WAN AKH154D Employae•Furey, Benefit Leve11 $12.24 16785]561M SNINO OERNUIR En,plo e.l MnAill¢vAl 58.33 262657557M SALVIHO ANR[O Employee Only 0enelil levelI $4.m 3331341WM SUBJERA LRENEE ANBREA Employeewly Benafitlwell N.39 M2611.00 SAMNIATORRES JULIO EmPby-Only Benefit LevelI k.J9 262657894100 SAUNDERS JANICE Emplem,.l Bmefit 1.11 lU333 315.1676M SCHULLER SCAN EmployeeOnly Benefit Levett 54.39 1 .Ani]M SHAHRYM WCHELLE Empbyee.I Benci twell SCA3 262657479M SHUT CHENE EmplayeeOnly Benefit Leve11 $e.39 2650NAAFM SINGH BLAKNE Employee Oniy Benefit LeveLI $4.39 331271927M SUCH MY EmpbyeeOnly Benefit LevelI St.. 3MD151M mIOAgN GAR[IA EmployreOnly BenefitLarval t Sa.39 28173567800 SPEAR WTNE Employee0my Benefit knell N.39 16265]433M SPENCER WILLIE Employee.1 Permit )well $LJ3 26265CLOUR STH HER WIRMY Employee Only Oenefft met $I.A 26ZW312W SIEVFNS TANIA Employee.I Benefit Intel $833 li.07904M TAYLOR CORRY Employee Only Ben.l 1-11 k.39 262WOl M TERMZAS AbNIG Employee. Family Benefit Level $1L14 JW6574A M TNWMS AHAUO Employee, Family Benefit Levelt $12.24 MB]55M]M TINNJS ROVANO EmployeeOnly Benefit Level $4.39 3087556I9[0 THOAPSON GEORGE Employee.) Be Mt L-L1 A. Y.wi N UROW BMBgPq Empgee.l Bmem LevNl lam 26165]3]5Ot V.A MICHAEL Emplga Only Benefit Leven 56.39 33 l58PW VIELOT CmOE EURRRyee. Fa ly Benefit LeWAI $iLH 3.1.101O] V451C ASHLEV Eieeo .1 Benefit Level $B.31 26265]]93R WALMN FPK Enonee. Fernity Benefit tevell $1214 262651699W WARREN CA%ANBBA Employee ONLY BMefII LeWl1 $419 26265165400 WASHINGTON IN "LLIS Em BWP,-FUNNY Benefit LeelI SIL24 26265]60. WEST COPENYA Empbyee. Family Benefit levet1 $12.24 26265781600 W6IBERRY AIEON Erfoo N,. Faly BenelR LeM1 S1Z.24 262657465W WHITE DEW EmlRayre Only Benefit LNe11 312]106ZSW WNRSOH AMA 'Bnpf ee.I Benefit 1-11 $8.33 L942B]355W WILLIA45 BPYSHAWN ENNAWNe Only BeneHl tevell $4.39 26265]]HW WILLIAMS 0.WU5 Employee. Barely Benefit I'd1 $1LZ4 Z6265771. WRITER CYRUS Emplayee Only Benefit Lovell N39 Z6265]BSMI 2AMTA µaRLON Empl%a.t Benefll tevell 58:3) Louden TOYI: $1.109.60 .61.1. AD" LAUNA Employee Only Benefit tevell H.39 Retiree 2RO753IN I. TINMVS Emgoyee.i Bereflt Lehi Sam Retiree 2626575fiBW BAKER ERIC EmgoyreOnly Benefit Levell H 39 Retiree Z6Z65]. BAKER JAI Employee Onty Beeem Lovett 54.39 Retiree 26Z657MiLO BERNARBU WCHAEL Employee .t Bereflttevell Sam Retiree 2]551MIQUO' am". BARBNU EnirKerne OMY BeeefRlevelt $4.39 Retiree 26Z65771700 SERTUCCIO %SFPH Ern",_, Unefitlevelt $8.33 Befiree Z626T]521W BLIXRELL CHURN Employes Only Beneflttevell Se.39 Re. 26265TSN00 BLUST IAV,ES Employee .l 13exflt level $8.33 Retiree 26265]. BOLTON CNESLER EmplryeegAY Benefit Lend N.39 Retiree 262657612W BRULDE5 GLOPIA Employe .l