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

INVOICE NUMBER:     230801581733                                           PAGE:               1 of 2            
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                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                          $468.70                    $0.00                 $0.00                  $0.00                  $468.70
  014267-03                                       $10,057.54                    $0.00                 $0.00                  $0.00               $10,057.54
  014267-05                                        $3,232.17                    $0.00                 $0.00                  $0.00                $3,232.17
  014267-06                                          $101.45                    $0.00                 $0.00                  $0.00                  $101.45
  014267-07                                        $1,901.11                    $0.00                 $0.00                  $0.00                $1,901.11
  014267-08                                       $24,908.58                    $0.00                 $0.00                  $0.00               $24,908.58
  014267-12                                          $184.05                    $0.00                 $0.00                  $0.00                  $184.05
  014267-13                                           $79.64                    $0.00                 $0.00                  $0.00                   $79.64
  014267-15                                      ($1,967.25)                    $0.00                 $0.00                  $0.00              ($1,967.25)
  014267-22                                           $16.17                    $0.00                 $0.00                  $0.00                   $16.17
  014267-34                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-36                                        $2,159.59                    $0.00                 $0.00                  $0.00                $2,159.59
  014267-37                                          $628.86                    $0.00                 $0.00                  $0.00                  $628.86
014267- Total                                     $41,770.61                    $0.00                 $0.00                  $0.00               $41,770.61
Drug Total                                        $41,770.61                    $0.00                 $0.00                  $0.00               $41,770.61
                                                                                                                                                            
HDHP PPO
  014267-54                                       $12,175.52                    $0.00                 $0.00              $1,150.03               $13,325.55
014267- Total                                     $12,175.52                    $0.00                 $0.00              $1,150.03               $13,325.55
017697-00                                         $13,886.84                    $0.00                 $0.00              $1,159.87               $15,046.71
  017697-01                                        $6,865.57                    $0.00                 $0.00                $167.81                $7,033.38
  017697-10                                           $88.00                    $0.00                 $0.00                 $44.01                  $132.01
  017697-70                                           $77.03                    $0.00                 $0.00                  $9.07                   $86.10
017697- Total                                     $20,917.44                    $0.00                 $0.00              $1,380.76               $22,298.20
017728-00                                          $3,098.58                    $0.00                 $0.00                $166.93                $3,265.51
017728- Total                                      $3,098.58                    $0.00                 $0.00                $166.93                $3,265.51

                                                                                                                                                PAGE:2 of 2
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
104272-02                                         $42,574.63                    $0.00                 $0.00              $2,848.70               $45,423.33
  104272-09                                        $3,071.70                    $0.00                 $0.00                $117.54                $3,189.24
  104272-12                                          $135.79                    $0.00                 $0.00                 $83.29                  $219.08
  104272-19                                            $4.42                    $0.00                 $0.00                 $28.76                   $33.18
104272- Total                                     $45,786.54                    $0.00                 $0.00              $3,078.29               $48,864.83
HDHP PPO Total                                    $81,978.08                    $0.00                 $0.00              $5,776.01               $87,754.09
                                                                                                                                                            
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                                        $5,004.56                    $0.00                 $0.00                $200.64                $5,205.20
  014267-03                                       $13,014.49                    $0.00                 $0.00              $1,994.48               $15,008.97
  014267-05                                       $55,396.17                    $0.00                 $0.00              $1,450.89               $56,847.06
  014267-06                                        $4,150.42                    $0.00                 $0.00                $324.58                $4,475.00
  014267-07                                       $11,467.38                    $0.00                 $0.00              $1,280.03               $12,747.41
  014267-08                                        $1,972.33                    $0.00                 $0.00                $497.84                $2,470.17
  014267-12                                          $275.02                    $0.00                 $0.00                 $67.71                  $342.73
  014267-13                                            $0.00                    $0.00                 $0.00                 $64.68                   $64.68
  014267-15                                        $1,808.79                    $0.00                 $0.00                $150.80                $1,959.59
  014267-19                                            $0.00                    $0.00                 $0.00                  $7.19                    $7.19
  014267-22                                            $0.00                    $0.00                 $0.00                  $7.19                    $7.19
  014267-26                                          $844.99                    $0.00                 $0.00                 $68.21                  $913.20
  014267-34                                            $0.00                    $0.00                 $0.00                 $40.96                   $40.96
  014267-36                                       $32,182.08                    $0.00                 $0.00                $437.77               $32,619.85
  014267-37                                          $189.18                    $0.00                 $0.00                $107.75                  $296.93
014267- Total                                    $126,305.41                    $0.00                 $0.00              $6,700.72              $133,006.13
PPO Total                                        $126,305.41                    $0.00                 $0.00              $6,700.72              $133,006.13
Paid Claims/Expenses Summary Total                                                                                                              $262,535.63