ENROLLMENT BASED ADMINISTRATIVE CALCULATION                                     
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     230801581733                                           PAGE:               1 of 4            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/28/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         4 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      08/01/2023        

                      Group                                     Contracts                                    $ PCPM                    $ PCPM Admin Expense
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
    014267-01                                                          20                                     $5.00                                 $100.00
    014267-03                                                         107                                     $5.00                                 $535.00
    014267-05                                                          72                                     $5.00                                 $360.00
    014267-06                                                          18                                     $5.00                                  $90.00
    014267-07                                                          72                                     $5.00                                 $360.00
    014267-08                                                          45                                     $5.00                                 $225.00
    014267-12                                                           5                                     $5.00                                  $25.00
    014267-13                                                          10                                     $5.00                                  $50.00
    014267-15                                                          17                                     $5.00                                  $85.00
    014267-18                                                           1                                     $5.00                                   $5.00
    014267-19                                                           1                                     $5.00                                   $5.00
    014267-22                                                           2                                     $5.00                                  $10.00
    014267-26                                                           9                                     $5.00                                  $45.00
    014267-34                                                           4                                     $5.00                                  $20.00
    014267-36                                                          35                                     $5.00                                 $175.00
    014267-37                                                          13                                     $5.00                                  $65.00
014267- Total                                                         431                                                                         $2,155.00
Drug Total                                                            431                                                                         $2,155.00
                                                                                                                                                            
Facility
    053264-01                                                           1                                    $17.67                                  $17.67
053264- Total                                                           1                                                                            $17.67
Facility Total                                                          1                                                                            $17.67
                                                                                                                                                            
HDHP PPO
    014267-54                                                          63                                    $58.00                               $3,654.00

                                                                                                                                                PAGE:2 of 4
                                                                                                                                                            
                      Group                                     Contracts                                    $ PCPM                    $ PCPM Admin Expense
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
014267- Total                                                          63                                                                         $3,654.00
  017697-00                                                            61                                    $58.00                               $3,538.00
    017697-01                                                          19                                    $58.00                               $1,102.00
    017697-10                                                           4                                    $58.00                                 $232.00
017697- Total                                                          84                                                                         $4,872.00
  017728-00                                                            11                                    $58.00                                 $638.00
017728- Total                                                          11                                                                           $638.00
  104272-02                                                           145                                    $58.00                               $8,410.00
    104272-09                                                           6                                    $58.00                                 $348.00
    104272-12                                                           9                                    $58.00                                 $522.00
    104272-19                                                           1                                    $58.00                                  $58.00
104272- Total                                                         161                                                                         $9,338.00
HDHP PPO Total                                                        319                                                                        $18,502.00
                                                                                                                                                            
Major Medical
    053264-01                                                           1                                    $17.66                                  $17.66
053264- Total                                                           1                                                                            $17.66
Major Medical Total                                                     1                                                                            $17.66
                                                                                                                                                            
PPO
    014267-01                                                          19                                    $53.00                               $1,007.00
    014267-03                                                         107                                    $53.00                               $5,671.00
    014267-05                                                          72                                    $53.00                               $3,816.00
    014267-06                                                          18                                    $53.00                                 $954.00
    014267-07                                                          70                                    $53.00                               $3,710.00
    014267-08                                                          44                                    $53.00                               $2,332.00
    014267-12                                                           5                                    $53.00                                 $265.00
    014267-13                                                          10                                    $53.00                                 $530.00
    014267-15                                                          17                                    $53.00                                 $901.00
    014267-18                                                           1                                    $53.00                                  $53.00
    014267-19                                                           1                                    $53.00                                  $53.00
    014267-22                                                           2                                    $53.00                                 $106.00

                                                                                                                                                PAGE:3 of 4
                                                                                                                                                            
                      Group                                     Contracts                                    $ PCPM                    $ PCPM Admin Expense
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    014267-26                                                           9                                    $53.00                                 $477.00
    014267-34                                                           4                                    $53.00                                 $212.00
    014267-36                                                          35                                    $53.00                               $1,855.00
    014267-37                                                          13                                    $53.00                                 $689.00
014267- Total                                                         427                                                                        $22,631.00
PPO Total                                                             427                                                                        $22,631.00
                                                                                                                                                            
Professional
    053264-01                                                           1                                    $17.67                                  $17.67
053264- Total                                                           1                                                                            $17.67
Professional Total                                                      1                                                                            $17.67
                                                                                                                                                            
Stop Loss Carve Out Fee
    014267-01                                                          19                                     $4.00                                  $76.00
    014267-03                                                         107                                     $4.00                                 $428.00
    014267-05                                                          72                                     $4.00                                 $288.00
    014267-06                                                          18                                     $4.00                                  $72.00
    014267-07                                                          70                                     $4.00                                 $280.00
    014267-08                                                          44                                     $4.00                                 $176.00
    014267-12                                                           5                                     $4.00                                  $20.00
    014267-13                                                          10                                     $4.00                                  $40.00
    014267-15                                                          17                                     $4.00                                  $68.00
    014267-18                                                           1                                     $4.00                                   $4.00
    014267-19                                                           1                                     $4.00                                   $4.00
    014267-22                                                           2                                     $4.00                                   $8.00
    014267-26                                                           9                                     $4.00                                  $36.00
    014267-34                                                           4                                     $4.00                                  $16.00
    014267-36                                                          35                                     $4.00                                 $140.00
    014267-37                                                          13                                     $4.00                                  $52.00
    014267-54                                                          63                                     $4.00                                 $252.00
014267- Total                                                         490                                                                         $1,960.00
  017697-00                                                            61                                     $4.00                                 $244.00

                                                                                                                                                PAGE:4 of 4
                                                                                                                                                            
                      Group                                     Contracts                                    $ PCPM                    $ PCPM Admin Expense
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
    017697-01                                                          19                                     $4.00                                  $76.00
    017697-10                                                           4                                     $4.00                                  $16.00
017697- Total                                                          84                                                                           $336.00
  017728-00                                                            11                                     $4.00                                  $44.00
017728- Total                                                          11                                                                            $44.00
  053264-01                                                             1                                     $4.00                                   $4.00
053264- Total                                                           1                                                                             $4.00
  104272-02                                                           145                                     $4.00                                 $580.00
    104272-09                                                           6                                     $4.00                                  $24.00
    104272-12                                                           9                                     $4.00                                  $36.00
    104272-19                                                           1                                     $4.00                                   $4.00
104272- Total                                                         161                                                                           $644.00
Stop Loss Carve Out Fee Total                                         747                                                                         $2,988.00
                                                                                                                                                            
Enrollment Based Administrative Calculation Total                                                                                                $46,329.00