Berne. Leven $B.33 Retiree 2626524MW BP.SW MANN Employre Only Benefit leMI $t.39 Rehi Z6265]915W BROWN KENN. Empbyee Only Benem LeM1 %39 Red- 26265]513DJ BOOM LWIS EURIN, ONLY Deflit lc 1 $1. )9 Refirre 262657552W BROWN u¢HAEL Employee rt Benefit L-el1 $L33 RelVa 31WB3654W BRUNNEWER MINAL Employee.I Benem tevell SIM Kenn- ZM57350W CARLD. BRUCE Emploee .l Benefit I-el1 $B.33 PeRee 26265286600 CHANDLER CHNSTOPHER Erryt ee.F lY Benefit LeWil SVZ4 Ref ree Y.65OIJ. CHEPIAN OANIEL finfwx .I Berefit 1—(1 $8.33 PeHree 3Of.N"lBZ CONNOLLY ROBFAT Emgga Only BereRLl-il 51.39 Retiree 2626WMIM CRANWN TONK Empli ee Only Benefit Lerell 51.39 Rema MEMBRM, DAM WCHAEL Emplo Only BerrefrtleMl H.39 Red- 26265I514W BENNY HANCI Empb]tt Only Benefit Level 54.39 PeN- MZ65)596W GARM, G0N24L0 EmTAgxe,Minly BaMIIt Lerel1 $12.. Re1, 2626576410D GARONER EULA EnIpte ee Only &refit Lovell U39 Retiree .65]R3g1 GENNARO IgEPH Fmplayee.i Berom LeM1 5833 Be. 1340BL6930) GIAQUIN)O NAPIE Employee Ofly Beisfit Le lI $4.39 Retiree 26265]IOK0 GIWpNO RUMELI EmployeeOnly BeRefit tevel N.19 Retiree .65]YON GRNNAER TXOMAS Employee Only BenefltLevM1 $4.39 Retiree 26Z657665)N GPEF31 JACK EmployesOnly BgIeHILeuN1 $1.» Reu- 26265733%0 HAHSEN DONALD Emplayre .1 Benefit L-el1 $L33 Refiree 26265]693C0 HIM ROBEAT Em1AePee.1 Benem LevN1 W.33 .9- 26Z65T4]1W HOL. LLOYD Employee.1 Benefit LeMl $R33 Retiree 2626UMAND HIISOSKV XYSEPH Employee. C.R, Benefit le.MI $12.24 Retiree Z6Z617. R3HNI AH1FmNY Employe Only Benefit Leuelt St." Be.- 262674MA H. CHARLENE Employm.I Benefit LevNl $8.33 Retiree 260)B]IW IOHIl5ON VALLEY Employee Only Benefit Leet1 N39 Red- MZ65]3BeW MH6 NmS1EN O L'O ty Benefit.11 56.19 Retiree 26265751M KENON LLOYD Ennloyee Only Benefit Lovell $4.39 Retiree 26ZW47WO KIMWCH ROBERT Eno'ne.l Berefit AWN $8.33 Retiree 26265]620]0 KIRBY GONNA EmIA%ee.l Benefit Lovell $a.. Retiree 26M5I3B300 HiM KENNETH Ere NRe Only Bemflt LeWAI $439 Retiree 2626535Z4W LAND KENNETH Emplayx.I BenefiLLevelt $9.33 Retiree .1300 LAVILU APAgi11O Emgryalnly Berefiflerell $4.)9 Retiree 26265752BW U. III Employee. Farmly BeneHll. v l SILZ4 Re. 262653M500 MCA BRUCE EmlAoyre Only &vMTLeMt Sim Retiree 262657366W LONER RICHAND EmgayreOnly Benefit LevN1 U.39 Peliree 26265]545W MACE UUME Emp[W-. Fly Berefil YWA1 $1214 Reiree, 26207671. AURIANI )PARK EmPlayee.Family Benem Level $12.24 Retiree Z6]65]661W ]MAIN LINDA ETRnPee Onty Benefil LevNl U.39 Retiree 262657483W MCWNALD WARY Employee Only Benefit LevN1 $4.39 RRienee 26165151M WINES ROBERT FmplgreOnlY Benefillevell $1.39 Retiree M65I51]W MILLER WLES Empbyee Only Benefrl Lovell $4.39 ReN1tt E6itl]511W "INA OEBBIE EmFdgee Only Benefit LeWII S.." Retiree E6E61M. MOpp15 GLENN Empt"".1 Benefit