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

INVOICE NUMBER:     250708581712                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/04/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         1 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/08/2025        

               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                            $0.56                    $0.00                 $0.00                  $0.00                    $0.56
  014267-03                                       $14,021.60                    $0.00                 $0.00                  $0.00               $14,021.60
  014267-05                                        $5,778.42                    $0.00                 $0.00                  $0.00                $5,778.42
  014267-06                                       $34,354.06                    $0.00                 $0.00                  $0.00               $34,354.06
  014267-07                                        $3,144.36                    $0.00                 $0.00                  $0.00                $3,144.36
  014267-08                                        $1,103.03                    $0.00                 $0.00                  $0.00                $1,103.03
  014267-12                                          $938.43                    $0.00                 $0.00                  $0.00                  $938.43
  014267-13                                           $19.94                    $0.00                 $0.00                  $0.00                   $19.94
  014267-15                                            $0.53                    $0.00                 $0.00                  $0.00                    $0.53
  014267-26                                            $1.82                    $0.00                 $0.00                  $0.00                    $1.82
  014267-34                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-36                                        $3,167.91                    $0.00                 $0.00                  $0.00                $3,167.91
  014267-37                                        $3,398.13                    $0.00                 $0.00                  $0.00                $3,398.13
014267- Total                                     $65,928.79                    $0.00                 $0.00                  $0.00               $65,928.79
Drug Total                                        $65,928.79                    $0.00                 $0.00                  $0.00               $65,928.79
                                                                                                                                                            
HDHP PPO
  014267-54                                       $22,885.36                    $0.00                 $0.00                  $0.00               $22,885.36
014267- Total                                     $22,885.36                    $0.00                 $0.00                  $0.00               $22,885.36
017697-00                                         $17,048.88                    $0.00                 $0.00                  $0.00               $17,048.88
  017697-01                                        $4,498.27                    $0.00                 $0.00                  $0.00                $4,498.27
017697- Total                                     $21,547.15                    $0.00                 $0.00                  $0.00               $21,547.15
017728-00                                          $3,721.49                    $0.00                 $0.00                  $0.00                $3,721.49
017728- Total                                      $3,721.49                    $0.00                 $0.00                  $0.00                $3,721.49
104272-02                                         $24,797.75                    $0.00                 $0.00                  $0.00               $24,797.75
  104272-09                                          $467.63                    $0.00                 $0.00                  $0.00                  $467.63

                                                                                                                                                PAGE:2 of 2
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  104272-12                                        $1,635.25                    $0.00                 $0.00                  $0.00                $1,635.25
  104272-19                                          $546.43                    $0.00                 $0.00                  $0.00                  $546.43
104272- Total                                     $27,447.06                    $0.00                 $0.00                  $0.00               $27,447.06
HDHP PPO Total                                    $75,601.06                    $0.00                 $0.00                  $0.00               $75,601.06
                                                                                                                                                            
Major Medical
  053264-01                                          $141.60                    $0.00                 $0.00                  $0.00                  $141.60
053264- Total                                        $141.60                    $0.00                 $0.00                  $0.00                  $141.60
Major Medical Total                                  $141.60                    $0.00                 $0.00                  $0.00                  $141.60
                                                                                                                                                            
PPO
  014267-01                                       $36,767.59                    $0.00                 $0.00                  $0.00               $36,767.59
  014267-03                                       $30,147.19                    $0.00                 $0.00                  $0.00               $30,147.19
  014267-05                                       $25,936.51                    $0.00                 $0.00                  $0.00               $25,936.51
  014267-06                                       $25,734.90                    $0.00                 $0.00                  $0.00               $25,734.90
  014267-07                                        $6,122.59                    $0.00                 $0.00                  $0.00                $6,122.59
  014267-08                                        $3,702.92                    $0.00                 $0.00                  $0.00                $3,702.92
  014267-13                                        $1,734.56                    $0.00                 $0.00                  $0.00                $1,734.56
  014267-15                                          $730.93                    $0.00                 $0.00                  $0.00                  $730.93
  014267-26                                        $7,976.17                    $0.00                 $0.00                  $0.00                $7,976.17
  014267-36                                        $2,550.66                    $0.00                 $0.00                  $0.00                $2,550.66
  014267-37                                          $153.42                    $0.00                 $0.00                  $0.00                  $153.42
014267- Total                                    $141,557.44                    $0.00                 $0.00                  $0.00              $141,557.44
PPO Total                                        $141,557.44                    $0.00                 $0.00                  $0.00              $141,557.44
Paid Claims/Expenses Summary Total                                                                                                              $283,228.89