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Home My WebLink AboutInv# 2024-00001153 - FLORIDA MUNICIPAL INSURANCE TRUST - 11/21/2024 (2)DANIA BEACH FMIT # FH0129 SUMMARY BILLING PAGE +Due Date_ 11-01-2024' COVERAGE PREMIUMS ADJUSTMENT: TOTAL Medical UHC Plan 2 Employee + 1 39 $56,310.15 $0.00 $56,316.15 Medical UHC Plan Employee + Family 46 $101,918.98 $0.00 $101,918.98 Medical UHC Plan 2 Employee Only 88 $64,437.12 $0.00 $64,437.12 Medical UHC Plan 5 Employee + 1 0 $0.00 $0.00 $0.00 Medical UHC Plan Employee + Family 1 $1,914.39 $0.00 $1,914.39 Medical UHC Plan 5 Employee Only 11 $6,959.48 $0.00 $6,959.48 TERMED W/ADJ BALANCE FORWARD PAYMENTS CURRENT PREMIUMS ADJUSTMENTS $0.00 $0.00 $231,540.12 $0.00 $231,540,12 $237,686.94 Oct Paid $0.00 $231,540.12 $0.00 TOTAL DUE $469,227.06 Gen Date: 10-23-2024 $237,686.94 ID HW-, A M- Invoice Retiree report EMPLOYEENAME om COVERAGE PLAN NAME TIER PREMIUM ADJUSTMENT TOTAL First Name Middle Name Last Name Last Name BROWN KENNETH R Medical UHCPIan2 Employee Only $732.24 $O.OD $732.24 TRUE Kenneth Sean Brown BROWN BROWN LOUIS R Medical UHC Plan 2 Employee Only $73224 $0GO $732.24 TRUE Louis Brown BROWN BRUNNEMER MHAL R Medial UHCPlan 2 Employee+l $1,443.85 $0.00 $1,443.85 TRUE Mlkal Brunnemer BRUNNEMER CARUSO BRUCE R Medical UHCPIan2 EmplDyee+l $1,443.85 $0.00 $1,443.85 TRUE BRUCE CARUSO CARUSO CHANDLER CHRISTOPHER R Medical HER Plan 2 Employee + Family $2,225.63 $O.OD $2,215.63 TRUE Christopher Chandler CHANDLER CONNOLLY ROBERT R Medical UHC Plan 2 Employee Only $732.24 $ODD $732.24 TRUE Robert Connolly Connolly DAM MICHAEL R Medical UHCPIan2 Employee Only $732.24 $0.00 $732.24 TRUE Michael Frank Dara DAM GARCIA GONZALO R Medical UHCPlan 2 Employee+Family $2,215+63 $O.W $2,215.63 TRUE GONZALO GARCIA GARCIA GONZAGA LIVANIA R Medial UHCPIan2 Employee Only $732.24 $0.00 $732.24 TRUE Uvanla G.maga GONZAGA HUNG PETER R Medinl UHCPIan2 Employee Only $782.24 $O.OD $732.24 TRUE Peter A Heng HENG HUSOSKY JOSEPH R Medical UHCPlan 2 Employee+Family $2,215.63 $ODD $2,215.63 TRUE JOSEPH HUSOSKY HUSOSKY JOHNSON ANTHONY R Medical UHC Plan 2 Employee Only $732.24 $O.W $732.24 TRUE ANTHONY JOHNSON JOHNSON KENON FLOYD R Medical UHC Plan 2 Employee Only $7a2.24 Sow $732.24 TRUE FLOYD KENON KENON IAVINA ARMENIO R Medial UHC Plan 2 Employee Only $732.24 $0.w $732.24 TRUE Armenia Levine IAVINA HEM JOHN R Medical UHC Plan 2 Employee+Family $2,215.63 $0.00 $2,215.63 TRUE JOHN IENA LEM LIEM BRUCE R Medical UHC Plan 2 EmplDyee Only $732.24 $O.W $732.24 TRUE Bruce Glenn Uem LIEM IDRBfR RICHARD R Medial UHCPlan 2 Employee Only $732.24 $O.w $732.24 