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

INVOICE NUMBER:     250722585752                                           PAGE:               1 of 2            
BILL ACCOUNT NUMBER:CN02401002                                             PAID CLAIMS MONTH:  July 2025         
BILL ACCOUNT NAME:  Admiral Peary                                          CLAIMS PAID THRU:   07/18/2025        
CLIENT NUMBER:      0240                                                   BILL CYCLE:         3 of 4            
CLIENT NAME:        Admiral Peary                                          PREPARED DATE:      07/22/2025        

               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
Drug
  014267-01                                           $29.63                    $0.00                 $0.00                  $0.00                   $29.63
  014267-03                                       $26,120.37                    $0.00                 $0.00                  $0.00               $26,120.37
  014267-05                                       $12,830.31                    $0.00                 $0.00                  $0.00               $12,830.31
  014267-06                                        $2,316.75                    $0.00                 $0.00                  $0.00                $2,316.75
  014267-07                                        $2,507.17                    $0.00                 $0.00                  $0.00                $2,507.17
  014267-08                                        $1,945.44                    $0.00                 $0.00                  $0.00                $1,945.44
  014267-12                                          $700.63                    $0.00                 $0.00                  $0.00                  $700.63
  014267-13                                        $1,941.57                    $0.00                 $0.00                  $0.00                $1,941.57
  014267-15                                            $8.58                    $0.00                 $0.00                  $0.00                    $8.58
  014267-26                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-36                                          $573.44                    $0.00                 $0.00                  $0.00                  $573.44
  014267-37                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
014267- Total                                     $48,973.89                    $0.00                 $0.00                  $0.00               $48,973.89
Drug Total                                        $48,973.89                    $0.00                 $0.00                  $0.00               $48,973.89
                                                                                                                                                            
HDHP PPO
  014267-54                                       $22,382.20                    $0.00                 $0.00                  $0.00               $22,382.20
014267- Total                                     $22,382.20                    $0.00                 $0.00                  $0.00               $22,382.20
017697-00                                         $13,922.55                    $0.00                 $0.00                  $0.00               $13,922.55
  017697-01                                        $8,986.49                    $0.00                 $0.00                  $0.00                $8,986.49
  017697-10                                           $25.00                    $0.00                 $0.00                  $0.00                   $25.00
017697- Total                                     $22,934.04                    $0.00                 $0.00                  $0.00               $22,934.04
017728-00                                         $19,794.25                    $0.00                 $0.00                  $0.00               $19,794.25
017728- Total                                     $19,794.25                    $0.00                 $0.00                  $0.00               $19,794.25
104272-02                                         $27,594.83                    $0.00                 $0.00                  $0.00               $27,594.83
  104272-09                                          $442.12                    $0.00                 $0.00                  $0.00                  $442.12

                                                                                                                                                PAGE:2 of 2
                                                                                                                                                            
               Group                             Paid Claims              Healthcare             Capitation          Value Based                Paid Claims
                                                                          Adjustments                                Reimbursement                /Expenses
_____________________________________________________________________________________________________________________________________________________________
                                                                                                                                                            
  104272-12                                        $1,363.87                    $0.00                 $0.00                  $0.00                $1,363.87
  104272-19                                        $6,048.91                    $0.00                 $0.00                  $0.00                $6,048.91
104272- Total                                     $35,449.73                    $0.00                 $0.00                  $0.00               $35,449.73
HDHP PPO Total                                   $100,560.22                    $0.00                 $0.00                  $0.00              $100,560.22
                                                                                                                                                            
Major Medical
  053264-01                                          $312.00                    $0.00                 $0.00                  $0.00                  $312.00
053264- Total                                        $312.00                    $0.00                 $0.00                  $0.00                  $312.00
Major Medical Total                                  $312.00                    $0.00                 $0.00                  $0.00                  $312.00
                                                                                                                                                            
PPO
  014267-01                                          $751.81                    $0.00                 $0.00                  $0.00                  $751.81
  014267-03                                       $22,946.66                    $0.00                 $0.00                  $0.00               $22,946.66
  014267-05                                       $11,904.46                    $0.00                 $0.00                  $0.00               $11,904.46
  014267-06                                       $22,725.37                    $0.00                 $0.00                  $0.00               $22,725.37
  014267-07                                        $9,769.93                    $0.00                 $0.00                  $0.00                $9,769.93
  014267-08                                        $4,325.27                    $0.00                 $0.00                  $0.00                $4,325.27
  014267-12                                          $913.48                    $0.00                 $0.00                  $0.00                  $913.48
  014267-13                                        $2,678.96                    $0.00                 $0.00                  $0.00                $2,678.96
  014267-15                                           $99.93                    $0.00                 $0.00                  $0.00                   $99.93
  014267-26                                          $286.32                    $0.00                 $0.00                  $0.00                  $286.32
  014267-34                                            $0.00                    $0.00                 $0.00                  $0.00                    $0.00
  014267-36                                       $27,071.69                    $0.00                 $0.00                  $0.00               $27,071.69
  014267-37                                          $409.53                    $0.00                 $0.00                  $0.00                  $409.53
014267- Total                                    $103,883.41                    $0.00                 $0.00                  $0.00              $103,883.41
PPO Total                                        $103,883.41                    $0.00                 $0.00                  $0.00              $103,883.41
Paid Claims/Expenses Summary Total                                                                                                              $253,729.52