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

INVOICE NUMBER:     230725589774                                           PAGE:               1 of 3            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2023         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/21/2023        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         3 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/25/2023        

               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                        $2,518.42              ($2,435.57)                 $0.00                  $0.00                   $82.85
  014267-03                                       $27,744.75             ($22,101.11)                 $0.00                  $0.00                $5,643.64
  014267-05                                       $22,556.56              ($6,683.16)                 $0.00                  $0.00               $15,873.40
  014267-06                                          $112.17                ($286.30)                 $0.00                  $0.00                ($174.13)
  014267-07                                        $1,925.60                ($704.86)                 $0.00                  $0.00                $1,220.74
  014267-08                                        $8,636.29              ($7,831.63)                 $0.00                  $0.00                  $804.66
  014267-12                                        $1,644.60              ($1,790.21)                 $0.00                  $0.00                ($145.61)
  014267-13                                          $529.17              ($1,012.91)                 $0.00                  $0.00                ($483.74)
  014267-15                                        $1,104.42              ($1,617.25)                 $0.00                  $0.00                ($512.83)
  014267-19                                            $2.90                    $0.00                 $0.00                  $0.00                    $2.90
  014267-22                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-26                                           $12.74                ($297.94)                 $0.00                  $0.00                ($285.20)
  014267-36                                        $4,964.70              ($1,803.28)                 $0.00                  $0.00                $3,161.42
  014267-37                                          $687.12                 ($55.19)                 $0.00                  $0.00                  $631.93
014267- Total                                     $72,439.44             ($46,619.41)                 $0.00                  $0.00               $25,820.03
Drug Total                                        $72,439.44             ($46,619.41)                 $0.00                  $0.00               $25,820.03
                                                                                                                                                            
Facility
  053264-01                                          $556.58                    $0.00                 $0.00                  $0.00                  $556.58
053264- Total                                        $556.58                    $0.00                 $0.00                  $0.00                  $556.58
Facility Total                                       $556.58                    $0.00                 $0.00                  $0.00                  $556.58
                                                                                                                                                            
HDHP PPO
  014267-54                                       $24,802.31              ($4,777.43)                 $0.00                  $0.00               $20,024.88
014267- Total                                     $24,802.31              ($4,777.43)                 $0.00                  $0.00               $20,024.88
017697-00                                         $11,218.86              ($2,549.68)                 $0.00                  $0.00                $8,669.18

                                                                                                                                                PAGE:2 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  017697-01                                        $1,791.83              ($6,429.66)                 $0.00                  $0.00              ($4,637.83)
  017697-10                                        $1,965.85                ($990.72)                 $0.00                  $0.00                  $975.13
  017697-70                                           $10.81                    $0.00                 $0.00                  $0.00                   $10.81
017697- Total                                     $14,987.35              ($9,970.06)                 $0.00                  $0.00                $5,017.29
017728-00                                            $311.82                ($182.94)                 $0.00                  $0.00                  $128.88
017728- Total                                        $311.82                ($182.94)                 $0.00                  $0.00                  $128.88
104272-02                                         $56,616.79              ($9,257.11)                 $0.00                  $0.00               $47,359.68
  104272-09                                        $5,249.65              ($1,399.49)                 $0.00                  $0.00                $3,850.16
  104272-12                                        $1,865.64                ($624.61)                 $0.00                  $0.00                $1,241.03
  104272-19                                          $567.07                ($154.90)                 $0.00                  $0.00                  $412.17
104272- Total                                     $64,299.15             ($11,436.11)                 $0.00                  $0.00               $52,863.04
HDHP PPO Total                                   $104,400.63             ($26,366.54)                 $0.00                  $0.00               $78,034.09
                                                                                                                                                            
Major Medical
  053264-01                                          $499.20                ($659.65)                 $0.00                  $0.00                ($160.45)
053264- Total                                        $499.20                ($659.65)                 $0.00                  $0.00                ($160.45)
Major Medical Total                                  $499.20                ($659.65)                 $0.00                  $0.00                ($160.45)
                                                                                                                                                            
PPO
  014267-01                                          $503.21                    $0.00                 $0.00                  $0.00                  $503.21
  014267-03                                       $18,749.85                    $0.00                 $0.00                  $0.00               $18,749.85
  014267-05                                       $11,756.75                    $0.00                 $0.00                  $0.00               $11,756.75
  014267-06                                        $1,815.19                    $0.00                 $0.00                  $0.00                $1,815.19
  014267-07                                       $14,534.28                    $0.00                 $0.00                  $0.00               $14,534.28
  014267-08                                        $1,567.65                    $0.00                 $0.00                  $0.00                $1,567.65
  014267-12                                           $69.55                    $0.00                 $0.00                  $0.00                   $69.55
  014267-15                                          $964.17                    $0.00                 $0.00                  $0.00                  $964.17
  014267-22                                           $92.16                    $0.00                 $0.00                  $0.00                   $92.16
  014267-26                                        $1,016.66                    $0.00                 $0.00                  $0.00                $1,016.66
  014267-36                                        $5,468.43                    $0.00                 $0.00                  $0.00                $5,468.43
  014267-37                                        $1,825.81                    $0.00                 $0.00                  $0.00                $1,825.81
014267- Total                                     $58,363.71                    $0.00                 $0.00                  $0.00               $58,363.71

                                                                                                                                                PAGE:3 of 3
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
PPO Total                                         $58,363.71                    $0.00                 $0.00                  $0.00               $58,363.71
Paid Claims/Expenses Summary Total                                                                                                              $162,613.96