Invoice Number: | 148348 |
Reconciliation Period: | 01/01/2007 - 01/31/2007 |
Master Number: | 03000-00 |
Group Number: | 93705-000-00000-00000 |
Description: | |
Phone Number: | (999) 999-0000 |
SELF INSURED |
BENEFITS ADMINISTRATOR |
321 UNIVERSITY AVENUE |
ANYWHERE, USA 55555-0000 |
ACTIVE SUBSCRIBERS |
---|
Member Number | Member Last Name | Member First Name | Effective Date | Coverage |
---|
00989776543 | ADAMS | SARAH | 01/01/2005 | S+Family |
00213456789 | ALBERTSON | BRENDA | 08/01/2006 | S+Family |
00652331254 | ALLEN | SALLY | 01/01/2005 | S+Family |
00456789012 | ALOMAR | MARIA | 08/01/2006 | S+Family |
00652698745 | AVERY | HEATHER | 01/01/2005 | Single |
00220563429 | BERG | DORIS | 01/01/2007 | S+Family |
00642153297 | BOONE | ROBERT | 01/01/2005 | S+Family |
00123456789 | BROWN | SHEILA | 01/01/2005 | Single |
00654418897 | CARLSON | DONALD | 07/01/2006 | Single |
00666778888 | CHASE | THOMAS | 11/01/2006 | Single |
00909090909 | COOPER | DUSTON | 04/01/2006 | S+Family |
00232123152 | DETMER | CLARENCE | 01/01/2005 | S+Family |
00884562917 | DONALDSON | RYAN | 01/01/2005 | S+Family |
00332362514 | GARRISON | ALFRED | 01/01/2005 | Single |
00222114444 | GAUSS | PERRY | 04/01/2006 | S+Family |
00654241595 | GILBERT | BETH | 01/01/2005 | S+Family |
00113425697 | GILMORE | REBECCA | 01/01/2007 | S+Family |
00652392687 | GLAZA | PETER | 10/01/2006 | S+Family |
00123546789 | GONZALEZ | JESUS | 01/01/2005 | S+Family |
00114741259 | GREEN | LINDA | 07/01/2005 | S+Family |
00505050505 | GREENE | JANET | 01/01/2005 | Single |
00325325652 | GUNN | HILARY | 01/01/2005 | S+Family |
00606060606 | HAGEN | DEBRA | 08/01/2005 | Single |
00526134082 | HAMM | ANGELA | 01/01/2005 | S+Family |
00999112222 | HENESSEY | BRIAN | 01/01/2005 | S+Family |
00707070707 | HERMANN | STEVEN | 08/01/2005 | S+Family |
00808080808 | HEWITT | RAYMOND | 01/01/2005 | S+Family |
00121134121 | HOUSTON | PATRICIA | 08/01/2005 | Single |
00666666666 | HUGHES | LAURA | 01/01/2006 | Single |
00332133213 | HUNTINGTON | WENDY | 08/01/2006 | Single |
00132459876 | IVANSKI | ELAINE | 01/01/2005 | S+Family |
00222334444 | JOHNSON | KENNETH | 01/01/2005 | Single |
00303030303 | KELLER | LOUISE | 01/01/2005 | S+Family |
00213056241 | KEYSER | RENEE | 01/01/2005 | S+Family |
00774512398 | KNAPP | WILLIAM | 01/01/2005 | S+Family |
00321456987 | KOWALSKI | BRAD | 02/01/2005 | S+Family |
00689565874 | KRUEGER | MATTHEW | 01/01/2005 | S+Family |
00111223333 | LANG | JASON | 01/01/2005 | S+Family |
00654777149 | LARSON | BRANDON | 01/01/2005 | S+Family |
00353562895 | LEE | CRYSTAL | 01/01/2005 | S+Family |
00333333333 | LEWIS | SHAYNA | 01/01/2005 | Single |
00101010101 | MARKS | LYLE | 01/01/2007 | S+Family |
00265412564 | MARTINEZ | ANGELA | 01/01/2005 | Single |
00623541578 | MCDONALD | PAUL | 01/01/2005 | Single |
00444556666 | MCKINELY | HELEN | 01/01/2005 | Single |
00542418975 | MEAD | PHILLIP | 09/01/2005 | S+Family |
00653251298 | MILLER | STUART | 01/01/2005 | S+Family |
00541147485 | MORRIS | AMY | 05/01/2006 | S+Family |
00452154129 | OH | KIM | 01/01/2005 | S+Family |
00454123412 | OLSON | GLADYS | 01/01/2005 | Single |
00528419367 | PENNINGTON | CHARLES | 01/01/2007 | Single |
00123456789 | POOLE | RICHARD | 01/01/2005 | S+Family |
00555555555 | PORTER | ELIZABETH | 06/01/2006 | S+Family |
00888888888 | POWELL | TERRENCE | 01/01/2005 | S+Family |
00261749538 | PRATT | EARL | 01/01/2005 | S+Family |
00652398741 | RAMSEY | KERRI | 01/01/2005 | S+Family |
00111111111 | REICH | JOHN | 01/01/2005 | S+Family |
00555667777 | ROBERTS | BRUCE | 09/01/2006 | S+Family |
00888991111 | ROGERS | PATRICK | 11/01/2006 | S+Family |
00999999999 | RUIZ | JOHN | 01/01/2005 | S+Family |
00262654162 | RUNYON | PAULINE | 05/01/2005 | S+Family |
00202020202 | SCHNEIDER | HARVEY | 01/01/2005 | Single |
00444444444 | SMITH | DAVID | 01/01/2005 | Single |
00333456789 | STONE | KERWIN | 01/01/2007 | S+Family |
00992992541 | THOMPSON | EDWARD | 01/01/2005 | S+Family |
00333445555 | VANG | DAO | 01/01/2005 | S+Family |
00321549876 | VAUGN | DIANE | 01/01/2005 | S+Family |
00626285945 | VILLANUEVA | GUADALUPE | 01/01/2005 | Single |
00404040404 | VIZQUEL | ALEX | 04/01/2005 | Single |
00565456485 | VIZQUEL | OMAR | 01/01/2005 | S+Family |
00888991111 | VOLK | CHRISTINE | 01/01/2005 | S+Family |
00999112222 | WALKER | KYLE | 07/01/2006 | Single |
00333552222 | WARFIELD | LINDA | 01/01/2005 | S+Family |
00222114444 | WHITE | ELMER | 01/01/2005 | S+Family |
00454123421 | WHITNEY | NORBERT | 01/01/2005 | S+Family |
00652987451 | WINGER | FRED | 01/01/2005 | Single |
00231548970 | WINKELMAN | CINDY | 01/01/2006 | S+Family |
00456789012 | WINTERS | CONNIE | 01/01/2005 | S+Family |
00321324121 | WU | SHIGERA | 01/01/2005 | Single |
00657444849 | YANG | HOUA | 10/01/2005 | Single |
00445464129 | YOUNG | DONITA | 01/01/2005 | S+Family |
00123456798 | ZELLMER | JANET | 01/01/2005 | Single |
00325418749 | ZIMMERMAN | MARY | 08/01/2005 | Single |