PAID CLAIMS/EXPENSES SUMMARY                                             
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     230711585895                                           PAGE:               1 of 3            
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        

               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                           $36.93                    $0.00                 $0.00                  $0.00                   $36.93
  014267-03                                        $7,084.58                    $0.00                 $0.00                  $0.00                $7,084.58
  014267-05                                       $21,512.71                    $0.00                 $0.00                  $0.00               $21,512.71
  014267-06                                        $1,477.91                    $0.00                 $0.00                  $0.00                $1,477.91
  014267-07                                        $1,530.45                    $0.00                 $0.00                  $0.00                $1,530.45
  014267-08                                          $955.33                    $0.00                 $0.00                  $0.00                  $955.33
  014267-12                                          $714.81                    $0.00                 $0.00                  $0.00                  $714.81
  014267-13                                        ($240.46)                    $0.00                 $0.00                  $0.00                ($240.46)
  014267-15                                        $1,444.79                    $0.00                 $0.00                  $0.00                $1,444.79
  014267-19                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-34                                         ($27.44)                    $0.00                 $0.00                  $0.00                 ($27.44)
  014267-36                                        ($795.18)                    $0.00                 $0.00                  $0.00                ($795.18)
  014267-37                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
014267- Total                                     $33,694.43                    $0.00                 $0.00                  $0.00               $33,694.43
Drug Total                                        $33,694.43                    $0.00                 $0.00                  $0.00               $33,694.43
                                                                                                                                                            
Facility
  053264-01                                       $39,591.51                    $0.00                 $0.00                  $0.00               $39,591.51
053264- Total                                     $39,591.51                    $0.00                 $0.00                  $0.00               $39,591.51
Facility Total                                    $39,591.51                    $0.00                 $0.00                  $0.00               $39,591.51
                                                                                                                                                            
HDHP PPO
  014267-54                                       $18,676.08                    $0.00                 $0.00                  $0.00               $18,676.08
014267- Total                                     $18,676.08                    $0.00                 $0.00                  $0.00               $18,676.08
017697-00                                          $8,133.28                    $0.00                 $0.00                  $0.00                $8,133.28
  017697-01                                        $4,641.03                    $0.00                 $0.00                  $0.00                $4,641.03

                                                                                                                                                PAGE:2 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  017697-10                                        $2,522.52                    $0.00                 $0.00                  $0.00                $2,522.52
  017697-70                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
017697- Total                                     $15,296.83                    $0.00                 $0.00                  $0.00               $15,296.83
017728-00                                            $189.56                    $0.00                 $0.00                  $0.00                  $189.56
017728- Total                                        $189.56                    $0.00                 $0.00                  $0.00                  $189.56
104272-02                                         $42,291.07                    $0.00                 $0.00                  $0.00               $42,291.07
  104272-09                                       $29,632.45                    $0.00                 $0.00                  $0.00               $29,632.45
  104272-12                                          $188.90                    $0.00                 $0.00                  $0.00                  $188.90
104272- Total                                     $72,112.42                    $0.00                 $0.00                  $0.00               $72,112.42
HDHP PPO Total                                   $106,274.89                    $0.00                 $0.00                  $0.00              $106,274.89
                                                                                                                                                            
Major Medical
  053264-01                                            $4.80                    $0.00                 $0.00                  $0.00                    $4.80
053264- Total                                          $4.80                    $0.00                 $0.00                  $0.00                    $4.80
Major Medical Total                                    $4.80                    $0.00                 $0.00                  $0.00                    $4.80
                                                                                                                                                            
PPO
  014267-01                                          $912.70                    $0.00                 $0.00                  $0.00                  $912.70
  014267-03                                       $22,732.26                    $0.00                 $0.00                  $0.00               $22,732.26
  014267-05                                       $21,551.86                    $0.00                 $0.00                  $0.00               $21,551.86
  014267-06                                        $1,073.42                    $0.00                 $0.00                  $0.00                $1,073.42
  014267-07                                        $9,292.45                    $0.00                 $0.00                  $0.00                $9,292.45
  014267-08                                       $19,951.26                    $0.00                 $0.00                  $0.00               $19,951.26
  014267-13                                          $697.04                    $0.00                 $0.00                  $0.00                  $697.04
  014267-15                                          $717.44                    $0.00                 $0.00                  $0.00                  $717.44
  014267-26                                          $565.29                    $0.00                 $0.00                  $0.00                  $565.29
  014267-36                                        $4,354.03                    $0.00                 $0.00                  $0.00                $4,354.03
  014267-37                                          $863.14                    $0.00                 $0.00                  $0.00                  $863.14
014267- Total                                     $82,710.89                    $0.00                 $0.00                  $0.00               $82,710.89
PPO Total                                         $82,710.89                    $0.00                 $0.00                  $0.00               $82,710.89
                                                                                                                                                            
Professional

                                                                                                                                                PAGE:3 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  053264-01                                          $183.66                    $0.00                 $0.00                  $0.00                  $183.66
053264- Total                                        $183.66                    $0.00                 $0.00                  $0.00                  $183.66
Professional Total                                   $183.66                    $0.00                 $0.00                  $0.00                  $183.66
Paid Claims/Expenses Summary Total                                                                                                              $262,460.18