Level1 $E33 Retiree 26265753600 NUMBER JANES FmpleyeeOrty BeMflt Lavell $1.39 Befi- E6E Jlfifi MUSIELIERJR ENNQUE Employee+l Benefit LCRl1 58.33 Refirre EBASSRUP2W REAL TODD Employee Only Bermflt LevHI N.39 Neu- 26265194BW ORLANDO GAMIC Employ - .I oKn.fit.11 %.33 Retiree 1RA.7SSN, PARKA RDBFA3 Employe+l Beneflttevell $8.33 R."Oe, E626SJAAWN PA]F,. LOU ANN Employee Only Benefit t-ll $C.39 Retiree 26265)5BIW PATO[ASON DIANNA Employre Only Benefit LRYAI N.39 Befiree 262657WW PELLECER I.. Employee Only Benefit level( N.N Retiree E6E65J7CEW PERRY LEONARD Employe Only Bellefl[LNe11 $8.39 BeUree 3E0615 7600 PEGHGL LLI JAGES Employee Only Benefit Lexll %39 Retiree 2783,61]BW PHIPPS BR1AH Emgoyee Only Befit L-LI U.N Re een 2626110500 PINK 11.1. Enno.,.I Benefl[Leve11 $B.31 Retj- .75600 QUIGLEY TINOTHY Employee Only Becefl[Levelt $1.39 Retire 33SM0E11W REBOUR JEAN PAUL Employe Only Bneflt Level1 U.19 Retiree JOAAAOE&p REID IANEG Employ -Only Neel Level $6.]9 1(eUree E6M5735100 NGO RUDOLF Employee Onty Benefit Level ReNr- 26E65E63100 RW EAE IOSUN Ontl I III Lend1 $8.33 Be.- 26265795f1A ROBERSON CHARLENE Ere A,- .1 Bm.t 1111 58.33 Pat- 26265]A51W RODN.UEE 105E ERNA,-Only Inrefll levell N.39 Refir- 26265757MO ROSE PERRY Empt,-.l Bmefit Level $8.33 ReNr- Z6265WW RM$ ENANK B 4ny-.l EII LevM1 $B.]] .01 E]91]IOIDW RUOBECK BENJAWN EmFAgee. Eamlly Brnellt LaN1 $12.24 Retiree 26265]615W RHEIH RICHARD EmpWyre.I BeneNI LevNI $8.33 Retiree 26265102500 SALGADO JOSE EmplOytt Only Bmefit Lcd1 5,139 Retiree 26265]6Tq] SAT3ERfIEID HICKI E.Nelee.I BeeN[Levell $0.33 Reur- 26265]152M SAVAGE JAMES Empoyre. t Benefit Leel f $8.33 Retiree 2AHM13W SCHRODER THGA,AS Empty-.1 ..., levelI $B.N Netlree 11.11. WIN NCHgRD Employtt Only Benefi[L-ell $i.39 Retire 26265]16WJ AADE CURBS Empoyee Only Benefit LwNi U.39 Net- 26265753500 $6UTN MICHAEL Employee Only Benefit Lerell U.]9 Reh- E626P6E5(p SNELL MOLD Empoyee. Famty BeoeN[L-LI $1LN Rem- 2620791 SOMERS HOWARD Employre.I B.-fLLevelt $8.33 Retiree 26265] ARD STUBBS DANIEL Fmpb2-.1 BercH L-11 S813 Retiree 26265]95EW NLLAWAN DAWN Employ -Only Henefl[L-t1 $6.39 peU- 26265]a90o EMILY EDWARD En loyee.I Benefit LaYet1 $8.33 Retiree 262657. TUBwOY TI. E.,J.,.I BeneRL Le-I1 SB.33 .- HEADS. UBTECHO R1SE EHRA y Only Bexflt LevN1 Se.39 Retiree 26265]]6M0 WLLTERS LEROY EnrWayee .1 Benefit Le ell $8.33 ReNrte 262WWBO WABWICK RANGY EANvpr Only Benefit .I $1.39 Retiree M265]46]W WEMY m 1FAH Empoy-Only Bmefit LeM1 $e.39 Retiree 26265"1500 WHI2AREA MPHEN Empayee Only BmeM LeelI N.39 Retiree 26265768. WILUAAG U. EnnIA, +1 Benefit tevelt $8.33 Re.- E6E6 Hfi Hum "BlIfi EW Empoy- .1 Benefll Leaelt $8.13 Reye,e Laea11-11eL-Tmal: $638.8t) Full Month Total: $1,7 .