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

INVOICE NUMBER:     230718587835                                           PAGE:               1 of 3            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/14/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         2 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/18/2023        

               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                          $877.34                    $0.00                 $0.00                  $0.00                  $877.34
  014267-03                                        $5,234.78                    $0.00                 $0.00                  $0.00                $5,234.78
  014267-05                                        $4,584.58                    $0.00                 $0.00                  $0.00                $4,584.58
  014267-06                                        $1,626.55                    $0.00                 $0.00                  $0.00                $1,626.55
  014267-07                                        $1,577.30                    $0.00                 $0.00                  $0.00                $1,577.30
  014267-08                                          $887.57                    $0.00                 $0.00                  $0.00                  $887.57
  014267-12                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-13                                            $9.76                    $0.00                 $0.00                  $0.00                    $9.76
  014267-15                                        $2,848.83                    $0.00                 $0.00                  $0.00                $2,848.83
  014267-22                                            $5.40                    $0.00                 $0.00                  $0.00                    $5.40
  014267-26                                          $315.48                    $0.00                 $0.00                  $0.00                  $315.48
  014267-36                                           $74.45                    $0.00                 $0.00                  $0.00                   $74.45
  014267-37                                          $129.49                    $0.00                 $0.00                  $0.00                  $129.49
014267- Total                                     $18,171.53                    $0.00                 $0.00                  $0.00               $18,171.53
Drug Total                                        $18,171.53                    $0.00                 $0.00                  $0.00               $18,171.53
                                                                                                                                                            
HDHP PPO
  014267-54                                       $56,438.68                    $0.00                 $0.00                  $0.00               $56,438.68
014267- Total                                     $56,438.68                    $0.00                 $0.00                  $0.00               $56,438.68
017697-00                                          $3,901.74                    $0.00                 $0.00                  $0.00                $3,901.74
  017697-01                                          $903.30                    $0.00                 $0.00                  $0.00                  $903.30
  017697-10                                          $250.52                    $0.00                 $0.00                  $0.00                  $250.52
  017697-70                                        $1,081.57                    $0.00                 $0.00                  $0.00                $1,081.57
017697- Total                                      $6,137.13                    $0.00                 $0.00                  $0.00                $6,137.13
017728-00                                            $329.52                    $0.00                 $0.00                  $0.00                  $329.52
017728- Total                                        $329.52                    $0.00                 $0.00                  $0.00                  $329.52

                                                                                                                                                PAGE:2 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
104272-02                                         $22,480.19                    $0.00                 $0.00                  $0.00               $22,480.19
  104272-09                                        $5,356.37                    $0.00                 $0.00                  $0.00                $5,356.37
  104272-12                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
104272- Total                                     $27,836.56                    $0.00                 $0.00                  $0.00               $27,836.56
HDHP PPO Total                                    $90,741.89                    $0.00                 $0.00                  $0.00               $90,741.89
                                                                                                                                                            
Major Medical
  053264-01                                           $21.99                    $0.00                 $0.00                  $0.00                   $21.99
053264- Total                                         $21.99                    $0.00                 $0.00                  $0.00                   $21.99
Major Medical Total                                   $21.99                    $0.00                 $0.00                  $0.00                   $21.99
                                                                                                                                                            
PPO
  014267-01                                        $7,256.03                    $0.00                 $0.00                  $0.00                $7,256.03
  014267-03                                       $34,536.40                    $0.00                 $0.00                  $0.00               $34,536.40
  014267-05                                       $12,740.22                    $0.00                 $0.00                  $0.00               $12,740.22
  014267-06                                        $1,570.16                    $0.00                 $0.00                  $0.00                $1,570.16
  014267-07                                        $8,502.21                    $0.00                 $0.00                  $0.00                $8,502.21
  014267-08                                        $1,481.44                    $0.00                 $0.00                  $0.00                $1,481.44
  014267-12                                          $525.47                    $0.00                 $0.00                  $0.00                  $525.47
  014267-13                                           $69.55                    $0.00                 $0.00                  $0.00                   $69.55
  014267-15                                        $1,032.83                    $0.00                 $0.00                  $0.00                $1,032.83
  014267-22                                          $103.00                    $0.00                 $0.00                  $0.00                  $103.00
  014267-26                                          $615.60                    $0.00                 $0.00                  $0.00                  $615.60
  014267-36                                       $14,805.14                    $0.00                 $0.00                  $0.00               $14,805.14
  014267-37                                        $2,564.26                    $0.00                 $0.00                  $0.00                $2,564.26
014267- Total                                     $85,802.31                    $0.00                 $0.00                  $0.00               $85,802.31
PPO Total                                         $85,802.31                    $0.00                 $0.00                  $0.00               $85,802.31
                                                                                                                                                            
Professional
  053264-01                                          $654.90                    $0.00                 $0.00                  $0.00                  $654.90
053264- Total                                        $654.90                    $0.00                 $0.00                  $0.00                  $654.90
Professional Total                                   $654.90                    $0.00                 $0.00                  $0.00                  $654.90

                                                                                                                                                PAGE:3 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Paid Claims/Expenses Summary Total                                                                                                              $195,392.62