OTHER CLAIM RELATED FEE SUMMARY                                           
                     Other Claim Related Fee Description/Incurred Date/Product/Sub Group-8 Digit                     

INVOICE NUMBER:     230711585895                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/07/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         1 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/11/2023        

Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Prepay Claims Savings Fee
  05/23
    Prepay Claims Savings Fee
      104272-02                                                                                                        $31.50
      104272- Total                                                                                                    $31.50
    Prepay Claims Savings Fee Total                                                                                    $31.50
  05/23 Total                                                                                                          $31.50
  06/23
    Prepay Claims Savings Fee
      014267-01                                                                                                       $116.82
      014267-05                                                                                                        $33.22
      014267-07                                                                                                        $93.84
      014267-08                                                                                                      ($83.41)
      014267-12                                                                                                        $58.27
      014267-54                                                                                                        $29.35
      014267- Total                                                                                                   $248.09
      017697-00                                                                                                        $15.97
      017697- Total                                                                                                    $15.97
    Prepay Claims Savings Fee Total                                                                                   $264.06
  06/23 Total                                                                                                         $264.06
  07/23
    Prepay Claims Savings Fee
      014267-36                                                                                                        $17.45
      014267- Total                                                                                                    $17.45
    Prepay Claims Savings Fee Total                                                                                    $17.45
  07/23 Total                                                                                                          $17.45
Prepay Claims Savings Fee Total                                                                                       $313.01

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Other Claim Related Fee Description                                                                                Fee Amount                            
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Other Claims Related Fee Summary Total                                                                                $313.01