TRUE Richard Mods Lorber FORMER MACE ANGELINA R Medical UHCPlan 2 Employee Only $23214 Saw $232.24 TRUE Angelina E Mace MACE MARIAM JENNIFER R Medical UHCPlan 2 Employee Only $732.24 $O.CA $732.24 TRUE Jennifer L Marlani MARIANI MCDONALD MAW R Walmd UHCPlan 2 Employee Only $732.24 $O.DO $732.24 TRUE MARY MCDONALD MCDONALD MUSTEUER LISA R Medical UHCPlan 2 Employee Only $73214 Saw $732.24 TRUE Lisa MUSTEDER MUSTELIER NEAL TODD R Medial UHC PIan2 Emploree Only $732.24 $0.00 $73224 TRUE Todd Neal NEAL PARKA ROBERT R Medial UHC Plan 2 Employee +l $1,443m $O.DO $1,443.851 TRUE Robert L Parra PARKA PATTERSON DIANNA R Medical UHC Plant Employee Only $732.24 $0.00 $732.24 TRUE DIANNA PATTERSON PATTERSON PELLECER SERGIO R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24 TRUE SERGIO PELLECER PELLECER PETRUZZEW JAMES R Medical UHCPlan 2 Employee Only $732.24 $ODD $732.24 TRUE James H Petruzxeili PETRUZZELLI PHIPPS BRIAN R Medical UHC Plan 2 Employee Only $732.24 $0.00 $732.24 TRUE Brian Phipps PHIPPS 4UIGLEY TIMOTHY R Medical UHCPIar5 Employee Only $632.68 $0.00 $63268 TRUE Timotby A Culgley Quigley REBOUR JEAN-PAUL R Medlcal UHC Plan Employee OFFY $732.24 $0.00 $732.24 TRUE Jean Paul Rebour Rebour REID JAMES R Medlcal UHC Plan Employee Only $23224 $0.00 $23424 TRUE James Reld Reid RIVIERE JOSEPH R Medial UHC Plant Employee+l $1,443.85 $0GR $F VUL85 TRUE JOSEPH RIVIERE RIVIERE ROSE MARY R Medical UHC Plant Employee Only $732.24 $DOD $73224 TRUE Mary P Rose ROSE ROSS LUISA R Medial UHC Plan 2 Employre Only $732.24 $600 $23424 TRUE Tulsa Clinton Ross ROSS RUDBECK BENJAMIN R Medical UHC Plan Employee+Family $2,215.63 $0.00 $2,215.63 TRUE Benjamin lean Rudbeck RUDBECK SALGADO JOSE R Medical UHC Plan 2 Employee Only $732.24 $0.00 $73224 TRUE lose SailmdO Salgado SATTERFIELD NICKI R Medical UHC Plant Employee +l $1,"Gm $D00 $1,443.85 TRUE NICKI SATIERFIELD SATTERFIELD TEN RICHARD R Medial UHC Plans Employee Only $632+68 $0.00 $632.68 TRUE Richard Slab SIEB STAGE CURTIS R Medical UHC Plant Employee Only $732.24 $0.00 $732-24 TRUE CURTIS W SILAGE STAGE SNELL ARNOLD R Medial UHCPIan2 Employre+Family $2,215.63 $0.00 $2.2JS63 TRUE Arnold Snell SNELL STUBBS DANIEL R Medical UHC Plan Employee +l $11443.85 $0.00 $1,443.85 TRUE DANIEL STUBBS STUBBS SULLIVAN DARIN R Medical URIC Plan Employee Onty $732.24 Saw $732.24 TRUE Darin Ann Sullivan SULLIVAN TRAVAGLIO-WILLIAMS CHER R Medial UHCPIan2 Employee Only $73124 $OOD $732.24 TRUE Cher R Traagll0-Willis TRAVAGLiO-WIWAM! URTECHO LOSE R Medical UHC Plan 2 Employee Only $722.24 $O.OD $732.24 TRUE 105E Gean URTECHO URTECHO WILLWMSON JOHN 46