HEALTHCARE ADJUSTMENT                                                
                                              Product/Sub Group-8 Digit                                              

INVOICE NUMBER:     250715583733                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/11/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         2 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/15/2025        

                Group                     Incurred             Provider Rate             Medical/Drug              Manual             Healthcare 
                                            Date                Adjustments                 Rebate              Adjustments           Adjustments
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                              01/01/2025                        $                 ($11.30)                     $              ($11.30)
  014267-01                              03/01/2025                        $              ($2,563.14)                     $           ($2,563.14)
  014267-03                              01/01/2025                        $                 ($79.10)                     $              ($79.10)
  014267-03                              02/01/2025                        $              ($3,289.18)                     $           ($3,289.18)
  014267-03                              03/01/2025                        $             ($12,876.07)                     $          ($12,876.07)
  014267-05                              01/01/2025                        $                   $23.15                     $                $23.15
  014267-05                              02/01/2025                        $              ($6,440.23)                     $           ($6,440.23)
  014267-05                              03/01/2025                        $              ($8,479.41)                     $           ($8,479.41)
  014267-06                              02/01/2025                        $                ($251.61)                     $             ($251.61)
  014267-06                              03/01/2025                        $              ($1,910.14)                     $           ($1,910.14)
  014267-07                              01/01/2025                        $                   $20.58                     $                $20.58
  014267-07                              03/01/2025                        $              ($3,777.46)                     $           ($3,777.46)
  014267-08                              02/01/2025                        $             ($14,308.58)                     $          ($14,308.58)
  014267-08                              03/01/2025                        $              ($5,235.81)                     $           ($5,235.81)
  014267-12                              03/01/2025                        $              ($1,705.46)                     $           ($1,705.46)
  014267-13                              01/01/2025                        $                   $41.16                     $                $41.16
  014267-13                              03/01/2025                        $                ($977.54)                     $             ($977.54)
  014267-15                              03/01/2025                        $                ($552.16)                     $             ($552.16)
  014267-36                              03/01/2025                        $              ($2,475.89)                     $           ($2,475.89)
  014267-37                              03/01/2025                        $                ($151.89)                     $             ($151.89)
  014267- Total                                                        $0.00             ($65,000.08)                 $0.00          ($65,000.08)
Drug Total                                                             $0.00             ($65,000.08)                 $0.00          ($65,000.08)
                                                                                                                                                            
HDHP PPO
  014267-54                              10/01/2024                        $                ($311.52)                     $             ($311.52)
  014267-54                              01/01/2025                        $                 ($11.30)                     $              ($11.30)

                                                                                                                                                PAGE:2 of 2
                                                                                                                                                            
                Group                     Incurred             Provider Rate             Medical/Drug              Manual             Healthcare 
                                            Date                Adjustments                 Rebate              Adjustments           Adjustments
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  014267-54                              02/01/2025                        $                ($883.53)                     $             ($883.53)
  014267-54                              03/01/2025                        $             ($16,810.36)                     $          ($16,810.36)
  014267- Total                                                        $0.00             ($18,016.71)                 $0.00          ($18,016.71)
  017697-00                              01/01/2025                        $                   $33.44                     $                $33.44
  017697-00                              02/01/2025                        $              ($4,154.18)                     $           ($4,154.18)
  017697-00                              03/01/2025                        $              ($5,347.10)                     $           ($5,347.10)
  017697-01                              10/01/2024                        $                ($311.52)                     $             ($311.52)
  017697-01                              03/01/2025                        $              ($7,976.51)                     $           ($7,976.51)
  017697- Total                                                        $0.00             ($17,755.87)                 $0.00          ($17,755.87)
  017728-00                              01/01/2025                        $                 ($11.30)                     $              ($11.30)
  017728-00                              03/01/2025                        $              ($1,279.17)                     $           ($1,279.17)
  017728- Total                                                        $0.00              ($1,290.47)                 $0.00           ($1,290.47)
  104272-02                              01/01/2025                        $              ($7,235.22)                     $           ($7,235.22)
  104272-02                              02/01/2025                        $              ($4,805.56)                     $           ($4,805.56)
  104272-02                              03/01/2025                        $             ($10,789.16)                     $          ($10,789.16)
  104272-12                              02/01/2025                        $                ($297.84)                     $             ($297.84)
  104272-12                              03/01/2025                        $              ($1,654.17)                     $           ($1,654.17)
  104272-19                              02/01/2025                        $                ($251.61)                     $             ($251.61)
  104272-19                              03/01/2025                        $                ($792.70)                     $             ($792.70)
  104272- Total                                                        $0.00             ($25,826.26)                 $0.00          ($25,826.26)
HDHP PPO Total                                                         $0.00             ($62,889.31)                 $0.00          ($62,889.31)
Healthcare Adjustment Total                                                                                                         ($127,889.39)