PAID CLAIMS/EXPENSES SUMMARY                                             
                                              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                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                           $10.38              ($2,574.44)                 $0.00                  $0.00              ($2,564.06)
  014267-03                                        $4,324.67             ($16,244.35)                 $0.00                  $0.00             ($11,919.68)
  014267-05                                        $4,941.44             ($14,896.49)                 $0.00                  $0.00              ($9,955.05)
  014267-06                                        $2,504.77              ($2,161.75)                 $0.00                  $0.00                  $343.02
  014267-07                                        $5,040.24              ($3,756.88)                 $0.00                  $0.00                $1,283.36
  014267-08                                        $1,187.89             ($19,544.39)                 $0.00                  $0.00             ($18,356.50)
  014267-12                                        $1,975.15              ($1,705.46)                 $0.00                  $0.00                  $269.69
  014267-13                                        $1,268.91                ($936.38)                 $0.00                  $0.00                  $332.53
  014267-15                                        $1,017.33                ($552.16)                 $0.00                  $0.00                  $465.17
  014267-36                                          $714.99              ($2,475.89)                 $0.00                  $0.00              ($1,760.90)
  014267-37                                          $187.02                ($151.89)                 $0.00                  $0.00                   $35.13
014267- Total                                     $23,172.79             ($65,000.08)                 $0.00                  $0.00             ($41,827.29)
Drug Total                                        $23,172.79             ($65,000.08)                 $0.00                  $0.00             ($41,827.29)
                                                                                                                                                            
HDHP PPO
  014267-54                                       $15,907.83             ($18,016.71)                 $0.00                  $0.00              ($2,108.88)
014267- Total                                     $15,907.83             ($18,016.71)                 $0.00                  $0.00              ($2,108.88)
017697-00                                         $14,500.60              ($9,467.84)                 $0.00                  $0.00                $5,032.76
  017697-01                                        $2,841.28              ($8,288.03)                 $0.00                  $0.00              ($5,446.75)
  017697-10                                           $30.83                    $0.00                 $0.00                  $0.00                   $30.83
017697- Total                                     $17,372.71             ($17,755.87)                 $0.00                  $0.00                ($383.16)
017728-00                                         $12,627.79              ($1,290.47)                 $0.00                  $0.00               $11,337.32
017728- Total                                     $12,627.79              ($1,290.47)                 $0.00                  $0.00               $11,337.32
104272-02                                         $50,943.49             ($22,829.94)                 $0.00                  $0.00               $28,113.55
  104272-09                                          $237.61                    $0.00                 $0.00                  $0.00                  $237.61
  104272-12                                        $4,702.24              ($1,952.01)                 $0.00                  $0.00                $2,750.23

                                                                                                                                                PAGE:2 of 2
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  104272-19                                        $2,858.12              ($1,044.31)                 $0.00                  $0.00                $1,813.81
104272- Total                                     $58,741.46             ($25,826.26)                 $0.00                  $0.00               $32,915.20
HDHP PPO Total                                   $104,649.79             ($62,889.31)                 $0.00                  $0.00               $41,760.48
                                                                                                                                                            
Major Medical
  053264-01                                          $256.00                    $0.00                 $0.00                  $0.00                  $256.00
053264- Total                                        $256.00                    $0.00                 $0.00                  $0.00                  $256.00
Major Medical Total                                  $256.00                    $0.00                 $0.00                  $0.00                  $256.00
                                                                                                                                                            
PPO
  014267-01                                        $1,954.68                    $0.00                 $0.00                  $0.00                $1,954.68
  014267-03                                       $24,034.94                    $0.00                 $0.00                  $0.00               $24,034.94
  014267-05                                       $48,275.50                    $0.00                 $0.00                  $0.00               $48,275.50
  014267-06                                        $2,596.59                    $0.00                 $0.00                  $0.00                $2,596.59
  014267-07                                       $13,151.44                    $0.00                 $0.00                  $0.00               $13,151.44
  014267-08                                       $78,616.84                    $0.00                 $0.00                  $0.00               $78,616.84
  014267-12                                          $369.56                    $0.00                 $0.00                  $0.00                  $369.56
  014267-13                                          $361.54                    $0.00                 $0.00                  $0.00                  $361.54
  014267-15                                          $268.88                    $0.00                 $0.00                  $0.00                  $268.88
  014267-26                                           $87.34                    $0.00                 $0.00                  $0.00                   $87.34
  014267-36                                        $3,847.21                    $0.00                 $0.00                  $0.00                $3,847.21
  014267-37                                        $1,416.59                    $0.00                 $0.00                  $0.00                $1,416.59
014267- Total                                    $174,981.11                    $0.00                 $0.00                  $0.00              $174,981.11
PPO Total                                        $174,981.11                    $0.00                 $0.00                  $0.00              $174,981.11
                                                                                                                                                            
Professional
  053264-01                                           $32.52                    $0.00                 $0.00                  $0.00                   $32.52
053264- Total                                         $32.52                    $0.00                 $0.00                  $0.00                   $32.52
Professional Total                                    $32.52                    $0.00                 $0.00                  $0.00                   $32.52
Paid Claims/Expenses Summary Total                                                                                                              $175,202.82